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Heartburn symptoms contribute to healthcare-seeking among patients with gastroesophageal reflux disease (GERD). Despite clinical guidance, management is often dictated by insurance restrictions. Several potassium-competitive acid blockers (PCABs) are under development as a new class of therapy. We performed economic analyses to align GERD drug development with the needs of gastroenterologists, insurers and patients in a value-based environment. A decision-analytic model was constructed to compare vonoprazan 20 mg daily (an example of a PCAB), common over-the-counter or prescription proton pump inhibitor regimens, and no treatment over a 1-year time horizon. Clinical responses were evaluated based on the proportions of heartburn-free days in a recent phase 3 multicenter trial. Healthcare utilization for persistent reflux symptoms was derived from national observational studies compared with healthy control subjects. Costs and quality-adjusted life years were reported. Without insurance coverage for appropriate therapy, patients spend $4443 and insurers spend $3784 on average per year for inadequately treated GERD symptoms. Our model estimates that PCABs could save at least $3000 in annual costs to patients and insurers, could generate quality-adjusted life year gains (+0.06 per year), and could be cost-saving to insurers as a covered option at a price up to $8.57 per pill, if these drugs are able to demonstrate similar effectiveness to proton pump inhibitors in future trials evaluating heartburn relief and erosive esophagitis healing to regulators. Threshold prices reflect pricing after all pharmacy benefits manager rebates and discounts. We demonstrate that aiming GERD-related drug development toward heartburn relief appears critical to align cost-effective incentives for industry and insurers with those of patients and gastroenterologists. [Display omitted] [ABSTRACT FROM AUTHOR]

The short-circuit ratio index (SCR) can effectively quantify the voltage support strength in traditional DC grid-connected scenarios, yet it cannot reasonably describe the voltage support strength in diverse device grid connection scenarios. This paper introduces a new calculation method of the complex short-circuit ratio index (SCR∼) and derives the threshold value of the complex short-circuit ratio index to enable a comprehensive quantitative assessment of grid voltage support strength across diverse device grid connection scenarios. Firstly, critical short-circuit ratio (CSCR) under different assumed conditions were derived based on the short-circuit ratio index. Secondly, the calculation method of the complex short-circuit ratio index was introduced, considering both the equivalent impedance angle of the device and the Thevenin equivalent impedance angle. This was followed by the determination of the threshold value of the complex short-circuit ratio (CSCR∼), enabling a precise quantitative evaluation of power grid voltage support strength in diverse device grid connection scenarios. Finally, the example analysis proves the accuracy and efficacy of the complex short-circuit ratio index in assessing the voltage support strength of diverse devices in grid-connected scenarios.

Author(s): Jiayao Lei 1,2,3,4, Kate Cuschieri 5, Hasit Patel 6, Alexandra Lawrence 7, Katie Deats 1, YouScreen trial team, Peter Sasieni 1,*, Anita W. W. Lim 4 Introduction Cervical cancer [...], Background Human papillomavirus (HPV) testing of self-collected vaginal samples has potential to improve coverage of cervical screening programmes, but current guidelines mostly require those HPV positive on a self-sample to attend for routine screening. Methods and findings A pragmatic modified stepped-wedge implementation feasibility trial was conducted at primary care practices in England. Individuals aged 25 to 64 years who were at least 6 months overdue for cervical screening could provide a self-collected sample. The primary outcomes included the monthly proportion of non-attenders screened, changes in coverage, and uptake within 90 days. Self-samples from 7,739 individuals were analysed using Roche Cobas 4800. Individuals with a positive self-sample were encouraged to attend clinical screening. In this post hoc study of the trial, we related the HPV type (HPV16, HPV18, or other high-risk type) and cycle threshold (Ct) value on the self-sample to the results of clinician-collected sample and cervical intraepithelial neoplasia grade 2 or worse (CIN2+). We wished to triage HPV-positive individuals to immediate colposcopy, clinician sampling, or 12-month recall depending on risk. A total of 1,001 women tested positive through self-samples, and 855 women who had both an HPV-positive self-sample and a subsequent clinician-sample were included in this study. Of these, 71 (8.3%) had CIN2+. Self-sample Ct values were highly predictive of HPV in the clinician sample. Combining HPV type and Ct value allowed stratification into 3 risk groups; 44/855 (5%) were high-risk of whom 43% (19/44, 95% confidence interval [29.7%, 57.8%]) had CIN2+. The majority (52.9%, 452/855) were low-risk, of whom 4% (18/452, 95% CI [2.5%, 6.2%]) had CIN2+. The main limitation of our study was the colposcopy assessment was restricted to individuals who had abnormal cytology after positive results of both self-sample and clinician-collected sample. Conclusions HPV type and Ct value on HPV-positive self-samples may be used for triage. The difference in the risk of CIN2+ in these groups appears sufficient to justify differential clinical management. A prospective study employing such triage to evaluate laboratory workflow, acceptability, and follow-up procedure and to optimise clinical performance seems warranted. Trial Registration ISRCTN12759467.

