bluuebunny/crossref_metadata_2025 huggingface dataset:
Early prediction of sepsis in emergency department patients using various methods and scoring systems
Authors: Song Yun‐Feng , Huang Hao‐Neng , Ma Jia‐Jun , Xing Rui , Song Yu‐Qi , Li Li , Zhou Jin , Ou Chun‐Quan
Published: October 2024

Background

Early recognition of sepsis, a common life‐threatening condition in intensive care units (ICUs), is beneficial for improving patient outcomes. However, most sepsis prediction models were trained and assessed in the ICU, which might not apply to emergency department (ED) settings.

Aims

To establish an early predictive model based on basic but essential information collected upon ED presentation for the follow‐up diagnosis of sepsis observed in the ICU.

Study Design

This study developed and validated a reliable model of sepsis prediction among ED patients by comparing 10 different methods based on retrospective electronic health record data from the MIMIC‐IV database. In‐ICU sepsis was identified as the primary outcome. The potential predictors encompassed baseline demographics, vital signs, pain scale, chief complaints and Emergency Severity Index (ESI). 80% and 20% of the total of 425 737 ED visit records were randomly selected for the train set and the test set for model development and validation, respectively.

Results

Among the methods evaluated, XGBoost demonstrated an optimal predictive performance with an area under the curve (AUC) of 0.90 (95% CI: 0.90–0.91). Logistic regression exhibited a comparable predictive ability to XGBoost, with an AUC of 0.89 (95% CI: 0.89–0.90), along with a sensitivity and specificity of 85% (95% CI: 0.83–0.86) and 78% (95% CI: 0.77–0.80), respectively. Neither of the five commonly used severity scoring systems demonstrated satisfactory performance for sepsis prediction. The predictive ability of using ESI as the sole predictor (AUC: 0.79, 95% CI: 0.78–0.80) was also inferior to the model integrating ESI and other basic information.

Conclusions

The use of ESI combined with basic clinical information upon ED presentation accurately predicted sepsis among ED patients, strengthening its application in ED.

Relevance to Clinical Practice

The proposed model may assist nurses in risk stratification management and prioritize interventions for potential sepsis patients, even in low‐resource settings.
Fast dehydration reduces bundle sheath conductance in C4 maize and sorghum
Authors: Bellasio Chandra , Stuart‐Williams Hilary , Farquhar Graham D. , Flexas Jaume
Published: October 2024

In the face of anthropogenic warming, drought poses an escalating threat to food production. C4 plants offer promise in addressing this threat. C4 leaves operate a biochemical CO2 concentrating mechanism that exchanges metabolites between two partially isolated compartments (mesophyll and bundle sheath), which confers high‐productivity potential in hot climates boosting water use efficiency. However, when C4 leaves experience dehydration, photosynthesis plummets. This paper explores the physiological mechanisms behind this decline.

In a fast dehydration experiment, we measured the fluxes and isotopic composition of water and CO2 in the gas exchanged by leaves, and we interpreted results using a novel biochemical model and analysis of elasticity.

Our findings show that, while CO2 supply to the mesophyll and to the bundle sheath persisted during dehydration, there was a decrease in CO2 conductance at the bundle sheath‐mesophyll interface.

We interpret this as causing a slowdown of intercellular metabolite exchange – an essential feature of C4 photosynthesis. This would impede the supply of reducing power to the bundle sheath, leading to phosphoglycerate accumulation and feedback inhibition of Rubisco carboxylation. The interplay between this rapid sensitivity and the effectiveness of coping strategies that C4 plants deploy may be an overlooked driver of their competitive performance.
ZmKTF1 promotes salt tolerance by mediating RNA‐directed DNA methylation in maize
Authors: Wang Jinyu , Zheng Leiming , Peng Yexiang , Lu Zizheng , Zheng Minghui , Wang Zi , Liu Juan , He Yan , Luo Jinhong
Published: October 2024

The epigenetic process of RNA‐directed DNA methylation (RdDM) regulates the expression of genes and transposons. However, little is known about the involvement of RdDM in the response of maize (Zea mays) to salt stress.

Here, we isolated a salt‐sensitive maize mutant and cloned the underlying gene, which encodes KOW DOMAIN‐CONTAINING TRANSCRIPTION FACTOR1 (KTF1), an essential component of the RdDM pathway. Evolutionary analysis identified two homologs of KTF1 (ZmKTF1A and ZmKTF1B) with highly similar expression patterns.

Whole‐genome bisulfite sequencing revealed that mutations in ZmKTF1 substantially decrease genome‐wide CHH (H = A, C, or T) methylation levels. Moreover, our findings suggest that ZmKTF1‐mediated DNA methylation regulates the expression of multiple key genes involved in oxidoreductase activity upon exposure to salt, concomitant with increased levels of reactive oxygen species. In addition, insertion–deletion mutations (InDels) in the promoter of ZmKTF1 affect its expression, thereby altering Na+ concentrations in seedlings in a natural maize population. Therefore, ZmKTF1 might represent an untapped epigenetic resource for improving salt tolerance in maize.

