The synergy of artificial intelligence and personalized medicine for the enhanced diagnosis, treatment, and prevention of disease.

INTRODUCTION: The completion of the Human Genome Project in 2003 marked the beginning of a transformative era in medicine. This milestone laid the foundation for personalized medicine, an innovative approach that customizes healthcare treatments. CONTENT: Central to the advancement of personalized medicine is the understanding of genetic variations and their impact on drug responses. The integration of artificial intelligence (AI) into drug response trials has been pivotal in this domain. These technologies excel in handling large-scale genomic datasets and patient histories, significantly improving diagnostic accuracy, disease prediction and drug discovery. They are particularly effective in addressing complex diseases such as cancer and genetic disorders. Furthermore, the advent of wearable technology, when combined with AI, propels personalized medicine forward by offering real-time health monitoring, which is crucial for early disease detection and management. SUMMARY: The integration of AI into personalized medicine represents a significant advancement in healthcare, promising more accurate diagnoses, effective treatment plans and innovative drug discoveries. OUTLOOK: As technology continues to evolve, the role of AI in enhancing personalized medicine and transforming the healthcare landscape is expected to grow exponentially. This synergy between AI and healthcare holds great promise for the future, potentially revolutionizing the way healthcare is delivered and experienced.

Optimizing Gantry Breakpoint Angles in Proton Therapy: Enhancing Efficiency and Patient Experience.

Purpose: The breakpoint for a 360° radiotherapy gantry is typically positioned at 180°. This arbitrary setting has not been systematically evaluated for efficiency and may cause redundant gantry rotation and extended setup times. Our study aimed to identify an optimal gantry breakpoint angle for a full-gantry proton therapy system, with the goal of minimizing gantry movement. Materials and Methods: We analyzed 70 months of clinically delivered proton therapy plans (9152 plans, 131 883 fractions), categorizing them by treatment site and mapping the fields from a partial-gantry to full-gantry orientation. For each delivered fraction, we computed the minimum total gantry rotation angle as a function of gantry breakpoint position, which was varied between 0° and 360° in 1° steps. This analysis was performed separately within the entire plan cohort and individual treatment sites, both with and without the capability of over-rotating 10° past the breakpoint from either direction (20° overlap). The optimal gantry breakpoint was identified as one which resulted in a low average gantry rotation per fraction. Results: Considering mechanical constraints, 130° was identified as a reasonable balance between increased gantry-rotation efficiency and practical treatment considerations. With a 20° overlap, this selection reduced the average gantry rotation by 41.4° per fraction when compared to the standard 180° breakpoint. Disease site subgroups showed the following reduction in average gantry rotation: gastrointestinal 192.2°, thoracic 56.3°, pediatric 44.9°, genitourinary 19.9°, central nervous system 10.7°, breast 2.8°, and head and neck 0.1°. Conclusion: For a full-gantry system, a breakpoint of 130° generally outperforms the conventional 180° breakpoint. This reduction is particularly impactful for gastrointestinal, pediatric, and thoracic sites, which constitute a significant proportion of cases at our center. The adjusted breakpoint could potentially streamline patient delivery, alleviate mechanical wear, and enhance treatment precision by reducing the likelihood of patient movement during delivery.

Treating wastewater for microplastics to a level on par with nearby marine waters.

Retention of microplastics (MPs) at the third largest wastewater treatment plant (WWTP) in Sweden was investigated. The plant is one of the most modern and advanced of its kind, with rapid sand filter for tertiary treatment in combination with mechanical, biological, and chemical treatment. It achieved a significantly high treatment efficiency, which brought the MP concentration in its discharge on par with concentrations measured in marine waters of the same region. This novel data shows that properly designed modern WWTPs can reduce the MP content of sewage down to background levels measured in the receiving aquatic environment. Opposite to current understanding of the retention of MP by WWTPs, a modern and well-designed WWTP does not have to be a significant point source for MP. MPs were quantified at all major treatment steps, including digester inlet and outlet sludge. MPs sized 10-500 µm were analyzed by a focal plane array based micro-Fourier transform infrared (FPA-µFTIR) microscopy, a hyperspectral imaging technique, while MPs above 500 µm were analyzed by Attenuated Total Reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Mass was estimated from the hyperspectral images for MPs <500 µm and from microscope images >500 µm. The overall treatment efficiency was in terms of MP counts 99.98 %, with a daily input of 6.42 × 1010 and output of 1.04 × 107 particles. The mass removal efficiency was 99.99 %. The mechanical part of the treatment, the pre-treatment, and primary stages, reduced both the MP counts and mass by approximately 71 %. The combined biological treatment, secondary settling, and final polishing with rapid sand filtration removed nearly all the remaining 29 %. MPs became successively smaller as they passed the different treatment steps. The digester inlet received 1.04 × 1011 MPs daily, while it discharged 9.96 × 1010 MPs, causing a small but not significant decrease in MP counts, with a corresponding MP mass reduction of 9.56 %.