Introduction:Considering the inconsistent results regarding the association between the severity and duration of olfactory dysfunction (OD), and the viral load in coronavirus disease 2019 (COVID-19) patients, we aimed to conduct this study. Materials and Methods:This is a prospective cohort study in which COVID-19 patients were evaluated for the initial cycle threshold value (Ct values) measured by the nasopharyngeal samples along with olfactory function measured by the University of Pennsylvania Smell Identification Test (UPSIT) within 2 months of COVID-19 onset.Results:Among 309 COVID-19 patients who were included in this study, 108 (34.9%), 112 (36.2%) and 89 (28.8%) were normosmic, hyposmic, and anosmic, respectively based on the UPSIT. The severity of COVID-19 and the rate of hospitalization were higher in anosmic patients (p

Abstract Background Acute kidney injury (AKI) is a prevalent complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, and a predictor of disease severity and mortality; furthermore, a prompt diagnosis and treatment of this complication may enhance COVID‐19 prognosis. Therefore, we aim to investigate potential risk factors for SARS‐CoV‐2‐associated AKI, including SARS‐CoV‐2 PCR cycle threshold value (CT value), which correlation with AKI is conflicting. Methods This case–control study included 110 hospitalized patients with SARS‐CoV‐2‐associated AKI as cases and 110 random SARS‐CoV‐2 hospitalized patients as controls. Reverse transcription real‐time PCR of admission nasopharyngeal swabs evaluated E gene cycle thresholds. Additional clinical and paraclinical information extracted from medical records. The patient's status at discharge, and 14 and 30 days after discharge. Therefore, after adjusting for age and gender, the correlation between variables was assessed. Results SARS‐CoV‐2 AKI is significantly associated with age above 60, hypertension, diabetes mellitus, ischemic heart disease, and underlying kidney diseases. Abnormal admission hemoglobin or alkaline phosphatase, proteinuria or hematuria in urine sediment, and abnormal creatinine during hospitalization were the paraclinical features correlated to SARS‐CoV‐2 AKI. AKI group demonstrated greater in‐hospital, 14‐ and 30‐day mortality. Nevertheless, this study did not evidence a correlation between the admission CT value and mortality or AKI. Conclusion Admission CT values provide limited information regarding the dynamic viral load and varying hospitalization time points; thus, they may not be reliable for predicting the prognosis and complications of COVID‐19 in all populations. Further studies with serial CT measurements or symptom onset time adjustment are recommended.

To explore and identify an optimal serum ferritin (SF) threshold level in diagnosing hemophagocytic lymphohistiocytosis (HLH) in Chinese children.

At present, electrode line impedance supervision (ELIS) based protection is widely used to detect faults on grounding electrode lines, which are indispensable elements of high-voltage direct current (HVDC) systems. The existing theoretical analysis of measured impedance is based on lumped line model and the threshold value is generally set according to engineering experience, which have caused the dead zone problem and even accidents. Therefore, a study on measured impedance of ELIS-based protection and its threshold value selection method is carried out to solve this problem. In this study, the expressions of measured impedance under normal operation and fault conditions are deduced based on rigorous and accurate line model. Based on the expressions, the characteristics of the measured impedance are calculated and analyzed. With the characteristics of the measured impedance, the applicability of the protection with the traditional threshold value is further discussed and the distribution of the dead zone can be located. Then, the method to calculate the threshold value of ELIS-based protection is proposed. With a proper threshold value selected by the proposed method, the dead zone of ELIS-based protection is effectively eliminated, and the protection can identify all types of faults even with large transition resistances. Case studies on PSCAD/EMTDC have been conducted to verify the conclusion.

