Analytical and clinical performance evaluation of a new NT-proBNP assay.

BACKGROUND: The study evaluated the performance of the Mindray N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a healthy population in China, focusing on creating a reference range for future clinical applications adjusted according to different demographics. METHODS: The study measured NT-proBNP in 2277 healthy individuals. We analyzed age and sex-stratified data, performed precision, accuracy, linearitcvy, and detection limit studies, and evaluated method comparison and consistency between Roche and Mindray assays on 724 serum samples. We used Excel 2010, Medcalc, and GraphPad Prism 9. RESULTS: In males, the 97.5th centile NT-proBNP concentration at age < 45, 45 to 54, 55 to 64, 65 to 74 and ≧ 75 were 89.4 ng/L, 126 ng/L, 206 ng/L, 386 ng/L and 522 ng/L, respectively. In females, the concentration of NT-proBNP at the same age was 132 ng/L, 229 ng/L, 262 ng/L, 297 ng/L and 807 ng/L, respectively. The repeatability precision coefficient of variation (CV%) for NT-proBNP was between 0.86 and 1.65 in analytical performance. In contrast, the reproducibility precision (CV%) for NT-proBNP was between 1.52 and 3.22, respectively. The study found a bias of accuracy of 3.73% in low-value samples (concentration: 148.69) and 7.31% in high-value samples (concentration: 1939.08). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 125 ng/L were 96.6%, 92.3%, 84.2%, and 98.5%, respectively. In contrast, those of 300 ng/L were 94.0%, 98.2%, 95.7% and 97.5%, respectively. CONCLUSIONS: The Mindray NT-proBNP assay showed increased levels in both males and females with age, with higher levels in women. It performs well and aligns with manufacturer specifications. We recommend adjusting cutoff values based on demographic factors.

Social Media Authentication and Users' Assessments of Health Information: Random Assignment Survey Experiment.

BACKGROUND: In an effort to signal the authenticity of user accounts, social networking sites (SNSs) such as Facebook and X, formerly known as Twitter, use visual heuristics (blue checkmarks) to signify whether accounts are verified. While these verification badges are generally well recognized (and often coveted) by SNS users, relatively little is known about how they affect users' perceptions of accuracy or their likelihood of engaging with web-based information. This is particularly true in the case of information posted by medical experts and health care professionals. OBJECTIVE: This study aims to use an experimental survey design to assess the effect of these verification badges on SNS users' assessments of information accuracy as well as their proclivity to recirculate health information or follow verified medical experts in their social network. METHODS: A survey experiment using random assignment was conducted on a representative sample of 534 adult SNS users in Florida, United States. A total of 2 separate experimental scenarios exposed users to vaccine-related posts from verified medical experts on X. In each case, the original post contained a platform-issued verification badge (treatment group), which was subsequently edited out of the image as an experimental control. For each scenario, respondents were randomly assigned to either the treatment or control group, and responses to 3 follow-up questions were assessed through a series of chi-square analyses and 2 logit regression models. Responses were fielded using a stratified quota sampling approach to ensure representativeness of the state's population based on age, sex, race, ethnicity, and political affiliation. RESULTS: Users' assessments of information accuracy were not significantly impacted by the presence or absence of verification badges, and users exposed to the experimental treatment (verification badge) were not any more likely to repost the message or follow the author. While verification badges did not influence users' assessments or subsequent behaviors, reliance on social media for health-related information and political affiliation were substantial predictors of accuracy assessments in both experimental scenarios. In scenario 1, which included a post addressing COVID-19 vaccine efficacy, users who relied on social media "a great deal" for health information were 2 times more likely to assess the post as accurate (odds ratio 2.033, 95% CI 1.129-3.661; P=.01). In scenario 2, which included a post about measles vaccines, registered Republicans were nearly 6 times less likely to assess the post as accurate (odds ratio 0.171, 95% CI 0.097-0.299; P<.001). CONCLUSIONS: For health professionals and medical experts wishing to leverage social networks to combat misinformation and spread reliable health-related content, account verification appears to offer little by way of added value. On the basis of prior research, other heuristics and communication strategies are likely to yield better results.

Evaluation and clinical application of a bracketing calibration-based isotope dilution liquid chromatography-tandem mass spectrometry candidate reference measurement procedure for serum theophylline.

