bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment
Authors: Pouncey Anna Louise , Loría-Rebolledo Luis Enrique , Sharples Linda , Bicknell Colin , Ryan Mandy , Powell Janet
Published: February 2025

Objectives

Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons’ decision-making for infrarenal AAA repair.

Design

Discrete choice experiment.

Setting

Simulated environment using case scenarios with varying patient attributes.

Participants

Vascular surgeons.

Interventions

Surgical decision-making.

Main outcome measures

AAA repair versus no repair and endovascular versus open repair.

Results

182 surgeons completed 2987 scenarios. When all other attributes were equal, a woman was more likely to be offered an AAA repair (marginal rate of substitution (MRS) 3.86 (95% CI 2.93, 4.79)), while very high anaesthetic risk (MRS −4.33 (95% CI –5.63, –3.03)) and hostile anatomy (MRS −3.28 (95% CI –4.55, –2.01)) were deterrents. Increasing age did not adversely affect the likelihood of offering repair to men but decreased the likelihood for women, which negated women’s selection advantage from the age of 83 years. Women were also more likely to be offered endovascular repair (MRS 2.57 (95% CI 1.30, 3.84)).

Conclusions

Patient sex alone did not account for real-world disparity observed in selection for surgery. Rather, being a woman was associated with a higher likelihood of being offered AAA repair but also a higher likelihood of being offered less invasive endovascular repair. Increased age decreased the likelihood of surgical selection for women but not men. Preference for less invasive repair, combined with inferior rates of anatomical suitability, and the comparably older age of women at the time of AAA repair selection may account for lower rates of repair for women observed.
Developing patient-reported experience measures to evaluate an Emergency Department Outreach Programme for people experiencing homelessness in Toronto, Canada: a community-based participatory research study protocol
Authors: Xiao Sarah , Handford Curtis , Pinto Andrew , Snider Carolyn
Published: February 2025

Introduction

People experiencing homelessness (PEH) have diverse and complex health and social needs and experience significant barriers to accessing support. As a result, PEH often use the emergency department (ED) for their unmet health and social needs. To address these challenges, the ED Outreach Programme at St. Michael’s Hospital was developed with community partners within the Downtown East Toronto Ontario Health Team in Toronto, Canada. PEH presenting in the ED are connected to an outreach worker to identify immediate needs for a safe discharge and to access health and social supports in the community. Following discharge, the outreach worker continues to maintain contact with clients to ensure continuity of care and assists with the coordination, navigation and follow-up of healthcare and community services.

Methods

A three-phase community-based participatory research (CBPR) study will be conducted to evaluate patient experience in the ED Outreach Programme. Phase 1 involves conducting interviews with clients and staff/providers to understand their experiences with the programme and identify patient experience domains, constructs and measures. In Phase 2, programme clients, staff/providers and partners with lived experience co-design a set of patient-reported experience measures (PREMs) through focus groups. In Phase 3, the PREMs are pilot-tested to ensure their applicability and utility in the clinical setting. Central to CBPR principles, shared leadership and ownership of the project are facilitated by engaging and empowering community members. This study will contribute to new knowledge of building partnerships with PEH and marginalised communities in healthcare research, evaluation and quality improvement, particularly in developing PREMs.

Ethics and dissemination

This study has been approved by the Unity Health Toronto Research Ethics Board (REB#21–315). Findings will be disseminated in peer-reviewed journals, conferences and forums, as well as through collaborating with partners with lived experience, community agencies and government bodies.
Ventilator settings for fibreoptic bronchoscopy during mechanical ventilation: a study protocol for a pragmatic randomised double-blind controlled trial VentSetFib
Authors: Lemyze Malcolm , Granier Maxime , Laouki Chems-Eddine , Belmeguenai Amir , Chared Habib , Audegond Clotilde , Mallat Jihad
Published: February 2025

Introduction

Fibreoptic bronchoscopy (FOB) is a challenging procedure during mechanical ventilation (MV) as it considerably reduces the endotracheal tube’s internal diameter, causing a drastic increase in respiratory resistance, which may compromise the delivery of ventilatory assistance. According to respiratory physiology principles applied to MV, the reduction of inspiratory flow and tidal volume is likely to reduce airway pressure during the inspiratory phase when respiratory resistances increase. Based on this assumption, we propose new ventilator settings aimed at reducing airway pressure during FOB. This study represents the first investigation to test special ventilator settings in order to facilitate FOB during MV.

Methods and analysis

This is a single-centre randomised double-blind controlled trial, in which intubated patients undergoing an FOB will be assigned (1/1) either to receive the new ventilatory strategy or to stay on the ventilator settings previously selected by the attending physician. The intervention group will be applied the specific ventilator settings (inspiratory flow ≤25 L/min, tidal volume=5 mL/Kg, 1 s≤inspiratory time≤1.3 s, respiratory frequency=16 c/min, positive end-expiratory pressure=5 cm H2O). The primary endpoint will be the reduction of the occurrence of a serious adverse event (inability to deliver ventilatory support, significant arterial desaturation or haemodynamics instability) during FOB, prompting the interruption of the procedure. The primary endpoint will be validated a posteriori by an external adjudication committee. The sample size was estimated at a minimum of 42 patients to demonstrate a 50% reduction in the occurrence of such a serious adverse event with a power of 90% and an alpha risk of 0.05 (χ2test). Considering the possibility of technical problems in 10% of cases, 46 patients will be included.

