Skeleton-guided multi-scale dual-coordinate attention aggregation network for retinal blood vessel segmentation.

Deep learning plays a pivotal role in retinal blood vessel segmentation for medical diagnosis. Despite their significant efficacy, these techniques face two major challenges. Firstly, they often neglect the severe class imbalance in fundus images, where thin vessels in the foreground are proportionally minimal. Secondly, they are susceptible to poor image quality and blurred vessel edges, resulting in discontinuities or breaks in vascular structures. In response, this paper proposes the Skeleton-guided Multi-scale Dual-coordinate Attention Aggregation (SMDAA) network for retinal vessel segmentation. SMDAA comprises three innovative modules: Dual-coordinate Attention (DCA), Unbalanced Pixel Amplifier (UPA), and Vessel Skeleton Guidance (VSG). DCA, integrating Multi-scale Coordinate Feature Aggregation (MCFA) and Scale Coordinate Attention Decoding (SCAD), meticulously analyzes vessel structures across various scales, adept at capturing intricate details, thereby significantly enhancing segmentation accuracy. To address class imbalance, we introduce UPA, dynamically allocating more attention to misclassified pixels, ensuring precise extraction of thin and small blood vessels. Moreover, to preserve vessel structure continuity, we integrate vessel anatomy and develop the VSG module to connect fragmented vessel segments. Additionally, a Feature-level Contrast (FCL) loss is introduced to capture subtle nuances within the same category, enhancing the fidelity of retinal blood vessel segmentation. Extensive experiments on three public datasets (DRIVE, STARE, and CHASE_DB1) demonstrate superior performance in comparison to current methods. The code is available at https://github.com/wangwxr/SMDAA_NET.

Measure of Strength of Evidence for Visually Observed Differences between Subpopulations.

For measuring the strength of visually-observed subpopulation differences, the Population Difference Criterion is proposed to assess the statistical significance of visually observed subpopulation differences. It addresses the following challenges: in high-dimensional contexts, distributional models can be dubious; in high-signal contexts, conventional permutation tests give poor pairwise comparisons. We also make two other contributions: Based on a careful analysis we find that a balanced permutation approach is more powerful in high-signal contexts than conventional permutations. Another contribution is the quantification of uncertainty due to permutation variation via a bootstrap confidence interval. The practical usefulness of these ideas is illustrated in the comparison of subpopulations of modern cancer data.

The recovery of parabolic avalanches in spatially subsampled neuronal networks at criticality.

Scaling relationships are key in characterizing complex systems at criticality. In the brain, they are evident in neuronal avalanches-scale-invariant cascades of neuronal activity quantified by power laws. Avalanches manifest at the cellular level as cascades of neuronal groups that fire action potentials simultaneously. Such spatiotemporal synchronization is vital to theories on brain function yet avalanche synchronization is often underestimated when only a fraction of neurons is observed. Here, we investigate biases from fractional sampling within a balanced network of excitatory and inhibitory neurons with all-to-all connectivity and critical branching process dynamics. We focus on how mean avalanche size scales with avalanche duration. For parabolic avalanches, this scaling is quadratic, quantified by the scaling exponent, χ = 2, reflecting rapid spatial expansion of simultaneous neuronal firing over short durations. However, in networks sampled fractionally, χ is significantly lower. We demonstrate that applying temporal coarse-graining and increasing a minimum threshold for coincident firing restores χ = 2, even when as few as 0.1% of neurons are sampled. This correction crucially depends on the network being critical and fails for near sub- and supercritical branching dynamics. Using cellular 2-photon imaging, our approach robustly identifies χ = 2 over a wide parameter regime in ongoing neuronal activity from frontal cortex of awake mice. In contrast, the common 'crackling noise' approach fails to determine χ under similar sampling conditions at criticality. Our findings overcome scaling bias from fractional sampling and demonstrate rapid, spatiotemporal synchronization of neuronal assemblies consistent with scale-invariant, parabolic avalanches at criticality.

Balanced Scorecards and sustainability Balanced Scorecards for corporate social responsibility strategic alignment: A systematic literature review.