Background: Emerging epidemiological studies indicate a paradoxical association between smoking and coronavirus disease 2019 (COVID-19). This retrospective study aimed to investigate the association between cycle threshold (Ct) values and clinical type among COVID-19-positive smokers and nonsmokers. Methods: The study was conducted from October 3, 2020, to October 3, 2022. Five hundred and sixty COVID-19 patients were enrolled, which included 320 smoking group (SG) and 240 non-SG (NSG). Demographic and clinical features were acquired, and comparison was based drawn on gender, age, Ct range, and clinical type (mild/mild-moderate/severe COVID-19). COVID-19 was confirmed by real time reverse-transcription polymerase chain reaction test based on Ct value below 35. Results: Initial evaluation revealed no significant association between Ct range and clinical type either within or between SG and NSG. Follow-up at 7/14 days revealed no significant difference between the groups for Ct range/clinical type; however, within groups Ct range showed a clear change towards higher values. The recovery rate was also evaluated which displayed no difference at 7 days while at 14 days' recover rate was 47.5% for SG and 80.0% for NSG. Moreover, in both groups un-recovered patients were mostly observed either in mild-moderate and severe COVID state; however, SG showed more patients in mild-moderate group and longer discharge time. Conclusions: We found that Ct value and clinical type have no significant association in COVID-19 smokers versus nonsmokers and smokers are at high risk and take a longer time to recover from COVID.

Currently, bacterial classification at the species level relies on the 95-96% average nucleotide identity (ANI) value that is known to be equivalent to a 70% digital DNA-DNA hybridization (dDDH) value. However, during the routine identification of bacteria in the uteri of camels with a history of conception failure, we found that four out of the seven strains (2298A, 2569A, 2652, 2571B, 1103A, 2571A, and 335C) could not be assigned to any valid Corynebacterium species. Furthermore, a 70% dDDH value did not correspond to a 95-96% ANI value in strain 2569A. Thus, we aimed to classify these strains and explain the mechanisms underlying gene repertoire diversity and the disagreement we found between the ANI and dDDH cutoff values. For this study, we extracted information from the genomes of 150 Corynebacterium -type species and seven sequenced genomes of uterine Corynebacterium isolates. We found that the 96.67% OrthoANI value should be used in place of the generally accepted 95-96% ANI threshold in order to obtain an equivalent 70% dDDH value. Phylogenomic analysis determined the evolutionary position of each uterine strain. Then, strains 2652 and 2571B were classified as C. camporealensis based on the ANI value (98.44% and 98.72%) and dDDH value (85.8% and 88.5%). Strain 2569A had a 96.58% ANI and a 69.4% dDDH value and was classified as C. urogenitale. The strains 335C, 1103A, 2571A, and 2298A were classified as novel Corynebacterium based on the ANI value (77.12, 94.01%, 94.26%, and 94.03%) and dDDH value (21.3%, 54.1%, 54.9%, and 51.3%), respectively. Genes for menaquinone biosynthesis and the saturation of chains were detected in uterine strains and their closely related type strains. Gene gain predominates as a source of variation in the gene repertoire. Most of these genes are gained by horizontal gene transfer, driven by genomic islands and prophage. In summary, we refined the ANI cutoff value for an accurate diagnosis of Corynebacterium . Moreover, we clarified the mechanism underlying the diversity of the gene repertoire and expanded the number of Corynebacterium species isolated from the camel uterus.

