Ambiguous Cases Research Articles

Nelotanserin as symptomatic treatment for rapid eye movement sleep behavior disorder: a double-blind randomized study using video analysis in patients with dementia with Lewy bodies or Parkinson's disease dementia

Study objectivesRapid eye movement sleep behavior disorder (RBD) is frequent in dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), and poses a risk of injury to patients and their bed partners. We assessed the efficacy of nelotanserin, a selective 5-HT (2A) inverse agonist, for symptomatic treatment of RBD using systematic video analysis. MethodsThis was a phase 2 multicenter study in DLB or PDD with video polysomnography (vPSG)-confirmed RBD. After a single-blind placebo run-in period, patients meeting eligibility criteria entered a 4-week double-blind treatment period (1:1 ratio with nelotanserin 80 mg/placebo). Whole-night vPSG was conducted during the run-in and at the end of the treatment period. Videos of all rapid eye movement (REM) sleep periods were analysed for RBD behaviors (movements and vocalizations) using the Innsbruck classification system by two of the central reviewers, and a third reviewer adjudicated ambiguous cases. Results34 patients (N = 26 DLB, N = 8 PDD; 85.3% men; mean age 71.3 ± 6.36 years) were included in the analyses. Two (5.9%) patients were excluded due to protocol deviation in treatment compliance. Systematic video analysis demonstrated no difference between nelotanserin and placebo in RBD behaviors. Bland–Altman plot showed high interrater reliability. ConclusionsDespite negative results, this is the first randomized, placebo-controlled study on symptomatic RBD treatment using objective outcome measures based on systematic video analysis. This study provides a new method for outcome research in RBD and proves that movement analysis is a feasible and meaningful outcome for studies evaluating changes in RBD severity. Clinical trial informationClinicalTrials.gov. NCT Number NCT02708186. https://clinicaltrials.gov/ct2/show/NCT02708186.

When the response does not match the threat: The relationship between threat assessment and behavioural response in ambiguous lethal force decision-making.

Deciding when to use lethal force inherently depends on assessing threat, a process that itself incorporates numerous perceptual factors. This study assessed this relationship between perception-based threat assessment and behaviour-based threat response. Specifically, participants completed multiple tasks designed to elicit either a threat rating (e.g., perception-informed threat assessment) or a binary behavioural response (e.g., shoot/don't-shoot). Actor posture and weapon presence significantly affected the threat assessment, which was an extremely powerful omnibus predictor of threat response. However, for ambiguous threat stimuli, perceived threat became a poor predictor for threat response relative to the omnibus test. Participants appeared to adopt additional rules to inform behaviour independent of the threat assessment when faced with an ambiguous situation. These results demonstrate an intriguing disparity between subjective threat assessment and the behavioural response to use force that does not apply well to ambiguous cases or adequately explain errors in lethal force decisions.

Endosalpingiosis Is Negative for GATA3.

Endosalpingiosis is a benign Müllerian inclusion that can mimic metastatic low-grade mammary carcinoma, particularly when encountered in axillary lymph nodes excised for breast cancer staging. Immunohistochemistry can be useful in histologically ambiguous cases, and a targeted immunopanel should include a marker of gynecologic tract origin and a marker of mammary origin. GATA3 is a sensitive immunomarker for breast carcinoma, but the immunoreactivity of GATA3 in endosalpingiosis has not been systematically evaluated. To evaluate whether GATA3 immunohistochemistry could be used to differentiate endosalpingiosis from metastatic mammary carcinoma. Whole slide sections of 15 cases of endosalpingiosis involving nonneoplastic tissues were subjected to GATA3 immunohistochemistry. Nuclear GATA3 labeling was scored as percentage and intensity labeling, with any labeling considered positive; GATA3 labeling was recorded in all cells present in the sections. Half (47%, n = 7 of 15) of the endosalpingiosis cases involved lymph nodes (2 axillary, 5 pelvic) and half (53%, n = 8 of 15) involved pelvic organs or soft tissue (3 myometrial, 2 paratubal, 2 periadnexal soft tissue, and 1 pelvic sidewall). GATA3 immunohistochemistry was negative in all cases of endosalpingiosis, with intact, positive control labeling in lymphocytes. The benign fallopian tube epithelium present on the sections of paratubal endosalpingiosis displayed focal (<5%), weak labeling for GATA3, specifically within the ciliated and secretory cells. These findings support the diagnostic utility of GATA3 immunohistochemistry and its use in a targeted immunopanel to resolve the differential diagnosis of metastatic low-grade mammary carcinoma (GATA3+) and nodal endosalpingiosis (GATA3-).

