bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonographic measurement of the optic nerve sheath diameter to detect intracranial hypertension: an observational study
Authors: Yic Christian Daniel , Pontet Julio , Mercado Mauricio , Muñoz Matias , Biestro Alberto
Published: February 2023

Objectives

To evaluate the ultrasonographic measurement of optic nerve sheath diameter (ONSD) as a predictor of intracranial hypertension as compared to the invasive measurement of intracranial pressure (ICP).

Design

Cross-sectional observational study.

Setting

Intensive Care Unit (ICU) of two tertiary university hospitals in Montevideo, Uruguay.

Patients

We included 56 adult patients, over 18 years of age, who required sedation, mechanical ventilation, and invasive ICP monitoring as a result of a severe acute neurologic injury (traumatic or non-traumatic) and had a Glascow Coma Score (GCS) equal to or less than 8 on admission to the ICU.

Interventions

Ultrasonographic measurement of ONSD to detect intracranial hypertension.

Measurements and main results

In our study, a logistic regression model was performed in which it was observed that the variable ONSD is statistically significant with a p value of 0.00803 (< 0.05). This model estimates and predicts the probability that a patient will have an ICP greater than 20 mmHg. From the analysis of the cut-off points, it is observed that a value of 5.7 mm of ONSD maximizes the sensitivity (92.9%) of the method (a greater number of individuals with ICP > 20 mmHg are correctly identified).

Conclusions

In sedated neurocritical patients, with structural Acute Brain Injury, the ONSD measurement correlates with the invasive measurement of ICP. It was observed that with ONSD values less than 5.7 mm, the probability of being in the presence of ICP above 20 mmHg is very low, while for ONSD values greater than 5.7 mm, said probability clearly increases.
Correlations between physical activity and quality of life in entrepreneurs from Wrocław, Poland
Authors: Puciato Daniel , Bączkowicz Dawid , Rozpara Michał
Published: February 2023

Background

Limited physical activity is one of the main reasons for the rapid increase in the prevalence of diseases of affluence, which can lead to premature deaths in adults. Quality of life may be one of potential determinants of physical activity. The aim of this article is to identify the relationships between physical activity and quality of life in entrepreneurs from Wroclaw, Poland.

Methods

A cross-sectional study was conducted on a group of 616 entrepreneurs (216 women and 400 men). A diagnostic survey method was used with a direct interview technique. The research tools included the International Physical Activity Questionnaire Short Form and the World Health Organization Quality of Life Questionnaire.

Results

Among the studied entrepreneurs, along with their higher ratings of overall quality of life, the odds of high rather than low levels of physical activity increased nearly fivefold (OR 4.86, CI 3.34–7.07). Entrepreneurs with higher assessment levels of their perceived health condition were nearly twice as likely to report high rather than low physical activity levels (OR 1.92, CI 1.42–2.59). The conditional probability of high rather than low levels of physical activity also increased in the entrepreneurs with higher assessments of quality of life in the physical, psychological, social, and environmental domains, by 34%, 11%, 5%, and 6%, respectively.

Conclusion

Programs promoting physical activity among entrepreneurs, which focus on moderate and high intensity exercise, should be considered desirable in the context of the study findings. Activities aimed at improving quality of life in the physical and psychological domains as a potential determinant of the level of physical activity of entrepreneurs are also worth recommending.
MedLexSp – a medical lexicon for Spanish medical natural language processing
Authors: Campillos-Llanos Leonardo
Published: February 2023

Background

Medical lexicons enable the natural language processing (NLP) of health texts. Lexicons gather terms and concepts from thesauri and ontologies, and linguistic data for part-of-speech (PoS) tagging, lemmatization or natural language generation. To date, there is no such type of resource for Spanish.

Construction and content

This article describes an unified medical lexicon for Medical Natural Language Processing in Spanish. MedLexSp includes terms and inflected word forms with PoS information and Unified Medical Language System$$^{\circledR }$$

®

(UMLS) semantic types, groups and Concept Unique Identifiers (CUIs). To create it, we used NLP techniques and domain corpora (e.g. MedlinePlus). We also collected terms from the Dictionary of Medical Terms from the Spanish Royal Academy of Medicine, the Medical Subject Headings (MeSH), the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT), the Medical Dictionary for Regulatory Activities Terminology (MedDRA), the International Classification of Diseases vs. 10, the Anatomical Therapeutic Chemical Classification, the National Cancer Institute (NCI) Dictionary, the Online Mendelian Inheritance in Man (OMIM) and OrphaData. Terms related to COVID-19 were assembled by applying a similarity-based approach with word embeddings trained on a large corpus. MedLexSp includes 100 887 lemmas, 302 543 inflected forms (conjugated verbs, and number/gender variants), and 42 958 UMLS CUIs. We report two use cases of MedLexSp. First, applying the lexicon to pre-annotate a corpus of 1200 texts related to clinical trials. Second, PoS tagging and lemmatizing texts about clinical cases. MedLexSp improved the scores for PoS tagging and lemmatization compared to the default Spacy and Stanza python libraries.