Ethics and dissemination

The study has been approved by the national ethics committee for the protection of the individuals (ID number: 2024-A00747-40). Written informed consent will be obtained from all patients. The results will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT06562725.
Risk factors associated with urogenital schistosomiasis: a multilevel assessment approach using an Oversampling Schistosomiasis Survey (SOS) community-based, Plateaux region, Togo 2022
Authors: Alidou Smaila , Kamassa Hélène E , Lack Fiali , Ataba Essoham , Fleming Fiona M , Sossou Efoe , Hemou Manani , Yakpa Kossi , Tchalim Mawèké , Gnossike Piham , Vounatsou Penelope , Pullan Rachel , Gass Katherine , Dorkenoo Ameyo M
Published: February 2025

Background

Urogenital schistosomiasis is endemic in Togo. Since 2010, Togo has used preventive chemotherapy to control the disease and periodically assess its impact. This study aimed to estimate the prevalence of urogenital schistosomiasis and identify associated risk factors among school-age children in three districts of the Plateaux Region of Togo.

Methods

A cross-sectional study surveyed school-age children in three Togo districts, using an oversampling strategy of door-to-door visits to collect urine samples, metadata and lifestyle data. Statistical analyses, including descriptive and multilevel regression, were used to determine prevalence and investigate individual/community risk factors associated with urogenital schistosomiasis and infection intensity.

Results

This study surveyed 6400 children, uncovering a 15.0% prevalence of urogenital schistosomiasis (95% CI: 14.1% to 15.8%). Notably, 48.3% (95% CI: 45.1% to 51.5%) showed heavy-intensity infections, averaging 38 eggs per 10 mL (range: 0–9688). Key risk factors included age (adjusted OR (aOR)=1.9), swimming in surface water (aOR=2.6) and residing in the Ogou district (aOR=11.2), while the Est-Mono district posed a lower risk (aOR=0.2). Factors such as gender, with boys at higher risk (aOR=1.7), age (aOR=2.9), school attendance (aOR=2.4) and swimming in surface water (aOR=4.7) were linked to infection intensity. Consumption of public tap water (aOR=2.4; 95% CI: 1.0 to 5.2) and residing in Ogou (aOR=28.6) increased intensity, whereas living in Est-Mono (aOR=0.0; 95% CI: 0.0 to 0.08) or using rainwater (aOR=0.0; 95% CI: 0.0 to 0.4) decreased it.

Conclusions

The prevalence and intensity of urogenital schistosomiasis were found to be correlated with household and behavioural risk factors. Integrating these factors into national control programmes and improving access to safe water and sanitation facilities will be crucial in eliminating this disease as a public health concern in Togo.
Unemployment and associations with diagnosed health problems in the Norwegian GP-DEP study: a repeated cross-sectional register study (2010–2016)
Authors: Haukenes Inger , Ruths Sabine , Smith-Sivertsen Tone , Hetlevik Øystein , Hensing Gunnel , Knudsen Ann Kristin , Baste Valborg
Published: February 2025

Introduction

While differences in mental health between recipients and non-recipients of unemployment benefits are well known, it is not known whether such differences exist for musculoskeletal and cardiovascular health problems. This study examined the difference in registry-based diagnoses between short term, long term and non-recipients of unemployment benefits in the Norwegian working-age population and further examined if these associations differed by educational level.

Methods

A cross-sectional repeated register study comprising all working-age individuals (age 21–67 years) with pensionable income in Norway in the period 2010 (N=2 610 956) to 2016 (N=2 791 103). Data were retrieved from the Norwegian population registry, the Education Database, the Database of Social Insurance and the Control and Reimbursement of Health Care Claims Database and linked on individual level. Associations between recipients and non-recipients of unemployment benefits and physician-certified diagnoses were examined with Poisson regression with robust variance estimates (relative risk (RR) with 95% CI) and stratified by education.

Results

Both short-term and long-term recipients of unemployment benefits were associated with an increased likelihood of having one or more musculoskeletal, psychological or cardiovascular diagnoses compared with non-recipients. The strength of the associations increased with cumulative days of unemployment, with adjusted RRs (95% CIs) for musculoskeletal disorder 1.7 (1.7 to 1.7); psychological diagnoses 2,.2 (2.2 to 2.3); subgroup depression 3.3 (3.2 to 3.3) and for cardiovascular disease 1.3 (1.3 to 1.3) compared with non-recipients. Among highly educated people, the association between unemployment and having a diagnosis was stronger than among unemployed with medium and low education.

Conclusions

Unemployment benefits recipiency were associated with musculoskeletal, psychological and cardiovascular diagnoses, and the strength of the association increased with higher education. The direction of the relationship could not be determined in this study.
Evaluating the utilisation patterns of pharmacological therapy in COVID-19 patients: an ecological study in Italy
Authors: Marino Maria Lucia , Di Filippo Aurora , Onder Graziano , Eleuteri Davide , Trotta Francesco
Published: February 2025

Backgound

The drug central monitoring system set up in Italy to evaluate the real-time trends of medicines used in hospital and primary care settings contributed to inform drug supplies, avoided stockpiling and allowed to monitor adherence to clinical practice guidelines for the treatment of COVID-19 patients. The primary objective of the study is to understand how and to what extent the drug utilisation tracked the evolution of COVID-19 pandemic and evaluate the different pharmacological approaches adopted in hospital and primary care settings.