Correction to 'Behavioural hypervolumes of spider communities predict community performance and disbandment'.

Correction to 'Behavioural hypervolumes of spider communities predict community performance and disbandment'.

The boundary between “Judaism” and “Aryanism”: Anti-Semitic logic, litigation, and bureaucratic practices relating to the classification of “half-Jews” in Occupied France (1940-1944)

Under the Occupation, the French Jewish Statute made no provisions for an intermediary status for individuals of mixed heritage (who the administration called “half-Jews”), to the contrary of Nazi legislation in Germany. Consequently, there were no first- or second-degree mixed-heritage people in France; one was either Jewish or not. But the criteria for defining whether or not “half-Jews” were of “the Jewish race” varied between German and French texts, case law, and the practices of specialized bureaucrats. The boundary between “Jewish” and “non-Jewish” was tenuous, often arbitrary, and shaped by religious affiliation, a divorce, a marriage, or other fact of life. Being classified on the “good” or “bad” side of the “barricade” (according to the formulation of George Montandon, the ethno-racial expert of the Paris Prefecture of Police and the Commissariat-General for Jewish Affairs [CGQJ]) was very often a matter of life or death. The administration (mainly the “Jewish Service” of the Prefecture of Police and the CGQJ) and the courts had to rule on thousands of “ambiguous cases.” The CGQJ delivered over 11,000 “Certificates of Non-Belonging to the Jewish Race” after painstaking investigations. This article considers the categories that agents of the State used to sort out these borderline cases, and tries to understand the root causes of this dogged quest to determine the legal and political boundary between “Jew” and “non-Jew.”

Transcriptional Differences between Canine Cutaneous Epitheliotropic Lymphoma and Immune-Mediated Dermatoses.

Canine cutaneous epitheliotropic T-cell lymphoma (CETL) and immune-mediated T-cell predominant dermatoses (IMD) share several clinical and histopathological features, but differ substantially in prognosis. The discrimination of ambiguous cases may be challenging, as diagnostic tests are limited and may prove equivocal. This study aimed to investigate transcriptional differences between CETL and IMD, as a basis for further research on discriminating diagnostic biomarkers. We performed 100bp single-end sequencing on RNA extracted from formalin-fixed and paraffin-embedded skin biopsies from dogs with CETL and IMD, respectively. DESeq2 was used for principal component analysis (PCA) and differential gene expression analysis. Genes with significantly different expression were analyzed for enriched pathways using two different tools. The expression of selected genes and their proteins was validated by RT-qPCR and immunohistochemistry. PCA demonstrated the distinct gene expression profiles of CETL and IMD. In total, 503 genes were upregulated, while 4986 were downregulated in CETL compared to IMD. RT-qPCR confirmed the sequencing results for 5/6 selected genes tested, while the protein expression detected by immunohistochemistry was not entirely consistent. Our study revealed transcriptional differences between canine CETL and IMD, with similarities to human cutaneous lymphoma. Differentially expressed genes are potential discriminatory markers, but require further validation on larger sample collections.

Orbital aspergillosis: a case report and review of the literature

BackgroundOrbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease.Case presentationA 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously.ConclusionsIn the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.

Implications of extreme serum neurofilament light chain levels for the management of patients with relapsing multiple sclerosis.

