Selection of an alternate cementitious mortar using ceramic tile dust waste: a hybrid MCDM approach.

Selection of a suitable alternative material from a pool of alternatives with many conflicting criteria becomes a Multi-Criteria Decision Making (MCDM) problem. In the present study, ternary blended mortars were prepared using ceramic tile dust waste (CTD), fly ash (FA), and ground granulated blast furnace slag (GGBFS) as binder components. Crusher dust (CD) was used as a fine aggregate component. Binder to aggregate ratios of 1:3 and 1:1 were prepared considering suitable flow. A total of 16 mortar mixes were cast. These mortars were tested for various conflicting criteria compressive strength, flexural strength, porosity, water absorption, bulk density, thermal conductivity, specific heat, thermal diffusivity, and thermal effusivity whose weightages obtained were 29.09%, 20.08%, 12.77%, 10.60%, 8.74%, 6.74%, 5.54%, 4.47%, and 1.97%, respectively, as per AHP analysis. Later, considering these different criteria and alternate mortars, it was observed that a 1:1 mortar with 20% CTD, 30% FA, and 50% GGBFS (RC20F30G50) is found to be the suitable mortar with the highest relative closeness coefficient of 0.861 and the highest net outranking flow of 0.316 with respect to MCDM techniques: technique for order of preference by similarity to ideal solution (TOPSIS) and preference ranking organization method for enrichment of evaluations (PROMETHEE-II), respectively. The ranking of the mortar in both methods complies with the relative weightages of the criteria and the performance of the mortars with respect to the above criteria.

Optimizing Tourniquet Pressure in Primary Total Knee Arthroplasty: Limb Occlusion Pressure vs Systolic Blood Pressure Method: A Randomised Controlled Study.

Background: This study aims to systematically compare the efficacy of two distinct approaches that is limb occlusion pressure (LOP) and systolic blood pressure (SBP) in determining the optimal tourniquet pressure for primary total knee arthroplasty. The overarching goal is to identify the method that yields superior outcomes in minimizing post-operative thigh pain while simultaneously reducing complications in our patient population. Methods: 311 patients scheduled for primary total knee replacement (TKR) were randomized in two groups. Group A (LOP) had 154 patients and group B had 157 patients. In group A, LOP was determined for all patients. After adding the safety margin, the tourniquet pressure was determined which was kept during the procedure. By adding 150 mm Hg to SBP in group B, the tourniquet inflation pressure was ascertained. Postoperatively, thigh pain was evaluated from day 1 to day 3 and at 6 weeks. Results: The average tourniquet pressure in group A patients having thigh circumference between 40 and 50 cm was 223.8 mm + - 19.8 mm Hg and in group B it was 262.1 + - 15.9 mm Hg (P < .01). Patients having thigh circumference between 51 and 60 cm had average tourniquet pressure of 240.07 + - 20.1 mm Hg in group A and 264.5 + - 17.4 mm Hg in group B (P < .01). The average tourniquet pressure for patients with thigh circumference more than 60 cm was 296 + /15.3 mm Hg in group A and 267.3 + /19.2 mm Hg in group B (P < 0.01). Conclusion: Tourniquet pressure determination based on the limb occlusion pressure (LOP) method provide less postoperative thigh pain and better range of motion. Graphical Abstract: Optimizing Tourniquet Pressure in Primary Total Knee Replacement: Limb Occlusion Pressure vs Systolic blood pressure method to minimize thigh pain.

Dissonance-Based Eating Disorder Prevention for Body-Dissatisfied Brazilian Cisgender Gay and Bisexual Men: A Randomized Controlled Trial With a 1-Year Follow-Up.

OBJECTIVE: Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance-based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men. METHOD: Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment-only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post-intervention, 1-month, 6-month, and 1-year follow-up. Those in the intervention condition also completed acceptability measures. RESULTS: Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post-intervention results were not significant, except for self-objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time-points of follow-ups (Cohen's d = -0.31 to -0.76). At follow-up, the DB condition showed significantly greater decreases in appearance-ideal internalization, drive for muscularity, self-objectification, ED and MD symptoms at 1-month, 6-month, and 1-year follow-ups (d = -0.33 to -0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1-month, 6-month, and 1-year follow-ups (d = 0.31-0.81). DISCUSSION: Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1-year in Brazilian cisgender gay and bisexual men. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-62fctqz.

