Alternative Criteria Research Articles

Defining Stable Phases of Open Quantum Systems

The steady states of dynamical processes can exhibit stable nontrivial phases, which can also serve as fault-tolerant classical or quantum memories. For Markovian quantum (classical) dynamics, these steady states are extremal eigenvectors of the non-Hermitian operators that generate the dynamics, i.e., quantum channels (Markov chains). However, since these operators are non-Hermitian, their spectra are an unreliable guide to dynamical relaxation timescales or to stability against perturbations. We propose an alternative dynamical criterion for a steady state to be in a stable phase, which we name uniformity: Informally, our criterion amounts to requiring that, under sufficiently small local perturbations of the dynamics, the unperturbed and perturbed steady states are related to one another by a finite-time dissipative evolution. We show that this criterion implies many of the properties one would want from any reasonable definition of a phase. We prove that uniformity is satisfied in a canonical classical cellular automaton, and we provide numerical evidence that the gap determines the relaxation rate between nearby steady states in the same phase, a situation we conjecture holds generically whenever uniformity is satisfied. We further conjecture some sufficient conditions for a channel to exhibit uniformity and therefore stability. Published by the American Physical Society 2024

Noise hindering sound complexity in urban environments: Towards a novel evaluation criterion for urban sustainability

Urban environments are complex adaptive systems, wherein changes in one area can lead to unforeseen consequences in others. Environmental noise emerges as a multifaced issue influencing various receivers across different spatial and temporal scales. The perception of noise as a high-intensity or unwanted sound has defined the concept of quietness accordingly overlooking sustainability co-benefits. This study proposes an alternative evaluation criterion for urban planning and design, focusing on the sound complexity of public spaces that are vulnerable to environmental noise fluctuations. To determine the sensitivity of sound complexity to environmental noise, sound level measurements and sound recordings were conducted along the waterfront of a Mediterranean metropolis during the pandemic lockdowns (April 2021). Additionally, the bird dawn chorus phenomenon was studied. The analysis of collected data revealed an inverse relationship between complexity and noise, highlighting an additional impact on the urban sound environment. The promotion of sound complexity as a strategy for livable and sustainable cities can guide urban planners and designers in developing quiet and ecologically resilient urban environments.

The formation and post-formation processes of vortex rings discharged from laminar starting jets

Motivated by biological systems, vortex rings can enhance the propulsive efficiency in industrial systems. To study the vortex properties during the formation and post-formation stages, impulsively starting jets are investigated by simulations. The effects of the stroke ratio and nozzle geometry are studied at a fixed jet Reynolds number of 2500. The stroke ratio at the formation number is found to be not enough to produce a vortex ring with maximum circulation. The stroke ratio is suggested to be about twice as large as the formation number. An alternative criterion based on the circulation ratio is proposed to describe the onset of pinch-off. This criterion states that the pinch-off would start when the vortex ring attains about 80% of the total jet circulation. During the formation stage, the scaling laws for vortex trajectories and circulation are proposed for continuous formation. By combining the suggested scaling relations and Saffman's velocity formula, the evolution of non-dimensional energy can be predicted. During the post-formation stage, the scaling laws for vortex properties (e.g., the vortex ring diameter, translational velocity, and circulation) are found to be independent of both the nozzle configuration and the vortex Reynolds number. On the grounds of the invariance of impulse in vortex decay, the scaling laws of vortex motion are derived for the non-dimensional energy, circulation, and diffusivity scale of the vortex core. In consequence, the normalized energy and circulation found in experiments can be successfully derived from the similarity model for both nozzle configurations.

Sociodemographic Disparities in Hepatitis B Treatment: A Real-World Analysis of 3 Safety-Net Health Systems in the United States

