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The 0 to 10 numeric rating scale (NRS) of pain intensity is a standard outcome in randomized controlled trials (RCTs) of pain treatments. For individuals taking analgesics, there may be a disparity between “observed” pain intensity (the NRS, irrespective of concurrent analgesic use), and “underlying” pain intensity (what the NRS would be had concurrent analgesics not been taken). Using a contemporary causal inference framework, we compare analytic methods that can potentially account for concurrent analgesic use, first in statistical simulations, and second in analyses of real (non-simulated) data from an RCT of lumbar epidural steroid injections (LESI). The default analytic method was ignoring analgesic use, which is the most common approach in pain RCTs. Compared to ignoring analgesic use and other analytic methods, simulations showed that a quantitative pain and analgesia composite outcome based on adding 1.5 points to observed pain intensity for those who were taking an analgesic (the QPAC1.5) optimized power and minimized bias. Analyses of real RCT data supported the results of the simulations, showing greater power with analysis of the QPAC1.5 as compared to ignoring analgesic use and most other methods examined. We propose alternative methods that should be considered in the analysis of pain RCTs.

Worldwide, people are facing diabetes which is characterized by high Fast Blood Glucose Level (FBGL) over a prolonged period of time. The main drawbacks of existing methods for estimation of FBGL are their high cost and invasive nature requiring frequent blood with-drawls. Hence, there is an unmet need to find an alternate method that can estimate blood glucose level conventionally, non-invasively and affordably. In the proposed work, an alternative method for estimating blood glucose based on variation in the electrochemical parameters of saliva is discussed. The role of saliva as a diagnostic tool is assessed by correlating fasting blood serum glucose and salivary glucose in the patient. The proposed system consists of sensor module, processor module, and IOT module. A proof of concept prototype is developed with integrated sensor for all the relevant parameters. PIC Microcontroller is the controlling unit of the whole system. The various sensors for measuring heart rate, temperature, pH and humidity are used in the work. This non-invasive blood glucose monitoring method is efficient and painless for FBGL estimation from saliva.

Objectives Chronic hepatitis C (CHC) infection affects more than 70 million people worldwide and imposes considerable health and economic burdens on patients and society. This study estimated 2 understudied components of the economic burden, patient out-of-pocket (OOP) costs and time costs, in patients with CHC in a tertiary hospital clinic setting and a community clinic setting. Methods This was a multicenter, cross-sectional study with hospital-based (n = 174) and community-based (n = 101) cohorts. We used a standardized instrument to collect healthcare resource use, time, and OOP costs. OOP costs included patient-borne costs for medical services, nonprescription drugs, and nonmedical expenses related to healthcare visits. Patient and caregiver time costs were estimated using an hourly wage value derived from patient-reported employment income and, where missing, derived from the Canadian census. Sensitivity analysis explored alternative methods of valuing time. Costs were reported in 2020 Canadian dollars. Results The mean 3-month OOP cost was $55 (95% confidence interval [CI] $21-$89) and $299 (95% CI $170-$427) for the community and hospital cohorts, respectively. The mean 3-month patient time cost was $743 (95% CI $485-$1002) (community) and $465 (95% CI $248-$682) (hospital). The mean 3-month caregiver time cost was $31 (95% CI $0-$63) (community) and $277 (95% CI $174-$380) (hospital). Patients with decompensated cirrhosis bore the highest costs. Conclusions OOP costs and patient and caregiver time costs represent a considerable economic burden to patient with CHC, equivalent to 14% and 21% of the reported total 3-month income for the hospital-based and community-based cohorts, respectively.

Background: Cerclage fixation is a known orthopedic technique shown to be beneficial for circumferential augmentation when screw fixation cannot be used or is undesirable. However, ongoing advances in suture materials and knot techniques exist, and there is a paucity of evidence existing which evaluates comparisons between the two. The objective of this study was to investigate the strength and durability of cerclage fixation between the Nice knot suture technique and monofilament wire. Methods: Static displacement over time and compression load testing were analyzed. Compression testing was conducted with the Jamar Hydraulic Hand Dynamometer. Distraction testing was conducted using the Instron test system with its associated program. The Nice knot was tied using number 2 and number 5 FiberWire (Arthrex) and compared to monofilament wire. Clinical failure (displacement of 10 mm), absolute failure (opening of the knot or material failure), maximum compression achieved, and steady state compression maintained were the outcomes of interest. Results: Double-stranded monofilament wire produces maximum consistent compression of 90 kg, followed by single-stranded monofilament wire (60 kg). Number 5 FiberWire has a higher maximum compression load than number 2 FiberWire (50 kg vs. 22 kg), but it is lower than that of the double-stranded monofilament wire constructs. When compared to the single-stranded monofilament construct, the number 5 FiberWire Nice knot is comparable (P < .05). Average steady state compression achieved after 10 minutes of resting showed double-stranded monofilament wire to be 65 kg compared to single- stranded monofilament wire at 42 kg, which when, compared to suture, number 5 FiberWire measured at 15 kg and number 2 FiberWire at 8 kg. Average tension results from Instron distraction testing showed the double-stranded monofilament wire construct was able to withstand greater forces up to a displacement of 6 mm, after which the number 5 FiberWire Nice knot was stiffer. Number 5 FiberWire shows the most linear tension relationship, revealing it more efficiently withstands elastic forces. Load to failure was higher in the number 5 FiberWire Nice knot construct than that in both the monofilament wire constructs. The modes of failure for the Nice knot were always at the knot suture interface rather than at the knot. Conclusion: We propose this suture technique to be a viable alternative method for cerclaging to fix upper limb long-bone fractures.

