The gasification kinetic modelling of two Victorian brown coal(Yallourn and Maddingley)chars and the validity for entrained flow gasification were investigated in this study.The study was conducted in a thermogravimet...The gasification kinetic modelling of two Victorian brown coal(Yallourn and Maddingley)chars and the validity for entrained flow gasification were investigated in this study.The study was conducted in a thermogravimetric analyzer(TGA)at 750–1100℃,30%–90%CO_(2)concentration using different char particle sizes within 20–106 mm.It was found that random pore model and modified volumetric model are applicable for TGA results,but volumetric model and grain model are not.The effect of particle size under106 mm on gasification rate is very limited.Activation energies of Maddingley char and Yallourn char in CO_(2)gasification are 219–220 and 197–208 k J/mol,respectively.The pre-exponential factors are in the same order of magnitude,and they increased as particle size decreased.A mathematical model was developed to predict carbon conversion over time for entrained flow gasification of Victorian brown coal chars at 1000–1400℃.展开更多
<strong>Background: </strong>Coronavirus disease 2019 which is officially known as COVID-19 belongs to family viruses. COVID-19 manifestations vary among affected people. These symptoms may become more ser...<strong>Background: </strong>Coronavirus disease 2019 which is officially known as COVID-19 belongs to family viruses. COVID-19 manifestations vary among affected people. These symptoms may become more serious among patients suffering from chronic disease and those who are on treatment which may af-fect their defense mechanism or immune-compromised patients who become more vulnerable to complications of COVID-19, and at high risk for morbidity and mortality with any bacterial or viral illness. <strong>Method: </strong>A retrospective, non-experimental research design was applied with a quantitative approach among patients with COVID-19 who were admitted to COVID-19 department at AVH with a total of 72 patients. Data were extracted from a patients’ elec-tronic medical record. <strong>Results:</strong> During COVID-19 outbreak 72 patients were admitted to COVID department at AVH, 54.2% were female and 33% of study participants were from Gaza governorate followed by Jerusalem 27%. Most participants 34.7% had first clinic visit after two days from the onset of COVID-19 symptoms. 45.8% were discharged to home while 13.9% died. All inflammatory markers that include ferritin, C-RP, IL-6 and D-dimer are in-creasing in all patients that were admitted to hospital;IL-6 and D-dimer were significant inflammatory markers in relation to the mortality rate. The study found the risk of mortality with IL-6 mean (218.5), and D-dimer mean (12). Furthermore there was a relation between increased risk of mortality and im-mune comprised. <strong>Conclusion:</strong> Mortality rate increased among COVID-19 pa-tients when IL-6 was higher than 218.5 and D-dimer higher than 12, and there was a relationship between increased risk of mortality and immune comprised.展开更多
Botanic gardens around the world maintain collections of living plants for science, conservation, education, beauty and more. These collections change over time-in scope and content-but the predicted impacts of climat...Botanic gardens around the world maintain collections of living plants for science, conservation, education, beauty and more. These collections change over time-in scope and content-but the predicted impacts of climate change will require a more strategic approach to the succession of plant species and their landscapes. Royal Botanic Gardens Victoria has recently published a 'Landscape Succession Strategy'for its Melbourne Gardens, a spectacular botanical landscape established in 1846. The strategy recognizes that with 1.6 million visitors each year, responsibility for a heritage-listed landscape and the need to care for a collection of 8500 plant species of conservation and scientific importance, planting and planning must take into account anticipated changes to rainfall and temperature. The trees we plant today must be suitable for the climate of the twenty-second century. Specifically, the Strategy sets out the steps needed over the next twenty years to transition the botanic garden to one resilient to the climate modelled for2090. The document includes a range of practical measures and achievable(and at times somewhat aspirational) targets. Climate analogues will be used to identify places in Australia and elsewhere with conditions today similar to those predicted for Melbourne in 2090, to help select new species for the collection. Modelling of the natural and cultivated distribution of species will be used to help select suitable growth forms to replace existing species of high value or interest. Improved understanding of temperature gradients within the botanic garden, water holding capacity of soils and plant water use behaviour is already resulting in better targeted planting and irrigation. The goal is to retain a similar diversity of species but transition the collection so that by 2036 at least 75% of the species are suitable for the climate in 2090. Over the next few years we hope to provide 100% of irrigation water from sustainable water sources, and infrastructure will be improved to adapt to predicted higher temperatures and more climatic extremes. At all times there will be a strong focus on assisting the broader community in their response to climate change.展开更多