Background Coronavirus disease 2019 can spread rapidly. Surgery in the oral cavity poses a high risk of transmission of severe acute respiratory syndrome coronavirus 2. The American Dental Association and the Centers for Disease Control and Prevention recommend the use of mouthwash containing 1.5% hydrogen peroxide (H 2O 2) or 0.2% povidone iodine (PI) to reduce the viral load in the upper respiratory tract and decrease the risk of transmission. The aim of the present study was to analyze the effect of mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water on the cycle threshold (CT) value obtained by real-time reverse transcription polymerase chain reaction (RT-PCR). Methods This study is a randomized single blind controlled clinical trial which has been registered in the International Standard Randomized Controlled Trial Number (ISRCTN) registry on the 3 rd February 2022 (Registration number: ISRCTN18356379). In total, 69 subjects recruited from Persahabatan General Hospital who met the inclusion criteria were randomly assigned to one of four treatment groups or the control group. The subjects were instructed to gargle with 15 mL of mouthwash for 30 s in the oral cavity followed by 30 s in the back of the throat, three times per day for 5 days. CT values were collected on postprocedural days 1, 3, and 5. Results The results of the Friedman test significantly differed among the groups (n=15). The CT values increased from baseline (day 0) to postprocedural days 1, 3, and 5. Conclusions Mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water increased the CT value.

Objective: To explore the relationship between the cycle threshold (Ct) value of ORF1ab gene and N gene in the first admission detected by novel coronavirus (Omicron) nucleic acid and the negative conversion cycle of infected patients. Methods: 5 212 patients with novel coronavirus omicron variant infection were admitted to the Northern Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2022 to April 2022 were collected, according to the patient′s previous history and the tests of relevant indexes after admission, including 2 746 cases in non-basic disease group and 2 466 cases in the basic disease group. All subjects received the Ct value of the ORF1ab genes and the N genes tests. Statistical analysis of the difference of the negative conversion cycle of ORF1ab gene and N gene between non-basic disease group and basic disease group under different Ct values at the first admission. Pearson linear correlation analysis was used to assess the association of Ct value of ORF1ab gene and N gene with the negative conversion cycle, and multiple linear regression was used to analyze the factors affecting the negative conversion cycle. Results: The Ct values of ORF1ab gene and N gene in patients novel coronavirus infection were negatively correlated with the negative conversion cycle (rORF1ab=-0.4622, P

Congenital hypothyroidism is the most common preventable cause of intellectual disability. Therefore, the majority of developed countries have aimed to diagnose cases early through screening programs. In these screening programs, levels of thyroid-stimulating hormone (TSH) and free thyroxine are examined in dried blood spots taken between days 3 and 5 of life. While many countries accept TSH threshold value of 8 mU/L, there is still no consensus on the ideal TSH threshold value. As no twin studies on the TSH threshold value have been conducted previously, this study was planned. Eight pairs of twins were included in the study, with one of the twins having plasma TSH value ≥8 mU/L and the other <8 mU/L, measured between days 3 and 5 of life. The study aimed to investigate whether determining threshold TSH value of 8 mU/L would be beneficial by comparing somatic growth, mental development, and neuromotor development between twins. The age, gender, gestational weeks, birth weights, height, weight, and initial TSH values taken between days 3 and 5 of all cases were recorded. The patients' plasma Vitamin B12, folate, 25-OH Vitamin D, ferritin, and hemoglobin levels were measured. After that, they were evaluated by a child and adolescent psychiatry. Finally, the Denver Developmental Test was applied to the cases. There was no significant impairment in somatic growth, mental development, and neuromotor development in the long-term outcomes of cases with plasma TSH ≥ 8 mU/L compared to those with plasma TSH < 8 mU/L among the twins participating in our study., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To establish an optimal preoperative HbA1c threshold that enhances surgical outcomes and minimises postoperative complications in diabetic patients undergoing elective total knee arthroplasty (TKA)., Study Design: Prospective cohort study. Place and Duration of the Study: Department of Orthopaedics, First People's Hospital of Lianyungang, China, from January 2021 to March 2024., Methodology: A total of 152 diabetic patients scheduled for elective TKA were included. Data on preoperative HbA1c levels were collected and analysed to assess their impact on postoperative outcomes using the Oxford Knee Score (OKS). Patients were divided into groups based on HbA1c levels and compared for functional and pain recovery one year postoperatively. Statistical analyses included binary and multivariate logistic regression, with an emphasis on the minimum clinically important difference for OKS., Results: Patients with a preoperative HbA1c below 7.35mmol/L exhibited significantly better functional and pain recovery outcomes at one-year post-TKA. The receiver operating characteristic curve (ROC) analysis confirmed the predictive power of HbA1c, with an Area Under the Curve of 0.734 for functional improvement and 0.721 for pain improvement., Conclusion: The study identifies 7.35mmol/L as the optimal preoperative HbA1c threshold for diabetic patients undergoing elective TKA, with lower levels associated with improved functional and pain outcomes. Maintaining HbA1c below this level preoperatively can significantly enhance postoperative recovery and patient satisfaction., Key Words: Diabetes mellitus, Total knee arthroplasty, Haemoglobin A1c, Oxford knee score.

