Background Characteristics Research Articles

The association between internet use and the choice of medical institution among Chinese older adults

BackgroundAs older people have complex medical needs and still encounter challenges in accessing online health information, the relationship between Internet use and the choice of medical institution made by them is unclear, and we aimed to examine this relationship.MethodsData from the newly released 2020 China Family Panel Survey database were used. Furthermore, we used descriptive statistics to analyze the background characteristics of the sample and a logistic regression model to estimate the impact of Internet use on the choice of medical institution made by older adults. We conducted a stratified analysis to explore the influence of different characteristics on the relationship between Internet use and the choice of medical institution.ResultsTotally 4,948 older adults were included. Multivariate logistic regression showed that, compared to non-Internet users, Internet users were less likely to choose community health service centers over general hospitals (P < 0.001, OR = 0.667, 95CI%: 0.558–0.797). The subgroup analyses found that Internet use only had an impact on the choice of medical institution in older adults aged 65–69 years, those with partners, those with primary or secondary education, those residing in urban areas, those without medical insurance, those with a self-rated health status as average or healthy, those with unchanged or better health trend, and those without chronic disease. The effect of Internet use on the choice of medical institution did not differ by sex, satisfaction, or trust in doctors.ConclusionInternet use may significantly affect older adults’ tendency to choose general hospitals to meet their daily medical needs. The subgroup analyses indicated that different characteristics of older people affected this association.

Embedding enhancement with foreground feature alignment and primitive knowledge for few-shot learning

Few-Shot Learning (FSL) targets a model to quickly discriminate new categories with limited samples. While most methods struggle to effectively utilize the knowledge learned in the base classes, resulting in models that fail to alleviate the domain gap between training and evaluation. Conversely, humans often enable rapid discrimination by two ways: reinforcing impressions through comparing unknown categories with related objects in memory; Searching for the maximum shared information within the intra-class. Motivated by this, in this paper, we propose a novel Transformer-based Embedding Enhancement Network (TEEN) that adaptively leverages the knowledge learned from the base classes, which we refer to as ‘primitive knowledge’, to complete and distinguish the embeddings for novel classes. Additionally, to reduce interference from background features, we introduce the Transformer-based Foreground Feature Alignment (TFFA) to enhance the representation of image foreground. Ultimately, TEEN enhances the embeddings through foreground alignment and primitive knowledge completion, achieving improved performance in few-shot classification. Extensive experiments on inductive few-shot tasks demonstrate the effectiveness of our approach, achieving state-of-the-art results in cross-domain few-shot tasks.

OTHR-11. TITLE: ELECTROGRAPHIC SEIZURES AND EEG BACKGROUND FEATURES IN PEDIATRIC NEURO-ONCOLOGY PATIENTS ADMITTED TO THE PEDIATRIC INTENSIVE CARE UNIT

Abstract BACKGROUND Electrographic seizures (ES) are common in critically ill children with the incidence of ES ranging from 10-50%. Continuous EEG (cEEG) is frequently obtained in children with brain tumors due to encephalopathy or concern for seizures. Despite this, little is known about the incidence of ES, EEG background features, or the impact of EEG on clinical management in this population. METHODS This is a prospective single center study of critically ill children with brain tumors admitted to the pediatric intensive care unit (PICU) from July 2021 to July 2023. Patients with new or known primary brain tumors and cEEG completed during their admission were included. We excluded patients with planned admissions for EEG. Clinical variables included age, sex, oncologic diagnosis, tumor grade and location, indication for EEG, EEG features, and changes in management. RESULTS Thirty-six patients were identified who met the inclusion criteria. 21 patients were female. The median age was 11.0 years (IQR 6.6– 15.4 years). The most common indication for EEG was encephalopathy in 42% followed by clinical seizure in 31%. ES were captured in 19% (7/36) with the majority being subclinical; in patients with acute encephalopathy, ES were captured in 20% (3/15). The EEG background was abnormal in 97% of cases. The most common EEG background was slow disorganized with background asymmetry seen in in 74%. EEG background features met criteria for the ictal-interictal continuum in 14%. A higher rate of ES was seen in patients with disseminated tumors (p=0.03) and severe encephalopathy on EEG (p=0.006). EEG led to a change in management in 31% of patients. CONCLUSIONS ES are common in critically ill children with brain tumors and would go undetected without cEEG. EEG findings often led to a change in clinical management and is a vital tool for the evaluation of this population.