This paper reports on the major cations(Ca, Mg, Na and K) and arsenic(As) compositions of surface waters collected from major creeks, rivers and lakes in Central Victoria (Australia). The surface waters were fou...This paper reports on the major cations(Ca, Mg, Na and K) and arsenic(As) compositions of surface waters collected from major creeks, rivers and lakes in Central Victoria (Australia). The surface waters were found to be neutral to alkaline (pH 6.7-9.4), oxidised (average redox potential (Eh) about 130 mV) and showed variable concentrations of dissolved ions (EC, about 51-4386 /μS/cm). The concen- trations of dissolved major cations in surface waters were found to be in the order of Na〉〉Mg〉Ca〉K and in soils the contents of metals followed an order of abundance as: Ca〉Mg〉〉K〉Na. While Na was the least abundant in soils, it registered the highest dissolved cation in surface waters. Of the four major cations, the average concentration ofNa(98.7 mg/L) was attributed to the weathering of feldspars and atmospheric input. Relatively highly dissolved concentrations of Na and Mg compared with the world average values of rivers reflected the weathering of rock and soil minerals within the catchments. The As soil level is naturally high(linked to lithology) as reflected by high background soil values and mining operations are also considered to be a contributory factor. Under relatively alkaline-oxidative conditions low mobility of dissolved As (average about 7.9 μg/L) was observed in most of the surface waters with a few higher values(〉15 μg/L) around a sewage disposal site and mine railings. Arsenic in soils is slowly released into water under alkaline and/or lower Eh conditions. The efficient sink of Fe, AI and Mn oxides acts as a barrier against the As release under near neutral-oxidising conditions. High As content (average about 28.3 mg/kg) in soils was found to be associated with Fe-hydroxides as revealed by XRD and SEM analysis. The dissolved As concentration was found to be below the recommended maximum levels for recreational water in all surface waters(lakes and rivers) in the study area. Catchment lithology exerted the fundamental control on surface water chemistry. Sites impacted by mining waste dumps showed a decline in water quality.展开更多
BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pa...BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.展开更多
A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disea...A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.展开更多
BACKGROUND Remarkable progress over the last decade has equipped clinicians with many options in the treatment of inflammatory bowel disease.Clinicians now have the unique opportunity to provide individualized treatme...BACKGROUND Remarkable progress over the last decade has equipped clinicians with many options in the treatment of inflammatory bowel disease.Clinicians now have the unique opportunity to provide individualized treatment that can achieve and sustain remission in many patients.However,issues of primary non-response(PNR)and secondary loss of response(SLOR)to non-tumour necrosis factor inhibitor(TNFi)therapies remains a common problem.Specific issues include the choice of optimization of therapy,identifying when dose optimization will recapture response,establishing optimal dose for escalation and when to switch therapy.AIM To explores the issues of PNR and SLOR to non-TNFi therapies.METHODS This review explores the current evidence and literature to elucidate management options in cases of PNR/SLOR.It will also explore potential predictors for response following SLOR/PNR to therapies including the role of therapeutic drug monitoring(TDM).RESULTS In the setting of PNR and loss of response to alpha-beta7-integrin inhibitors and interleukin(IL)-12 and IL-23 inhibitors dose optimization is a reasonable option to capture response.For Janus kinase inhibitors dose optimization can be utilized to recapture response with loss of response.CONCLUSION The role of TDM in the setting of advanced non-TNFi therapies to identify patients who require dose optimization and as a predictor for clinical remission is not yet established and this remains an area that should be addressed in the future.展开更多
Biodegradable implants from magnesium(Mg)alloys have emerged in the biomedical field especially in the orthopedic and cardiovascular stent applications owing to their low density,high specific strength,excellent machi...Biodegradable implants from magnesium(Mg)alloys have emerged in the biomedical field especially in the orthopedic and cardiovascular stent applications owing to their low density,high specific strength,excellent machinability,good biocompatibility,and biodegradability.The primary shortcoming of Mg-based implants is their low corrosion resistance in the physiological environment,which results in premature mechanical integrity loss before adequate healing and the production of excessive hydrogen gas,which is harmful to the body tissues and negatively affects the biocompatibility of the implant.Laser surface modification has recently received attention because it can improve the surface properties such as surface chemistry,roughness,topography,corrosion resistance,wear resistance,hydrophilicity,and thus cell response to the surface of the material.The composition and microstructures including textures and phases of laser-treated surfaces depend largely on the laser processing parameters(input laser power,laser scan velocity,frequency,pulse duration,pressure,gas circulation,working time,spot size,beam focal position,and laser track overlap)and the thermophysical properties of the substrate(solubility,melting point,and boiling point).This review investigates the impacts of various laser surface modification techniques including laser surface melting,laser surface alloying,laser cladding,laser surface texturing,and laser shock peening,and highlights their significance in improving the surface properties of biodegradable Mg alloys for implant applications.Additionally,we explore how different laser process parameters affect its composition,microstructure,and surface properties in each laser surface modification technique.展开更多
