Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.

Pediatric restrictive cardiomyopathy due to a heterozygous mutation of the TNNI3 gene

Pediatric restrictive cardiomyopathy is rare and most commonly idiopathic in origin. Here, we applied a candi- date gene approach and identified a missense mutation in the cardiac troponin I gene in a 12-year-old Chinese girl with restrictive cardiomyopathy. This study indicates that mutation in sarcomere protein genes may play an im- portant role in idiopathic pediatric restrictive cardiomyopathy.

Restrictive Cardiomyopathy Resulting from a Troponin Ⅰ Type 3 Mutation in a Chinese Family

Objective To identify the pathogenic variant responsible for restrictive cardiomyopathy （RCM） in aChinese family.Methods Next generation sequencing was used for detecting the mutation and results verified bysequencing. We used restriction enzyme digestion to test the mutation in the family members and 200 unrelatednormal subjects without any cardiac inherited diseases when the mutation was identified.Results Five individuals died from cardiac diseases, two of whom suffered from sudden cardiacdeath. Two individuals have suffered from chronic cardiac disorders. Mutation analysis revealed a novelmissense mutation in exon 7 of troponin I type 3 （TNNI3）, resulting in substitution of serine （S） withproline （P） at amino acid position 150, which cosegregated with the disease in the family, which is predictedto be probably damaging using PolyPhen-2. The mutation was not detected in the 200 unrelated subjectswe tested.Conclusion Using next generation sequencing, which has very recently been shown to be successfulin identifying novel causative mutations of rare Mendelian disorders, we found a novel mutation of TNNI3 in aChinese family with RCM.

Quantification and control of restrictive ecological factors in acidogenic de-sulfate bioreactor

As an artificial microbial ecosystem, acidogenic de sulfate bioreactor has high efficiency of sulfate removal. The restrictive ecological factors, including causing ecological factors, such as COD/SO 4 2- ratio and sulfate loading rate (Ns), and following ecological factors, such as pH value, oxidation reduction potential (ORP) and alkalinity (ALK) have significant effect on the ability and stability of acidogenic de sulfate bio reactor. Continuous flow and batch test were carried out to investigate the quantification and control of COD/SO 4 2- ratio, Ns, pH value, ORP and ALK in acidogenic de sulfate bioreactor supplied with molasses wastewater as sole organic carbon source and sodium sulfate as electron donor. It was demonstrated that In order to maintain high sulfate removal rate (SRR) of 80% to 90%, the restrictive factors should meet all the requirement as follows: k COD/ SO 4 2-  ratio≥2.0, Ns≤7.5 kg (m 3·d) -1 ,pH=5.7～6.2,ORP=-320～-420 mV and  ALK= 1 500～2 000 mg/L.

Insights into restrictive cardiomyopathy from clinical and animal studies

Cardiomyopathies are diseases that primarily affect the myocardium, leading to serious cardiac dysfunction and heart failure. Out of the three major categories of cardiomyopathies （hypertrophic, dilated and restrictive）, restrictive cardiomyopathy （RCM） is less common and also the least studied. However, the prognosis for RCM is poor as some patients dying in their childhood. The molecular mechanisms behind the disease development and progression are not very clear and the treatment of RCM is very difficult and often ineffective. In this article, we reviewed the recent progress in RCM research from the clinical studies and the translational studies done on diseased transgenic animal models. This will help for a better understanding of the mechanisms underlying the etiology and development of RCM and for the design of better treatments for the disease.

Physiological response of flag leaf and yield formation of winter wheat under different spring restrictive irrigation regimes in the Haihe Plain,China