Non-thermal atmospheric pressure plasma treatment has emerged as a promising potential seed quality enhancement method over recent years. This study focuses on the effect of atmospheric pressure plasma treatment on seed germination and growth of Long Bean-KPN (Vigna unguiculata L.) seeds under laboratory conditions. In this study, the Long Bean seeds were exposed to a dry air non-thermal atmospheric pressure plasma for different periods between 4 and 10 min to study its effect on seed germination and growth behavior. It was observed that Germination percentage and Seed Vigor Index were negatively affected by plasma treatment for more than 6 min. The performance of seeds treated for 4 min had a slight improvement in germination over the control specimen, while it showed a significant improvement in average seed vigor index. The study confirmed that non-thermal atmospheric pressure plasma treatment can be stimulatory for seed germination and growth of Vigna unguiculate L. seeds if exposed to plasma for periods less than 4 min and it can be inhibitory for the purpose if exposure time exceeds 6 min.

Thick cladding of copper is required for diverse applications, however, only a handful of processes can be used for bulk material cladding. This study has been undertaken to suggest a better alternative method for cladding thick layer of copper on aluminium substrate. Cladding of 3 mm thick layer of copper on 6 mm thick aluminium substrate has been successfully performed using friction stir welding process (FSW). Detailed microscopic study, XRD and microhardness evaluation of the samples proved the quality of clad layer. Interestingly even after three FSW passes no substrate material could reach near the top of clad layer.

Knowledge distillation is a highly effective method for transferring knowledge from a cumbersome teacher network to a lightweight student network. However, teacher networks are not always available. An alternative method called online knowledge distillation, which applies a group of peer networks to learn collaboratively with each other, has been proposed previously. In this study, we revisit online knowledge distillation and find that the existing training strategy limits the diversity among peer networks. Thus, online knowledge distillation cannot achieve its full potential. To address this, a novel online knowledge distillation with elastic peer (KDEP) strategy is introduced here. The entire training process is divided into two phases by KDEP. In each phase, a specific training strategy is applied to adjust the diversity to an appropriate degree. Extensive experiments have been conducted on individual benchmarks, including CIFAR-100, CINIC-10, Tiny ImageNet, and Caltech-UCSD Birds. The results demonstrate the superiority of KDEP. For example, when the peer networks are ShuffleNetV2-1.0 and ShuffleNetV2-0.5, the target peer network ShuffleNetV2-0.5 achieves 57.00 % top-1 accuracy on Tiny ImageNet via KDEP.

An electrocardiogram (ECG) consists of complex P-QRS-T waves. Detecting long-term ECG recordings is time-consuming and error-prone for cardiologists . Deep neural networks (DNNs) can learn deep representations and empower automatic arrhythmia detection. However, when applying DNNs in practice, they usually suffer from domain shift that exits between the training data and testing data. Such shift can be caused by the high variability contained in ECG signals between patients and internal-variability of heartbeats for same patients, leading to degrading performance and impeding generalization of DNNs. To tackle this problem, we propose an unsupervised semantic-aware adaptive feature fusion network (USAFFN) to reduce such shift by alleviating the semantic distribution discrepancy between the feature spaces of two domains. Furthermore, an ECG contains rich information from different angles (beat, rhythm, and frequency levels), which is essential for arrhythmia detection. Therefore, a multi-perspective adaptive feature fusion (MPAFF) module is introduced to extract informative ECG representations. The experimental results show that the detection performance of our approach is highly competitive with the upper bound of alternative methods on the ARDB, and the generalization is confirmed on the INCART and LTDB.

This project work aims the study of productivity improvement methods in AUTOMOBILE INDUSTRY’s Cathodic Electro Deposition painting line by optimizing jig density. In AUTOMOBILE INDUSTRY’s PTCED line, SM parts lifted using dedicated jigs on continuously moving OH conveyor. Present production capacity of CED line is 110 units/shift at 90% efficiency with consumption of 5.8 jigs/tractor. Objective of the project work is to improve the existing productivity by increasing jig density. Usual methods of productivity improvements mainly focusses on increasing the conveyor speed and automation introductions. Alternative method of increasing the loading capacity per jig and exploring the feasibilities of changing the existing loading patterns being adopted in this project work. The modified loading jigs and patterns observed for 2 months resulted an increase in productivity from 105 units to 141 units/shift operations.

Bilateral erector spinae fascial plane blocks (ESPB) offers a novel, alternative method of regional post-operative pain control to thoracic epidural analgesia (TEA). The aim of this study was to compare rates of postoperative hypotension, and other standard enhanced recovery after surgery (ERAS) endpoints, in patients receiving ESPB versus TEA for open hepatopancreaticobiliary (HPB) surgery.This retrospective analysis compared historical controls of ERAS patients undergoing open HPB surgery with TEA versus ESPB. The incidence of postoperative hypotension and clinical outcomes, including opioid requirements, were compared.Forty patients receiving TEA were compared to 27 ESPB patients. Return of bowel function and length of stay (mean 7.2 versus7.4 days; P = 0.83) were similar. ESPB patients received less intraoperative colloid (142cc versus 340cc; P = 0.01) and had less postoperative hypotension versus TEA (22% versus 55%; P = 0.03). No ESPB patient required patient-controlled analgesia (versus 32.5% TEA; P0.001). ESPB MME requirements decreased over time, while TEA MME requirements increased over 72 hours (P = 0.019).ESPB is a novel method that shows promising outcomes in improving enhanced recovery parameters and minimizing opioid administration in open HPB surgery.