Does gender matter in Supported Employment? A qualitative study of participants’ experiences

BACKGROUND: In Sweden, gender differences have been found in standard vocational rehabilitation as well as in evidenced-based methods such as Supported Employment (SE). However, these quantitative findings have not been followed up by qualitative research to clarify the issue. OBJECTIVE: To explore participants’ experiences of participating in an SE intervention and the influence of gender on their experiences. METHOD: Semistructured interviews with 10 women and 7 men participating in SE in Sweden were conducted. Qualitative content analysis followed by a gender analysis were performed using the material. RESULTS: The participating men and women had different background characteristics. Overall, the participants shared the same experiences of SE. They valued a trustful relationship with the employment specialist and the diversified and individualized support from the employment specialist. Unlike the men, the women had experienced difficulties receiving SE from authorities, and when receiving SE, they expressed the value of a slow start, being challenged, and whole-life support. CONCLUSION: The findings might moderate the rapid job principle in SE and indicate the need to acknowledge that the path to employment might look different, depending on the participants’ gendered experiences and living conditions, for SE to be more successful for both men and women.

Person-Centred Pain Measurement in the ICU: A Multicentre Clinimetric Comparison Study of Pain Behaviour Observation Scales in Critically Ill Adult Patients with Burns

Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63–72 and 87–80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.

The protective effects of Axitinib on blood-brain barrier dysfunction and ischemia-reperfusion injury in acute ischemic stroke

Background and purposeThe pathophysiological features of acute ischemic stroke (AIS) often involve dysfunction of the blood-brain barrier (BBB), characterized by the degradation of tight junction proteins (Tjs) leading to increased permeability. This dysfunction can exacerbate cerebral injury and contribute to severe complications. The permeability of the BBB fluctuates during different stages of AIS and is influenced by various factors. Developing effective therapies to restore BBB function remains a significant challenge in AIS treatment. High levels of vascular endothelial growth factor (VEGF) in the early stages of AIS have been shown to worsen BBB breakdown and stroke progression. Our study aimed to investigate the protective effects of the VEGF receptor inhibitor Axitinib on BBB dysfunction and cerebral ischemia/reperfusion-induced injury. MethodsBEnd3 cell exposed to oxygen–glucose deprivation (OGD) model was constructed to estimate pharmacological activity of Axitinib (400 ng/ml) on anti-apoptosis and pathological barrier function recovery. In vivo, rats were subjected to a 1 h transient middle cerebral artery occlusion and 23 h reperfusion (tMCAO/R) to investigate the permeability of BBB and cerebral tissue damage. Axitinib was administered through the tail vein at the beginning of reperfusion. BBB integrity was assessed by Evans blue leakage and the expression levels of Tjs claudin-5 and occludin. ResultsOur research revealed that co-incubation with Axitinib enhanced the cell viability of OGD-insulted bEnd3 cells, decreased LDH leakage rate, and suppressed the expression of apoptosis-related proteins cytochrome C and Bax. Axitinib also mitigated the damage to Tjs and facilitated the restoration of transepithelial electrical resistance in OGD-insulted bEnd.3 cells. In vivo, Axitinib administration reduced intracerebral Evans blue leakage and up-regulated the expression of Tjs in the penumbra brain tissue in tMCAO/R rats. Notably, 10 mg/kg Axitinib exerted a significant anti-ischemic effect by decreasing cerebral infarct volume and brain edema volume, improving neurological function, and reducing pro-inflammatory cytokines IL-6 and TNF-α in the brain. ConclusionsOur study highlights Axitinib as a potent protectant of blood-brain barrier function, capable of promoting pathological blood-brain barrier recovery through VEGF inhibition and increased expression of tight junction proteins in AIS. This suggests that VEGF antagonism within the first 24 h post-stroke could be a novel therapeutic approach to enhance blood-brain barrier function and mitigate ischemia-reperfusion injury.

Remote Sensing Image Harmonization Method for Fine-Grained Ship Classification

Target recognition and fine-grained ship classification in remote sensing face challenges of high inter-class similarity and sample scarcity. A transfer fusion-based ship image harmonization algorithm is proposed to overcome these challenges. This algorithm designs a feature transfer fusion strategy based on the combination of a region-aware instantiation and attention mechanism. Adversarial learning is implemented through an image harmony generator and discriminator module to generate realistic remote sensing ship harmony images. Furthermore, the domain encoder and domain discriminator modules are responsible for extracting feature representations of the foreground and background, and further align the ship foreground with remote sensing ocean background features through feature discrimination. Compared with other advanced image conversion techniques, our algorithm delivers more realistic visuals, improving classification accuracy for six ship types by 3% and twelve types by 2.94%, outperforming Sim2RealNet. Finally, a mixed dataset containing data augmentation and harmonizing samples and real data was proposed for the fine-grained classification task of remote sensing ships. Evaluation experiments were conducted on eight typical fine-grained classification algorithms, and the accuracy of the fine-grained classification for all categories of ships was analyzed. The experimental results show that the mixed dataset proposed in this paper effectively alleviates the long-tail problem in real datasets, and the proposed remote sensing ship data augmentation framework performs better than state-of-the-art data augmentation methods in fine-grained ship classification tasks.

