Fluorescence spectra of native purple bacterial reaction center (RC) and bacterial pheophytin (Bphe) replaced RCs were obtained from 600 nm to 900 nm with a selective excitation at 597 nm. With the help of measuring ...Fluorescence spectra of native purple bacterial reaction center (RC) and bacterial pheophytin (Bphe) replaced RCs were obtained from 600 nm to 900 nm with a selective excitation at 597 nm. With the help of measuring the fluorescence from bacterial chlorophyll, bacterial pheophytin and plant pheophytin, the corresponding components in the RCs are classified for fluorescence emission. Results showed that pheophytin substitution influences the composition of fluorescence spectra. Therefore, four, three and two components were obtained from fluorescence spectra of native RC, Bphe B_replaced RC and Bphe A,B _replaced RC, respectively. Fluorescence components are well correlated to the binding of plant pheophytin. The decay of excited state of primary electron donor P in different RCs was also studied by measuring the fluorescence decay at 686.4, 674.1 and 681.1 nm, respectively. The decaying kinetics changed in different RCs, indicating that pheophytin replacement influenced the energy transduction and primary photochemical reaction in purple bacterial reaction centers.展开更多
[ Objective] The paper was to operate the application and promotion of non-pesticide replacing high-toxic pesticides techniques in Kunming City, and to analyze its benefit. [ Method ] Through application and promotion...[ Objective] The paper was to operate the application and promotion of non-pesticide replacing high-toxic pesticides techniques in Kunming City, and to analyze its benefit. [ Method ] Through application and promotion of frequency trembler grid lamps, sticking plate trapping technology, construction of treatment ponds for field waste vegetable leaves, standardized (accurate) cultivation techniques, cultivation techniques of disease-resistant varieties and diverse cultivation technologies, the promotion benefit of non-pesticide replacing high-toxic pesticides techniques was comprehensively investigated and evaluated. [ Result ] The appli- cation and promotion area of non-pesticide replacing high-toxic pesticides techniques in Kunming City during 2006 -2010 reached 94 667 hm2. The investigation on control efforts and quantitative analysis of cost/benefit showed that the beneficial result of application and promotion of non-pesticide replacing high-toxic pesticides techniques was higher than the direct benefit of application and promotion of traditional pesticide replacing techniques. This improvement innovated the traditional pesticide replacing method in replacement work of high-toxic pesticides, reducing the usage volume of pesticide in Kunming City. [ Conclusion] The application and promotion of non-pesticide replacing high-toxic pesticides techniques improved the economic, social and ecological benefit of replacement work of high-toxic pesticides, protected the agricultural ecological environment and promoted the sustainable development of agricultural production.展开更多
The West Development Policy being implemented in China causes significant land use and land cover (LULC) changes in West China, of which the two most important types of LULC change are replacing farmland and re-greeni...The West Development Policy being implemented in China causes significant land use and land cover (LULC) changes in West China, of which the two most important types of LULC change are replacing farmland and re-greening the desertification land with forest or grass. This paper modifies the prevailing regional climate model (RCM) by updating its lower boundary conditions with the up-to-date satellite database of the Global Land Cover Characteristics Database (GLCCD) created by the United States Geological Survey and the University of Nebraska-Lincoln. The modified RCM is used to simulate the possible regional climate changes due to the LULC variations. The preliminary results can be summarized as that the two main types of LULC variation, replacing farmland and greening the desertification lands with forest or grass in west China, will affect the regional climate mostly in northwest and north China, where the surface temperature will decrease and the precipitation will increase. The regional climate adjustments in South, Southwest China and on the Tibet Plateau are uncertain.展开更多
Some new criteria for the chaotic lag synchronization are proposed. At first,lag synchronization scheme for identical master-slave Lur‘ e systems by replacing variables control and the relevant error system are given...Some new criteria for the chaotic lag synchronization are proposed. At first,lag synchronization scheme for identical master-slave Lur‘ e systems by replacing variables control and the relevant error system are given, and the relations between absolute stability of the error system and the chaotic lag synchronization are described. Then, based on a quadratic Lyapunov function, two new Lur‘ e criteria for the above chaotic lag synchronization are proved. Four corresponding frequency domain criteria are further derived by means of Meyer-Kalman-Yacubovia Lemma. These frequency domain criteria are applied to analyze the lag synchronization of general master-slave Chua's circuits so that some ranges of the parameters in which the master-slave Chua's circuits achieve chaotic lag synchronization by replacing single-variable control are attained. Finally, some examples are given to verify the theoretical results.展开更多