Epidemiological control of coronavirus disease 2019 (COVID-19) is needed to estimate the infection period of confirmed cases and identify potential cases. The present study, targeting confirmed cases for which the time of COVID-19 symptom onset was disclosed, aimed to investigate the relationship between intervals (day) from symptom onset to testing the cycle threshold (CT) values of real-time reverse transcription-polymerase chain reaction. Of the COVID-19 confirmed cases, those for which the date of suspected symptom onset in the epidemiological investigation was specifically disclosed were included in this study. Interval was defined as the number of days from symptom onset (as disclosed by the patient) to specimen collection for testing. A locally weighted regression smoothing (LOWESS) curve was applied, with intervals as explanatory variables and CT values (CTR for RdRp gene and CTE for E gene) as outcome variables. After finding its non-linear relationship, a polynomial regression model was applied to estimate the 95% confidence interval values of CTR and CTE by interval. The application of LOWESS in 331 patients identified a U-shaped curve relationship between the CTR and CTE values according to the number of interval days, and both CTR and CTE satisfied the quadratic model for interval days. Active application of these results to epidemiological investigations would minimize the chance of failing to identify individuals who are in contact with COVID-19 confirmed cases, thereby reducing the potential transmission of the virus to local communities.

ABSTRACTDespite having high analytical sensitivities and specificities, qualitative SARS-CoV-2 nucleic acid amplification tests (NAATs) cannot distinguish infectious from non-infectious virus in clinical samples. In this study, we determined the highest cycle threshold (Ct) value of the SARS-CoV-2 targets in the Xpert Xpress SARS-CoV-2/Flu/RSV (Xpert 4plex) test that corresponded to the presence of detectable infectious SARS-CoV-2 in anterior nasal swab samples. A total of 111 individuals with nasopharyngeal swab specimens that were initially tested by the Xpert Xpress SARS-CoV-2 test were enrolled. A healthcare worker subsequently collected anterior nasal swabs from all SARS-CoV-2-positive individuals, and those specimens were tested by the Xpert 4plex test, viral culture, and laboratory-developed assays for SARS-CoV-2 replication intermediates. SARS-CoV-2 Ct values from the Xpert 4plex test were correlated with data from culture and replication intermediate testing to determine the Xpert 4plex assay Ct value that corresponded to the presence of infectious virus. Ninety-eight of the 111 (88.3%) individuals initially tested positive by the Xpert Xpress SARS-CoV-2 test. An anterior nasal swab specimen collected from positive individuals a median of 2 days later (range, 0–9 days) tested positive for SARS-CoV-2 by the Xpert 4plex test in 39.8% (39/98) of cases. Of these samples, 13 (33.3%) were considered to contain infectious virus based on the presence of cultivable virus and replication intermediates, and the highest Ct value observed for the Xpert 4plex test in these instances was 26.3. Specimens that yielded Ct values of ≤26.3 when tested by the Xpert 4plex test had a likelihood of containing infectious SARS-CoV-2; however, no infectious virus was detected in specimens with higher Ct values.IMPORTANCEUnderstanding the correlation between real-time PCR test results and the presence of infectious SARS-CoV-2 may be useful for informing patient management and workforce return-to-work or -duty. Further studies in different patient populations are needed to correlate Ct values or other biomarkers of viral replication along with the presence of infectious virus in clinical samples.

