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ImportanceBefore surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.ObjectiveTo evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.Design, setting, and participantsRandomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.InterventionPatients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.ResultsOf the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.Conclusions and relevanceAmong patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.Trial registrationClinicalTrials.gov Identifier: NCT03374449.

This study delves into the implications of incorporating AI tools, specifically ChatGPT, in higher education contexts. With a primary focus on understanding the acceptance and utilization of ChatGPT among university students, the research utilizes the Unified Theory of Acceptance and Use of Technology (UTAUT) as the guiding framework. The investigation probes into four crucial constructs of UTAUT--performance expectancy, effort expectancy, social influence and facilitating conditions--to understand their impact on the intent and actual use behaviour of students. The study relies on data collected from six universities in two countries and assessed through descriptive statistics and structural equation modelling techniques, and also takes into account participants' gender and study level. The key findings show that performance expectancy, effort expectancy, and social influence significantly influence behavioural intention. Furthermore, behavioural intention, when considered alongside facilitating conditions, influences actual use behaviour. This research also explores the moderating impact of gender and study level on the relationships among these variables. The results not only augment our comprehension of technology acceptance in the context of AI tools but also provide valuable input for formulating strategies that promote effective incorporation of ChatGPT in higher education. The study underscores the need for effective awareness initiatives, bespoke training programmes, and intuitive tool designs to bolster students' perceptions and foster the wider adoption of AI tools in education.

The paper presents a fatigue test of AA2519 T62 aluminium alloy in high-cycles region for smooth and notched specimens with stress concentration factors 1.75 and 2.28 for radii r1 = 2 mm and r2 = 1 mm, respectively. A number of cycles with no notch effect was determined for each notched specimens. The estimated values were compared with the distribution estimated on the literature data. Based on this knowledge, an analytical-experimental method was proposed to determine S-N curves for notched elements for aluminium alloys. The verification of the method gives satisfactory results. Additionally, the FITNET method and the Lee & Taylor method were used for comparison. The proposed method got the best results. The FITNET method and Lee & Taylor method obtained overestimated fatigue life and it can be concluded that the analytical method presented methods are suitable for steel materials. The proposed method can be used by engineers.

AI-powered chat technology is an emerging topic worldwide, particularly in areas such as education, research, writing, publishing, and authorship. This study aims to explore the factors driving students' acceptance of ChatGPT in higher education. The study employs the unified theory of acceptance and use of technology (UTAUT2) theoretical model, with an extension of Personal innovativeness, to verify the Behavioral intention and Use behavior of ChatGPT by students. The study uses data from a sample of 503 Polish state university students. The PLS-SEM method is utilized to test the model. Results indicate that Habit has the most significant impact (0.339) on Behavioral intention, followed by Performance expectancy (0.260), and Hedonic motivation (0.187). Behavioral intention has the most significant effect (0.424) on Use behavior, followed by Habit (0.255) and Facilitating conditions (0.188). The model explains 72.8% of the Behavioral intention and 54.7% of the Use behavior variance. While the study is limited by the sample size and selection, it is expected to be a starting point for more research on ChatGPT-like technology in university education, given that this is a recently introduced technology.

Digital and media literacies refer to a specific set of skills and abilities. The range of these skills as they concern the educational process has been broadly discussed. In this paper, we analyzed the Polish educational system to determine the scope of the sorts of digital skills young people and students should achieve in order to be considered digitally and media literate. We compared sets of recommendations from the last ten years issued by different national governmental and nonprofit organizations for the Polish education system. We identified a set of skills that should be expected to be possessed by young people and students during their education. Additionally, we discussed results regarding the situation caused by the COVID-19 pandemic and the shift from regular education to distance learning.

The proposed research is devoted to the comprehensive theoretical and experimental study of the concept of the wireless low power dc socket for residential applications. The main goal of this work is to provide safe dc source for residential customers at power level which is enough in order to supply all typical appliances without power factor correctors. Such types of devices can be already connected to the dc grid and decoupled from ac grid. This paper considers several typical solutions that can be used for realization. The comparative analysis of an LLC converter with a series-parallel compensation circuit is one of the outputs of this paper. Eventually, simulation and experimental verification is given. The main advantages and constraints are discussed in the conclusions.

Introduction. This study aimed to investigate the relationship between obstructive sleep apnea (OSA), circadian rhythms, and individual sleep–wake preferences, as measured by chronotype, and to assess the association between circadian clock gene expression and subjective sleep-related variables. Methods: A total of 184 individuals were recruited, underwent polysomnography (PSG), and completed questionnaires including a chronotype questionnaire (CQ), insomnia severity index (ISI), and Epworth sleepiness scale (ESS). Blood samples were collected in the evening before and morning after PSG. Gene expression analysis included BMAL1, CLOCK, PER1, CRY1, NPAS2, and NR1D1. Results: In the OSA group, the subjective amplitude (AM score of CQ) positively correlated with all circadian clock genes in the morning (R ≥ 0.230 and p < 0.05 for each one), while the morningness–eveningness (ME score of CQ) was only associated with the evening BMAL1 level (R = 0.192; p = 0.044). In healthy controls, insomnia severity correlated with evening expression of BMAL1, PER1, and CRY1. Conclusions: The findings highlight the complex interplay between OSA, circadian rhythms, and sleep-related variables, suggesting potential determinants of morning chronotype in OSA and implicating disrupted circadian clock function in subjective feelings of energy throughout the day. Further research is warranted to elucidate underlying mechanisms and guide personalized management strategies.