In order to identify the optimum period of spring water-restrictive irrigation for winter wheat(Triticum aestivum L.)in the Haihe Plain,China and elucidate its effects on flag leaf senescence and yield formation,field experiments were conducted at the Xinji Experimental Station of Hebei Agricultural University from 2016 to 2019 by using different irrigation regimes in spring,including the conventional regime involving two irrigation periods(control(CK),the 3-leaf unfolding stage and the anthesis stage)and a series of single,restrictive irrigation regimes(SRI)comprising irrigation at the 3-leaf unfolding stage(3 LI),4 LI,5 LI,and 6 LI.There are five major findings:(1)The senescence(determined by the green leaf area,GLA)in the 4 LI treatment occurred moderately earlier than that in CK,showed no significant difference with that in 5 LI and 6 LI,and occurred significantly later than that in 3 LI.(2)Compared with other SRI treatments,the GLA value and photosynthetic rate in 4 LI were 14.82 and 20.1%higher,respectively.Microstructural analysis of flag leaf also revealed that the mesophyll cells and chloroplasts were irregularly arranged under drought stress in 3 LI and 6 LI;however,drought stress had minimal negative effects on the microstructure in 4 LI and 5 LI.(3)Postponed irrigation in spring could significantly increase superoxide dismutase(SOD)and catalase(CAT)activities in the early stage of grain filling;however,these activities would subsequently decrease.Among the four SRI treatments,the overall enzyme activities were the highest in 4 LI,and the combined malondialdehyde(MDA)content in flag leaves in 4 LI and 5 LI was 14.5%lower on average than that in 3 LI and 6 LI.(4)The soluble sugar(SS)and proline(Pro)contents in 4 LI were the highest among the four SRI treatments;however,they were lower than those in CK.The abscisic acid(ABA)hormone content in 4 LI and 5 LI was lower than that in 3 LI and 6 LI,respectively,suggesting a smaller drought stress effect in 4 LI and 5 LI.(5)In two growing seasons,there was a larger number of spikes per unit area in 4 LI(i.e.,13.4%higher than that in 5 LI and 6 LI)and the 1000-grain weight in 4 LI was the highest among the four SRI treatments(i.e.,6.0%higher than that in the other three SRI treatments).Therefore,a single restrictive irrigation regime at the 4-leaf unfolding stage is recommended to be effective in slowing down the senescence process of flag leaves and achieving high yield.

Model identification with BPNN on restrictive ecological factors of SRB for sulfate-reduction

The model of back-propagation neural network (BPNN) was presented to demonstrate the effect of restrictive ecological factors, COD/SO 4 2- ratio, pH value, alkalinity (ALK) and SO 4 2- loading rate (Ns), on sulfate reduction of Sulfate Reducing Bacteria (SRB) in an acidogenic sulfate reducing reactor supplied with molasses as sole organic carbon source and sodium sulfate as electron acceptor. The compare of experimental results and computer simulation was also discussed. It was shown that the method of BPNN had a powerful ability to analyze the ecological characteristic of acidogenic sulfate reducing ecosystem quantitatively.

Terrain Rendering LOD Algorithm Based on Improved Restrictive Quadtree Segmentation and Variation Coefficient of Elevation

Aiming to deal with the difficult issues of terrain data model simplification and crack disposal,the paper proposed an improved level of detail(LOD)terrain rendering algorithm,in which a variation coefficient of elevation is introduced to express the undulation of topography.Then the coefficient is used to construct a node evaluation function in the terrain data model simplification step.Furthermore,an edge reduction strategy is combined with the improved restrictive quadtree segmentation to handle the crack problem.The experiment results demonstrated that the proposed method can reduce the amount of rendering triangles and enhance the rendering speed on the premise of ensuring the rendering effect compared with a traditional LOD algorithm.

Efficient Virtual Network Embedding Algorithm Based on Restrictive Selection and Optimization Theory Approach

Network virtualization(NV) is widely considered as a key component of the future network and promises to allow multiple virtual networks(VNs) with different protocols to coexist on a shared substrate network(SN). One main challenge in NV is virtual network embedding(VNE). VNE is a NPhard problem. Previous VNE algorithms in the literature are mostly heuristic, while the remaining algorithms are exact. Heuristic algorithms aim to find a feasible embedding of each VN, not optimal or sub-optimal, in polynomial time. Though presenting the optimal or sub-optimal embedding per VN, exact algorithms are too time-consuming in smallscaled networks, not to mention moderately sized networks. To make a trade-off between the heuristic and the exact, this paper presents an effective algorithm, labeled as VNE-RSOT(Restrictive Selection and Optimization Theory), to solve the VNE problem. The VNERSOT can embed virtual nodes and links per VN simultaneously. The restrictive selection contributes to selecting candidate substrate nodes and paths and largely cuts down on the number of integer variables, used in the following optimization theory approach. The VNE-RSOT fights to minimize substrate resource consumption and accommodates more VNs. To highlight the efficiency of VNERSOT, a simulation against typical and stateof-art heuristic algorithms and a pure exact algorithm is made. Numerical results reveal that virtual network request(VNR) acceptance ratio of VNE-RSOT is, at least, 10% higher than the best-behaved heuristic. Other metrics, such as the execution time, are also plotted to emphasize and highlight the efficiency of VNE-RSOT.

Cultural Context in Literary Translation——from the Perspective of Explanatory Function and Restrictive Function

Literary translation is not merely the transformation of words,but it is a cross-cultural activity from cultural perspective.The paper mainly explores the concept of cultural context and the relationship between cultural context and literary translation,and analyzes explanatory function and restrictive function of cultural context in literary translation.If these functions can be involved in the literary translation,it is necessary for translators to resort to different translation strategies according to the different target cultural context.The selection of translation strategies is never random,but constrained by the cultural context.

