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This study, based in San Bernardino County, Southern California, collected and examined tap water samples within the area to explore the feasibility of adopting non-industrial equipment and methods to reduce water hardness and total dissolved solids(TDS). We investigated how water quality could be improved by utilizing water boiling, activated carbon and sodium bicarbonate additives, as well as electrolysis methods. The results show that heating is effective at lower temperatures rather than long boils, as none of the boiling tests were lower than the original value. Activated carbon is unable to lower TDS, because it is unable to bind to any impurities present in the water. This resulted in an overall TDS increase of 3.5%. However, adding small amounts of sodium bicarbonate(NaHCO 3 ) will further eliminate water hardness by reacting with magnesium ions and improve taste, while increasing the pH. When added to room temperature tap water, there is a continuous increase in TDS of 24.8% at the 30 mg/L mark. The new findings presented in this study showed that electrolysis was the most successful method in eliminating TDS, showing an inverse proportion where an increasing electrical current and duration of electrical lowers more amounts of solids. This method created a maximum decrease in TDS by a maximum of 22.7%, with 3 tests resulting in 15.3–16.6% decreases. Furthermore, when water is heated to a temperature around 50°C (122°F), a decrease in TDS of around 16% was also shown. The reduction of these solids will help lower water hardness and improve the taste of tap water. These results will help direct residents to drink more tap water rather than bottled water with similar taste and health benefits for a cheaper price as well as a reduction on plastic usage.

PurposeCOVID-19 has caused critical supply chain problems, especially in sustainable supply chain management, but very few empirical studies have been explored how to improve the firm sustainability through supply chain endeavours such as supply chain agility to manage the impacts of COVID-19. This paper aims to develop a model to incorporate supply chain agility and supply chain relationships that link firm sustainability to mitigate the impacts of the pandemic.Design/methodology/approachThe authors conducted an online survey and collected 203 valid responses from businesses in the United Arab Emirates, and employed an exploratory factor analysis, mediated regression analysis and structural equation modelling methodology to test the models and hypotheses.FindingsThe authors find that the adoption of supply chain agility can improve supply chain relationships and positively impact sustainability. Meanwhile, supply chain relationships partially mediate the relationship between supply chain agility and sustainability. In addition, sustainability mitigates the impacts of COVID-19 pandemic on supply chains.Originality/valueThe results provide fruitful insights and implications for the challenges and uncertainties caused by the pandemic post COVID-19 and provide several directions for further research.

Tolvaptan is the first disease-modifying drug proven to slow eGFR decline in high-risk patients with ADPKD. However, barriers from the patient perspective to its use in real-life settings have not been systemically examined in a large cohort. This was a single-center, retrospective study of 523 existing or new patients with ADPKD followed at the Center for Innovative Management of PKD in Toronto, Ontario, between January 1, 2016 to December 31, 2018. All patients underwent clinical assessment including total kidney volume measurements and Mayo Clinic Imaging Class (MCIC). Those who were deemed to be at high risk were offered tolvaptan with their preference (yes or no) and reasons for their choices recorded. Overall, 315/523 (60%) patients had MCIC 1C-1E; however, only 96 (30%) of them were treated with tolvaptan at their last follow-up. Among these high-risk patients, those not treated versus treated with tolvaptan were more likely to have a higher eGFR (82 ± 26 vs. 61 ± 27 ml/min/1.73 m 2 ), CKD stages 1–2 (79% vs. 41%), and MCIC 1C (63% vs. 31%). The most common reasons provided for not taking tolvaptan were lifestyle preference related to the aquaretic effect (51%), older age ≥ 60 (12%), and pregnancy/family planning (6%). In this real-world experience, at least 60% of patients with ADPKD considered to be at high risk for progression to ESKD by imaging were not treated with tolvaptan; most of them had early stages of CKD with well-preserved eGFR and as such, were prime targets for tolvaptan therapy to slow disease progression. Given that the most common reason for tolvaptan refusal was the concern for intolerability of the aquaretic side-effect, strategies to mitigate this may help to reduce this barrier to tolvaptan therapy.

Purpose This study aims to investigate the impacts of product modularity (PM) and multiskilled employees (MEs) on new product development (NPD) outcomes and explore the moderating effect of supply chain involvement. Design/methodology/approach The authors used data collected from 317 manufacturers to empirically examine the conceptual model and conducted hierarchical regression analysis to test the hypotheses. Findings The results reveal that PM significantly improves NPD outcomes. The relationship between PM/MEs and NPD outcomes is strengthened when the level of supplier involvement is high, whereas the relationship between MEs and NPD outcomes is weakened when the level of customer involvement is high. Research limitations implications First, this study only focuses on PM and MEs as two types of modular designs. Second, the inter-relationship between modular designs and supply chain involvement might be contingent. Third, the authors use cross-sectional data that cannot reflect causal effects of modularity on NPD outcomes. Originality/value The findings contribute to the understanding of the alignment between modular designs and supply chain involvement considering NPD outcomes. This study also contributes to the concept of modularity by identifying MEs as a type of modular design.