Treatment Efficiency of Maxillary and Mandibular Orovestibular Tooth Expansion and Compression Movements with the Invisalign® System in Adolescents and Adults.

OBJECTIVES: Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner efficiency of orovestibular movements for the entire dentition was systematically evaluated using 3D superimposition, taking into account the influence of jaw, tooth type and Invisalign® system. METHODS: Group 1 (n = 18 adults, Invisalign®) and Group 2 (n = 17 adolescents, Invisalign® Teen) were treated with Invisalign® Ex30 aligner material and Invisalign® specific auxiliary means. In this non-interventional retrospective study, pre- and post-treatment maxillary and mandibular plaster cast models were scanned and superimposed with ClinChecks® via Surface-Surface Matching Algorithm on unmoved teeth providing stable references. Effectivity of planned versus clinically realized movements was evaluated for each tooth. Statistics were performed with a t-test and Bonferroni-Holm correction (α = 0.05). RESULTS: Orovestibular movement efficiency was excellent without statistical significance regarding jaw, tooth type or Invisalign® system. Mandibular translational tooth movements were highly effective, and outstanding for premolars (91-98%). Maxillary translational tooth movements were successful for incisors and premolars, but less effective for canines and molars. Almost all teeth were moderately or very effectively corrected by crown tipping, performing better for mandibular (70-92%) than maxillary (22-31%) canines as much as for adolescent upper front teeth (81-85%) and lower canines (92%). CONCLUSIONS: Aligners are able to effectively implement translational orovestibular movements, supported by tilting the crowns for even more efficient implementation of the movements. This phenomenon was observed in our studies for all teeth in both jaws, regardless of the Invisalign® system used. Treatment planning should nevertheless take into account the individual patient parameters with regard to the movements to be performed in order to make the aligner therapy as successful as possible in terms of realizing the desired therapeutic goal.

Comparing the Efficacy of Different Archwire Materials in Accelerating Orthodontic Tooth Movement.

Background: Orthodontic treatment is commonly used to correct misaligned teeth and improve dental aesthetics and function. Archwires play a crucial role in this treatment by exerting forces on teeth, prompting them to shift into desired positions. Materials and Methods: For this experimental study, 60 participants requiring orthodontic treatment were selected and divided into three groups: Group A, treated with stainless steel archwires; Group B, treated with nickel-titanium archwires; and Group C, treated with beta-titanium archwires. Standardized orthodontic procedures were followed for all participants. The rate of tooth movement was measured over a period of 6 months using digital models and a calibrated measurement technique. Results: The study revealed notable differences in the rate of orthodontic tooth movement among the three groups. Group B (nickel-titanium archwires) demonstrated the highest mean rate of tooth movement, with an average of 1.5 mm per month. Group A (stainless steel archwires) exhibited a mean rate of 1.2 mm per month, while Group C (beta-titanium archwires) showed the lowest mean rate at 0.9 mm per month. Conclusion: In conclusion, this study highlights the varying efficacy of different archwire materials in accelerating orthodontic tooth movement. Nickel-titanium archwires exhibited the highest rate of tooth movement compared to stainless steel and beta-titanium archwires.

Grey water footprint for evaluating Zefta wastewater treatment plant: a case study.