Methods

A national ecological study correlating the drug utilisation of specific categories of drugs related to SARS-CoV-2 with the number of SARS-CoV-2 hospitalised or positive subjects. The correlation is estimated by using linear regression models and reporting the angular coefficients (slope) with relative p value.

Results

Overall, 15 drug categories are identified: 7 categories are available in both settings, 6 categories are prevalent in hospital setting and 2 categories are used in primary care. As for drugs common to both settings, a statistically significant positive association between the number of SARS-CoV-2-positive subjects and drug consumption is found only for low-molecular-weight heparin, oxygen, azithromycin and steroids. As regards drugs used exclusively in hospital, a significant correlation is observed for cardiac stimulants, general anaesthetics, hypnotics and sedatives as well as muscle relaxant drugs. Among drugs used exclusively in primary care, the study has shown a positive correlation only for vitamin D. Finally, the adoption in clinical practice of the recommendations issued by the competent authorities was assessed: at hospital level, the use of drugs with a negative recommendation (such as hydroxychloroquine and azithromycin) was promptly stopped.

Conclusions

Study findings show a positive correlation between the use of specific drug categories used during the pandemic and the number of COVID-19-positive and hospitalised patients, suggesting the relevant role of evaluating drug utilisation patterns in tracking the evolution of pandemics and guideline adherence in clinical practice.
Determining kidney function-specific thresholds for N-terminal pro-B-type natriuretic peptide in heart failure risk prediction among patients with chronic kidney disease: a multicentre, observational, cohort study
Authors: Lu Yi , Chen Junzhe , Chen Ruixuan , Lukwaro Andrew Fanuel , Zhou Shiyu , Luo Yuxin , Nie Sheng , Tang Ying
Published: February 2025

Background

Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are common in patients with chronic kidney disease (CKD), but uniform thresholds derived from the general population may not accurately predict heart failure (HF) risk across stages of kidney function. This study aimed to determine whether thresholds specific to kidney function categories improve HF risk prediction in CKD.

Methods

This retrospective cohort study used data from the China Renal Data System, including 18 261 patients with CKD without prior HF. Kidney function-specific thresholds for NT-proBNP were established based on estimated glomerular filtration rate (eGFR) categories, and associations with HF risk were assessed using multivariable Cox proportional hazard models. The predictive value of these thresholds was compared with a uniform threshold of 125 pg/mL using Net Reclassification Improvement (NRI).

Results

Elevated NT-proBNP was observed in 67% of patients using the uniform threshold compared with 23% when using eGFR-specific thresholds. Optimal NT-proBNP thresholds increased with declining kidney function, reaching the highest level in stage 5 CKD (eGFR <15 mL/min/1.73 m²). eGFR-specific thresholds significantly improved HF risk prediction, with NRI gains of 19% to 55% across stages 1 to 5, while the uniform threshold added no predictive value for patients with stage 5 CKD.

Conclusions

In patients with CKD, NT-proBNP levels must be interpreted in the context of kidney function, as eGFR-specific thresholds provide superior HF risk stratification. These findings support adopting kidney function-adjusted thresholds rather than a uniform cut-off to improve HF risk prediction.
Examining contextual differences in suicide by rural–urban designation and military status, 2009–2019: a cross-sectional analysis of the National Violent Death Reporting System
Authors: Vakkalanka J Priyanka , Santos Leon Eliezer , Davis Jon , Williams Cameron , Casteel Carri
Published: February 2025

Objective

To evaluate differences in mental health and substance use circumstances by rurality and military affiliations among suicide decedents.

Methods

Multiyear (2009–2019) cross-sectional study of adult suicide decedents reported to the National Violent Death Reporting System. We classified suicide decedents into a four-level variable by geography (urban/rural) and military status and evaluated the prevalence of current and past alcohol and substance use problems, mental health problem recognition and mental illness treatment. We estimated prevalence ratios using multiple imputation chain equations to account for missing data and log-binomial regression models and present stratified estimates by military and rural classification.

Findings

There was no significant relationship between rural-military classification and alcohol use problem. Compared with urban civilians, other groups had a lower risk identified of having a substance use problem: urban military (adjusted prevalence ratio (aPR): 0.65; 95% CI: 0.60 to 0.71), rural military (aPR: 0.57; 95% CI: 0.50 to 0.66) and rural civilians (aPR: 0.95; 95% CI: 0.90 to 1.00). Recognition of a mental health problem was lower among both rural military (aPR: 0.88; 95% CI: 0.81 to 0.96) and rural civilians (aPR: 0.89; 95% CI: 0.86 to 0.92). The likelihood of current mental treatment was lower in other groups (urban military (aPR: 0.93; 95% CI: 0.89 to 0.96); rural military (aPR: 0.87; 95% CI: 0.81 to 0.94); and rural civilian (aPR: 0.89; 95% CI: 0.85 to 0.92)). There was no evidence of effect modification by military and rural classification for any outcome.

