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Anna Volerman,1 Kristin Kan,2,3 Delesha Carpenter,4 Valerie G Press1 1University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA; 2Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; 3Northwestern University Feinberg School of Medicine, Advanced General Pediatrics Division, Department of Pediatrics, Chicago, IL, USA; 4University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USACorrespondence: Valerie G PressUniversity of Chicago, 5841 S Maryland, MC 2007, Chicago, IL, 60637, USATel +1 773-702-5170Fax +1 773-834-2288Email vpress@bsd.uchicago.eduAbstract: Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. Given the significant consequences of improper inhaler use in children, the goal of this review is to comprehensively describe existing and potential solutions to improve inhaler technique. Because children move through various settings, including clinical practices, schools, pharmacies, and homes, in their daily routine, there is great opportunity to teach and reinforce proper inhaler technique across settings. Within each setting, in-person and technology-based interventions have shown promise to improve technique. These solutions need to be more broadly adopted to deliver tailored education with support for provider training, team-based care, communication structures, and reimbursement. Such solutions hold the potential to improve inhaler use among children, with potential for decreasing morbidity and costs.Keywords: asthma, devices, inhalers, pediatric

We present two cases of hepatic abscesses that mimicked metastases in patients having undergone Whipple surgery. Both patients had similar imaging features on computed tomographic (CT) scan and ultrasound, and at the time of referral for biopsy neither patient was clinically suspected to have liver abscess. Both patients underwent biopsy of liver lesions and developed postprocedural infectious complications.

Metal oxide semiconductors are promising for solar photochemistry if the issues of excessive charge carrier recombination and material degradation can be resolved, which are both influenced by surface quality and interface chemistry. Coating the semiconductor with an overlayer to passivate surface states is a common remedial strategy but is less desirable than application of a functional coating that can improve carrier extraction and reduce recombination while mitigating corrosion. In this work, a data-driven materials science approach utilizing high-throughput methodologies, including inkjet printing and scanning droplet electrochemical cell measurements, is used to create and evaluate multi-element coating libraries to discover new classes of candidate passivation and electron-selective contact materials for p-type CuBi2O4. The optimized overlayer (Cu1.5TiOz) improves the onset potential by 110 mV, the photocurrent by 2.8×, and the absorbed photon-to-current efficiency by 15.5% compared to non-coated photoelectrodes. It is shown that these enhancements are related to reduced surface recombination through passivation of surface defect states as well as improved carrier extraction efficiency through Fermi level engineering. This work presents a generalizable, high-throughput method to design and optimize passivation materials for a variety of semiconductors, providing a powerful platform for development of high-performance photoelectrodes for incorporation into solar-fuel generation systems.

Abstract Background In Japan dialyzers are classified as type I, II, III, IV, or V on the basis of the β 2-microglobulin clearance. In 2023, Type V dialyzers were defined as super high-flux membrane dialyzers. Herein, we investigate the association between dialyzer type and mortality. Methods A cohort study was conducted using the Japanese Society for Dialysis Therapy Renal Data Registry database from 31 December 2017, to 31 December 2019. We enrolled 181,879 patients on hemodialysis who were divided into type I–V groups per the Japanese classification. We assessed the associations of each group with 2-year all-cause mortality using Cox proportional hazard models. Furthermore, propensity score matching analysis was performed. Results By the end of 2019, 34,196 patients (18.8%) had died. The hazard ratio (95% confidence interval) was significantly higher in the type I (1.25 [1.12–1.39]), type II (1.21 [1.13–1.31]), and type III (1.07 [1.02–1.13]) groups and significantly lower in the type V group (0.86 [0.80–0.92] P

Abstract Background We examined whether the pharmacodynamic drug–drug interaction between esaxerenone and trimethoprim enhances the hyperkalemic effect. Methods A retrospective observational study was conducted to identify patients >18 years undertaking esaxerenone alone or esaxerenone plus trimethoprim at Mie University Hospital from May 2019 to December 2022. We performed propensity score-matching (1:1) to compare between-group differences in the maximum change in serum potassium levels (ΔK) using the Mann–Whitney U test. For esaxerenone plus trimethoprim, Spearman's correlation coefficients were used to examine correlations between ΔK and variables, including changes in blood urea nitrogen (ΔBUN), serum creatinine levels (ΔCr), and weekly trimethoprim cumulative dose. Results Out of propensity score-matched groups (n=8 each), serum potassium levels significantly increased after administration of esaxerenone alone (4.4 [4.2 to 4.7] meq/L to 5.2 [4.7 to 5.4] meq/L, p=0.008) and esaxerenone plus trimethoprim (4.2 [4.0 to 5.1] meq/L to 5.4 [4.7 to 5.5] meq/L, p=0.023). ΔK did not significantly differ between the groups (esaxerenone alone; 0.6 [0.3 to 0.9] meq/L vs. esaxerenone plus trimethoprim; 1.0 [0.4 to 1.3] meq/L, p=0.342). ΔK positively correlated with ΔBUN (r=0.988, p

This paper analyzes the effects of parenting practices on children's education. Our empirical analyses are based on household data from Taiwan. More specifically, we investigate the influence of parents' child-rearing practices (i.e., encouragement and punishment) on their children's education attainments and aspirations. We also explore the association between parents' socioeconomic background and their child-rearing practices. The empirical results help explain the relationship between family background and education attainments.