EFFECT OF INTER-IMPLANT DISTANCE ON FRACTURE RESISTANCE OF IMPLANT SUPPORTED PROVISIONAL FIXED DENTAL PROSTHESIS.

This study aimed to identify the ideal inter-implant distance for optimum outcome on immediately loaded implant supported prosthesis. Hence this study was taken up to analyze the effect of varying inter-implant distance on fracture resistance of implant supported provisional FDP. A total of 24 bis-acrylate composite resin samples were prepared. Inter- implant distance was present in the metal die for placement of dummy implants at distances of 14 mm, 21 mm & 30 mm respectively. Wax-up for 3 unit, 4 unit & 5 unit implant supported provisional restoration were made. Silicone molds were used for making multiple interim prostheses using bis-acrylate composite material. All samples were subjected to fracture test in the universal testing machine with a crosshead speed of 1 mm/min. All samples were loaded with gradual force starting from 100 N till it fractured. The Load was applied at the center of prosthesis. Data was analyzed by one way ANOVA and Bonferroni post hoc test. Mean Fracture resistance of 3 unit provisional FDP at 14 mm of inter-implant distance showed 1342.61 ± 179.15 N. Mean Fracture resistance of 4 unit provisional FDP at 21 mm of inter-implant distance showed 1420.44 ± 170.37 N. Mean Fracture resistance of 5 unit provisional FDP at 30 mm of inter-implant distance showed 791.61 ± 203.59 N. Both 14mm and 21mm of inter implant distance are suitable span lengths to be considered for the optimum outcome during immediately loading with implant supported provisional restorations. Limitations of the study was force application was static in nature and not dynamic and the arch form was not "U" shaped but longitudinal using Bis-Acrly material only with no cantilever. Future studies can be done to evaluate the fracture resistance of bis- acrylate material considering biomechanics and arch form of natural dentition. Distal cantilever should be considered along with different material for fabricating provisional restoration.

Cosine similarity and distance measures for p , q - quasirung orthopair fuzzy sets: Applications in investment decision-making.

Similarity measures and distance measures are used in a variety of domains, such as data clustering, image processing, retrieval of information, and recognizing patterns, in order to measure the degree of similarity or divergence between elements or datasets. p , q - quasirung orthopair fuzzy ( p , q - QOF) sets are a novel improvement in fuzzy set theory that aims to properly manage data uncertainties. Unfortunately, there is a lack of research on similarity and distance measure between p , q - QOF sets. In this paper, we investigate different cosine similarity and distance measures between to p , q - quasirung orthopair fuzzy sets ( p , q - ROFSs). Firstly, the cosine similarity measure and the Euclidean distance measure for p , q - QOFSs are defined, followed by an exploration of their respective properties. Given that the cosine measure does not satisfy the similarity measure axiom, a method is presented for constructing alternative similarity measures for p , q - QOFSs. The structure is based on the suggested cosine similarity and Euclidean distance measures, which ensure adherence to the similarity measure axiom. Furthermore, we develop a cosine distance measure for p , q - QOFSs that connects similarity and distance measurements. We then apply this technique to decision-making, taking into account both geometric and algebraic perspectives. Finally, we present a practical example that demonstrates the proposed justification and efficacy of the proposed method, and we conclude with a comparison to existing approaches.

Disturbance rejecting PID-FF controller design of a non-ideal buck converter using an innovative snake optimizer with pattern search algorithm.