DiffRank: Enhancing efficiency in discontinuous frame rate analysis for urban surveillance systems

Urban public safety management relies heavily on video surveillance systems, which provide crucial visual data for resolving a wide range of incidents and controlling unlawful activities. Traditional methods for target detection predominantly employ a two-stage approach, focusing on precision in identifying objects such as pedestrians and vehicles. These objects, typically sparse in large-scale, lower-quality surveillance footage, induce considerable redundant computation during the initial processing stage. This redundancy constrains real-time detection capabilities and escalates processing costs. Furthermore, transmitting raw images and videos laden with superfluous information to centralized back-end systems significantly burdens network communications and fails to capitalize on the computational resources available at diverse surveillance nodes. This study introduces DiffRank, a novel preprocessing method for fixed-angle video imagery in urban surveillance. The method strategically generates candidate regions during preprocessing, thereby reducing redundant object detection and improving the efficiency of the detection algorithm. Drawing upon change detection principles, a background feature learning approach utilizing shallow features has been developed. This approach prioritizes learning the characteristics of fixed-area backgrounds over direct background identification. As a result, alterations in ROI are efficiently discerned using computationally efficient shallow features, markedly accelerating the generation of proposed Regions of Interest (ROIs) and diminishing the computational demands for subsequent object detection and classification. Comparative analysis on various public and private datasets illustrates that DiffRank, while maintaining high accuracy, substantially outperforms existing baselines in terms of speed, particularly with larger image sizes (e.g., an improvement exceeding 300 % at 1920×1080 resolution). Moreover, the method demonstrates enhanced robustness compared to baseline methods, efficiently disregarding static targets like mannequins in display windows. The advancements in candidate area preprocessing enable a balanced approach between detection accuracy and overall detection speed, making the algorithm highly applicable for real-time on-site analysis in edge computing scenarios and cloud-edge collaborative computing environments.

Background and clustering characteristics of recent seismicity in Southwestern China

SUMMARY This study analysed seismicity in southwestern China (1 January 2008 to 30 June 2021) using the earthquake catalogue compiled by the China Earthquake Network Center and four different space–time Epidemic-Type Aftershock Sequence models: the 2-D point-source (PS) model, the 2-D finite-source (FS) model, the 3-D PS model and the 3-D FS model. Our objective was to understand the features of the background seismicity and the patterns of earthquake clusters to better evaluate the regional seismic hazard. We carefully investigated the aftershock sequences that followed 7 of the 10 MS ≥ 6.0 earthquakes that have struck this region since the occurrence of the 2008 Wenchuan MS 8.0 earthquake [i.e. the Panzhihua (31 August 2008; MS 6.0), Yaoan (9 July 2009; MS 6.0), Lushan (20 April 2013; MS 7.0), Ludian (3 August 2014; MS 6.5), Jinggu (7 October 2014; MS 6.6), Kangding (11 November 2014; MS 6.3) and Yangbi (21 May 2021; MS 6.4) earthquakes]. Our results revealed the following. (1) The background seismicity level for natural earthquakes is usually stable but can experience sudden change due to major events, such as the 2014 Ludian MS 6.5, and the 2014 Jinggu MS 6.6 events. Such changes in the background rate can reach 50 per cent. (2) Reservoir-induced earthquakes substantially increase the level of regional seismicity, indicating that they cannot be ignored when analysing natural seismicity and evaluating regional earthquake hazards. (3) Events triggered directly by the main shock occur mostly in regions adjacent to areas with large coseismic slip, showing a pattern complementary to the main shock ruptures.

Environmentally adaptive fast object detection in UAV images

Detecting objects in aerial images poses a challenging task due to the presence of numerous small objects and complex environmental information. To address these problems, we propose an efficient detector specifically designed for aerial images, named EAF-YOLOv8, based on YOLOv8-S. In this paper, we introduce a novel backbone network called EAFNet, specifically designed for small object detection. EAFNet consists of the Rapidly Merging Receptive Fields Aggregation Module (RMRFAM) and Multi-Scale Channel Attention (MSCA). The RMRFAM utilizes dilated convolution (DConv) and partial convolution (PConv) to acquire richer receptive fields, capturing more extensive contextual information at higher levels while reducing redundancy in channel information, thereby accelerating inference speed. Furthermore, inspired by denoising tasks, we focus on the feature information surrounding the target background and propose MSCA. MSCA integrates channel attention with an embedded self-attention feature pyramid, extending the feature learning scope to the surrounding environment of the target, beyond the target itself. This approach utilizes enhanced background features to elicit a higher response for small targets, reducing false positives. Experimental results demonstrate that in UAVDT and VisDrone2019, the proposed EAF-YOLOv8 achieves mAP50 scores of 34.3% and 49.7%, respectively. Additionally, EAF-YOLOv8 exhibits high real-time inference speeds of 77.60 FPS and 55.56 FPS, showcasing competitive detection performance.