The numbers of wastewater treatment plants (WWTP) in Egypt are increasing, yet the general level of pollution associated with wastewater discharge after treatment has not been evaluated. Grey water footprint (GWF) was used to assess the effluent discharges from Zefta WWTP. GWF, before and after treatment, was calculated and followed up to determine its impact on the receiving freshwater body. 150 samples were collected and analysed for BOD5 to determine the optimum operating conditions. Averages values were DO = 2.2, SV30 = 500, SVI = 167, SA = 9.3 d, MLVSS = 2392 mg/L, f/m = 0.16, MLSS in RAS = 7922 mg/L, WAS = 140 m3/d and the HRT = 12 h. The removal efficiency of COD and TSS in the primary settling tank reached 39% and 69%, respectively. Average calculations of removal efficiency percentile reached 90-93%. Average freshwater quantities required to reduce pollutants in the receiving body stream were seasonally determined for Zefta WWTP as 5.3 × 107 m3/year. The average influent BOD5 was 376 mg/L, it was reduced to 47 mg/L in the effluent, wherever the Cmin is 6 mg/L and Cnat is 10 mg/L. Statistical analysis has shown a significant direct relation between ΔWFG,mef and WFG,ref reached 0.952 and a significant inverse relation with Cef -0.982. WFG,T has shown a significant direct relation with Cr 0.974. WFG,T- ref has shown a significant direct relation with Cr as 0.971 and WFG,T as 0.803. It can be concluded that ΔWF is effective in evaluating the efficiency of wastewater treatment and its effect on the quality of receiving water bodies.

Occurrence of F-Specific Bacteriophages in Untreated and Treated Wastewaters in Mumbai.

F + coliphages are considered as potential enteric viral indicators in water systems as a tool for on-site validation of wastewater treatment processes. The present study evaluated the occurrence of F + coliphages in wastewaters collected from three wastewater treatment plants (WWTPs) in Mumbai city, to assess this potential. The detection and enumeration of F + coliphages was carried out from WWTPs Z1, Z3 and Z5 using the ISO 10705-1 and U.S EPA 1601 methods. F + coliphages were majorly detected in untreated wastewater samples followed by a few secondary treated samples in WWTP-Z1 and Z3 and one tertiary treated sample from Z1, these differences were found to be statistically significant. The difference in F + coliphage levels between the treatment stages highlight their potential as indicators for monitoring the efficiency of wastewater treatment. The overall positivity of F + coliphage was 35.09% for Salmonella. typhimurium WG49 host (as per ISO 10705-1), was higher by 10.52% for Escherichia coli Famp HS host (as per U.S EPA 1601) (45.61%), highlighting the efficiency of the latter host over the former in F + coliphage detection. Significant difference in F + coliphage counts using the two bacterial hosts were observed in WWTP-Z3 (p = 0.001) and WWTP-Z1 (p = 0.047) but not in WWTP-Z5 (p = 0.332). Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01181-7.

Endocrine disrupting chemicals in Italian drinking water systems: Insights from a three-year investigation combining chemical and effect-based tools.

Drinking water quality can be compromised by endocrine-disrupting chemicals (EDCs). Three phenolic compounds [bisphenol A (BPA), nonylphenol (NP), and 4-octylphenol (OP)] and three hormones [17ß-estradiol (E2), estrone (E1), and 17α-ethinylestradiol (EE2)] were analyzed as EDCs potentially occurring in source and drinking water from three full-scale drinking water treatment plants (DWTPs) in the Romagna area (Italy) by a combined approach of HPLC-MS/MS target analysis and effect-based tests for estrogenicity and genotoxicity. The EDC removal efficiency was evaluated at different steps along the treatment process in the most advanced DWTP. NP prevailed in all samples, followed by BPA. Sporadic contamination by OP and E1/E2 appeared only in the source waters; EE2 was never detected. No estrogenic or genotoxic activity was found, except for two samples showing estrogenicity well below the effect-based trigger value suggested for drinking water safety (0.9 ng/L EEQ). BPA and NP levels were largely below the threshold value; however, increases were observed after the intermediate steps of the treatment chain. The good quality of the water relied on the last step, i.e. the activated carbon filtration. DWTPs may represent an extra source of EDCs and monitoring chemical occurrence at all steps of the process is advisable to improve efficiency.

Evaluating the Effects of Water Balloons on High-Intensity Focused Ultrasound for Treating Uterine Fibroids.