Background:Serum neurofilament light chain (sNfL) is a promising biomarker to complement the decision-making process in multiple sclerosis (MS) patients. However, although sNfL levels are able to detect disease activity and to predict future disability, the growing evidence has not yet been translated into practicable recommendations for an implementation into clinical routine.Methods:The observation of a patient with extensive inflammatory activity in magnetic resonance imaging (MRI) along with an extremely high sNfL level in the absence of any clinical symptoms prompted us to investigate common characteristics of our MS patients with the highest sNfL levels in a retrospective cohort study. The 97.5th percentile was chosen as a cut-off value because the mean sNfL level of the resulting extreme neurofilament light chain (NfL) cohort corresponded well to the sNfL level of the presented case. Patient characterization included clinical and MRI assessment with a focus on disease activity markers. sNfL levels were determined by single molecule array.Results:The 97.5th percentile of our MS cohort (958 sNfL measurements in 455 patients) corresponded to a threshold value of 46.1 pg/ml. The mean sNfL level of the extreme sNfL cohort (n = 24) was 95.6 pg/ml (standard deviation 68.4). Interestingly, only 15 patients suffered from a relapse at the time point of sample collection, whereas nine patients showed no signs of clinical disease activity. sNfL levels of patients with and without relapse did not differ [median 81.3 pg/ml (interquartile range [IQR] 48.0–128) versus 80.2 pg/ml (IQR 46.4–97.6), p = 0.815]. The proportion of patients with contrast-enhancing lesions was high and also did not differ between patients with and without relapse (92.9% versus 87.5%, p = 0.538); 78.9% of the patients not receiving a high-efficacious therapy had ongoing disease activity during a 2-year follow-up.Conclusion:Extremely high sNfL levels are indicative of subclinical disease activity and might complement treatment decisions in ambiguous cases.

Simultaneous Learning of Perceptual Ambiguity and Expected Value Estimates Alter Preferences, Discrimination Performance, and Choice

The ability to simultaneously learn how to distinguish between visually similar unknown items and their value was tested in three studies conducted across multiple days. In each study, participants took the role of a merchant in a market for obscure fruits. Merchants traded unknown fruits and earned money by identifying ripe ones. The ripe fruits had a fixed positive value, while the unripe ones had varying values at certain unknown probabilities. Participants had to learn that one fruit category (ripe or unripe) was always associated with a fixed monetary gain, whereas another category was associated with a lottery that had either monetary gains or losses. The fruit categories were always perceptually similar. We show that learning the value of items typically leads to (1) improvement in the ability to visually discriminate between high/low-value ones, and (2) a change in subjective preference towards the high-value items. When item values are ambiguous and determined by lotteries, participants do not show preference change. In those ambiguous cases, as the values of items become known, individuals’ risk-tolerance is predictive of item preferences such that a reinforcement learning model can be used to estimate the preferences. Despite the consistent behavior by the participants, their reflections on the decision heuristics typically fail to recognize key drivers of the rational choices. This suggests a discrepancy between the explicit interpretation of the choice heuristics and the intuitive decision practices. We propose a rationale for the behavioral outcomes and ways to use the novel experimental paradigm for further decision theory explorations.

Application Peter Chew Rule in Calculator Design

Mathematics has always been a challenging topic for high school and university students around the world. Literature revealed that use of technological tool have had a major impact on advanced mathematics teaching and mathematics learning. Mathematical tools such as online calculator and math applications, photo math applications and calculators contain only the knowledge already stated in the book such as the sine and cosine rule. However, if we are given 2 sides and an include angle, it cannot be solve by cosine Rule and sine rule directly, it make some online calculator cannot solve the problem. Peter Chew Rule can solve problem mention directly. If we use online calculator Math portal, we can see that Math portal can solve problems that can be solved directly by sine rule or cosine rule. However, Math portal cannot solve the problem of using the cosine rule plus the sine rule as described above. If we ask Math portal to solve the problem of using cosine rule plus sine rule, Math portal will show error. The reason is the design of Math portal no have Peter chew rule. Therefore, a new product with Peter Chew Rule is needed today to help solve problem mention, which is one the main goal of the PCET calculator. PCET calculator can solve the problems mention cause PCET calculator design have Peter Chew rule. Another problem of some on online calculator like Symbolab and Math portal is they just provided acute angle for the ambiguous case of triangle solution. So, if we use on online calculator like Symbolab and Math portal for help calculate some problem by current method, we will get the wrong answer. But PCET calculator no have this problem cause PCET calculator design using Peter Chew rule.