Conclusions

The lexicon is distributed in a delimiter-separated value file; an XML file with the Lexical Markup Framework; a lemmatizer module for the Spacy and Stanza libraries; and complementary Lexical Record (LR) files. The embeddings and code to extract COVID-19 terms, and the Spacy and Stanza lemmatizers enriched with medical terms are provided in a public repository.
Exponential stabilisation of highly nonlinear neutral stochastic systems by variable-delay feedback control
Authors: Shen Mingxuan , Fei Chen
Published: February 2023

This paper is devoted to dealing with the exponential stabilisation of highly nonlinear hybrid neutral stochastic differential equation (NSDE) by variable delay feedback control. There have been so far few results on the stabilization of variable delay stochastic systems by variable delay feedback control, although the stabilisation of neutral stochastic systems on the current state has been investigated. Finally, an illustrative example is provided for verifying our theoretical results.
A model for predicting overall survival in bladder cancer patients with signet ring cell carcinoma: a population-based study
Authors: Liu Liang , Li Chuangui , Wang Qiang , Yuan Haibo , Wang Yuanyuan
Published: February 2023

Introduction

This study is to examine the predictors of survival and to construct a nomogram for predicting the overall survival (OS) of primary bladder signet ring cell carcinoma (SRCC) patients based on the analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

A total of 219 eligible patients diagnosed with SRCC were analyzed using the 2004–2015 data from SEER database. Univariate and multivariate Cox regression were used to determine independent prognostic factors, followed by development of a nomogram based on the multivariate Cox regression models. The consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve were used to validate the prognostic nomogram.

Results

The nomograms indicated appreciable accuracy in predicting the OS, with C-index of 0.771 and 0.715, respectively. The area under the curve (AUC) of the nomogram was 0.713 for 1 year, 0.742 for 3 years, and 0.776 for 5 years in the training set, while was 0.730 for 1 year, 0.727 for 3 years, and 0.697 for 5 years in the validation set. The calibration curves revealed satisfactory consistency between the prediction of deviation correction and ideal reference line.

Conclusions

The prognostic nomogram developed in the analytical data of SEER it provided high accuracy and reliability in predicting the survival outcomes of primary bladder SRCC patients and could be used to comprehensively assess the risk of SRCC. Moreover, they could enable clinicians to make more precise treatment decisions for primary bladder SRCC patients.
Feed intake patterns of modern genetics lactating sows: characterization and effect of the reproductive parameters
Authors: Rodríguez María , Díaz-Amor Gonzalo , Morales Joaquín , Koketsu Yuzo , Piñeiro Carlos
Published: February 2023

Background

Knowing the feed intake pattern during lactation of modern genetic sows is crucial because it allows to anticipate possible problems and maximize their performance. On the other side, electronic feeders permit real-time data to be available for a more accurate evaluation of sow eating behavior. This work aimed to characterize the feed intake patterns of lactating highly prolific sows and determine their effect on reproductive performance. A database of 1,058 registers of feed intake collected from a commercial farm was used to identify five consistent sets of clusters (feeding curves) using machine learning. In the second step, the five feeding curves were characterized into five patterns by high, medium and low feed intake during 0–6 d and 7–28 d of lactation: 1-HH, 2-MH, 3-HM, 4-MM and 5-LL.

Results

The mean daily feed intake of all the sows was 6.2 kg (0.06 SEM) across the 5 patterns. As the pattern numbers increased from 1-HH, 2-MH, 3-HM and 4-MM to 5-LL, their mean daily feed intake decreased from 7.6 to 6.9, 6.4, 5.8 and 4.3 (0.06 SEM) kg, respectively (P < 0.01). Sows with Pattern 1-HH tended to have shorter weaning-to-first service interval (P = 0.06) and had a higher farrowing rate than those with Pattern 5-LL (P < 0.01). Furthermore, contrast analysis showed that sows with Patterns 1-HH and 2-MH tended to have more piglets weaned (P = 0.05) and lower preweaning mortality (P = 0.07) than those with Patterns 3-HM and 4-MM. Also, sows with Patterns 1-HH and 3-HM had fewer stillborn piglets and a lower percentage of stillborn piglets and mummies than those with Patterns 2-MH and 4-MM (P < 0.01).

Conclusions

This study indicates the importance of reaching Pattern 1-HH by rapidly increasing feed intake during early lactation and high feed intake during late lactation, which is associated with high weaning performance and subsequent reproductive performance of the sows. Also, the current study suggests that Pattern 1-HH is linked to good farrowing with a low percentage of stillborn piglets and mummies. Finally, it is critical for producers to timely identify a problem of sows’ eating behavior and to make a prompt decision to intervene.
The efficacy of oral pain relief cocktail during pan-retinal photocoagulation for diabetic retinopathy: a randomized clinical trial
Authors: Johari Mohammadkarim , Safniyat Sarah , Badie Mohammadreza , Amini Abdulrahim , Sanie-Jahromi Fatemeh
Published: February 2023

Purpose

to evaluate the pain-relieving effect of analgesic combinations during pan-retinal photocoagulation (PRP) in patients with non-proliferative diabetic retinopathy (NPDR).

Methods

This study was a randomized, double-blind, placebo-controlled trial. Patients with severe NPDR without previous history of PRP were included in the study. Both eyes of the patients were treated with a pan-retinal photocoagulation procedure. The retina was divided into four quadrants and the treatment plan for patients submitted to PRP was divided into four sessions. Different oral medications were given to patients 1 hour before the procedure. Capsules containing a combination of analgesic drugs (including 325 mg acetaminophen, 200 mg ibuprofen, and 40 mg caffeine, referred to as N), pregabalin capsules (75 mg, referred to as P), a combination of N capsules and P capsules (referred to as NP), and the placebo were used in each session. Each patient scored the pain sensation immediately after the procedure using a visual analog scale (VAS).