The integration of social and environmental issues into their business model is today a major issue for companies facing the challenge of sustainability. This is leading them to redefine their models of performance measurement. In this perspective, integrated and multi-dimensional frameworks such as Balanced Scorecards (BSCs) and Sustainability Balanced Scorecards (SBSCs) offer attractive opportunities. Drawing on a systematic literature review (SRL), this article provides an analysis of the literature to identify the main trends in research on (S)BSCs and their contribution to CSR and sustainability issues. While the SLR reveals a major stream of instrumentalist and functionalist research aimed at demonstrating the relevance of SBSC in the strategic alignment of CSR, more critical approaches question the foundations, purposes and architecture of these instruments regarding the macroscopic challenges of sustainability. More precisely, focused on an organizational performance measurement, these tools would struggle to embrace the full complexity of sustainability issues. The article contributes novel insights to expand current models of SBSC from the perspective of a real contribution to strong sustainability challenges.

Application of the Unbalanced Ensemble Algorithm for Prognostic Prediction Outcomes of All-Cause Mortality in Coronary Heart Disease Patients Comorbid with Hypertension.

Purpose: This study sought to develop an unbalanced-ensemble model that could accurately predict death outcomes of patients with comorbid coronary heart disease (CHD) and hypertension and evaluate the factors contributing to death. Patients and Methods: Medical records of 1058 patients with coronary heart disease combined with hypertension and excluding those acute coronary syndrome were collected. Patients were followed-up at the first, third, sixth, and twelfth months after discharge to record death events. Follow-up ended two years after discharge. Patients were divided into survival and nonsurvival groups. According to medical records, gender, smoking, drinking, COPD, cerebral stroke, diabetes, hyperhomocysteinemia, heart failure and renal insufficiency of the two groups were sorted and compared and other influencing factors of the two groups, feature selection was carried out to construct models. Owing to data unbalance, we developed four unbalanced-ensemble prediction models based on Balanced Random Forest (BRF), EasyEnsemble, RUSBoost, SMOTEBoost and the two base classification algorithms based on AdaBoost and Logistic. Each model was optimised using hyperparameters based on GridSearchCV and evaluated using area under the curve (AUC), sensitivity, recall, Brier score, and geometric mean (G-mean). Additionally, to understand the influence of variables on model performance, we constructed a SHapley Additive explanation (SHAP) model based on the optimal model. Results: There were significant differences in age, heart rate, COPD, cerebral stroke, heart failure and renal insufficiency in the nonsurvival group compared with the survival group. Among all models, BRF yielded the highest AUC (0.810; 95% CI, 0.778-0.839), sensitivity (0.990; 95% CI, 0.981-1.000), recall (0.990; 95% CI, 0.981-1.000), and G-mean (0.806; 95% CI, 0.778-0.827), and the lowest Brier score (0.181; 95% CI, 0.178-0.185). Therefore, we identified BRF as the optimal model. Furthermore, red blood cell count (RBC), body mass index (BMI), and lactate dehydrogenase were found to be important mortality-associated risk factors. Conclusion: BRF combined with advanced machine learning methods and SHAP is highly effective and accurately predicts mortality in patients with CHD comorbid with hypertension. This model has the potential to assist clinicians in modifying treatment strategies to improve patient outcomes.

Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries.

BACKGROUND: Undernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNS) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. OBJECTIVES: We examined effects of SQ-LNS provided during pregnancy, compared to a) iron and folic acid or standard of care (IFA/SOC) or b) multiple micronutrient supplements (MMS), and identified characteristics that modified the estimates of effects of SQ-LNS on birth outcomes. METHODS: We conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNS provided during pregnancy (n = 5,273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether results differed depending on methods for gestational age dating, birth anthropometry, or study design. RESULTS: SQ-LNS (vs IFA/SOC) increased birth weight (mean difference: +49g; 95% CI: 26, 71g) and all birth anthropometric z-scores (+0.10-0.13 SD); it reduced risk of low birthweight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNS and MMS; p-values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age +0.11; 95% CI: -0.01, 0.23). Effect estimates for SQ-LNS vs IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index < 20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNS vs MMS were greater for certain outcomes among female infants, first-born infants, and mothers < 25 y. CONCLUSIONS: SQ-LNS had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNS and MMS is needed. Targeting SQ-LNS to vulnerable subgroups may be worth considering. Analysis registered at www.crd.york.ac.uk/PROSPERO (CRD42021283391). REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: Registered at www.crd.york.ac.uk/PROSPERO as CRD42021283391 on 11 April 2021.