Although there are immune checkpoint inhibitors (ICIs) available for the treatment of renal cell carcinoma (RCC), the utility of PD-L1 detection by immunohistochemistry (IHC) as a predictive biomarker in clear cell RCC (ccRCC) remains controversial. Nevertheless, alternative methods for PD-L1 detection, such as RNA sequencing (RNA-Seq), may be clinically useful in ccRCC; therefore, we sought to determine the ability of RNA-Seq to accurately and sensitively detect PD-L1 expression across different ccRCC clinical samples in comparison with IHC.Patients with ccRCC (n=127) who received treatment from Washington University in St. Louis between 2018 and 2020 were identified. Tumors from these patients were analyzed using RNA-Seq and IHC.PD-L1 detection by RNA-Seq strongly correlated with IHC (P.001), which was further validated using two independent datasets. Furthermore, RNA-Seq analysis identified an immune-enriched (higher PD-L1 positivity) and an immune-desert (lower PD-L1 positivity) microenvironment of ccRCC, which also correlated with IHC (P.00001).The results demonstrate the ability of RNA-Seq to detect PD-L1 in various ccRCC clinical samples compared to IHC. Ultimately, these findings suggest that PD-L1 detection by RNA-Seq can be further developed to determine the clinical utility of this methodology in ccRCC.

Dose to the contralateral breast (CLB) from radiotherapy treatment has the potential to induce secondary breast cancer. Electronic tissue compensation (eComp) for breast cancer patients is one of the alternative methods to conventional 3D-conformal radiotherapy that eliminates the use of wedges. Several studies have investigated dose to the CLB using tangential fields involving wedges, intensity-modulated radiation therapy and volumetric modulated arc radiation therapy and various other techniques via treatment planning system calculations, Monte Carlo methods and phantoms. However, there are limited data published in assessing the actual dose received by the CLB from treatment with eComp-based tangential fields. In this study, the CLB dose for patients undergoing tangential field radiotherapy with eComp and enhanced dynamic wedged (standard) tangential fields was measured and compared to assess the CLB dose between the two methods. Measurements were conducted on a randomised trial of 40 patients, 20 of them had undergone standard planning, and the remaining 20 were treated with eComp. The mean surface dose measured with TLDs at 3cm from the medial tangential border for eComp and standard techniques was 10.04±1.37% and 10.14±2.05%, respectively for a prescription dose of 2.65Gy/fraction. The estimated dose at 1cm depth in tissue, measured with the use of perspex domes placed over the TLD at the same location, was 5.12±0.87% and 6.29±2.01% for eComp and standard, respectively. The CLB dose is dependent on the proximity of the medial tangential field edge to the contralateral breast and is patient-specific. The results of this study show that at 1cm depth, eComp technique delivers significantly less dose (p

6 pages, 4 tables, 1 figure.-- Under a Creative Commons license, Listeria monocytogenes is a major foodborne pathogen which mainly infects susceptible individuals through the consumption of contaminated foods. To this end, ready-to-eat (RTE) food products are of particular concern as this microorganism is widely distributed, can survive, and even grow, under adverse conditions, and thus must be carefully controlled. In the present study, an interlaboratory ring trial was organized to evaluate an open formula qPCR-based method for the detection of L. monocytogenes. The molecular method was evaluated on a novel RTE seafood product, developed in the framework of a European project, the SEAFOODAGE (EAPA_758/2018). Six laboratories located in Spain and Portugal participated in the study, and the results obtained indicated that this new method presented high diagnostic sensitivity (100%) reaching a low limit of detection (, This work was financially supported by the Seafood Age project, which was co-financed by the Interreg Atlantic Area Program (EAPA_758/2018) though the European Development Fund (ERDF). Mrs. Sarah Azinheiro was financed by a Ph.D. grant from the Fundação para a Ciência e a Tecnologia (SFRH/BD/140396/2018). Dr. Alejandro Garrido-Maestu and Luís D. R. Melo acknowledge funding from the Fundação para a Ciência e Tecnologia through the Scientific Employment Stimulus Program (2021.02810. CEECIND and 2021.00221. CEECIND, respectively). This study was supported by the Fundação para a Ciência e a Tecnologia (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit

We have reported a new reconstruction method using a pectoralis major and serratus anterior muscle flap for diaphragmatic defects after chondrosarcoma resection. The reconstruction of diaphragmatic defects is challenging. In diaphragmatic reconstruction with chest wall defects, strong chest wall reconstruction and diaphragmatic flexibility are important to avoid interference with respiration. The artificial material Gore-Tex is used as the first choice, but it has infection-, exposure-, and durability-related drawbacks. As an alternative method using artificial material, we have reported our new technique—diaphragmatic reconstruction using a reversed-combined pectoralis major and serratus anterior muscle flap.

Background The refining process aims to eliminate the undesirable components in crude vegetable oil to yield refined oil with improved stability and consumer preference. The refining process can be conducted chemically (degumming, neutralization, bleaching, and deodorization) or physically (without neutralization). Every stage of the refining process has its function to remove particular undesirable compounds that improve the quality of the oils. The implementation of ultrasound technology has attracted interest in edible oil refining as an alternative method to the conventional degumming and bleaching processes. Scope and approach Cavitation is generated through the application of ultrasounds (sound waves more than 20 kHz) to enhance the refining process. This review systematically evaluates and discusses current knowledge on the application of ultrasound technology in edible oil refining. Conventional edible oil refining and ultrasound-assisted refining are reviewed in this article. Key findings and conclusions This ultrasound technology offers several advantages over conventional refining, such as improved oil yield, reduced dosage of materials, and saved cost. This article provides a better understanding of ultrasound mechanism on the oil quality and insightful information to stimulate impending applications in the oil industry.