The optimal design of a proportional-integral-derivative controller with two cascaded first-order low-pass filters (PID-FF) for non-ideal buck converters faces significant challenges, including effective disturbance rejection, robustness to parameter variations, and the mitigation of high-frequency signal noise, with existing approaches often struggling and leading to suboptimal performance in practical applications. This study addresses these challenges by introducing a constraint on the open-loop crossover frequency to mitigate high-frequency noise and ensuring the controller prioritizes maintaining constant output voltage and robust responsiveness to input voltage and load current variations. This study also introduces an innovative metaheuristic algorithm, the opposition-based snake optimizer with pattern search (OSOPS), designed to address these limitations. OSOPS enhances the Snake Optimizer (SO) by integrating opposition-based learning (OBL) and Pattern Search (PS), thereby improving its exploration and exploitation capabilities. The proposed algorithm design includes a crossover frequency constraint aimed at counteracting high-frequency noise and ensuring robust performance under diverse disturbances. The efficacy of the OSOPS algorithm is demonstrated through rigorous statistical box plot analysis and convergence response comparisons with the original SO algorithm. Additionally, we systematically compare the performance of the OSOPS-based PID-FF-controlled non-ideal buck converter system against systems utilizing the original SO algorithm and the classical pole placement (PP) method. This evaluation encompasses transient and frequency responses, disturbance rejection, and robustness analysis. The results reveal that the OSOPS-based system outperforms the SO- and PP-based systems with 14.21 % and 32.10 % faster rise times, along with 15.38 % and 84.95 % faster settling times, respectively. The OSOPS and SO systems also exhibit higher bandwidths, exceeding the PP-based system by 18.74 % and 17.03 %, respectively. By addressing the key challenges in PID-FF controller design for non-ideal buck converters, this study provides a substantial advancement in control strategy, promising enhanced performance in practical applications.

Considerations for protein and amino acids in standardized reference diet for parthenogenetic marbled crayfish Procambarus virginalis model organism.

The concept of a standardized reference diet (SRD) is used in laboratory model organisms to ensure nutritional control between studies and laboratories. Although models using the genetically identical, all female parthenogenetic marbled crayfish (Procambarus virginalis) are growing in popularity, research into nutrition in this species still has many knowledge gaps. To fast track the development of a SRD in terms of protein and amino acids (SRDprotein) for this species, we first analyzed the composition of its body amino acids to determine the ideal protein concept (IPC) of indispensable amino acids in wild-caught P. virginalis (which had an unusually high preponderance of leucine and arginine). Then, we strategically evaluated three common clusters of types of fish feed: (1) ornamental fish feed (SER) fortified with a naturally occurring alga (Spirulina). This type of feed was protein-high in arginine and leucine (SER + SPI) that fulfils the species' IPC for iso-protein (~ 40%), iso-phosphorus (~ 0.8%) and near iso-energetic (~ 475 kcal 100 g-1); (2) freeze-dried live feed consisting of chironomid larvae (CHI) fortified with Spirulina (CHI + SPI) that fulfils the IPC for iso-protein (~ 46%), iso-phosphorus (~ 0.7%) and near iso-energetic (~ 405 kcal 100 g-1); and (3) a commercially standardized 'starter diet' for carnivorous fish larvae (FISH) and post-larval shrimps (SHRIMP) with iso-protein (~ 56%) and iso-phosphorus (~ 1.6%). A total of six diets, embracing a diverse range of proteinaceous feeds, were used in a 100-day ad libitum feeding and growth trial. The FISH group outperformed all the other groups (p < 0.05) and our exploratory multivariate analysis revealed an ideal demand of > 44% protein (tailored to deliver high arginine 3% and leucine 4%, followed by the usual lysine > 3.5% and methionine 1.2%) but also the lowest carbohydrate level (21%). For SRDprotein, our findings show that the FISH diet is ideal and suggest the possibilities of using a CHI + SPI diet for further optimization (more economic use of protein and phosphorus).

L-Asparaginase producing ability of Aspergillus species isolated from tapioca root soil and optimized ideal growth parameters for L-Asparaginase production.