A candidate reference measurement procedure (RMP) for serum theophylline via isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed. With a single-step precipitation pretreatment and a 6-min gradient elution, the method achieved baseline separation of theophylline and its analogs on a C18-packed column. A bracketing calibration method was used to ensure repeatable signal intensity and high measurement precision. The intra-assay and inter-assay imprecisions were 1.06%, 0.84%, 0.72% and 0.47%, 0.41%, 0.25% at concentrations of 4.22 µg/mL (23.40 µmol/L), 8.45 µg/mL (46.90 µmol/L), and 15.21 µg/mL (84.43 µmol/L), respectively. Recoveries ranged from 99.35 to 102.34%. The limit of detection (LoD) was 2 ng/mL, and the lowest limit of quantification (LLoQ) was 5 ng/mL. The linearity range extended from 0.47 to 60 µg/mL (2.61-333.04 µmol/L). No ion suppression and carry-over (< 0.68%) were observed. The relative bias for this candidate RMP that participated in 2023 External Quality Control for Reference Laboratories (RELA) conducted by the International Federation of Clinical Chemistry (IFCC) was within a range of 0.17 to 0.93%. Furthermore, two clinical immunoassay systems were compared with this candidate RMP, demonstrating good correlations. The results of the Trueness Verification Plan indicate significant differences among routine systems, highlighting the need for standardization efforts. The developed candidate RMP for serum theophylline serves as a precise reference baseline for standardizing clinical systems and assigning values to reference materials.

A Quantitative Review of Certified Burn Therapist's Involvement in the JBCR Publications and ABA Leadership.

The Burn Therapist Certification (BT-C) was introduced in 2018 to acknowledge occupational and physical therapists with specialized knowledge, skill, and experience in promotion of quality burn rehabilitation. Currently, BT-Cs make up 11.7% of therapists working in burn rehabilitation (n=39/333). The purpose of this review is to report on contributions of BT-Cs to organizational leadership of the American Burn Association (ABA) and in the generation of new knowledge through peer-reviewed publications. Despite the small percentage of burn therapists who are certified, they have a disproportionately large involvement in leadership within the ABA and burn research in the Journal of Burn Care and Rehabilitation (JBCR). From 2018-2023, BT-Cs have contributed to nearly one-half (n=26/56) of therapy authored publications in the JBCR and almost one-third (n=65/202) of accepted abstracts at the ABA annual meeting. Certified burn therapists demonstrate substantial involvement throughout the ABA including maintaining an 85% membership rate and on average serve in 53% (n=31/59) of the therapy allotted committee positions. Therapist pursuit of certification can have a profound impact on the burn community through publication, leadership, and development of care standards. Although therapists have indicated a desire to pursue certification, barriers related to a lack of association and center support have been identified. The burn community has endorsed certification as a mark of excellence for nurses and physicians. Maximizing the value of a transdisciplinary approach to burn care is also dependent on excellence from therapies. If the burn community desires improved engagement and contribution from therapies, it should support therapist certification.

Phylogenetic and pangenomic analyses of members of the family Micrococcaceae related to a plant-growth-promoting rhizobacterium isolated from the rhizosphere of potato (Solanum tuberosum L.).

We report the results of taxonomic studies on members of the family Micrococcaceae that, according to the 16S rRNA, internal transcribed spacer 1 (ITS1), average nucleotide identity (ANI), and average amino acid identity (AAI) tests, are related to Kocuria rosea strain RCAM04488, a plant-growth-promoting rhizobacterium (PGPR) isolated from the rhizosphere of potato (Solanum tuberosum L.). In these studies, we used whole-genome phylogenetic tests and pangenomic analysis. According to the ANI > 95 % criterion, several known members of K. salina, K. polaris, and K. rosea (including K. rosea type strain ATCC 186T) that are related most closely to isolate RCAM04488 in the ITS1 test should be assigned to the same species with appropriate strain verification. However, these strains were isolated from strongly contrasting ecological and geographical habitats, which could not but affect their genotypes and phenotypes and which should be taken into account in evaluation of their systematic position. This contradiction was resolved by a pangenomic analysis, which showed that the strains differed strongly in the number of accessory and strain-specific genes determining their individuality and possibly their potential for adaptation to different ecological niches. Similar results were obtained in a full-scale AAI test against the UniProt database (about 250 million records), by using the AAI-profiler program and the proteome of K. rosea strain ATCC 186T as a query. According to the AAI > 65 % criterion, members of the genus Arthrobacter and several other genera belonging to the class Actinomycetes, with a very wide geographical and ecological range of sources of isolation, should be placed into the same genus as Kocuria. Within the paradigm with vertically inherited phylogenetic markers, this could be regarded as a signal for their following taxonomic reclassification. An important factor in this case may be the detailing of the gene composition of the strains and the taxonomic ratios resulting from analysis of the pangenomes of the corresponding clades.