The acetabular labrum is essential for stability during physiologic motion of the hip. Labral repairs frequently are attempted in cases of primary tears, although labral reconstruction is an important alternative in the revision setting or in the primary setting when the tissue is unsalvageable. Labral reconstruction has been shown to restore the hip’s suction-seal and fluid pressurization to that of the premorbid state, and cohort studies have demonstrated significantly improved patient-reported outcomes at midterm follow-up. Notably, the cost is of consideration during any reconstruction, and techniques have been described using both allograft and autograft sources. Autograft sources include the iliotibial band, ligamentum teres, gracilis tendon, and hip capsule. A previously described technique using the capsule was noted to hinder routine capsular closure. We present an alternative method for labral reconstruction using hip capsular tissue that is easily performed and allows for routine capsular closure., Technique Video Video 1 The patient is positioned supine in a lower-extremity traction table to undergo a right hip arthroscopy. An assessment of the central compartment and labral tissue is performed where it is determined that a labral reconstruction is indicated. Given the laxity of the capsular tissue, a capsular autograft is harvested longitudinally from the interportal capsulotomy for labral reconstruction. A traction stitch is placed in the capsulotomy to perform a complete femoral osteochondroplasty. A dynamic examination using fluoroscopy confirms complete resection of cam-type impingement. Labral reconstruction using capsular autograft is then performed along the areas of labral deficiency.

Demand for compounds from natural sources are increasing day by day. Ginsenosides are secondary metabolites, belonging to triterpenoid saponin groups which are present in Panax species. Ginsenosides possess wide range of therapeutic activities which includes anti-aging, anti-oxidative, anti-cancerous, etc. Cultivation of plants containing ginsenosides requires a long duration of time, ranging from five to seven years, along with extensive efforts for controlling the quality despite of the unfavorable environmental conditions. Isolation and production of ginsenosides is also time-consuming and not feasible, when exploiting the conventional methods. Therefore, an alternative method is required for its enhanced production. Biotechnological methods such as shoot culture, cell suspension culture, root culture and hairy root culture are largely being executed for enhanced production of ginsenosides. Bioreactors are also utilized for scaling up the production of ginsenosides. Therefore, this review provides a comprehensive information about pharmaceutical applications of ginsenosides, different biotechnological approaches (shoot, root, hairy root and callus/cell suspension culture) that are used for the production of ginsenosides and scale up strategies for large scale production. Information about different in vitro systems has also been compiled after a panoramic literature survey and last twenty years data has been taken into consideration for this review.

Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.

Barbiturate overdose as a method of euthanasia is becoming unacceptable. This has made alternative methods of euthanasia very important. Gunshot or captive bolt euthanasia is among methods that are acceptable, but they may not be esthetically acceptable. This has led to the use of other methods of euthanasia. Inducing anesthesia prior to euthanasia offers an easier method of control. Adjunctive techniques using intravenous potassium or magnesium salts administered intravenously and intracardiac administration of potassium chloride or intrathecal lidocaine offer alternatives that work well and are more environmentally safer than barbiturates. Pithing and exsanguination are also environmentally safer but may not be as esthetically acceptable as the other methods.

Background In recent years, animal proteins are being replaced by plant-based proteins worldwide. Artificial meat and eggs made from plant-based proteins have been widely commercialized, especially in developed countries such as the United States. However, the traditional wet separation can damage the isolated proteins as well as have a negative impact on the environment. Therefore, there is a growing research interest in developing alternative methods, such as dry separation, for high quality plant protein separation. Scope and approach Electrostatic separation, a dry technology based on the different triboelectric charging properties of materials, has been used for plant protein separation in recent years. This review summarizes the technical issues that need to be considered, from material preparation to equipment construction, for electrostatic separation. Moreover, the separation efficiency, energy consumption, combination with other separation methods, the functionality of the resulting protein concentrates, and prospects for electrostatic separation are also reviewed here. Key findings and conclusions Factors influencing the outcomes of electrostatic separation include the pretreatment of materials, design of the electrostatic separator, and process parameters. The separation efficiency of electrostatic separation can be further improved by cyclic separation or a combination of electrostatic separation with other methods. However, although the proteins obtained by electrostatic separation maintain their native functional properties, they are affected by the presence of other components such as phenolics or starch. Thus, electrostatic separation has several limitations that need to be addressed before it can be used widely.

An entry point medial to the tip of the greater trochanter is considered optimal for antegrade femur nailing. The deforming forces in a subtrochanteric fracture often make it difficult to establish a perfect entry point during antegrade cephalomedullary nailing. To overcome this problem, we report a simple technique of making a retrograde entry portal for select difficult subtrochanteric fractures. The technique was used in 12 subtrochanteric fractures. Our indications were morbid obesity, revision nailing and atypical fractures. The technique involves creating a nail entry portal through the fracture from distal to proximal taking advantage of the abducted proximal fragment. Fracture reduction and nail insertion then proceeds in a standard manner. Additional reaming of the thick endosteal lateral cortex through the fracture was performed in atypical fractures. Satisfactory fracture reduction was achieved in all patients and 11 out of the 12 fractures united in the series. 1 patient developed an infected nonunion and was considered failure of treatment. The retrograde entry portal is a valuable alternative method that can be considered in nailing of difficult subtrochanteric fractures to establish an ideal entry point and nail trajectory.

The difficulties involved in performing autopsies of patients who had died due to COVID-19 required the use of alternative methods in order to obtain tissue samples of affected organs. We describe the technique of core needle aspiration, without ultrasonographic guidance, which we used in 19 cadavers and which produced a high yield in lungs, heart (>94%) and liver (>89%), thus enabling the study of the morphological changes produced by SARS-CoV-2.