This research was designed to isolate the predominant L-asparaginase-producing fungus from rhizosphere soil of tapioca field and assess the suitable growth conditions required to produce maximum L-asparaginase activity. The Aspergillus tubingensis was identified as a predominant L-asparaginase producing fungal isolate from 15 isolates, and it was characterized by 18S rRNA sequencing. The L-asparaginase-producing activity was confirmed by pink color zone formation around the colonies in modified Czapek Dox agar plate supplemented with 1% L-Asparagine. The optimal growth conditions required for the L-asparaginase production by A. tubingensis were optimized as pH 6.0, temperature 30 °C, glucose as carbon source, 1.5% of L-Asparagine, ammonium sulphate as nitrogen source, rice husk as natural L-Asparagine enriched source, and 8 days of the incubation period. The L-Asparaginase activity from A. tubingensis was excellent under these optimal growth conditions. It significantly used rice husk as an alternative to synthetic L-Asparagine. As a result, this may be considered a sustainable method of converting organic waste into valuable raw material for microbial enzyme production.

Implementation of the Versius robotic surgical system for thoracic surgery: first clinical evaluation of feasibility and performance.

OBJECTIVES: The aim of this study is to demonstrate the ability of the Versius surgical system to successfully and safely complete a range of thoracic procedures aligned with Stage 2a (Development) of the Idea, Development, Exploration, Assessment and Long-term follow-up framework for surgical innovation. METHODS: This prospective study included the first 30 consecutive patients who underwent robotic surgery with Versius by 2 surgeons without prior robotic experience between 1 April 2023 and 30 December 2023 [25 lung resections (wedge, segmentectomy and lobectomy) and 5 thymectomies]. There were no specific predetermined selection criteria for each case. The primary outcome was safe completion of the procedure without unplanned conversion. Secondary outcomes included intraoperative and postoperative complications, intraoperative device-related outcomes and pathology results. RESULTS: Twenty-eight (93.3%) cases were completed without conversion. Both conversions were to thoracoscopy, one due to a 'console alarm' and the other due to pulmonary artery bleeding. In lung resections, median console time was 103 (90-129) min. Five (20%) patients experienced postoperative complications, most frequent was persistent air leak (16%). Median length-of-stay was 3 (2-4) days. Neither readmissions nor mortality was observed. In thymectomies, no intraoperative or postoperative complications, readmissions, reinterventions or mortality were observed. Median console time was 77 (75-89) min and median length of stay was 1 (1-1) day. CONCLUSIONS: This phase 2a IDEAL-D study confirms lung resections and thymectomies are feasible with the use of Versius system, laying the foundation for larger phase 2b and 3 clinical studies within the IDEAL-D framework.

The effect of fat model variation on muscle fat fraction quantification in a cross-sectional cohort.

Spectroscopic imaging, rooted in Dixon's two-echo spin sequence to distinguish water and fat, has evolved significantly in acquisition and processing. Yet precise fat quantification remains a persistent challenge in ongoing research. With adequate phase characterization and correction, the fat composition models will impact measurements of fatty tissue. However, the effect of the used fat model in low-fat regions such as healthy muscle is unknown. In this study, we investigate the effect of assumed fat composition, in terms of chain length and double bond count, on fat fraction quantification in healthy muscle, while addressing phase and relaxometry confounders. For this purpose, we acquired bilateral thigh datasets from 38 healthy volunteers. Fat fractions were estimated using the IDEAL algorithm employing three different fat models fitted with and without the initial phase constrained. After data processing and model fitting, we used a convolutional neural net to automatically segment all thigh muscles and subcutaneous fat to evaluate the fitted parameters. The fat composition was compared with those reported in the literature. Overall, all the observed estimated fat composition values fall within the range of previously reported fatty acid composition based on gas chromatography measurements. All methods and models revealed different estimates of the muscle fat fractions in various evaluated muscle groups. Lateral differences changed from 0.5% to 5.3% in the hamstring muscle groups depending on the chosen method. The lowest observed left-right differences in each muscle group were all for the fat model estimating the number of double bonds with the initial phase unconstrained. With this model, the left-right differences were 0.64% ± 0.31%, 0.50% ± 0.27%, and 0.50% ± 0.40% for the quadriceps, hamstrings, and adductors muscle groups, respectively. Our findings suggest that a fat model estimating double bond numbers while allowing separate phases for each chemical species, given some assumptions, yields the best fat fraction estimate for our dataset.

A robust triphenylamine-based monolithic polymer network for selective sieving of CO2 and PM from flue gas.

