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Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects. Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM + CP technique (SMCP), failure MARPE (FM), and FM + CP (FMCP). Successful groups presented more skeletal expansion and dental tipping than failure groups (P <0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P <0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P <0.05). Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears to have a positive impact, increasing the chance of treatment success. • Bone thickness is a factor in the success of midpalatal suture openings with MARPE. • A more advanced suture maturation may be correlated to age and bone thickness. • Corticopuncture increases MARPE success in older patients with thin palatal bone thickness. [ABSTRACT FROM AUTHOR]

Developing diagnostic and treatment solutions for medical applications is often challenging due to the complex dynamics, partial observability, high inter- and intra-population variability, and the presence of unknown delays and disturbances. A characteristic case is the control of glucose concentration in people with Type 1 Diabetes (T1D) through the administration of exogenous insulin. The above complexities, enhanced by the significant cognitive burden associated with the estimation of optimal insulin dosing related to daily activities such as food intake and exercise, call for advanced insulin administration solutions towards a fully automated Artificial Pancreas System (APS). Reinforcement Learning (RL) is currently being explored in the development of APSs thanks to its demonstrated potential in problems characterized by complex dynamics and uncertainties. Despite the progress, RL algorithms in T1D still require manual estimation and announcement of meal carbohydrate (CHO) content or rely on small meal scenarios. In this study, we proposed G2P2C, a modular deep RL algorithm, which aims to fully automate glucose control in T1D, eliminating the need for CHO estimation and announcement. G2P2C was designed based on the state-of-the-art Proximal Policy Optimization (PPO) algorithm, augmented by two novel optimization phases: (i) model learning and (ii) planning. The former integrated an auxiliary learning task to learn a glucose dynamics model. The latter fine-tuned the learned control strategy to a short-time horizon by simulating glucose trajectories into the future. We evaluated the performance of G2P2C in-silico on a challenging meal protocol (180 g of CHO per day) for 20 subjects (10 adults and 10 adolescents) using an open-source version of a T1D simulator approved by the United States Food and Drug Administration (FDA). G2P2C was compared with state-of-the-art RL algorithms and two basal-bolus (BB) clinical treatment strategies, which involve manual meal announcement and CHO estimation with automated correction insulin boli for elevated glucose. G2P2C obtained statistically significant (P < 0. 05) reward improvements compared to PPO in 18 out of 20 subjects, while maintaining a lower failure rate. In addition, G2P2C achieved a time in range of 73% and 64% for the adult and adolescent cohorts, respectively, outperforming BB strategies in the adult cohort although no meal announcement was performed. The control performance and algorithmic characteristics of G2P2C show promise as a candidate algorithm for glucose control in APSs. We released the codebase of G2P2C (https://github.com/chirathyh/G2P2C) and an online demonstration tool (https://capsml.com/), where users can perform custom simulations to compare G2P2C with BB strategies, under the MIT license. • We propose G2P2C, an Reinforcement Learning (RL) algorithm for glucose regulation. • G2P2C automates treatment by eliminating manual meal estimation and announcement. • It is evaluated in-silico based on an FDA-approved Type 1 Diabetes Simulator. • G2P2C improves performance compared to clinical treatment and RL benchmarks. • We release the code base of G2P2C and provide an online demonstration tool (CAPSML). [ABSTRACT FROM AUTHOR]

A voltammetric sensor based on the electropolymerization of cobalt-poly(methionine) (Co-poly(Met)) on a glassy carbon electrode (GCE) was developed and applied for the determination of estriol by differential pulse voltammetry (DPV) for the first time. The electrochemical properties of the Co-poly(Met)/GCE were analysed by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) were used to characterize the polymers on the GCE surface. The deposition of the Co-poly(Met) film on the GCE surface enhanced the sensor electronic transfer. CV studies revealed that estriol exhibits an irreversible oxidation peak at +0.58 V for the Co-poly(Met)/GCE (vs. Ag/AgCl reference electrode) in 0.10 mol/L Britton-Robinson buffer solution (pH = 7.0). Different voltammetric scan rates (10–200 mV/s) suggested that the estriol oxidation on the Co-poly(Met)/GCE surface is controlled by adsorption and diffusion processes. Based on the optimized DPV conditions, the linear responses for estriol quantification were from 0.596 μmol/L to 4.76 μmol/L (R2 = 0.996) and from 5.66 μmol/L to 9.90 μmol/L (R2 = 0.994) with a limit of detection (LOD) of 0.0340 μmol/L and a limit of quantification (LOQ) of 0.113 μmol/L. The DPV-Co-poly(Met)/GCE method provided good intra-day and inter-day repeatability with RSD values lower than 5%. Also, no interference of real sample matrices was observed on the estriol voltammetric response, making the DPV-Co-poly(Met)/GCE highly selective for estriol. The accuracy test showed that the estriol recovery was in the ranges 96.7%–103% and 98.7%–102% for pharmaceutical tablets and human urine, respectively. The estriol quantification in pharmaceutical tablets performed by the Co-poly(Met)/GCE-assisted DPV method was comparable to the official analytical protocols. [ABSTRACT FROM AUTHOR]

