Complications are common after surgery, highlighting the need for innovations that reduce postsurgical morbidity and mortality. In this report, we describe the design, development, and implementation ...of an Enhanced Recovery After Surgery program in the Kaiser Permanente Northern California integrated health care delivery system. This program was implemented and disseminated in 2014, targeting patients who underwent elective colorectal resection and those who underwent emergent hip fracture repair across 20 Medical Centers. The program leveraged multidisciplinary and broad-based leadership, high-quality data and analytic infrastructure, patient-centered education, and regional-local mentorship alignment. This program has already had an impact on more than 17,000 patients in Northern California. It is now in its fourth phase of planning and implementation, expanding Enhanced Recovery pathways to all surgical patients across Kaiser Permanente Northern California.
The reaction characteristics of switchgrass conversion in subcritical water were investigated using a batch reactor under conditions of rapid rising to 250–350 °C and pressure of 20 MPa, with ...reaction times varying from 1–300 s. The effects of temperature and reaction time on product distribution and yields of chemical products were investigated. High conversion of switchgrass (90 wt.% on dry biomass basis) can be obtained in less than 60 s under a relative lower reaction temperature of 350 °C, compared with that in a switchgrass flash pyrolysis process where switchgrass conversion achieves only 58.9–78.8 wt.% in temperature range of 450–550 °C. The yield of water solubles (WS) can reach 37 wt.% after reaction for 1 s at 250 °C. The increases in temperature and reaction time lead to increases of the biomass conversion and the yield of gas, while WS yield decreases by secondary decomposition reactions. Many lignin-derived compounds were identified by GC-MS analysis and could well be recovered in methanol solubles (MS). Scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR) analysis of methanol insolubles (MI) indicated that the lignocellulosic matrix could be significantly decomposed, and no char formation was observed, while many lignin structures were left in the MI products. These results provide important information for recovering value-added chemicals from energy crops and biomass waste.
Objectives. To (1) compare the bone strength, lower limb muscular strength, functional balance performance, and balance self-efficacy between Ving Tsun (VT) martial art practitioners and ...nonpractitioners and (2) identify the associations between lower limb muscular strength, functional balance performance, and balance self-efficacy among the VT-trained participants. Methods. Thirty-five VT practitioners (mean age ± SD = 62.7 ± 13.3 years) and 49 nonpractitioners (mean age ± SD = 65.9 ± 10.5 years) participated in the study. The bone strength of the distal radius, lower limb muscular strength, functional balance performance, and balance self-efficacy were assessed using an ultrasound bone sonometer, the five times sit-to-stand test (FTSTS), the Berg balance scale (BBS), and the Chinese version of the activities-specific balance confidence scale, respectively. A multivariate analysis of covariance was performed to compare all the outcome variables between the two groups. Results. Elderly VT practitioners had higher radial bone strength on the dominant side ( P < 0.05 ) , greater lower limb muscular strength ( P = 0.001 ) , better functional balance performance ( P = 0.003 ) , and greater balance confidence ( P < 0.001 ) than the nonpractitioners. Additionally, only the FTSTS time revealed a significant association with the BBS score ( r = - 0.575 , P = 0.013 ) . Conclusions. VT may be a suitable health-maintenance exercise for the elderly. Our findings may inspire the development of VT fall-prevention exercises for the community-dwelling healthy elderly.
Postgraduate medical education in Singapore underwent a major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American ...system. We aimed to identify the relative importance of factors influencing the choice of sponsoring institution (SI) for residency among medical students during this transition period.
A questionnaire-based cross-sectional study of Singapore undergraduate medical students across all years of study was performed in 2011. Participants rated the degree of importance of 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) to their choice of SIs on a five-point Likert scale. Differences in gender and seniority were compared.
705 out of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SI (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and a positive working environment. Preclinical students rated research and marketing aspects more highly, while clinical students valued a positive working environment more.
Quality of education, mentorship, experiences during clerkship and a positive working environment were the most important factors influencing the choice of SI.
Blood-based biomarkers (liquid biopsy) are increasingly used in precision oncology. Yet, little is known about cancer patients' perspectives in clinical practice. We explored patients' depth of ...preferences for liquid vs tissue biopsies and knowledge regarding the role of blood biomarkers on their cancer.
Three interviewer-administered trade-off scenarios and a 54-item self-administered questionnaire were completed by cancer outpatients across all disease sites at the Princess Margaret Cancer Centre.
Of 413 patients, 54% were female; median age was 61 (range 18-101) years. In trade-off scenario preference testing, 90% (n=372) preferred liquid over tissue biopsy at baseline; when wait times for their preferred test were increased from 2 weeks, patients tolerated an additional mean of 1.8 weeks (SD 2.1) for liquid biopsy before switching to tissue biopsy (with wait time 2 weeks). Patients also tolerated a 6.2% decrease (SD 8.8) in the chance that their preferred test would conclusively determine optimal treatment before switching from the baseline of 80%. 216 patients (58%) preferred liquid biopsy even with no chance of adverse events from tissue biopsy. Patients' knowledge of blood-based biomarkers related to their cancer was low (mean 23%); however, the majority viewed development of blood biomarkers as important.
