The advent of blockchain technology can refine the concept of DTs by ensuring transparency, decentralized data storage, data immutability, and peer-to-peer communication in industrial sectors. A DT ...is an integrated multiphysics, multiscale, and probabilistic simulation, representation, and mirroring of a real-world physical component. The DTs help to visualize designs in 3D, perform tests and simulations virtually prior to creation of any physical component, and consequently play a vital role in sustaining and maintaining Industry 4.0. It is anticipated that DTs will become prevalent in the foreseeable future because they can be used for configuration, monitoring, diagnostics, and prognostics. This article envisages how blockchain can reshape and transform DTs to bring about secure manufacturing that guarantees traceability, compliance, authenticity, quality, and safety. We discuss several benefits of employing blockchain in DTs. We taxonomize the DTs literature based on key parameters (e.g., DTs levels, design phases, industrial use cases, key objectives, enabling technologies, and core applications). We provide insights into ongoing progress made towards DTs by presenting recent synergies and case studies. Finally, we discuss open challenges that serve as future research directions.
Aluminium (Al) toxicity is the most important soil constraint for plant growth and development in acid soils (pH < 5.5) globally in agricultural regions. Boron (B) is an essential micronutrient for ...the growth and development of higher plants. The results of previous studies propose that B might ameliorate Al toxicity; however, none of the studies have been conducted on trifoliate orange to study this effect. Thus, a study was carried out in hydroponics comprising of two different Al concentrations, 0 and 400 μM. For every concentration, two B treatments (0 and 10 μM as H3BO3) were applied to investigate the B-induced alleviation of Al toxicity and exploring the underneath mechanisms. The results revealed that Al toxicity under B deficiency severely hampered the root growth and physiology of plant, caused oxidative stress and membrane damage, leading to severe root injury and damage. However, application of B under Al toxicity improved the root elongation and photosynthesis, while reduced Al uptake and mobilization into plant parts. Moreover, B supply regulated the activities of antioxidant enzymes, proline, secondary metabolites (phenylalanine ammonia lyase and polyphenol oxidase) contents, and stabilized integrity of proteins. Our study results imply that B supply promoted root growth as well as defense system by reducing reactive oxygen species (ROS) and Al concentrations in plant parts thus B induced alleviation of Al toxicity; a fact that might be significant for higher productivity of agricultural plants grown in acidic conditions.
•Boron (B) supply improves root elongation under Al toxicity.•B supply eliminates oxidative stress and Al induced root cell injury by regulating antioxidant defense system.•The B-induced alleviation of Al toxicity might be associated with the reduced uptake of Al.
In this study, the spectral responses to drought stress of different parts in the leaf of oil palm seedlings named base, middle, and tip were investigated. The ability to detect stress even before ...symptoms emerge requires knowledge of which part of oil palm leaves responds more quickly to the stress. The analysis of the reflectance spectra in region 650-1050 nm was conducted on respective sections of the leaves of the oil palm seedlings. The analysis revealed that the stress affects the tip of the leaf, followed by the middle and then the base. It was noticed that the greatest loss of water and chlorophyll content was at the tip of the leaf. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) were used for clustering, while support vector machine (SVM) and linear discriminant analysis (LDA) were applied for categorization purposes. The outcomes of the PCA and HCA showed that the separation between the samples was based on the day and stress levels at respective sections of the leaf. With this, the possession of distinct morphological and physiological features by each part of the leaf can be concluded. From the PCA loadings, it was found that the regions 699-756 nm, 833-877 nm, and 933-958 nm showed noticeable bands and can be used to distinguish between the oil palm seedlings under stress. In addition, LDA and SVM classifiers demonstrated that the prediction accuracy of the stress level in oil palm seedlings was not influenced by the location in the leaf where the spectra were acquired.
Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI). Conservative treatments such as ...pelvic floor muscle training (PFMT), electrical stimulation and lifestyle changes can be undertaken to help manage the symptoms of UI.
To assess the effects of conservative interventions for managing urinary incontinence after prostate surgery.
We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings (searched 22 April 2022). We also searched the reference lists of relevant articles.
We included randomised controlled trials (RCTs) and quasi-RCTs of adult men (aged 18 or over) with UI following prostate surgery for treating prostate cancer or LUTS/BPO. We excluded cross-over and cluster-RCTs. We investigated the following key comparisons: PFMT plus biofeedback versus no treatment; sham treatment or verbal/written instructions; combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions; and electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions.
We extracted data using a pre-piloted form and assessed risk of bias using the Cochrane risk of bias tool. We used the GRADE approach to assess the certainty of outcomes and comparisons included in the summary of findings tables. We used an adapted version of GRADE to assess certainty in results where there was no single effect measurement available.