Overall, our work demonstrates the critical role of ZmKTF1 involved in the RdDM pathway in maize salt tolerance.
Development and Validation of Machine Learning Models for Predicting Tumor Progression in OSCC
Authors: Mei Xueying , Luo Wenhao , Duan Wan , Guo Zhuming , Lao Xiaomei , Zhang Sien , Yang Le , Zeng Bin , Gong Jianbin , Deng Wei , Liao Guiqing , Liang Yujie
Published: October 2024

Objectives

Development of a prediction model using machine learning (ML) method for tumor progression in oral squamous cell carcinoma (OSCC) patients would provide risk estimation for individual patient outcomes.

Patients and Methods

This predictive modeling study was conducted of 1163 patients with OSCC from Hospital of Stomatology, SYSU and SYSU Cancer Center from March 2009 to October 2021. Clinical, pathological, and hematological features of the patients were collected. Six ML algorithms were explored, and model performance was assessed by accuracy, sensitivity, specificity, f1 score, and AUC. SHAP values were used to identify the variables with the greatest contribution to the model.

Results

Among the 1163 patients (mean [SD] age, 55.36 [12.91] years), 563 are from development cohort and 600 are from validation cohort. The Logistic Regression algorithm outperformed all other models, with a sensitivity of 94.7% (68.2%), a specificity of 55.3% (63.7%), and the AUC of 0.76 ± 0.09 (0.723) in the development (validation) cohort. The most predictive feature was neutrophil count.

Conclusion

This study demonstrated ML models can improve clinical prediction of oral squamous cell carcinoma progression through basic information of patients. These tools could be used to provide individual risk estimation and may help direct intervention.
Early visual modulation and selection predict saccadic timing during visual search: An ERP study
Authors: Ringer Ryan V. , Leonard Carly J.
Published: October 2024

Saccadic eye movements, a critical aspect of real‐world visual behavior, are preceded by an initial accumulation of visual information followed by the selection of a single location to move one's eyes. However, it is currently unclear how each of these stages uniquely affects saccadic timing. In this study, participants searched for a contour integration target while EEG was used to measure posterior cortical activity between search display onset and first saccade initiation. The goal was to determine whether saccade timing could be attributed to differences in early ERP amplitudes, with the P1 reflecting the magnitude of early perceptual information accumulation and the N1 reflecting the strength of selection leading to the saccadic decision. EOG was used to measure saccade timing, and trials were divided into fast, middle, and slow bins. The N1 response was smallest in the slow saccade tertile, relative to both the fast and middle tertiles, suggesting weak selection. In contrast, the P1 response was largest for this same slow saccadic tertile relative to the middle saccadic tertile, suggesting vigorous information accumulation. Therefore, delays in saccadic behavior may occur when the visual system is overwhelmed with visual input, thus increasing the time to reach a saccadic decision. These findings reconcile models of eye movement behavior which often prioritize either the impact of information accrual or selection, rather than regarding both as an integrated whole.
Real Time, Simulated Time and Two Types of Time Travel
Authors: Arvan Marcus
Published: October 2024

This article argues that the possibility that we live in a computer simulation has important implications for the philosophy of time and time travel. Section 2 distinguishes real time from simulated time. Section 3 argues that whatever is true of real time, simulated time realises a functional analogue within real time to versions of presentism in which features of the present play the role of an uninstantiated past and future. Section 4 then argues that whereas real time travel paradoxes depend upon the ultimate nature of ‘base‐reality’ and consistency with observed physics, the possibility of simulated time travel depends instead on a simulation's code, which may allow seemingly ‘miraculous’ exceptions to ‘physical laws’. Finally, Section 5 concludes that if miraculous forms of time travel are discovered, this may provide evidence by inference to the best explanation that we live in a simulation.
How Does Tax Avoidance Affect a Firm's Investment Inefficiency in Taiwan's Semiconductor Industry?
Authors: Huang Jr‐Tsung , Kuo Po‐Sheng
Published: October 2024

This study examines an important issue regarding how tax avoidance affects a firm's investment inefficiency in Taiwan's semiconductor industry. In addition, the dynamic effect of a firm's investment inefficiency and spillover effect of investment inefficiency from competitors are also explored. This study adopts 44 listed firms from 2013 to 2021 and constructs the “competitor‐dependence matrix” to replace the “spatial‐dependence matrix” in the dynamic spatial autoregressive model. According to the difference generalized method of moments estimation, the primary finding of this study is that the tax avoidance has a statistically and significantly positive effect on a firm's investment inefficiency while it is overinvestment, but a negative effect while it is underinvestment. Moreover, the dynamic effect is statistically insignificant, but the spillover effect is statistically and significantly negative.
Periodontal treatment needs in children and adolescents with inflammatory bowel disease
Authors: Zellos Aglaia , Koutsochristou Vassiliki , Dimakou Konstantina , Panayotou Ioanna , Siahanidou Sultana , Roma‐Giannikou Eleftheria , Tsami Alexandra
Published: October 2024

Background

Increased incidence of periodontal disease is described in adult patients with inflammatory bowel disease (IBD), implicating similarities in gut immunopathogenesis and periodontitis.