Background Many phenotypes in animal breeding are derived from incomplete measures,especially if they are challenging or expensive to measure precisely.Examples include time-dependent traits such as reproductive statu...Background Many phenotypes in animal breeding are derived from incomplete measures,especially if they are challenging or expensive to measure precisely.Examples include time-dependent traits such as reproductive status,or lifespan.Incomplete measures for these traits result in phenotypes that are subject to left-,interval-and rightcensoring,where phenotypes are only known to fall below an upper bound,between a lower and upper bound,or above a lower bound respectively.Here we compare three methods for deriving phenotypes from incomplete data using age at first elevation(>1 ng/mL)in blood plasma progesterone(AGEP4),which generally coincides with onset of puberty,as an example trait.Methods We produced AGEP4 phenotypes from three blood samples collected at about 30-day intervals from approximately 5,000 Holstein–Friesian or Holstein–Friesian×Jersey cross-bred dairy heifers managed in 54 seasonal-calving,pasture-based herds in New Zealand.We used these actual data to simulate 7 different visit scenarios,increasing the extent of censoring by disregarding data from one or two of the three visits.Three methods for deriving phenotypes from these data were explored:1)ordinal categorical variables which were analysed using categorical threshold analysis;2)continuous variables,with a penalty of 31 d assigned to right-censored phenotypes;and 3)continuous variables,sampled from within a lower and upper bound using a data augmentation approach.Results Credibility intervals for heritability estimations overlapped across all methods and visit scenarios,but estimated heritabilities tended to be higher when left censoring was reduced.For sires with at least 5 daughters,the correlations between estimated breeding values(EBVs)from our three-visit scenario and each reduced data scenario varied by method,ranging from 0.65 to 0.95.The estimated breed effects also varied by method,but breed differences were smaller as phenotype censoring increased.Conclusion Our results indicate that using some methods,phenotypes derived from one observation per offspring for a time-dependent trait such as AGEP4 may provide comparable sire rankings to three observations per offspring.This has implications for the design of large-scale phenotyping initiatives where animal breeders aim to estimate variance parameters and estimated breeding values(EBVs)for phenotypes that are challenging to measure or prohibitively expensive.展开更多
I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data f...I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.展开更多
This paper presents an asynchronous output-feed-back control strategy of semi-Markovian systems via sliding mode-based learning technique.Compared with most literature results that require exact prior knowledge of sys...This paper presents an asynchronous output-feed-back control strategy of semi-Markovian systems via sliding mode-based learning technique.Compared with most literature results that require exact prior knowledge of system state and mode information,an asynchronous output-feedback sliding sur-face is adopted in the case of incompletely available state and non-synchronization phenomenon.The holonomic dynamics of the sliding mode are characterized by a descriptor system in which the switching surface is regarded as the fast subsystem and the system dynamics are viewed as the slow subsystem.Based upon the co-occurrence of two subsystems,the sufficient stochastic admissibility criterion of the holonomic dynamics is derived by utilizing the characteristics of cumulative distribution functions.Furthermore,a recursive learning controller is formulated to guarantee the reachability of the sliding manifold and realize the chattering reduction of the asynchronous switching and sliding motion.Finally,the proposed theoretical method is substantia-ted through two numerical simulations with the practical contin-uous stirred tank reactor and F-404 aircraft engine model,respectively.展开更多
文摘The gasification kinetic modelling of two Victorian brown coal(Yallourn and Maddingley)chars and the validity for entrained flow gasification were investigated in this study.The study was conducted in a thermogravimetric analyzer(TGA)at 750–1100℃,30%–90%CO_(2)concentration using different char particle sizes within 20–106 mm.It was found that random pore model and modified volumetric model are applicable for TGA results,but volumetric model and grain model are not.The effect of particle size under106 mm on gasification rate is very limited.Activation energies of Maddingley char and Yallourn char in CO_(2)gasification are 219–220 and 197–208 k J/mol,respectively.The pre-exponential factors are in the same order of magnitude,and they increased as particle size decreased.A mathematical model was developed to predict carbon conversion over time for entrained flow gasification of Victorian brown coal chars at 1000–1400℃.