The increasingly urgent issue of climate change is driving the development of carbon dioxide (CO2) capture and separation technologies in flue gas after combustion. The monolithic adsorbent stands out in practical adsorption applications for its simplified powder compaction process while maintaining the inherent balance between energy consumption for regeneration and selectivity for adsorption. However, optimizing the adsorption capacity and selectivity of CO2 separation materials remains a significant challenge. Herein, we synthesized monolithic polymer networks (N-CMPs) with triphenylamine adsorption sites, acid-base environment tolerance, and precise narrow microchannel pore systems for the selective sieving of CO2 and particulate matter (PM) in flue gas. The inherent continuous covalent bonding of N-CMPs, along with their highly delocalized π-π conjugated porous framework, ensures the stability of the monolithic polymer network's adsorption and separation capabilities under wet and acid-base conditions. Specifically, under the conditions of 1 bar at 273 K, the CO2 adsorption capacity of N-CMP-1 is 3.35 mmol/g. Attributed to the highly polar environment generated by triphenylamine and the inherent high micropore/mesopore ratio, N-CMPs exhibit an excellent ideal adsorbed solution theory (IAST) selectivity for CO2/N2 under simulated flue gas conditions (CO2/N2 = 15:85). Dynamic breakthrough experiments further visualize the high separation efficiency of N-CMPs in practical adsorption applications. Moreover, under acid-base conditions, N-CMPs achieve a capture efficiency exceeding 99.76 % for PM0.3, enabling the selective separation of CO2 and PM in flue gas. In fact, the combined capture of hazardous PM and CO2 from the exhaust gases produced by the combustion of fossil fuels will play a pivotal role in mitigating climate change and environmental issues until low-carbon and alternative energy technologies are widely adopted.

Effective and adaptable: Four studies on the shortened attitude toward the color blue marker variable scale.

This research is an extension of the recent scale development efforts for the marker variable Attitude Toward the Color Blue (ATCB), which addresses the efficacy of multiple shorter permutations of the scale. The purpose of this study is to develop a shorter version of an ideal marker variable scale used to detect common method variance. Potential uses of the shorter version of ATCB include intensive longitudinal studies, implementation of experience sampling methodology, or any brief survey for which the original version might be cumbersome to implement repeatedly or appear very odd to the respondent when paired with only a few other substantive items. Study 1, uses all six-, five-, and four-item versions of ATCB in confirmatory factor analysis (CFA) marker technique tests on a bivariate relationship. Study 2 analyzes the best- and worst-performing versions of reduced lengths of the ATCB scale found in the first study on another bivariate relationship. Study 3 compares the original seven-item version, as well as randomly selected reduced length versions in a data set with 15 model relationships. Study 4 uses an experiment to determine the efficacy of providing respondents with one of three shorter ATCB scales in a model of three substantive variables. Our findings indicate that ATCB of different permutations and lengths can detect CMV successfully, and that researchers should choose the length of scale based on their survey length. We conclude that ATCB is adaptable for a variety of research situations, presenting it as a valuable tool for high-quality research.

Current Perspectives of Protein in Bone Tissue Engineering: Bone Structure, Ideal Scaffolds, Fabrication Techniques, Applications, Scopes, and Future Advances.

In view of their exceptional approach, excellent inherent biocompatibility and biodegradability properties, and interaction with the local extracellular matrix, protein-based polymers have received attention in bone tissue engineering, which is a multidisciplinary field that repairs and regenerates fractured bones. Bone is a multihierarchical complex structure, and it performs several essential biofunctions, including maintaining mineral balance and structural support and protecting soft organs. Protein-based polymers have gained interest in developing ideal scaffolds as emerging biomaterials for bone fractured healing and regeneration, and it is challenging to design ideal bone substitutes as perfect biomaterials. Several protein-based polymers, including collagen, keratin, gelatin, serum albumin, etc., are potential materials due to their inherent cytocompatibility, controlled biodegradability, high biofunctionalization, and tunable mechanical characteristics. While numerous studies have indicated the encouraging possibilities of proteins in BTE, there are still major challenges concerning their biodegradability, stability in physiological conditions, and continuous release of growth factors and bioactive molecules. Robust scaffolds derived from proteins can be used to replace broken or diseased bone with a biocompatible substitute; proteins, being biopolymers, provide excellent scaffolds for bone tissue engineering. Herein, recent developments in protein polymers for cutting-edge bone tissue engineering are addressed in this review within 3-5 years, with a focus on the significant challenges and future perspectives. The first section discusses the structural fundamentals of bone anatomy and ideal scaffolds, and the second section describes the fabrication techniques of scaffolds. The third section highlights the importance of proteins and their applications in BTE. Hence, the recent development of protein polymers for state-of-the-art bone tissue engineering has been discussed, highlighting the significant challenges and future perspectives.

