Admissible Values Research Articles

The Value of Admission Glycated Hemoglobin and Associated Factors in Non-Diabetic Patients with Heart Failure in Aden

Introduction: Heart failure (HF) is a multifactorial disorder characterized by impaired cardiac function, systemic inflammation and neurohormonal activation. It is a major cause of morbidity and mortality worldwide and has significant impacts on the quality of life, cost and longevity. This study was conducted to investigate the value of admission glycated hemoglobin (HbA1c) and associated factors among non-diabetic patients with heart failure. Methods: This is a descriptive prospective-hospital based study included 42 non-diabetic patients with HF on first occasion for admission at three major Aden hospitals for the period (January1st–December 31st, 2021). After thorough clinical history and examination, patients were investigated for random blood sugar, lipid profile, Pro Brain Natriuretic Peptide (Pro-BNP), HbA1c and followed till hospital discharge. Results: HF in non-diabetic patients predominates in males (81.0%) with a mean age of 56.0 ±11.5 years. The main associated factors were arterial hypertension (47.6%), coronary artery disease (9.5%), Khat chewing (57.1%), smoking (31.0%), obesity (28.6%), and family history of HF (21.4%). patients presented with New York Heart Association (NYHA) class III (47.6%) and low ejection fraction of ≤40.0% (76.2%). The median Pro-BNP was 2166.0 pg/mL, the mean admission HbA1c was 5.8% and the case fatality rate was 4.8%. The mean body mass index (BMI) was increasing with increasing level of admission HbA1c. HbA1c of 6.0-6.4% was associated with mortality cases and had significant positive association with BMI and significant negative association with total cholesterol. Conclusion: The admission HbA1c of 6.0-6.4% was associated with HF hospitalization and mortality in non-diabetic patients. This association is independent of age, gender, hypertension, hypercholesterolemia, glycemia, and clinical outcome suggesting direct effects of BMI on the development of high HbA1c level in non-diabetic patients with HF.

Association Between Changes in Haematological Parameters and Mortality in Patients Hospitalized Due to Severe COVID-19 in a Peruvian Reference Hospital

Objective: To determine the association between changes in haematological parameters and mortality in patients hospitalized due to severe COVID-19 at a Peruvian reference hospital from April to December 2020. Materials and Methods: Observational, analytical, historical cohort study based on the review of clinical records of patients hospitalized due to severe COVID-19 from April to December 2020. We evaluated changes in common haematological parameters, including white blood cells (WBCs), lymphocytes, neutrophils, and platelet counts, as well as the neutrophil-to-lymphocyte ratio (NLR) on the third and seventh days of hospitalization compared with admission values in the deceased and nondeceased groups. Changes in haematological parameters were expressed as median and interquartile ranges (IQR). Multivariate Poisson regression analysis was further done to evaluate the effect of haematological changes in mortality, adjusting for gender, age, and comorbidities. Results: We included 1033 cases, of which 68.05% were male. Deceased patients had a significant increase in total WBC on the third day (1.0 *103/μL; IQR -1.7 to 5.4) and the seventh day (1.6*103/μL; IQR -1.9 to 4.9) compared to their admission values. The neutrophil count in the deceased patients also increased on the third day (1.2; IQR -1.7 to 4.9) and seventh day (1.9; IQR-1.5 to 5.8), as did the NLR ratio on the third day (0.2; IQR -0.4 to 1.6) and seventh day (0.7; IQR -0.2 to 2.2). Surviving patients showed an opposite trend in these parameters. In contrast, platelet counts increased on the third day (49*105/μL; IQR -0.3 to 1.3) and the seventh day (90*105; IQR 0.0 to 2.0) in surviving patients, whereas deceased patients did not show significant changes. All these differences remained statistically significant in the adjusted analysis. Conclusion: An increase in total WBC, neutrophils, and NLR at the third and seventh days compared to admission values was associated with higher mortality in patients hospitalized due to COVID-19, while an increase in platelet count was associated with decreased mortality. Monitoring these changes can help in identifying those patients with higher mortality risk.