ProgNet: COVID-19 Prognosis Using Recurrent and Convolutional Neural Networks

Aims: Prognosis of lung mathology severity after Covid-19 infection using chest X-ray time series Background: We have been inspired by methods analysing time series of images in remote sensing for change detection. During the current Covid-19 pandemic, our motivation is to provide an automatic tool to predict severity of lung pathologies due to Covid-19. This can be done by analysing images of the same patient acquired at different dates. Since no analytical model is available, and also no accurate quantification tools can be used due to many unknowns about the pathology, feature-free methods are good candidates to analyse such temporal images. Objective: This contribution helps improving performances of medical structures facing the Covid-19 pandemic. The first impact is medical and social since more lives could be saved with a 92% rate of good prognosis. In addition to that, patients in intensive care units (up to 15%) could a posteriori suffer from less sequels due to an early and accurate prognosis of their PP. Moreover, accurate prognosis can lead to a better planning of patient’s transfer between units and hospitals, which is linked to the second claimed economical impact. Indeed, prognosis is linked to lower treatment costs due to an optimized predictive protocol using ragiological prognosis. Methods: Using Convolutional Neural Networks (CNN) in combination with Recurrent Neural Networks (RNN). Spatial and temporal features are combines to analyse image time series. A prognosis score is delivered indicating the severity of the pathology. Learning is made on a publicly available database. Results: When applied to radiological time-series, promising results are obtained with an accuracy rates higher than 92%. Sensitivity and specificity rates are also very interesting. Conclusion: Our method is segmentation-free, which makes it competitive with respect to other assessment methods relying on time-consuming lung segmentation algorithms. When applied on radiographic data, the proposed ProgNet architecture showed promising results with good classification performances, especially for ambiguous cases. Specifically, the reported low false positive rates are interesting for an accurate and personalised care workflow.

Исследование генетического разнообразия вариантов ВИЧ как инструмент оптимизации системы эпидемиологического надзора

Analysis of nucleotide sequences of HIV should be used as an additional tool in epidemiological investigations. Considering the current trend of the emergence of “complex” ambiguous cases of HIV infection, there is an urgent need to consider a filigree approach to investigating cases of HIV infection, with the possibility of using it as an additional tool for epidemiological surveillance, planning and modeling the epidemiological process.

Genotype-phenotype association by echocardiography offers incremental value in patients with Noonan Syndrome with Multiple Lentigines.

Noonan Syndrome with Multiple Lentigines (NSML) and Noonan Syndrome (NS) can be difficult to differentiate clinically in early childhood. This study aims to describe characteristics of the ventricular septum that may differentiate NSML from NS. We hypothesize that the shape of the ventricular septum determined by echocardiography correlates with genotype and may distinguish patients with NSML from those with NS. We analyzed data from 17 NSML and 67 NS patients. Forty normal and 30 sarcomeric hypertrophic cardiomyopathy (HCM) patients were included as controls. Septal morphology was qualitatively evaluated, and septal angle was measured quantitatively at end diastole. We recorded the presence of a ventricular septal bulge (VSB) and reviewed genetic testing results for each patient. The most important findings were a sigmoid septum (71%) and VSB (71%) in NSML. NSML septal angle was decreased compared to the normal and sarcomeric HCM control groups, respectively (149 ± 13 vs. 177 ± 3, p < 0.001; 149 ± 13 vs. 172 ± 7, p < 0.001). NS septal angle was similar to the controls (176 ± 6 vs. 177 ± 3, p > 0.5; 176 ± 6 vs. 172 ± 7, p > 0.5). NSML-linked pathogenic variants were associated with sigmoid septum and VSB. These findings provide novel phenotypic evidence to clinicians that may offer incremental diagnostic value in counseling families in ambiguous NSML/NS cases. Characteristics of the ventricular septum are linked to specific gene variants that cause NSML and NS. Sigmoid septum and VSB are associated with NSML. This novel echocardiographic association may help clinicians distinguish NSML from NS in ambiguous cases. Early distinction between the two may be important, as syndrome-specific therapies may become available in the near future. This study may encourage further research into genotype-phenotype associations in other forms of HCM.