Aim

Evaluation of periodontal status and treatment needs of children with IBD in remission, according to disease phenotype, sex, age, and oral hygiene status, and compare them to age‐matched healthy population of a dental practice.

Methods

Fifty‐five children with IBD (mean age 12.27 ± 3.67 years) and 55 matched healthy controls of a dental practice (mean age 12.21 ± 3.96 years) were assessed with the simplified gingival index (GI‐S) and the plaque control record (PCR) index and the community periodontal index of treatment needs (CPITNs). A dental questionnaire on therapy, oral hygiene, gum bleeding, and dental attendance was completed by participants.

Results

Children with IBD in remission had higher gingival inflammation and periodontal treatment needs compared to controls. In patients with IBD, the CPITN was higher in older compared to younger children (59.37% vs. 47.83%) and in boys compared to girls (65% vs. 46.67%). Among controls, CPITN was also higher in older children (21.88% vs. 4.34%) and in boys (16% vs. 13.33%).

Conclusion

Older children and boys with IBD have more periodontal treatment needs, compared to controls, despite similar oral hygiene.
Delegitimizing protest: Psychology's omissions and commissions
Authors: Porter‐Cash Aiyana L.
Published: October 2024

Psychological research has failed to take accountability for the ways it has aligned with State interests, at the expense of solidarity with Black people protesting the criminal legal system and pursuing liberation in the U.S. Through a case study analysis of six psychological research articles, ranging from 1968 to 2022, this paper tracks evidence of psychology's alignment with the State's interests. Evidence emerges in clinical disease(s) assigned to enslaved and incarcerated Black people (drapetomania, protest psychosis) and in empirical assumptions and (il)logics binding research methods and analyses. While theoretical and methodological frameworks, language (“patients,” “rioters,” “ghetto residents,” “minority group members”) and levels of analysis (psyche, personality, social, community, identity, movement) evolve over time and across subdisciplines, racialized carceral ideologies persist across psychological research approaches. By tracing carceral footprints across this vast psychological literature, this analysis reveals how traditional empirical research weaponized pathologizing and criminalizing accounts to delegitimize Black protests of State violence from the Civil Rights Movement to the Movement for Black Lives and beyond.
COVID‐19 Labor Market Protection and Support for the Welfare State: Job Retention Versus Job Loss in Four European Countries
Authors: Zola Andrew , Naumann Elias , Marzec Piotr
Published: October 2024

The COVID‐19 pandemic presents a natural setting to study how labor market protection policies may influence welfare attitudes because while lockdowns and economic recession threatened millions of jobs, job retention schemes shielded many workers from unemployment. We investigate support for unemployment protection and the unemployed among people active in the labor force and participating in the Mannheim Corona Study in Germany, Coping with COVID‐19 in France, ResPOnsE in Italy, and the British Social Attitudes survey in Great Britain. Two‐way fixed effects analyses on the German data show that there was a general increase in respondents' support over the onset of the pandemic and that while job loss significantly boosted support, there was little attitudinal difference between those who experienced job retention and those who continued working. We confirm these patterns with cross‐sectional analyses in all four countries, providing comparative insight into attitudes across the largest European economies. Unemployment is materially similar to job retention, but because it is associated with higher support, we contend that nonmaterial factors such as risk perceptions may be consequential in influencing preference changes when individuals lose their jobs.
Education researchers as negotiators: Leveraging expertise across teachers and scientists to implement authentic data investigations in grade 7–12 classrooms
Authors: Peterson Franziska , Siddons Christina , Toolin Regina , Van Der Eb Marina , Davis Kelsey E. , Lindsay Sara M. , McKay Susan R.
Published: October 2024

Incorporating authentic research skills and practices into K‐12 science, technology, engineering, and mathematics (STEM) instruction is a challenging yet crucial approach for introducing students to authentic science inquiry. While recommendations for emphasizing data literacy and quantitative reasoning in science classroom contexts are well‐established, implementation remains challenging. Over the span of 4 years (2019–2023), a multi‐institution team of teachers, education researchers, and forest scientists established a partnership with the overarching goal of integrating authentic forest research and data into middle and high school classrooms. The education researchers played a critical role in facilitating effective scientist and teacher interactions while addressing classroom implementation challenges. Importantly, the effectiveness and mutual benefits of the research partnership were greatly influenced by specific practices implemented by the education research team, and the assumption of different collaborative roles by all stakeholders involved. In this study, we examine these roles, relationships, and interactions of all stakeholders in the partnership, with “stakeholder” referring to participating teachers, education researchers, and collaborating forest scientists.
The Invertebrates of The Romualdo Formation, Araripe Basin: Analysis of Paleoecological and Paleogeographical Data
Authors: Gomes Bruno de Araújo , Cadeira do Prado Ludmila Alves , Franca Barreto Alcina Magnólia
Published: October 2024