Patient-specific deep learning for 3D protoacoustic image reconstruction and dose verification in proton therapy.

BACKGROUND: Protoacoustic (PA) imaging has the potential to provide real-time 3D dose verification of proton therapy. However, PA images are susceptible to severe distortion due to limited angle acquisition. Our previous studies showed the potential of using deep learning to enhance PA images. As the model was trained using a limited number of patients' data, its efficacy was limited when applied to individual patients. PURPOSE: In this study, we developed a patient-specific deep learning method for protoacoustic imaging to improve the reconstruction quality of protoacoustic imaging and the accuracy of dose verification for individual patients. METHODS: Our method consists of two stages: in the first stage, a group model is trained from a diverse training set containing all patients, where a novel deep learning network is employed to directly reconstruct the initial pressure maps from the radiofrequency (RF) signals; in the second stage, we apply transfer learning on the pre-trained group model using patient-specific dataset derived from a novel data augmentation method to tune it into a patient-specific model. Raw PA signals were simulated based on computed tomography (CT) images and the pressure map derived from the planned dose. The reconstructed PA images were evaluated against the ground truth by using the root mean squared errors (RMSE), structural similarity index measure (SSIM) and gamma index on 10 specific prostate cancer patients. The significance level was evaluated by t-test with the p-value threshold of 0.05 compared with the results from the group model. RESULTS: The patient-specific model achieved an average RMSE of 0.014 ( p < 0.05 ${{{p}}}<{0.05}$ ), and an average SSIM of 0.981 ( p < 0.05 ${{{p}}}<{0.05}$ ), out-performing the group model. Qualitative results also demonstrated that our patient-specific approach acquired better imaging quality with more details reconstructed when comparing with the group model. Dose verification achieved an average RMSE of 0.011 ( p < 0.05 ${{{p}}}<{0.05}$ ), and an average SSIM of 0.995 ( p < 0.05 ${{{p}}}<{0.05}$ ). Gamma index evaluation demonstrated a high agreement (97.4% [ p < 0.05 ${{{p}}}<{0.05}$ ] and 97.9% [ p < 0.05 ${{{p}}}<{0.05}$ ] for 1%/3  and 1%/5 mm) between the predicted and the ground truth dose maps. Our approach approximately took 6 s to reconstruct PA images for each patient, demonstrating its feasibility for online 3D dose verification for prostate proton therapy. CONCLUSIONS: Our method demonstrated the feasibility of achieving 3D high-precision PA-based dose verification using patient-specific deep-learning approaches, which can potentially be used to guide the treatment to mitigate the impact of range uncertainty and improve the precision. Further studies are needed to validate the clinical impact of the technique.

How often do fingerprint examiners disagree in routine casework?

During routine casework, fingerprint examiners are required to make decisions pertaining to the sufficiency of friction ridge skin impressions. Prior experimental research has established that differences of opinion between examiners are expected, though it is uncertain if these findings are representative of the decisions made during casework. In this study, 5000 job-cards completed by fingerprint experts of the NSW Police Force were scrutinised to track the differences of opinion that occurred between examiners. Experts recorded 19,491 casework decisions, which resulted in 8964 reported identification and inconclusive determinations. Expert decision making was found to be unanimous in 94.8 % of these determinations; 4.6 % involved one expert-to-expert disagreement; and 0.5 % involved two expert-to-expert disagreements. Nil determinations featured more than two expert-to-expert disagreements. Expert-to-expert disagreements occurred in 3.7 % of all identification and inconclusive casework verification decisions. However, verifying experts were more likely to agree with a prior expert's identification decision, than a prior expert's inconclusive decision. The observed expert-to-expert identification disagreement rate was 2.0 %, whereas the observed expert-to-expert inconclusive disagreement rate was 12.5 %. Overall, most casework disagreements arose due to subjective differences concerning the suitability of friction ridge skin information for comparison or sufficiency for identification. Experts were more concordant in their decision-making with other experts than with trainees, and approximately three times more likely to disagree with a prior trainees' identification or inconclusive decision than a prior experts' identification or inconclusive decision. We assume these differences reflect trainees' developing proficiencies in assessing the suitability or sufficiency of friction ridge skin impression information. Differences of opinion in casework are expected, which exposes the subjective nature of fingerprint decision-making. Computer-based quality metric and likelihood ratio tools should be considered for use in casework to guide examiner evaluations and mitigate examiner disagreements.