Implicit and Explicit Attitudes Toward Prosecutors and Defense Attorneys

Research consistently finds that jurors bring preexisting attitudes and opinions, which can influence trial outcomes, into the courtroom. This research seeks to understand if juror decision-making is influenced by implicit and explicit perceptions of legal actor trustworthiness. Participants were recruited from Amazon’s Mechanical Turk online platform and were randomly assigned to read a summarized trial scenario and render a guilty or not guilty verdict. Two of the three trials differed according to presentation of “compromising” evidence by either the prosecution or the defense, with the third serving as a control condition. To establish if participants had trustworthy or untrustworthy implicit attitudes toward prosecutors or defense attorneys, participants completed an Implicit Association Test (IAT). Participants then reported their explicit attitudes toward prosecutors and defense attorneys, in addition to providing their demographic information and attitudes toward the criminal legal system. Results indicate that implicit and explicit biases, as well as certain socio-demographics, are associated with verdicts in the trial scenarios. However, in particularly ambiguous cases (control condition), preexisting implicit biases of legal actor trustworthiness appear to inform verdicts more than explicit attitudes. These results suggest that attorney reliance on explicit attitudes during voir dire may be more informative, except in cases in which the evidence for both the prosecution and defense is particularly ambiguous.

Early fetal cardiac scan as an element of the sonographic first-trimester screening.

Early fetal cardiac scan (EFCS) is becoming an increasingly common element of the first trimester ultrasound screening carried out at 11-14 gestational weeks. It offers the first possibility to detect congenital heart defects (CHD) or, in ambiguous cases, to identify those pregnancies where a more detailed cardiac scan would be required later in pregnancy. The size of the fetal heart at the end of the first trimester and the associated relatively low image resolution make it impossible to capture all cardiac data to inform the ultimate picture. However, even at this stage, cues of anatomical and functional abnormalities can be picked up, which suggest not only a CHD, but also a likelihood of cardiovascular symptoms typical of genetic disorders. EFCS should focus on cardiac position, atrioventricular (AV) connections, AV valve function, initial assessment of ventriculo-arterial (VA) connections and the presence of red flag signs in the three vessel and trachea view (3VTV). Proper use of color Doppler mapping makes it possible to overcome the low resolution of B-mode to a certain extent. Here we present our long-term experience in EFCS.

Mitochondrial DNA analysis efficiently contributes to the identification of metastatic contralateral breast cancers

PurposeIn daily practice, a contralateral breast cancer (CBC) is usually considered as a new independent tumor despite the indications of several studies showing that the second neoplasia may be a metastatic spread of the primary tumor. Recognition of clonal masses in the context of multiple synchronous or metachronous tumors is crucial for correct prognosis, therapeutic choice, and patient management. Mitochondrial DNA (mtDNA) sequencing shows high informative potential in the diagnosis of synchronous neoplasms, based on the fact that somatic mtDNA mutations are non-recurrent events, whereas tumors sharing them have a common origin. We here applied this technique to reveal clonality of the CBC with respect to the first tumor.MethodsWe analyzed 30 sample pairs of primary breast cancers and synchronous or metachronous CBCs with detailed clinical information available and compared standard clinico-pathological criteria with mtDNA sequencing to reveal the metastatic nature of CBCs.ResultsMtDNA analysis was informative in 23% of the cases, for which it confirmed a clonal origin of the second tumor. In addition, it allowed to solve two ambiguous cases where histopathological criteria had failed to be conclusive and to suggest a clonal origin for two additional cases that had been classified as independent by pathologists.ConclusionOverall, the mtDNA-based classification showed a more accurate predictive power than standard histopathology in identifying cases of metastatic rather than bilateral breast cancers in our cohort, suggesting that mtDNA sequencing may be a more precise and easy-to-use method to be introduced in daily routine to support and improve histopathological diagnoses.