Improved multi-strategy artificial rabbits optimization for solving global optimization problems.

Artificial rabbits optimization (ARO) is a metaheuristic algorithm based on the survival strategy of rabbits proposed in 2022. ARO has favorable optimization performance, but it still has some shortcomings, such as weak exploitation capacity, easy to fall into local optima, and serious decline of population diversity at the later stage. In order to solve these problems, we propose an improved multi-strategy artificial rabbits optimization, called IMARO, based on ARO algorithm. In this paper, a roulette fitness distance balanced hiding strategy is proposed so that rabbits can find better locations to hide more reasonably. Meanwhile, in order to improve the deficiency of ARO which is easy to fall into local optimum, an improved non-monopoly search strategy based on Gaussian and Cauchy operators is designed to improve the ability of the algorithm to obtain the global optimal solution. Finally, a covariance restart strategy is designed to improve population diversity when the exploitation is stagnant and to improve the convergence accuracy and convergence speed of ARO. The performance of IMARO is verified by comparing original ARO algorithm with six basic algorithms and seven improved algorithms. The results of CEC2014, CEC2017, CEC2022 show that IMARO has a good exploitation and exploration ability and can effectively get rid of local optimum. Moreover, IMARO produces optimal results on six real-world engineering problems, further demonstrating its efficiency in solving real-world optimization challenges.

Postoperative Hydration in Children Using Intermittent Boluses of Balanced Salt Solution: Results of a Randomized Control Trial.

BACKGROUND: Postoperative maintenance fluids are traditionally provided via hypotonic dextrose containing fluids administered intravenously by continuous infusion. We hypothesized that scheduled weight-based boluses of balanced salt solution would be more physiologic, reduce fluid volumes, and improve patient comfort. METHODS: As part of an IRB-approved randomized controlled trial (Boluses of Ringer's in Surgical Kids, BRiSK), we randomized patients aged 1-21 years undergoing elective abdominal or thoracic surgery to post-operatively receive weight-based D50.45NS+20mEq/L KCl at a continuous rate or intermittent boluses of Lactated Ringer's solution until oral liquid toleration. Patients with nephropathy, diabetes, or receiving parenteral nutrition were excluded. We analyzed electrolytes, urine output, fluid volume, and adverse events. RESULTS: We enrolled and randomized 60 patients: 29 to continuous fluids and 31 to bolus fluids. One patient from the bolus group dropped out. No patients crossed over due to difficulties with application of the bolus protocol. There were no baseline differences between groups with a mean age of 12.6 ± 1.4yr and weight of 50.9 ± 7.2 kg. There were no serious adverse events or electrolyte disturbances in either group. Patients in the bolus group received significantly less total fluid than those in the continuous group (0.43 mL/kg/h vs 1.1 mL/kg/h, p < 0.001) with no difference in urine output [1.4 ± 0.2 mL/kg/h vs 1.6 ± 0.3 mL/kg/h, p = 0.211]. There were two episodes of mild hypoglycemia in the bolus group compared to seven episodes of mild hyperglycemia in the continuous group. CONCLUSIONS: Administration of post-operative intravenous fluids as boluses of balanced salt solution is feasible, safe, and results in significantly less fluid administered compared to a traditional continuous protocol. LEVEL OF EVIDENCE: II.

Well-being balance and lived experiences assessment: a valid, comprehensive measure of positive well-being.