Abstract Background Timely treatment of chronic hepatitis B (CHB) reduces risks of cirrhosis and hepatocellular carcinoma. Gaps in timely treatment persist, especially among underserved safety-net populations. We aim to evaluate gaps and disparities in CHB treatment in the United States. Methods Adults with treatment-naive CHB without human immunodeficiency virus were identified from 2010 to 2018 across 3 safety-net health systems. CHB treatment eligibility was assessed using American Association for the Study of Liver Diseases (AASLD) criteria and alternative criteria, including the Simplified Approach for Hepatitis B Algorithm. Differences in CHB treatment between groups were evaluated using χ2 methods, adjusted Kaplan-Meier methods, and adjusted Cox proportional hazards models. Results Among 3749 patients with treatment-naive CHB (51.5% women, 38.7% White, 33.7% African American, 19.6% Asian, 24.6% cirrhosis), 30.0% were AASLD treatment eligible, among whom 31.0% were treated. Men were more likely than women to be treated (33.5% vs 26.6%, P < .01). On multivariable regression, there remained a trend toward greater treatment in men versus women (adjusted hazard ratio [aHR], 1.21 [95% confidence interval {CI}, .96–1.54]). Disparities by race/ethnicity and insurance status were observed. When exploring outcomes using SABA criteria, similar trends were observed. Among treatment-eligible patients, greater likelihood of treatment was observed in men versus women (aHR, 1.40 [95% CI, 1.14–1.70]) and in Asians versus Whites (aHR, 1.50 [95% CI, 1.16–1.94]). Conclusions Among an ethnically diverse multicenter safety-net cohort of CHB patients, less than one-third of treatment-eligible patients received antiviral treatment. Significant disparities in CHB treatment were observed by sociodemographic characteristics.

Physio-biochemical and molecular characterization of wheat cultivars (Triticum aestivum L.) under post-anthesis heat stress

BackgroundHeat stress is one of the abiotic stresses that make wheat crops vulnerable, which significantly impacts crop production around the world. An increase in temperature during the reproductive phase (anthesis) beyond the optimal range of 15–20 °C leads to decreased crop production, poor quality of the grain, and altered physiological and biochemical processes. To study the association between high temperature and physio-biochemical traits under normal and late sown, a set of fifteen genotypes was utilized.ResultsRelative water content under high temperatures had an overall decrease of 8.7%. However, grain protein and malondialdehyde content were higher in the stressed conditions than in the control, with increases of 20.2% and 38.9%, respectively. Marker Xgwm67, located on chromosome 5B, was found to be significantly associated with malondialdehyde content (R2 = 21%) and Xgwm570, located on 6A, was closely linked to relative water content as well as grain protein content (R2 = 16%) revealed by regression analysis. The correlation matrix displays a positive association between the control and stressed condition by R2 = 0.92, 0.82, and 0.53 in malondialdehyde, relative water content, and grain protein, respectively. However, there was a negative correlation between water content–malondialdehyde and malondialdehyde–grain protein, though there was only a 4% correlation between grain protein content (control) and relative water content (stressed). Based on the tolerance matrix, WH730 and RAJ4079 were heat tolerant, and DBW173 and HD3086 were sensitive.ConclusionsThese findings indicate that to identify tolerant genotypes, physiological and biochemical traits can be utilized as an alternate criterion, and these closely associated markers can be applied for improved late-planted wheat production through MAS. The breeding scheme and genome editing by recognizing novel genes through physio-biochemical parameters, marker-assisted selection, and prospective screening of tolerant genotypes are proclaimed by the study.

Clustering of clinical symptoms using large language models reveals low diagnostic specificity of proposed alternatives to consensus mast cell activation syndrome criteria

The rate of diagnosis of mast cell activation syndrome (MCAS) has increased since the disorder's original description as a mastocytosis-like phenotype. While a set of consortium MCAS criteria is well described and widely accepted, this increase occurs in the setting of a broader set of proposed alternative MCAS criteria. Effective diagnostic criteria must minimize the range of unrelated diagnoses that can be erroneously classified as the condition of interest. We sought to determine if the symptoms associated with alternative MCAS criteria result in less concise or consistent diagnostic alternatives, reducing diagnostic specificity. We used multiple large language models, including ChatGPT, Claude, and Gemini, to bootstrap the probabilities of diagnoses that are compatible with consortium or alternative MCAS criteria. We utilized diversity and network analysis to quantify diagnostic precision and specificity compared to control diagnostic criteria including systemic lupus erythematosus (SLE), Kawasaki disease, and migraines. Compared to consortium MCAS criteria, alternative MCAS criteria are associated with more variable (Shannon diversity 5.8 vs. 4.6, respectively; p-value=0.004) and less precise (mean Bray-Curtis similarity 0.07 vs 0.19, respectively; p-value=0.004) diagnoses. The diagnosis networks derived from consortium and alternative MCAS criteria had lower between-network similarity compared to the similarity between diagnosis networks derived from two distinct SLE criteria (cosine similarity 0.55 vs. 0.86, respectively; p-value=0.0022). Alternative MCAS criteria are associated with a distinct set of diagnoses compared to consortium MCAS criteria and have lower diagnostic consistency. This lack of specificity is pronounced in relation to multiple control criteria, raising the concern that alternative criteria could disproportionately contribute to MCAS overdiagnosis, to the exclusion of more appropriate diagnoses.