Conclusions

Mental health outcomes by military affiliation and urbanicity/rurality may need to be independently assessed as social determinants of health.
Homozygous loss of function variant inLMNB2gene causes major brain malformation and perinatal death
Authors: Desgrouas Camille , Deryabin Igor , Duvillier Clémence , Frankel Diane , Kaspi Elise , Quibel Thibaud , Le Goff Gabriel , Cerino Mathieu , Mortreux Jérémie , Gérard Bénédicte , Dard Rodolphe , Badens Catherine
Published: February 2025

Lamins play a major role in the mechanical stability of cell nuclei, the organisation of chromatin and the DNA replication, transcription and repair. The expression profiles of A-type and B-type lamins vary depending on developmental stages, cell types and tissues. Lamin B2 is expressed very early in embryogenesis, especially in the central nervous system, where it is essential for neuronal migration and brain development. Pathogenic missense variants in lamin B2 have been linked to conditions such as lipodystrophy, progressive myoclonic epilepsy and primary microcephaly. Here, we report clinical data and molecular findings for two related newborns carrying a homozygous loss-of-function variant in theLMNB2gene. Both newborns died in the perinatal period and exhibited a similar phenotype at birth, including severe brain development abnormalities, which closely mirror findings observed in severalLmnb2-deficient mouse models. Western blot and immunofluorescence cell labelling performed on the patient’s fibroblasts obtained at birth confirmed the complete absence of lamin B2 and revealed an increase in lamin B1, together with alterations in alpha-tubulin and vimentin organisation. This novel clinical form of laminopathy associated with lamin B2 deficiency expands the molecular causes of brain development abnormalities toLMNB2gene variants.
Outcomes and experiences of genetic testing in children with congenital heart disease
Authors: Morrish Ansley M , O’Malley Bridget R , Hilton Desiree C K , Webb Annabel E , Bennetts Bruce , Sholler Gary F , Smith Janine , Blue Gillian M
Published: February 2025

Background

Following genomic advances, genetic testing options for paediatric patients with congenital heart disease (CHD) have evolved significantly. A single-site audit was conducted to assess testing outcomes and a survey created to explore family experiences and preferences.

Method

All genetic tests ordered in postcardiac surgery patients with CHD at The Children’s Hospital at Westmead between January 2017 and December 2021 were reviewed. Diagnostic yield, clinical and demographic factors, and testing trends over time were evaluated. Surveys were sent to parents of children who had met a clinical geneticist (n=112).

Results

Genetic testing was completed in 607 individuals (74 molecular testing; 533 cytogenetic testing only). The diagnostic rate was 36% and 9%, respectively. Use of molecular testing significantly increased over time (p=0.033), but yield did not (p=0.288). Molecular testing yield was high in neonates (64%), and patients with extracardiac anomalies (40%) or relevant family history (40%). Brain (p=0.022), haematological/cancer (p≤0.001), immune (p≤0.001), endocrine (p≤0.001) anomalies and intellectual disability (p=0.027) were associated with a diagnosis following cytogenetic testing. Short stature was significantly associated with diagnostic yield following molecular testing (p=0.012). Survey respondents (n=28) reported a positive experience (p=0.013) with minimal decisional regret (p=0.322).

Conclusion

Cytogenetic testing remains an important first-tier test in CHD. Furthermore, molecular testing guided by a clinical geneticist generates a high rate of genetic diagnoses. Parents of children with CHD value genetic testing with little regret.
Impact of sedentary behaviour reduction on desk-worker workplace satisfaction, productivity, mood and health-related quality of life: a randomised trial
Authors: Quinn Tyler D , Perera Subashan , Conroy Molly B , Jakicic John M , Muldoon Matthew F , Huber Kimberly A , Alansare Abdullah B , Holmes Anthony J , Barone Gibbs Bethany
Published: February 2025

Objectives

Sedentary behaviour (SB) is related to lower worker health-related quality of life (HRQOL), mental health and productivity. However, it is unknown whether reducing SB improves these outcomes. This study assessed whether a 3-month SB reduction intervention improved or was associated with dose-response changes in workplace satisfaction, productivity, mood and HRQOL.

Methods

Inactive desk workers with elevated blood pressure were randomised to a 3-month SB reduction intervention (n=135) or control (n=136). The intervention used a sit-stand desk, wrist-worn activity prompter and bi-monthly individual coaching to primarily replace work SB with standing and stepping. SB measured via a thigh-mounted activPAL3 micro, workplace satisfaction, productivity, mood and HRQOL were assessed at baseline and 3 months. Analyses of covariance compared changes in outcomes between groups with adjustment for baseline values. In both groups, associations between changes in work and non-work SB and outcomes were examined using linear regression.

Results

Compared with control, reducing SB did not significantly change workplace satisfaction, productivity or HRQOL. Among mood measures, only vigour improved (1.01 vs 0.1 points, p=0.0302). Among all participants, reductions in non-work SB were associated with improvements in workplace satisfaction (+0.15 and +0.27 points/hour of non-work standing and stepping, respectively) and productivity (+0.47 points/hour of non-work stepping), while changes in SB during work were not related.

Conclusions

Interventions reducing non-work rather than work SB may be more impactful for improving workplace satisfaction and HRQOL outcomes. Future studies should explore workplace-based SB reduction interventions that are longer and target non-work time to improve similar outcomes.

