This paper focuses on the core challenges of the smart home enterprise ecological collaboration platform,and deeply discusses the absence of a governance mechanism and the inefficiency of the supply chain.The purpose ...This paper focuses on the core challenges of the smart home enterprise ecological collaboration platform,and deeply discusses the absence of a governance mechanism and the inefficiency of the supply chain.The purpose is to improve the overall efficiency by constructing an effective collaborative governance framework and optimizing the supply chain process.It is found that the implementation of multi-agent dynamic contract governance,the construction of an open data sharing middle platform,the introduction of AI-driven elastic supply chain planning,and the establishment of a distributed cloud manufacturing network are the key paths.From the research conclusion,these measures can significantly improve the transparency of cross-agent collaboration,break the data barriers,and achieve the accurate matching of supply and demand,and finally promote the ecological collaboration efficiency of the smart home industry to achieve a substantial leap.展开更多
Natural resource management is essential to sustain human well-being and the environment.Water and soil are two of the most important natural resources that require careful management.The western part of India faces m...Natural resource management is essential to sustain human well-being and the environment.Water and soil are two of the most important natural resources that require careful management.The western part of India faces multiple challenges,including climatic variability,soil degradation,water scarcity,deforestation,etc.The basin’s sub-watersheds are delineated and prioritised using the Soil and Water Assessment Tool(SWAT)and Sub Watershed Prioritization Tool(SWPT),respectively,using morphometric and topo-hydrological characteristics,and the sub-watersheds are further ranked using Weighted Sum Analysis(WSA).The findings indicate that SWS19,SWS18,SWS1,SWS17,SWS16,and SWS15,which are drained by the rivers Chambal,Kali Sindh,Mashi,Parbati,Parwan,and Beradi,are highly vulnerable sub-watersheds.By integrating remote sensing,GIS techniques,and quantitative morphometric analysis,parameters such as drainage density,stream frequency,bifurcation ratio,and slope gradient were evaluated.The analysis revealed critical sub-watersheds characterized by steep slopes,high drainage density,and poor vegetation cover,indicating their susceptibility to erosion and runoff.The findings underscore the necessity for targeted soil conservation measures,such as contour bunding,afforestation,and water retention structures.This study highlights the utility of geospatial tools for sustainable watershed management and provides a replicable framework for prioritizing sub-watersheds in similar regions.展开更多
G Home是一家以葫芦为核心灵感的设计工作室。在一次去墨西哥的短途旅行中,因为发现了很多在功能和外形上极具当地特色的葫芦制品,我们开始重新从设计的角度思考这一熟悉却未曾被正视的材料。葫芦是世界范围内最早被人类驯化的植物品种...G Home是一家以葫芦为核心灵感的设计工作室。在一次去墨西哥的短途旅行中,因为发现了很多在功能和外形上极具当地特色的葫芦制品,我们开始重新从设计的角度思考这一熟悉却未曾被正视的材料。葫芦是世界范围内最早被人类驯化的植物品种,目前考古遗迹可追踪到12000年以前,其影响范围也覆盖了有人居住的每一个大洲。基于这些丰富的文化资源,和其天然,可持续的材料特性,G Home在2024年正式在美国成立,旨在做出基于历史,面向未来的设计;通过创新的家居产品,营造多元,自然的室内空间和生活方式。展开更多
In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community ca...In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.展开更多
Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new proph...Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.展开更多
Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objecti...Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objective of this study is to evaluate the safety and efficacy of a low energy pulsed-light device combined with galvanic energy, intended for home-use hair removal on dark skin. Materials and Methods: Fifteen women with skin types V and VI and dark terminal hair in axillaarea self-administrated 6 treatments at 2 week intervals, using a hand-held IPL combined with galvanicenergy device, using HPL (Home Pulsed Light) technology. Hair count and photographs were performed pre-treatment and 1 and 3 months after the last sixth treatment. Adverse events and subject satisfaction scores were recorded. Results: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. Hair counts were significantly reduced by 57.3% 1 month following last treatment and by 44.5% 3 months following last treatment. No adverse events were recorded. Subject satisfaction scores of the device usability and the treatment outcome were high. Conclusions: Low energy pulsed light combined with galvanic energy may be applied safely and effectively for at-home hair removal for people with dark skin types V and VI.展开更多
Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging inte...Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging interventions targeting engagement enhancement. Objective: To depict the activities interests of nursing homes residents. Method: An electronic version of the Test of Interest “TILT” which regroups 40 images of activities has been developed and adapted for the Ipad. Residents were asked to answer by yes or no to the question “are you interested by this activity”, for each activity found interesting, the patient had then to categorize it in either Work/ occupation-Personal-Leisure-Family. Population: A total of 601 residents from 19 nursing homes have completed the survey from March to May 2011. The surveyed nursing homes from the South East of France were comparable of nursing homes figures in France. Results: We interviewed 601 individuals (female, n = 484) aged 85.9 years, out of those, 56% had stayed more than one year in an institution. Nearly half of the population (45.3%) was from 80 - 89 year of age, followed by 36.1% from 90 - 99. The educational background was principally from primary school (36%) and high school (30.8%). Most of the residents were classified has having dementia (35.3%). From the 40 activities presented to each participant, “enjoying a good meal” has been found to be the most interesting activity by 83% of the population followed by “dressing up”, 75.9% and “watching TV”, 75.5%. Female participants reported more interest in place of worship, family pictures and being with grand children then males (p < 0.01). We found that the presence of “dementia” diagnosis” triggered the lack of interest compared to none demented or none cognitively impaired residents (p < 0.01). It was found that participants aged 55 - 69 were more the most interested to do video games (p < 0.05), though this may be interpreted as a positive step toward functional and cognitive rehabilitation program using virtual reality as a mean for intervention.展开更多
Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to depres...Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units （clusters） in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment （n = 295, 39%） were randomized to systematic medication review where the physician received support from peers （collegial mentoring） or were given care as usual （control condition）. Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group （n = 43, 32%） compared to control （n = 11, 10%）; Incidence Rate Ratio = 0.8, 95% CI = 0.7？0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values （mean 134 mmHg）. Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four （P = 0.031） and nine （P = 0.041）. Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.展开更多
The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidem...The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.展开更多
为解决当前电网通信背景流量生成方法在协议行为建模、时序依赖捕捉及流量类别控制等方面存在的不足,提出一种基于扩散模型和双向流特征(diffusion models and bidirectional flow,DMBF)的背景流量生成方法。通过改进的流量图像化表示(t...为解决当前电网通信背景流量生成方法在协议行为建模、时序依赖捕捉及流量类别控制等方面存在的不足,提出一种基于扩散模型和双向流特征(diffusion models and bidirectional flow,DMBF)的背景流量生成方法。通过改进的流量图像化表示(transforming basic flow data into an intuitive picture,FlowPic)机制提取具有方向性、时间性与包长耦合特征的双向会话图像,结合Transformer实现时序建模;引入条件控制机制为不同类别的流量设定生成比例;通过扩散模型生成背景流量。为验证方法的实用性与通用性,在包含公开流量和来源于实际网络环境的通信数据上进行实验,覆盖多个典型业务场景与交互模式。结果表明,DMBF在生成精度与分布一致性上优于传统生成对抗网络方法,JSD降至28.89%,MAE和RMSE分别为26.24%、30.91%。展开更多
Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Ph...Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.展开更多
BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints...BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.展开更多
文摘This paper focuses on the core challenges of the smart home enterprise ecological collaboration platform,and deeply discusses the absence of a governance mechanism and the inefficiency of the supply chain.The purpose is to improve the overall efficiency by constructing an effective collaborative governance framework and optimizing the supply chain process.It is found that the implementation of multi-agent dynamic contract governance,the construction of an open data sharing middle platform,the introduction of AI-driven elastic supply chain planning,and the establishment of a distributed cloud manufacturing network are the key paths.From the research conclusion,these measures can significantly improve the transparency of cross-agent collaboration,break the data barriers,and achieve the accurate matching of supply and demand,and finally promote the ecological collaboration efficiency of the smart home industry to achieve a substantial leap.
文摘Natural resource management is essential to sustain human well-being and the environment.Water and soil are two of the most important natural resources that require careful management.The western part of India faces multiple challenges,including climatic variability,soil degradation,water scarcity,deforestation,etc.The basin’s sub-watersheds are delineated and prioritised using the Soil and Water Assessment Tool(SWAT)and Sub Watershed Prioritization Tool(SWPT),respectively,using morphometric and topo-hydrological characteristics,and the sub-watersheds are further ranked using Weighted Sum Analysis(WSA).The findings indicate that SWS19,SWS18,SWS1,SWS17,SWS16,and SWS15,which are drained by the rivers Chambal,Kali Sindh,Mashi,Parbati,Parwan,and Beradi,are highly vulnerable sub-watersheds.By integrating remote sensing,GIS techniques,and quantitative morphometric analysis,parameters such as drainage density,stream frequency,bifurcation ratio,and slope gradient were evaluated.The analysis revealed critical sub-watersheds characterized by steep slopes,high drainage density,and poor vegetation cover,indicating their susceptibility to erosion and runoff.The findings underscore the necessity for targeted soil conservation measures,such as contour bunding,afforestation,and water retention structures.This study highlights the utility of geospatial tools for sustainable watershed management and provides a replicable framework for prioritizing sub-watersheds in similar regions.
文摘In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home(H2H)program that has been operating since 2017.In this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards.For the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.
文摘Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.
文摘Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objective of this study is to evaluate the safety and efficacy of a low energy pulsed-light device combined with galvanic energy, intended for home-use hair removal on dark skin. Materials and Methods: Fifteen women with skin types V and VI and dark terminal hair in axillaarea self-administrated 6 treatments at 2 week intervals, using a hand-held IPL combined with galvanicenergy device, using HPL (Home Pulsed Light) technology. Hair count and photographs were performed pre-treatment and 1 and 3 months after the last sixth treatment. Adverse events and subject satisfaction scores were recorded. Results: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. Hair counts were significantly reduced by 57.3% 1 month following last treatment and by 44.5% 3 months following last treatment. No adverse events were recorded. Subject satisfaction scores of the device usability and the treatment outcome were high. Conclusions: Low energy pulsed light combined with galvanic energy may be applied safely and effectively for at-home hair removal for people with dark skin types V and VI.