In 2010, the European Parliament and the European Union adopted a directive on the protection of animals used for scientific purposes. The directive aims to protect animals in scientific research, with the final goal of complete replacement of procedures on live animals for scientific and educational purposes as soon as it is scientifically viable. Furthermore, the directive announces the implementation of the 3Rs principle: "When choosing methods, the principles of replacement, reduction and refinement should be implemented through a strict hierarchy of the requirement to use alternative methods." The visibility, accessibility, and the rapid growth of the chorioallantoic membrane (CAM) offers a clear advantage for various manipulations and for the simulation of different Bio-Barriers according to the 3R principle. The extensive vascularisation on the CAM provides an excellent substrate for the cultivation of tumour cells or tumour xenografts which could be used for the therapeutic evaluation of nanoscale drug delivery systems. The tumour can be targeted either by topical application, intratumoural injection or i.v. injection. Different application sites and biological barriers can be examined within a single model.

Bacterial infections cause huge losses to aquaculture globally, and increased antibiotic resistance means that alternative methods of reducing mortality from bacterial diseases are required. We compared the resistance of Juvenile olive flounders, Paralichthys olivaceus, to Streptococcus iniae between those reared in biofloc and seawater conditions for ten months. Experimental fish were challenged with S. iniae at concentrations of 0, 3.36 × 106, 3.36 × 107, 3.36 × 108, and 3.36 × 109 colony forming units (CFU)/g fish for 96 h to evaluate the difference in S. iniae susceptibility of flounders reared in biofloc and seawater. The 96 h lethal concentration 50% (LC50) of fish injected with S. iniae was 2.41 × 109 CFU/g fish in biofloc and 1.51 × 108 CFU/g fish in seawater. Hematological parameters such as hemoglobin and hematocrit significantly decreased when fish were challenged by S. iniae. Plasma components such as calcium, glucose, cholesterol, total protein, GOT, GPT, and ALP were significantly altered by S. iniae infection and acetylcholinesterase activity was significantly inhibited. These results indicate that S. iniae infection affects the survival rates, hematological parameters, and neurotransmitter levels of flounders reared in biofloc and seawater, and that S. iniae susceptibility was higher in flounders reared in seawater than those reared in biofloc.

Permeability of experimental and standard micropore carbon materials, before and after the heat treatment at 1550 °C, was investigated using gas permeability measurements (GP) and mercury intrusion porosimetry (MIP). Permeability of both materials increased after the annealing. Experimental micropore carbon material was less permeable than standard one, both before and after the heat treatment. Measured gas permeabilities were compared with permeabilities determined based on MIP measurements using two different models: Hagen−Poiseuille and Carman−Kozeny equation. Using the inverse problem approach, for the first time Carman−Kozeny constant was determined for micropore carbon materials. Carman−Kozeny model gave more accurate results (i.e. close to gas permeability measurements) than Hagen−Poiseuille model. Performed investigations showed that mercury intrusion porosimetry might be alternative method to investigate infiltration resistance of low permeable materials.

Background Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques. Methods We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and ‘related articles’ (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty. Results We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group (‘standard’ CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest. Conclusion Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output. PROSPERO registration number CRD42019152925.

Anti-Ro/SSA antibodies are associated with a risk of 1-2 % to develop complete atrioventricular block (AVB) in fetuses of positive mothers. Complete AVB is irreversible, but studies suggest that anti-inflammatory treatment during the transition period from a normal fetal heart rate (FHR) to an AVB might stop this progression and restore sinus rhythm. The most efficient method for diagnostic evaluation of this arrhythmia is the pulsed-Doppler fetal echocardiography. However, weekly or bi-weekly recommended fetal echocardiographic surveillance can rarely identify an AVB in time for treatment success, also because the transition from a normal rhythm to a third degree AVB is very fast. Daily FHR monitoring in a medical facility could increase the chances of identifying the AVB onset but is difficult to realize. For this reason, an alternative method of FHR monitoring, performed directly by mothers in their home context, has been recently proposed. We present a case report utilizing this approach and review the current evidence about this condition.

The minimum and maximum void ratios are required to establish the relative density of sandy soil. Undisturbed simple shear test specimens are often too small to provide enough material to employ the Japanese Standard JIS A 1224:2009 Test Method. An alternative test method for evaluating the dry minimum and maximum densities of soil is proposed for those cases when a test specimen does not provide enough material to use the standard-size mold. The alternative test method was applied to soil from 42 small test specimens. Soil from test specimens of the same material were subsequently mixed to produce eight soil composites for which their minimum and maximum densities could be determined using both the standard and alternative methods. The minimum and maximum void ratios determined by both methods for the composite soil are in good agreement. Moreover, trends in the dataset are consistent with those from previous studies on sand and non-plastic fine-grained soil.

Effective detection of microbiological contaminations present in medicinal cellular products is a crucial step to ensure patients’ safety. In recent decades, several rapid microbiological methods have been developed and validated, but variabilities linked to the use of different resources have led to discordant validation of methods and performance results. Considering this, while developing an in-house BacT/Alert-based method, we evaluated all of the materials used in its validation. Of particular importance, we noticed that the syringe gauge used to inject the samples into the bottles was crucial to obtain robust results. We chose to conduct a comparative test between the BacT/Alert system and the compendial method described in the European Pharmacopoeia, using five dilutions of nine reference microorganism strains and 21G or 27G needles. Our results confirmed that the BacT/Alert system is a valid and faster alternative method to assess sterility of clinical cell therapy products, and that the use of 27G needles increases its sensitivity to detect reference anaerobe microorganisms., Graphical Abstract, The BacT/Alert system is used in GMP control activities to test the sterility of ATMPs. The use of 27G needles decreases the TTD of most of the tested microorganisms, when compared to the European Pharmacopeia method, and allows less air intrusion and improves the growth and sensitivity of the method for anaerobic microorganisms.