Using alternative plant-derived dietary protein to replace fishmeal,combined with practical evaluation indexes,is a recent focus for aquaculture practices.An 8-week feeding experiment with giant freshwater prawn Macro...Using alternative plant-derived dietary protein to replace fishmeal,combined with practical evaluation indexes,is a recent focus for aquaculture practices.An 8-week feeding experiment with giant freshwater prawn Macrobrachium rosenbergii post-larvae was conducted to determine the eff ects of replacing fi shmeal(FM)with soybean meal in the feed,in terms of growth performance,antioxidant capacity,intestinal microbiota,and mRNA expression of target of rapamycin(TOR)and ribosomal protein S6 kinase B1(S6K1).Four isonitrogenous diets with isocaloric value were prepared to contain 100%,75%,50%,or 25%FM as the protein source(dietary treatments FM100,FM75,FM50,and FM25,respectively).Each diet was fed to post-larval prawns(mean weight 0.045±0.002 g)twice a day in four replicates.No signifi cant diff erence in weight gain was observed among all groups,but the survival rate of prawns fed the FM50 and FM25 diets was signifi cantly lower than that of prawns fed the FM diet.The mRNA expression of both TOR and S6K1 were the lowest in hepatopancreas of prawns fed the FM25 diet.Superoxide dismutase activity of prawns fed the FM25 diet was significantly lower than that of prawns fed FM50.In contrast,the malondialdehyde content was signifi cantly higher in prawns fed FM25 as compared with those fed FM75.The proportion of fishmeal in the diet did not affect the composition of core(phylum-level)intestinal microbiota,but greater fishmeal replacement with soybean meal had a potential risk to increase the relative abundance of opportunistic pathogens in the gut when considered at the genus level.These results suggest that fishmeal replacement with soybean meal should not exceed 50%in a diet for post-larval M.rosenbergii.展开更多
A 105-day feeding study was conducted to evaluate the effect of partial (0%, 20%, 40%, 60% and 80%) and complete (100%) substitution of dietary fish meal (FM) with frozen Artemia on growth performance and feed u...A 105-day feeding study was conducted to evaluate the effect of partial (0%, 20%, 40%, 60% and 80%) and complete (100%) substitution of dietary fish meal (FM) with frozen Artemia on growth performance and feed utilization of Giant freshwater prawn (Macrobrachium rosenbergii) post larvae (PL) reared in fiberglass tanks under controlled conditions. A total of 1080 M. rosenbergii PL, average weight of 6.10 ± 0.4 mg, were equally distributed over 18 fiberglass tanks, (1 m^3 each, and triplicate per treatment). Six experimental isocaloric (14 MJ/kg/digestible energy) and isonitrogenous (35% crude protein) diets were lbrmulated. Control diet (D1, 100% FM) was formulated with FM as the main protein source (0% Artemia). Diets D2-D6 were substituted with five dietary protein levels of frozen Artemia (20%, 40%, 60%, 80% and 100%), respectively. Results showed that growth performance of M. rosenbergii PL fed different Artemia based diets was either equal or superior to prawn fed control FM diet. In addition, increasing dietary frozen Artemia replacement level from 20% up to 100% led to a significant (P 〈 0.05) increase in survival, growth and feed utilization, which indicate that the essential nutrient requirements needed for M. rosenbergii PL was covering with improving feed satiation of PLs. It could be concluded that frozen Artemia biomass instead of fishmeal in M. rosenbergii PL diets can improve survival rate, growth performance, feed utilization, contributing to reducing the use of FM in practical diets and the nursery phase could be shorter and more profitable.展开更多
Formerly,uranium exploration at the Husab Uranium Project was based on sample chemical uranium assays with little uranium equivalent data( e U) obtained from γ probing. The high cost of performing chemical assays has...Formerly,uranium exploration at the Husab Uranium Project was based on sample chemical uranium assays with little uranium equivalent data( e U) obtained from γ probing. The high cost of performing chemical assays has a significant impact on the overall cost of uranium exploration. Between 2015 and 2016,the Resource Upgrade Project Zone 2 was undertaken at the Husab Project,which identified the reliability and feasibility of γ probing through comparison of chemical uranium assays with uranium equivalent grades. This project analyzed the sources of errors and proposed a method to correct them. Uranium equivalent data from gamma probing can be used to replace the chemical assays to reduce the cost and time,therefore increasing the efficiency for uranium exploration at the Husab Uranium Project.展开更多
BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effec...BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.展开更多
Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising st...Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising strategies for preventing the hereditary transmission of mtDNA diseases.While pronuclear transfer has been used to generate mitochondrial replacement mouse models and human embryos,its application in non-human primates has not been previously reported.In this study,we successfully generated four healthy cynomolgus monkeys(Macaca fascicularis)via female pronuclear transfer.These individuals all survived for more than two years and exhibited minimal mtDNA carryover(3.8%–6.7%),as well as relatively stable mtDNA heteroplasmy dynamics during development.The successful establishment of this nonhuman primate model highlights the considerable potential of pronuclear transfer in reducing the risk of inherited mtDNA diseases and provides a valuable preclinical research model for advancing mitochondrial replacement therapies in humans.展开更多