文摘Lack of engagement in activities is a common feature of nursing homes residents. As apathy is the most frequent behavioural disturbance, understanding residents’ interests is a milestone for tailored challenging interventions targeting engagement enhancement. Objective: To depict the activities interests of nursing homes residents. Method: An electronic version of the Test of Interest “TILT” which regroups 40 images of activities has been developed and adapted for the Ipad. Residents were asked to answer by yes or no to the question “are you interested by this activity”, for each activity found interesting, the patient had then to categorize it in either Work/ occupation-Personal-Leisure-Family. Population: A total of 601 residents from 19 nursing homes have completed the survey from March to May 2011. The surveyed nursing homes from the South East of France were comparable of nursing homes figures in France. Results: We interviewed 601 individuals (female, n = 484) aged 85.9 years, out of those, 56% had stayed more than one year in an institution. Nearly half of the population (45.3%) was from 80 - 89 year of age, followed by 36.1% from 90 - 99. The educational background was principally from primary school (36%) and high school (30.8%). Most of the residents were classified has having dementia (35.3%). From the 40 activities presented to each participant, “enjoying a good meal” has been found to be the most interesting activity by 83% of the population followed by “dressing up”, 75.9% and “watching TV”, 75.5%. Female participants reported more interest in place of worship, family pictures and being with grand children then males (p < 0.01). We found that the presence of “dementia” diagnosis” triggered the lack of interest compared to none demented or none cognitively impaired residents (p < 0.01). It was found that participants aged 55 - 69 were more the most interested to do video games (p < 0.05), though this may be interpreted as a positive step toward functional and cognitive rehabilitation program using virtual reality as a mean for intervention.
文摘Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units （clusters） in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment （n = 295, 39%） were randomized to systematic medication review where the physician received support from peers （collegial mentoring） or were given care as usual （control condition）. Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group （n = 43, 32%） compared to control （n = 11, 10%）; Incidence Rate Ratio = 0.8, 95% CI = 0.7？0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values （mean 134 mmHg）. Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four （P = 0.031） and nine （P = 0.041）. Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.
文摘The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.
文摘为解决当前电网通信背景流量生成方法在协议行为建模、时序依赖捕捉及流量类别控制等方面存在的不足,提出一种基于扩散模型和双向流特征(diffusion models and bidirectional flow,DMBF)的背景流量生成方法。通过改进的流量图像化表示(transforming basic flow data into an intuitive picture,FlowPic)机制提取具有方向性、时间性与包长耦合特征的双向会话图像,结合Transformer实现时序建模;引入条件控制机制为不同类别的流量设定生成比例;通过扩散模型生成背景流量。为验证方法的实用性与通用性,在包含公开流量和来源于实际网络环境的通信数据上进行实验,覆盖多个典型业务场景与交互模式。结果表明,DMBF在生成精度与分布一致性上优于传统生成对抗网络方法,JSD降至28.89%,MAE和RMSE分别为26.24%、30.91%。
基金funded by the Technology Development Board(TDB)of India's Ministry of Science and Technology(TDB/M-25/2018-19).
文摘Objective:To investigate the potential link between chromosomal polymorphisms in couples who had a medical history of idiopathic recurrent pregnancy loss.Methods:Cytogenetic investigation was conducted with mitogen(Phytohemagglutinin-M,Gibco)stimulated blood T lymphocytes by Giemsa trypsin Giemsa banding and Ag-NOR banding on 580 couples with a history of idiopathic recurrent pregnancy loss and 240 couples from the general population.Thirty good chromosomal spreads were captured,karyotyped,and analyzed.The karyotypes were designated using the International System for Human Cytogenomic Nomenclature 2024.Pearson Chi-square test was used to compare the frequency of chromosomal polymorphism variations in the idiopathic recurrent pregnancy loss group with the general population group.Results:A conventional cytogenetic investigation revealed that 45.43%of couples experiencing idiopathic recurrent pregnancy loss presented with various types of chromosomal polymorphic variants,compared to 11.88%in the general population.The overall frequency of these chromosomal polymorphic variants was significantly higher in the idiopathic recurrent pregnancy loss group compared to the general population group(OR 9.97,95%CI 6.99-14.21;P<0.05).Additionally,the prevalence of polymorphic variants was higher among males(49.14%)than females(41.72%)(P=0.01).Conclusions:Chromosomal polymorphic analysis may play a crucial role in the assessment and careful clinical management of cases with idiopathic recurrent pregnancy loss,especially when no other conclusive reasons are identified during the initial evaluation.Therefore,heteromorphism should not be overlooked while investigating the causes of idiopathic recurrent pregnancy loss.
文摘BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.