文摘<strong>Background: </strong>Coronavirus disease 2019 which is officially known as COVID-19 belongs to family viruses. COVID-19 manifestations vary among affected people. These symptoms may become more serious among patients suffering from chronic disease and those who are on treatment which may af-fect their defense mechanism or immune-compromised patients who become more vulnerable to complications of COVID-19, and at high risk for morbidity and mortality with any bacterial or viral illness. <strong>Method: </strong>A retrospective, non-experimental research design was applied with a quantitative approach among patients with COVID-19 who were admitted to COVID-19 department at AVH with a total of 72 patients. Data were extracted from a patients’ elec-tronic medical record. <strong>Results:</strong> During COVID-19 outbreak 72 patients were admitted to COVID department at AVH, 54.2% were female and 33% of study participants were from Gaza governorate followed by Jerusalem 27%. Most participants 34.7% had first clinic visit after two days from the onset of COVID-19 symptoms. 45.8% were discharged to home while 13.9% died. All inflammatory markers that include ferritin, C-RP, IL-6 and D-dimer are in-creasing in all patients that were admitted to hospital;IL-6 and D-dimer were significant inflammatory markers in relation to the mortality rate. The study found the risk of mortality with IL-6 mean (218.5), and D-dimer mean (12). Furthermore there was a relation between increased risk of mortality and im-mune comprised. <strong>Conclusion:</strong> Mortality rate increased among COVID-19 pa-tients when IL-6 was higher than 218.5 and D-dimer higher than 12, and there was a relationship between increased risk of mortality and immune comprised.
文摘Botanic gardens around the world maintain collections of living plants for science, conservation, education, beauty and more. These collections change over time-in scope and content-but the predicted impacts of climate change will require a more strategic approach to the succession of plant species and their landscapes. Royal Botanic Gardens Victoria has recently published a 'Landscape Succession Strategy'for its Melbourne Gardens, a spectacular botanical landscape established in 1846. The strategy recognizes that with 1.6 million visitors each year, responsibility for a heritage-listed landscape and the need to care for a collection of 8500 plant species of conservation and scientific importance, planting and planning must take into account anticipated changes to rainfall and temperature. The trees we plant today must be suitable for the climate of the twenty-second century. Specifically, the Strategy sets out the steps needed over the next twenty years to transition the botanic garden to one resilient to the climate modelled for2090. The document includes a range of practical measures and achievable(and at times somewhat aspirational) targets. Climate analogues will be used to identify places in Australia and elsewhere with conditions today similar to those predicted for Melbourne in 2090, to help select new species for the collection. Modelling of the natural and cultivated distribution of species will be used to help select suitable growth forms to replace existing species of high value or interest. Improved understanding of temperature gradients within the botanic garden, water holding capacity of soils and plant water use behaviour is already resulting in better targeted planting and irrigation. The goal is to retain a similar diversity of species but transition the collection so that by 2036 at least 75% of the species are suitable for the climate in 2090. Over the next few years we hope to provide 100% of irrigation water from sustainable water sources, and infrastructure will be improved to adapt to predicted higher temperatures and more climatic extremes. At all times there will be a strong focus on assisting the broader community in their response to climate change.