Fossil invertebrates are good paleoenvironmental indicators due to their sensitivity to abiotic conditions, which contributes to the understanding of the Aptian-Albian of the Araripe Basin. However, much of the paleoecological and paleobiogeographical information on these organisms is scarce in the literature. The aim of this paper is to compile relevant data on the macroinvertebrates of the Romualdo Formation and to analyze and point out gaps in knowledge. To achieve this, extensive bibliographical research was carried out, using scientific publications based on the families of Spinicaudata, echinoids, gastropods, bivalves, shrimps and crabs of the Romualdo Formation and their distribution in Brazil and globally throughout the Aptian-Albian, using specialized online databases. Paleoecological and paleogeographical data were compiled for 46 invertebrate taxa, highlighting those with better studied routes of origin. Thus, it was possible to highlight the lack of data regarding the way of life of certain mollusc families and systematic problems regarding the identification of the families of several species of shrimp. Finally, the predominance of taxa from marine (34), brackish (7) and lacustrine (5) waters was shown. Of these, 18 taxa have a typical tethyan distribution and another 12 also present occurrences in the Austral, Boreal or both domains. The only typical freshwater group was Spinicaudata, marking environments with little or no marine influence and with rare occurrences during the Aptian-Albian.
Strain Analysis of Vacuum Interrupter Bellows
Authors: Yoshida Keiko , Ueda Masashi , Nishimura Yusuke , Kajinami Nobuhiko , Kitamura Toru
Published: October 2024

The vacuum interrupter (VI) is the main part of the vacuum circuit breaker (VCB), and an essential component of its design is the bellows. In future high-voltage VCBs, faster switching speeds will lead to higher dynamic impact-type loads, and the oscillation of the bellows after the contact opening and closing could shorten the mechanical life of the bellows. This article provides a 1D computer-aided engineering (CAE) analysis of the strain of the bellows oscillation in a VI caused by the axial load from the impact of the contact. A formula for the oscillation is derived using the longitudinal vibration response of a mass-spring 1D model, calculated by the convolution integral of the input and the impulse response function of the vibration modes. The proposed 1D analysis was verified and shown to be effective under four different experimental conditions. This article also provides a 1D CAE analysis of the mechanical life of the bellows. These 1D analyses estimate the effect of stress reducing countermeasures on the bellows' lifetime without increasing its size.
Multi Combustor Turbine Engine Acceleration Process Control Law Design
Authors: Cai Changpeng , Zhang Haibo
Published: October 2024

Focusing on the collaborative fuel supply and acceleration problem of multicombustor turbine engine, a variable geometry composite regulation acceleration control law design method based on the combination of compressor intermediate stage air bleed (CIB) and low-pressure turbine guide vanes (LTGV) is proposed. The multicombustor collaborative fuel supply law and variable geometry regulation law during acceleration process are obtained by Particle Swarm Optimization-Sequence Quadratic Program (PSO-SQP) optimization, and the composite regulation acceleration control strategy of dual/single combustion chamber idle acceleration process is explored. The multicombustor acceleration process simulation results indicate that the variable geometry composite regulation method can effectively alleviate the stability margin limitation of the compressor during the initial acceleration stage. Compared with conventional acceleration methods, the maximum relative reduction in acceleration time of our method reaches 26%; enhancing the combustion exergy efficiency during the acceleration process can significantly improve the engine's acceleration performance. For the acceleration process from single combustion chamber idle operation to normal operation of a dual combustion chamber, simultaneous fuel supply from both combustion chambers during acceleration has a shorter acceleration time. The research results of this paper can provide important references for the design of transition state control systems for multicombustor turbine engines.
A Passively Actuated Spoiler Using Sequential, Interacting Instabilities
Authors: Wheatcroft Ed , Shen Jiajia , Groh Rainer , Pirrera Alberto , Schenk Mark
Published: October 2024

Gust load alleviation systems can reduce the peak stresses an airframe may experience during its lifetime, allowing for a more lightweight structural design. Consequently, many gust load alleviation systems have been proposed, but most are ‘active’ in the sense that they rely on sensors and actuators in order to function. Such ancillary systems add weight, complexity and cost to an aircraft design, partly diluting any benefit from the load alleviation function. We therefore propose a fully ‘passive’ gust load alleviation spoiler, whose only stimulus for deployment is the deformation of the wing into which it is integrated. The optimal structural response for such a device is outlined, and the concept of sequential, interacting instabilities is adopted to meet these requirements — this approach allows the spoiler to remain stowed until a critical strain in the wing is reached, after which the spoiler deploys rapidly. The working principle of the passive spoiler concept is introduced using a simple bar and spring model, and a physical prototype is detailed. An experimental setup is also presented to verify the structural performance of the spoiler under aerodynamic loading. In summary, this work paves the way for potentially lighter and more efficient aircraft designs through the development of a simple yet effective passive load alleviation mechanism.
Machine Learning Predictive Algorithm for Self-Sensing Electric Vehicle Battery Enclosure
Authors: Nieduzak Tymon B. , Zhou Tianyi , Tronci Eleonora M. , Demo Luke B. , Feng Maria Q.
Published: October 2024

