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Research in the field of autism spectrum disorders (ASD) focuses mainly on school-aged children and male participants. This has left substantial gaps in our understanding of the life course of autistic individuals, particularly autistic females, once they reach adulthood. The objective of this concise narrative review is to discuss the current literature on autistic women with a focus on transitioning to adulthood, specifically in the areas of quality of life, post-secondary education and employment. Given that the evidence so far suggests widely inconsistent findings, we conclude that future research is needed to more carefully elucidate the unique needs of women on the spectrum during the process of transitioning to adulthood, and to identify evidence-based practices that could better support this population.

Widespread electric vehicle (EV) adoption is critical for meeting economy-wide decarbonization goals and, as a result, states are considering enabling policies and rate designs to accelerate EV deployment. EVs can provide possible financial upside to electric utilities and ratepayers in several ways. For example, from the utility perspective, EVs could drive increased electricity sales and new earnings opportunities through increased capital investments. From the ratepayer perspective, increased electric loads from EVs could reduce average all-in retail rates. The degree to which there are net benefits or costs to shareholders and/or ratepayers depends on how EVs are integrated and managed through enabling grid investments and charging strategies. Using Berkeley Lab’s Financial Impacts of Distributed Energy Resources (FINDER) model that mimics the electric utility investment planning and ratemaking processes, we estimate the utility earnings and customer rate impacts of EVs using a bookend approach of “managed” (i.e., best case) and “mismanaged” (i.e., worst case) charging strategies for a generic summer-peaking, investor-owned, and vertically integrated utility. The analysis also examines the sensitivity of results to different assumptions of EV deployment characteristics, EV impacts on retail electricity sales, incremental distribution system costs, EV charging location, and utility EV enablement costs (i.e., utility costs to invest in EV charging, controls, and communication to deliver and administer EV programs). The results are intended to inform EV policies and deployment strategies that maximize utility system benefits and minimize ratepayer costs.

PURPOSE: Injectable biologics have not only been described and developed to treat dermal wounds, cardiovascular disease, and cancer, but have also been reported to treat chronic pain conditions. Despite emerging evidence supporting regenerative medicine therapy for pain, many aspects remain controversial. METHODS: The American Society of Pain and Neuroscience (ASPN) identified the educational need for an evidence-based guideline on regenerative medicine therapy for chronic pain. The executive board nominated experts spanning multiple specialties including anesthesiology, physical medicine and rehabilitation, and sports medicine based on expertise, publications, research, and clinical practice. A steering committee selected preliminary questions, which were reviewed and refined. Evidence was appraised using the United States Preventive Services Task Force (USPSTF) criteria for evidence level and degree of recommendation. Using a modified Delphi approach, consensus points were distributed to all collaborators and each collaborator voted on each point. If collaborators provided a decision of disagree or abstain, they were invited to provide a rationale in a non-blinded fashion to the committee chair, who incorporated the respective comments and distributed revised versions to the committee until consensus was achieved. RESULTS: Sixteen questions were selected for guideline development. Questions that were addressed included type of injectable biologics and mechanism, evidence in treating chronic pain indications (eg, tendinopathy, muscular pathology, osteoarthritis, intervertebral disc disease, neuropathic pain), role in surgical augmentation, dosing, comparative efficacy between injectable biologics, peri-procedural practices to optimize therapeutic response and quality of injectate, federal regulations, and complications with mitigating strategies. CONCLUSION: In well-selected individuals with certain chronic pain indications, use of injectable biologics may provide superior analgesia, functionality, and/or quality of life compared to conventional medical management or placebo. Future high-quality randomized clinical trials are warranted with implementation of minimum reporting standards, standardization of preparation protocols, investigation of dose-response associations, and comparative analysis between different injectable biologics.

OBJECTIVE: To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. DATA SOURCES: Publicly available FDA data on drugs and devices approved in 2022. REVIEW METHODS: A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgerys (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. CONCLUSION: A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. IMPLICATIONS FOR PRACTICE: Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.