We identified 25 studies including a total of 3079 participants. Twenty-three studies assessed men who had previously undergone radical prostatectomy or radical retropubic prostatectomy, while only one study assessed men who had undergone transurethral resection of the prostate. One study did not report on previous surgery. Most studies were at high risk of bias for at least one domain. The certainty of evidence assessed using GRADE was mixed. PFMT plus biofeedback versus no treatment, sham treatment or verbal/written instructions Four studies reported on this comparison. PFMT plus biofeedback may result in greater subjective cure of incontinence from 6 to 12 months (1 study; n = 102; low-certainty evidence). However, men undertaking PFMT and biofeedback may be less likely to be objectively cured at from 6 to 12 months (2 studies; n = 269; low-certainty evidence). It is uncertain whether undertaking PFMT and biofeedback has an effect on surface or skin-related adverse events (1 study; n = 205; very low-certainty evidence) or muscle-related adverse events (1 study; n = 205; very low-certainty evidence). Condition-specific quality of life, participant adherence to the intervention and general quality of life were not reported by any study for this comparison. Combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions Eleven studies assessed this comparison. Combinations of conservative treatments may lead to little difference in the number of men being subjectively cured or improved of incontinence between 6 and 12 months (RR 0.97, 95% CI 0.79 to 1.19; 2 studies; n = 788; low-certainty evidence; in absolute terms: no treatment or sham arm: 307 per 1000 and intervention arm: 297 per 1000). Combinations of conservative treatments probably lead to little difference in condition-specific quality of life (MD -0.28, 95% CI -0.86 to 0.29; 2 studies; n = 788; moderate-certainty evidence) and probably little difference in general quality of life between 6 and 12 months (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; n = 742; moderate-certainty evidence). There is little difference between combinations of conservative treatments and control in terms of objective cure or improvement of incontinence between 6 and 12 months (MD 0.18, 95% CI -0.24 to 0.60; 2 studies; n = 565; high-certainty evidence). However, it is uncertain whether participant adherence to the intervention between 6 and 12 months is increased for those undertaking combinations of conservative treatments (RR 2.08, 95% CI 0.78 to 5.56; 2 studies; n = 763; very low-certainty evidence; in absolute terms: no intervention or sham arm: 172 per 1000 and intervention arm: 358 per 1000). There is probably no difference between combinations and control in terms of the number of men experiencing surface or skin-related adverse events (2 studies; n = 853; moderate-certainty evidence), but it is uncertain whether combinations of treatments lead to more men experiencing muscle-related adverse events (RR 2.92, 95% CI 0.31 to 27.41; 2 studies; n = 136; very low-certainty evidence; in absolute terms: 0 per 1000 for both arms). Electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions We did not identify any studies for this comparison that reported on our key outcomes of interest.
Despite a total of 25 trials, the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain. Existing trials are typically small with methodological flaws. These issues are compounded by a lack of standardisation of the PFMT technique and marked variations in protocol concerning combinations of conservative treatments. Adverse events following conservative treatment are often poorly documented and incompletely described. Hence, there is a need for large, high-quality, adequately powered, randomised control trials with robust methodology to address this subject.
The optimal treatment for men with high-risk localized or locally advanced prostate cancer (PCa) remains unknown.
To perform a systematic review of the existing literature on the effectiveness of the ...different primary treatment modalities for high-risk localized and locally advanced PCa. The primary oncological outcome is the development of distant metastases at ≥5 yr of follow-up. Secondary oncological outcomes are PCa-specific mortality, overall mortality, biochemical recurrence, and need for salvage treatment with ≥5 yr of follow-up. Nononcological outcomes are quality of life (QoL), functional outcomes, and treatment-related side effects reported.
Medline, Medline In-Process, Embase, and the Cochrane Central Register of Randomized Controlled Trials were searched. All comparative (randomized and nonrandomized) studies published between January 2000 and May 2019 with at least 50 participants in each arm were included. Studies reporting on high-risk localized PCa (International Society of Urologic Pathologists ISUP grade 4–5 Gleason score {GS} 8–10 or prostate-specific antigen PSA >20 ng/ml or ≥ cT2c) and/or locally advanced PCa (any PSA, cT3–4 or cN+, any ISUP grade/GS) or where subanalyses were performed on either group were included. The following primary local treatments were mandated: radical prostatectomy (RP), external beam radiotherapy (EBRT) (≥64 Gy), brachytherapy (BT), or multimodality treatment combining any of the local treatments above (±any systemic treatment). Risk of bias (RoB) and confounding factors were assessed for each study. A narrative synthesis was performed.