OBJECTIVE: In the treatment of uterine fibroids with ultrasound-guided high-intensity focused ultrasound (HIFU), water balloons are considered to be a valuable aid for improving safety and efficiency. However, the water balloons worsen the pathway for acoustic transmission, causing degraded performance both in ultrasound therapy and in ultrasound imaging. This study was aimed at establishing a protocol to evaluate the effects of the water balloon. METHODS: Simulations and experiments were carefully conducted to quantitatively investigate the effects of water ballons on the efficiency of HIFU energy delivery and on the quality of ultrasound guiding images. More specifically, HIFU-induced temperature increases in the focal region, together with spatial resolution, contrast and signal-to-noise ratio in the ultrasound guiding images, were compared under the conditions with and without the water balloon. RESULTS: Experiment results revealed that the use of water balloons led to decreases in temperature up to 10ºC within the focal region in some specific situations, but the quality of the guiding images was relatively less affected. CONCLUSION: The study provided knowledge on what influence the water balloon could have in ultrasound-guided HIFU treatment; it also established a practical and standardized evaluation scheme for further optimizing the water balloon, for example, its material and internal liquid compositions. This study can potentially help improve the efficiency and safety of treating uterine fibroids with ultrasound-guided HIFU systems.

Application of New Filling Material Based on Combined Heat and Power Waste for Sewage Treatment in Constructed Wetlands.

The filling of constructed wetlands (CWs) affects the efficiency of sewage treatment and proper operation. Mineral aggregates are most often used as filling materials. Significant environmental burdens from mineral mining operations justify the search for waste fill. This study aimed to determine the possibility of increasing the efficiency of CW by using a Certyd aggregate as a new filling. Certyd is produced in the sintering process of coal ash, a waste from combined heat and power (CHP) plant operation. Comprehensive two-year studies were conducted using two real-scale subsurface vertical flow (SS VF) CWs supplied with domestic sewage. One bed was filled with a Certyd and the other was filled with appropriate fractions of a mineral aggregate. Both beds worked in parallel, and to compare their effectiveness, account seasonality was taken into account. The SS-VF Certyd-filled bed achieved an average efficiency of 88.0% for biological oxygen demand (BOD5), 80.2% for chemical oxygen demand (COD), 80.4% for suspended solids (SSs), 80.2 for ammonia nitrogen (N-NH4), 72.2% for total nitrogen (TN), and 55.3% for total phosphorus (TP), while the gravel-filled bed achieved 84.5%, 77.0%, 86.9%, 74.2%, 69.4%, and 57.8% for the whole research period, respectively. A higher effect of the removed unit load was achieved in the bed filled with Certyd (36.2 g BOD5 m-2 d-1, 50.0 g COD m-2 d-1, 5.88 g SS m-2 d-1, 7.1 g TN m-2 d-1, 7.9 g N-NH4 m-2 d-1, 0.79 g TP m-2 d-1) compared to the gravel-filled bed (34.7 g BOD5 m-2 d-1, 47.0 g COD, 6.35 g SS m-2 d-1, 6.9 g TN m-2 d-1, 7.3 g m-2 d-1 N-NH4, 0.83 g TP m-2 d-1).

Proton pencil beam scanning craniospinal irradiation (CSI) with a single posterior brain beam: Dosimetry and efficiency.

This study explores the feasibility and potential dosimetric and time efficiency benefit of proton Pencil Beam Scanning (PBS) craniospinal irradiation with a single posterior-anterior (SPA) brain field. The SPA approach was compared to our current clinical protocol using Bilateral Posterior Oblique brain fields (BPO). Ten consecutive patients were simulated in the head-first supine position on a long BOS frame and scanned using 3 mm CT slice thickness. A customized thermoplastic mask immobilized the patient's head, neck, and shoulders. A vac-lock was used to secure the legs. PBS proton plans were robustly optimized with 3mm setup errors and 3.5% range uncertainties in the Eclipse V15.6 treatment planning system (n = 12 scenarios). In order to achieve a smooth gradient dose match at the junction area, at least 5 cm overlap region was maintained between the segments and 5 mm uncertainty along the cranial-cauda direction was applied to each segment independently as additional robust optimization scenarios. The brain doses were planned by SPA or BPO fields. All spine segments were planned with a single PA field. Dosimetric differences between the BPO and SPA approaches were compared, and the treatment efficiency was analyzed according to timestamps of beam delivery. Results: The maximum brain dose increases to 111.1 ± 2.1% for SPA vs. 109.0 ± 1.7% for BPO (p < 0.01). The dose homogeneity index (D5/D95) in brain CTV was comparable between techniques (1.037 ± 0.010 for SPA and 1.033 ± 0.008 for BPO). Lens received lower maximum doses by 2.88 ± 1.58 Gy (RBE) (left) and 2.23 ± 1.37 Gy (RBE) (right) in the SPA plans (p < 0.01). No significant cochlea dose change was observed. SPA reduced the treatment time by more than 4 minutes on average and ranged from 2 to 10 minutes, depending on the beam waiting and allocation time. SPA is dosimetrically comparable to BPO, with reduced lens doses at the cost of slightly higher dose inhomogeneity and hot spots. Implementation of SPA is feasible and can help to improve the treatment efficiency of PBS CSI treatment.

Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model.

OBJECTIVES: To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. MATERIALS AND METHODS: An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. RESULTS: High EP /low F settings demonstrated superior treatment efficiency compared to low EP /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. CONCLUSIONS: Our findings suggest that high EP /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.

Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency.

PURPOSE: To compare the effectiveness and efficiency of supervised dichoptic action-videogame play to occlusion therapy in children with amblyopia. METHODS: Newly diagnosed children with amblyopia aged 4-12 years were recruited, excluding strabismus >30PD. After 16 weeks of refractive adaptation children were randomized to gaming 1 h/week supervised by the researcher, or electronically monitored occlusion 2 h/day. The gaming group played a dichoptic action-videogame using virtual reality goggles, which included the task of catching a snowflake presented intermittently to the amblyopic eye. Contrast for the fellow eye was self-adjusted until 2 identical images were perceived. The primary outcome was visual acuity (VA) change from baseline to 24 weeks. RESULTS: We recruited 96 children, 29 declined and 2 were excluded for language or legal issues. After refractive adaptation, 24 of the remaining 65 no longer met the inclusion criteria for amblyopia, and 8 dropped out. Of 16 children treated with gaming, 7 (6.7 years) completed treatment, whereas 9 younger children (5.3 years) did not. Of 17 treated with occlusion, 14 (5.1 years) completed treatment and 3 (4.5 years) did not. Of 5 children with small-angle strabismus, 3 treated with occlusion completed treatment and 2 treated with gaming did not. Median VA improved by 0.30 logMAR (IQR 0.20-0.40) after gaming, 0.20 logMAR (0.00-0.30) after occlusion (p = 0.823). Treatment efficiency was 1.25 logMAR/100 h (range 0.42-2.08) with gaming, 0.08 (-0.19-0.68) with occlusion (p < 0.001). CONCLUSION: Dichoptic gaming seems a viable alternative for older children with refractive amblyopia after glasses adaptation. Treatment efficiency with gaming under continuous supervision was 15 times higher than with occlusion at home.

Total organic halogen (TOX) in drinking water: Occurrence, correlation analysis, and precursor removal during drinking water treatment.

Total organic halogen (TOX) in drinking water provides a measurement of the overall organic halogenated disinfection by-products (DBPs) formed during disinfection. Yangtze River Delta is one of the regions with the highest population density, the fastest urbanization process, and the most severe water pollution in China. Collecting water samples from full-scale drinking water treatment plants (DWTPs) in this region, this study firstly surveyed TOX occurrence in drinking water. Besides, the correlation of TOX formation potential (TOXFP) and trihalomethane formation potential (THMFP) with general water quality parameters (e.g., dissolved organic carbon [DOC], UV254, and specific ultraviolet absorbance) and the removal efficiencies of TOX precursors by different water treatment processes were also investigated. TOX levels in DWTP effluents (i.e., finished water) ranged from 29 to 165 µg/L (median 67 µg/L), and those in simulated distribution system waters ranged from 101 to 276 µg/L (median 158 µg/L). There were generally higher linear regression coefficient values for raw water (R2 = 0.51-0.88) than for treated water (R2 = 0.33-0.64) in terms of the relationship between DBP formation potentials and general parameters. However, a relatively stronger correlation between THMFP and TOXFP was observed for treated water (R2 = 0.80, p < 0.001) than for raw water (R2 = 0.64, p < 0.001). The overall treatment efficiencies of investigated parameters in DWTPs generally followed the order of UV254 > DOC > TOX precursors > THM precursors. Notably, the overall removal rates of DOC and TOX precursors in summer (averaging 59 % and 54 %, respectively) were obviously higher than those in winter (averaging 39 % and 38 %, respectively), which was assumed to be related to the seasonal variation of bioactivity in sand filter. These results could expand the knowledge of TOX in drinking water, and provide valuable perspectives to water industry and DBP research.

A bi-directional beam-line energy ramping for efficient patient treatment with scanned proton therapy.