Obstructive sleep apnea (OSA) has been linked to disruptions in circadian rhythm and neurotrophin (NFT) signaling. This study explored the link between neuromodulators, chronotype, and insomnia in OSA. The participants (n = 166) underwent polysomnography (PSG) before being categorized into either the control or the OSA group. The following questionnaires were completed: Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Chronotype Questionnaire (morningness-eveningness (ME), and subjective amplitude (AM). Blood samples were collected post-PSG for protein level assessment using ELISA kits for brain-derived neurotrophic factor (BDNF), proBDNF, glial-cell-line-derived neurotrophic factor, NFT3, and NFT4. Gene expression was analyzed utilizing qRT-PCR. No significant differences were found in neuromodulator levels between OSA patients and controls. The controls with insomnia exhibited elevated neuromodulator gene expression (p < 0.05). In the non-insomnia individuals, BDNF and NTF3 expression was increased in the OSA group compared to controls (p = 0.007 for both); there were no significant differences between the insomnia groups. The ISI scores positively correlated with all gene expressions in both groups, except for NTF4 in OSA (R = 0.127, p = 0.172). AM and ME were predicting factors for the ISI score and clinically significant insomnia (p < 0.05 for both groups). Compromised compensatory mechanisms in OSA may exacerbate insomnia. The correlation between chronotype and NFT expression highlights the role of circadian misalignments in sleep disruptions.

Introduction Recent studies have emphasized the importance of clinical manifestations, such as insomnia and sleepiness, in defining phenotypes of obstructive sleep apnea (OSA), shifting from a focus on OSA severity and sleep structure. Objectives The study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA. Methods A total of 181 participants undergoing polysomnography (PSG) were asked to fill out questionnaires, including Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Back Depression Index (BDI). They were categorized into phenotypes: insomnia-sleepiness (I+S; ESS≥11; ISI≥15; n=20), sleepiness (S; ESS≥11; ISI

IntroductionRecent research highlights the significance of insomnia and sleepiness, shifting from obstructive sleep apnea (OSA) severity and sleep structure, in defining OSA phenotypes.ObjectivesThis study aimed to characterize insomnia and sleepiness associated with OSA phenotypes and assess their involvement in depression symptoms (DS) in OSA.Materials and methodsThis cross-sectional, clinical study included 181 participants who underwent polysomnography (PSG) and filled out questionnaires, including the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Index (BDI). They were categorized into phenotypes: insomnia–sleepiness (I + S; ESS ≥ 11; ISI ≥ 15; n = 20), sleepiness (S; ESS ≥ 11; ISI < 15; n = 22), insomnia (I; ESS < 11; ISI ≥ 15), and asymptomatic (A; ESS < 11; ISI

The rapid formation of glacial lakes is one of the most conspicuous landscape changes caused by atmospheric warming in glacierised regions. However, relatively little is known about the history and current state of glacial lakes in the High Arctic. This study aims to address this issue by providing the first inventory of glacial lakes in Svalbard, focusing in particular on the post-Little Ice Age evolution of glacial lakes and their typology. To do so, we used aerial photographs and satellite imagery together with archival topographic data from 1936 to 2020. The inventory comprises the development of 566 glacial lakes (146 km2) that were still in direct contact with glaciers during the period 2008–2012. The results show a consistent increase in the total area of glacial lakes from the 1930s to 2020 and suggest an apparent link between climatic and geological factors, and the formation of specific lake dam types: moraine, ice, or bedrock. We also detected 134 glacial lake drainage events that have occurred since the 1930s. This study shows that Svalbard has one of the highest rates of glacial lake development in the world, which is an indicator of the overall dynamics of landscape change in the archipelago in response to climate change.

This study proposes an example of a wireless charging station design for a small-scale vehicle available on the market. The article analyzes basic transmitter inverter topologies and their compensation methods in terms of flexibility of control, tolerance to uncertainty in positioning, and the possibility of decreasing the integration price. Our comprehensive analysis focuses on the battery voltage range, energy capacity, cost, and travel distance. We evaluate the constraints of efficiency, transmitted power, amount of used material, and size of the energy delivery system based on our design example. The aim is to increase the penetration of wireless technology in terms of convenience and integration capabilities.

Artificial intelligence (AI) is currently becoming a leading field in data processing [...]

Probiotics may represent a safe and easy-to-use treatment option for depression or its metabolic comorbidities. However, it is not known whether metabolic features can influence the efficacy of probiotics treatments for depression. This trial involved a parallel-group, prospective, randomized, double-blind, controlled design. In total, 116 participants with depression received a probiotic preparation containing Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175 or placebo over 60 days. The psychometric data were assessed longitudinally at five time-points. Data for blood pressure, body weight, waist circumference, complete blood count, serum levels of C-reactive protein, cholesterol, triglycerides, and fasting glucose were measured at the beginning of the intervention period. There was no advantage of probiotics usage over placebo in the depression score overall (PRO vs. PLC: F(1.92) = 0.58; p = 0.45). However, we found a higher rate of minimum clinically important differences in patients supplemented with probiotics than those allocated to placebo generally (74.5 vs. 53.5%; X2(1,n = 94) = 4.53; p = 0.03; NNT = 4.03), as well as in the antidepressant-treated subgroup. Moreover, we found that the more advanced the pre-intervention metabolic abnormalities (such as overweight, excessive central adipose tissue, and liver steatosis), the lower the improvements in psychometric scores. A higher baseline stress level was correlated with better improvements. The current probiotic formulations may only be used as complementary treatments for depressive disorders. Metabolic abnormalities may require more complex treatments. ClinicalTrials.gov identifier: NCT04756544.