Air pollution is the fourth-highest risk factor for premature deaths globally and the second-highest risk factor for premature deaths in Ghana. Understanding the socioeconomic correlates of cooking stove/fuel choices and stove stacking patterns is a precursor to designing effective household air pollution interventions. The study applies the multinomial logit model (MNL) to identify socio-economic determinants of household cooking stoves in three unique analyses. In the first analysis, the study examines socio-economic determinants of primary stove choice for LPG, charcoal, and three-stone stoves. Secondly, the study examines determinants of stove choice for primary and secondary stoves when the order is not taken into account: LPG-charcoal, LPG-3-stone, and charcoal-3-stone. The third analysis examines determinants of stove use patterns among stove stackers when the order is taken into consideration: LPG-charcoal, LPG-3-stone, charcoal-3-stone, charcoal-LPG, 3-stone-LPG, and 3-stone-charcoal stove combinations. A cross-sectional design is used to collect data from sampled districts in all 16 regions of Ghana, covering about 7400 household-level respondents in 370 enumeration areas (EAs); across 177 urban EAs and 193 rural EAs. The results show that primary cooks with higher education, smaller, wealthier, and urban households are more likely to use LPG; more likely to use a stacking mix that includes LPG, and more likely to use a stacking combination where LPG is the primary stove-fuel used. Ghana is currently undertaking a National LPG Promotion Programme (NLPGPP) that seeks to increase LPG access by providing subsidized "starter kits" (stoves, regulators and cylinders) to periurban and rural households. Our findings can aid in targeting households effectively. Our results suggest that households that are female-headed; have less educated household heads; have household heads who double as the primary cook; have larger family sizes, have lower socio-economic status, and are rural, will have an increased probability of adopting and using a cleaner stack of cooking technologies and have an increased probability of using LPG long term, conditional on receiving a starter kit. Such a targeted intervention with a multifaceted approach to shifting households to a cleaner stack of cooking technologies could result in widespread adoption and contribute to significant reductions of CO and PM2.5 emissions in Ghana. A cleaner stack of cooking technologies, given the socio-demographics that are least likely to adopt and sustain use, will have a significant impact on health, the environment, and climate change. • higher levels of education are associated with the stacking mix that includes LPG • the highest level of education is associated with the primary LPG and secondary charcoal stove stack • when there is agency on the part of the primary cook, the cook chooses a cleaner fuel • wealthier households are more likely to use LPG as the primary stove; a stacking mix that includes LPG; and a stacking combination where LPG is primary, and a charcoal stove is secondary [ABSTRACT FROM AUTHOR]

Objectives: These studies sought to investigate the impact on mortality of coronary flow after passage of the wire through the culprit vessel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing mechanical reperfusion. Background: Reduced spontaneous coronary flow before percutaneous coronary intervention influences mortality in patients with STEMI. Response to vessel wiring in patients with an occluded coronary artery before intervention might further discriminate outcomes irrespective of pre- and post-intervention coronary flow. Methods: Data from the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) trials were pooled: of 919 index procedures, 902 films (98%) were technically adequate for core laboratory TIMI (Thrombolysis In Myocardial Infarction) flow determination. Results: TIMI flow grade 0 was present before percutaneous coronary intervention in 59% of infarct vessels, TIMI flow grade 1 to 2 was found in 21%, whereas the remainder of infarct arteries presented with TIMI flow grade 3. In 49% of patients who showed persistent TIMI flow grade 0 after wire insertion (AWI), mortality was higher at 30 days (5.3%) and 1 year (9.4%) compared with patients in whom TIMI flow grade before percutaneous coronary intervention was either >0 (0.8%; p < 0.003 and 3.6%, p < 0.008) or improved from 0 AWI (1.5%, p < 0.04 and 3.6%, p < 0.02). After correcting for multiple imbalances, including baseline and final flow, persistent TIMI flow grade 0 AWI remained associated at 30 days to 2-fold (risk ratio [RR]: 2.1, 95% confidence interval [CI]: 1.08 to 5.00; p = 0.038) and at 1 year to almost 3-fold increases of mortality (RR: 2.7, 95% CI: 1.3 to 5.6; p = 0.008). Conclusions: STEMI patients displaying persistent no-flow AWI have a lower survival rate despite an apparently successful mechanical intervention. As an early marker for high residual mortality risk, persistent no-flow AWI may qualify STEMI patients for dedicated pharmacomechanical treatment strategies. [Copyright &y& Elsevier]