The Development and Performance of Alternative Criteria for Lung Cancer Screening.

The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people. To determine whether alternative criteria can identify these high-benefit people. Model-based projections. United States. People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria. Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. "High-benefit" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening. The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; P < 0.001) and specificity (86% vs. 84%; P < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [P < 0.001]; Hispanic: 95% vs. 73% [P = 0.086]; Asian: 94% vs. 68% [P = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities. The results were based on model projections. These results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups. U.S. Department of Veterans Affairs Lung Precision Oncology Program.

New hybrid EC-PROMETHEE method with multiple iterations of random weight ranges: Step-by-step application in Python

The decision-making process consists of finding the best solution to an analyzed problem. This search is carried out in the face of countless interactions when analyzing an alternative criterion by criterion, under which weights are assigned that distinguish the degree of importance they have for the decision-makers. The definition of weight for each criterion gives rise to three lines of thought on the subject. There are objective, subjective, and hybrid methods. This discussion concerns the degree to which experts define the criteria weights. Based on this discussion, we developed a hybrid method to integrate the Entropy and CRITIC methods with the PROMETHEE method, called EC-PROMETHEE. The innovation of this method is that the combination of the Entropy and CRITIC methods does not result in a single set of weights. In reality, the weights generated by each method are used to define each criterion's upper and lower limits. The range of weights generated for each criterion is emulated "n" times and builds a set of weights that are applied to the ranking definition process. The model generates "n" rankings, defining a single ranking. In this article, we demonstrate a step-by-step application of a tool developed in Python called EC-PROMETHEE and use it as an example of the problem of choosing rotary-wing airplanes for application in the military police service.➢The method reduces discretion in determining the weights of the criteria;➢The innovation lies in the use of a range of weights for criteria;➢Consistency in defining the final ranking.

Prevalence of Mild and Severe Cognitive Impairment in World Trade Center Exposed Fire Department of the City of New York (FDNY) and General Emergency Responders.

The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations. A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests. The prevalences of domain-specific impairments were estimated based on the results of norm-referenced tests, and the Montreal Cognitive Assessment (MoCA), Jak/Bondi criteria, Petersen criteria, and the National Institute on Aging and Alzheimer's Association (NIA-AA) criteria were used to diagnose MCI. NIA-AA criteria were also used to diagnose severe cognitive impairment. Generalized linear models were used to compare prevalence estimates of cognitive impairment to a large sample of WTC-exposed-non-FDNY responders from the General Responder Cohort (GRC; n = 7102) who completed the MoCA during a similar time frame. Among FDNY responders under 65 years, the unadjusted prevalence of MCI varied from 52.57% to 71.37% depending on the operational definition of MCI, apart from using a conservative cut-off applied to MoCA total scores (18 < MoCA < 23), which yielded a markedly lower crude prevalence (24.31%) compared to alternative criteria. The prevalence of MCI was higher among WTC-exposed-FDNY-responders, compared to WTC-exposed-non-FDNY-GRC-responders (adjusted RR = 1.53, 95% C.I. = [1.24, 1.88], p < .001) and meta-analytic estimates from different global, community, and clinical populations. Following NIA-AA diagnostic guidelines, 4.96% of WTC-exposed-FDNY-responders met the criteria for severe impairments (95% CI = [2.91% to 7.82%]), a prevalence that remained largely unchanged after excluding responders over the age of 65 years. There is a high prevalence of mild and severe cognitive impairment among WTC-responders highlighting the putative role of occupational/environmental and disaster-related exposures in the etiology of accelerated cognitive decline.

Daptomycin eosinophilic pneumonia, a systematic review of the literature and case series.

Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare yet severe adverse event that requires rapid recognition and management. Diagnosing a definite case is challenging and involves meeting the American Thoracic Society (ATS) criteria, although alternative criteria have been suggested. This study aims to conduct a systematic review of literature and includes a case series. Six cases of DIEP identified at Perugia Hospital, Perugia, Italy have been described. A systematic review was carried out adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. a total of 74 cases of DIEP were analysed. Using ATS clinical criteria, 15 were classified as definite (20.3%), 54 as probable (73.0%), and 5 as possible (6.8%). Phillips criteria and the Lyon Algorithm identified 43/74 (58.2%) and 64/67 (95.5%) cases as definite, respectively. Bronchoalveolar lavage (BAL) was performed in 43 cases, revealing an average eosinophil count of 28.6% (SD 24.4). Radiological findings highlighted recurring features like bilateral opacities (68.1%), ground-glass opacities (41.7%), patchy infiltrates (30.6%), and peripheral predominance (19.4%). Upon suspicion, daptomycin was discontinued; 20 cases required no additional treatment, 38 received corticosteroids, and 12 received both corticosteroids and antibiotics. Recovery rates were high across all treatment types (≥ 73.7%). Most reports described rapid improvement post-withdrawal (within 96h). DIEP is a rare, fast-progressing condition where early diagnosis and prompt treatment are vital. Diagnosis relies on clinical, laboratory, and radiological evaluations. Stopping daptomycin is essential, with corticosteroids often necessary. Further research is needed to enhance diagnostic accuracy for this disease.

Lag order selection for long-run variance estimation in econometrics

. Estimating the long-run variance (LRV) is crucial for several econometric issues. Constructing reliable heteroskedasticity autocorrelation consistent (HAC) variance-covariance matrices and implementing efficient generalized method of moments (GMM) estimation procedures require a consistent LRV estimate. A good VARHAC estimator (HAC matrix with the spectral density at frequency zero constructed using a VAR spectral estimation) requires accurately estimating the sum of autoregressive (AR) coefficients; however, a criterion that minimizes the innovation variance does not necessarily yield the best spectral estimate. This article implements an optimal VARHAC estimator using an alternative information criterion, considering the bias in the sum of the parameters for the AR estimator of the spectral density at frequency zero.

On the Outflow Boundary Opening Size for Internal Erosion Testing of Widely Graded Sand and Gravel

Abstract Permeameter testing of a widely graded soil to evaluate its potential for internal instability requires the opening size of the outflow boundary to allow unstable finer fraction particles to pass while retaining the stable coarser fraction. Results from a parametric study, on three widely graded soils and five outflow boundaries, yielded paired-data for opening size Om and d85,e of eroded soil mass passing through the outflow boundary. Gradation shape analysis established d85′ of the finer fraction of each soil used in testing. An opening size ratio 5 ≤ Om/d85′ ≤ 10 correlates with a grain size ratio 1 ≤ d85,e/d85′ ≤ 2 and thus an eroded soil mass believed representative of the finer fraction of the widely graded soil. The novel Om/d85′ criterion for sizing the outflow boundary in permeameter testing is found consistent with an alternate criterion using concepts of base-filter incompatibility.

Evaluation of Explainable Artificial Intelligence using TOPSIS Method

Explainable Artificial Intelligence (XAI) refers to the development of AI systems are transparent, explainable and their comprehensible for results can provide explanations or predictions. As AI technologies, particularly machine learning models, become more complex and sophisticated, there is a growing need to ensure that their decisions can be comprehended and trusted by humans, especially health, Finance and such as criminal justice in important domains. Evaluating Explainable Artificial Intelligence (XAI) is essential to ensure transparency, accountability, and user trust in AI systems. Interpretability is a key factor, examining how easily the model's internal mechanisms can be understood. Model transparency, feature importance, and the clarity of visualizations contribute to this aspect. Differentiate between post-hoc and intrinsic explanations, considering whether the model inherently provides interpretable insights. The distinction between local and global explanations is crucial, as it determines whether explanations focus on individual predictions or the overall model behavior. Robustness and consistency are assessed through stability and sensitivity analysis, ensuring that explanations remain reliable across similar instances. Additionally, ethical considerations, such as fairness and transparency in decision-making, must be addressed to uncover and mitigate biases. User feedback and the relevance of explanations to the specific use case contribute to a comprehensive evaluation, fostering the development of XAI systems that are not only technically robust but also ethically sound and user-friendly. The significance of research in Explainable Artificial Intelligence (XAI) lies in addressing critical challenges associated with the adoption and deployment of AI systems in various domains. As AI technologies, particularly complex machine learning models, become integral to decision-making processes in areas such as healthcare, finance, and criminal justice, the need for transparency and interpretability becomes paramount. Topsis involves optimizing from an advantageous standpoint by simultaneously minimizing the distance to and maximizing the distance from a reference point, which is defined in relation to solutions within a set of alternative options and numerous identification criteria. The importance of Topsis criteria lies in the potential to integrate comparative weights. This study conducts a comprehensive review of Topsis, exploring various weighing schemes and employing different distance measurements. Numerous applications of Topsis are examined, particularly its utilization in comparing results for a diverse set of multiple criteria data with varying weights. Interpretable Machine Learning Models, Human-Centric Design in XAI, Ethical Implications of XAI, Industry-specific Applications of XAI and Hybrid Approaches for Model Interpretability. Interpretability Metrics, Human-Subjective Evaluation, Algorithmic Robustness and Real-world Impact. the Ranking of Evaluation Explainable Artificial Intelligence. Industry-specific Applications of XAI is got the first rank whereas is the Ethical Implications of XAI is having the Lowest rank.