Introduction: Widely used measures of self-reported subjective well-being and flourishing generally do not directly measure positive experiences that have been demonstrated to improve subjective well-being and flourishing, which could aid in developing personalized interventions to improve individuals' well-being. The present study evaluated the validity of the Well-being Balance and Lived Experience (WBAL) Model and Assessment, a new model of well-being and corresponding assessment instrument that evaluates the self-reported frequency of positive experiences and positive feelings of well-being, balanced across activation and arousal levels. Methods: A total of 496 evaluable subjects completed the WBAL Assessment, the PERMA+ Profiler (PERMA+) and the Well-Being Assessment Adult 24-item (WBA-24). A confirmatory factor model corresponding to the WBAL construct was created, and internal and external validity of the WBAL Assessment were interrogated. Results: The confirmatory factor model showed good fit, indicating that each of the model factors are related but distinct and all items load significantly onto their factors. The WBAL Assessment demonstrated high internal consistency (Cronbach's α = 0.95) and internal validity across well-being factors and Feelings (r = 0.96) and Experiences (r = 0.94) domains. The WBAL Assessment demonstrated strong convergent validity in comparison to PERMA+ (r = 0.80) and WBA-24 (r = 0.75), indicating that the WBAL Assessment measures a similar overall concept of well-being and flourishing. Discriminant validity of WBAL factors was demonstrated for an average of 14.3 of 17 comparator domains. The main differences between instruments are WBAL's assessment of positive Experiences, the comparator instruments' inclusion of feelings with negative valence, and WBA-24's inclusion of financial stability. Discussion: The WBAL Assessment is a reliable and valid instrument to comprehensively measure positive aspects of well-being that evaluates multiple modifiable contributors to individuals' well-being to guide design of personalized assessment and intervention programs to enhance positive well-being.

Dosage sensitivity shapes balanced expression and gene longevity of homoeologs after whole-genome duplications in angiosperms.

Following whole-genome duplication (WGD), duplicate gene pairs (homoeologs) can evolve varying degrees of expression divergence. However, the determinants influencing these relative expression level differences (RFPKM) between homoeologs remain elusive. Here, we analyzed the RFPKM between homoeologs in three angiosperms, Nymphaea colorata, Nelumbo nucifera, and Acorus tatarinowii, all having undergone a single WGD since the origin of angiosperms. Our results show significant positive correlations in RFPKM of homoeologs among tissues within the same species, and among orthologs across these three species, indicating convergent expression balance/bias between homoeologous gene copies following independent WGDs. We linked RFPKM between homoeologs to gene attributes associated with dosage balance constraints, such as protein-protein interactions, lethal-phenotype scores in Arabidopsis (Arabidopsis thaliana) orthologs, domain numbers, and expression breadth. Notably, homoeologs with lower RFPKM often had more interactions and higher lethal-phenotype scores, indicating selective pressures favoring balanced expression. Also, homoeologs with lower RFPKM were more likely to be retained after WGDs in angiosperms. Within Nelumbo, greater RFPKM between homoeologs correlated with increased cis- and trans-regulatory differentiation between species, highlighting the ongoing escalation of gene expression divergence. We further found that expression degeneration in one copy of homoeologs is inclined towards nonfunctionalization. Our research highlights the importance of balanced expression, shaped by dosage balance constraints, in the evolutionary retention of homoeologs in plants.

Balanced Crystalloid (Sterofundin) vs. Normal Saline for Diabetic Ketoacidosis: A Prospective Intervention Trial with Historical Controls.

BACKGROUND: Fluid therapy with normal saline (NS) in diabetic ketoacidosis (DKA) can cause hyperchloremic acidosis and delay DKA resolution. Balanced crystalloids may address this concern, though results with Ringer lactate and Plasma-Lyte have been mixed. AIM: This study aimed to compare the effectiveness of Sterofundin (SF) vs. NS in the management of DKA. METHODS: A prospective, intervention trial with historical controls was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Patients aged 13 years or older with DKA were enrolled. The primary outcome was the time taken to DKA resolution, with a predefined superiority margin of a one-fourth reduction in resolution time. Secondary outcomes included total intravenous fluid and short-acting regular insulin requirements, the need for 0.45% saline, hospital stay duration, and in-hospital mortality. RESULTS: A total of 150 patients (mean age 36.8 years, 56.7% males) were included, with 75 receiving SF (intervention group) and 75 receiving NS (historical control group). The SF group showed a significantly shorter mean time to DKA resolution (13.8 ± 6.0 hours) compared to the NS group (18.1 ± 5.5 hours; P < 0.001). SF patients required less total intravenous fluid (4500 mL vs. 6000 mL; P = 0.004), less insulin (98 units vs. 112 units; P = 0.017), and had a lower need for 0.45% saline (8% vs. 74.3%; P < 0.001). Patients receiving SF had shorter hospital stays (4 [IQR 3-5] days vs. 4 [IQR 4-6] days; P = 0.020). Mortality rates were similar between the groups (SF: 9.3%, NS: 8.1%; P = 0.791). CONCLUSION: SF may be a superior alternative to NS for fluid therapy in DKA.