Little information has been available regarding the usefulness of Ranawat triangle method in estimating anatomical hip joint center in the Japanese population. In this study, we aimed to determine the accuracy of the method in estimating hip joint center.Using digitally reconstructed radiographs of 123 normal hips (123 patients), we measured the hip joint center coordinates (Cx, Cy) with reference to the ipsilateral lowest point of the teardrop, the pelvic width, and the pelvic height. Using these measurement values, we performed the following analyses: (1) the relationship of hip joint center location with pelvic dimensions; (2) accuracy of Ranawat method in estimating hip joint center; (3) alternative methods to estimate hip joint center using pelvic height.The mean Cx and Cy were 32 ± 3.0 mm and 13 ± 2.1 mm, respectively. Pelvic height was positively correlated with Cx (r = 0.51, p 0.001) and Cy (r = 0.69, p 0.001), but the correlations of pelvic width with Cx and Cy were negligible. The mean estimation error of the Ranawat method was -6.7 ± 2.6 mm in x-axis and 6.6 ± 1.9 mm in y-axis, respectively. The hip joint center was estimated within a 5 mm error in both axes in only 8 hips (6.5%). Thus, we developed two estimating methods using pelvic height, modified Ranawat method and pelvic height ratio method, and the estimation errors of these methods were within 5 mm in both axes in 118 hips (96%) and 116 hips (94%), respectively.Ranawat method showed poor accuracy in estimating anatomical hip joint center and is not recommended for clinical use. Our alternative methods may be useful for surgeons planning the position of the acetabular component in total hip arthroplasty.

Interpreting practitioners and students have been taught that when any interlocutor swears, they need to do the same. In court, where the highest level of accuracy is required, interpreters have been expected to render expletives literally into the target language. This has brought about hilarious scenarios especially in the case of female interpreters. As a result, I developed my method of using euphemisms to interpret expletives. This method allows me to interpret expletives accurately without swearing. Based on interview data from lawyers and interpreters, and taking into account gender differences, this empirical study answers the question of whether expletives must be interpreted as they are or my alternative method of interpreting expletives accurately but not literally fares better. Results of this study indicate that the latter holds true. Accordingly, I propose the use of euphemisms to interpret expletives so as not to compromise either accuracy or the interpreter's comfort and dignity.

Ti alloys are the ideal material for a great range of applications but their industrial implementation is hindered by current technological and manufacturing limitations. This work presents the scientific development of an emerging alternative route to manufacture Ti alloys from particulate materials. Experimental evidences to show that the proposed manufacturing route, which takes advantage of the benefits of particulate processing, permits to obtain structurally sound Ti alloys using much shorter production routines removing some of the technological and manufacturing limitations hindering the use of Ti alloys in engineering applications are presented. It is found that the relative density increases with the sintering temperature reaching values around 93% and dissolution of the alloying elements is complete. The mechanical properties of the produced representative blended elemental α ± β Ti alloy also increase with the temperature reaching a maximum ultimate tensile strength of 850 MPa.

A 5-month old, intact, female domestic shorthair cat was referred for evaluation of a heart murmur. Echocardiography revealed a large, left-to-right shunting patent ductus arteriosus (PDA). One month after initial presentation, the cat underwent transvenous PDA occlusion via Amplatz occlusion device. A 4-mm Canine Duct Occluder (ACDO) was successfully placed via introduction into the right jugular vein and retrograde manipulation from the pulmonary artery across the ductal opening. No residual flow was detected postoperatively, and the patient recovered uneventfully without significant complications. At recheck evaluations one and seven months post-operatively, the patient was clinically well with trivial residual diastolic flow and improved left heart dimensions. This report demonstrates the feasibility of transvenous PDA occlusion via ACDO device in the feline patient, although further experience is needed to establish the repeatability and safety of this approach compared with alternative methods.

In ALK-positive anaplastic large-cell lymphomas, positive qualitative PCR for NPM1–anaplastic lymphoma kinase (ALK) in peripheral blood and/or bone marrow at diagnosis and during treatment are associated with a higher risk of treatment failure. Real-time quantitative PCR allows identification of very high risk patients. However, this latter technique initially designed for patients with lymphomas carrying the most frequent NPM1-ALK translocation necessitates calibration curves, limiting interlaboratory reproducibility. An ALK universal quantitative PCR based on 3′ALK transcript amplification was designed to allow the detection of all ALK fusion transcripts. The absolute concordance of 3′ALK quantitative PCR results were validated with the routine NPM1-ALK qualitative and quantitative PCR on 46 samples. The universality of ALK fusion transcript detection also was validated on TPM3-, ALO17-, and ATIC-ALK–positive samples, and the EML4-ALK–positive cell line. Digital droplet PCR using the 3′ALK universal probe showed highly concordant results with 3′ALK universal quantitative PCR. A major benefit of digital droplet PCR is a reduced experimental set-up compared with quantitative PCR, without generation of standard curves, leading to a reliable protocol for multilaboratory validation in multicenter clinical trials essential for this rare pathology. Our ALK universal method could be used for the screening of ALK fusion transcripts in liquid biopsy specimens of other ALK-positive tumors, including non–small cell lung carcinomas.

