Half of methadone maintenance treatment (MMT) participants experience a tapering phase, however, the guidelines vary from country to country and lack individualized strategies based on relapse risk. ...A detailed and individualized tapering strategy is needed in China. This study aims to explore dose tapering strategies for Chinese individuals with different relapse risks.
A retrospective study was conducted from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 549 participants. The end point was the first relapse within 12 months of the start of tapering. Relapse risks before tapering for each participant were determined from a Cox model.
Out of 549 participants, 173 (31.5 %) relapsed within 12 months after tapering. Findings indicated that a taper dose of less than 5 mg/week is better than other taper doses. Subpopulation treatment effect pattern plot (STEPP) methodology revealed different tapering strategies benefit participants according to relapse risk before tapering. Overall, findings indicated that a less than 5 mg/week reduction in MMT dose is better than reductions of other amounts. For participants with a low relapse risk before tapering, a reduction of less than 2.5 mg/week in MMT dose is better than a 2.5–5 mg/week reduction.
A taper dose of less than 5 mg/week appears to be the best dose tapering strategy for Chinese participants. Furthermore, for participants with a low relapse risk, a more gradual taper dose (less than 2.5 mg/week) works better than 2.5–5 mg/week. This benefit was not seen in participants with a high relapse risk before tapering.
•The study focused on relapse risk and individualized tapering strategy for methadone maintenance treatment.•The benefits of different dose tapering strategies vary depending on the participant's relapse risk.•Benefits vary in dose tapering strategies for participants with different relapse risks.•For participants with low relapse risk, a more gradual taper dose (less than 2.5 mg/week) works better than 2.5–5 mg/week.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We investigate taper tapping in three types of single-mode fibers using simulations and experiments: Standard single-mode fiber (SMF), bend-resistant single-mode fiber (BR-SMF) with a shallow index ...trench, and bend-insensitive single-mode fiber (BI-SMF) with a deep index trench. Both trench-assisted fibers demonstrate a larger mode field expansion than the standard single-mode fiber, making them more susceptible to taper-tapping than standard single-mode fibers. Tapering both SSMF and BR-SMF fibers to as little as 25μm diameter results in a high information extraction efficiency for an eavesdropper (≥−20 dB) while maintaining low loss for the legitimate channel (≤1 dB), underlining the vulnerability of all fiber types to taper tapping. We also use optical time-domain reflectometry (OTDR) to identify changes in the fiber before and after tapering. Changes in the back reflected power of ≤0.5 dB and ≤0.25 dB are observed in 25μm tapers in SMF and BR-SMF respectively.
This brief presents the development of an <inline-formula> <tex-math notation="LaTeX">{E} </tex-math></inline-formula>-band (71-76 GHz) continuous wave (CW) space traveling wave tube (TWT) with ...substantial performance improvement. This tube was designed using modified folded waveguide (FWG) and dynamic phase velocity tapering (DVT) circuits, together with four-stage depressed collectors made of graphite. Based on calculation and simulation data, a prototype <inline-formula> <tex-math notation="LaTeX">{E} </tex-math></inline-formula>-band space TWT was fabricated, with the testing conducted at a relatively lower beam voltage of 14.1 kV and current of 70.3 mA. The test results show the prototype is capable of providing output power up to 106 W, gain of 41 dB and overall efficiency of 52%, at 71-76 GHz. It is also found within the 5 GHz bandwidth, the electronic efficiency is over 10.6%, while a maximum saturated output power reaches 122 W, with a corresponding overall efficiency of 55%. Given the above data, attained at the relatively lowered operating voltage and current, it is believed the overall performance of this <inline-formula> <tex-math notation="LaTeX">{E} </tex-math></inline-formula>-band TWT exhibits a substantial improvement as compared to those of the reported similar tubes.
Sidelobes (SLs) in the two-way radiation pattern are of serious concern in a radar array. Several techniques have evolved to mitigate the problem, which include amplitude tapering, genetic algorithm ...(GA) optimization, thinning transceiver aperture, and two-weight amplitude distribution. With such optimization schemes, the SLs can be considerably suppressed but at the cost of a reduction in directivity or taper efficiency. Furthermore, such amplitude tapers require a complex feeding network design. This work alleviates such design restrictions and proposes a systematic approach to lower the SLs in radar two-way shared aperture arrays. The proposed methodology can achieve an SL level (SLL) of below −52 dB in both linear and planar arrays, which is about 18 dB enhancement in SLL compared with uniform transmit and thinned receive arrays. In addition, as a result of the equal transceiver array size in the proposed design, an improvement of approximately 0.44 dB and 0.68 dB in directivity is achieved in linear and planar arrays, respectively. A novel feeding architecture is also illustrated to reduce the cost and complexity of the overall feeding network. A set of full-wave simulations have also been performed to validate the theoretical results.
Abstract
Objectives
To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA.
Methods
Using semi-structured interview guides, we conducted individual interviews and ...focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists.
Results
We recruited 28 adult patients with RA (64% women; disease duration 1–54 y) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to ‘recapture’ the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration and current life roles. Rheumatologists’ perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision-making (SDM) and close monitoring during tapering, with ready access to their health-care team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients.
Conclusion
The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.
Overcoming the noise in neural computing Aimone, James B; Agarwal, Sapan
Science (American Association for the Advancement of Science),
2024-Feb-23, 2024-02-23, 20240223, Volume:
383, Issue:
6685
Journal Article
Peer reviewed
Circuit strategies can enable noisy analog hardware to achieve high precision.
Abstract The venturi effect can be used to control the fluid pressure at different locations in the pipe, and the pressure difference generated based on this principle can push the piston inside the ...hydraulic impactor up and down to impact the drilling tool, thus expanding the use of coiled tubing and improving the efficiency of drilling. In this paper, the effects of several different necking sizes, tapering angles and diffusion angles on the flow field state and pressure control performance inside the venturi are studied, and the influence laws are analyzed by using Fluent finite element software, and the effects are verified by numerical simulation. The related research have a great significance to the selection of venturi structure size, and it also provides the theoretical basis for the optimization of the structure parameters of the hydraulic impactor.
Background
The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining ...the correct diagnosis of hair loss presentations.
Objective
Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns.
Methods
Thirty‐nine studies were eligible for the quantitative analysis. Meta‐analysis and subgroup analysis were performed.
Results
Thirty‐nine studies (29 cross‐sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs.
Conclusion
There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Pemphigus consists of a group of rare and severe autoimmune blistering diseases mediated by pathogenic autoantibodies mainly directed against two desmosomal adhesion proteins, desmoglein (Dsg)1 and ...Dsg3 (also known as DG1 and DG3), which are present in the skin and surface-close mucosae. The binding of autoantibodies to Dsg proteins induces a separation of neighbouring keratinocytes, in a process known as acantholysis. The two main pemphigus variants are pemphigus vulgaris, which often originates with painful oral erosions, and pemphigus foliaceus, which is characterised by exclusive skin lesions. Pemphigus is diagnosed on the basis of either IgG or complement component 3 deposits (or both) at the keratinocyte cell membrane, detected by direct immunofluorescence microscopy of a perilesional biopsy, with serum anti-Dsg1 or anti-Dsg3 antibodies (or both) detected by ELISA. Corticosteroids are the therapeutic mainstay, which have recently been complemented by the anti-CD20 antibody rituximab in moderate and severe disease. Rituximab induces complete remission off therapy in 90% of patients, despite rapid tapering of corticosteroids, thus allowing for a major corticosteroid-sparing effect and a halved number of adverse events related to corticosteroids.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