A Catalog of Bipolar Active Regions Violating the Hale Polarity Law, 1989 – 2018

There is no list of bipolar active regions (ARs) with reverse polarity (anti-Hale regions), although statistical investigations of such ARs (bearing the imprint of deep subphotospheric processes) are important for understanding solar-cycle mechanisms. We studied 8606 ARs from 1 January 1989 to 31 December 2018 to detect anti-Hale regions and to compile a catalog. The Solar and Heliospheric Observatory (SOHO) and the Solar Dynamics Observatory (SDO) data, as well as the Debrecen Photoheliographic Data, the Mount Wilson Observatory catalog and drawings, and the USAF/NOAA Solar Region Summary were used. Complex, ambiguous cases related to anti-Hale region identification were analyzed. Two basic and four additional criteria to identify an AR as an anti-Hale region were formulated. The basic criteria assume that: i) dominating features of an AR have to form a bipole of reverse polarity with sunspots/pores of both polarities being present; ii) magnetic connections between the opposite polarities has to be observed. A catalog of anti-Hale regions (275 ARs) is compiled. The catalog contains: NOAA number, date of the greatest total area of sunspots, coordinates, and corrected sunspot area for this date. The tilt and the most complex achieved Mount Wilson magnetic class are also provided. The percentage of anti-Hale groups meeting the proposed criteria is ~3.0% from all studied ARs, which is close to early estimations by authors who had examined each AR individually: ~2.4% by Hale and Nicholson (Ap.J. 62, 270, 1925) and ~3.1% by Richardson (Ap.J. 107, 78, 1948). The enchancement of the anti-Hale percentage in later research might be related to: i) increasing sensitivity of instruments (considering smaller and smaller bipoles); ii) the ambiguities in the anti-Hale region identification.

In mehrdeutigen und unsicheren Fällen

Abstract The important role of Jewish medical practitioners in medieval and early modern Aschkenas has been underlined time and again. Regardless of legal restrictions and anti-Jewish polemics Jewish physicians were highly appreciated by Christian patients. However, although sources are rather scare, there were also Jewish patients who consulted Christian doctors. Practice records of the Nuremberg physician Johann Christoph Götz (1688–1733) and letters of his contemporary Christoph Jacob Trew (1695–1769) indicate that Jewish children, women and men from nearby Fürth asked for medical advice or treatment. The documents bear witness to a vivid exchange of ideas between Trew and the Jewish physician Wolf Enoch Levin from Fürth in the age of Enligthment. In ambiguous and difficult cases, Wolf often addressed himself to Trew as intermediary for his sick coreligionists.

Proletarian and Revolutionary Literature in a Transnational Perspective (1920–1940)

Abstract Simultaneously an emblematic and ambiguous case of engaged literature, proletarian and revolutionary writings from 1920–1940 have been the focus of numerous studies: whether they be in Germany, France, the United States or Soviet Russia, the principal actors have been identified, certain works have been republished, and the ways in which these movements were first encouraged and then dismantled by the Communist International in the interest of the only accepted socialist realism have been demonstrated. However, the transnational and even global dimensions of this movement and the profound similarities among institutional processes carried out in different countries have been overlooked. Drawing on little-known critical sources from the Francophone world, this article reworks the terrain and presents the state of institutional sites of proletarian and revolutionary literature. To this end, small groups, magazines, and associations will be considered in order to shed new light on this era when, across the globe, workers turned into writers.

Optimal strategies for identifying quasars in DESI

As spectroscopic surveys continue to grow in size, the problem of classifying spectra targeted as quasars (QSOs) will need to move beyond its historical reliance on human experts. Instead, automatic classifiers will increasingly become the dominant classification method, leaving only small fractions of spectra to be visually inspected in ambiguous cases. In order to maximise classification accuracy, making best use of available classifiers will be of great importance, particularly when looking to identify and eliminate distinctive failure modes. In this work, we demonstrate that the machine learning-based classifier QuasarNET will be of use for future surveys such as the Dark Energy Spectroscopic Instrument (DESI), comparing its performance to the DESI pipeline classifier redrock. During the first of four passes across its footprint DESI will need to select high-z (z ⩾ 2.1) QSOs for reobservation, and so we first assess the classifiers' performance at identifying high-z QSOs from single-exposure spectra. We then quantify the classifiers' abilities to construct QSO catalogues in both low- and high-z bins, using coadded spectra to simulate end-of-survey data. For such tasks, QuasarNET is able to out-perform redrock in its current form, identifying approximately 99% of high-z QSOs from single exposures and producing QSO catalogues with sub-percent levels of contamination. By combining QuasarNET and redrock's outputs, we can further improve the classification strategies to identify up to 99.5% of high-z QSOs from single exposures and reduce final QSO catalogue contamination to below 0.5%. These combined strategies address DESI's QSO classification needs effectively.