The aims of this study were (i) to assess the soil Cu concentration in the mineral A horizon and cambic Bw horizon, (ii) to determine the background threshold value (BTV), and (iii) to quantify the differences between the horizons in terra rossa soil from Dalmatia. A total of 128 samples from 64 soil profiles located on terrains used for non-agricultural purposes were analysed for aqua regia soluble Cu concentration. The soils were classified according to the Croatian Soil Classification System and World Reference Base for Soil Resources as terra rossa soil and Chromic and Rhodic Cambisols. The median value of Cu concentration in A horizon (CuA) and cambic Bw horizon (CuB) were 34.9 and 36.1 mg/kg, respectively, and ranged between 16.2 and 69.5 mg/kg in the CuA and from 17.0 to 73.0 mg/kg in the CuB horizon. The estimated BTV for CuA varied between 43.6 and 58.4 mg/kg depending on the calculation method applied. The median ratio CuA/CuB of 0.96 was close to identical. The Wilcoxon matched pairs signed rank test and the Hodges-Lehmann estimator showed that the median difference in Cu concentration between the CuA and CuB was very small (-1.78 mg/kg). Mentioned statistical evidence on the small differences in Cu concentration between the horizons suggests that Cu concentrations measured in the Bw horizon can be considered a “local background” for the samples collected in A horizon and its utilization in screening terra rossa soil contamination can be suggested.

In this work, a new heavy-tailed Lomax model is proposed for the reliability and actuarial risk analysis. Simulations are conducted to investigate how the estimators behave. Parameters are derived through maximum likelihood estimation techniques. The efficacy of the newly proposed heavy-tailed Loma distribution is illustrated using the USA indemnity loss datasets. The findings clearly indicate that the new loss model offers a superior parametric fit compared to other competing distributions. Analyzing metrics such as value-at-risk, tail mean variance, tail variance, peaks over a random threshold value-at-risk (PORT-VAR), and the mean-of-order-P (MOP(P)) can aid in risk assessment and in identifying and describing significant events or outliers within the USA indemnity loss. This research introduces PORT-VAR estimators tailored specifically for risk analysis using the USA indemnity loss dataset. The study emphasizes determining the optimal order of P based on the true mean value to enhance the characterization of critical events in the dataset.

Introduction: Tuberculosis (TB) is a major global health problem caused by Mycobacterium tuberculosis (MTB). The National Tuberculosis Elimination Programme (NTEP) emphasises early diagnosis and treatment of TB cases. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) is a semi-automated molecular assay that rapidly detects MTB Deoxyribonucleic Acid (DNA) and Rifampicin (RIF) resistance-associated mutations using Real-Time Polymerase Chain Reaction (RT-PCR). Aim: This cross-sectional study aims to assess the association between the Cycle Threshold (Ct) value of CBNAAT and the clinical severity of Pulmonary Tuberculosis (PTB). Materials and Methods: The study was conducted at the Department of Respiratory Medicine, Navodaya Medical College Hospital and Research Centre-Raichur, from January 2020 to July 2021. A sample size of 106 participants, aged ≥18 years and meeting the NTEP guidelines for presumptive PTB cases, were enrolled. Participants underwent chest radiography, sputum smear microscopy for Acid-Fast Bacilli (AFB), and CBNAAT testing. Clinical severity of PTB was categorised as mild, moderate, or severe using the Bandim TB score. Data was entered into Microsoft Excel 2017, and statistical analysis was performed using SPSS version 23. Descriptive statistics, frequencies, percentages, means, and standard deviations were calculated, and the chi-square test was utilised to assess associations between qualitative variables. Results: Among the participants, the majority (55.7%, n=59) had moderate clinical severity. Of these, 12.3% (n=13) had high CBNAAT Ct values, 20.8% (n=22) had medium Ct values, 11.3% (n=12) had low Ct values, and 11.3% (n=12) had very low Ct values. A total of 31.1% (n=33) had severe clinical severity, with 13.2% (n=6) having high Ct values, 12.3% (n=13) having medium Ct values, and 6.6% (n=7) each having low and very low Ct values. Additionally, 13.2% (n=14) had mild clinical severity, with 0.9% (n=1) having high Ct values, 3.8% (n=4) having medium Ct values, 5.7% (n=6) having low Ct values, and 2.8% (n=3) having very low Ct values. The chi-square value was 4.697, with a p-value of 0.58. Conclusion: There is no association between the Ct value of CBNAAT and the clinical severity of PTB.