Anchorage Research for CFRP Tendons: A Review.

Carbon fiber reinforced polymer (CFRP) tendons are composite materials that offer significant advantages in terms of tensile strength and lightweight properties. They are being increasingly utilized in the construction industry, particularly in bridge cables and building structures. However, due to their relatively poor transverse mechanical properties compared to steel cables, securing these tendons with anchors presents a challenge. This paper reviews the structure and force characteristics of three types of anchors for CFRP tendons-clamping anchorage, bonded anchorage, and composite anchorage-analyzes and summarizes the anchorage characteristics and damage mechanisms of each type of anchorage, and highlights that the optimization of the mechanical properties of the tendons is key to the design and research of anchoring systems. The new composite anchorage offers comprehensive advantages, such as minimal tendon damage at the anchorage section, more uniform stress distribution, and better anchorage performance, despite being more complex in design compared to single-type anchorages. However, there remain challenges and research gaps in testing and validating these anchoring systems under realistic loading and environmental conditions, including impacts, cyclic stresses, humidity, and high temperatures. Future efforts should focus on developing new testing techniques and models to simulate real-world conditions, enabling more accurate assessments of anchorage performance and longevity. By doing so, we can fully harness the mechanical properties of CFRP tendons and further enhance the safety and efficiency of our built environment.

In Situ Induced Interface Engineering in Hierarchical Fe3O4 Enhances Performance for Alkaline Solid-State Energy Storage.

Rechargeable aqueous batteries adopting Fe-based materials are attracting widespread attention by virtue of high-safety and low-cost. However, the present Fe-based anodes suffer from low electronic/ionic conductivity and unsatisfactory comprehensive performance, which greatly restrict their practicability. Concerning the principle of physical chemistry, fabricating electrodes that could simultaneously achieve ideal thermodynamics and fast kinetics is a promising issue. Herein, hierarchical Fe3O4@Fe foam electrode with enhanced interface/grain boundary engineering is fabricated through an in situ self-regulated strategy. The electrode achieves ultrahigh areal capacity of 31.45 mA h cm-2 (50 mA cm-2), good scale application potential (742.54 mA h for 25 cm2 electrode), satisfied antifluctuation capability, and excellent cycling stability. In/ex situ characterizations further validate the desired thermodynamic and kinetic properties of the electrode endowed with accurate interface regulation, which accounts for salient electrochemical reversibility in a two-stage phase transition and slight energy loss. This work offers a suitable strategy in designing high-performance Fe-based electrodes with comprehensive inherent characteristics for high-safety large-scale energy storage.

A systematic review on the effectiveness of robot-assisted minimally invasive gastrectomy.