Result

60 eyes of 30 patients were studied. The mean value of VAS in patients receiving the placebo was 3.3 ± 1.822 units, while this scale was 3.067 ± 1.507, 3.5 ± 1.479, and 3.5 ± 1.77 in the N, P, and NP consumed patients, respectively. There was no significant difference in VAS levels and the patient’s vital signs between different sessions (P = 0.512).

Conclusion

No evidence of the pain-relieving effect of N, P or NP was found during PRP.

Trial registration: IRCT20200915048724N1. Registered 20 October 2020, https://www.irct.ir/trial/51345
Quantitative cone contrast threshold testing in patients with differing pathophysiological mechanisms causing retinal diseases
Authors: White Kayla M. , Livnat Itamar , Frambach Caroline R. , Doan John , Mehta Urmi V. , Yuh Clara , Palma Anton M. , Jameson Kimberly A. , Kenney M. Cristina , Mehta Mitul C. , Boisvert Chantal J. , Crow Wade R. , Browne Andrew W.
Published: February 2023

Background

Cone contrast threshold testing (CCT) provides quantitative measurements of color and contrast function to reveal changes in vision quality that are not standard endpoints in clinical trials. We utilize CCT to measure visual function in patients with multiple sclerosis (MS), age-related macular degeneration (AMD), epiretinal membrane (ERM), and retinal vein occlusion (RVO).

Methods

Retrospective data was gathered from 237 patients of the Gavin Herbert Eye Institute. Subjects included 17 patients with MS, 45 patients with AMD, 41 patients with ERM, 11 patients with RVO, and 123 healthy controls. Patients underwent the primary measurement outcome, CCT testing, as well as Sloan visual acuity test and spectral domain optical coherence tomography during normal care.

Results

Color and contrast deficits were present in MS patients regardless of history of optic neuritis. AMD with intermediate or worse disease demonstrated reduced CCT scores. All 3 stages of ERM demonstrated cone contrast deficits. Despite restoration of visual acuity, RVO-affected eyes demonstrated poorer CCT performance than unaffected fellow eyes.

Conclusions

CCT demonstrates color and contrast deficits for multiple retinal diseases with differing pathophysiology. Further prospective studies of CCT in other disease states and with larger samples sizes is warranted.
Assessment of quality of life in children with epilepsy in Oman
Authors: Alnaamani Asia , Ahmad Faraz , Al-Saadoon Muna , Rizvi Syed Gauhar Alam , Al-Futaisi Amna
Published: February 2023

Purpose

The study aims to describe the quality of life (QoL) in Omani children with epilepsy at Sultan Qaboos University Hospital, Oman.

Methods

One hundred and one Omani children, with an age range from 5 to 18 years, diagnosed with epilepsy were enrolled in the study over 3 months. Descriptive epidemiology was used to characterize QoL in these children. QoL was measured using the PedsQL (4.0) questionnaire, a 23-item child and parent report questionnaire. Analysis of variance (ANOVA) was used to compare mean QoL scores, and agreement between the QoL reports of children and parents was evaluated using Spearman’s rho; while, Multivariate analysis of variance (MANOVA) was performed to determine differences in subscale ratings.

Results

Factors affecting QoL included family status, income level, social security coverage, type of treatment, seizure frequency, age of onset, and seizure-free duration in years. Children between 5 and 7 years and females, in general, were most affected, as reflected by the overall QoL subscale. Consistency between the children's self-reports and parent proxy reports on the PedsQL™ was moderate to low.

Conclusion

Omani children with epilepsy have poor QoL, and their psychosocial function is severely affected. Therefore, QoL should be an important outcome measure in managing children with epilepsy rather than just seizure control.
A first detection of Exorista segregata (Rondani, 1859) (Diptera: Tachinidae) as a larval parasitoid of Orgyia trigotephras Boisduval, 1829 (Lepidoptera: Erebidae) from Tunisia
Authors: Hammami Sonia , Ezzine Olfa , Bystrowski Cezary , Ben Jamâa Mohamed Lahbib
Published: February 2023

Background

The tachinid parasitoid, Exorista segregata (Rondani, 1859) (Diptera: Tachinidae) is a polyphagous fly recorded on larvae of lepidopterans. Larvae of the Erebidae, Orgyia trigotephras Boisduval were collected from Northern Tunisia and reared in the laboratory at INRGREF. Larvae were kept individually until emergence of parasitoid’s adults.

Results

Morphological data including dissected genitalia was used to identify E. segregate as a parasitoid of O. trigotephras larvae.

Conclusion

The larval parasitoid, E. segregata is recorded from a new host O. trigotephras for the first time in Tunisia. This species could be considered in the programs of biological control of different lepidopterans’ pests in Tunisia and neighboring countries.
The “SALPARE study” of spontaneous intracerebral hemorrhage: part 1
Authors: De Rosa Ludovica , Manara Renzo , Vodret Francesca , Kulyk Caterina , Montano Florian , Pieroni Alessio , Viaro Federica , Zedde Maria Luisa , Napoletano Rosa , Ermani Mario , Baracchini Claudio
Published: February 2023

Background

Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke with a huge impact on patients and families. Expanded use of oral anticoagulants and ageing population might contribute to an epidemiological change. In view of these trends, we planned a study to obtain a contemporary picture and identify early prognostic factors to improve secondary prevention.