Backgrounds: Beauty standards vary across cultures and regions. To date, no research has identified ideal nasal profiles for Thai individuals. This study aims to determine the preferred nasal aesthetics among the Thai population. Methods: This cross-sectional study employed an online self-assessment questionnaire to investigate the ideal nasal profiles among Thai adults aged 18–60. Data were collected from participants across all regions of Thailand and included demographic information, rhinoplasty intentions, and perceptions of ideal nasal features. Results: Of the 1452 respondents, 35.74% (519 individuals) have either undergone or plan to undergo rhinoplasty, while the remaining 64.26% (933 individuals) expressed either no interest or uncertainty about the procedure. The ideal nasolabial angle was found to be between 97 and 108 degrees for males and 88 to 98 degrees for females, respectively. Male participants in the rhinoplasty and control groups exhibited statistically significant differences in nasolabial angle ( p = 0.017), nasofrontal angle ( p

Rebecca Hui Shan Ong,1 Milawaty Nurjono,1 Hong Choon Oh,1– 3 Christopher Tsung Chien Lien,4 Junisha Jumala,5 Raymond Choon Chye Teo,6 Peiying Gan,7 Karen Lai Ming Kan,8 Lina Farhana Rosle,8 Moi Kim Wee,8 Shou Lin Low4 1Health Services Research, Changi General Hospital, Singapore; 2Centre for Population Health Research and Implementation, Singapore Health Services, Singapore; 3Health Services & Systems Research, Duke-NUS Medical School, Singapore; 4Geriatric Medicine, Changi General Hospital, Singapore; 5Rehabilitative Services, Changi General Hospital, Singapore; 6Singapore Sport & Exercise Medicine Centre, Changi General Hospital, Singapore; 7Community Nursing, Changi General Hospital, Singapore; 8Community and Mental Health, Changi General Hospital, SingaporeCorrespondence: Rebecca Hui Shan Ong, Health Services Research, Changi General Hospital, 2 Simei Street 3, 529889, Singapore, Tel +65 6788 8833, Fax +65 67826049, Email Rebecca.ong.h.s@singhealth.com.sgPurpose: Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of “Steady Feet” (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore.Material and Methods: This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors.Results: Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation.Conclusion: Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers’ capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.Keywords: falls prevention, community-dwelling, older adults, exercise, qualitative, precede-proceed

Abstract Dialyzers are classified into five types based on their β2-microglobulin clearance rate and albumin sieving coefficient: Ia, Ib, IIa, and IIb. In addition, a new classification system introduced a type S dialyzer. However, limited information is available regarding the impact of dialyzer type on patient outcomes. A cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry database. Total 181,804 patients on hemodialysis (HD) were included in the study, categorized into four groups (type Ia, IIa, IIb, and S). The associations between each group and two-year all-cause mortality were assessed using Cox proportional hazard models. Furthermore, propensity score-matching analysis was performed. By the end of 2019, 34,185 patients on dialysis had died. After adjusting for all confounders, the risk for all-cause mortality was significantly lower in the type IIa, and S groups than in the type Ia group. These significant findings were consistent after propensity score matching. In conclusion, our findings suggest that super high-flux dialyzers, with a β2-microglobulin clearance of ≥ 70 mL/min, may be beneficial for patients on HD, regardless of their albumin sieving coefficient. In addition, type S dialyzers may be beneficial for elderly and malnourished patients on dialysis. Trial registration number: UMIN000018641

Abstract Background Approximately 16.4% of patients on hemodialysis (HD) in Japan are treated with intermittent infusion hemodiafiltration (I-HDF). However, large-scale data on clinical outcomes with this modality are lacking. This study aimed to compare the outcomes of I-HDF with those of conventional HD. Methods A cohort study was conducted using the Japanese Society for Dialysis Therapy Renal Data Registry database from December 31, 2017 to December 31, 2019. The subjects were 210,574 patients on maintenance HD. The exposure of interest was I-HDF treatment versus conventional HD. The I-HDF group was divided into two subgroups based on substitution: low-volume (