Unraveling the intricate relationship between mechanical factors and brain activity is a pivotal endeavor, yet the underlying mechanistic model of signaling pathways in brain mechanotransduction remains enigmatic. To bridge this gap, we introduced an in situ multi-scale platform, through which we delineate comprehensive brain biomechanical traits in white matter (WM), grey-white matter junctions (GW junction), and the pons across human brain tissue from four distinct donors. We investigate the three-dimensional expression patterns of Piezo1, Piezo2, and TMEM150C, while also examining their associated histological features and mechanotransduction signaling networks, particularly focusing on the YAP/β-catenin axis. Our results showed that the biomechanical characteristics (including stiffness, spring term, and equilibrium stress) associated with Piezo1 vary depending on the specific region. Moving beyond Piezo1, our result demonstrated the significant positive correlations between Piezo2 expression and stiffness in the WM. Meanwhile, the expression of Piezo2 and TMEM150C was shown to be correlated to viscoelastic properties in the pons and WM. Given the heterogeneity of brain tissue, we investigated the three-dimensional expression of Piezo1, Piezo2, and TMEM150C. Our results suggested that three mechanosensitive proteins remained consistent across different vertical planes within the tissue sections. Our findings not only establish Piezo1, Piezo2, and TMEM150C as pivotal mechanosensors that regulate the region-specific mechanotransduction activities but also unveil the paradigm connecting brain mechanical properties and mechanotransduction activities and the variations between individuals.

Objective Past vegetarians research has often found that they have lower blood pressure (BP). Effects may include their lower BMI and higher intake levels of fruit and vegetables. Besides, the study pursues to extend this evidence in a diverse population containing vegans, lacto-ovo vegetarians and omnivores. Design The study analyzed data on five hundred vigorous individuals aged 20 years or older from a standard medical screening program and provided validated questionnaire. Criteria were established for vegan, lacto-ovo vegetarian, partial vegetarian and omnivorous dietary patterns. Setting Health screening programs were conducted at a standard medical screening program in Taiwan between 2006 and 2017. Dietary data were gathered by self-administered questionnaire. Subjects Five hundred Taiwanese subjects representing the cohort. Results Multiple regression analyses confirmed that the vegan vegetarians had lower systolic and diastolic BP (mmHg) than omnivorous Taiwanese (β =  − 6.8, p  < 0.05 and β =  − 6.9, p  < 0.001). Findings for lacto-ovo vegetarians (β =  − 9.1, p  < 0.001 and β =  − 5.8, p  < 0.001) were similar. The vegetarians were also less likely to be using antihypertensive medications. Defining hypertension as systolic BP > 139 mmHg or diastolic BP > 89 mmHg or routine of antihypertensive medications, the odds ratio of hypertension compared with omnivores was 0.37 (95% CI = 0.19–0.74), 0.57 (95% CI = 0.36–0.92) and 0.92 (95% CI = 0.50–1.70), respectively, for vegans, lacto-ovo vegetarians and partial vegetarians. Results were reduced after adjustment for BMI. Conclusions The study concludes from this relatively large study that vegetarians, especially vegans, with otherwise diverse characteristics but stable diets, do have lower systolic and diastolic BP and less hypertension than omnivores.

Cranioplasty is a commonly performed neurosurgical procedure used to repair defects of the cranial vault. For large defects, 3D printing allows for the creation of patient-specific synthetic cranioplasties. Although these implants provide excellent cosmetic results for patients, costs are quite high. This makes their routine use challenging in the current Canadian healthcare environment. The purpose of this study is to report our experience with a novel, cost-effective method for cranioplasty using desktop 3D printers to manufacture patient-specific molds to aid in the shaping of polymethyl methacrylate (PMMA) cranioplasty intraoperatively. A retrospective review of patients who underwent cranioplasty utilizing 3D printed custom molds was conducted at a single center between 2018 and 2020. Either a two-piece self-align or open-air mold was utilized. Material cost, as well as demographic, clinical, and radiologic data, was reviewed. A five-point ordinance scale was used to evaluate patient satisfaction with cosmesis. Four patients had previous craniectomies with infected bone flaps, 2 patients had significant bony destruction from tumor invasion, and 1 patient had bone flap resorption. Three patients underwent an open-air mold technique with a Ti-mesh/PMMA-combined implant. The remaining 4 patients underwent two-piece mold with PMMA-only implant. All patients had 'Good' to 'Excellent' cosmetic outcome with one post-operative acute subdural hematoma and one post-operative infection. Two-piece mold resulted in improved cosmetic outcome and cost savings. 3D printing can be used in a cost-effective manner to deliver good cranioplasty cosmesis. Wider adoption of this technique can result in significant healthcare cost savings without compromising patient outcome.