Methods

This multicenter prospective cohort study included consecutive adult patients with non-traumatic ICH admitted to three academic Italian hospitals (Salerno, Padova, Reggio Emilia) over a 2-year period. Demographic characteristics, vascular risk profile, clinical data and main radiological characteristics were correlated to 90-day clinical outcome.

Results

Out of 682 patients [mean age: 73 ± 14 years; 316 (46.3%) females] enrolled in this study, 40% died [86/180 (47.8%) in Salerno, 120/320 (37.5%) in Padova, 67/182 (36.8%) in Reggio Emilia; p < 0.05)] and 36% were severely disabled at 90 days. Several factors were associated with a higher risk of poor functional outcome such as antithrombotic drug use, hyperglycemia, previous cerebrovascular accident, low platelet count, and pontine/massive/intraventricular hemorrhage. However, at multivariate analysis only pre-ICH mRS score (OR 30.84), GCS score at presentation (OR 11.88), initial hematoma volume (OR 29.71), and NIHSS score at presentation (OR 25.89) were independent predictors of death and poor functional outcome.

Conclusion

Despite the heterogeneity among centers, this study on ICH has identified four simple prognostic factors that can independently predict patients outcome, stratify their risk, and guide their management.
A discrete unified gas-kinetic scheme for multi-species rarefied flows
Authors: Xin Ziyang , Zhang Yue , Guo Zhaoli
Published: February 2023

A discrete unified gas kinetic scheme (DUGKS) is developed for multi-species flow in all flow regimes based on the Andries-Aoki-Perthame (AAP) kinetic model. Although the species collision operator in the AAP model conserves fully the mass, momentum, and energy for the mixture, it does not conserve the momentum and energy for each species due to the inter-species collisions. In this work, the species collision operator is decomposed into two parts: one part is fully conservative for the species and the other represents the excess part. With this decomposition, the kinetic equation is solved using the Strang-splitting method, in which the excess part of the collision operator is treated as a source, while the kinetic equation with the species conservative part is solved by the standard DUGKS. Particularly, the time integration of the source term is realized by either explicit or implicit Euler scheme. By this means, it is easy to extend the scheme to gas mixtures composed of Maxwell or hard-sphere molecules, while the previous DUGKS [Zhang Y, Zhu L, Wang R et al, Phys Rev E 97(5):053306, 2018] of binary gases was only designed for Maxwell molecules. Several tests are performed to validate the scheme, including the shock structure under different Mach numbers and molar concentrations, the Couette flow under different mass ratios, and the pressure-driven Poiseuille flow in different flow regimes. The results are compared with those from other reliable numerical methods based on different models. And the influence of molecular model on the flow characteristics is studied. The results also show that the present DUGKS with implicit source discretization is more stable and preferable for gas mixture problems involving different flow regimes.
Risk of complications with prolonged operative time in morbidly obese patients undergoing elective total knee arthroplasty
Authors: Mundi Raman , Nucci Nicholas , Wolfstadt Jesse , Pincus Daniel , Chaudhry Harman
Published: February 2023

Background

Patients with a high body-mass index (BMI) are at increased risk for significant complications after total knee arthroplasty (TKA). We explored whether operative time is a modifiable risk factor for infectious and thromboembolic complications.

Methods

A retrospective observational cohort study of the ACS-NSQIP registry, including all patients who underwent primary TKA (2015–2018), and were morbidly obese (BMI 40 kg/m2 or greater) was performed. We created four categories of operative time in minutes: less than 60, 60–90, 91–120, and greater than 120. The association of prolonged operative time with superficial/deep surgical site infection (SSI), DVT and PE within 30 days postoperatively was evaluated using multivariate logistic regression.

Results

34,190 patients were included (median age 63 [IQR 57–68], mean BMI of 44.6 kg/m2 [SD 4.4]). The majority of patients had an operative time between 60–90 mins (n = 13,640, 39.9%) or 91–120 mins (n = 9908, 29.0%). There was no significant association between longer operative time and superficial/deep/organ-space SSI or PE. DVT risk was significantly increased. Patients with time exceeding 120 mins had nearly 2.5 greater odds of DVT compared to less than 60 minutes (OR 2.47, 95% CI: 1.39–4.39, P = 0.002). Odds of DVT were 1.73 times greater in those with time of 91–120 mins (OR 1.73, 95%CI: 0.98–3.05, P = 0.06).

Conclusion

Early infection and thromboembolic complications with prolonged operative time in morbidly obese patients remain low. We did not identify a significant association with increased operative time and superficial/deep SSI, or PE. There was a significantly increased risk for deep vein thrombosis with prolonged operative time.
Physicochemical and sensory characteristics of traditional Kırklareli meatballs with added cowpea (Vigna unguiculata) flour
Authors: Kahraman Esra , Dağlioğlu Orhan , Yilmaz İsmail
Published: February 2023