Abstract Background The 2020 Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) annual survey was sent to 4493 dialysis facilities in Japan. Methods Questionnaires were sent to all facilities that provide patients with dialysis therapy in Japan. Data were collected and compiled to form cross-sectional results of renal replacement therapy from various aspects. Results In total, 4437 facilities (98.8%) responded to the facility questionnaire and 4271 (95.1%) responded to the patient questionnaire. The number of chronic dialysis patients in Japan continues to increase every year, reaching 347,671 at the end of 2020 and giving a prevalence rate of 2754 patients per million population. The mean age was 69.40 years. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (39.5%), followed by chronic glomerulonephritis (25.3%) and nephrosclerosis (12.1%). There were 40,744 incident dialysis patients during 2020, representing a decrease of 141 from 2019. The average age of patients on dialysis was 70.88 years, with diabetic nephropathy being the most common underlying disease (40.7%) second most common was nephrosclerosis (17.5%), which was unchanged from the previous year and surpassed chronic glomerulonephritis (15.0%). There were 34,414 patient deaths in 2020; the crude mortality rate was 9.9%. The main causes of death were heart failure (22.4%), infection (21.5%), and malignancy (9.0%), which were almost the same as the percentages for the previous year. Since 2012, the number of patients treated by hemodiafiltration has increased rapidly; in 2020, the number of patients on this modality was 163,825, accounting for 47.1% of all patients on maintenance dialysis. The number of patients on peritoneal dialysis has been on the rise since 2017, reaching 10,338 in 2020; 20.8% of whom received combined therapy with hemodialysis or hemodiafiltration, showing no change from the previous year. A total of 751 patients were on home hemodialysis at the end of 2020, representing a decrease of 9 from the end of 2018. In 2020, coronavirus disease 2019 (COVID-19) infection and malignancy were added as new items in the survey. Continuing on from the 2019 survey, history of kidney donation for a living-donor transplant was investigated. Conclusions Present issues and challenges in renal replacement therapy were identified in the responses to the new questionnaire items included in this survey. A more detailed evaluation with adjustment for patient background factors should clarify the characteristics of the underlying diseases and conditions in dialysis patients. Trial registration The JRDR was approved by the Japanese Society for Dialysis Therapy ethics committee. It was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry on 10 September 2020 and in the UMIN clinical trials registration system (UMIN000018641).

In current engineering, the transition process of pump turbines from pump to turbine mode mainly includes the shutdown process of pump operating and the startup process of turbine operating, and the switching of working conditions mostly depends on the opening and closing of the ball valve. While, this article focuses on the transitional process of pump turbine from pump to turbine condition without relying on ball valve, which will significantly reduce the response time of the unit and enable quick switching of operating conditions in emergency situations. In this study, the torque balance equation is employed to analyze the transition process of the entire flow system from pump to turbine operation. Additionally, the entropy production theory is utilized to investigate the correlation between pressure, flow state, and energy loss in the pump-turbine, shedding light on the changes in external characteristics through the evolution of internal characteristics. Furthermore, the transition process from pump mode to turbine mode is segmented into five stages based on the variations in the guide vanes (GV). The findings reveal that the rotation of GV triggers sharp fluctuations in static pressure, torque, and axial force. During stage four, the initiation of all three GV positions results in an increase in flow rate and torque, accompanied by a decrease in axial force. In stage two, the closure of GV leads to a decrease in pressure within the spiral casing (SC) and stay vanes (SV) domains, coupled with an increase in pressure in the bladeless zone, runner, and draft tube domains. Simultaneously, the pressure difference between both sides of the runner decreases significantly, directly causing a drop in torque and axial force. In stage three, GV closure interrupts the flow in the pump-turbine, resulting in significant backflow in the SC, SV, and runner domains, alongside high-speed circulation in the bladeless area. Moreover, the location of the high entropy production rate (EPR) value within the unit aligns with the reflux zone, indicating considerable energy loss attributable to reflux. The above research results will provide reference for the rapid switching of operating conditions of pump turbines in emergency situations.

Abstract Background Recent studies have focused on immune checkpoint inhibitors. Renal complications associated with the use of immune checkpoint inhibitors are uncommon compared with other immune-related adverse events. Acute interstitial nephritis accounts for most of these renal complications, with nephrotic syndrome quite rare. We herein report a case of nephrotic syndrome associated with immune checkpoint inhibitors that was more severe than that in previous cases. By comparing this case with previous reports, the possible reasons for the particular severity of this case are discussed. Case presentation A 75-year-old man developed nephrotic syndrome with acute kidney injury after the first combination therapy of nivolumab and ipilimumab for malignant pleural mesothelioma. The results of a kidney biopsy indicated minimal change disease with mild atherosclerosis, acute interstitial nephritis, and fusion of nearly all podocyte foot processes. Nivolumab and ipilimumab therapy were stopped, and treatment with corticosteroids was initiated. We investigated previously reported cases of nephrotic syndrome using immune checkpoint inhibitors. Seventeen cases of immune checkpoint inhibitor-related nephrotic syndrome, including ours, have been reported. Two of the 17 patients with immune checkpoint inhibitor-related nephrotic syndrome required hemodialysis treatment for acute kidney injury. Unlike many previously reported cases, the present patient was administered two different immune checkpoint inhibitors, which may be one of the reasons for the development of severe nephrotic syndrome. Conclusions In addition to previously reported risk factors, immune checkpoint inhibitor combination therapy can exacerbate nephrotic syndrome compared to immune checkpoint inhibitor monotherapy.