Aortoesophageal fistula (AEF) is a rare pathology with a poor prognosis. Historically, open repair approaches were undertaken. With the advent of endovascular techniques, alternative methods such as thoracic endovascular aortic repair (TEVAR) have emerged. This case describes a patient who presented with severe hematemesis and, upon imaging, an AEF was discovered. Urgent TEVAR was indicated with a graft oversized to the native aorta by 10% to 15%, along with coil embolization of the intercostal artery. We report here on the successful management of AEF via TEVAR.

The Artisan-Ophtec aphakic iris-enclaved anterior chamber intraocular lens (IOL) has been used to advantage in children and adults who lack capsular support for implantation of a standard posterior chamber IOL. However, even the most skilled anterior segment surgeon may encounter difficulties enclaving the IOL to the iris using the enclavation needle. We describe a simple, secure, rapid alternative method for enclaving the IOL that requires only two eye incisions: one at the corneal limbus and the other through the pars plana.

Detailed chemistry simulations of heterogeneous solid propellant combustion at the microstructure scale are very costly as they involve large and stiff chemical schemes in the gas phase. A usual workaround is to use global chemistry to approximate gas phase reactions. A drawback of this approach is the need for an a priori calibration which necessitates reference data and often limits the operating conditions range of validity. An alternative method based on 1-D burner-stabilized flames tabulation is proposed in this paper. The theoretical and numerical frameworks are detailed. An appropriate tabulation space is introduced to store useful thermochemical variables as well as Jacobian terms used for time-integration. Jump conditions are also rewritten to cope with tabulated chemistry formalism. Several 1-D validations are performed on classical propellant compositions. Detailed comparisons with available experimental data demonstrate the ability of the proposed methodology to tackle inner flame structure (temperature and species) as well as the evolution of the burning rate with pressure and composition. Finally, 2-D laminate propellant simulations are conducted showing the ability of the methodology to capture complex flame regimes and associated burning rate modifications.

Determination of abundances of proteins involved in uptake, distribution, metabolism and excretion of xenobiotics is a prerequisite to understand and predict elimination mechanisms in tissue. Mass spectrometry promises simple and accurate measurements of individual proteins in complex mixtures using isotopically labeled peptide standards. However, comparisons of measurements performed in different laboratories have shown considerable discrepancies in the data generated. Even when very similar approaches are compared, the results differ significantly. An alternative method of measuring protein titers is global proteomics. Depending on sample type, this allows quantification of hundreds to thousands of proteins in a single analysis. It enables system-wide insights by providing protein copy numbers and cell sizes. Regardless of differences, the workflows of both the labeled standard-based and the proteomic approach share several steps. Each can be critical. Selection of optimal techniques is the prerequisite for accurate and reproducible protein quantification. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

Traditional rotary ultrasonic vibration drilling rock (fz 2A) was proposed. The mechanism of ultrasonic vibration assisted drilling rock was analyzed, and the propagation of ultrasonic energy in the process of ultrasonic vibration assisted drilling rock was analyzed. Using the small diameter cemented carbide triangular bit as the drilling tool, the comparative test of ultrasonic vibration assisted drilling and traditional drilling of sandstone, marble, and basalt was carried out. The experimental results showed that there was a specific feed rate range for each type of rock, so that the weight on bit required for ultrasonic vibration assisted drilling was less than that of traditional drilling. With the increase of firmness coefficient of sandstone, marble, and basalt, the ratio of weight on bit to feed rate was increased, and the effective feed rate range of ultrasonic vibration assisted drilling was reduced. The ultrasonic vibration assisted drilling rock (fz > 2A) was one of the alternative methods for drilling rock on the asteroid surface.

This article tests the feasibility of using the diameter-length (Le-D) technique to determine the bulk etch rate (Vb) in a CR-39 nuclear track detector. The detector was irradiated with alpha particles energies: 5.3, 4.7, 4.1 and 3.5 MeV, which were emitted from a 241Am source. The detector was etched in a 6.25 N NaOH solution at 60 °C for periods of 1–10 h. The average Vb found by means of the (Le-D) method is approximately 0.76 ± 0.05 µm/h, which is consistent with the result found separately by the thickness-measurement method (i.e. 0.836 ± 0.06 µm/h). Moreover, the results show that the Vb of the CR-39 detector is independent of the alpha energies. This can pave the way for the use of the (Le-D) method as a reliable alternative method for measuring the bulk etch rate.

In the present paper, a mathematical modeling of high-temperature synthesis process in powder system Ni + Al under linear heating conditions was carried out. A comparative analysis of numerical modeling results and experimental data which were obtained for mechanically activated powder mixtures is pre- sented. The criterion for determining the characteristic ignition temperature in the case of forced ignition was proposed. This criterion makes it possible to establish a relationship between the thermokinetic pa- rameters at the ignition limit. With the use of the model, the dependencies of the ignition temperature, the induction time, and the conversion degree on the effective activation energy were established. It was found that these dependencies are close to linear that allows making the predictive estimates. It was shown that the ignition temperature depends most significantly on the activation energy of the synthesis while its dependence on other kinetic parameters is of secondary importance. Based on the criterion pro- posed, an alternative method for determining the effective activation energy of synthesis was considered.