The effects of cowpea (Vigna unguiculata) flour on some physical, chemical, textural and sensory properties of Kırklareli meatballs were investigated. For this purpose, cowpea flour was added to the traditional Kırklareli meatball formulation in four different proportions (2, 4, 6 and 8%). As a result of the analysis on cowpea flour; pH, water activity (aw), moisture, protein, fat, ash, carbohydrate, acidity, starch, total dietary fiber, total monounsaturated fatty acids, total polyunsaturated fatty acids, total unsaturated fatty acids and total saturated fatty acids were found as 6.25, 0.52, 10.20, 20.35, 0.53, 2.94, 65.43%, 0.06, 45.09, 20.90, 5.86, 59.88, 65.74 and 34.26%, respectively. Depending on the increase in incorporation rate of cowpea flour, changes in L* (43,40-53,88), b* (13,92-18,11), pH (5,83-5,94), aw (0,96-0,98), moisture (44,03-50,63%), protein (17,70-21,89%), fat (19,49-22,97%), carbohydrate (6,77-12,11%), salt (1,28-1,74%), total dietary fiber (2,81-5,08%) values of the raw samples and a* (5,64-9,44), b* (9,77-18,06), moisture (39,27-45,24%), protein (19,92-23,45%), fat (23,08-26,19%), carbohydrate (5,92-11,30%), total dietary fiber (3,28-5,40%) values of the cooked Kırklareli meatball samples were statistically significant (P < 0.05), while the changes in weight loss, ash, free fatty acidity, texture and sensory results were found insignificant (P > 0.05). Total saturated, total unsaturated and trans fatty acid contents of cowpea flour added meatball samples were significantly (P < 0.05) different from the control samples. In the sensory analysis, meatball samples with 4% cowpea flour received the highest general acceptability score. According to the obtained data, cowpea flour can be added up to 4% on basic meat values without changing the textural and sensory properties of Kırklareli meatballs. Cowpea flour could be added as a functional ingredient in meatballs.

Graphical Abstract
The factorial structure and psychometric properties of the PERMA-Profiler Arabic version to measure well-being within a Palestinian adult population
Authors: Mahamid Fayez , Veronese Guido , Bdier Dana
Published: February 2023

Background

The PERMA-Profiler is an international methods designed to test the general wellbeing of adults in terms of 5 pillars: positive and negative emotions, engagement, relationships, meaning, and accomplishment .In our study, we tested the psychometric properties and the factorial structure of PERMA-Profiler within the Palestinian context using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The sample of the current study consisted of 582 Palestinian adults recruited from online advertisements, e-mail campaigns and social media.

Results

The PERMA-Profiler showed good validity and reliability indicators in assessing general wellbeing among Palestinians, the CFA results revealed a stable five-factor construct of the PERMA-Profiler.

Conclusions

More future studies validating the PERMA-Profiler with diverse groups in the Palestinian context are recommendable, which will enable mental health providers to develop clinical interventions targeting individuals who suffer from mental distress and low levels of well-being.
Unfolding the science behind policy initiatives targeting plastic pollution
Authors: Nielsen Maria Bille , Clausen Lauge Peter Westergaard , Cronin Richard , Hansen Steffen Foss , Oturai Nikoline Garner , Syberg Kristian
Published: February 2023

The intensive global plastic production, use and associated plastic pollution have caused concern for the potential risks to human health and the environment. This has led to the adoption of numerous regulatory initiatives aiming to combat plastic pollution. Despite the considerable regulatory activity in the field of plastic, it appears that there is still debate about the actual risks of plastic to humans and the environment. This raises the question of to what extent the current plastic regulation is evidence-based, a declared ambition in the European Union. Therefore, the aim of this study was to investigate to what extent key policy initiatives targeting plastic pollution are based on scientific evidence. Selection of initiatives was based on expert elicitation accounting for the opinions of persons involved in the development of the policy initiatives, and a thorough assessment of the historical development of plastic pollution regulation, with focus on their importance both with respect to regulation of plastics as well as their historical importance as drivers for societal actions on plastic pollution. We find that scientific evidence appears to be generally present in the scientific foundation for the policy initiatives analysed in this study. All the initiatives are supported by scientific articles and reports about among others plastic sources, ecological impacts of plastic production and consumption patterns. Marine litter monitoring data was found to contribute to the evidence base for 4 out of the 6 policy initiatives and thereby appears to be one of the central scientific drivers behind the societal actions on plastic pollution. Other scientific tools applied when shaping the policy initiatives include risk assessment, impact assessment and life cycle assessment. Despite the prevalent consideration and application of scientific evidence, there seems to be a broad recognition in the preparatory work of the initiatives that there is still a lot of uncertainty related to determining the harm of plastic pollution. In these cases, taking precautionary actions seems however to be justified, recalling not least the precautionary principle. As the issue of plastic pollution is complex and still subject to uncertainty, it seems important both that policy initiatives allow for flexibility and continuing adjustment to the on-going knowledge generation and that the scientific community provides the needed research to continue the science-informed policy development.
Associations between app usage and behaviour change in a m-health intervention to improve physical activity and sleep health in adults: secondary analyses from two randomised controlled trials
Authors: Murphy Leah L. , Dascombe Ben J. , Murawski Beatrice , Rayward Anna T. , Brown Wendy J. , Plotnikoff Ronald C. , Vandelanotte Corneel , Holliday Elizabeth G. , Duncan Mitch J.
Published: February 2023

Background

To examine associations between user engagement and activity-sleep patterns in a 12-week m-health behavioural intervention targeting physical activity and sleep.