An experimental validation of a filtering approach for prompt gamma prediction in a research proton treatment planning system.

Prompt gamma (PG) radiation generated from nuclear reactions between protons and tissue nuclei can be employed for range verification in proton therapy. A typical clinical workflow for prompt gamma range verification compares the detected prompt gamma profile with a predicted one. Recently, a novel analytical prompt gamma prediction algorithm based on the so-called filtering formalism has been proposed and implemented in a research version of RayStation (RaySearch Laboratories AB), which is a widely adopted treatment planning system. In this work, the said algorithm is validated against experimental data and benchmarked with another well-established prompt gamma prediction algorithm implemented in a MATLAB-based software REGGUI. Furthermore, a new workflow based on several PG profile quality criteria and analytical methods is proposed for data selection. The workflow also calculates sensitivity and specificity information, which can help practitioners to decide on irradiation course interruption during treatment and monitor spot selection at the treatment planning stage. With the proposed workflow, the comparison can be performed on a limited number of selected high-quality irradiation spots without neighbouring-spot aggregation. The mean shifts between the experimental data and the simulated PG detection (PGD) profiles (ΔPGD) by the two algorithms are estimated to be 1.5~2.1 mm and -0.6~2.2 mm for the filtering and REGGUI prediction methods, respectively. The ΔPGD difference between two algorithms is observed to be consistent with the beam model difference within uncertainty. However, the filtering approach requires a much shorter computation time compared to the REGGUI approach.

Clinical applicability of Linac-integrated CBCT based NIPAM 3D dosimetry: a dual-institutional investigation.

OBJECTIVE: To develop and benchmark a novel 3D dose verification technique consisting of polymer-gel-dosimeter (PGD) with cone-beam-CT (CBCT) readout through a two-institution study. The technique has potential for wide and robust applicability through reliance on CBCT readout. Approach: Three treatment plans (3-Field, TG119-C-shape spine, 4-target SRS) were created by two independent institutions (Institution A and B). A Varian Truebeam LINAC was used to deliver the plans to NIPAM polymer gel dosimeters produced at both institutions using an identical approach. For readout, a slow CBCT scan mode was used to acquire pre- and post-irradiation images of the gel (1 mm slice thickness). Independent gel analysis tools were used to process the PGD images (A: VistaAce software, B: in-house MATLAB code). Comparing planned and measured doses, the analysis involved a combination of 1D line profiles, 2D contour plots, and 3D global gamma maps (criteria ranging between 2%1mm and 5%2mm, with a 10% dose threshold). Main Results: For all gamma criteria tested, the 3D gamma pass rates were all above 90% for 3-field and 88% for the SRS plan. For the C-shape spine plan, we benchmarked our 2% 2mm result against previously published work using film analysis (93.4%). For 2%2mm, 99.4% (Institution A data), and 89.7% (Institution B data) were obtained based on VistaAce software analysis, 83.7% (Institution A data), and 82.9% (Institution B data) based on MATLAB. Significance: The benchmark data demonstrate that when two institutions follow the same rigorous procedures gamma passing rates up to 99%, for 2%2mm criteria can be achieved for substantively different treatment plans. The use of different software and calibration techniques may have contributed to the variation in the 3D gamma results. By sharing the data across institutions, we observe the gamma passing rate is more consistent within each pipeline, indicating the need for standardized analysis methods.

How to verify and validate a Clinical Microbiology test before it can be used in routine diagnostics, a practical guide.