Balanced Fluids Versus Normal Saline for Initial Fluid Resuscitation in Adults With Diabetic Ketoacidosis.

Background: Normal saline (NS) has been the choice fluid for volume resuscitation in diabetic ketoacidosis (DKA) for decades. Large volume resuscitation with NS can lead to hyperchloremic metabolic acidosis and is associated with a higher incidence of major adverse kidney events compared to balanced fluids (BF). Objective: Compare safety and effectiveness of fluid resuscitation with BF vs NS in adult patients with DKA. Methods: Single-center retrospective cohort study evaluated patients who received NS or BF for DKA treatment between July 2020 and August 2021. Primary endpoint was time to DKA resolution. Secondary endpoints included time to anion gap ≤12, HCO3 ≥15 and ≥18 mmol/L, acute kidney injury, and hospital and intensive care unit length of stay. Results: 110 patients were included (NS 55% (n = 60), BF 45% (n = 50)). Time to DKA resolution was faster in patients who received BF vs NS (13 (10 - 19) hours vs 17 (11 - 25) hours, P = 0.02). Treatment with NS was associated with a longer time to resolution of DKA when adjusted for initial bicarbonate and AKI at admission. Conclusion: BF was associated with a shorter time to DKA resolution compared to NS.

Fetus Conceived via In Vitro Fertilization With Mosaic Uniparental Isodisomy and Two Balanced Translocations.

We present a case of a fetus acquiring two different balanced translocations from each parent and subsequent uniparental isodisomy from postzygotic loss of a paternal chromosome. Balanced chromosomal translocations occur in 0.14% of the population and increase the risk of other genetic abnormalities, such as uniparental disomy (UPD) and mosaicism. Preimplantation genetic testing (PGT) can identify some genetic abnormalities. Translocations t(6;21) and t(5;15) have been reported individually but never together in a viable fetus. A non-consanguineous couple who were known carriers of two different balanced translocations conceived via classic in vitro fertilization (IVF). They had a normal PGT completed. Chorionic villus sampling (CVS) revealed that the fetus had received t(6;21) from the mother and t(5;15) from the father. The probability of the fetus acquiring both translocations was 2.8%. CVS also revealed UPD of chromosome 14. Amniocentesis was performed, which was consistent with the CVS in detecting the balanced translocations but provided more information about the UPD, determining that it was a mosaic maternal uniparental isodisomy of chromosome 14 (UPD(14)mat). The couple underwent genetic counseling to discuss the above findings and ultimately decided on dilation and evacuation at 17 weeks of gestation. The likelihood of conception of this fetus and survival past the first trimester is extremely rare. These specific chromosomal translocations and (UPD(14)mat) have never been reported before. This case emphasizes the concomitant nature of imprinted genes, resulting in multiple genetically unique alterations. This report also highlights the limitations of PGT, CVS, and amniocentesis in being reproducibly consistent, which is important to discuss prior to IVF conception.

Mesomelia-synostoses syndrome: contiguous deletion syndrome, SULF1 haploinsufficiency or enhancer adoption?

BACKGROUND: Mesomelia-Synostoses Syndrome (MSS)(OMIM 600,383) is a rare autosomal dominant disorder characterized by mesomelic limb shortening, acral synostoses and multiple congenital malformations which is described as a contiguous deletion syndrome involving the two genes SULF1 and SLCO5A1. The study of apparently balanced chromosomal rearrangements (BCRs) is a cytogenetic strategy used to identify candidate genes associated with Mendelian diseases or abnormal phenotypes. With the improved development of genomic technologies, new methods refine this search, allowing better delineation of breakpoints as well as more accurate genotype-phenotype correlation. CASE PRESENTATION: We present a boy with a global development deficit, delayed speech development and an ASD (Asperger) family history, with an apparently balanced "de novo" reciprocal translocation [t(1;8)(p32.2;q13)dn]. The cytogenetic molecular study identified a likely pathogenic deletion of 21 kb in the 15q12 region, while mate pair sequencing identified gene-truncations at both the 1p32.2 and 8q13 translocation breakpoints. CONCLUSIONS: The identification of a pathogenic alteration on 15q12 involving GABRA5 was likely the main cause of the ASD-phenotype. Importantly, the chr8 translocation breakpoint truncating SLCO5A1 exclude SLCO5A1 as a candidate for MSS, leaving SULF1 as the primary candidate. However, the deletions observed in MSS remove a topological associated domain (TAD) boundary separating SULF1 and SLCO5A1. Hence, Mesomelia-Synostoses syndrome is either caused by haploinsufficiency of SULF1 or ectopic enhancer effects where skeletal/chrondrogenic SULF1 enhancers drive excopic expression of developmental genes in adjacent TADs including PRDM14, NCOA2 and/or EYA1.