Methods

This secondary analysis used data pooled from two Randomised Control Trials (RCT, [Synergy and Refresh]) that aimed to improve physical activity and sleep (PAS) among physically inactive adults with poor sleep. Both RCTs include a PAS intervention group (n = 190 [Synergy n = 80; Refresh n = 110]) and a wait list Control (CON n = 135 [Synergy n = 80; Refresh n = 55]). The PAS groups received a pedometer and accessed a smartphone/tablet “app” with behaviour change strategies, and email/SMS support. Activity-sleep patterns were quantified using the activity-sleep behaviour index (ASI) based on self-report measures. Intervention usage was quantified as a composite score of the frequency, intensity and duration of app usage during intervention (range: 0–30). Assessments were conducted at baseline, 3 and 6 months. Relationships between usage and ASI were examined using generalised linear models. Differences in ASI between the control group and intervention usage groups (Low [0–10.0], Mid [10.1–20.0], High [20.1–30.0]) were examined using generalised linear mixed models adjusted for baseline values of the outcome. Trial Registration: ACTRN12617000376347; ACTRN12617000680369.

Results

During the 3-month intervention, the mean (± sd) usage score was 18.9 ± 9.5. At 3 months (regression coefficient [95%CI]: 0.45 [0.22, 0.68]) and 6 months (0.48 [0.22, 0.74]) there was a weak association between usage score and ASI in the intervention group. At 3 months, ASI scores in the Mid (Mean [95%CI] = 57.51 [53.99, 61.04]) and High (60.09 [57.52, 62.67]) usage groups were significantly higher (better) than the control group (51.91 [49.58, 54.24]), but not the Low usage group (47.49 [41.87, 53.12]). Only differences between the high usage and control group remained at 6 months.

Conclusion

These findings suggests that while higher intervention usage is associated with improvements in behaviour, the weak magnitude of this association suggests that other factors are also likely to influence behaviour change in m-health interventions.

Trial registration number: ACTRN12617000376347; ACTRN12617000680369.
Genetic profiling analysis design of well-differentiated aggressive grade 2 and 3 gastroenteropancreatic neuroendocrine tumors in the phase III randomized controlled COMPOSE trial.
Authors: Halfdanarson Thorvardur Ragnar , Capdevila Jaume , Halperin Daniel M. , Herrmann Ken , Kong Grace , Leyden Simone , Mailman Josh , Reidy-Lagunes Diane , Srirajaskanthan Rajaventhan , Erdö Máté , Rotger Amanda , Thevenet Thomas
Published: February 2023

TPS660

Background: Deeper comprehension of gastroenteropancreatic neuroendocrine tumor (GEP-NET) characteristics has led to development of therapeutic interventions such as targeted radionuclide therapies (TRT). In the prospective, randomized, controlled, open-label, multi-center, Phase III COMPOSE trial, the radiolabeled somatostatin analogue 177Lu-edotreotide will be compared to approved standard of care with everolimus, CAPTEM or FOLFOX in patients with well-differentiated aggressive grade 2 and 3 (Ki-67 index 15−55%), somatostatin receptor positive GEP-NETS. While TRT is advantageous, a key unmet need is to identify additional markers intended to guide patient selection for TRT. This is highly relevant as TRT is a therapy of growing interest likely to be broadly available for patients with variable phenotypes. Profiling analysis as part of COMPOSE plans to analyze the genetic signature of GEP-NETS through full exome sequencing and gene expression analysis of tumor histology and longitudinal blood samples. This analysis may guide detection of pathogenic mutations in NET patients, to potentially inform treatment and surveillance strategies. Methods: Whole exome analysis of tumor-suppressor- and proto-oncogenes included in several pan-cancer panels, upstream and downstream regulators, and novel candidate genes, will be studied. Following patient consent, historical tumor biopsy and blood samples will undergo genetic analysis. Genetic profiling analysis inclusion will not impact trial involvement or disease management. DNA will be assessed to determine the impact of different types of mutations; mRNA will be assessed to confirm and quantify these assumptions and compare gene expression at different treatment phases. Samples will be analyzed in a central pathology laboratory. The aim of this analysis is to develop software that would integrate genetic data with structural and functional imaging, histopathology and phenotype information for implementation into clinical practice. Clinical trial information: NCT04919226 .
Phase I study of PTM-101 as neoadjuvant therapy for borderline resectable or locally advanced pancreatic ductal adenocarcinoma: A trial in progress.
Authors: Pilgrim Charles , Smith Marty , Ban Jun , Ellis Sam , Zalcberg John Raymond , Markman Ben , Lashof-Sullivan Margaret , Indolfi Laura
Published: February 2023