Abstract Background and aims Colorectal cancer (CRC) is a significant global health concern, with studies estimating a rise in new cases to 2.5 million by 2035. Type 2 diabetes (T2D) is also a growing issue, with an estimated 642 million adults affected by 2040. However, the relationship between T2D, its medications, and CRC remains unclear. Materials and methods This case-control study includes 810 controls without CRC and 684 cases with CRC admitted to Rasoul-Akram and Firouzgar Hospitals from September 2019 to 2023. Adjusted and unadjusted odds ratios (OR) were calculated to investigate the effect of T2D and sulfonylurea consumption on the chance of CRC development, using univariate and multivariate logistic regression analyses. The relationship between T2D and the clinicopathological features of the tumor was investigated. Results The results show that the effect of T2D on CRC is significant based on unadjusted OR (OR = 1.39, CI = 1.07, 1.81) and insignificant in adjusted OR (OR = 0.67, CI = 0.37, 1.20). The effect of sulfonylurea consumption on CRC was significant in both unadjusted (OR = 2.39, CI = 1.40, 4.09) and adjusted ORs (OR = 2.35, CI = 1.12, 4.91). All analyses related to the relationship between T2D and tumor clinicopathological characteristics were insignificant. Conclusion This study found an insignificant association between type 2 diabetes and the chance of CRC development in an adjusted state. Sulfonylurea consumption was also associated with a higher chance of CRC development among patients with T2D. These findings have implications for clinical practice and public health strategies in CRC prevention for patients with T2D.

Abstract Introduction Ovarian granulosa cell tumor (OGCT) is a rare female pathology with few available demographic data. Besides, there are no comprehensive clinical characteristics regarding the OGCT in Iran. Thus, this study aimed to assess the clinical features and survival rate of OGCT patients in Iran to expand the scope of knowledge in this field. Materials and methods In this 10-year retrospective study (2013–2023), the cases were gathered from the oncologic clinic of women (Imam Khomeini Hospital, Tehran, Iran). The patients with definite OGCT diagnosis were selected based on the inclusion and exclusion criteria including medical history, interfering backgrounds, demographic data, histopathological assessment, clinical and para-clinical features, survival rates, and all previous medical reports for definite diagnosis of OGCT along with approved pathology samples. Results The median age and BMI values of Iranian patients were 45 (19 ~ 83) years and 28.04 (19.4 ~ 48.0), respectively. The most common symptom was abdominal pain (56%) and 69.2% of cases were menopause. In 81.3% of cases, ovarian tumors were detected and metastasis was rare. Most patients (40.6%) underwent total abdominal hysterectomy and OGCT relapsing cases were seen in 13.2% of patients. The median of overall survival (OS) value using the Kaplan-Meier estimate was 52 months (95%CI:37.47–66.53), and the median of disease-free survival (DFS) was 45 months (95%CI: 28.88–61.12). There was a significant (p

Background: Heart valve replacement (HVR) surgery represents a significant life event that can potentially impact the well-being (WB) of patients; however, there is a shortage of research on the understanding of WB in HVR patients. This study aims to elucidate the WB experiences of patients who have undergone HVR surgery.Methods: A qualitative directed content analysis approach was employed, focusing on patients who had undergone HVR surgery at hospitals affiliated with Mashhad University of Medical Sciences in Iran from March 2021 to June 2022. Data collection involved conducting 23 face-to-face, semi-structured, in-depth interviews with HVR patients until data saturation was reached. Data analysis was performed using the Elo and Kyngäs approach in MAXQDA software version 10.Results: The analysis revealed 11 generic categories based on the Biopsychosocial-Spiritual (BPSS) model, encompassing the WB experiences of HVR patients. These categories included physical improvements, facilitated treatment compliance, personal and environmental mastery, optimism in life, resilience, healing therapeutic communication of medical staff, a positive supportive atmosphere, job and financial assurance, faith in a higher power, optimism regarding a purposeful future, and gratitude mixed with generosity.Conclusion: The findings of the current study revealed that the experience of WB in HVR patients was influenced by various conditions. By recognizing these conditions, healthcare providers can develop targeted interventions to improve the WB experience in these patients. Also, the findings provide a foundation for future research on WB in medical contexts.

Abstract In this study, for the first time, the optimization of applied pressure for achieving the one of the best tribological properties of diamond-like carbon (DLC) coating on graphite surface using plasma-enhanced chemical vapor deposition (PECVD) method was investigated. Raman spectroscopy and microscopy methods were used to characterize the applied coating. Additionally, the mechanical properties of the coating were investigated through nanoindentation testing. The wear resistance of coating has been tested as functional test. The results indicated that with increasing gas pressure, the sp3 hybridization percentage decreases, while the ID/IG ratio increases. The average roughness values for the uncoated sample and the coated samples at working pressures of 25, 30, and 35 mTorr were obtained as 1.6, 5.1, 3, and 2.4 nm, respectively. The results of hardness and wear tests showed that these properties were optimized by reducing the applied gas pressure. The highest hardness was 11.59 GPa, and the best sample in terms of the mechanical properties of the coating was the sample applied at a gas pressure of 25 mTorr. Results show that the optimal sample in tribological performance is the one applied at a working pressure of 25 mTorr. Because this sample demonstrates the lowest coefficient of friction, and wear depth.