文摘This paper reports on the major cations(Ca, Mg, Na and K) and arsenic(As) compositions of surface waters collected from major creeks, rivers and lakes in Central Victoria (Australia). The surface waters were found to be neutral to alkaline (pH 6.7-9.4), oxidised (average redox potential (Eh) about 130 mV) and showed variable concentrations of dissolved ions (EC, about 51-4386 /μS/cm). The concen- trations of dissolved major cations in surface waters were found to be in the order of Na〉〉Mg〉Ca〉K and in soils the contents of metals followed an order of abundance as: Ca〉Mg〉〉K〉Na. While Na was the least abundant in soils, it registered the highest dissolved cation in surface waters. Of the four major cations, the average concentration ofNa(98.7 mg/L) was attributed to the weathering of feldspars and atmospheric input. Relatively highly dissolved concentrations of Na and Mg compared with the world average values of rivers reflected the weathering of rock and soil minerals within the catchments. The As soil level is naturally high(linked to lithology) as reflected by high background soil values and mining operations are also considered to be a contributory factor. Under relatively alkaline-oxidative conditions low mobility of dissolved As (average about 7.9 μg/L) was observed in most of the surface waters with a few higher values(〉15 μg/L) around a sewage disposal site and mine railings. Arsenic in soils is slowly released into water under alkaline and/or lower Eh conditions. The efficient sink of Fe, AI and Mn oxides acts as a barrier against the As release under near neutral-oxidising conditions. High As content (average about 28.3 mg/kg) in soils was found to be associated with Fe-hydroxides as revealed by XRD and SEM analysis. The dissolved As concentration was found to be below the recommended maximum levels for recreational water in all surface waters(lakes and rivers) in the study area. Catchment lithology exerted the fundamental control on surface water chemistry. Sites impacted by mining waste dumps showed a decline in water quality.
文摘BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.
文摘A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.
文摘BACKGROUND Remarkable progress over the last decade has equipped clinicians with many options in the treatment of inflammatory bowel disease.Clinicians now have the unique opportunity to provide individualized treatment that can achieve and sustain remission in many patients.However,issues of primary non-response(PNR)and secondary loss of response(SLOR)to non-tumour necrosis factor inhibitor(TNFi)therapies remains a common problem.Specific issues include the choice of optimization of therapy,identifying when dose optimization will recapture response,establishing optimal dose for escalation and when to switch therapy.AIM To explores the issues of PNR and SLOR to non-TNFi therapies.METHODS This review explores the current evidence and literature to elucidate management options in cases of PNR/SLOR.It will also explore potential predictors for response following SLOR/PNR to therapies including the role of therapeutic drug monitoring(TDM).RESULTS In the setting of PNR and loss of response to alpha-beta7-integrin inhibitors and interleukin(IL)-12 and IL-23 inhibitors dose optimization is a reasonable option to capture response.For Janus kinase inhibitors dose optimization can be utilized to recapture response with loss of response.CONCLUSION The role of TDM in the setting of advanced non-TNFi therapies to identify patients who require dose optimization and as a predictor for clinical remission is not yet established and this remains an area that should be addressed in the future.
基金the Australian Research Council(ARC)through the discovery grant DP210101862。
文摘Biodegradable implants from magnesium(Mg)alloys have emerged in the biomedical field especially in the orthopedic and cardiovascular stent applications owing to their low density,high specific strength,excellent machinability,good biocompatibility,and biodegradability.The primary shortcoming of Mg-based implants is their low corrosion resistance in the physiological environment,which results in premature mechanical integrity loss before adequate healing and the production of excessive hydrogen gas,which is harmful to the body tissues and negatively affects the biocompatibility of the implant.Laser surface modification has recently received attention because it can improve the surface properties such as surface chemistry,roughness,topography,corrosion resistance,wear resistance,hydrophilicity,and thus cell response to the surface of the material.The composition and microstructures including textures and phases of laser-treated surfaces depend largely on the laser processing parameters(input laser power,laser scan velocity,frequency,pulse duration,pressure,gas circulation,working time,spot size,beam focal position,and laser track overlap)and the thermophysical properties of the substrate(solubility,melting point,and boiling point).This review investigates the impacts of various laser surface modification techniques including laser surface melting,laser surface alloying,laser cladding,laser surface texturing,and laser shock peening,and highlights their significance in improving the surface properties of biodegradable Mg alloys for implant applications.Additionally,we explore how different laser process parameters affect its composition,microstructure,and surface properties in each laser surface modification technique.