In this work,we employ the cache-enabled UAV to provide context information delivery to end devices that make timely and intelligent decisions.Different from the traditional network traffic,context information varies ...In this work,we employ the cache-enabled UAV to provide context information delivery to end devices that make timely and intelligent decisions.Different from the traditional network traffic,context information varies with time and brings in the ageconstrained requirement.The cached content items should be refreshed timely based on the age status to guarantee the freshness of user-received contents,which however consumes additional transmission resources.The traditional cache methods separate the caching and the transmitting,which are not suitable for the dynamic context information.We jointly design the cache replacing and content delivery based on both the user requests and the content dynamics to maximize the offloaded traffic from the ground network.The problem is formulated based on the Markov Decision Process(MDP).A sufficient condition of cache replacing is found in closed form,whereby a dynamic cache replacing and content delivery scheme is proposed based on the Deep Q-Network(DQN).Extensive simulations have been conducted.Compared with the conventional popularity-based and the modified Least Frequently Used(i.e.,LFU-dynamic)schemes,the UAV can offload around 30%traffic from the ground network by utilizing the proposed scheme in the urban scenario,according to the simulation results.展开更多
In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from...In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.展开更多
Objective The standardization of warfarin anticoagulant therapy is the key to lifelong treatment for patients after heart valve replacement.The present study explored the possible risk factors for anxiety and depressi...Objective The standardization of warfarin anticoagulant therapy is the key to lifelong treatment for patients after heart valve replacement.The present study explored the possible risk factors for anxiety and depression during the coronavirus disease 2019(COVID-19)pandemic and analyzed the influence of psychological state on medication safety.Methods Eligible patients received a web-based questionnaire survey via the Wenjuanxing platform during outpatient visits.Depression was evaluated by the Self-Rating Depression Scale(SDS).Anxiety was evaluated by the Self-Rating Anxiety Scale(SAS).Medication adherence was evaluated by the Morisky scale.Results A total of 309 patients(aged 52.2±11.4 years)were included in the present study.The SDS score of all included patients was 36.9±9.4 points,of which 11(3.6%)patients were diagnosed as having depression.The SAS score of all included patients was 43.1±9.3 points,of which 71(23%)patients were diagnosed as having anxiety.Seven patients(2.3%)had both anxiety and depression.Logistic regression analysis revealed that only monthly income was an independent influencing factor for depression.Regarding anxiety,patients who underwent repeated operations had a 2.264-fold greater risk,and patients who received combination medication had a 2.140-fold greater risk.More bleeding events and coagulation disorders could be observed in patients with anxiety,depression or both.When anxiety occurred,patients showed worse medication adherence.However,depression had no significant effect on medication adherence.Conclusion During the COVID-19 pandemic,the detection rate of mental illnesses such as anxiety and depression was high,which seriously affected the medication safety of warfarin.Analysis of its influencing factors will provide a reference for further standardized regulation of warfarin anticoagulant therapy after valve replacement.展开更多
Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediat...Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk patients.In 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials.However,these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles.While currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite recovery.Nonetheless,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.Furthermore,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population.Thus,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.展开更多
In the conventional CMAC learning scheme, the correcting amounts of errors are equally distributed into all addressed weight, regardless the temporal credibility of those weights. In order to solve the temporal credit...In the conventional CMAC learning scheme, the correcting amounts of errors are equally distributed into all addressed weight, regardless the temporal credibility of those weights. In order to solve the temporal credit assignment problem of the CMAC, an improved CMAC neural network based on replacing eligibility learning concept was designed. The proposed improved leaning approach uses the replacing eligibility learning concept of the reinforcement learning to improve the prediction capability. The simulations for chaotic system identification show that the improved CMAC neural network is effective.展开更多
Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the hum...Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the humeral head, depending upon the pathological process involved. Degenerative glenohumeral arthritis with mild to moderate involvement of subchondral bone allowed for a resurfacing option, while severe humeral head involvement required a partial or full humeral head replacement attached to an intramedullary stem for fixation. All components evolved from cemented to cementless application by 1982. The purpose of this paper is to describe the progression of Buechel-Pappas (B-P) shoulder replacement development from the early 1970’s in both cemented and cement less applications. Methods: Clinical evaluations of “Floating-Socket” TSR, followed by B-P stem-type, resurfacing types, bipolar-type and revision components, all of which comprise the B-P Shoulder Replacement System, were performed over a 49-year period. Results: “Floating-Socket” implants improved the results of simple, constrained ball-in-socket designs, but generally failed by glenoid component loosening in both chimpanzee and human applications. Unconstrained resurfacing-type components, both anatomical humeral head and full proximal humeral components, were quite successful, with minimal failures observed in long-term studies. Bipolar salvage implants, used for severe proximal deficiencies, revisions and massive rotator cuff arthropathy, were also very successful;providing overhead range of motion in many patients. Conclusions: Resurfacing hemiarthroplasty, in patients with intact or repairable rotator cuff mechanisms, gave the most satisfactory results and were the least technically complicated to perform, requiring minimal instrumentation. Resurfacing of full proximal humeral deficiencies, using femoral resurfacing components, gave similar clinical results to more complex semi-constrained devices, also with less technical difficulties and simple instrumentation.展开更多
Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (...Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.展开更多
The Tyrannosauridae,which is characterized by specialized pachydont dentition and putative bone-cracking predatory strategies,is one of the most extensively studied theropod lineages.Although tooth replacement pattern...The Tyrannosauridae,which is characterized by specialized pachydont dentition and putative bone-cracking predatory strategies,is one of the most extensively studied theropod lineages.Although tooth replacement patterns,crucial for understanding feeding behaviors,have been thoroughly studied in this group,studies on non-tyrannosaurid tyrannosauroids are relatively scarce.This study utilizes high-resolution CT data to investigate the tooth replacement pattern in two specimens of Guanlong wucaii,a Late Jurassic tyrannosauroid,and provides insights into the evolution of tooth replacement across Tyrannosauroidea.Second-generation replacement teeth,a rarity observed mainly in giant predatory theropods(e.g.some tyrannosaurids),were detected in the dentary dentition of the juvenile Guanlong.Zahnreihen reconstructions display a consistent cephalad alternating tooth replacement pattern in the maxilla and the dentary of both of the examined individuals,with Z-spacing values exceeding 2.0.As Guanlong grows,the Z-spacing value in the maxillary dentition increases,resembling the ontogenetic changes documented in the Tyrannosauridae.Additionally,like Tarbosaurus,Guanlong also displays a discontinuity between the tooth replacement waves at the premaxilla-maxilla boundary.This study thus demonstrates that some tyrannosaurid-like tooth replacement patterns were acquired before the origin of the Tyrannosauridae.展开更多
A notable portion of cachelines in real-world workloads exhibits inner non-uniform access behaviors.However,modern cache management rarely considers this fine-grained feature,which impacts the effective cache capacity...A notable portion of cachelines in real-world workloads exhibits inner non-uniform access behaviors.However,modern cache management rarely considers this fine-grained feature,which impacts the effective cache capacity of contemporary high-performance spacecraft processors.To harness these non-uniform access behaviors,an efficient cache replacement framework featuring an auxiliary cache specifically designed to retain evicted hot data was proposed.This framework reconstructs the cache replacement policy,facilitating data migration between the main cache and the auxiliary cache.Unlike traditional cacheline-granularity policies,the approach excels at identifying and evicting infrequently used data,thereby optimizing cache utilization.The evaluation shows impressive performance improvement,especially on workloads with irregular access patterns.Benefiting from fine granularity,the proposal achieves superior storage efficiency compared with commonly used cache management schemes,providing a potential optimization opportunity for modern resource-constrained processors,such as spacecraft processors.Furthermore,the framework complements existing modern cache replacement policies and can be seamlessly integrated with minimal modifications,enhancing their overall efficacy.展开更多
BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness...BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.展开更多
Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to...Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.展开更多
基金The State Key Basic Research and Development Plan(G1998010100)the National Natural Science Foundation of China(39870161).