Electric Vehicles (EVs) are a favorable and rapidly growing tactic for reducing carbon emissions. However, the most commonly used power source in EVs, Lithium-Ion Batteries (LIBs), can pose a significant safety risk in the form of thermal runaway. This is a fast-acting and dangerous failure mode that may lead to fires and explosions. To address this issue, the authors’ previous work developed a self-sensing composite battery enclosure with embedded micro-temperature sensors to provide LIB condition monitoring. The prior work produced extensive experimental and simulation results, characterizing an enclosure-embedded battery management system. It was found that the top composite layer causes a time lag in temperature detection, impeding an early warning signal. This current study aims to create a regression model leveraging machine learning (ML) strategies which is able to predict interior battery enclosure temperatures when trained on the prior study’s thermal experiments and simulations. The temperature inference model predicts the enclosure’s surface temperatures using embedded temperature measurements in real-time, compensating for the time lag. Random Forest (RF) and Recurrent Neural Network (RNN) ML models are compared, considering performance and computational costs. Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE) are utilized to quantify the prediction accuracies of both approaches. The temperature inference model enhances the practicality of a self-sensing composite battery enclosure as a battery management system, mitigating risks associated with LIB thermal runaway events. By monitoring embedded temperature changes and predicting the temperatures on the interior surface of the enclosure, the system provides insights into potential hazards, enabling timely interventions and ensuring EV safety.
Organising pneumonia due to inadequately cleared COVID-19 infection while on rituximab
Authors: Olson Caroline G. , Karime Christian , Dawson Nancy
Published: October 2024

A male patient in his 70s with a history of tobacco use, organising pneumonia and rheumatoid arthritis that had been treated for several years with rituximab currently being treated with tocilizumab, presented with progressively worsening shortness of breath, increasing oxygen requirements and weakness. He had a history of COVID-19 infection 6 months prior to presentation. Initial COVID-19 PCR testing at presentation was negative. Bronchoalveolar lavage was positive for COVID-19 but negative for spike antibodies. It was thought that he did not clear his prior COVID-19 infection due to his immunocompromised state while taking rituximab. On recommendation of infectious disease, he was treated with a prolonged course of nirmatrelvir/ritonavir, remdesivir and corticosteroids with significant symptom improvement.
Lymphocytic choriomeningitis virus infection following occupational ocular exposure
Authors: Mosset Patricia , Lazor-Blanchet Catherine
Published: October 2024

A man in his mid-20s presented to the occupational health service following an ocular projection with a concentrated solution of lymphocytic choriomeningitis virus (LCMV clone-13). Subsequently, a regular clinical and biological follow-up was initiated. 7 days after exposure, the patient developed influenza-like symptoms. During the acute phase, specific RT-PCR testing of blood plasma was negative for LCMV. Symptomatic treatment was administered, and the symptoms resolved after a few days. The patient remained asymptomatic in the following weeks. Serological follow-up detected a seroconversion 6 weeks after exposure, indicating a recent infection. The occupational health service’s protocol, comprising clinical monitoring and serological surveillance, facilitated the detection of seroconversion. This case underscores ocular mucosal exposure as a route of occupational LCMV transmission, which is often not considered. It served as an opportunity to review and enhance prevention measures and laboratory protocols within the biosafety level P2 facility.
Influence of surgeon learning on outcomes in new ophthalmic procedures: quantified nationwide evidence in endothelial corneal transplantation
Authors: Shanmugaranjan Shaminie , Hopkinson Cathy , Downward Lewis , Larkin Daniel F P
Published: October 2024

Aims

To investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes.

Methods

A prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial corneal dystrophy or pseudophakic bullous keratopathy undergoing a first EK procedure in that eye between 2005 and 2020. EK procedures were either Descemet Stripping Endothelial Keratoplasty (DSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK). Primary outcome was transplant survival at 2 years. Secondary outcomes at 1-year post-transplant were (1) best-corrected visual acuity, (2) requirement for repeat air injection procedures to treat graft detachment and (3) iatrogenic primary graft failure.

Results

Following analysis of 11 516 EK transplants, significant impact of surgeon learning was indicated by (1) the influence of surgeon prior experience in that EK technique, (2) the influence of surgeon prior experience in postoperative management and (3) the time interval from introduction of that EK technique in the United Kingdom to time of surgery. EK grafts reported to have failed within the first 6 months were a significant proportion of all transplant failures.