TPS775

Background: While there have been tremendous advances in cancer treatment, critical challenges remain including limited ability of drugs to successfully reach the tumor, short half-life, and low retention rate on site. Local control of non-metastatic pancreatic adenocarcinoma (PDAC) remains a major challenge. Up to 40% of patients present with locally advanced and borderline resectable anatomy, for whom enhanced local downsizing of disease could improve symptoms and increase overall survival (OS). Targeted therapies with reduced systemic toxicity are needed for the treatment of PDAC since current therapies have not provided meaningful advances. PTM-101 is a paclitaxel-impregnated absorbable product which is designed for direct, sustained release of the therapeutic agent at the tumor site. Preclinical animal studies demonstrate that PTM-101 results in enhanced drug levels in the tumor compared with comparable systemic paclitaxel dosing leading to tumor reduction, metastasis inhibition and survival benefit (Indolfi et al, 2016). Large animal (i.e. pigs) and human cadaver studies show that PTM-101 can successfully be deployed to the peritumoral pancreatic surface by a standard laparoscopic procedure. Further, large animal studies show no evidence of neutropenia, pancreatitis, severe fibrosis or scarring, or infection after placement of PTM-101. Methods: This Phase I trial will assess the addition of PTM-101 prior to mFOLFIRINOX in 6 subjects with newly diagnosed borderline resectable or locally advanced PDAC. The primary objective is to assess the safety, toxicity and feasibility of a single administration of PTM-101. It is hypothesized that PTM-101 will be readily implanted during diagnostic laparoscopy and will result in clinically meaningful delivery of paclitaxel directly towards the tumor area with good tolerance and minimal local systemic exposure of drug. Patients enrolled and treated on study will be monitored closely for local and systemic toxicities as well as preliminary signals of efficacy. Enrollment is in progress and 3 patients have been enrolled and completed prospective follow up at the time of abstract submission. Clinical trial information: ACTRN12621000881831 .
Combined Arterial Hypertension and Ischemic Stroke Exaggerate Anesthesia-Related Hypotension and Cerebral Oxygenation Deficits: A Preclinical Study
Authors: Zhang Tracy , Thakkar Pratik , Emans Tonja W. , Fong Debra , Thampi Suma , Felippe Igor S. A. , Barrett Carolyn J. , Billing Robyn , Campbell Douglas , McBryde Fiona D.
Published: February 2023

Background:

Intraoperative arterial hypotension (IOH) is a common side effect of general anesthesia (GA), associated with poor outcomes in ischemic stroke. While IOH is more prevalent with hypertension, it is unknown whether IOH may differ when GA is induced during ischemic stroke, versus other clinical settings. This is important given that many stroke patients receive GA for endovascular thrombectomy.

Methods:

We evaluate the cardiovascular responses to volatile GA (isoflurane in 100% o
2) before and during middle cerebral artery occlusion stroke in rats instrumented to record blood pressure (BP) and cerebral tissue oxygenation (po
2) in the projected penumbra, in clinically relevant cohorts of normotensive (Wistar rat, n = 10), treated hypertensive (spontaneously hypertensive [SH] + enalapril, n = 12), and untreated hypertensive (SH rat, n = 12).

Results:

During baseline induction of GA, IOH was similar in normotensive, treated hypertensive, and untreated hypertensive rats during the induction phase (first 10 minutes) (–24 ± 15 vs −28 ± 22 vs −48 ± 24 mm Hg; P > .05) and across the procedure (−24 ± 13 vs −30 ± 35 vs −39 ± 27 mm Hg; P > .05). Despite the BP reduction, cerebral po
2 increased by ~50% in all groups during the procedure. When inducing GA after 2 hours, all stroke groups showed a greater magnitude IOH compared to baseline GA induction, with larger falls in treated (−79 ± 24 mm Hg; P = .0202) and untreated(−105 ± 43 mm Hg; P < .001) hypertensive rats versus normotensives (−49 ± 21 mm Hg). This was accompanied by smaller increases in cerebral po
2 in normotensive rats (19% ± 32%; P = .0144 versus no-stroke); but a decrease in cerebral po
2 in treated (−11% ± 19%; P = .0048) and untreated (−12% ± 15%; P = .0003) hypertensive rats. Sham animals (normotensive and hypertensive) showed similar magnitude and pattern of IOH when induced with GA before and after sham procedure.

Conclusions:

Our findings are the first demonstration that ischemic stroke per se increases the severity of IOH, particularly when combined with a prior history of hypertension; this combination appears to compromise penumbral perfusion.
Anesthetic Considerations for Second-Trimester Surgical Abortions
Authors: Ozery Elizabeth , Ansari Jessica , Kaur Simranvir , Shaw Kate A. , Henkel Andrea
Published: February 2023

Although most abortion care takes place in the office setting, anesthesiologists are often asked to provide anesthesia for the 1% of abortions that take place later, in the second trimester. Changes in federal and state regulations surrounding abortion services may result in an increase in second-trimester abortions due to barriers to accessing care. The need for interstate travel will reduce access and delay care for everyone, given limited appointment capacity in states that continue to support bodily autonomy. Therefore, anesthesiologists may be increasingly involved in care for these patients.

There are multiple, unique anesthetic considerations to provide safe and compassionate care to patients undergoing second-trimester abortion. First, a multiday cervical preparation involving cervical osmotic dilators and pharmacologic agents results in a time-sensitive, nonelective procedure, which should not be delayed or canceled due to risk of fetal expulsion in the preoperative area. In addition, a growing body of literature suggests that the older anesthesia dogma that all pregnant patients require rapid-sequence induction and an endotracheal tube can be abandoned, and that deep sedation without intubation is safe and often preferable for this patient population through 24 weeks of gestation. Finally, concomitant substance use disorders, preoperative pain from cervical preparation, and intraoperative management of uterine atony in a uterus that does not yet have mature oxytocin receptors require additional consideration.
Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study
Authors: Connelly Neil Roy , Adler Adam C. , Vanderberg Laura E. , Conlin Frederick , Mitchell John D. , Goldstein Sheldon , Haspel Richard L. ,   the ATEST Collaborators
Published: February 2023

BACKGROUND:

Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge.