Overall, 90 studies met the inclusion criteria. RoB and confounding factors revealed high RoB for selection, performance, and detection bias, and low RoB for correction of initial PSA and biopsy GS. When comparing RP with EBRT, retrospective series suggested an advantage for RP, although with a low level of evidence. Both RT and RP should be seen as part of a multimodal treatment plan with possible addition of (postoperative) RT and/or androgen deprivation therapy (ADT), respectively. High levels of evidence exist for EBRT treatment, with several randomized clinical trials showing superior outcome for adding long-term ADT or BT to EBRT. No clear cutoff can be proposed for RT dose, but higher RT doses by means of dose escalation schemes result in an improved biochemical control. Twenty studies reported data on QoL, with RP resulting mainly in genitourinary toxicity and sexual dysfunction, and EBRT in bowel problems.
Based on the results of this systematic review, both RP as part of multimodal treatment and EBRT + long-term ADT can be recommended as primary treatment in high-risk and locally advanced PCa. For high-risk PCa, EBRT + BT can also be offered despite more grade 3 toxicity. Interestingly, for selected patients, for example, those with higher comorbidity, a shorter duration of ADT might be an option. For locally advanced PCa, EBRT + BT shows promising result but still needs further validation. In this setting, it is important that patients are aware that the offered therapy will most likely be in the context a multimodality treatment plan. In particular, if radiation is used, the combination of local with systemic treatment provides the best outcome, provided the patient is fit enough to receive both. Until the results of the SPCG15 trial are known, the optimal local treatment remains a matter of debate. Patients should at all times be fully informed about all available options, and the likelihood of a multimodal approach including the potential side effects of both local and systemic treatment.
We reviewed the literature to see whether the evidence from clinical studies would tell us the best way of curing men with aggressive prostate cancer that had not spread to other parts of the body such as lymph glands or bones. Based on the results of this systematic review, there is good evidence that both surgery and radiation therapy are good treatment options, in terms of prolonging life and preserving quality of life, provided they are combined with other treatments. In the case of surgery this means including radiotherapy (RT), and in the case of RT this means either hormonal therapy or combined RT and brachytherapy.
High-risk and locally advanced prostate cancer (PCa) patients are likely to undergo multimodality treatment. Patients should at all times be fully informed about all available options and the likelihood of a multimodal approach, including the potential side effects of both local and systemic treatment.
For high-risk localized and locally advanced PCa, both radical prostatectomy as part as multimodal therapy and external beam radiotherapy (EBRT) + long-term androgen deprivation therapy (ADT) can be recommended as primary treatment.
For high-risk localized PCa, EBRT + BT can also be offered despite a less favorable toxicity profile. In selected high-risk PCa patients, a shorter duration of ADT might be considered.
Until the results of the SPCG15 trial are known, the optimal local treatment remains a matter of debate.
In this article, a novel maximum power point tracking (MPPT) controller for the fast-changing irradiance of photovoltaic (PV) systems is introduced. Our technique utilizes a modified incremental ...conductance (IC) algorithm for the efficient and fast tracking of MPP. The proposed system has a simple implementation, fast tracking, and achieved steady-state oscillation. Traditional MPPT techniques use a tradeoff between steady-state and transition-state parameters. The shortfalls of various techniques are studied. A comprehensive comparative study is done to test various existing techniques against the proposed technique. The common parameters discussed in this study are fast convergence, efficiency, and reduced oscillations. The proposed method successfully addresses these issues and improves the results significantly by using a proportional integral deferential (PID) controller with a genetic algorithm (GA) to predict the variable step size of the IC-based MPPT technique. The system is designed and tested against the perturbation and observation (P&O)-based MPPT technique. Our technique effectively detects global maxima (GM) for fast-changing irradiance due to the adopted GA-based tuning of the controller. A comparative analysis of the results proves the superior performance and capabilities to track GM in fewer iterations.
Distribution networks are facing new challenges with the emergence of smart grids, such as capacity limitations, voltage instability, and many others. These challenges can potentially lead to ...brownouts and blackouts. This paper presents an innovative technique for optimal siting and sizing of distributed generators (DGs) in radial distribution networks (RDNs). The proposed technique uses a novel algorithm that combines improved grey wolf optimization with particle swarm optimization (I-GWOPSO) by incorporating dimension learning-based hunting (DLH). The proposed I-GWOPSO employs a novel aspect of DLH to reduce the gap between local and global searches to maintain a balance. The main optimization objectives aim to optimally site and size the DG with minimization of active power loss, voltage deviation, and improvement of voltage stability in RDNs. Case studies are simulated with IEEE 33-bus and IEEE 69-bus test systems, for the optimal allocation of DG units by considering various power factors. The results validate the efficacy of the proposed algorithm with a significant reduction in real power loss (up to 98.1%), improvement in voltage profile, and optimal reduced cost of DG operation with optimal sizing across all considered cases. A comparative analysis of the proposed approach with existing literature validates the improved performance of the proposed algorithm.