Abstract Energy system optimization models offer insights into energy and emissions futures through least-cost optimization. However, real-world energy systems often deviate from deterministic scenarios, necessitating rigorous uncertainty exploration in macro-energy system modeling. This study uses modeling techniques to generate diverse near cost-optimal net-zero CO2 pathways for the United States’ energy system. Our findings reveal consistent trends across these pathways, including rapid expansion of solar and wind power generation, substantial petroleum use reductions, near elimination of coal combustion, and increased end-use electrification. We also observe varying deployment levels for natural gas, hydrogen, direct air capture of CO2, and synthetic fuels. Notably, carbon-captured coal and synthetic fuels exhibit high adoption rates but only in select decarbonization pathways. By analyzing technology adoption correlations, we uncover interconnected technologies. These results demonstrate that diverse pathways for decarbonization exist at comparable system-level costs and provide insights into technology portfolios that enable near cost-optimal net-zero CO2 futures.

Background: The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients. Methods: This observational case–control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level. Results: Delta impedance values showed higher amounts in a PEEP range of 11–17 cm H2O and in patients with TB-ARDS (P > 0.05). In addition, both hyperdistention and collapse rates were nonsignificantly higher in TB-ARDS patients (P > 0.05), and the compromised levels of hyperdistention and collapse rates were at 15–17 cm H2O, indicating the most favorable PEEP level. Conclusions: The observed patterns of hyperdistention and collapse rates across various PEEP levels provide valuable insights into the susceptibility of TB-ARDS patients to barotrauma. Notably, the identified optimal PEEP range between 15 and 17 cm H2O may guide ventilator management strategies in mitigating both hyperdistention and collapse; nonetheless, due to the high variability of lung compliances within groups, we strongly recommend individualized consideration for tailored respiratory support and evaluation.

Ryan S D’Souza,1 Yeng F Her,1 Nasir Hussain,2 Jay Karri,3 Michael E Schatman,4 Aaron K Calodney,5 Christopher Lam,6 Thomas Buchheit,7 Brennan J Boettcher,8 George C Chang Chien,9 Scott G Pritzlaff,10 Christopher Centeno,11 Shane A Shapiro,12 Johana Klasova,1 Jay S Grider,13 Ryan Hubbard,14 Eliana Ege,15 Shelby Johnson,8 Max H Epstein,16 Eva Kubrova,8 Mohamed Ehab Ramadan,17 Alexandra Michelle Moreira,18 Swarnima Vardhan,19 Yashar Eshraghi,20 Saba Javed,21 Newaj M Abdullah,22 Paul J Christo,17 Sudhir Diwan,23 Leslie C Hassett,24 Dawood Sayed,6 Timothy R Deer25 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH, USA; 3Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA; 4Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 5Precision Spine Care, Tyler, TX, USA; 6Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 7Department of Anesthesiology, Duke University, Durham, NC, USA; 8Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; 9Department of Regenerative Medicine, GCC Institute, Torrance, CA, USA; 10Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA; 11Centeno-Schultz Clinic, Broomfield, CO, USA; 12Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA; 13Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA; 14Department of Sports Medicine, Anderson Orthopedic Clinic, Arlington, VA, USA; 15Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA; 16Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA; 17Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA; 18Department of Physical Medicine & Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, FL, USA; 19Department of Internal Medicine, Yale New Haven Health – Bridgeport Hospital, Bridgeport, CT, USA; 20Department of Anesthesiology & Critical Care Medicine, Ochsner Health System, New Orleans, LA, USA; 21Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 22Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA; 23Department of Pain Medicine, Advanced Spine on Park Avenue, New York City, NY, USA; 24Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA; 25Department of Anesthesiology and Pain Medicine, West Virginia University School of Medicine, Charleston, WV, USACorrespondence: Ryan S D’Souza, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA, Tel +1-(507)-284-9696, Fax +1-(507)-266-7732, Email dsouza.ryan@mayo.eduPurpose: Injectable biologics have not only been described and developed to treat dermal wounds, cardiovascular disease, and cancer, but have also been reported to treat chronic pain conditions. Despite emerging evidence supporting regenerative medicine therapy for pain, many aspects remain controversial.Methods: The American Society of Pain and Neuroscience (ASPN) identified the educational need for an evidence-based guideline on regenerative medicine therapy for chronic pain. The executive board nominated experts spanning multiple specialties including anesthesiology, physical medicine and rehabilitation, and sports medicine based on expertise, publications, research, and clinical practice. A steering committee selected preliminary questions, which were reviewed and refined. Evidence was appraised using the United States Preventive Services Task Force (USPSTF) criteria for evidence level and degree of recommendation. Using a modified Delphi approach, consensus points were distributed to all collaborators and each collaborator voted on each point. If collaborators provided a decision of “disagree” or “abstain”, they were invited to provide a rationale in a non-blinded fashion to the committee chair, who incorporated the respective comments and distributed revised versions to the committee until consensus was achieved.Results: Sixteen questions were selected for guideline development. Questions that were addressed included type of injectable biologics and mechanism, evidence in treating chronic pain indications (eg, tendinopathy, muscular pathology, osteoarthritis, intervertebral disc disease, neuropathic pain), role in surgical augmentation, dosing, comparative efficacy between injectable biologics, peri-procedural practices to optimize therapeutic response and quality of injectate, federal regulations, and complications with mitigating strategies.Conclusion: In well-selected individuals with certain chronic pain indications, use of injectable biologics may provide superior analgesia, functionality, and/or quality of life compared to conventional medical management or placebo. Future high-quality randomized clinical trials are warranted with implementation of minimum reporting standards, standardization of preparation protocols, investigation of dose–response associations, and comparative analysis between different injectable biologics.Keywords: regenerative medicine, injectable biologics, platelet-rich plasma, mesenchymal stem cell, bone marrow aspirate concentrate, pain medicine