Trial registration number

NCT03307343.
Study of compositional and luminescence properties of calcite in lapis lazuli for provenance investigations of archaeological findings
Authors: Magalini Marta , Guidorzi Laura , Re Alessandro , Marabotto Miriana , Borghi Alessandro , Gallo Paolo , Vidale Massimo , La Torre Leonardo , Campostrini Matteo , Lemasson Quentin , Pichon Laurent , Moignard Brice , Pacheco Claire , Couture Pierre , Palitsin Vladimir , Lo Giudice Alessandro
Published: February 2025

In this study, calcite crystals within 42 lapis lazuli reference rocks coming from four distinct mining regions (in present-day Afghanistan, Tajikistan, Siberia and Myanmar) were characterised in terms of their compositional and luminescence properties in order to identify potential provenance markers. A non-destructive approach based on Ion Beam Analysis was employed, in particular using μ-Particle Induced X-rays Emission (μ-PIXE) and μ-Ion Beam Induced Luminescence (μ-IBIL). The results indicate that calcite crystals in Afghan rocks are characterised by the highest quantity of Mg and Mn; whereas, Siberian calcite exhibit the highest Sr content. The application of Principal Component Analysis also enhanced the possibility of discriminating between the Myanmar and Tajik rocks, as well as between the four provenances in general, by exploiting the compositional variability of Mg, Mn, Sr and Y elements. Regarding the luminescence properties, notable differences in the intensity ratio between the 360 nm and the 620 nm luminescence bands were detected among the provenances. In the second part of this study, the new results were employed to infer the origin of the raw material of certain archaeological findings discovered in two different historical sites: four lapis lazuli fragments from Shahr-i Sokhta (Iran, 3rd millennium BCE) and a lapis lazuli tessera from the city of Tanis (Egypt, 1050–700 BCE). The results of the analysis indicate that, among the four provenances considered in the reference rocks database, the best compatibility of the data from both case studies is found with the Afghan dataset. This suggests that the area of Afghanistan is the most probable source for the raw materials of the investigated findings.
Exponential stability of a variable coefficient semilinear wave equation with viscoelastic acoustic boundary conditions
Authors: Hao Jianghao , Zhang Tong
Published: February 2025

In this paper, we consider a variable coefficient semilinear wave equation with viscoelastic nonlocally acoustic boundary conditions. Such boundary conditions can describe the viscoelastic properties of elastic materials at the boundary, and can more accurately describe the propagation and reflection characteristics of sound waves at the material boundary. By the potential well method, we get the global existence of solution. Furthermore together with the energy method and the multiply method, we obtain the exponential decay result of energy. The obtained results of this paper generalize and improve some earlier results.
Research on correlate and cost optimization of the down stream mining operations with rock blasting results
Authors: Ma Jianbo , Xiu Zihao , Liu Zhenyi , Li Pengliang , Li Mingzhi , Wang Zhongqi
Published: February 2025

To address the issue of high cost associated with open-pit mining, a cost optimization model was established and an open model was developed to visualize these costs by comprehensively considering the entire open-pit-mining process and linking the effects of mine blasting to the various processes involved in open-pit mining. The established model optimized the open-pit mining cost by 10%. Among all the parameters considered, drill diameter exerted the greatest influence on the mining cost, with a sensitivity of 0.653. The study results demonstrated that the established model effectively optimized open-pit mining costs and could serve as a reference for controlling the costs associated with mining operations.
Prophet Inequalities via the Expected Competitive Ratio
Authors: Ezra Tomer , Reiffenhauser Rebecca , Russo Matteo , Tsigonias-Dimitriadis Alexandros , Leonardi Stefano
Published: February 2025

We consider prophet inequalities under general downward-closed constraints. In a prophet inequality problem, a decision-maker sees a series of online elements with values, and needs to decide immediately and irrevocably whether or not to select each element upon its arrival, subject to an underlying feasibility constraint. Traditionally, the decision-maker’s expected performance has been compared to the expected performance of the
prophet
, i.e., the expected offline optimum. We refer to this measure as the
Ratio of Expectations
(or, in short,
RoE
). However, a major limitation of the
RoE
measure is that it only gives a guarantee against what the optimum would be on average, while, in theory, algorithms still might perform poorly compared to the realized ex-post optimal value. Hence, we study alternative performance measures. In particular, we suggest the
Expectation of Ratio
(or, in short,
EoR
), which is the expectation of the ratio between the value of the algorithm and the value of the prophet. This measure yields desirable guarantees, e.g., a constant
EoR
implies achieving a constant fraction of the ex-post offline optimum with constant probability. Moreover, in the single-choice setting, we show that the
EoR
is equivalent (in the worst case) to the probability of selecting the maximum, a well-studied measure in the literature. However, the probability of selecting the maximum does not generalize meaningfully to combinatorial constraints (beyond single-choice), since its direct equivalent is the probability of selecting an optimal overall set. We, thus, introduce the
EoR
as a cardinal variant of the probability of selecting the maximum, which extends naturally to combinatorial settings. Our main goal is to understand the relation between
RoE
and
EoR
in combinatorial settings. Specifically, we establish two reductions: for every feasibility constraint, the
RoE
and the
EoR
are at most a constant factor apart on worst case instances. Additionally, we show that the
EoR
is a stronger benchmark than the
RoE
in that for every instance (feasibility constraint and product distribution) the
RoE
is at least a constant fraction of the
EoR
, but not vice versa. Both these reductions imply a wealth of
EoR
results in multiple settings where
RoE
results are known.
Lack of Association of Serum MMP‐9 Concentration and rs17576 Single Nucleotide Variant MMP-9 Gene With the Degree of Coronary Atherosclerosis and Other Risk Factors in Ukrainian Patients With Coronary Artery Disease
Authors: Pogorielova Oksana S. , Korniienko Viktoriia V. , Chumachenko Yaroslav D. , Obukhova Olha A. , Stroy Yelizaveta A. , Harbuzova Viktoriia Yu
Published: February 2025