Conclusions

Influence of surgeon learning and inexperience in EK of clinical and statistical significance can be quantified and diminishes over time. Equivalent analyses may be feasible for novel procedures in other ophthalmology specialties and surgical training. Training programmes and nationwide advisory networks may be helpful in reducing the duration and impact of surgeon learning curves.
Traumatic Optic Neuropathy Treatment Trial 2 (TONTT-2): evaluating the efficacy of different doses of erythropoietin – a multicentre, randomised, double-blind clinical trial
Authors: Abdolalizadeh Parya , Kashkouli Mohsen Bahmani , Ghazizadeh Mahya , Pakdel Farzad , Etezad Razavi Mohammad , Nojomi Marzieh , Abri Aghdam Kaveh , Sanjari Mostafa Soltan , Karimi Nasser , Ghahvehchian Hossein , Soleimani Mohammad , Tabatabaei Seyed Ali
Published: October 2024

Aim

The aim is to compare the efficacy and safety of three different weight-adjusted intravenous erythropoietin (EPO) doses in patients with indirect traumatic optic neuropathy (TON).

Methods

This study is a multicentre, randomised, parallel-group, double-blind, dose-finding trial on patients aged ≥7 years with a confirmed diagnosis of indirect TON in ≤3 weeks. The trial had a 3-day treatment period and a 3-month follow-up period. Patients were randomly allocated (1:1:1) to receive EPO at doses of 900 IU/kg (300 IU/kg/day), 1800 IU/kg (600 IU/kg/day) or 3600 IU/kg (600 IU/kg/day on presentation and then 1 month later) EPO. The changes in the best-corrected visual acuity (BCVA), colour vision and relative afferent pupillary defect (RAPD) were assessed.

Results

Out of 118 eligible patients, 95 were randomised and 93 (31 in each group) completed the follow-ups. Three groups were not different regarding baseline BCVA (p=0.66), colour vision (p=0.25) and RAPD (p=0.79). All three groups showed a significant improvement of BCVA and RAPD with no significant differences among the groups. Colour vision showed a significant improvement only in the group with 3600 IU/kg EPO (p=0.005), even though final colour vision was not significantly different between the groups (p=0.49). Initial vision of no light perception (OR=7.79 (95% CI: 2.98 to 20.36), p<0.001), older age (OR=4.76 (95% CI: 1.92 to 11.76), p<0.001), longer trauma-treatment interval (OR=2.72, 95% CI: 1.16 to 6.33, p=0.02) and posterior orbital fractures (OR=2.63 (95% CI: 1.13 to 6.13), p=0.02) led to a significantly worse visual recovery.

Conclusion

Increasing dose of EPO in patients with TON did not result in a better BCVA, colour vision and RAPD improvement.

Trial registration number

NCT03308448.
Low energy availability surrogates are associated with Relative Energy Deficiency in Sport outcomes in male athletes
Authors: Holtzman Bryan , Kelly Rose K , Saville Grace H , McCall Lauren , Adelzedah Kaya A , Sarafin Samantha R , Nikam Prakruthi , Meneguzzi Isabella , McIntyre Abby , Kraus Emily K , Ackerman Kathryn E
Published: October 2024

Objectives

To determine the association between surrogates of low energy availability (EA) and proposed health and performance outcomes of Relative Energy Deficiency in Sport (REDs) in a clinical sample of adolescent and young adult male athletes.

Methods

Male athletes ages 15–30 years presenting to a sports medicine clinic at two tertiary care centres were invited to complete a survey about athlete health and well-being. Participants were divided into low EA and adequate EA groups based on survey responses. The associations between low EA and REDs outcomes were evaluated using χ2tests and ORs were calculated using binomial logistic regression (significance: p<0.05).

Results

Low EA was associated with increased frequency of self-reported immunological, metabolic, psychological, cardiovascular and gastrointestinal dysfunction; reduced endurance performance, response to training, judgement, coordination and muscle strength; and increased irritability and depression. Low EA athletes were more likely to have self-reported cardiovascular dysfunction (OR 2.87, 95% CI 1.56 to 5.26) and psychological illness (OR 3.23, 95% CI 1.91 to 5.41), decreased training response (OR 2.64, 95% CI 1.38 to 5.03) and endurance performance (OR 2.26, 95% CI 1.13 to 4.52) and were less likely to have self-reported gonadal dysfunction (OR 0.49, 95% CI 0.30 to 0.81), than adequate EA athletes (p<0.05).

Conclusions

Low EA surrogates are associated with many adverse health outcomes and performance effects of REDs in male athletes. More prospective REDs research in males is needed to improve various aspects of REDs screening in young male athletes.
Development and internal validation of prehospital prediction models for identifying intracerebral haemorrhage in suspected stroke patients
Authors: Almubayyidh Mohammed , Parry-Jones Adrian R , Jenkins David A
Published: October 2024

Introduction

Distinguishing patients with intracerebral haemorrhage (ICH) from other suspected stroke cases in the prehospital setting is crucial for determining the appropriate level of care and minimising the onset-to-treatment time, thereby potentially improving outcomes. Therefore, we developed prehospital prediction models to identify patients with ICH among suspected stroke cases.