BACKGROUND: Before a new test can be routinely used in your laboratory, its reliability must be established in the laboratory where it will be used. International standards demand validation and verification procedures for new tests. The International Organization for Standardization (ISO) 15189 was recently updated, and the European Commission's In Vitro Diagnostic Regulation (IVDR) came into effect. These events will likely increase the need for validation and verification procedures. OBJECTIVES: This paper aims to provide practical guidance in validating or verifying microbiology tests, including antimicrobial susceptibility tests in a clinical microbiology laboratory. SOURCES: It summarizes and interprets standards, such as ISO 15189: 20222 and regulations, such as IVDR 2017/745. CONTENT: The reasons for choosing a new test and the outline of the validation and verification plan are discussed. Further, the following topics are touched upon: the choice of reference standard, number of samples, testing procedures, how to solve the discrepancies between results from new test and reference standard, and acceptance criteria. Arguments for selecting certain parameters (such as reference standard and samples size) and examples are given. IMPLICATIONS: With the expected increase in validation and verification procedures due to implementation of IVDR, this paper may aid in planning and executing these procedures.

Chapter 3: Setting the Hearing Aid Response and Verifying Signal Processing and Features in the Test Box.

The test box can be used for fitting hearing aids (verifying audibility for the individual), for setting and fine-tuning specific signal processing (e.g., directional microphones, noise reduction, frequency lowering, telecoil responses), and for setting the response for specific accessories (e.g., remote microphones). If you have selected these features for your patient, it is important to make sure they are working properly and turned on. In addition, these tests can help you address specific patient complaints. Let us start by using the test box to pre-set a hearing aid and then we will move on to speech tests of signal processing and features.

Performance verification of a biochemical detection system for hydrothorax and ascites and clinical diagnostic accuracy evaluation of exudate and tuberculous effusion.

Background: Lactate dehydrogenase (LDH), total protein (TP) and glucose (Glu) in pleural hydrothorax and ascites can be used in the diagnosis of exudate, and adenosine deaminase (ADA) can be used in the diagnosis of tuberculous effusion. However, the manufacturers do not claim that their biochemical reagents can be used to detect hydrothorax and ascites samples. Therefore, medical laboratories must conduct suitability studies on biochemical reagents for hydrothorax and ascites samples to comply with regulatory requirements for humor detection. This study aimed to verify the analytical performance and clinical diagnostic accuracy of the Mindray biochemical reagents, including LDH, TP, Glu and ADA, for hydrothorax and ascites. Methods: The repeatability, detection limits and reference intervals of Mindray biochemical reagents (LDH, TP, Glu, ADA) in detecting hydrothorax and ascites were determined. The comparison of different measurement procedures was performed. Meanwhile, the diagnostic accuracy of LDH, TP, Glu and ADA were assessed. Results: The quality control results of LDH, TP, Glu, and ADA were all under control. The repeatability coefficient of variation (%) of LDH, TP, Glu, and ADA were all less than 1%. The limits of blank of LDH, TP, Glu, and ADA were 0.33 U/L, 0.45 g/L, 0.00 mmol/L, and 0.04 U/L, respectively; the limits of detection were 1.57 U/L, 1.85 g/L, 0.05 mmol/L, and 0.12 U/L, respectively. Compared with the reference measurement program, the correlation coefficients of LDH, TP, Glu and ADA were 0.9931, 0.9983, 0.9996 and 0.9966, respectively; the regression equations were y=1.0082x-10.06, y=0.9965x-0.4732, y=0.9903x+0.0522 and y=1.0051x-0.0232, respectively. The reference intervals of LDH, TP, Glu, and ADA in hydrothorax and ascites were ≤198.39 U/L, ≤32.97 g/L, ≥5.03 mmol/L. and ≤11.00 U/L respectively. For differentiating between exudates and transudates, the area under the curve (AUC) of LDH, TP, and Glu were 0.913, 0.875, and 0.767, respectively; the AUC of ADA for the differential diagnosis of tuberculous and nontuberculous effusions was 0.876. Conclusions: The LDH, TP, Glu, and ADA assays were validated for use with the Mindray BS-2800 analyzer for hydrothorax and ascites evaluation. LDH, TP, and Glu in hydrothorax and ascites are applicable to the differential diagnosis of exudates and transudates; ADA in hydrothorax and ascites can be employed to differentiate and diagnose tuberculous and nontuberculous effusions.