An Efficient Restrictive Blind Signature Scheme with Applications to Electronic Cash

In this paper, a new restrictive blind signature scheme is proposed. Compared with Brands restrictive blind signature scheme, our scheme is even more restrictive and efficient. And our scheme is proved secure, too. A new withdrawal protocol of electronic cash system is designed by using our restrictive blind signature scheme, which is more efficient than the withdrawal protocol and is more appropriate for adopting pre processing and post processing.

Chronic lung allograft dysfunction post-lung transplantation:The era of bronchiolitis obliterans syndrome and restrictive allograft syndrome

Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.

Bright light enhances the efficiency of physical activity in combination with a restrictive diet

The purpose of this study was to analyze the effectiveness of measures aimed at correcting obesity in women and including bright light exposure during aerobic exercise combined with a restrictive diet. A one-stage, randomized study involved 80 obese women aged 20 to 58 years. The inclusion criterion for selecting participants for this research was the presence of primary alimentary-constitutional obesity with body mass index equal to or higher than 30 kg/m2. All the women were distributed into three groups according to the set of applied treatments. In Group 1, the women were on a restrictive diet;in Group 2, the restrictive diet was accompanied with daily aerobic exercise;in Group 3, women were exposed to bright light during exercise. Before and after the treatment course (3 weeks), body weight, waist and hip circumferences were measured;fat amount was determined by the impedancemetry method;and oxygen consumption was determined by indirect calorimetry. Women in Group 1 had reduced body weight, waist and hip circumferences, fat mass and oxygen consumption. Similar changes were identified in women of Group 2, but weight loss was greater, and the level of oxygen consumption increased as compared to the baseline. In women of Group 3, weight loss and increased oxygen consumption were more pronounced than in those of Group 2. The number of metabolic equivalents (MET) in women of Group 3 increased to nearly 1, which corresponded to the value of this index that reflected the resting metabolic rate in patients with normal body weight. Thus, exposure to bright full-spectrum light increases energy metabolism and enhances the effectiveness of exercises, despite prolonged food restriction, which is one of the mechanisms to improve the efficiency of obesity correction.

A More Restrictive Upper Bound for the Bare Pomeron Intercept

By studying the properties of the modified Gribov-Levin-Ryskin evolution equation which incorporates both shadowing and antishadowing effects,the more restrict upper bound is set for the bare pomeron intercept in the case when gluons uniformly distribute within the proton.

Effects of maternal methyl donor intake during pregnancy on ileum methylation and function in an intrauterine growth restriction pig model

Background Intrauterine growth retardation(IUGR)affects intestinal growth,morphology,and function,which leads to poor growth performance and high mortality.The present study explored whether maternal dietary methyl donor(MET)supplementation alleviates IUGR and enhances offspring’s growth performance by improving intestinal growth,function,and DNA methylation of the ileum in a porcine IUGR model.Methods Forty multiparous sows were allocated to the control or MET diet groups from mating until delivery.After farrowing,8 pairs of IUGR and normal birth weight piglets from 8 litters were selected for sampling before suckling colostrum.Results The results showed that maternal MET supplementation tended to decrease the IUGR incidence and increased the average weaning weight of piglets.Moreover,maternal MET supplementation significantly reduced the plasma concentrations of isoleucine,cysteine,urea,and total amino acids in sows and newborn pig-lets.It also increased lactase and sucrase activity in the jejunum of newborn piglets.MET addition resulted in lower ileal methionine synthase activity and increased betaine homocysteine S-methyltransferase activity in the ileum of newborn piglets.DNA methylation analysis of the ileum showed that MET supplementation increased the methyla-tion level of DNA CpG sites in the ileum of newborn piglets.Down-regulated differentially methylated genes were enriched in folic acid binding,insulin receptor signaling pathway,and endothelial cell proliferation.In contrast,up-regulated methylated genes were enriched in growth hormone receptor signaling pathway and nitric oxide biosyn-thetic process.Conclusions Maternal MET supplementation can reduce the incidence of IUGR and increase the weaning litter weight of piglets,which may be associated with better intestinal function and methylation status.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

Cooperative UAV search strategy based on DMPC-AACO algorithm in restricted communication scenarios