The Immediate and Delayed Maximal Nonirritating Skin Testing Concentrations of β-Lactam Antibiotics

BackgroundMaximal skin testing (ST) nonirritant concentrations (NICs) are consistent for penicillin and aminopenicillin amongst guidelines. However, there is variability amongst guidelines for maximal ST NICs of cephalosporins. ObjectiveTo determine maximal immediate and delayed ST NICs of 15 β-lactams in β-lactam-tolerant and β-lactam-naïve participants. MethodsWe performed a single-center, nonrandomized prospective study between September 2019 and January 2022 in adult participants. Participants received skin prick testing (SPT) and intradermal test (IDT) injections at six increasing concentrations of 1 or more β-lactams. A concentration was considered irritant when more than 5% of participants had a positive test. A positive test was defined as a wheal ≥3 mm than negative control accompanied by a ≥5 mm flare for SPT/IDT and induration ≥5 mm with associated erythema at 48 hours for delayed readings (dIDT). Sensitivity analyses using 3 alternative IDT positive criteria were conducted. ResultsA total of 747 participants with a median age of 64 (IQR 54-72), 52% males, 85% White, and 92% Non-Hispanic underwent 20,858 skin tests. All undiluted SPT concentrations were nonirritant. We found the following maximal IDT/dIDT NICs (mg/ml): ampicillin (41.6/125), ampicillin-sulbactam (93.8/187.5), aztreonam (6.3/25), cefazolin (55/165), cefepime (35/140), cefoxitin (45/90), ceftaroline (7.5/15), ceftriaxone (58.3/175), cefuroxime (55/110), ertapenem (16.6/50), imipenem-cilastin (6.3/25), meropenem (8.3/25), nafcillin (31.3/62.5), oxacillin (20.9/83.5), and piperacillin-tazobactam (112.5/225). dIDTs were almost all completely non-irritant close or at undiluted concentrations. There were no differences when we applied 3 IDT positivity criteria to our raw data. ConclusionOur results suggest that SPTs with undiluted stock β-lactam antibiotic concentrations are nonirritant. Compared to previously published nonirritant concentrations, we propose a 2 to 50-fold increase to the maximal IDT and dIDT NICs of 15 β-lactam antibiotics. When performing dIDTs, a higher concentration should be used rather than the same IDT concentration.

Parental Loss and Mental Health in Post-Khmer-Rouge Cambodia

Adverse childhood events (ACE) may have lasting consequences throughout the life course. We focus on one particular type of ACE, parental loss in Cambodia—a country that lost nearly 25% of its population during the 1975-79 Khmer-Rouge regime—and on mental health disorders, one of the potential mechanisms through which ACE may have long-term consequences. Self-reports of symptoms that map on to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) criteria for anxiety, depression, and post-traumatic stress disorder (PTSD) were collected from 4,405 adults aged 20 and over. We first assess exposure to traumatic events and the prevalence of anxiety, depression, and PTSD using the DSM and alternative criteria. Based on the DSM criteria and previously validated Likert-scale thresholds, we find a high prevalence of anxiety (56.0%), depression (42.8%), and PTSD (2.3%), and even higher levels even among KRR survivors. We then use logit models to analyze the effect of parental loss before age 20 on the likelihood of having experienced traumatic events and experiencing mental health disorders. We find the loss of one parent increases the likelihood of full-PTSD symptoms, but the loss of both parents does not. These findings may result from positive selection into better-off households for orphans whose parents have both died but may also reflect the grief-related difficulties faced by the surviving parent of paternal or maternal orphans. While alternative thresholds for PTSD produced higher prevalence estimates, these measures did not perform better for assessing the effect of parental loss on mental health.