This study probes the relationship between serum matrix metalloproteinase‐9 (MMP‐9) levels, the genetic variant rs17576 in the MMP‐9 gene, and the extent of coronary atherosclerosis among Ukrainian patients diagnosed with coronary artery disease (CAD). A cohort of 128 patients was assessed, comprising 25 with angiographically intact (normal) coronary arteries, 40 with acute coronary syndrome (ACS), and 63 with chronic coronary syndrome (CCS). Utilizing clinical, anthropometric, and biochemical analyses, alongside ELISA immunoassays, genotyping, electrocardiography, and coronary angiography, we conducted a comprehensive evaluation. Our findings indicate that MMP‐9 levels peaked in ACS patients, particularly those with single and triple‐vessel coronary lesions, while the lowest levels were observed in individuals with unaltered coronary arteries. Notably, the glomerular filtration rate (GFR) was highest in patients with angiographically normal coronary arteries, averaging 79.91 ± 27.8 mL/min. In the context of ACS, individuals carrying the GG allele exhibited the highest GFR, whereas AA allele carriers had the lowest. Conversely, in the CCS cohort, GG carriers demonstrated the lowest GFR and heterozygotes the highest, although these differences did not reach statistical significance. A significant disparity in serum MMP‐9 levels was observed between ACS patients, CCS patients, and individuals with unimpaired coronary arteries. Moreover, a substantial correlation was established between the degree of coronary artery lesions and GFR in the CCS group, providing a predictive measure for GFR in patients with triple‐vessel involvement. However, no significant association was detected between serum MMP‐9 levels, the rs17576 genetic variant in the MMP‐9 gene, and the number of affected vessels or GFR in both ACS and CCS patients.
Effect of the 5:2 Diet on Weight Loss and Cardiovascular Disease Risk Factors in Overweight and/or Obesity: A Systematic Review and Meta‐Analysis
Authors: Wu Cui , Chen Binqin , Yu Jing , Zhang Qi , Piao Chunli
Published: February 2025

Introduction: We conducted a systematic review and meta‐analysis to evaluate the effects of the 5:2 diet on weight loss and cardiovascular disease (CVD) risk factors in overweight and obese individuals.

Methods: Databases (PubMed, The Cochrane Library, Web of Science, Embase) were searched for randomized controlled trials of the intervention effects of the 5:2 diet in overweight and obese individuals. The search period was from database establishment to April 2024. RevMan 5.3 and Stata 14.0 were used for the meta‐analysis.

Results: A total of 20 articles with 1393 participants were finally included. There were 689 participants in the treatment groups and 704 in the control groups. The meta‐analysis showed that the 5:2 diet significantly reduces body weight, body mass index, waist circumference, body fat percentage, hip circumference, fat mass, fat‐free mass, low‐density lipoprotein, systolic blood pressure, and homeostasis model assessment‐insulin resistance levels relative to the control group (p < 0.05). However, there was no significant difference in levels of visceral fat, total cholesterol, triglycerides, high‐density lipoprotein, diastolic blood pressure, insulin, fasting blood glucose, glycated hemoglobin A1c, and heart rate. Although there were no serious adverse events in the 5:2 diet group, participants in this group experienced mild physical and psychological side effects during the fasting period, which resolved spontaneously after fasting.

Conclusion: The 5:2 diet is effective for weight reduction and amelioration of CVD risk factors in overweight/obesity and is safe and feasible. However, the patient’s physical condition during the fasting period should be monitored and timely adjustments should be made accordingly.
Exploring Batch Normalization’s Impact on Dense Layers of Multiclass and Multilabel Classifiers
Authors: Widneh Misganaw Aguate , Alemu Amlakie Aschale , Getie Dereje Derib
Published: February 2025

Leveraging batch normalization (BN) is crucial for deep learning for quick and precise identification of objects. It is a commonly used approach to reduce the variation of input distribution using BN. However, the complex parameters computed at the classifier layer of convolutional neural network (CNN) are the reason for model overfitting and consumption of long training time. This study is proposed to make a comparative analysis of models’ performances on multiclass and multilabel classifiers with and without BN at dense layers of CNN. Consequently, for both classifications, BN layers are incorporated at the fully connected layer of CNN. To build a model, we used datasets of medical plant leaves, potato leaves, and fashion images. The pretrained models such as Mobile Net, VGG16, and Inception Net are customized (tuned) using the transfer learning technique. We made adjustments to training and model hyperparameters, including batch size, number of layers, learning rate, number of epochs, and optimizers. After several experiments on the three models, we observed that the best way to improve the model’s accuracy is by applying BN at the CNN’s dense layer. BN improved the performances of the models on both multiclass and multilabel classifications. This improvement has more significant change in the multilabel classification. Hence, using medicinal plant dataset, the model achieved accuracy of 93% and 83% for multilabel with and without BN, respectively, while achieving 99.2% and 99% for multiclass classification. The experiment also proved that the effectiveness of BN is affected on type datasets, depth of CNN, and batch sizes.
Cladribine Added to Idarubicin and Cytarabine as an Induction Regimen for Patients with De Novo Acute Myeloid Leukemia: A Multicenter, Randomized Phase III Trial
Authors: Zhang Xiang , Han Yue , Qiu Huiying , Han Miaoxinqi , Sun Aining , Xue Shengli , Jin Zhengming , Miao Miao , Wang Ying , Fu Chengcheng , Tang Xiaowen , Chen Suning , Li Caixia , Bai Lian , Lin Zhihong , Chen Jun , Han Haohao , Chen Jia , Wu Depei
Published: February 2025