Improvement of integrated battlefield situational awareness in complex environments involving dynamic factors such as restricted communications and electromagnetic interference(EMI)has become a contentious research problem.In certain mission environments,due to the impact of many interference sources on real-time communication or mission requirements such as the need to implement communication regulations,the mission stages are represented as a dynamic combination of several communication-available and communication-unavailable stages.Furthermore,the data interaction between unmanned aerial vehicles(UAVs)can only be performed in specific communication-available stages.Traditional cooperative search algorithms cannot handle such situations well.To solve this problem,this study constructed a distributed model predictive control(DMPC)architecture for a collaborative control of UAVs and used the Voronoi diagram generation method to re-plan the search areas of all UAVs in real time to avoid repetition of search areas and UAV collisions while improving the search efficiency and safety factor.An attention mechanism ant-colony optimization(AACO)algorithm is proposed for UAV search-control decision planning.The search strategy is adaptively updated by introducing an attention mechanism for regular instruction information,a priori information,and emergent information of the mission to satisfy different search expectations to the maximum extent.Simulation results show that the proposed algorithm achieves better search performance than traditional algorithms in restricted communication constraint scenarios.

Restrictive versus Liberal Blood Transfusion Strategies in Egyptian Patients with Esophageal Variceal Bleeding

Background and Study Aim: Esophageal variceal bleeding is a major medical emergency and one of the most important indications for hospital admission and for blood transfusion. However, the safest and the effective blood transfusion strategy is controversial. Here, we studied the safety and the effectiveness of the restrictive versus liberal transfusion strategies in patients with esophageal variceal bleeding. Patients and Methods: The study included 342 patients with esophageal variceal bleeding. Patients were divided into 2 groups: group I (Restrictive strategy) transfusion when the hemoglobin level is ≤7 g/dl and group II (Liberal strategy): transfusion when the hemoglobin level is ≤9 g/dl. All patients were subjected to complete blood counts, liver and kidney profiles, coagulation profile, pelvi-abdominal ultrasonography and upper GI endoscopy. Clinical outcome measures include rebleeding, infection, allergic transfusion reactions thromboembolic events, and mortality. Results: Of all patients admitted to hospital with esophageal variceal bleeding, the number of transfused RBCs units and hospital stay were more in the liberal transfusion strategy. Also, the overall rate of complications was higher in the liberal transfusion strategy (49.7% versus 38.5% in the restrictive transfusion strategy). The most common complications were rebleeding (26.9%) and infection (21.6%). As regard the death rate, 13 cases (7.6%) died in the restrictive transfusion strategy versus 25 cases (14.6%) in the liberal transfusion one. Conclusions: For esophageal variceal bleeding, restrictive transfusion strategy is better than the liberal one as regard cost-effectiveness, risk of complications and hospital stay with no harm and less mortality as compared to liberal strategy.

Numerical Solution of the Diffusion Equation with Restrictive Pade Approximation

The problem of solving the linear diffusion equation by a method related to the Restrictive Pade Approximation (RPA) is considered. The advantage is that it has the exact value at certain r. This method will exhibit several advantages for example highly accurate, fast and with good results, etc. The absolutely error is still very small. The obtained results are compared with the exact solution and the other methods. The numerical results are in agreement with the exact solution.

Association between restrictive pulmonary disease and type 2 diabetes in Koreans:A cross-sectional study

BACKGROUND Diabetes is a progressive disease that increases glucose levels in the blood.While studies have shown that patients with pulmonary disease(both obstructive and restrictive pulmonary disease)have a higher prevalence of type 2 diabetes mellitus(T2DM),there have been more studies on restrictive patterns than chronic obstructive pulmonary disease.AIM To assess whether restrictive and obstructive pulmonary diseases are associated with T2DM in Koreans.METHODS For our analysis,we used data from the Korea National Health and Nutrition Examination Survey.A total of 2830 subjects were included in this study.Spirometry results were categorized into three patterns:Normal,restrictive pulmonary disease(RPD),and obstructive pulmonary disease(OPD).RESULTS The factors used as diabetic indicators(i.e.homeostatic model assessment of insulin resistance,homeostatic model assessment of beta-cell function,glycated hemoglobin,and fasting insulin)were among the highest in RPD but not in OPD.Based on multivariate logistic regression analysis,subjects with RPD were found with an increased odds ratio[OR:1.907,95%confidence interval(CI):1.110-3.277]for T2DM compared with subjects with normal pulmonary function,whereas in patients with OPD,the OR had not increased.Model 4,which adjusted for the variables that could affect diabetes and pulmonary disease,showed a significant increase in the T2DM OR to RPD(OR:2.025,95%CI:1.264-3.244).On the other hand,no statistically significant difference was shown in OPD(OR:0.982,95%CI:0.634-1.519).CONCLUSION RPD,not OPD,is highly associated with T2DM regardless of the risk factors of various T2DMs that can be confounds.