A syntactic evidence network model for fact verification.

In natural language processing, fact verification is a very challenging task, which requires retrieving multiple evidence sentences from a reliable corpus to verify the authenticity of a claim. Although most of the current deep learning methods use the attention mechanism for fact verification, they have not considered imposing attentional constraints on important related words in the claim and evidence sentences, resulting in inaccurate attention for some irrelevant words. In this paper, we propose a syntactic evidence network (SENet) model which incorporates entity keywords, syntactic information and sentence attention for fact verification. The SENet model extracts entity keywords from claim and evidence sentences, and uses a pre-trained syntactic dependency parser to extract the corresponding syntactic sentence structures and incorporates the extracted syntactic information into the attention mechanism for language-driven word representation. In addition, the sentence attention mechanism is applied to obtain a richer semantic representation. We have conducted experiments on the FEVER and UKP Snopes datasets for performance evaluation. Our SENet model has achieved 78.69% in Label Accuracy and 75.63% in FEVER Score on the FEVER dataset. In addition, our SENet model also has achieved 65.0% in precision and 61.2% in macro F1 on the UKP Snopes dataset. The experimental results have shown that our proposed SENet model has outperformed the baseline models and achieved the state-of-the-art performance for fact verification.

Direction-of-Arrival Estimation for Unmanned Aerial Vehicles and Aircraft Transponders Using a Multi-Mode Multi-Port Antenna.

Increasing airspace safety is an important challenge, both for unmanned aerial vehicles (UAVs) as well as manned aircraft. Future developments of collision avoidance systems are supposed to utilize information from multiple sensing systems. A compact sensing system could employ a multi-mode multi-port antenna (M 3PA). Their ability to radiate multiple orthogonal patterns simultaneously makes them suitable for communication applications as well as bearing and ranging applications. Furthermore, they can be designed to flexibly originate near-omnidirectional and/or directional radiation patterns. This option of flexibility with respect to the radiation characteristic is desired for antennas integrated in collision avoidance systems. Based on the aforementioned properties, M 3PAs represent a compelling option for aircraft transponders. In this paper, direction-of-arrival (DoA) estimation using an M 3PA designed for aerial applications is put to the test. First, a DoA estimation scheme suitable to be employed with M 3PAs is introduced. Next, the validity of the proposed method is confirmed through numerical simulations. Lastly, practical experiments are conducted in an antenna measurement chamber to verify the numerical results.

Genome-wide analyses of member identification, expression pattern, and protein-protein interaction of EPF/EPFL gene family in Gossypium.

BACKGROUND: Epidermal patterning factor / -like (EPF/EPFL) gene family encodes a class of cysteine-rich secretory peptides, which are widelyfound in terrestrial plants.Multiple studies has indicated that EPF/EPFLs might play significant roles in coordinating plant development and growth, especially as the morphogenesis processes of stoma, awn, stamen, and fruit skin. However, few research on EPF/EPFL gene family was reported in Gossypium. RESULTS: We separately identified 20 G. raimondii, 24 G. arboreum, 44 G. hirsutum, and 44 G. barbadense EPF/EPFL genes in the 4 representative cotton species, which were divided into four clades together with 11 Arabidopsis thaliana, 13 Oryza sativa, and 17 Selaginella moellendorffii ones based on their evolutionary relationships. The similar gene structure and common motifs indicated the high conservation among the EPF/EPFL members, while the uneven distribution in chromosomes implied the variability during the long-term evolutionary process. Hundreds of collinearity relationships were identified from the pairwise comparisons of intraspecifc and interspecific genomes, which illustrated gene duplication might contribute to the expansion of cotton EPF/EPFL gene family. A total of 15 kinds of cis-regulatory elements were predicted in the promoter regions, and divided into three major categories relevant to the biological processes of development and growth, plant hormone response, and abiotic stress response. Having performing the expression pattern analyses with the basic of the published RNA-seq data, we found most of GhEPF/EPFL and GbEPF/EPFL genes presented the relatively low expression levels among the 9 tissues or organs, while showed more dramatically different responses to high/low temperature and salt or drought stresses. Combined with transcriptome data of developing ovules and fibers and quantitative Real-time PCR results (qRT-PCR) of 15 highly expressed GhEPF/EPFL genes, it could be deduced that the cotton EPF/EPFL genes were closely related with fiber development. Additionally, the networks of protein-protein interacting among EPF/EPFLs concentrated on the cores of GhEPF1 and GhEPF7, and thosefunctional enrichment analyses indicated that most of EPF/EPFLs participate in the GO (Gene Ontology) terms of stomatal development and plant epidermis development, and the KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways of DNA or base excision repair. CONCLUSION: Totally, 132 EPF/EPFL genes were identified for the first time in cotton, whose bioinformatic analyses of cis-regulatory elements and expression patterns combined with qRT-PCR experiments to prove the potential functions in the biological processes of plant growth and responding to abiotic stresses, specifically in the fiber development. These results not only provide comprehensive and valuable information for cotton EPF/EPFL gene family, but also lay solid foundation for screening candidate EPF/EPFL genes in further cotton breeding.