BACKGROUND: Robot-assisted minimally invasive gastrectomy (RAMIG) is increasingly used as a surgical approach for gastric cancer. This study assessed the effectiveness of RAMIG and studied which stages of the IDEAL-framework (1 = Idea, 2A = Development, 2B = Exploration, 3 = Assessment, 4 = Long-term follow-up) were followed. METHODS: The Cochrane Library, Embase, Pubmed, and Web of Science were searched for studies on RAMIG up to January 2023. Data collection included the IDEAL-stage, demographics, number of participants, and study design. For randomized controlled trials (RCTs) and long-term studies, data on intra-, postoperative, and oncologic outcomes, survival, and costs of RAMIG were collected and summarized. RESULTS: Of the 114 included studies, none reported the IDEAL-stage. After full-text reading, 18 (16%) studies were considered IDEAL-2A, 75 (66%) IDEAL-2B, 4 (4%) IDEAL-3, and 17 (15%) IDEAL-4. The IDEAL-stages were followed sequentially (2A-4), with IDEAL-2A studies still ongoing. IDEAL-3 RCTs showed lower overall complications (8.5-9.2% RAMIG versus 17.6-19.3% laparoscopic total/subtotal gastrectomy), equal 30-day mortality (0%), and equal length of hospital stay for RAMIG (mean 5.7-8.5 days RAMIG versus 6.4-8.2 days open/laparoscopic total/subtotal gastrectomy). Lymph node yield was similar across techniques, but RAMIG incurred significantly higher costs than laparoscopic total/subtotal gastrectomy ($13,423-15,262 versus $10,165-10,945). IDEAL-4 studies showed similar or improved overall/disease-free survival for RAMIG. CONCLUSION: During worldwide RAMIG implementation, the IDEAL-framework was followed in sequential order. IDEAL-3 and 4 long-term studies showed that RAMIG is similar or even better to conventional surgery in terms of hospital stay, lymph node yield, and overall/disease-free survival. In addition, RAMIG showed reduced postoperative complication rates, despite higher costs.

Nurses experiences regarding ideal clinic project implementation in eThekwini district.

Background: The South African National Department of Health introduced the ideal clinic realisation and maintenance (ICRM) programme in response to primary health care (PHC) services and to lay a strong foundation for the National Health Insurance implementation. The progress report 2015-2016 on the implementation of this programme indicated that achieving the 50% target in selected vital areas such as staffing, resource allocation, and utilisation was not achieved. Aim: The study aimed to explore and describe nurses' experiences regarding the ideal clinic project (ICP) implementation. Setting: The study was conducted in 18 PHC clinics in eThekwini district, KwaZulu-Natal. Methods: An exploratory descriptive, contextual qualitative design was employed guided by Donabedian's structure, process, and outcomes model. Data were collected using semi-structured interviews with 24 nurses between 15 September and 25 October 2020 following receipt of ethics and analysed using Tesch's open coding approach. Results: The three themes that emerged included structural limitations, processes involved in running the clinic, and support offered to the PHC clinics. These were highlighted as challenges experienced by nurses during the implementation of an ICP. Conclusion: Nurses' negative experiences and perceptions made it difficult for them to accomplish the ICP standards. Contribution: The findings from the study highlighted critical actions by the health care institution management which if instituted, could facilitate improved implementation of the ICP and achievement of the 50% target in selected vital areas.

IDEAL-IQ measurement can distinguish dysplastic nodule from early hepatocellular carcinoma: a case-control study.

Background: Previous studies have confirmed that malignant transformation of dysplastic nodule (DN) into hepatocellular carcinoma (HCC) is accompanied by reduction of iron content in nodules. This pathological abnormality can serve as the basis for magnetic resonance imaging (MRI). This study was designed to identify the feasibility of iterative decomposition of water and fat with echo asymmetry and least squares estimation-iron quantitative (IDEAL-IQ) measurement to distinguish early hepatocellular carcinoma (eHCC) from DN. Methods: We reviewed MRI studies of 35 eHCC and 23 DN lesions (46 participants with 58 lesions total, 37 males, 9 females, 31-80 years old). The exams include IDEAL-IQ sequence and 3.0T MR conventional scan [including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and Gadopentic acid (Gd-GDPA)-enhanced]. Then, 3 readers independently diagnosed eHCC, DN, or were unable to distinguish eHCC from DN using conventional MRI (CMRI), and then assessed R2* value of nodules [R2* value represents the nodule iron content (NIC)] and R2* value of liver background [R2* value represents the liver background iron content (LBIC)] with IDEAL-IQ. Statistical analysis was conducted using the t-test for comparison of means, the Mann-Whitney test for comparison of medians, the chi-square test for comparison of frequencies, and diagnostic efficacy was evaluated by using receiver operating characteristic (ROC) curve. Results: This study evaluated 35 eHCC participants (17 males, 6 females, 34-81 years old, nodule size: 10.5-27.6 mm, median 18.0 mm) and 23 DN participants (20 males, 3 females, 31-76 years old, nodule size: 16.30±4.095 mm). The NIC and ratio of NIC to LIBC (NIC/LBIC) of the eHCC group (35.926±12.806 sec-1, 0.327±0.107) was lower than that of the DN group (176.635±87.686 sec-1, 1.799±0.629) (P<0.001). Using NIC and NIC/LBIC to distinguish eHCC from DN, the true positive/false positive rates were 91.3%/94.3% and 87.0%/97.1%, respectively. The rates of CMRI, NIC and NIC/LBIC in diagnosis of eHCC were 77.1%, and 94.3%, 97.1%, respectively, and those of DN were 65.2%, 91.3%, and 87.0%, respectively. The diagnosis rate of eHCC and DN by CMRI was lower than that of NIC and NIC/LBIC (eHCC: P=0.03, 0.04, DN: P=0.02, 0.04). Conclusions: Using IDEAL-IQ measurement can distinguish DN from eHCC.