Background: Coronary artery disease (CAD) is increasing at an alarming rate worldwide, and psychological risk factors are also involved in the morbidity and spread of the disease. The present study aimed to determine the effectiveness of emotionally focused couple therapy (EFCT) on affective temperaments in patients with CAD. Methods: This semi-experimental study was conducted with two groups using a pre-test, post-test, and follow-up design involving 34 couples, where one partner had CAD, in Mashhad, Iran, in 2022. The couples were selected via two-stage cluster sampling and allocated into two groups: The intervention group (16 couples) and the control group (18 couples) through permuted block randomization. An EFCT based on the healing hearts together (HHT) educational program was performed in the intervention group during eight weekly 2-hour sessions. The control group received only routine care. Data were collected using a demographic questionnaire and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A) before, after, and two months following the intervention. Data were analyzed using the chi-square test, independent t-test, and repeated measures ANOVA by SPSS software, version 26. Results: The EFCT significantly decreased the mean score of irritable, anxious, and depressed temperaments but significantly increased the mean score of hyperthymic temperament in the post-test and follow–up. However, the changes observed at the follow-up stage were less pronounced than those at the post-test stage (P0.05). Conclusion: Using EFCT in couples can improve affective temperaments in patients with CAD. EFCT in couples, where one partner has CAD, can be effective in health maintenance and promotion, as well as in enhancing the quality of life (QoL) for patients with CAD.

Abstract Background To evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients. Methods This prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage. Results Two hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04–4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16–2.68) (P

Abstract Background In recent years, Iran has witnessed a remarkable increase in the incidence of cancer. This has led to an emerging challenge in the field of oncofertility, which seeks to address the impact of cancer treatments on fertility and endeavors to preserve reproduction. The study assessed healthcare providers’ awareness, attitudes, and practices regarding fertility preservation (FP) in Iran. Methods A cross-sectional study was conducted to assess healthcare providers’ knowledge, attitudes, and practices regarding oncofertility. An online self-made oncofertility survey of twenty-four items was administered to randomly selected participants from a list of healthcare providers registered with the Medical Council. The data were collected anonymously via Google Forms. Descriptive statistics, including number (n), prevalence (%), mean, and standard deviation, were calculated using SPSS 26.0. Additionally, chi-square tests were used to examine associations between categorical variables. Participants were categorized into oncology, obstetrics and gynecology (OB/GYN), and other specialties. Results A total of 423 responses were received and analyzed. Approximately 60% of the participants were obstetrics and gynecology subspecialists, while the remaining participants represented various disciplines such as surgery (9.7%), radiotherapy (6.4%), nuclear medicine (5.2%), and pediatrics (1.4%). More than 30% of the participants had not received any specific education about oncofertility, and more than 20% stated that FP strategies are not part of their routine treatment plan for young cancer patients. Oncologists had more education than those in the Obstetrics & Gynecology group. Half the participants were unaware of insurance coverage, and FP options were infrequently recommended. Conclusions These findings highlight the urgent need to enhance healthcare workers’ knowledge and attitudes toward FP in Iran and enable them to provide comprehensive support and guidance to cancer patients.