Detecting black hole attackers is tedious in Vehicular Ad Hoc Networks due to vehicles’ high mobility. The main consequence faced because of these attackers is an increase in the number of dropped packets which converts secure and fastest paths to compromised ones. Since these attackers can act individually and collaboratively as a group, early detection of these attackers must be feasible to preserve the network’s performance. The majority of current methods rely on predetermined threshold and trust score values, which are ineffective in accurately identifying black hole attackers. Hence, this paper proposes a hybrid approach using dynamic threshold value and node credibility for early detection of black hole attackers. RSUs periodically compute the dynamic threshold value and categorize the vehicles into categories 1, 2, and 3. Vehicles classified as Category 1 are legitimate, whereas Category 3 vehicles are attackers. Vehicles in Category 2 are suspicious, requiring further analysis using node credibility values to identify attackers. It is protected against single, multiple, and collaborative black hole attackers. The NS2 simulation results demonstrate that the suggested method is optimal concerning PDR, Throughput, Delay, and Packet Loss Ratio compared to recent techniques. Since the proposed scheme efficiently identifies the attackers, it has 89.67% PDR, which is higher when compared to other schemes.

The article presents the method for an objective determination of threshold value, needed for filtering out the anatomical roughness signal, with filter based on fast Fourier Transform (FFT), from surface roughness profile after machining. The method includes experimental preparation of solid wood surface by cutting in such a way to get a surface that can be considered to represent only anatomical roughness, with no other influence. Experiments were performed on radial cross section of solid oak wood (Quercus robur L.) so that the results could be compared with roughness profiles that were previously obtained in experiments after sawing with circular saw. From these samples and based on frequency analysis of anatomical roughness signals, the threshold value was determined to be 1.6 μm. The average value of Ra parameter of anatomical roughness for specimens of radial cross section of solid oak wood was 2.1 μm with standard deviation of 0.3 μm. The importance of choosing adequate sampling length in threshold determination, based on frequency analysis of anatomical roughness signal, was also established.

DEMATEL technique is a graphical representation method to deal with complex systems. The final analyzed cause and effect categorization would be fundamentally dependent on the threshold value setting. This research is intended to present some mathematical models for calculating the threshold value in the DEMATEL method. The min(max) operator has been intentionally used for considering three equations to identify the threshold value. Additionally, the proposed mathematical equations are gradually developed to gain more useful data to yield a threshold value as well. Particularly, the expert's initial scoring for building the primary matrix would also be applied in one equation. Results show eliciting an expert's opinions regarding the value of a threshold value determination leads to setting relatively high thresholds. But, there would be an equation which takes advantage of more data derived from the total influence matrix T. Moreover, a span of different threshold values is gained by making use of the Hamacher t-conorms operator which especially would cause better complexity management of the final total matrix T based on expert's opinions. As a contribution to this research, threshold value determination is developed mathematically by making use of the direct data gained by the total matrix T. Besides combining data derived from total matrix T, the initial influence direct matrix given by experts, a simpler aggregating procedure and no need for statistical information compared to special Lenth's method hints at this research's novelty as well. (original abstract)

Abstract Risk‐based corrective action (RBCA) programs employ conservative models to develop default values for soil screening, which simplify the risk assessment process. However, for several naturally occurring metals (e.g., arsenic and lead), these published screening values are often unrealistic and well below the documented background levels in soil. This can lead to confusion among the regulated community and inexperienced regulators, as it will inappropriately identify naturally occurring conditions as a release (false positive or Type I error). An effective RBCA program requires the incorporation of defensible background threshold values (BTVs) in the screening process. Recent datasets and BTV development methods are available to enhance existing RBCA programs and reduce the occurrence of Type I errors. This review evaluated the role “background” currently plays in the Texas Risk Reduction Program (TRRP) and offers defensible approaches in minimizing Type I errors estimated by one Texas municipality to directly result in an unnecessary expenditure of over $250,000 annually to address this confusion in the form of additional assessment, remediation, soil management, and even disposal requirements. The same BTV development process demonstrated in this Texas case study can also inform risk assessment efforts in other areas where BTVs can supplement existing RBCA programs.