METHODS:

A validated transfusion medicine examination and accompanying survey were forwarded by program directors to residents for anonymous completion on May 5 and closed on June 30, 2021. The outcome of interest was the mean examination score. Secondary areas of interest were performance by year of training and previous educational experience in transfusion reported by the trainees. Rasch analysis was performed on the examination quality and individual question performance. Kruskal-Wallis H tests were used to identify differences between mean scores. Post hoc comparisons were used to assess specific pairwise differences between mean test scores by survey variable.

RESULTS:

Four hundred twenty-three anesthesiology residents in 37 programs completed the examination. The mean score was 45.5% ± 12.6%. There was a significant difference in mean cumulative examination scores between different resident training levels (P < 0.001). There was a significant difference in scores between clinical anesthesia (CA)-1 and CA-2 residents (P = 0.011) and CA-1 and CA-3 residents (P = 0.012). No significant difference in examination scores was observed between CA-2 and CA-3 residents (P = 0.95). All these subgroups scored below 50% on the examination. Significant differences between the residency training programs and cumulative scores were identified (P < 0.001).

CONCLUSIONS:

This examination highlights gaps in transfusion medicine knowledge within US anesthesiology residents. Targeted education may improve knowledge in this area and patient care.
Failure to Rescue and Mortality Differences After Appendectomy in a Low-Middle-Income Country and the United States
Authors: Rosero Eric B. , Eslava-Schmalbach Javier , Garzón-Orjuela Nathaly , Buitrago Giancarlo , Joshi Girish P.
Published: February 2023

BACKGROUND:

Major disparities in complications and mortality after appendectomy between countries with different income levels have not been well characterized, as comparative studies at patient level between countries are scant. This study aimed to investigate variations in postoperative complications, mortality, and failure to rescue after appendectomy between a high-income country and a low-to-middle–income country.

METHODS:

Hospital discharges on adult patients who underwent appendectomy were extracted from administrative databases from Colombia and 2 states of the United States (Florida and New York). Outcomes included major postoperative complications, in-hospital mortality, and failure to rescue. Univariate analyses were conducted to compare outcomes between the 2 countries. Multivariable logistic regression analyses were conducted to examine the independent effect of country on outcomes after adjustment for patient age, sex, comorbidity index, severity of appendicitis, and appendectomy route (laparoscopic/open).

RESULTS:

A total of 62,338 cases from Colombia and 57,987 from the United States were included in the analysis. Patients in Colombia were significantly younger and healthier but had a higher incidence of peritonitis. Use of laparoscopy was significantly lower in Colombia (5.9% vs 89.4%; P < .0001). After adjustment for covariates, multivariable logistic regression analyses revealed that compared to the United States, Colombia had lower complication rates (2.8% vs 6.6%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.39–0.44; P < .0001) but higher mortality (0.44% vs 0.08%; OR, 8.92; 95% CI, 5.69–13.98; P < .0001) and failure to rescue (13.6% vs 1.0%; OR, 17.01; 95% CI, 10.66–27.16; P < .0001).

CONCLUSIONS:

Despite lower rates of postoperative complications, in-hospital mortality after appendectomy was higher in Colombia than in the United States. This difference may be explained by higher rates of failure to rescue in the low-to-middle–income country (ie, decreased ability of Colombian hospitals to rescue patients from complications).
Postoperative Outcomes in Elderly Patients Undergoing Cardiac Surgery With Preoperative Cognitive Impairment: A Systematic Review and Meta-Analysis
Authors: Au Emily , Thangathurai Gowtham , Saripella Aparna , Yan Ellene , Englesakis Marina , Nagappa Mahesh , Chung Frances
Published: February 2023

BACKGROUND:

Older patients with preoperative cognitive impairment are at risk for increased postoperative complications after noncardiac surgery. This systematic review and meta-analysis aimed to determine the association between preoperative cognitive impairment and dementia and postoperative outcomes in older surgical patients after cardiac surgery.

METHODS:

Eight electronic databases were searched from inception to January 4, 2022. Inclusion criteria were cardiac surgery patients ≥60 years of age; preoperative cognitive impairment; ≥1 postoperative complication reported; comparator group with no preoperative cognitive impairment; and written in English. Using a random-effects model, we calculated effect sizes as odds ratio (OR) and standardized mean differences (SMDs). Risk of random error was assessed by applying trial sequential analysis.

RESULTS:

Sixteen studies (62,179 patients) were included. Preoperative cognitive impairment was associated with increased risk of delirium in older patients after cardiac surgery (70.0% vs 20.5%; OR, 8.35; 95% confidence interval [CI], 4.25–16.38; I2, 0%; P < .00001). Cognitive impairment was associated with increased hospital length of stay (LOS; SMD, 0.36; 95% CI, 0.20–0.51; I2, 22%; P < .00001) and intensive care unit (ICU) LOS (SMD, 0.39; 95% CI, 0.09–0.68; I2, 70%; P = .01). No significant association was seen for 30-day mortality (1.7% vs 1.1%; OR, 2.58; 95% CI, 0.64–10.44; I2, 55%; P = .18).

CONCLUSIONS:

In older patients undergoing cardiac surgery, cognitive impairment was associated with an 8-fold increased risk of delirium, a 5% increase in absolute risk of major postoperative bleeding, and an increase in hospital and ICU LOS by approximately 0.4 days. Further research on the feasibility of implementing routine neurocognitive testing is warranted.