Experiments were conducted to investigate how specimen preparation (crushing and sieving) affects the swell index (SI) of bentonite-polymer (B–P) composites and the relationship between SI and hydraulic conductivity of B–P GCLs. Seven B–P and one Na–B GCLs were used in this study. Tests were conducted using DI water and synthetic municipal solid waste incineration ash leachates. Specimens were prepared using the ASTM D5890 and two alternative methods prior to SI testing. For both Na–B and B–P composites

Alternative methods for insulin delivery instead of subcutaneous injection in diabetic patients is of great essential, and biocompatible polymers are one of the most efficient vehicles for this purpose. This research aims to investigate the capability of tragacanthic acid (TA) to bind insulin and release it under physiological conditions without alteration in the structure and conformation of insulin. Interactions between TA and insulin were studied using spectroscopic techniques and computational modeling by docking and molecular dynamics simulations. Our results demonstrate an entropy-driven spontaneous interaction between insulin and TA, where hydrogen bonds act as the main enthalpic contribution. According to our findings, the weak interaction between insulin and TA provides the basis for efficient capture and appropriate release of insulin by TA as a potential part of the insulin delivery system. In conclusion, tragacanth acid can be a proper candidate for insulin delivery.

Background Pediatric clinical facilities have become oversaturated and increasingly restrictive, limiting student exposure to acutely ill children. It is imperative to find alternative methods to provide opportunities for students to work with high-acuity patients, which assist in developing clinical judgment. The sample consisted of participants including 234 students enrolled in child health in a baccalaureate nursing degree program. Methods This repeated measures pilot study used the Lasater Clinical Judgment Rubric to evaluate the effect of a virtual simulation on students' self-perceived clinical judgment skills. Results Improved clinical judgment was illustrated by students' ability to obtain minimal simulation scores in fewer attempts. Student self-perception of clinical judgment abilities was demonstrated by improved clinical judgment scores. Study results show statistically significant findings in attempts and in student self-perception of their clinical judgment abilities. Conclusion Findings suggest that virtual simulation is beneficial to student learning and the development of clinical judgment skills.

Background Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques. Methods The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and “trapped” directly under the dermis by closing the superficial fascia and adipose tissue beneath it. Results Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8–10 weeks after superficialization. Conclusions This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature.

Femtosecond laser technology has evolved as an alternative method to make surgical incisions in keratoplasty. The use of this approach has a number of purported advantages that may lead to superior clinical outcomes. However, there remains a low uptake of the femtolaser-assisted keratoplasty within public healthcare, and incongruity remains between perceived expert opinion on the presence and significance of superior clinical outcomes based on available data.This review is registered publicly on the Open Science Framework registry and aims to evaluate the evidence base on femtolaser-assisted keratoplasty and its comparison with manual trephination in intraoperative and postoperative outcomes. Over 2000 studies were screened and critically appraised in the field of keratoplasty, using multiple databases. 17 studies were included via predetermined criteria for full analysis. The studies covered interventional research into penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and posterior lamellar keratoplasty (PLK).The results of this review show that PK studies shared a trend of improved visual outcomes with the femtolaser, and evidence for earlier suture removal. Complication rates were similar. When used for DALK, studies showed some evidence of improved visual outcomes with the femtolaser, and evidence for earlier suture removal, reduced intraoperative complications and increased wound healing activity. The use in Descemet’s membrane endothelial keratoplasty (DMEK) showed reduced graft detachment whereas in Descemet’s stripping automated endothelial keratoplasty (DSAEK) the results were limited.Overall, this review shows a trend that the use of the femtolaser may improve clinical outcomes in PK, DALK and DMEK. However, it was also clear that in order to corroborate the superiority of femtolaser-assisted keratoplasty versus manual methods, further research is required.

An increasing number of peptide drugs have been identified or synthesized in recent decades, and they have played an important role in disease treatments and scientific research. Peptide drugs have become emerging candidates in the pharmaceutical market, despite some inherent disadvantages that have hindered their further development (i.e., they are chemically and physically unstable). Considering that cold-storage conditions are not easily accessible, particularly in developing countries, it remains a significant challenge to find a facile way to enhance the stability of peptide drugs. In this study, we developed an efficient and facile strategy to provide peptide drugs a strong protection against harsh conditions by biomineralizing metal-organic frameworks (MOFs) around the peptide drugs. Our results showed that the peptides released from MOFs retained their structures and full biological activities after being exposed to high temperatures, repeated freeze-thaw cycles and enzyme degradation. This study provides an alternative method for the storage of biopharmaceuticals and for enhancing their stability under ambient conditions.

This paper concentrates on the study of robust stability of fractional order system with polynomial uncertainties. Polynomial uncertainties means that the coefficients of the fractional system are polynomial functions of the parameters, and the uncertain parameters vary in semialgebraic set. The roots of the fractional order characteristic function are assigned in the shifted half plane. Therefore, the fractional system can maintain certain robustness and time domain performance. In order to check the robust stability of fractional order polynomial system, alternative methods are presented by using Sum of Squares (SOS) programs. Since SOS programs can be all written as Linear Matrix Inequalities (LMI) feasibility tests, our proposed method embraces the advantages of LMI techniques. Numerical examples are presented to illustrate the proposed results.

The purpose of this report is to describe the procedure for CT fluoroscopy– guided Cervical medial branch block and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning with visualization of bony landmarks and at the same time be aware of the adjoining soft tissue anatomy with good localization of adjacent critical non-targeted areas such as the neural foramina and the dorsal root ganglia. This serves as an alternative method for performing medial branch blocks and facet radiofrequency ablation.

In toxicology, there is a strong push towards replacing animal experiments with alternative methods, which include cell-based in vitro methods for the assessment of adverse health effects in humans. High-throughput methods are of central interest due to the large and steadily growing numbers of compounds that require assessment. Tremendous progress has been made during the last decade in developing and applying such methods. Innovative technologies for addressing complex biological interactions include induced pluripotent stem cell- and organoid-based approaches, organotypic coculture systems, and microfluidic 'multiorgan' chips. Combining in vitro methods with bioinformatics and in silico modeling generates new powerful tools for toxicity assessment, and the rapid progress in the field is expected to continue.