Sistem Pendukung Keputusan Cerdas untuk Pemilihan Jenis Tanaman Pertanian Kota

Urban farming activities have become increasingly popular to meet their food needs in urban areas. Jakarta as provinces with a population density of high, have a program of urban farming is developed by the farmers to urban Balkot Farm. This study aims to support system to develop a clever move the crop farm a town with the simple additive weighting (SAW). The methods used to obtain the highest related alternative plant assessed according to its parameters that affect the eligibility of land and a room with a variety of plants. The methodology used software development life cycle (SDLC) prototyping model consisting of five of the communication, quick plan, modeling quick design, construction of prototype deployment and delivery and feedback. Data collection method using interviews and the study of literature. Research results of a web application system that has an alternative menu, criteria, subcriteria, rating match and results. Smart decision support system based on black box testing and user acceptance testing successfully shows menus according to land criteria that will be used according to stakeholder needs.

The Spillover Effects of Extending Liver Transplantation to Patients with Colorectal Liver Metastases: A Discrete Event Simulation Analysis.

Liver transplantation is an alternative treatment for patients with nonresectable colorectal cancer liver-only metastases (CRLM); however, the potential effects on wait-list time and life expectancy to other patients on the transplant waiting list have not been considered. We explored the potential effects of expanding liver transplantation eligibility to include patients with CRLM on wait-list time and life expectancy in Norway. We developed a discrete event simulation model to reflect the Norwegian liver transplantation waiting list process and included 2 groups: 1) patients currently eligible for liver transplantation and 2) CRLM patients. Under 2 alternative CRLM-patient transplant eligibility criteria, we simulated 2 strategies: 1) inclusion of only currently eligible patients (CRLM patients received standard-of-care palliative chemotherapy) and 2) expanding waiting list eligibility to include CRLM patients under 2 eligibility criteria. Model outcomes included median waiting list time, life expectancy, and total life-years. For every additional CRLM patient listed per year, the overall median wait-list time, initially 52 d, increased by 8% to 11%. Adding 2 additional CRLM patients under the most restrictive eligibility criteria increased the CRLM patients' average life expectancy by 10.64 y and decreased the average life expectancy for currently eligible patients by 0.05 y. Under these assumptions, there was a net gain of 149.61 life-years over a 10-y programmatic period, which continued to increase under scenarios of adding 10 CRLM patients to the wait-list. Health gains were lower under less restrictive CRLM eligibility criteria. For example, adding 4 additional CRLM patients under the less restrictive eligibility criteria increased the CRLM patients' average life expectancy by 5.64 y and decreased the average life expectancy for currently eligible patients by 0.12 y. Under these assumptions, there was a net gain of 96.36 life-years over a 10-y programmatic period, which continued to increase up to 7 CRLM patients. Our model-based analysis enabled the consideration of the potential effects of enlisting Norwegian CRLM patients for liver transplantation on wait-list time and life expectancy. Enlisting CRLM patients is expected to increase the total health effects, which supports the implementation of liver transplantation for CRLM patients in Norway. Given the Norwegian donor liver availability, adding patients with nonresectable colorectal cancer liver-only metastases (CRLM) to the liver transplantation waiting list had an overall modest, but varying, impact on total waiting list time.Survival gains for selected CRLM patients treated with liver transplantation would likely outweigh the losses incurred to patients listed currently.To improve the total life-years gained in the population, Norway should consider expanding the treatment options for CRLM patients to include liver transplantation.Other countries may also have an opportunity to gain total life-years by extending the waiting list eligibility criteria; however, country-specific analyses are required.

Postpartum glycemic and cardiometabolic profile of women testing positive for gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups (IADPSG) but negative by alternate criteria: Insights from CHIP–F study