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ABSTRACT Objectives: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient – B = −0.087, 95% confidence interval [CI] = −0.135 to −0.040) and postpubertal (B = −0.101, 95% CI, −0.145 to −0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean = −0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

Introduction: Platelet count is crucial for clinical decision. In cases of microcytosis, platelet count based on impedance technique (PLT-I) may overestimate platelet count., Aim: To compare PLT-I with platelet count using the optical technique (PLT-O) and establish a Mean Corpuscular Volume (MCV) threshold for considering PLT-O., Methods: A prospective analytical study conducted over two months involved blood samples collected in standard K2 EDTA tubes for complete blood count analysis, revealing microcytosis (MCV<80 fL). PLT-O analysis in channel-Ret mode was performed using the Sysmex-XN1000 (Sysmex Corporation, Kobe, Japan). Percentage of fragmented red cells (FRC%) and percentage of microcytic red cells (Micro-R%) were recorded. Blood smears stained with May-Grünwald-Giemsa were examined for potential interfering particles., Results: A strong correlation was observed between the two techniques for all platelet values as well as for PLT <150 x 109/L (correlation coefficient r = 0.971, 95% CI: [0.956-0.982]; P<10-3 and r = 0.90, 95% CI: [0.79-0.95]; P< 10-3). The Bland-Altman plot revealed a bias of 16.53 x 109/L between the two methods, with agreement limits between -55.8 and 88.8 x 109/L. A threshold MCV value indicating the use of the optical method, with a cut-off at 72.9fL, demonstrated promising performance consistent with literature findings. However, less favorable performance was observed with Micro-R%., Conclusion: Impedance could be employed in routine practice. However, for MCV<72.9 fL or in the presence of schizocytes, the hemogram validation procedure may incorporate the use of PLT-O.

The farmland around wetland in the arid areas in northwest China is easily salinized. Reasonably controlling and reducing groundwater levels in real time is an effective way of protecting wetland and preventing and controlling farmland salinization. The typical demonstration zone is selected in the transitional zone of wetland and farmland near the Dengmaying Lake of the Shiyang River Basin in the arid area. The dynamic characteristics of groundwater depth and the synergic relationship between groundwater depth and salt content of topsoil are analyzed. The threshold value of the ecological water table is confirmed. The Intelligentized dual control technology of water table and its quantity is developed, which is based on groups of radial wells connected by siphons. The key points of the technology are as follows：one well collecting many radial wells by siphons is used for increasing the water yield of the well in the aquitard and contributing to control the water level in the form of a plane. The subsystem consisting of the electricity system, signal system and controllers is used to control the groundwater level and water yield in real time. Demonstration test of the key technology application is carried out and the application effect is remarkable. The results show that when the groundwater depth increases，the risk of salinization and bulrush coverage fraction in wetland decreases. The threshold value of groundwater depth for protecting wetland and preventing and controlling farmland salinization ranges from 1.9 to 3.0 m. The intelligentized regulatory system could make the groundwater depth stay in the suitable ecological range in the stage of evaporation from phreatic water in July and August of each year, when is the critical period of topsoil salification. The regulation not only can decrease the increasing amplitude of soil conductivity caused by irrigation, but also reduce the speed of topsoil salification. The effect of dissolving and controlling salt by the dual control technology of water table and its quantity is more obvious under the condition of fresh water irrigation than under the condition of brackish water. The technology can help realize the accurate regulation and control of groundwater level and it is of realistic significance for wetland protection and preventing and controlling farmland salinization in arid areas.