Abstract Background Intravenous administration of magnesium sulfate (MgSO4) to expectant individuals before childbirth, has been evaluated to reduce the likelihood of mortality and occurrence cerebral palsy in their offspring. Therefore, this systematic review and meta-analysis conducted to determine if were the prophylactic use of magnesium sulfate in women at risk for preterm delivery leads to decrease in the incidence of death or cerebral palsy. Methods A comprehensive search of electronic databases was done to identify relevant studies. Selection of eligible studies was based on predetermined inclusion criteria. Data extraction was performed, and the methodological quality of the selected studies was assessed using appropriate evaluative tools. A meta-analysis was carried out to estimate the overall effect of intravenous administration of magnesium sulfate on the incidence of death or cerebral palsy. Results A total of 7 studies met the inclusion criteria and were included in the final analysis. No significant publication bias was observed. The risk of fetal neurological impairment was significantly lower in the MgSO4 group compared to the control group relative risk (RR = 0.70, 95% CI: 0.56 to 0.87; I20%). However, neonatal mortality was not significantly associated with MgSO4 injection. (RR = 1.03, 95% CI: 0.88 to 1.21; I2 = 42%). Subgroup analysis was done based on the bolus dosage of MgSO4 and the duration of the trial follow-up. revealing a non-significant differences between-group. Conclusion This study demonstrated that MgSO4 administration can improve fetal neurological impairment and cerebral palsy but is not linked to reducing mortality. Further studies are necessary to strengthen the evidence and clarify the underlying mechanisms.

Background: The COVID-19 pandemic has affected millions globally, and still continues to do so. Regarding the cardiovascular influences of COVID-19, this study aimed to investigate the relationship between cardiac indices, particularly cardiac output (CO), and severity of disease. Methods: This retrospective cohort study was conducted on intubated COVID-19 patients admitted to the intensive care unit (ICU). The study involved analyzing data from mechanically ventilated patients, excluding those with preexisting cardiovascular or pulmonary comorbidities. Hemodynamic parameters were evaluated by ultrasonic cardiac output monitoring (USCOM), and the severity of disease was evaluated by acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scoring systems. Results: The study included 41 patients, predominantly male with an average age of 63.1 years. Hemodynamic parameters and scores were reported for 6 days. This showed significant changes in CO, SOFA, and APACHE II over time (with P = 0.02, 0.04, 0.03, respectively). A negative correlation was found between CO and both SOFA and APACHE II scores (P < 0.05), indicating that as CO increased, the severity scores decreased. Conclusion: This study emphasizes the importance of continuous hemodynamic monitoring in ICU settings for COVID-19 patients. The correlation between CO and severity scores suggests that USCOM, along with APACHE II and SOFA, can be crucial in assessing the dynamic clinical state of patients, contributing to better management and potentially improving outcomes.