ObjectiveTo evaluate burden of postpartum diabetes and other cardiometabolic risk factors among women who test positive for gestational diabetes mellitus (GDM) by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, but negative by alternate criteria. MethodsThis prospective cross-sectional study was conducted from 2019 to 2022 and is a sub-study of the CHIP–F cohort (Cohort Study of Indian Women with Hyperglycemia in Pregnancy and their Families). ResultsStudy participants (n = 826; 183 with normoglycemia and 643 with GDM using IADPSG criteria) were evaluated at a median (IQR) postpartum interval of 31 (21–45) months. Using the United Kingdom National Institute of Health and Care Excellence (UK NICE), Canadian Diabetes Association (CDA), and Diabetes in Pregnancy Study Group India (DIPSI) criteria, 251 (39.0 %), 148 (23.0 %) and 384 (59.7 %) women who tested positive for GDM by IADPSG criteria, would have tested negative. The incidence of postpartum diabetes among such women was 30.4, 34.3, and 48.2 per 1000 women-years, respectively, which was significantly higher than those testing negative by both IADPSG and UK NICE (5.0 per 1000 women-years), IADPSG and CDA (9.2/1000 women-years) and IADPSG and DIPSI criteria (5.0/1000 women-years). The burden of obesity and metabolic syndrome was also significantly higher in such women. ConclusionsWe found a significant burden of postpartum diabetes and cardiometabolic risk factors among women who tested positive for GDM by IADPSG, but negative by alternate criteria. There are potential clinical implications of a “failed” diagnosis for future cardiometabolic diseases that need to be carefully examined.

The Association of High and Low Glycation With Incident Diabetic Retinopathy in Adults With Type 1 Diabetes.

We investigated the risk of incident diabetic retinopathy (DR) among high glycator compared to low glycator patients based on the hemoglobin glycation index (HGI). Visit-to-visit variations in HGI also were assessed. Glycated hemoglobin (HbA1c) and continuous glucose monitoring data were collected up to 7 years prior to the date of eye examination defining incident DR or no retinopathy (control). Hemoglobin glycation index was calculated as difference in measured HbA1c and an estimated A1c from sensor glucose (eA1c) to define high (HbA1c - eA1c >0%) or low (HbA1c - eA1c <0%) glycator. Stable glycators were defined as ≥75% of visits with same HGI category. Logistic regression was used to assess the association between glycation category and incident DR. Of 119 adults with type 1 diabetes (T1D), 49 (41%) were stable low glycator (HbA1c - eA1c <0%), 36 (30%) were stable high glycator (HbA1c - eA1c >0%), and 34 (29%) were unstable glycator. Using alternate criteria to define high vs low glycator (consistent difference in HbA1c - eA1c of > 0.4% or <0.4%, respectively), 53% of the adults were characterized as unstable glycator. Compared to low glycators, high glycators did not have a significantly higher risk for incident DR over time when adjusted for age, T1D duration and continuous glucose monitoring (CGM) sensor type (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 0.48-3.62, P = .15). The risk of diabetic retinopathy was not found to differ significantly comparing high glycators to low glycators in adults with T1D. Moreover, HbA1c - eA1c relationship was not stable in nearly 30% to 50% adults with T1D, suggesting that discordance in HbA1c and eA1c are mostly related either HbA1c measurements or estimation of A1c from sensor glucose rather than physiological reasons.

Proposal and Validation of a Clinically Relevant Modification of the Japanese Association for Acute Medicine Disseminated Intravascular Coagulation Diagnostic Criteria for Sepsis.

Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria were launched nearly 20 years ago. Following the revised conceptual definition of sepsis and subsequent omission of systemic inflammatory response syndrome (SIRS) score from the latest sepsis diagnostic criteria, we omitted the SIRS score and proposed a modified version of JAAM DIC criteria, the JAAM-2 DIC criteria. To validate and compare performance between new JAAM-2 DIC criteria and conventional JAAM DIC criteria for sepsis. We used three datasets containing adult sepsis patients from a multicenter nationwide Japanese cohort study (J-septic DIC, FORECAST, and SPICE-ICU registries). JAAM-2 DIC criteria omitted the SIRS score and set the cutoff value at ≥3 points. Receiver operating characteristic (ROC) analyses were performed between the two DIC criteria to evaluate prognostic value. Associations between in-hospital mortality and anticoagulant therapy according to DIC status were analyzed using propensity score weighting to compare significance of the criteria in determining introduction of anticoagulants against sepsis. Final study cohorts of the datasets included 2,154, 1,065, and 608 sepsis patients, respectively. ROC analysis revealed that curves for both JAAM and JAAM-2 DIC criteria as predictors of in-hospital mortality were almost consistent. Survival curves for the anticoagulant and control groups in the propensity score-weighted prediction model diagnosed using the two criteria were also almost entirely consistent. JAAM-2 DIC criteria were equivalent to JAAM DIC criteria regarding prognostic and diagnostic values for initiating anticoagulation. The newly proposed JAAM-2 DIC criteria could be potentially alternative criteria for sepsis management.