文摘Fluorescence spectra of native purple bacterial reaction center (RC) and bacterial pheophytin (Bphe) replaced RCs were obtained from 600 nm to 900 nm with a selective excitation at 597 nm. With the help of measuring the fluorescence from bacterial chlorophyll, bacterial pheophytin and plant pheophytin, the corresponding components in the RCs are classified for fluorescence emission. Results showed that pheophytin substitution influences the composition of fluorescence spectra. Therefore, four, three and two components were obtained from fluorescence spectra of native RC, Bphe B_replaced RC and Bphe A,B _replaced RC, respectively. Fluorescence components are well correlated to the binding of plant pheophytin. The decay of excited state of primary electron donor P in different RCs was also studied by measuring the fluorescence decay at 686.4, 674.1 and 681.1 nm, respectively. The decaying kinetics changed in different RCs, indicating that pheophytin replacement influenced the energy transduction and primary photochemical reaction in purple bacterial reaction centers.
基金Supported by Non-pesticide Replacing High-toxic Pesticides Project in Yunnan Province (ynzz-200733)~~
文摘[ Objective] The paper was to operate the application and promotion of non-pesticide replacing high-toxic pesticides techniques in Kunming City, and to analyze its benefit. [ Method ] Through application and promotion of frequency trembler grid lamps, sticking plate trapping technology, construction of treatment ponds for field waste vegetable leaves, standardized (accurate) cultivation techniques, cultivation techniques of disease-resistant varieties and diverse cultivation technologies, the promotion benefit of non-pesticide replacing high-toxic pesticides techniques was comprehensively investigated and evaluated. [ Result ] The appli- cation and promotion area of non-pesticide replacing high-toxic pesticides techniques in Kunming City during 2006 -2010 reached 94 667 hm2. The investigation on control efforts and quantitative analysis of cost/benefit showed that the beneficial result of application and promotion of non-pesticide replacing high-toxic pesticides techniques was higher than the direct benefit of application and promotion of traditional pesticide replacing techniques. This improvement innovated the traditional pesticide replacing method in replacement work of high-toxic pesticides, reducing the usage volume of pesticide in Kunming City. [ Conclusion] The application and promotion of non-pesticide replacing high-toxic pesticides techniques improved the economic, social and ecological benefit of replacement work of high-toxic pesticides, protected the agricultural ecological environment and promoted the sustainable development of agricultural production.
基金This study was supported bythe National Key Basic Research Development Programgranted by the Ministry of Science and Technology ofChina (MSTC) with project number G1999043500. Itwas also partly supported by the Innovation Program ofthe Chinese
文摘The West Development Policy being implemented in China causes significant land use and land cover (LULC) changes in West China, of which the two most important types of LULC change are replacing farmland and re-greening the desertification land with forest or grass. This paper modifies the prevailing regional climate model (RCM) by updating its lower boundary conditions with the up-to-date satellite database of the Global Land Cover Characteristics Database (GLCCD) created by the United States Geological Survey and the University of Nebraska-Lincoln. The modified RCM is used to simulate the possible regional climate changes due to the LULC variations. The preliminary results can be summarized as that the two main types of LULC variation, replacing farmland and greening the desertification lands with forest or grass in west China, will affect the regional climate mostly in northwest and north China, where the surface temperature will decrease and the precipitation will increase. The regional climate adjustments in South, Southwest China and on the Tibet Plateau are uncertain.
基金This work was supported by the National Natural Science Foundation of China (No. 10371136)the Natural Science Foundation of Guangdong Province of China (No.021765).
文摘Some new criteria for the chaotic lag synchronization are proposed. At first,lag synchronization scheme for identical master-slave Lur‘ e systems by replacing variables control and the relevant error system are given, and the relations between absolute stability of the error system and the chaotic lag synchronization are described. Then, based on a quadratic Lyapunov function, two new Lur‘ e criteria for the above chaotic lag synchronization are proved. Four corresponding frequency domain criteria are further derived by means of Meyer-Kalman-Yacubovia Lemma. These frequency domain criteria are applied to analyze the lag synchronization of general master-slave Chua's circuits so that some ranges of the parameters in which the master-slave Chua's circuits achieve chaotic lag synchronization by replacing single-variable control are attained. Finally, some examples are given to verify the theoretical results.