Patients had limited understanding of cancer-specific blood-based biomarkers, but 90% preferred liquid over tissue biopsies to assess biomarkers. There was little tolerance to wait longer for results, or for decreased test-conclusiveness. Developing accurate, low-risk tests for cancer diagnosis and management for blood biomarkers is therefore desirable to patients.
The ErbB2 (Her2/neu epidermal growth receptor family) oncogene is overexpressed in 30% to 40% of human breast cancers. Cyclin D1 is the regulatory subunit of the holoenzyme that phosphorylates and ...inactivates the retinoblastoma (pRb) tumor suppressor and is an essential downstream target of ErbB2‐induced tumor growth. Herein, we demonstrate that ErbB2 induces the activity of the Notch signaling pathway. ErbB2 induction of DNA synthesis, contact‐independent growth, and mammosphere induction required Notch1. ErbB2‐induced cyclin D1 and cyclin D1 expression was suficient to induce Notch1 activity, and conversely, genetic deletion of Notch1 in mammary epithelial cells using foxed Notch (Notchfl/fl) mice demonstrated that cyclin D1 is induced by Notch1. Genetic deletion of cyclin D1 or small interfering RNA (siRNA) to cyclin D1‐reduced Notch1 activity and reintroduction of cyclin D1 into cyclin D1‐deficient cells restored Notch1 activity through the inhibition of Numb, an endogenous inhibitor of Notch1 activity. Thus, cyclin D1 functions downstream as a genetic target of Notch1, amplifies Notch1 activity by repressing Numb, and identifies a novel pathway by which ErbB2 induces Notch1 activity via the induction of cyclin D1.
(abridged)Photometric redshifts for AGN (galaxies hosting an accreting supermassive black hole in their center) are notoriously challenging and currently better computed via SED fitting, assuming ...that deep photometry for many wavelengths is available. However, for AGN detected all-sky, the photometry is limited and provided by different projects. This makes the task of homogenising the data challenging and is a dramatic drawback for the millions of AGN that wide surveys like SRG/eROSITA will detect. This work aims to compute reliable photometric redshifts for X-ray-detected AGN using only one dataset that covers a large area: the 10th Data Release of the Imaging Legacy Survey (LS10) for DESI. LS10 provides deep grizW1-W4 forced photometry within various apertures, thus avoids issues related to the cross-calibration of surveys. We present the results from CircleZ, a machine-learning algorithm based on a Fully Connected Neural Network. CircleZ uses training sample of 14,000 X-ray-detected AGN and utilizes multi-aperture photometry. The accuracy and the fraction of outliers reached in a test sample of 2913 AGN are 0.067 and 11.6%, respectively. The results are comparable to or better than those obtained previously for the same field but with much less effort. We further tested the stability of the results by computing the photometric redshifts for the sources detected in CSC2 and Chandra-COSMOS Legacy, reaching comparable accuracy as in eFEDS when limiting the magnitude of the counterparts with respect to the depth of LS10. The method applies to fainter samples of AGN using deeper optical data from future surveys (e.g., LSST, Euclid), granted LS10-like information on the light distribution beyond a morphological type is provided. With the paper, we release an updated version of the photometric redshifts (including errors and probability distribution function) for eROSITA/eFEDS.
Ocular ischemia and inflammation are two major factors which induce retinal degeneration. Treatment of these diseases has been difficult, though numerous agents have been tried. Natural products ...could be a good field to venture into because various medicinal plants have been used for centuries to treat circulation stasis, inflammation, visual disturbances, and eyesight failure. Tetramethyl-pyrazine, coumarin, methyl tyramine, rescinnamine, apocynin, and hesperetin are some natural products isolated from Chinese herbs for improving ocular blood flow, particularly in the choroid and retina. For ocular inflammation, at least a dozen natural products are reviewed in this article. Among those, matrine, tetrandrine and osthole draw particular attention, because they are effective mainly as interleukin-1 blockers, but not as arachidonate blockers. As a result, these agents are potent anti-inflammatory agents and are even more potent than the prototype corticosteroid, prednisolone. It is hoped that all aforementioned agents can be used to treat retinopathies resulting from ocular ischemia and/or ocular inflammation. Scoparone, corylifolinin, epigallocatechin-3-0-gallate, esculetin, and lespedezaflavanone A are some natural products which can improve retinal functions measured with electroretinogram's b-wave recovery. Further research should be carried out to relate natural products which can improve ocular blood flow and inflammation to retinal function and vice versa.
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