Extended Abstract Background: Maize is an important crop that is cultivated in many parts of the world. The evaluation of genotypes in breeding programs often faces two important challenges, the genotype × environment interaction effect for the target trait and unfavorable relationships between the target traits. Even though many methods have been offered for stability analysis, especially graphical tools and their relatively good efficiency in interpreting the results, it seems that the best linear unbiased predictions (BLUP) method estimates the means with high accuracy, especially in mixed models, in multi-environmental trails (MET). Therefore, the stability index of weighted average absolute scores (WAASB), which is estimated from the integration of the two stability methods of additive main effect and multiplicative interaction (AMMI) and best linear unbiased predictions, can be used in METs to estimate more accurately the stability of genotypes. Maize breeding programs prioritize high grain yields and earliness as important traits. The multi-trait stability index (MTSI) is a valuable tool for the simultaneous selection of multiple traits. It is estimated based on the average performance and simultaneous stability of genotypes in different traits and environments. Therefore, the current research aimed to identify stable and high grain yield maize hybrids along with the optimal level of grain moisture percentage at harvest time and days to physiological maturity using the integration of AMMI and BLUP methods with WAASB, WAASBY, and MTSI indices. Methods: This study involved the evaluation of seven promising maize hybrids along with four commercial check varieties, including SC647, TWC647, SC704, and SC715, in maize METs based on a randomized complete block design with four replications across 10 regions (Karaj, Moghan, Shiraz, Kermanshah, Kerman, Mashhad, Dezful, Miyandoab, Jiroft, and Mazandaran) during two cropping seasons of 2019-2020. The recorded traits were grain yield adjusted at 14% moisture content, grain moisture percentage at harvest time, and days to physiological maturity. The WAASB was used to estimate genotypic stability for each genotype. It was computed from the singular value decomposition (SVD) of the matrix of best linear unbiased predictions of genotype vs. environment interaction effects generated by a linear mixed-effect model. The WAASBY index for simultaneous selection based on grain yield (Y) and stability (WAASB) was estimated by assigning different weights to grain yield and stability. The simultaneous selection for grain yield and stability based on several traits was conducted using the scores obtained from an exploratory factor analysis (MTSI). Results: Based on the grain yield across 10 environments over two years, promising hybrid NO. 3 had the highest grain yield with 12.80 tons per hectare. According to the likelihood ratio test (LRT), the genotype-by-environment interaction was significant for the traits of grain yield, grain moisture percent at harvest time, and the days to physiological maturity. Therefore, BLUP analysis can be performed on these data due to the significant genotype by environment interaction. The BLUPs performed for hybrids were followed by stability analysis using the AMMI method on these BLUPs. The results indicated that the first and second components justified 27.7% and 24.6% of the hybrid by environment interaction variances, respectively. The highest predicted grain yield by the BLUP method belonged to hybrids No. 3, 2, 4, and 1, with higher than average predicted grain yields. Based on the biplot for the first principal component of the environments against the nominal grain yield, hybrids 2, 6, 3, and 1, having the lowest scores of the first principal component (coefficient b or line slope), had a negligible contribution to the hybrid by environment interaction and were distinguished stable. To enable simultaneous selection based on both grain yield and stability, the WAASBY index was estimated by integrating grain yield (Y) and the WAASB stability index. Considering the 50% contribution of each of the two grain yield and yield stability components, five hybrids (1, 2, 3, 6, and 4) showed above-average WAASBY. Among these, hybrids 1, 2, and 3 had significantly higher WAASBY than the other hybrids. All four control cultivars SC647, TWC647, SC704, and SC715 had lower-than-average WAASBY. Based on the MTSI, hybrid 3 was selected as the best hybrid. In addition, the estimated variance components by restricted maximum likelihood (REML) for grain yield indicated that 75.72% and 7.57% of the phenotypic variance were explained by the environment and GEI variances, respectively, whereas the contribution of residual variance to the phenotypic variance was 16.77%. Conclusion: Based on the results, hybrid 3 (K47/2-2-1-4-2-1-1-1× MO17) was identified as a high-yielding hybrid, which can be introduced to farmers as a new superior maize hybrid. It seems that the use of the ratio of the WAASB stability index to grain yield (WAASB/Y) and the selection of superior genotypes based on the MTSI could identify hybrids with high grain yields, stability, and desirable levels of important agronomic traits.

Prosthetic socket manufacturing is experiencing a revolutionary shift towards using digital methods, such as 3D scanning and 3D printing. However, using digital methods requires the clinician to transfer their skills from making sockets by hand to making sockets with a computer. This shift in practice may change the socket geometry and fit; however, to what extent is unknown. Thus, the aim of this study was to explore the feasibility of analyzing geometric and clinical differences between digitally- and manually-designed sockets. Nine adult inpatients with below-knee amputation were recruited. Two sockets were 3D printed for each participant from 3D socket models that were developed from: (1) 3D scanning a manually-modified hand-casted positive mold of the residuum; and (2) a digitally-modified 3D scan of the residuum. Manual and digital procedures were compared for three measures: final socket geometry, the Socket Comfort Score, and a patient experience survey. Feasibility data were collected to measure protocol implementation fidelity to inform a future larger study. These data revealed that 89% of participants followed the intended protocol, no participants dropped out, and only one adverse event was report. As no significant geometric differences were found and participants experienced similar comfort scores between manually- and digitally-designed sockets, study feasibility was determined to be successful. Thus, a randomized control trial study will be conducted to draw statistically relevant conclusions from these outcome measures that may provide meaningful information for improving digital design procedures.