Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

实验性镉中毒大鼠尿钙症及其机理的探讨

经皮下一次注射镉金属硫蛋白诱发大鼠急性中毒,作为慢性镉中毒之模型,观察中毒大鼠肾皮质的组织病理学改变和脂质过氧化作用,测定尿液主要生化指标变化。结果显示尿总蛋白、葡萄糖含量,r-谷氨酰转移酶、碱性磷酸酶、N-乙酰-β-D-氨基葡萄糖苷酶活性均明显增加,尿钙增加较早。结合光镜和电镜下肾近曲小管病损,以及肾皮质脂质过氧化作用加剧,提示肾脏钙代谢紊乱是镉中毒性肾损害的始动因素,脂质过氧化作用是镉中毒性肾损害的机理之一。

The role of exosomes in peripheral nerve regeneration

Peripheral nerve injuries remain problematic to treat, with poor functional recovery commonly observed. Injuries resulting in a nerve gap create specific difficulties for axonal regeneration. Approaches to address these difficulties include autologous nerve grafts （which are currently the gold standard treatment） and synthetic conduits, with the latter option being able to be im- pregnated with Schwann cells or stem cells which provide an appropriate micro-environment for neuronal regeneration to occur. Transplanting stem cells, however, infers additional risk of malignant transformation as well as manufacturing difficulties and ethical concerns, and the use of autologous nerve grafts and Schwann ceils requires the sacrifice of a functioning nerve. A new approach utilizing exosomes, secreted extracellular vesicles, could avoid these complications. In this review, we summarize the current literature on exosomes, and suggest how they could help to improve axonal regeneration following peripheral nerve injury.

Familial brain tumours-genetics or environment?A nationwide cohort study of cancer risk in spouses and first-deg ree relatives of brain tumour patients

Our study investigated whether the f amilial aggregation of glioma is due to environmental or genetic effects and it investigated and compared the risk to spouses and firs t-degree relatives(FDR)of patients with primary brain tumou rs(PBT)for developing both PBT and the risk for other types of cancer.Al l PBT patients identified in Sweden f rom 1958-97in The Swedish Cancer Reg istry(SCR)were linked to the nationwide Swedish Fam ily Database,including persons in S weden born from 1932-97.The cohorts of spouses and FDR were linked to the SCR to identify observed cases of PBT and other cancer.S tandardised incidence ratios(SIR)were calculated using the incidence rates from SCR as the reference.We found that there were no increased risks for any specific type of PBT in the cohort of spouses.In the FDR cohort,generally the risk for a PBT was significantly increased by 2to 3times for the same h istopathology as the probands.Spouses of PBT patients had an increased risk of skin cancer.We conclude that FDR,not spouses,have a significantly increased risk,which indicates a genetic origin of the familial aggrega tion of brain

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Anastomotic leakage in rectal cancer surgery:The role of blood perfusion

Anastomotic leakage after anterior resection for rectal cancer remains a common and often devastating complication. Preoperative risk factors for anastomotic leakage have been studied extensively and are used for patient selection, especially whether to perform a diverting stoma or not. From the current literature,data suggest that perfusion in the rectal stump rather than in the colonic limb may be more important for the integrity of the colorectal anastomosis. Moreover, available research suggests that the mid and upper rectum is considerably more vascularized than the lower part, in which the posterior compartment seems most vulnerable. These data fit neatly with the observation that anastomotic leaks are far more frequent in patients undergoing total compared to partial mesorectal excision, and also that most leaks occur dorsally. Clinical judgment has been shown to ineffectively assess anastomotic viability, while promising methods to measure blood perfusion are evolving. Much interest has recently been turned to near-infrared light technology, enhanced with fluorescent agents, which enables intraoperative perfusion assessment. Preliminary data are promising, but large-scale controlled trials are lacking. With maturation of such technology, perfusion measurements may in the future inform the surgeon whether anastomoses are at risk. In high colorectal anastomoses, anastomotic revision might be feasible, while a diverting stoma could be fashioned selectively instead of routinely for low anastomoses.

Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

Periodic Motion Planning and Control for Double Rotary Pendulum via Virtual Holonomic Constraints

Periodic motion planning for an under-actuated system is rather difficult due to differential dynamic constraints imposed by passive dynamics, and it becomes more difficult for a system with higher underactuation degree, that is with a higher difference between the number of degrees of freedom and the number of independent control inputs. However, from another point of view, these constraints also mean some relation between state variables and could be used in the motion planning.We consider a double rotary pendulum, which has an underactuation degree 2. A novel periodic motion planning is presented based on an optimization search. A necessary condition for existence of the whole periodic trajectory is given because of the higher underactuation degree of the system. Moreover this condition is given to make virtual holonomic constraint(VHC) based control design feasible. Therefore, an initial guess for the optimization of planning a feasible periodic motion is based on this necessary condition. Then, VHCs are used for the system transformation and transverse linearization is used to design a static state feedback controller with periodic matrix function gain. The controller gain is found through another optimization procedure. The effectiveness of initial guess and performance of the closed-loop system are illustrated through numerical simulations.