Gradient-Robust Hybrid DG Discretizations for the Compressible Stokes Equations.

This paper studies two hybrid discontinuous Galerkin (HDG) discretizations for the velocity-density formulation of the compressible Stokes equations with respect to several desired structural properties, namely provable convergence, the preservation of non-negativity and mass constraints for the density, and gradient-robustness. The later property dramatically enhances the accuracy in well-balanced situations, such as the hydrostatic balance where the pressure gradient balances the gravity force. One of the studied schemes employs an H ( div ) -conforming velocity ansatz space which ensures all mentioned properties, while a fully discontinuous method is shown to satisfy all properties but the gradient-robustness. Also higher-order schemes for both variants are presented and compared in three numerical benchmark problems. The final example shows the importance also for non-hydrostatic well-balanced states for the compressible Navier-Stokes equations.

Feasibility of interleaved multislice averaged magnetization inversion-recovery acquisitions of the spinal cord.

PURPOSE: To establish an interleaved multislice variant of the averaged magnetization inversion-recovery acquisitions (AMIRA) approach for 2D spinal cord imaging with increased acquisition efficiency compared with the conventional 2D single-slice approach(es), and to determine essential prerequisites for a working interleaved multislice AMIRA approach in practice. METHODS: The general AMIRA concept is based on an inversion recovery-prepared, segmented, and time-limited cine balanced SSFP sequence, generating images of different contrast. For AMIRA imaging of multiple, independent slices in a 2D interleaved fashion, a slice loop within the acquisition loops was programmed. The former non-selective inversions were replaced with slice-selective inversions with user-definable slice thickness. RESULTS: The thickness of the slice-selective inversion in 2D interleaved multislice AMIRA should be doubled compared with the manufacturer's standard setting to avoid an increased sensitivity to flow and pulsation effects particularly in the CSF. However, this solution also limits its practical applicability, as slices located at directly adjacent vertebrae cannot be imaged together. Successful interleaved two-slice AMIRA imaging for a "reference" in vivo protocol with 0.50 × 0.50 mm2 in-plane resolution and 8-mm slice thickness is demonstrated, therefore halving its acquisition time per slice from 3 min down to 1.5 min. CONCLUSION: The investigated 2D interleaved two-slice AMIRA variant facilitates spinal cord imaging that maintains similar contrast and the same resolution as the conventional 2D single-slice AMIRA approach, but does so with a halved acquisition time.

Is Plasmalyte beneficial in resuscitation of diabetic ketoacidosis patients? A narrative review.

Fluid resuscitation is vital in the resuscitation of diabetic ketoacidosis patients. The purpose of this narrative review is to analyze the role of Plasmalyte in fluid resuscitation of adult diabetic ketoacidosis patients. A thorough search was conducted in PUBMED, EMBASE and MEDLINE. Studies conducted between 1st January 2010 and 31st March 2023 were collected. Of 123 results, 5 pertinent randomized controlled trials were included. The close resemblance of Plasmalyte's electrolyte composition to human plasma and its role in the prevention of hyperchloremic metabolic acidosis are some of its vital benefits in patients with diabetic ketoacidosis. Results on the role of Plasmalyte in length of stay, time to resolution of diabetic ketoacidosis and mortality in diabetic ketoacidosis patients are varied. Hence, further research on these topics is needed.

Exploring the Production Effect in Memory Reveals a Balanced Bilingual Advantage.