基金Supported by the Agriculture Ministry Key Laboratory of Healthy Freshwater Aquaculture and the Key Laboratory of Freshwater Aquaculture Genetic and Breeding of Zhejiang Province of the Zhejiang Institute of Freshwater Fisheries(No.ZJK201906)。
文摘Using alternative plant-derived dietary protein to replace fishmeal,combined with practical evaluation indexes,is a recent focus for aquaculture practices.An 8-week feeding experiment with giant freshwater prawn Macrobrachium rosenbergii post-larvae was conducted to determine the eff ects of replacing fi shmeal(FM)with soybean meal in the feed,in terms of growth performance,antioxidant capacity,intestinal microbiota,and mRNA expression of target of rapamycin(TOR)and ribosomal protein S6 kinase B1(S6K1).Four isonitrogenous diets with isocaloric value were prepared to contain 100%,75%,50%,or 25%FM as the protein source(dietary treatments FM100,FM75,FM50,and FM25,respectively).Each diet was fed to post-larval prawns(mean weight 0.045±0.002 g)twice a day in four replicates.No signifi cant diff erence in weight gain was observed among all groups,but the survival rate of prawns fed the FM50 and FM25 diets was signifi cantly lower than that of prawns fed the FM diet.The mRNA expression of both TOR and S6K1 were the lowest in hepatopancreas of prawns fed the FM25 diet.Superoxide dismutase activity of prawns fed the FM25 diet was significantly lower than that of prawns fed FM50.In contrast,the malondialdehyde content was signifi cantly higher in prawns fed FM25 as compared with those fed FM75.The proportion of fishmeal in the diet did not affect the composition of core(phylum-level)intestinal microbiota,but greater fishmeal replacement with soybean meal had a potential risk to increase the relative abundance of opportunistic pathogens in the gut when considered at the genus level.These results suggest that fishmeal replacement with soybean meal should not exceed 50%in a diet for post-larval M.rosenbergii.
文摘A 105-day feeding study was conducted to evaluate the effect of partial (0%, 20%, 40%, 60% and 80%) and complete (100%) substitution of dietary fish meal (FM) with frozen Artemia on growth performance and feed utilization of Giant freshwater prawn (Macrobrachium rosenbergii) post larvae (PL) reared in fiberglass tanks under controlled conditions. A total of 1080 M. rosenbergii PL, average weight of 6.10 ± 0.4 mg, were equally distributed over 18 fiberglass tanks, (1 m^3 each, and triplicate per treatment). Six experimental isocaloric (14 MJ/kg/digestible energy) and isonitrogenous (35% crude protein) diets were lbrmulated. Control diet (D1, 100% FM) was formulated with FM as the main protein source (0% Artemia). Diets D2-D6 were substituted with five dietary protein levels of frozen Artemia (20%, 40%, 60%, 80% and 100%), respectively. Results showed that growth performance of M. rosenbergii PL fed different Artemia based diets was either equal or superior to prawn fed control FM diet. In addition, increasing dietary frozen Artemia replacement level from 20% up to 100% led to a significant (P 〈 0.05) increase in survival, growth and feed utilization, which indicate that the essential nutrient requirements needed for M. rosenbergii PL was covering with improving feed satiation of PLs. It could be concluded that frozen Artemia biomass instead of fishmeal in M. rosenbergii PL diets can improve survival rate, growth performance, feed utilization, contributing to reducing the use of FM in practical diets and the nursery phase could be shorter and more profitable.
基金Supported by Husab Uranium Project,Resource Upgrade Project Zone 2,Namibia
文摘Formerly,uranium exploration at the Husab Uranium Project was based on sample chemical uranium assays with little uranium equivalent data( e U) obtained from γ probing. The high cost of performing chemical assays has a significant impact on the overall cost of uranium exploration. Between 2015 and 2016,the Resource Upgrade Project Zone 2 was undertaken at the Husab Project,which identified the reliability and feasibility of γ probing through comparison of chemical uranium assays with uranium equivalent grades. This project analyzed the sources of errors and proposed a method to correct them. Uranium equivalent data from gamma probing can be used to replace the chemical assays to reduce the cost and time,therefore increasing the efficiency for uranium exploration at the Husab Uranium Project.
文摘BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.