Ni–Co bimetallic coordination effect for long lifetime rechargeable Zn–air battery

The development of bifunctional oxygen electrocatalysts with high efficiency, high stability, and low cost is of great significance to the industrialization of rechargeable Zn–air batteries. A widely accepted view is that the oxygen reduction reaction(ORR) and the oxygen evolution reaction(OER) follow different catalytic mechanisms, and accordingly they need different active sites for catalysis. Transition metal elements have admirable electronic acceptance ability for coordinating with reactants, and this can weaken the bond energy between reactants, thus promoting the ORR or OER reactions. Herein, the ORR and OER activities of different transition metal supported nitrogen-doped carbon nanotubes were systematically studied and compared. The optimal catalyst for synchronous ORR and OER was obtained by pyrolyzing melamine, cobalt nitrate, and nickel nitrate on carbon nanotubes, called cobalt–nickel supported nitrogenmixed carbon nanotubes(CoNi–NCNT), which were equipped with two types of high-performance active sites—the Co/Ni–N–C structure for the ORR and Co Ni alloy particles for the OER—simultaneously. Remarkably, the optimized Co Ni–NCNT exhibited a satisfactory bifunctional catalytic activity for both the ORR and OER. The value of the oxygen electrode activity parameter,△E, of CoNi–NCNT was 0.81 V, which surpasses that of catalysts Pt/C and Ir/C, and most of the non-precious metal-based bifunctional electrocatalysts reported in previous literatures. Furthermore, a specially assembled rechargeable Zn–air cell with Co Ni–NCNT loaded carbon paper as an air cathode was used to evaluate the practicability. As a result, a superior specific capacity of 744.3 mAh/gZn, a peak power density of 88 mW/cm2, and an excellent rechargeable cycling stability were observed, and these endow the Co Ni–NCNT with promising prospects for practical application.

A blockchain-based trustworthy collaborative power trading scheme for 5G-enabled social internet of vehicles

Social Internet of Vehicles(SIoV)falls under the umbrella of social Internet of Things(IoT),where vehicles are socially connected to other vehicles and roadside units that can reliably share information and services with other social entities by leveraging the capabilities of 5G technology,which brings new opportunities and challenges,e.g.,collaborative power trading can address the mileage anxiety of electric vehicles.However,it relies on a trusted central party for scheduling,which introduces performance bottlenecks and cannot be set up in a distributed network,in addition,the lack of transparency in state-of-the-art Vehicle-to-Vehicle(V2V)power trading schemes can introduce further trust issues.In this paper,we propose a blockchain-based trustworthy collaborative power trading scheme for 5G-enabled social vehicular networks that uses a distributed market mechanism to introduce trusted power trading and avoids the dependence on a centralized dispatch center.Based on the game theory,we design the pricing and trading matching mechanism for V2V power trading to obtain maximum social welfare.We use blockchain to record power trading data for trusted pricing and use smart contracts for transaction matching.The simulation results verify the effectiveness of the proposed scheme in improving social welfare and reducing the load on the grid.

Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults

Purpose:This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior,light physical activity(LPA),and moderate-to-vigorous PA(MVPA)with sarcopenia and incident falls over 12 months.Methods:A total of 3334 Swedish 70-year-olds were assessed for sarcopenia,as defined by the revised definition of the European Working Group on Sarcopenia in Older People.Assessments were based on low scores for appendicular lean mass(dual-energy X-ray absorptiometry),hand grip strength,and the Timed Up and Go test.For 7 days after baseline,total time and total number of bouts(≥10 min of continuous activity at a given intensity)of activity performed at sedentary,LPA,and MVPA intensities were assessed by accelerometer.Incident falls were self-reported 6 months and 12 months after baseline.Results:Only 1.8%of participants had probable or confirmed sarcopenia.After multivariable adjustment for other levels of activity,only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass,low hand grip strength,and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria(all p<0.05),and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia(odds ratio=0.80,95%confidence interval:0.71-0.91 h/week).Similar associations were identified for total number of bouts,with no evidence of threshold effects for longer duration of bouts of MVPA.A total of 14%of participants reported-1 fall,but neither total time nor bouts of activity was associated with incident falls(all p>0.05).Conclusion:Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components,regardless of the length of bouts or amounts of sedentary behavior.