There is evidence suggesting that bilingual individuals demonstrate an advantage over monolinguals in performing various tasks related to memory and executive functions. The characteristics of this bilingual advantage are not unanimously agreed upon in the literature, and some even doubt it exists. The heterogeneity of the bilingual population may explain this inconsistency. Hence, it is important to identify different subgroups of bilinguals and characterize their cognitive performance. The current study focuses on the production effect, a well-established memory phenomenon, in bilingual young adults differing in their English and Hebrew proficiency levels, and the possible balanced bilingual advantage. The aims of this study are (1) to evaluate the production effect in three groups of bilingual participants: English-dominant bilinguals, Hebrew-dominant bilinguals, and balanced bilinguals, and (2) to examine whether memory advantage depends on varying degrees of bilingualism. One hundred twenty-one bilingual young adults who speak English and Hebrew at different levels participated. All learned lists of familiar words, in English and Hebrew, half by reading aloud and half by silent reading, followed by free recall tests. As expected, a production effect (better memory for aloud words than for silent words) was found for all groups in both languages. Balanced bilinguals remembered more words than did dominant participants, demonstrating a memory advantage in both languages. These findings support the hypothesis that the presence of cognitive advantage in bilingualism depends on the acquisition of a good proficiency level in each of the languages, with direct implications for family language policy and bilingual education.

Balanced Energy Protein Supplementation in Pregnancy: Adherence and Acceptability among Pregnant Women in Rural Ethiopia.

Background: Balanced energy protein (BEP) supplementation in pregnant women in low-and middle-income countries may reduce the risk of stillbirth and low birth weight. Objectives: The objective of this study was to assess the adherence to and acceptability of a corn-soy blend (CSB) BEP product among pregnant women in rural Ethiopia. Methods: This formative study was conducted from October to November 2018 among pregnant women in the rural Amhara region of Ethiopia prior to initiation of a clinical effectiveness study (ISRCTN: 15116516). We assessed adherence and acceptability of a micronutrient-fortified CSB BEP supplement among 40 pregnant women during a 4-wk utilization period. Acceptability was assessed using a 7-point Likert-style scale about the hedonic characteristics of the BEP product at 2 wk and 4 wk. Adherence was assessed by weekly monitoring and empty sachet counts for BEP consumption over 4 wk. Results: Adherence to the BEP was, on average, 89% over the month-long pilot. The BEP product was rated favorably (mean Likert score >6 of 7) for the following domains: color, taste, odor, and likeability at mid and endpoints. Women found the product convenient to eat [mean (standard deviation [SD] = 5.9 (1.0))] and filling (mean (SD) = 6.1 (1.5) out of 7). Scores on acceptability and perception of the product remained stable throughout the duration of use. A majority of women (63%) reported consuming the BEP as a snack to supplement meals and splitting the serving over 2 or more sessions (68%). A quarter of respondents reported sharing the supplement with family members. Conclusions: Adherence and acceptability of the CSB BEP product were high among this population in rural Amhara, Ethiopia. This formative data was important to select the final product and shape the counseling and delivery of BEP in the parent study.

An Improved Football Team Training Algorithm for Global Optimization.

The football team training algorithm (FTTA) is a new metaheuristic algorithm that was proposed in 2024. The FTTA has better performance but faces challenges such as poor convergence accuracy and ease of falling into local optimality due to limitations such as referring too much to the optimal individual for updating and insufficient perturbation of the optimal agent. To address these concerns, this paper presents an improved football team training algorithm called IFTTA. To enhance the exploration ability in the collective training phase, this paper proposes the fitness distance-balanced collective training strategy. This enables the players to train more rationally in the collective training phase and balances the exploration and exploitation capabilities of the algorithm. To further perturb the optimal agent in FTTA, a non-monopoly extra training strategy is designed to enhance the ability to get rid of the local optimum. In addition, a population restart strategy is then designed to boost the convergence accuracy and population diversity of the algorithm. In this paper, we validate the performance of IFTTA and FTTA as well as six comparison algorithms in CEC2017 test suites. The experimental results show that IFTTA has strong optimization performance. Moreover, several engineering-constrained optimization problems confirm the potential of IFTTA to solve real-world optimization problems.