基金supported by the National Natural Science Foundation of China (82021001,31825018)National Key Research and Development Program of China (2022YFF0710901)+3 种基金Shanghai Municipal Science and Technology Major Project (2018SHZDZX05)Strategic Priority Research Program of the Chinese Academy of Sciences (XDB32060100)Biological Resources Program of Chinese Academy of Sciences (KFJ-BRP-005)National Science and Technology Innovation 2030 Major Program 2021ZD0200900。
文摘Mutations in mitochondrial DNA(mtDNA)are maternally inherited and have the potential to cause severe disorders.Mitochondrial replacement therapies,including spindle,polar body,and pronuclear transfers,are promising strategies for preventing the hereditary transmission of mtDNA diseases.While pronuclear transfer has been used to generate mitochondrial replacement mouse models and human embryos,its application in non-human primates has not been previously reported.In this study,we successfully generated four healthy cynomolgus monkeys(Macaca fascicularis)via female pronuclear transfer.These individuals all survived for more than two years and exhibited minimal mtDNA carryover(3.8%–6.7%),as well as relatively stable mtDNA heteroplasmy dynamics during development.The successful establishment of this nonhuman primate model highlights the considerable potential of pronuclear transfer in reducing the risk of inherited mtDNA diseases and provides a valuable preclinical research model for advancing mitochondrial replacement therapies in humans.
基金supported in part by the National Key R&D Program of China under Grant 2019YFB1802803in part by Beijing Municipal Natural Science Foundation under Grant L192028in part by the Nature Science Foundation of China under Grant 61801011
文摘In this work,we employ the cache-enabled UAV to provide context information delivery to end devices that make timely and intelligent decisions.Different from the traditional network traffic,context information varies with time and brings in the ageconstrained requirement.The cached content items should be refreshed timely based on the age status to guarantee the freshness of user-received contents,which however consumes additional transmission resources.The traditional cache methods separate the caching and the transmitting,which are not suitable for the dynamic context information.We jointly design the cache replacing and content delivery based on both the user requests and the content dynamics to maximize the offloaded traffic from the ground network.The problem is formulated based on the Markov Decision Process(MDP).A sufficient condition of cache replacing is found in closed form,whereby a dynamic cache replacing and content delivery scheme is proposed based on the Deep Q-Network(DQN).Extensive simulations have been conducted.Compared with the conventional popularity-based and the modified Least Frequently Used(i.e.,LFU-dynamic)schemes,the UAV can offload around 30%traffic from the ground network by utilizing the proposed scheme in the urban scenario,according to the simulation results.
文摘In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.
文摘Objective The standardization of warfarin anticoagulant therapy is the key to lifelong treatment for patients after heart valve replacement.The present study explored the possible risk factors for anxiety and depression during the coronavirus disease 2019(COVID-19)pandemic and analyzed the influence of psychological state on medication safety.Methods Eligible patients received a web-based questionnaire survey via the Wenjuanxing platform during outpatient visits.Depression was evaluated by the Self-Rating Depression Scale(SDS).Anxiety was evaluated by the Self-Rating Anxiety Scale(SAS).Medication adherence was evaluated by the Morisky scale.Results A total of 309 patients(aged 52.2±11.4 years)were included in the present study.The SDS score of all included patients was 36.9±9.4 points,of which 11(3.6%)patients were diagnosed as having depression.The SAS score of all included patients was 43.1±9.3 points,of which 71(23%)patients were diagnosed as having anxiety.Seven patients(2.3%)had both anxiety and depression.Logistic regression analysis revealed that only monthly income was an independent influencing factor for depression.Regarding anxiety,patients who underwent repeated operations had a 2.264-fold greater risk,and patients who received combination medication had a 2.140-fold greater risk.More bleeding events and coagulation disorders could be observed in patients with anxiety,depression or both.When anxiety occurred,patients showed worse medication adherence.However,depression had no significant effect on medication adherence.Conclusion During the COVID-19 pandemic,the detection rate of mental illnesses such as anxiety and depression was high,which seriously affected the medication safety of warfarin.Analysis of its influencing factors will provide a reference for further standardized regulation of warfarin anticoagulant therapy after valve replacement.
文摘Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk patients.In 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized trials.However,these breakthrough trials excluded patients with certain unfavorable anatomies and odd profiles.While currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite recovery.Nonetheless,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these patients.Furthermore,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk population.Thus,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.