Late onset neonatal sepsis: Can plasma gelsolin be a promising diagnostic marker?

Plasma gelsolin (pGSN) correlates with clinical improvement in septic patients. We aimed to investigate pGSN levels as a diagnostic and prognostic marker of neonatal late-onset-sepsis (LOS). A case-control study was done on 184 neonates (92 with LOS and 92 controls). All participants were subjected to detailed history taking, full clinical evaluation, sepsis workup, and pGSN enzyme-linked immunosorbent-assay measurement. We detected significantly lower pGSN level among cases compared to controls (90.63 ± 20.64 vs 451.83 ± 209.59). It was significantly related to the severity of sepsis and mortality, with significantly lower values among cases with septic shock and multiorgan failure and non-survivors. Follow-up pGSN significantly increased after sepsis improvement in survivors compared to admission values. pGSN might be a reliable diagnostic and prognostic marker for LOS.

Relationship between high sensitivity troponin I and clinical outcomes in non–acute coronary syndrome (non-ACS) acute heart failure patients – a one-year follow-up study

ObjectiveThe primary objective of the study was to investigate the correlation between high-sensitivity troponin I (hsTropI) levels during hospitalization and the prognostic outcome in patients with non-acute coronary syndrome (non-ACS) acute heart failure, over a follow-up period of one year. The secondary objective was to assess and characterize acute heart failure during index hospitalization. MethodsHigh sensitivity troponin I value was noted both at the time of admission and discharge. The correlation of admission hsTropI along with other parameters and risk factors with in-hospital mortality was studied. Patients of index hospitalization after discharge were followed up for one year and the composite endpoint of cardiovascular death or re-hospitalization for heart failure was noted. The correlation between admission and discharge hsTropI values with the composite endpoint was then analyzed. ResultsOut of 350 patients, 38 (10.8 %) patients died during index hospitalization while 142 patients (46 %) developed composite outcomes during follow-up. Age, previous history of heart failure, atrial fibrillation, low left ventricular ejection fraction, systolic blood pressure, and high values of hsTropI above 99th percentiles were independent in-hospital mortality predictors. The value of hsTropI at the time of admission was not associated with poor composite outcome during follow-up. However, patients who showed an increasing trend of hsTropI value at the time of discharge were found to have a significant increase in the composite outcome. ConclusionHigh-sensitivity troponin I is a valuable biomarker that can predict in-hospital mortality and long-term follow-up outcomes in patients with acute heart failure. It plays a crucial role in developing improved strategies for heart failure surveillance and management in the community.

Evaluation of G3BP1 in the prognosis of acute and acute-on-chronic liver failure after the treatment of artificial liver support system.

The increased expression of G3BP1 was positively correlated with the prognosis of liver failure. To investigate the effect of G3BP1 on the prognosis of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) after the treatment of artificial liver support system (ALSS). A total of 244 patients with ALF and ACLF were enrolled in this study. The levels of G3BP1 on admission and at discharge were detected. The validation set of 514 patients was collected to verify the predicted effect of G3BP1 and the viability of prognosis. This study was shown that lactate dehydrogenase (LDH), alpha-fetoprotein (AFP) and prothrombin time were closely related to the prognosis of patients. After the ALSS treatment, the patient' amount of decreased G3BP1 index in difference of G3BP1 between the value of discharge and admission (difG3BP1) < 0 group had a nearly 10-fold increased risk of progression compared with the amount of increased G3BP1 index. The subgroup analysis showed that the difG3BP1 < 0 group had a higher risk of progression, regardless of model for end-stage liver disease high-risk or low-risk group. At the same time, compared with the inflammatory marks [tumor necrosis factor-α, interleukin (IL)-1β and IL-18], G3BP1 had higher discrimination and was more stable in the model analysis and validation set. When combined with AFP and LDH, concordance index was respectively 0.84 and 0.8 in training and validation cohorts. This study indicated that G3BP1 could predict the prognosis of ALF or ACLF patients treated with ALSS. The combination of G3BP1, AFP and LDH could accurately evaluate the disease condition and predict the clinical endpoint of patients.