Methods

Data were obtained from the Field Administration of Stroke Therapy-Magnesium prehospital stroke trial, where paramedics evaluated multiple variables in suspected stroke cases within the first 2 hours from the last known well time. A total of 19 candidate predictors were included to minimise overfitting and were subsequently refined through the backward exclusion of non-significant predictors. We used logistic regression and eXtreme Gradient Boosting (XGBoost) models to evaluate the performance of the predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), confusion matrix metrics and calibration measures. Additionally, models were internally validated and corrected for optimism through bootstrapping. Furthermore, a nomogram was built to facilitate paramedics in estimating the probability of ICH.

Results

We analysed 1649 suspected stroke cases, of which 373 (23%) were finally diagnosed with ICH. From the 19 candidate predictors, 9 were identified as independently associated with ICH (p<0.05). Male sex, arm weakness, worsening neurological status and high systolic blood pressure were positively associated with ICH. Conversely, a history of hyperlipidaemia, atrial fibrillation, coronary artery disease, ischaemic stroke and improving neurological status were associated with other diagnoses. Both logistic regression and XGBoost demonstrated good calibration and predictive performance, with optimism-corrected sensitivities ranging from 47% to 49%, specificities from 89% to 90% and AUCs from 0.796 to 0.801.

Conclusions

Our models demonstrate good predictive performance in distinguishing patients with ICH from other diagnoses, making them potentially useful tools for prehospital ICH management.
Improving the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust
Authors: Gunawardena Nipuna , Britton Hannah , Roy Jacqueline , Harding Samantha , Eckoldt Stephanie , Lovell Natasha
Published: October 2024

Background

Cultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital setting. The ‘Just Ask’ quality improvement project was designed to explore barriers to routine assessment of CRS needs, and to design resources and intervention to support staff to increase assessment of these needs.

Aims

The primary aim of the project was to increase the number of patients receiving end-of-life care in hospital with a documented CRS needs assessment from 43% (based on audit data) to greater than 50% over the 9-month project.

Design

The study occurred in two phases.

The scoping phase evaluated the current service, enablers, barriers and confidence in assessing CRS needs using an online staff survey and four staff focus groups. Results were analysed using qualitative content analysis, descriptive statistics and thematic analysis and informed the intervention phase.

The intervention phase consisted of two Plan-Do-Study-Act (PDSA) cycles focusing on resource visibility/accessibility, organisational value placed on CRS needs assessment and staff education.

Outcomes (documented CRS needs assessment) were measured by case notes review over 3 month periods - 1 year prior to and after the PDSA cycles. The impact of education interventions on staff confidence relating to CRS needs assessment were measured via an anonymous questionnaire.

Outcome

Documented assessment of CRS needs increased from 43% to 57% in patients receiving end-of-life care in our hospital. Staff confidence scores in CRS needs assessment increased by 46–87%.

Conclusions

The factors that influence the addressing of CRS needs in a busy hospital are multifactorial. Organisational culture, appropriate resource provision and visibility, and education are essential factors in supporting staff to recognise, understand and engage with CRS needs assessment in patients receiving end-of-life care in hospital.
Role of ethnicity and residency in active tuberculosis in Karakalpakstan: study protocol of a matched case-control study
Authors: Asadov Damin A , Aripov Timur , Alaverdyan Sevak , Sadikkhodjayeva Diloram , Yuldashev Gulmirza , Allakova Nargiza , Khamraev Atadjan K
Published: October 2024

Introduction

Uzbekistan is one of the 30 countries with the highest tuberculosis (TB) morbidity, accounting for 87% of all cases globally. The incidence of TB in the Republic of Karakalpakstan (RK) remains consistently high in comparison with other regions of Uzbekistan. The incidence rates of TB strongly differ even among the regions within RK. In 2019, the highest rates were registered in the northern and north-western regions, and the lowest in the southern regions. An important issue is the extent to which specific residencies impact individual health. The ethnic composition of the population of RK can be one of the possible causes for such geographical heterogeneity in TB morbidity.

Methods and analysis

The case-control design of this study primarily aims to evaluate the role of ethnicity and residency on the development of active TB in the community living in RK. Additionally, the study aims to measure the association between factors of TB morbidity and ethnicity/residency in the community of RK. It was decided to include one matched control for every included case, to control potential confounders. Cases with clinically diagnosed or bacteriologically confirmed TB will be randomly sampled from the patient registry. Controls will comprise individuals without TB, living in RK at the same time as the cases. They will be randomly sampled from a general roster of the residents.