Purpose:

To assess the efficacy and safety of an induction regimen composed of idarubicin, cytarabine, and cladribine (IAC) in patients with de novo acute myeloid leukemia (AML).

Patients and Methods:

Adult patients with newly diagnosed AML were randomized to the IAC group (cladribine 5 mg/m2/day for 5 days, idarubicin 8 mg/m2/day for 3 days, and cytarabine 100 mg/m2/day for 7 days) and the IA group (idarubicin 12 mg/m2/day for 3 days and cytarabine 100 mg/m2/day for 7 days) at a 1:2 ratio. The primary endpoint was complete remission (CR) after induction. Secondary endpoints included 2-year overall survival (OS), disease-free survival, and cumulative incidence of relapse.

Results:

A total of 618 adult patients with newly diagnosed AML were enrolled. The overall CR rate was 80.5% in the IAC group compared with 72.4% in the IA group (P = 0.029). The 2-year OS was 81.3% in the IAC group compared with 70.0% in the IA group (P = 0.011). Patients on the IAC regimen achieved a higher CR rate compared to those on the IA regimen, particularly in those with adverse risk (69.8% vs. 49.1%, P = 0.008), 2-year OS (80.1% vs. IA 58.1%, P = 0.014), and disease-free survival (78.8% vs. 51.3%, P = 0.009). In the subgroup of patients older than 45 years of age, the IAC regimen exerted better CR (77.1% vs. 62.6%, P = 0.033) and 2-year OS (74.7% vs. IA 55.0%, P = 0.019). There were no differences in chemotherapy-related toxicities between the groups.

Conclusions:

Cladribine added to the IA regimen was safe and effective in de novo AML. Patients with adverse risk or those between 45 and 60 years of age might benefit significantly on both response and survival with the IAC regimen.
Mechanisms Of Response And Resistance To PSMAXCD3 Bispecifics In CD34+ Humanized Mice
Authors: Mattson Cypert Bethany K. , Menard Krista , Chu Gerald , McDevitt Theresa , Verona Raluca I. , Rupnow Brent , Packman Kathryn
Published: February 2025

Prostate cancer is considered immunologically “cold”, with low mutational burden, tumor-infiltrating immune cells, and PD-L1 levels, culminating in poor response to immune checkpoint therapies. Bispecific CD3 redirection antibodies can elicit T cell-mediated cytotoxicity and hold promise for immune cell recruitment into prostate tumors. CD3 redirection antibodies in solid tumors are still in early phases of clinical development, and it is not yet understood whether these potential therapies will achieve the high response rates observed in hematological malignancies or result in durable T cell responses. Here we demonstrated that treatment with a PSMA targeted CD3 redirector resulted in efficacy against LnCaP.AR human prostate xenografts in CD34+ cord blood humanized mice. Efficacy correlated with T cell infiltration into tumors with an activated phenotype, but also increased PD-L1 expression. Engineered overexpression of PD-L1 in LNCaP.AR tumors resulted in resistance to PSMAxCD3 bispecific antibody treatment, whereas sensitivity was restored in combination with anti-PD-1 antibody pembrolizumab. PSMAxCD3 and anti-PD-1 combination treatment resulted in complete tumor responses in approximately 20% of mice, and elicited immune responses that delayed growth of rechallenged tumors. In a second prostate model, patient derived LuCaP 86.2 xenografts, PSMAxCD3 monotherapy treatment resulted in complete responses in 25% of mice. When PSMAxCD3-treated responder mice were rechallenged with LuCaP 86.2 tumors, partial control of tumor regrowth was associated with expansion of effector memory T cells. These studies show that PSMAxCD3 treatment elicits antitumor memory T cell responses, and that combination with PD-1 blockade can enhance these effects in tumors with immune suppressive tumor microenvironments.
Avian diversity in wetlands of southwestern Kerala of India during COVID
Authors: Vijayakumari Sudhakaran Bindu  , S. Sajitha
Published: February 2025