Interval estimation in discrete-time linear systems with parametric uncertainties

The problem of interval observer design for discrete-time linear systems under the external disturbances, measurement noise, and parametric uncertainties is studied. The relation allowing designing the interval observer of minimal dimension estimating the set of admissible values of the specified linear vector function of the system state are derived. Theoretical results are illustrated by the example.

Assessment of sleep quality in severe COVID-19 hospitalised patients.

To evaluate the quality of sleep in patients hospitalised with coronavirus disease-2019, and its impact on hospitalisation duration, need for intensive care unit admission and mortality. The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from May 2, 2021 to April 30, 2022, and comprised hospitalised coronavirus disease-2019 patients. Data was gathered using the Pittsburgh Sleep Quality Index questionnaire, including demographics, comorbidities, length of hospital stay, need for intensive care unit admission, C-reactive protein and D-dimer values at admission, and the outcome. The patients were divided into group A having good sleep quality score >5 and group B having poor sleep quality score <5. Data was analysed using SPSS 25. Of the 1,250 patients, 559(44.7%) were males and 691(55.3%) were females. There were 560(44.8%) patients in group A with mean age 53.80±14.85 years, and 690(55.2%) patients in group B with mean age 53.71±14.32 years. There were no significant intergroup differences in terms of age and high-resolution computed tomography scan (p>0.05). The difference was significant with respect to gender, comorbid conditions, education status as well C-reactive protein and D-dimer levels (p<0.001). Group B patients had a longer duration of hospitalisation (p<0.001) and a higher need for intensive care unit admission (p<0.001) compared to group A. The outcome was death in 166(13.28%) patients in group B compared to 40(3.2%) in group A (p<0.001). Poor sleep quality was found to be associated with longer hospital stay, increased need for mechanical ventilation, and higher mortality rate in coronavirus disease-2019 patients.

Predicting the Outcome of Patients with Severe COVID-19 with Simple Inflammatory Biomarkers: The Utility of Novel Combined Scores-Results from a European Tertiary/Referral Centre.

Background: The clinical significance of combinations of inflammatory biomarkers in severe COVID-19 infection is yet to be proved. Although several studies have evaluated the prognostic value of biomarkers in patients with COVID-19, there are limited data regarding the value of the combination scores that could take full advantage of the prognostic value of several biomarkers and that could account for the heterogeneity of patients with severe COVID-19. We investigated the prognostic value of combination scores of admission values of inflammatory biomarkers in adults with severe COVID-19. Methods: Adults admitted to the Department of Respiratory Medicine of the UHL with severe COVID-19 (April-September 2021, NCT05145751) were included. Demographics, medical history, laboratory tests and outcome (high-flow nasal cannula (HFNC), admission to Intensive Care Unit (ICU) or death) were recorded. The optimal cut-off points of on admission values of C-reactive protein (CRP), CRP to lymphocyte ratio (CLR), lymphocyte to neutrophil ratio (LNR) and derived variation of neutrophil to lymphocyte ratio (dv-NLR (neutrophil/white blood count-lymphocyte)) for the predetermined outcome were defined. Based on the cut-off of CRP, LNR, dv-NLR and CLR, which were found to be predictors for HFNC, 3 scores were defined: CRP and LNR (C-CRP #1), CRP and dv-NLR (C-CRP #2), CRP and CLR (C-CRP #3). Likewise, based on the cut-off of CRP and CLR, which were found to be predictors for death, the score of CRP and CLR (C-CRP #3*) was defined. The combination scores were then classified as: 2 points (both biomarkers elevated); 1 point (one biomarker elevated) and 0 points (normal values). None of the biomarkers was predictive for the ICU admission, so no further analysis was performed. Binomial logistic regression analysis was used to establish the predictive role for each biomarker. Results: One hundred and fifteen patients (60% males, mean age 57.7 years) were included. Thirty-seven (32.2%) patients required HFNC, nine (7.8%) died and eight (7%) were admitted to ICU, respectively. As far as HFNC is concerned, the cut-off point was 3.2 for CRP, 0.231 for LNR, 0.90 for dv-NLR and 0.004 for CLR. Two points of C-CRP #1 and 2 points of C-CRP #3 predicted HFNC with a probability as high as 0.625 (p = 0.005) and 0.561 (p < 0.001), respectively. Moreover, 1 point of C-CRP #2 and 2 points of C-CRP #2 predicted HFNC with a probability of 0.333 and 0.562, respectively. For death, the optimal cut-off point for CRP was 1.11 and for CLR 3.2*1033. Two points of C-CRP #3* with an accuracy of 0.922 predicted mortality (p = 0.0038) in severe COVID-19. Conclusions: The combination scores of CRP and inflammatory biomarkers, based on admission values, are promising predictors for respiratory support using HFNC and for mortality in patients suffering from severe COVID-19 infection.