基金funded by New Zealand dairy farmers through Dairy NZ Inc. and by the New Zealand Ministry of Business,Innovation and Employment (DRCX1302)support was kindly received from LIC and CRV
文摘Background Many phenotypes in animal breeding are derived from incomplete measures,especially if they are challenging or expensive to measure precisely.Examples include time-dependent traits such as reproductive status,or lifespan.Incomplete measures for these traits result in phenotypes that are subject to left-,interval-and rightcensoring,where phenotypes are only known to fall below an upper bound,between a lower and upper bound,or above a lower bound respectively.Here we compare three methods for deriving phenotypes from incomplete data using age at first elevation(>1 ng/mL)in blood plasma progesterone(AGEP4),which generally coincides with onset of puberty,as an example trait.Methods We produced AGEP4 phenotypes from three blood samples collected at about 30-day intervals from approximately 5,000 Holstein–Friesian or Holstein–Friesian×Jersey cross-bred dairy heifers managed in 54 seasonal-calving,pasture-based herds in New Zealand.We used these actual data to simulate 7 different visit scenarios,increasing the extent of censoring by disregarding data from one or two of the three visits.Three methods for deriving phenotypes from these data were explored:1)ordinal categorical variables which were analysed using categorical threshold analysis;2)continuous variables,with a penalty of 31 d assigned to right-censored phenotypes;and 3)continuous variables,sampled from within a lower and upper bound using a data augmentation approach.Results Credibility intervals for heritability estimations overlapped across all methods and visit scenarios,but estimated heritabilities tended to be higher when left censoring was reduced.For sires with at least 5 daughters,the correlations between estimated breeding values(EBVs)from our three-visit scenario and each reduced data scenario varied by method,ranging from 0.65 to 0.95.The estimated breed effects also varied by method,but breed differences were smaller as phenotype censoring increased.Conclusion Our results indicate that using some methods,phenotypes derived from one observation per offspring for a time-dependent trait such as AGEP4 may provide comparable sire rankings to three observations per offspring.This has implications for the design of large-scale phenotyping initiatives where animal breeders aim to estimate variance parameters and estimated breeding values(EBVs)for phenotypes that are challenging to measure or prohibitively expensive.
文摘I read with great interest the article“Concerns on the application of blood flow restriction resistance exercise and thrombosis risk in hemodialysis patients”by Correa et al.1 The study presents complementary data from a previous randomized controlled trial,2 exploring the application of intradialytic blood flow restriction exercise for hemodialysis patients.
基金supported in part by the National Science Fund for Excellent Young Scholars of China(62222317)the National Science Foundation of China(62303492)+3 种基金the Major Science and Technology Projects in Hunan Province(2021GK1030)the Science and Technology Innovation Program of Hunan Province(2022WZ1001)the Key Research and Development Program of Hunan Province(2023GK2023)the Fundamental Research Funds for the Central Universities of Central South University(2024ZZTS0116)。
文摘This paper presents an asynchronous output-feed-back control strategy of semi-Markovian systems via sliding mode-based learning technique.Compared with most literature results that require exact prior knowledge of system state and mode information,an asynchronous output-feedback sliding sur-face is adopted in the case of incompletely available state and non-synchronization phenomenon.The holonomic dynamics of the sliding mode are characterized by a descriptor system in which the switching surface is regarded as the fast subsystem and the system dynamics are viewed as the slow subsystem.Based upon the co-occurrence of two subsystems,the sufficient stochastic admissibility criterion of the holonomic dynamics is derived by utilizing the characteristics of cumulative distribution functions.Furthermore,a recursive learning controller is formulated to guarantee the reachability of the sliding manifold and realize the chattering reduction of the asynchronous switching and sliding motion.Finally,the proposed theoretical method is substantia-ted through two numerical simulations with the practical contin-uous stirred tank reactor and F-404 aircraft engine model,respectively.