Genome Annotation and Comparative Genomics of ORF Virus

ORF virus (ORFV), the etiological agent of contagious pustular dermatitis in small ruminants, belongs to members of the genus Parapoxvirus of the Poxviridae. The genome of the ORFV is dsDNA of 139,962 bp which has about 89% coding region, 63% GC content and codes 130 proteins. There are four unique genes within the genome revealed by homology search of them two posses’ strong regulatory region and transmembrane helices. One of the ORF-039 contains signal peptide indicating the possibilities to be secretory protein coding gene. Comparative genomic analysis reveals significant differences in Bovine Papular Stomatitis Virus (BPSV) strain BV-AR02 and ORFV strain OV-SA00, and these may account for differences in host range. Interspecies sequence variability is observed in all functional classes of genes but is the highest in putative virulence/host range genes. Notably, ORFV contains genes which are homologous of Vaccinia virus. Phylogenetic analysis reveals that although divergent, ORFV virus is distinct from other known mammalian cowpox virus. An improved understanding of Parapoxvirus (PPV) biology will permit the engineering of novel vaccine viruses and expression vectors with enhanced efficacy and greater versatility. The novel vaccine will have a significant role in the economy of a country through the control of disease in an economically important and small ruminant caused by ORFV.

Ionic Liquid Assisted Extraction of Nitrogen and Sulphur-Containing Air Pollutants from Model Oil and Regeneration of the Spent Ionic Liquid

Removal of air pollutants, such as nitrogen and sulphur containing compounds from a model oil (dodecane) was studied. An ionic liquid (1-ethyl-3-methylimidazolium chloride [C2mim] [Cl]) was used as an extractant. Liquid-liquid extraction by using 1-ethyl-3-methylimidazolium chloride [C2mim] [Cl] was found to be a very promising method for the removal of N- and S-compounds. This was evaluated by using a model oil (dodecane) with indole as a neutral nitrogen compound and pyridine as a basic nitrogen compound. Dibenzothiophene (DBT) was used as a sulphur compound. An extraction capacity of up to 90 wt% was achieved for the model oil containing pyridine, while only 76 wt% of indole in the oil was extracted. The extraction capacity of a model sulphur compound DBT was found to be up to 99 wt%. Regeneration of the spent ionic liquid was carried out with toluene back-extraction. A 1:1 toluene-to-IL wt ratio was performed at room temperature. It was observed that, for the spent ionic liquid containing DBT as a model compound more than 85 wt% (corresponding 3852 mg/kg) could be removed from the oil. After the second regeneration cycle, 86 wt% of the DBT was recovered from the ionic liquid to toluene. In the case of indole as the nitrogen containing species, more than 99 wt%, (corresponding to 2993 mg/kg) of the original indole was transferred from the model oil to the ionic liquid. After the first-regeneration cycle of the spent ionic liquid, 54 wt% of the indole–in-IL was transferred to toluene. Thus, both extractions of nitrogen and sulphur model compounds were successfully carried out from model oil and the back-extraction of these compounds from the ionic liquids to toluene demonstrated the proved the concept of the regeneration point of view.

Why Well Spread Probability Samples Are Balanced

When sampling from a finite population there is often auxiliary information available on unit level. Such information can be used to improve the estimation of the target parameter. We show that probability samples that are well spread in the auxiliary space are balanced, or approximately balanced, on the auxiliary variables. A consequence of this balancing effect is that the Horvitz-Thompson estimator will be a very good estimator for any target variable that can be well approximated by a Lipschitz continuous function of the auxiliary variables. Hence we give a theoretical motivation for use of well spread probability samples. Our conclusions imply that well spread samples, combined with the Horvitz- Thompson estimator, is a good strategy in a varsity of situations.

Potentiality of Clay Raw Materials from Northern Morocco in Ceramic Industry: Tetouan and Meknes Areas

This study aims at evaluating the potential suitability of Tetouan and Meknes (central Morocco) clay material as raw materials in various ceramic applications by investigating their textural, chemical, thermal and firing characteristics. Textural properties were identified by specific surface area, cation exchange capacity (CEC) and bulk density (ρs). Chemical and thermal properties were assessed using XRF and TG/DTA techniques, respectively. Firing characteristics at temperatures from 800℃ to 1100℃ were determined by linear firing shrinkage, loss on weight and water absorption capacity. The Meknes clays are characterised by medium cation exchange capacity (CEC) and specific surface area (SSA) values due to their moderate smectite content. The Tetouan clays have medium to low CEC and medium SSA values. The main oxides in the clayey samples are SiO2 (35 - 54.3 wt%), Al2O3 (20.6 - 43.9 wt%), and Fe2O3 (9.7 - 22.4 wt%). The amount of CaO in Meknes clays ranges from 8 to 12 wt%, whereas CaO is only present in some Tetouan clay (TE4, TE7, TN4 and TN5). A significant densification of ceramic behaviour could be noticed for most of Tetouan clays at firing temperatures above 1000℃. Meknes clays show earlier densification from 800℃. The chemical, textural and ceramic properties of Tetouan and Meknes clays indicate their suitability as raw materials for the production of structural ceramics. The high amount of Fe2O3 in all clays makes them inappropriate in fine ceramics.