Centralized normalization of harmonic voltages by the third-order passive filter

The values of harmonic voltages at network nodes should meet the standard limits. Harmonic voltages can be decreased to admissible values on a centralized basis. The paper addresses the problem of centralized decrease of harmonic voltages in the high voltage networks with distributed nonlinear loads using third-order passive filters. Mathematical expressions to determine parameters of the third-order passive filter are given. The parameters of the selected filters for 220 kV network supplying traction substations with power and also the estimates of the efficiency of work of these filters for different network configurations are presented as an example. The efficiency of the C-type and third-order filters are compared.

Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria.

In children with cerebral malaria (CM) admission blood lactate has previously guided intravenous fluid therapy and been validated as a prognostic biomarker associated with death. The usefulness of post-admission measurements of blood lactate in children with CM is less clear. The strength of association between blood lactate and neurological sequelae in CM survivors, as well as the optimal duration of post-admission measurements of blood lactate to identify children at higher risk of adverse outcomes is unknown. A retrospective cohort study of 1674 Malawian children with CM hospitalized from 2000 to 2018 who had blood lactate measurements every 6h for the first 24h after admission was performed. The strength of association between admission lactate or values measured at any time point in the first 24h post-admission and outcomes (mortality and neurological morbidity in survivors) was estimated. The duration of time after admission that lactate remained a valid prognostic biomarker was assessed. When lactate is analysed as a continuous variable, children with CM who have higher values at admission have a 1.05-fold higher odds (95% CI 0.99-1.11) of death compared to those with lower lactate values. Children with higher blood lactate at 6h have 1.16-fold higher odds (95% CI 1.09-1.23) of death, compared to those with lower values. If lactate levels are dichotomized into hyperlactataemic (lactate > 5.0 mmol/L) or not, the strength of association between admission lactate and mortality increases (OR = 2.49, 95% CI 1.47-4.22). Blood lactate levels obtained after 18h post-admission are not associated with outcomes. Similarly, the change in lactate concentrations through time during the first 24h of hospital admission is not associated with outcomes. Blood lactate during hospitalization is not associated with adverse neurologic outcomes in CM survivors. In children with CM, blood lactate is associated with death but not neurologic morbidity in survivors. To comprehensively estimate prognosis, blood lactate in children with CM should be assessed at admission and for 18h afterwards.

Model predictive control for asynchronously switched linear systems with mode-dependent dwell time

This paper presents a model predictive control (MPC) approach for a class of asynchronously switched linear systems with mode-dependent dwell time (MDT). Asynchronous switching which refers to the mismatch between system modes and desired mode-dependent controllers may result in infeasibility of the conventional switched MPC design or even make the closed-loop system unstable. To handle this problem, the concept of stage MDT is employed and its minimum admissible value is determined offline so as to ensure the reachable set of a starting region is included in a target region. Then, we compute a constraint admissible contractive asynchronous switching MDT invariant (AMI) set as the common terminal constraints for all the switching modes and find out an important property: The existence of such an AMI set is equivalent to the asymptotic stability of the asynchronously switched closed-loop system. By letting the reachable set be contained in the AMI set, we present two criteria to determine the minimum admissible stage MDT offline such that the closed-loop system is asymptotically stable. Finally, a numerical example is given to verify the theoretical results.