文摘In the conventional CMAC learning scheme, the correcting amounts of errors are equally distributed into all addressed weight, regardless the temporal credibility of those weights. In order to solve the temporal credit assignment problem of the CMAC, an improved CMAC neural network based on replacing eligibility learning concept was designed. The proposed improved leaning approach uses the replacing eligibility learning concept of the reinforcement learning to improve the prediction capability. The simulations for chaotic system identification show that the improved CMAC neural network is effective.
文摘Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the humeral head, depending upon the pathological process involved. Degenerative glenohumeral arthritis with mild to moderate involvement of subchondral bone allowed for a resurfacing option, while severe humeral head involvement required a partial or full humeral head replacement attached to an intramedullary stem for fixation. All components evolved from cemented to cementless application by 1982. The purpose of this paper is to describe the progression of Buechel-Pappas (B-P) shoulder replacement development from the early 1970’s in both cemented and cement less applications. Methods: Clinical evaluations of “Floating-Socket” TSR, followed by B-P stem-type, resurfacing types, bipolar-type and revision components, all of which comprise the B-P Shoulder Replacement System, were performed over a 49-year period. Results: “Floating-Socket” implants improved the results of simple, constrained ball-in-socket designs, but generally failed by glenoid component loosening in both chimpanzee and human applications. Unconstrained resurfacing-type components, both anatomical humeral head and full proximal humeral components, were quite successful, with minimal failures observed in long-term studies. Bipolar salvage implants, used for severe proximal deficiencies, revisions and massive rotator cuff arthropathy, were also very successful;providing overhead range of motion in many patients. Conclusions: Resurfacing hemiarthroplasty, in patients with intact or repairable rotator cuff mechanisms, gave the most satisfactory results and were the least technically complicated to perform, requiring minimal instrumentation. Resurfacing of full proximal humeral deficiencies, using femoral resurfacing components, gave similar clinical results to more complex semi-constrained devices, also with less technical difficulties and simple instrumentation.
文摘Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.
文摘The Tyrannosauridae,which is characterized by specialized pachydont dentition and putative bone-cracking predatory strategies,is one of the most extensively studied theropod lineages.Although tooth replacement patterns,crucial for understanding feeding behaviors,have been thoroughly studied in this group,studies on non-tyrannosaurid tyrannosauroids are relatively scarce.This study utilizes high-resolution CT data to investigate the tooth replacement pattern in two specimens of Guanlong wucaii,a Late Jurassic tyrannosauroid,and provides insights into the evolution of tooth replacement across Tyrannosauroidea.Second-generation replacement teeth,a rarity observed mainly in giant predatory theropods(e.g.some tyrannosaurids),were detected in the dentary dentition of the juvenile Guanlong.Zahnreihen reconstructions display a consistent cephalad alternating tooth replacement pattern in the maxilla and the dentary of both of the examined individuals,with Z-spacing values exceeding 2.0.As Guanlong grows,the Z-spacing value in the maxillary dentition increases,resembling the ontogenetic changes documented in the Tyrannosauridae.Additionally,like Tarbosaurus,Guanlong also displays a discontinuity between the tooth replacement waves at the premaxilla-maxilla boundary.This study thus demonstrates that some tyrannosaurid-like tooth replacement patterns were acquired before the origin of the Tyrannosauridae.
文摘A notable portion of cachelines in real-world workloads exhibits inner non-uniform access behaviors.However,modern cache management rarely considers this fine-grained feature,which impacts the effective cache capacity of contemporary high-performance spacecraft processors.To harness these non-uniform access behaviors,an efficient cache replacement framework featuring an auxiliary cache specifically designed to retain evicted hot data was proposed.This framework reconstructs the cache replacement policy,facilitating data migration between the main cache and the auxiliary cache.Unlike traditional cacheline-granularity policies,the approach excels at identifying and evicting infrequently used data,thereby optimizing cache utilization.The evaluation shows impressive performance improvement,especially on workloads with irregular access patterns.Benefiting from fine granularity,the proposal achieves superior storage efficiency compared with commonly used cache management schemes,providing a potential optimization opportunity for modern resource-constrained processors,such as spacecraft processors.Furthermore,the framework complements existing modern cache replacement policies and can be seamlessly integrated with minimal modifications,enhancing their overall efficacy.
基金Hebei Provincial Medical Science Research Key Project Plan,No.20181057.
文摘BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.
文摘Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.