Objective.The treatment of mobile tumours using Pencil Beam Scanning (PBS) has become more prevalent in the last decade. However, to achieve the same beam delivery quality as for static tumours, treatments have to be combined with motion mitigation techniques, not limited but including, breath hold, gating and re-scanning, which typically prolong treatment time. In this article we present a novel method of bi-directional energy modulation and demonstrate our initial experience in improvement of treatment efficiency. Approach.At Paul Scherrer Institute Gantry 2 mobile tumours are treated by combining PBS with gating and volumetric re-scanning (VR), where the target volume is irradiated multiple times. Initial implementation of VR used only descending beam energies, creating a substantial dead time due to the beam-line initialization (ramping) before each re-scan. In 2019 we commissioned an energy meandering strategy that allows us to avoid beam line ramping in-between energy series while maintaining beam delivery quality.Main results.The measured beam parameters difference for both energy sequence are in the order of the typical daily variations: 0.2 mm in beam position and 0.2 mm in range. Using machine log files, we performed point-to-point dose difference calculations between original and new applications where we observed dose differences of less than 2%. After three years of operation employing bi-directional energy modulation, we have analysed the individual beam delivery time for 181 patients and have compared this to simulations of the timing behaviour assuming uni-directional energy sequence application. Depending on treatment complexity, we obtained plan delivery time reductions of up to 55%, with a median time gain of 17% for all types of treatments.Significance. Bi-directional energy modulation can help improving patient treatment efficiency by reducing delivery times especially for complex and specialised irradiations. It could be implemented in many existing facilities without significant additional hardware upgrades.

Patient preferences as human factors for health data recommender systems and shared decision making in orthopaedic practice.

Background: A core set of requirements for designing AI-based Health Recommender Systems (HRS) is a thorough understanding of human factors in a decision-making process. Patient preferences regarding treatment outcomes can be one important human factor. For orthopaedic medicine, limited communication may occur between a patient and a provider during the short duration of a clinical visit, limiting the opportunity for the patient to express treatment outcome preferences (TOP). This may occur despite patient preferences having a significant impact on achieving patient satisfaction, shared decision making and treatment success. Inclusion of patient preferences during patient intake and/or during the early phases of patient contact and information gathering can lead to better treatment recommendations. Aim: We aim to explore patient treatment outcome preferences as significant human factors in treatment decision making in orthopedics. The goal of this research is to design, build, and test an app that collects baseline TOPs across orthopaedic outcomes and reports this information to providers during a clinical visit. This data may also be used to inform the design of HRSs for orthopaedic treatment decision making. Methods: We created a mobile app to collect TOPs using a direct weighting (DW) technique. We used a mixed methods approach to pilot test the app with 23 first-time orthopaedic visit patients presenting with joint pain and/or function deficiency by presenting the app for utilization and conducting qualitative interviews and quantitative surveys post utilization. Results: The study validated five core TOP domains, with most users dividing their 100-point DW allocation across 1-3 domains. The tool received moderate to high usability scores. Thematic analysis of patient interviews provides insights into TOPs that are important to patients, how they can be communicated effectively, and incorporated into a clinical visit with meaningful patient-provider communication that leads to shared decision making. Conclusion: Patient TOPs may be important human factors to consider in determining treatment options that may be helpful for automating patient treatment recommendations. We conclude that inclusion of patient TOPs to inform the design of HRSs results in creating more robust patient treatment profiles in the EHR thus enhancing opportunities for treatment recommendations and future AI applications.

Absolute quantification of Mycoplasma pneumoniae in infected patients by droplet digital PCR to track disease severity and treatment efficacy.

Mycoplasma pneumoniae is a common causative pathogen of community-acquired pneumonia. An accurate and sensitive detection method is important for evaluating disease severity and treatment efficacy. Digital droplet PCR (ddPCR) is a competent method enabling the absolute quantification of DNA copy number with high precision and sensitivity. We established ddPCR for M. pneumoniae detection, using clinical specimens for validation, and this showed excellent specificity for M. pneumoniae. The limit of detection of ddPCR was 2.9 copies/reaction, while that for real-time PCR was 10.8 copies/reaction. In total, 178 clinical samples were used to evaluate the ddPCR assay, which correctly identified and differentiated 80 positive samples, whereas the real-time PCR tested 79 samples as positive. One sample that tested negative in real-time PCR was positive in ddPCR, with a bacterial load of three copies/test. For samples that tested positive in both methods, the cycle threshold of real-time PCR was highly correlated with the copy number of ddPCR. Bacterial loads in patients with severe M. pneumoniae pneumonia were significantly higher than those in patients with general M. pneumoniae pneumonia. The ddPCR showed that bacterial loads were significantly decreased after macrolide treatment, which could have reflected the treatment efficacy. The proposed ddPCR assay was sensitive and specific for the detection of M. pneumoniae. Quantitative monitoring of bacterial load in clinical samples could help clinicians to evaluate treatment efficacy.