Comparison of early warning and sepsis scores for mortality prediction in patients with suspected infection admitted to medical intensive care units

Aims: To compare the mortality prediction efficiency of the Modified Early Warning Score (MEWS), Systemic Inflammatory Response Syndrome (SIRS), Sepsis Related Organ Failure Assessment (SOFA), and Quick Sepsis Related Organ Failure Assessment (qSOFA) calculated within 48 hours before ICU admission. Methods: A prospective, noninterventional, observational cohort study enrolled adult patients admitted to medical intensive care units (ICU) with suspected infection in a tertiary care medical center. MEWS SIRS, SOFA, and qSOFA scores were calculated at four different time points: 48, 24, and 8 hours before and at the time of the ICU admission (0. hour). The scores were analyzed for hospital mortality. Results: A total of 120 patients were included. The median age was 68 (IQR 59.8-79) years, and 44.2% of patients were male. Of the study population, 75.8% were admitted to the medical ICU from the emergency department, while the remaining were from the medical wards. Considering the scores observed 48 hours before ICU admission, Odds Ratio (OR) of SIRS≥2 and SOFA≥2 showed a value of 7.6 (95% CI: 1.5-38.0) and 13.2 (95% CI: 2.3-74.3), respectively, while no increase in risk was observed for MEWS and the qSOFA score. Receiver operating characteristic analysis (ROC) performed with the highest scores observed at any time within 48 hours before ICU admission (ICU admission values were omitted) regarding hospital mortality yielded area under the curve (AUC) values (95% CI) of 0.80 (0.72-0.89) for SOFA, 0.66 (0.54-0.76) for MEWS, 0.63 (0.51-0.74) for qSOFA, and 0.61 (0.49-0.73) for SIRS. SOFA had the highest sensitivity of 92.6% (82.7-100.0), whereas qSOFA had the highest specificity of 63.0% (49.1-77.0) for hospital mortality. Conclusion: SOFA score is the most sensitive scoring system to predict hospital mortality in patients admitted to the medical ICU with suspected infection compared to MEWS, SIRS, and qSOFA. Nevertheless, the sepsis and early warning scores should be combined in clinical practice whenever possible.

Organochlorine Pesticides in Dairy Cows’ Diet and the Carryover into Milk in NW Romania

Since modern agriculture relies on high volumes of chemical pesticides, monitoring the exposure to these dangerous substances in feed and the food chain is crucial. This study investigates the transfer of organochlorine pesticide (OCP) from water, soil, and feed to milk in free-range dairy cows using the carryover rates (CORs) and biotransfer factors (BTFs) from feed to milk as tools that can be used for human and animal risk assessments. BTFs can predict the transfer of OCPs into milk due to cows’ ingestion of contaminated feed. Samples were collected from ten small-scale dairy cow farms located near Baia Mare city, NW Romania, identified for distributing fresh milk in the local market. After the appropriate extraction was performed, the OCP concentrations were measured by gas chromatography equipped with an electron capture detector and randomly confirmed using mass spectrometry. The most prominent compounds in the soil, feed, and milk samples were hexachlorocyclohexane (HCH) isomers and dichlorodiphenyltrichloroethane (DDT) and its metabolites. The concentrations of OCPs were lower than the maximum admissible values in feed, water, soil, and milk. The CORs of OCPs varied over four orders of magnitudes, from 0.10% (2,4′–dichlorodiphenylchloroethylene, 2,4′–DDE) to 250% (4,4′–dichlorodiphenyltrichloroethane, 4,4′–DDT). Similar to CORs, the values of BTFs varied largely, from 0.0001 to 1.408. Additionally, the values higher than the unit for some BTFs could be due to the accumulation and biomagnification of these organochlorine compounds in the animal body. The cows’ dietary exposure was evaluated by the estimated daily intake (EDI), considering the three components of ingestion (feed, water, and soil), and varied in the range of 0.0008–0.3509 µg/day/body weight (bw).

Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation (BHGAL) due to severe postpartum hemorrhage

Objective: To evaluate the effect of bilateral hypogastric artery ligation (BHGAL) on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage. Methods: Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study. The records of cases were obtained from the hospital database, retrospectively. Maternal demographic data, morbidities or complications associated with BHGAL surgery, any additional haemostatic interventional or surgical procedures, preoperative admission and lowest postoperative haematocrit-hemoglobin values, blood products given, type of anaesthesia, intensive care unit (ICU) and length of hospital stay were recorded. In cases without surgical sterilization, future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation. Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed. Results: Sixty-eight patients with BHGAL surgery history were included in the study. 26 Of 37 cases (70%) that did not undergo surgical sterilization had a desire for pregnancy after the surgery. Six of these cases (23%) were diagnosed with secondary infertility. The fertility rate of these cases was 77%, and subsequent pregnancy was detected in 20 women. A total of 25 pregnancies, including first and second pregnancies, developed, and 15 of these pregnancies resulted in term delivery, six preterm births, one stillbirth, and three abortions. Conclusions: The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems, and this surgery does not seem to adversely affect pregnancy outcomes. This is a tertiary center experience and cohort studies with large patient series are needed.

Exploring Cerebral Perfusion Transcranial Doppler Parameters in Patients Admitted to Combined Medical Surgical Intensive Care Unit

Introduction: Encephalopathy, a common complication in Intensive Care Unit (ICU) patients, is often linked to poor outcomes. Transcranial Doppler (TCD), a non-invasive tool assesses cerebral perfusion via the Pulsatility Index (PI), Resistivity Index (RI), and Time-Averaged Peak (TAP) or Mean Flow Velocity (MFV). These parameters may offer insights into cerebral perfusion and outcomes in encephalopathic patients. Aim: To describe the PI, RI of the Middle Cerebral Artery (MCA), and MFV or TAP measured by TCD in patients admitted to the ICU, comparing those with and without encephalopathy at the time of admission. Materials And Methods: This cross-sectional observational study was conducted from January 2019 to November 2020, in a combined medical-surgical ICU of a tertiary care hospital, involving 45 enrolled patients. Patients were evaluated within 24 hours of admission and subsequently every 24 hours until ICU discharge, death, or discharge against medical advice. Bilateral Middle cerebral artery TCD studies were conducted using a 1-5 MHz phased array probe or TCD mode through the transtemporal window. The PI, RI, and MFV were measured on both sides, with the higher value used for analysis, and all statistical analyses were performed using Statistics and Data 13 software. Results: In the present study, 88% (n=40) of patients had encephalopathy (GCS&lt;15 and RAAS less than or more than 0). The mean APACHE II score was 19 (14-25), indicating severe illness with a predicted mortality of 30-40%. Patients with encephalopathy had significantly higher APACHE II scores compared to those without (19.5 (16-25) vs 10 (4-19)). Although there was a trend towards a higher Pulsatility Index in encephalopathic patients at admission (1.11±0.378 vs 1.07±0.12, p=0.81), PI, RI, and TAP values did not significantly differ in non-survivors (1.12±0.49 vs 1.11±0.33, p=0.750). Persistent encephalopathy was associated with a trend towards higher PI at admission (1.05±0.24 vs 1.16±0.46; p=0.756), and a moderate correlation was found between decreasing PI and improvement in GCS (rho=-0.489, p=0.001). Conclusions: PI, RI, and TAP at the time of admission were not found to be associated with occurrence and recovery of encephalopathy as well as mortality. The trend of change in PI moderately correlated with improvement in GCS suggesting the importance of trends rather than absolute values.