Based on disruptive innovation and Stackelberg noncooperative game theory, the paper focuses on supply chain coordination under the combined effects of block chain technology and random demand. Firstly, both a decentralized and a centralized supply chain decision models are built in a single-cycle newsvendor random demand situation. Then, through revenue sharing contract the study designs a brand-new supply chain coordination model which is Del trust, decentralized, and traded anonymously. Furthermore, the numerical comparative analysis on the optimal decision and supply chain coordination are conducted. It is found that the whole supply chain revenue can achieve and even beyond the performance level of the centralized supply chain with effectively expanding sales market and reducing supply chain risk. When the retail price is stable and supply chain is coordinated with revenue sharing mechanism, decentralized supply chain can achieve minimum optimal revenue. Coordination results have effect on short-term revenues of block chain members only. Implications and suggestions for future research in supply chain coordination are provided.

The popularity of virtual clinics has increased in many settings, especially during and following the COVID-19 pandemic. However, their applicability in neurosurgical care remains understudied. The primary goal of this study was to assess the feasibility of conducting a larger, more definitive study at our hospital site in the future. We assessed participant enrollment rate, ability to complete a neurosurgical consult virtually, need for a third party to be present, and participant satisfaction rates. Preliminary evidence on the utility of virtual examination substitutes, compared to currently used in-person assessments, was also explored in our sample of neurosurgical patients. In this feasibility study, a cohort of neurosurgery patients, consisting of both new referrals and follow-up visits, was evaluated. Each patient participated in a virtual neurological assessment via Zoom and subsequently in an in-person assessment. Both visits were completed by the same physician. We compared clinical findings and treatment decisions (surgical vs conservative management) between the 2 settings and recorded patient satisfaction with the virtual consultation. A total of 95 patients were deemed eligible for the study, and of the 52 patients contacted, 35 provided verbal consent and were enrolled. Both the virtual and in-person assessments were completed by 30 participants (86%) with an average length of 3.25 days between visits, which was within the required 2-week period outlined in the study protocol. No barriers were noted from participants (n=6; 20%) who required a third party to be present and this individual was present at both visits. Participant satisfaction rate with the virtual consults exceeded 90%. Clinical decisions were consistent between both visits in 28 cases, and in the 2 visits where decisions differed, it was noted to be a result of inconclusive findings during the virtual consultation. Comparison of individual examination components between the virtual and in-person consultations revealed exam findings to be consistent 77% of the time, and importantly, none of these discrepancies led to a change in clinical decision. No single examination component was noted to be inconsistent more than twice. These findings support the applicability of the proposed study design to a larger-scale project. No major obstacles or methodological challenges were encountered in achieving the goals of this feasibility study within the target timeframe. This study provides preliminary evidence to support further exploration of the use of virtual consults to help inform clinical decisions in a neurosurgical population.

Efficient delivery of biomolecules into neurons has significant impacts on therapeutic applications in the central nervous system (CNS) and fundamental neuroscience research. Existing viral and non‐viral delivery methods often suffer from inefficient intracellular access due to the endocytic pathway. Here, a neuron‐targeting and direct cytosolic delivery platform is discovered by using a 15‐amino‐acid peptide, termed the N1 peptide, which enables neuron‐specific targeting and cytosolic delivery of functional biomolecules. The N1 peptide initially binds hyaluronan in the extracellular matrix and subsequently passes the membrane of neurons without being trapped into endosome. This mechanism facilitates the efficient delivery of cell‐impermeable and photo‐stable fluorescent dye for super‐resolution imaging of dendritic spines, and functional proteins, such as Cre recombinase, for site‐specific genome modification. Importantly, the N1 peptide exhibits robust neuronal specificity across diverse species, including mice, rats, tree shrews, and zebra finches. Its targeting capability is further demonstrated through various administration routes, including intraparenchymal, intrathecal, and intravenous (i.v.) injections after blood‐brain barrier (BBB) opening with focused ultrasound (FUS). These findings establish the N1 peptide as a versatile and functional platform with significant potential for bioimaging and advanced therapeutic applications.