Abundance, characteristics, fate, and removal of microplastics during municipal wastewater treatment plant in the west of Iran: the case of Kermanshah city.

The threat of microplastics (MPs) in aquatic systems is almost a new challenge in environmental management. The municipal wastewater treatment plants (WWTPs) act both as collectors of MPs from anthropic use and as a source to natural environments. This study is aimed to determine the abundance, characteristics, and removal of MPs in a municipal WWTP with conventional activated sludge process. Particle size/type, influent loads, and removal rate of MPs in bar screen, grit chamber, primary sedimentation, returned activated sludge, and secondary clarification units of this WWTP were studied by collecting composite samples from wastewater and sludge over a 3-month sampling campaign. Suspected MP particles were counted by light microscopy and characterized using SEM, EDS, FTIR, and TGA-DSC techniques. The mean total MPs, fibers, and fragment concentration after the grit chamber were 6608, 3594, and 3014 which were reduced to 1855, 802, and 1053 particles/L in the effluent, respectively. The sludge retention of total MPs, fibers, and fragments were 8001, 3277, and 4719 particles/L, respectively. The overall efficiency of WWTP with an activated sludge process to remove MPs was 64% and it removed 66.6% and 60% of fibers and fragments, respectively. Fibers were the dominant shape for the collected samples after the grit chamber and fragments were prevalent in the effluent. Polyethylene polymer was detected in most wastewater samples. Existing treatment processes are effective in the removal of MP particles but still act as a potential source to the aquatic ecosystem.

Dynamics of runoff quality associated with an urban park and WSUD treatment train in a tropical climate.

A combination of discrete sampling using autosamplers triggered by area-velocity metres and continuous water quality monitoring using YSI datasondes enabled us to evaluate the dynamics of both stormwater runoff and dry weather water quality associated with an urban park and WSUD treatment train in Singapore. The WSUD treatment train consisted of a raingarden and sedimentation ponds. A first flush phenomenon was observed for total suspended solids (TSS) in three of four discrete-sampled events, but there was a less pronounced first flush characteristic for nutrients. Mean TN concentrations associated with runoff from the park (upstream of the WSUD treatment train) were in the range that would be associated with eutrophic conditions, while mean TP levels were in the mesotrophic/eutrophic boundary range. The raingarden reduced nutrient and TSS levels by 7-62% and loads by 65-93%, although nitrate levels were higher in the effluent compared to the influent. The sedimentation ponds successfully reduced sediment levels by 56%, based on continuous turbidity measurements. The dissolved oxygen levels in the sedimentation ponds were lower during drought periods, which has implications for aquatic organisms. The WSUD treatment train generally improved runoff quality from the park and such features can be easily integrated into the park design.

Biochar-assisted anaerobic membrane bioreactor towards high-efficient energy recovery from swine wastewater: Performances and the potential mechanisms.

A high-efficient energy recovery system of biochar-assisted anaerobic membrane bioreactor (BC-AnMBR) was established for swine wastewater treatment. Comparing with a conventional AnMBR, biochar addition accelerated volatile fatty acids (VFA) degradation during start-up stage, thereby shortened start-up duration by 44.0 %. Under a high organic loading rate (OLR) of 21.1 gCOD/L/d, BC-AnMBR promoted COD removal efficiency from 90.1 % to 95.2 %, and maintained a high methane production rate of 4.8L CH4/L/d. The relative abundance of Methanosaeta declined from 53.9 % in conventional AnMBR to 21.0 % in BC-AnMBR, whereas that of Methanobrevibacter dramatically increased from 10.3 % to 70.9 %, respectively. Metabolic pathway analysis revealed that biochar not only strengthened hydrogenotrophic methanogenesis pathway, but also upregulated the genes encoding electron transfer carriers and riboflavin metabolism, suggesting the role of biochar facilitating direct interspecies electron transfer for syntrophic methanogenesis. The excellent energy yield performances under high OLR confirmed BC-AnMBR as an advanced system for high-strength swine wastewater treatment.