Ethics and dissemination

This study was approved by the Bioethics Committee of the Medical Association of Uzbekistan (approval report of meeting #1 on 18 January 2024). The results of this study will be widely disseminated at scientific meetings and conferences, and published in a peer-reviewed journal.
Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy forHelicobacter pyloriinfection between 2013 and 2021: results from the European registry onH. pylorimanagement (Hp-EuReg)
Authors: Olmedo Llum , Calvet Xavier , Gené Emili , Bordin Dmitry S , Voynovan Irina , Castro-Fernandez M , Pabón-Carrasco Manuel , Keco-Huerga Alma , Perez-Aisa Ángeles , Lucendo Alfredo J , Rodrigo Luís , Sarsenbaeva Aiman S , Khlinov Igor B , Fadieienko Galyna , Zaytsev Oleg , Lanas Ángel , Martínez-Domínguez Samuel J , Alfaro Enrique , Jonaitis Laimas , Núñez Óscar , Pellicano Rinaldo , Hernández Luis , Gridnyev Oleksiy , Kupcinskas Juozas , Gasbarrini Antonio , Boltin Doron , Niv Yaron , Babayeva Gülüstan , Marcos-Pinto Ricardo , Tepes Bojan , Venerito Marino , Papp Veronika , Lerang Frode , Leja Mārcis , Phull Perminder S , Marlicz Wojciech , Doulberis Michael , Smith Sinead M , Milivojevic Vladimir , Kunovsky Lumir , Mestrovic Antonio , Matysiak-Budnik Tamara , Simsek Halis , Cano-Català Anna , Puig Ignasi , Moreira Leticia , Parra Pablo , Nyssen Olga P , Megraud Francis , O'Morain Colm , Gisbert Javier P
Published: October 2024

Background

Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treatingHelicobacter pyloriinfection even in areas of high bacterial antibiotic resistance.

Objective

To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry onHelicobacter pyloriManagement (Hp-EuReg).

Design

Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success.

Results

Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT—containing bismuth, metronidazole and tetracycline—plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness.

Conclusion

The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness.

Trial registration number

NCT02328131.
Sporadic hypertrophic and nodular port-wine stain: a study of 27 cases with emphasis on histological features and novel mutation type
Authors: Xue Shuang , Qiao Junbo , Yu Ruili , Li Mei , Ding Yanzhi , Fu Fangfang , Liu Qiuyu
Published: October 2024

Aims

To investigate the clinicopathological features and molecular characteristics of sporadic hypertrophic and nodular port-wine stains (PWS).

Methods

We analysed the clinicopathological and molecular characteristics of 27 sporadic hypertrophic and nodular PWS retrieved from our pathology database from 2013 to 2023 and reviewed the relevant literature.

Results

There were 13 men and 14 women who ranged in age from 10 to 66 years. The main sites were the head and neck (23/27, 85%), which showed irregular thickening and darkening of purplish-red patches on the skin surface and the development of nodularity. Histologically, immature venule-like channels with irregular dilation are arranged in clusters or honeycombs, which are widely distributed primarily in the papillary layer and deep dermis and partly extend into the subcutaneous fat layer and other deep tissues. Dilated vessels with irregular shapes often exhibit fibrous thickening and an increased number of large vessels without vascular endothelial cell proliferation. All vessels showed similar characteristics, with positive staining for CD34, ERG and GNAQ in the endothelial cells, and negative staining for elastic fibres. Nine patients had somaticGNAQmutations (9/11, 82%), including exon four mutations (6 cases, p.R183Q), exon five mutations (2 cases, p.Q209R) and exon two mutations (one case, p.G48V). Two patients had somaticBCL6corepressor-like 1 (BCORL1) gene mutations (2/11, 18%), including exon 3 mutations (p.T1111M) and exon 7 mutations (p.G1391R).

Conclusions

Sporadic hypertrophic and nodular PWS are mostly related to somaticGNAQmutations. This is the first study to identify the RareGNAQ G48Vand somaticBCORL1mutations.
Diverging mental health trends in the postpandemic era: results from the HUNT Study, Norway
Authors: Weiss Daniel , Lowenstein Christopher , Sund Erik Reidar , Vethe Daniel , Krokstad Steinar
Published: October 2024

Background

The purpose of this report is to examine to what extent the COVID-19 pandemic affected pre-existing trends in mental health, with a focus on subgroup differences across age, gender and socioeconomic status.

Methods

Our analysis uses data from two survey periods (HUNT4: 2017–2019 and HUNT-COVID: 2021–2023) from the Trøndelag Health Study in Norway. We estimate overall and stratified (by age, sex and educational attainment) prevalence values for above-threshold (≥8) anxiety and depression scores using the Hospital Anxiety and Depression Scale. For each outcome, we compare prevalences between HUNT-4 and HUNT-Covid within each subgroup.

Results

Above-threshold levels of anxiety were higher among women than men, while the opposite was true for depression. Symptoms generally decrease with age. Between HUNT4 and HUNT-COVID, for both women and men, anxiety symptoms decreased (except among women between 18–29 and 30–39) while depression symptoms increased (except for individuals over 80). Anxiety symptoms decreased across education levels between HUNT4 and HUNT-COVID while depression symptoms increased across education levels.

Conclusion

The findings illustrate the negative long-term effects of a shock such as a pandemic while also illustrating the potential positive effects of generous welfare benefits on inequalities in mental health.