The effect of cartilaginous rings on particle deposition by convection and Brownian diffusion

The deposition of spherical nanoparticles by convection and Brownian diffusion in a pipe with a cartilaginous ring structure is studied. Analytical results for a fully developed flow are found for small amplitude rings using the interactive boundary layer theory. It is found that the local deposition rate is at maximum at a position approximately one twelfth of the spacing between the rings before the minimum cross section of the tube. For larger ring amplitudes the problem is solved numerically and separation then takes place in the depressions between the rings, and maximum deposition is found at the point of reattachment of the flow approximately at the same point as in the analytical theory. Cumulative deposition results are also provided with larger deposition rates with the inclusion of the cartilaginous rings. Deposition results for a developing flow are also provided. For the same volume flux as for fully developed flow the deposition is about 25% larger. In general conclusions about the position of maximum deposition rate from the analytic theory of fully developed flow also applies qualitatively to the case of developing flow.

Impacts of Norwegian large carnivore management strategy on national grazing sector

Increasing populations of large carnivores are leading to tension and conflicts with livestock production,a situation that potentially might escalate.In Norway the objective of the large carnivore policy is two-folded:to ensure viable carnivore populations and to secure a sustainable grazing industry.The main instrument is zonation,with carnivore management zones(CMZs)prioritized for reproduction of the large carnivore species separated from other areas prioritized for grazing livestock.The objective of this paper is to describe current knowledge about the impact of the zoning management strategy on the grazing industry.This is done by documenting status and changes in sheep production,losses of livestock to predating carnivores,and the use of grazing areas inside and outside the CMZs.CMZsoffering protection for lynx,wolverine,bear and wolf cover 55%of the Norwegian mainland.30%of the sheep and 50%of the Sami reindeer grazing areas are found inside the CMZs.Livestock(semi-domestic reindeer excluded)is using 59%of the available natural pasture areas outside the CMZs,but only 26%inside the CMZs.The lowest use of available grazing areas was found inside zones for wolves(12%)and brown bears(6%).Livestock in these zones are confined to fenced enclosures,mostly on the farm itself,or moved to pastures outside the management zone for summer grazing.Livestock losses increased in the affected regions during the period when carnivores were reestablished.Later,losses declined when CMZs were established and mitigation efforts were implemented in these zones.The bulk of sheep and reindeer killed by carnivores are now found in boundary areas within 50 km off the CMZs,where sheep are still grazing on open mountain and forest ranges.Therefore,instruments to protect livestock in areas close to the CMZs are also needed.The number of sheep declined inside the CMZs from 1999 to 2014,but increased outside the zones.The reduction in the absolute number of sheep in the CMZs is balanced by a similar increase outside,thus the total sheep production in Norway is maintained.We conclude that although of little consequence for the total food production in Norway,the economic and social impact of the large carnivore management strategy can be serious for local communities and individual farmers who are affected.There is a need for more exact carnivore population monitoring to quantify the carnivore pressure,better documentation of reindeer losses,and a clearer and stricter practicing of the zoning strategy.Increased involvement of social sciences is important in order to understand the human dimension of the carnivore conflicts.

Haplotype-resolved genome assembly and allele- specific gene expression in cultivated ginger

Ginger(Zingiber officinale)is one of the most valued spice plants worldwide;it is prized for its culinary and folk medicinal applications and is therefore of high economic and cultural importance.Here,we present a haplotype-resolved,chromosome-scale assembly for diploid ginger anchored to 11 pseudochromosome pairs with a total length of 3.1 Gb.Remarkable structural variation was identified between haplotypes,and two inversions larger than 15Mb on chromosome 4 may be associated with ginger infertility.We performed a comprehensive,spatiotemporal,genome-wide analysis of allelic expression patterns,revealing that most alleles are coordinately expressed.The alleles that exhibited the largest differences in expression showed closer proximity to transposable elements,greater coding sequence divergence,more relaxed selection pressure,and more transcription factor binding site differences.We also predicted the transcription factors potentially regulating 6-gingerol biosynthesis.Our allele-aware assembly provides a powerful platform for future functional genomics,molecular breeding,and genome editing in ginger.