Schiff base ligand 2,2-{benzene-1,4-diylbis(E)methylylidene(1E,2E)hydrazine-2,1-diylidene(E)methylidene}diphenol (H2-BHMD) was synthesized by reacting together the ortho vaniline and ...1,4-bis(hydrazonomethyl)benzene. It was characterized by analytical and spectroscopic techniques including 1H-NMR, elemental analysis, FT-IR, and UV-Visible studies. Different transition metal ions like Co (II), Ni (II), Cu (II) and Zn (II) were reacted with well characterized ligand to obtain the metal derivatives. AAS, elemental analysis, FT-IR, molar conductance and UV-Visible methods were used to study the metal complexes. The analytical and spectroscopic technique suggested the formation of coordination polymers. The FT-IR results confirmed the bidentate binding of the ligand involving phenolic oxygen and azomethine nitrogen. The UV-visible studies suggested the formation of distorted square planar geometries for all the metal complexes. Hydrazone Schiff bases are known for their antioxidant activity, therefore the synthesized hydrazone and the corresponding metal complexes were also studied for their antioxidant capabilities utilizing DPPH free radicals. Among all complexes, the Co-BHMD demonstrated noteworthy percent hindrance to the free radicals, yet much lower than the standard medication utilized. The metal subsidiaries were likewise studied for their thermal degradation. The respective TG bands were utilized for dynamic and thermodynamic parameters estimation utilizing Horowitz-Metzger strategy.
Purpose
The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for ...surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management.
Methods
A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs.
Results
The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points).
Conclusion
The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk.
Urinary incontinence in women is a distressing condition that restricts quality of life and results in a large economic burden to both the NHS and women themselves.
To evaluate the clinical ...effectiveness, safety and cost-effectiveness of surgical treatment for stress urinary incontinence (SUI) in women and explore women's preferences.
An evidence synthesis, a discrete choice experiment (DCE) and an economic decision model, with a value-of-information (VOI) analysis. Nine surgical interventions were compared. Previous Cochrane reviews for each were identified and updated to include additional studies. Systematic review methods were applied. The outcomes of interest were 'cure' and 'improvement'. Both a pairwise and a network meta-analysis (NMA) were conducted for all available surgical comparisons. A DCE was undertaken to assess the preferences of women for treatment outcomes. An economic model assessed the cost-effectiveness of alternative surgeries and a VOI analysis was undertaken.
Data from 175 studies were included in the effectiveness review. The majority of included studies were rated as being at high or unclear risk of bias across all risk-of-bias domains. The NMA, which included 120 studies that reported data on 'cure' or 'improvement', showed that retropubic mid-urethral sling (MUS), transobturator MUS, traditional sling and open colposuspension were more effective than other surgical procedures for both primary outcomes. The results for other interventions were variable. In general, rate of tape and mesh exposure was higher after transobturator MUS than after retropubic MUS or single-incision sling, whereas the rate of tape or mesh erosion/extrusion was similar between transobturator MUS and retropubic MUS. The results of the DCE, in which 789 women completed an anonymous online questionnaire, indicate that women tend to prefer surgical treatments associated with no pain or mild chronic pain and shorter length of hospital stay as well as those treatments that have a smaller risk for urinary symptoms to reoccur after surgery. The cost-effectiveness results suggest that, over a lifetime, retropubic MUS is, on average, the least costly and most effective surgery. However, the high level of uncertainty makes robust estimates difficult to ascertain. The VOI analysis highlighted that further research around the incidence rates of complications would be of most value.
Overall, the quality of the clinical evidence was low, with limited data available for the assessment of complications. Furthermore, there is a lack of robust evidence and significant uncertainty around some parameters in the economic modelling.
To our knowledge, this is the most comprehensive assessment of published evidence for the treatment of SUI. There is some evidence that retropubic MUS, transobturator MUS and traditional sling are effective in the short to medium term and that retropubic MUS is cost-effective in the medium to long term. The VOI analysis highlights the value of further research to reduce the uncertainty around the incidence rates of complications. There is a need to obtain robust clinical data in future work, particularly around long-term complication rates.
This study is registered as PROSPERO CRD42016049339.
The National Institute for Health Research Health Technology Assessment programme.
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