ADMISSIBILITY OF CONFESSION UNDER INDIAN EVIDENCE ACT, 1872

In Indian criminal law, confessions are defined by the 1872 Indian Evidence Act. Confessions of guilt have legal implications. The Act classifies admissions as judgemental, out-of-court, and retracted. Judgemental confessions are admissible, whereas extrajudicial confessions are examined for pressure. Retracted confessions are carefully reviewed and may need third-party verification. Coerced, forced, or promised confessions and law enforcement confessions are illegal. Voluntary confessions protect the accused's identity. Mind, confession, and accused rights awareness determine voluntariness in court. Legal balance between law enforcement and private liberty ensures confession voluntariness in India. Other states prohibit forced confessions less strongly than the Indian Evidence Act. Unique to India, the Act forbids police confessions. Torture is defined, investigated, compensated, and punished under the 2017 Prevention of Torture Bill. It must be narrowed to balance law enforcement and freedoms enjoyed by individuals. Law enforcement and personal liberty deal effectively with detainee admissions. The Indian police and judge approach confessions differently to avoid prisoner torture and coercion. Section 25 of the Indian Evidence Act forbids police admissions for wrongdoing and power imbalance. According to Section 164 of the Code of Criminal Procedure, magistrate confessions are voluntary and honest. Courts consider the confession's conditions, medical records, and the accused's education, social status, and mental health. Criminal confession retraction affects trial evidence and poses admissibility and evidentiary value questions. Retracted confessions are less trustworthy than uncontested ones, thus courts must closely check them before convicting. If followed, procedural and technological flaws do not invalidate confessions, but Section 164 noncompliance does.

Turán graphs with bounded matching number

We determine the maximum possible number of edges of a graph with n vertices, matching number at most s and clique number at most k for all admissible values of the parameters.

An open trial for adults in a residential program for binge eating spectrum disorders

ABSTRACT The current study assessed treatment outcome for 99 adult admissions to a residential program specifically designed for binge eating spectrum disorders (BESD). Participants completed self-report measures at admission, discharge, and 12-month follow-up and were asked to complete blood draws at admission and follow-up. Primary outcomes were eating behaviors; secondary outcomes included comorbid symptoms and physiological variables. Eating behaviors improved significantly from admission to follow-up, as did most comorbid symptoms and quality of life, despite no change in body mass index. Some variables displayed a curvilinear relationship, with some worsening of symptoms from discharge to follow-up, although scores at follow-up remained well below admission values. Participation in the treatment program was associated with reduced problematic eating and comorbid symptoms and increased quality of life up to one year after discharge. Findings from this study may encourage the development of similar residential treatment programs for BESD for those who have not responded to outpatient care or mixed milieu settings, and may prompt randomized studies testing similar treatments versus usual care.

Experimental and numerical investigation of large-scale reinforced concrete deep beams designed with the Generative Tie Method

This study presents a comprehensive evaluation of the behavior of two large-scale reinforced concrete deep beams designed using the Generative Tie Method (GTM). Different admissible values of the loss of compressive strength in the concrete (ηadm) were considered, and the results were compared to a deep beam designed with the help of the Strut-and-Tie Method (STM). The study highlights the importance of selecting an appropriate ηadm value for designing reinforced concrete deep beams capable of exhibiting ductile behavior using the GTM. The results show that specimen SIIIa, designed using the GTM with a ηadm of 0.5, demonstrated a highly optimized reinforcement layout with the most pronounced reinforcement yielding, indicating ductile behavior. Among the studied specimens, the one designed using GTM with an ηadm of 0.7 exhibited the lowest maximum crack width and the highest ultimate load despite demonstrating brittle failure. Both GTM-designed specimens demonstrated maximized material efficiency and higher ductility ratios than the deep beam designed using STM. By integrating the bond-slip model proposed in the fib Model Code 2010 into the finite element analysis framework, the numerical simulations produced highly accurate predictions of the behavior of the deep beams. The authors suggest further investigations to enhance the proposed numerical strategy and apply the GTM for designing reinforced concrete deep beams with organic or optimized shapes.

The treatment of dissociative identity disorder in an eating disorder residential treatment setting.

Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.