Background: Current treatment standards for patients undergoing primary percutaneous coronary intervention support early infusion of abciximab, followed by bare-metal stent (BMS) implantation. Whether the use of sirolimus-eluting stent (SES) would result in a further improvement of clinical outcomes remains to be proven. Similarly, whether tirofiban administered at high-bolus dose (HBD) followed by standard infusion is a valuable alternative to abciximab in the setting of ST-segment elevation myocardial infarction remains uncertain. Study Design: Multicentre evaluation of single high-bolus dose tirofiban versus abciximab and sirolimus-eluting versus bare metal stent in acute myocardial infarction (MULTI-STRATEGY) is a phase III, open-label, multinational investigator-driven clinical trial evaluating, with a 2-by-2 factorial design, the safety/efficacy profile of 4 interventional strategies of reperfusion: tirofiban given at HBD (bolus of 25 μg/kg over 3 minutes), followed by an infusion of 0.15 μg/kg per minute for 18 to 24 hours versus abciximab and SES, as compared to BMS implantation in primary percutaneous coronary intervention. The coprimary objectives are (i) the evaluation of the effect of SES versus BMS on the incidence of major adverse cardiac events within 8 months of the index procedure and (ii) the degree of ST-segment resolution obtained after the mechanical intervention for the comparison of HBD tirofiban versus abciximab. The protocol mandates clinical follow-up for 5 years. Conclusions: MULTI-STRATEGY will evaluate the role of SES and HBD tirofiban versus BMS and abciximab in the acute management of patients presenting with ST-segment elevation myocardial infarction. [Copyright &y& Elsevier]

Background: Routine drug-eluting stent (DES) implantation has recently improved outcome in patients undergoing percutaneous treatment of left main (LM) coronary artery. However, even in the DES era, distal LM treatment remains an independent predictor of poor outcome. Whether single-vessel stenting (SVS) or bifurcation stenting (BS) should be performed to optimize treatment of such a lesion is unclear. Methods: From April 2002 to June 2004, 94 patients affected by distal LM disease underwent percutaneous intervention at our institution either with SVS (n = 48) or BS (n = 46). The 2 groups were well balanced for all baseline characteristics but the extension of disease in the LM carina. Results: After a median follow-up of 587 days (range, 328-1179), the cumulative incidence of MACE was similar between the 2 groups (31% in the BS vs 28% in SVS group, HR 0.96, 95% CI 0.46-1.49, P = .92), with no difference for the composite death/myocardial infarction or target vessel revascularization. After adjustment for confounders, the technique of stenting was not a predictor of either major adverse cardiac events or target vessel revascularization. Angiographic analysis—performed in 81% of eligible patients in SVS and 87% in the BS group—confirmed the equivalency between SVS versus BS. Conclusions: In consecutive patients undergoing catheter-based distal LM intervention, SVS or BS may perform equally under both clinical and angiographic perspective in current DES era. [Copyright &y& Elsevier]

Objectives: This study sought to investigate whether the anatomical location of the disease carries prognostic implications in patients undergoing drug-eluting stent (DES) implantation for the left main coronary artery (LMCA) stenosis. Background: Liberal use of DES, compared with a bare metal stent (BMS), has resulted in an improved outcome in patients undergoing LMCA intervention. However, the overall event rate in this subset of patients remains high, and alternative tools to risk-stratify this population beyond conventional surgical risk status would be desirable. Methods: From April 2002 to June 2004, 130 patients received DES as part of the percutaneous intervention for LMCA stenoses in our institution. Distal LMCA disease (DLMD) was present in 94 patients. They were at higher surgical risk and presented with a greater coronary disease extent compared with patients without DLMD. Results: After a median of 587 days (range 368 to 1,179 days), the cumulative incidence of major adverse cardiac events (MACE) was significantly higher in patients with DLMD at 30% versus 11% in those without DLMD (hazard ratio [HR] 3.42, 95% confidence interval [CI] 1.34 to 9.7; p = 0.007), mainly driven by the different rate of target vessel revascularization (13% and 3%; HR 6, 95% CI 1.2 to 29; p = 0.02). After adjustment for confounders, DLMD (HR 2.79,95% CI 1.17 to 8.9; p = 0.032) and surgical risk status (HR 2.18,95% CI 1.06 to 4.5; p = 0.038) remained independent and complementary predictors of MACE. Conclusions: Distal LMCA disease carries independent prognostic implications, and it may help in selecting the most appropriate patient subset for LMCA intervention beyond the conventional surgical risk status in the DES era. [ABSTRACT FROM AUTHOR]

Nations worldwide are facing new challenges in the protection of large remote marine habitats and searching for effective pathways to comply with international sustainable goals. In this letter, we discuss opportunities and uncertainties in the management of two recent remote Marine Protected Areas MPAs, St. Peter and S. Paul and Trindade and Martim Vaz Archipelagos, Brazil, and evaluate the application of Ecosystem-based Management framework in the current national legal system. 'Stakeholder involvement' is revealed a major gap in the baseline governance of the MPAs, as a highlight for decreased participation in decision-making of Seascapes. Image 1 • Brazil faces governance challenges in the management of the new remote MPAs. • Stakeholder Involvement is a major gap in the Brazilian MPA legal system. • Ecosystem-based Management is an appropriate framework to promote participation in MPAs. [ABSTRACT FROM AUTHOR]