The COVID-19 pandemic, known as the COVIDian era, has impacted ecosystems worldwide, including wetlands, which are essential habitats for avian biodiversity. The study on bird diversity in the wetlands of Kollam District, southwestern part of Kerala, employed a combination of field surveys and observational methods to assess the avian communities across various habitats. The survey areas were selected based on their significance as wetland ecosystems and included Polachira, Pozhikkara, and associated wetlands within Kollam District. The study documented 98 bird species across 41 families and 15 orders. Passeriformes was the most diverse order with 37 species, followed by Pelecaniformes and Charadriiformes with 13 species each. Apodiformes, Podicipediformes, and Psittaciformes each had a single recorded species. Ardeidae was the most abundant family with 10 species, followed by Rallidae (six species), Sturnidae, and Scolopacidae (five species each). Among the bird species recorded, 16 were migratory, 76 were resident, and six were local migrants. The study assessed bird diversity across Polachira, Pozhikkara, and associated wetlands using various indices, including Simpson, Simpson’s λ, Simpson’s D, Margalef, Berger-Parker, Shannon-Wiener, and Pielou. Shannon-Wiener diversity index at Polachira is 4.46, Pozhikkara 4.47 and associated wetlands is 4.45, which suggests that the overall avian diversity is comparable among these wetlands. Pozhikkara appears to have slightly higher species richness (Margalef’s index 14.64) and slightly lower dominance (Berger-Parker index 35.90) compared to the other two sites. This study elucidates the effects of pandemic-related disruptions on bird populations, highlighting the resilience and vulnerabilities of avifauna in wetland ecosystems.
Hypertension Prevention and Healthy Life Expectancy in Black Adults: The Jackson Heart Study
Authors: Foti Kathryn , Zhang Yiyi , Hennessy Susan E. , Colantonio Lisandro D. , Ghazi Lama , Hardy Shakia T. , Arabadjian Milla , Byfield Rushelle , Fontil Valy , Lewis Cora E. , Shimbo Daichi , Muntner Paul , Bellows Brandon K.
Published: February 2025

BACKGROUND:

The impact of preventing hypertension and maintaining normal blood pressure (BP) on life expectancy and healthy life expectancy (HLE) among Black adults, who are disproportionately affected by hypertension, has not been quantified.

METHODS:

We used a discrete event simulation to estimate life expectancy and HLE among a cohort of Black adults from the Jackson Heart Study (n=4933) from age 20 to 100 years or until death. We modeled preventing hypertension as having BP <130/80 mm Hg and maintaining normal BP as having BP <120/80 mm Hg across the lifespan. In the primary analysis, we assumed that lowering BP decreased the risk of cardiovascular disease events, resulting in life expectancy and HLE gains. In a secondary analysis, we assumed that preventing hypertension and maintaining normal BP directly reduced both cardiovascular disease and mortality risk.

RESULTS:

At age 20 years, the projected average life expectancy was age 80.8 (95% uncertainty interval [UI], 80.6–81.1) years, and HLE was 70.5 (95% UI, 70.3–70.7) healthy life years. In the primary analysis, preventing hypertension and maintaining normal BP added 0.9 (95% UI, 0.8–1.1) and 1.1 (95% UI, 0.9–1.3) years to life expectancy, respectively, and 2.7 (95% UI, 2.6–2.9) and 2.9 (95% UI, 2.7–3.1) healthy life years to HLE, respectively. In the secondary analysis, preventing hypertension and maintaining normal BP added 4.5 (95% UI, 4.3–4.6) and 4.6 (95% UI, 4.4–4.8) years to life expectancy, respectively, and 5.7 (95% UI, 5.6–5.8) and 5.9 (95% UI, 5.7–6.0) healthy life years to HLE, respectively.

CONCLUSIONS:

Preventing hypertension and maintaining normal BP were projected to increase life expectancy and HLE among Black adults.
Incidence But Not Severity of Intracerebral Hemorrhage Shows a Strong Pattern of Seasonal Variation
Authors: Martinez Oeckel Ariane , Misselwitz Bjoern , Foerch Christian
Published: February 2025

Background

A strong risk factor for intracerebral hemorrhage (ICH) is elevated arterial blood pressure, which is known to vary by season, with highest values in winter months. The objective was to assess seasonal trends of ICH incidence, clinical severity, and case fatality according to demographic and clinical characteristics.

Methods

This study was conducted on adult patients hospitalized for ICH between 2003 and 2022. Cases were identified from a stroke inpatient quality assurance registry covering the entire Federal State of Hesse, Germany. Population data were derived from the Hessian Bureau of Statistics. Incidence rates (IRs) per 100 000 person‐years of ICH, recorded with 4‐digit
International Statistical Classification of Diseases, Tenth Revision, German Modification
(
ICD‐10‐GM
) I61.x codes, were estimated by season, calendar month, and bleeding location. Seasonal variations and subgroup analyses were tested using Poisson distribution and the Wald test.

Results

A total of 33 444 patients were included (mean age, 72.4±13.6 years, 52% men). ICH IR correlated with the season of occurrence, demonstrating a peak in winter (IR winter, 34.6 [95% CI, 33.9–35.4], IR summer, 29.4 [95% CI, 28.7–30.1];
P
<0.01). Seasonal variation was equally present in men and women but was more pronounced in older compared with younger patients (peak at age 60–90 years;
P
<0.01). IR showed seasonal variation both for cortical and subcortical bleeding locations (
P
<0.01). Clinical severity and case fatality did not vary between seasons (mean, 24.3±0.8%).

Conclusions

This large cohort study demonstrates a seasonal incidence peak of ICH in winter. Whether ICH can be prevented by better control of arterial blood pressure in seasons with expected incidence peaks will require further studies.