Does expanding wild venison consumption substitute livestock meat consumption? Evidence from the demand systems analysis of meat products in Hokkaido, Japan.

In many countries, growing deer populations cause environmental, economic, and traffic safety problems. This study sheds light on the potential implications of expanding the consumption of venison from hunted wild deer through deer population management efforts. It focuses on changes in environmental impacts resulting from changes in the demand for livestock meat due to increased consumption of wild venison. We analyzed the demand system between them using the Quadratic Almost Ideal Demand System (QUAIDS) model and scanner data from a grocery store chain in Hokkaido Prefecture, Japan. The results show that wild venison is a substitute good for pork and lamb. By contrast, wild venison is a complementary good for imported and domestic beef. Based on the estimated demand system model, we conducted an environmental footprint analysis to estimate the changes in environmental impacts when venison consumption increased. This shows that the greenhouse gas, water, and land footprints would increase, indicating greater environmental impacts, under a scenario of expanded venison consumption. The results demonstrate that increased venison consumption does not necessarily reduce the net environmental impacts of meat consumption, which depends on the demand system for meat products and the environmental footprint intensities of the respective products.

A comparative study on 3D printing-assisted arthroscopic IDEAL point femoral tunnel positioning for anterior cruciate ligament reconstruction versus conventional arthroscopic positioning.

BACKGROUND: This study aimed to investigate the feasibility and precision of using a 3D-printed template for femoral tunnel placement in guiding the optimal positioning of the Internal anatomical stop and Low tension maintenance (IDEAL) bone tunnel during single-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: A retrospective analysis was conducted on 40 patients who underwent arthroscopic single-bundle ACL reconstruction at our hospital between April 2021 and November 2021. In the direct vision group, the IDEAL bone tunnel was positioned using radiofrequency localization directly visualized at the stump. In the 3D-printed positioning group, preoperative CT scans and Digital Imaging and Communications in Medicine (DICOM) data were employed. Following the Quadrant method by Bernard, the femoral tunnel's depth was set at 25% and its height at 29%. Postoperative plain CT scans enabled the reconstruction of 3D models for both groups. The accuracy of femoral tunnel placement was then compared. RESULTS: The central locations of the bone tunnels in the direct vision group were at a mean depth of 25.74 ± 1.84% and a height of 29.22 ± 2.97%. In the 3D printing localization group, these values were 25.39 ± 2.98% for depth and 28.89 ± 2.50% for height, respectively. No significant differences were found in tunnel positioning between the groups. Both groups demonstrated statistically significant improvements in International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm scores postoperatively, with no significant differences observed 12 months post-surgery. CONCLUSION: The findings of this study suggest that 3D printing-assisted arthroscopic IDEAL point femoral tunnel positioning and conventional arthroscopic positioning are feasible and effective for ACL reconstruction. Using 3D printing technology to design femoral anchor points in ACL reconstruction allows for the customization of anterior fork reconstruction and precise bone tunnel positioning, supporting the goal of individualized and accurate reconstruction.