Toward Clinical Generative AI: Conceptual Framework.

Clinical decision-making is a crucial aspect of health care, involving the balanced integration of scientific evidence, clinical judgment, ethical considerations, and patient involvement. This process is dynamic and multifaceted, relying on clinicians' knowledge, experience, and intuitive understanding to achieve optimal patient outcomes through informed, evidence-based choices. The advent of generative artificial intelligence (AI) presents a revolutionary opportunity in clinical decision-making. AI's advanced data analysis and pattern recognition capabilities can significantly enhance the diagnosis and treatment of diseases, processing vast medical data to identify patterns, tailor treatments, predict disease progression, and aid in proactive patient management. However, the incorporation of AI into clinical decision-making raises concerns regarding the reliability and accuracy of AI-generated insights. To address these concerns, 11 "verification paradigms" are proposed in this paper, with each paradigm being a unique method to verify the evidence-based nature of AI in clinical decision-making. This paper also frames the concept of "clinically explainable, fair, and responsible, clinician-, expert-, and patient-in-the-loop AI." This model focuses on ensuring AI's comprehensibility, collaborative nature, and ethical grounding, advocating for AI to serve as an augmentative tool, with its decision-making processes being transparent and understandable to clinicians and patients. The integration of AI should enhance, not replace, the clinician's judgment and should involve continuous learning and adaptation based on real-world outcomes and ethical and legal compliance. In conclusion, while generative AI holds immense promise in enhancing clinical decision-making, it is essential to ensure that it produces evidence-based, reliable, and impactful knowledge. Using the outlined paradigms and approaches can help the medical and patient communities harness AI's potential while maintaining high patient care standards.

Burn Center Verification and Safety-net Status: Are There Differences in Discharge to Inpatient Rehabilitation?

Discharge to acute rehabilitation following major burn injury is crucial for patient recovery and quality of life. However, barriers to acute rehabilitation, including race and payor type impede access. The effect of burn center organizational structure on discharge disparities remains unknown. This study aims to investigate associations between patient demographics, burn center factors, and discharge to acute rehabilitation on a population level. Using the California Healthcare Access and Information Database, 2009-2019, all inpatient encounters at verified and non-verified burn centers were extracted. The primary outcome was the proportion of patients discharged to acute rehabilitation. Key covariates included age, race, burn center safety net status, diagnosis related group, American Burn Association (ABA) verification status, and American College of Surgeons (ACS) Level 1 trauma center designation. Logistic regression and mixed-effects modeling were performed, with Bonferroni adjustment for multiple testing. Among 27,496 encounters, 0.8% (228) were discharged to inpatient rehabilitation. By race/ethnicity, the proportion admitted to inpatient rehabilitation was 0.9% for White, 0.6% for Black, 0.7% for Hispanic, and 1% for Asian. After adjusting for burn severity and age, notable predictors for discharge to inpatient rehabilitation included Medicare as payor (OR 0.30-0.88, p=0.015) compared to commercial insurance, trauma center status (OR 1.45-3.43, p<.001), ABA verification status (OR 1.16-2.74, p=0.008), and safety-net facility status (OR 1.09-1.97, p=0.013). Discharge to inpatient rehabilitation varies by race, payor status, and individual burn center. Verified and safety-net burn centers had more patients discharge to inpatient rehabilitation adjusted for burn severity and demographics.

Numerical studies on shortening the duration of HIFU ablation therapy and their experimental validation.

High Intensity Focused Ultrasound (HIFU) is used in clinical practice for thermal ablation of malignant and benign solid tumors located in various organs. One of the reason limiting the wider use of this technology is the long treatment time resulting from i.a. the large difference between the size of the focal volume of the heating beam and the size of the tumor. Therefore, the treatment of large tumors requires scanning their volume with a sequence of single heating beams, the focus of which is moved in the focal plane along a specific trajectory with specific time and distance interval between sonications. To avoid an undesirable increase in the temperature of healthy tissues surrounding the tumor during scanning, the acoustic power and exposure time of each HIFU beam as well as the time intervals between sonications should be selected in such a way as to cover the entire volume of the tumor with necrosis as quickly as possible. This would reduce the costs of treatment. The aim of this study was to quantitatively evaluate the hypothesis that selecting the average acoustic power and exposure time for each individual heating beam, as well as the temporal intervals between sonications, can significantly shorten treatment time. Using 3D numerical simulations, the dependence of the duration of treatment of a tumor with a diameter of 5 mm or 9 mm (requiring multiple exposure to the HIFU beam) on the sonication parameters (acoustic power, exposure time) of each single beam capable of delivering the threshold thermal dose (CEM43 = 240 min) to the treated tissue volume was examined. The treatment duration was determined as the sum of exposure times to individual beams and time intervals between sonications. The tumor was located inside the ex vivo tissue sample at a depth of 12.6 mm. The thickness of the water layer between the HIFU transducer and the tissue was 50 mm. The sonication and scanning parameters selected using the developed algorithm shortened the duration of the ablation procedure by almost 14 times for a 5-mm tumor and 20 times for a 9-mm tumor compared to the duration of the same ablation plan when a HIFU beam was used of a constant acoustic power, constant exposure time (3 s) and constant long time intervals (120 s) between sonications. Results of calculations of the location and size of the necrotic lesion formed were experimentally verified on ex vivo pork loin samples, showing good agreement between them. In this way, it was proven that the proper selection of sonication and scanning parameters for each HIFU beam allows to significantly shorten the time of HIFU therapy.

Delta4-based Dosimetric Error Detection in Volumetric-modulated Arc Therapy: Clinical Significance and Implications.

Background: Volumetric-modulated arc therapy (VMAT) is an efficient method of administering intensity-modulated radiotherapy beams. The Delta4 device was employed to examine patient data. Aims and Objectives: The utility of the Delta4 device in identifying errors for patient-specific quality assurance of VMAT plans was studied in this research. Materials and Methods: Intentional errors were purposely created in the collimator rotation, gantry rotation, multileaf collimator (MLC) position displacement, and increase in the number of monitor units (MU). Results: The results show that when the characteristics of the treatment plans were changed, the gamma passing rate (GPR) decreased. The largest percentage of erroneous detection was seen in the increasing number of MU, with a GPR ranging from 41 to 92. Gamma analysis was used to compare the dose distributions of the original and intentional error designs using the 2%/2 mm criteria. The percentage of dose errors (DEs) in the dose-volume histogram (DVH) was also analyzed, and the statistical association was assessed using logistic regression. A modest association (Pearson's R-values: 0.12-0.67) was seen between the DE and GPR in all intentional plans. The findings indicated a moderate association between DVH and GPR. The data reveal that Delta4 is effective in detecting mistakes in treatment regimens for head-and-neck cancer as well as lung cancer. Conclusion: The study results also imply that Delta4 can detect errors in VMAT plans, depending on the details of the defects and the treatment plans employed.

Examining gullibility with sentence verification judgments.

Three experiments were conducted to examine gullibility as measured by people's bias to respond with a True response when performing sentence verification judgment task. The experiments manipulated the location of unfamiliar concepts such that some sentences contained unfamiliar concepts in the subject while other sentences contained unfamiliar concepts in the predicate, hence measuring the bias to judge an idea to be true when one cannot make the decision relying on background knowledge. The results indicated: 1) a higher frequency of True response when an unfamiliar concept is located in the subject compared to when it is in the predicate; and 2) the frequency of True response was lower than chance level even when unfamiliar information is located in the subject. The results were discussed in relation to gullibility and how the verification judgment is processed as a plausibility judgment.