Burosumab treatment of X-linked hypophosphatemia patients: interim analysis of the SUNFLOWER longitudinal, observational cohort study.

X-linked hypophosphatemia (XLH) is a genetic disease that results in excessive FGF23, chronic hypophosphatemia, and musculoskeletal abnormalities, with affected patients experiencing symptoms such as bone pain, bone deformity, fracture, and pseudofracture. Burosumab is a fully human monoclonal antibody that binds to FGF23, improving lowered serum 1,25(OH)2D and phosphate levels in patients with XLH. There are insufficient data on the use of burosumab, its safety, and the outcomes of treated patients in a real-world setting. The SUNFLOWER (Study of longitUdinal observatioN For patients with X-Linked hypOphosphatemic rickets/osteomalacia in collaboration With Asian partnERs) study is an ongoing longitudinal, observational cohort study of patients with XLH in Japan and South Korea. Enrollment occurred between April 2018 and December 2020. This interim analysis compared the background characteristics of patients who received burosumab with those who did not, and assessed improvements in biomarkers, physical and motor function, health-related quality-of-life (HRQOL) and other patient-reported outcome (PRO) measures, as well as the safety of burosumab treatment in 143 Japanese patients from 15 institutions over 6mo. The patients had a median [interquartile range] age of 17.5 [11.0, 38.8] yr and 98 (68.5%) were female. Among patients aged <18 and ≥18yr, 40/73 (54.8%) and 25/70 (35.7%) received burosumab, respectively. More patients aged ≥18 who received burosumab had bone pain at baseline vs those not treated with burosumab (6/25, 24.0% vs 2/45, 4.4%, p=.021). Patients treated with burosumab had improved serum phosphate and 1,25(OH)2D levels; moreover, rickets severity and HRQOL/PRO measures, such as pain, appeared to improve over 6mo of burosumab treatment, and no new safety concerns were identified. This study identified trends in the background characteristics of patients with XLH who receive burosumab in real-world clinical practice. Furthermore, the results support the use of burosumab therapy in real-world settings.

Influence of multidisciplinary team care with abundant nurse staffing on patient-reported outcomes among patients with inflammatory bowel disease in clinical remission

BackgroundPatients with inflammatory bowel disease (IBD) experience difficulties in daily life and demanding self-care needs. The goal of our support for patients is to ease their difficulties and improve their belief in their capacity to self-manage their disease (self-efficacy), by increasing their ability for self-care. The nurse’s contribution is vital in empowering patients and supporting them to better manage their disease. There is evidence that higher nurse staffing levels are associated with better patient outcomes in acute care settings, but little is known about the outpatient setting. The objective of this study was to explore the impact of multidisciplinary team care with abundant nurse staffing levels on patient-reported outcome measures (PROMs) among patients with IBD, encompassing Crohn’s disease (CD) and ulcerative colitis (UC), in clinical remission.MethodsPatients with IBD in clinical remission were included because disease activity influences the patient’s subjective evaluation. A total of 499 valid responses from two different sources were analyzed: 318 from a specialized IBD clinic with abundant nurse staffing and a multidisciplinary care team (UC: 83, CD: 235) and 181 from an online survey panel (UC: 109, CD: 72). The IBD Self-Efficacy Scale (IBD-SES) and the difficulty of life scale (DLS) were used as disease-specific PROMs.ResultsIn two multiple regression models adjusted by background characteristics (age, sex, diagnosis [UC/CD], employment status, use of biologics, and disease duration) using the IBD-SES or DLS as a dependent variable, the responses from clinic patients showed a more favorable score (higher self-efficacy or lower difficulty) than the online responses.ConclusionsMultidisciplinary team care with abundant nurse staffing may improve self-efficacy and ease difficulties of life among patients with IBD in clinical remission. These results could help bring attention to nurse staffing in an outpatient setting, which has previously been overlooked, and be the first to provide evidence of its importance in encouraging enhanced staffing levels.

Orthogonal neural representations support perceptual judgements of natural stimuli.

In natural behavior, observers must separate relevant information from a barrage of irrelevant information. Many studies have investigated the neural underpinnings of this ability using artificial stimuli presented on simple backgrounds. Natural viewing, however, carries a set of challenges that are inaccessible using artificial stimuli, including neural responses to background objects that are task-irrelevant. An emerging body of evidence suggests that the visual abilities of humans and animals can be modeled through the linear decoding of task-relevant information from visual cortex. This idea suggests the hypothesis that irrelevant features of a natural scene should impair performance on a visual task only if their neural representations intrude on the linear readout of the task relevant feature, as would occur if the representations of task-relevant and irrelevant features are not orthogonal in the underlying neural population. We tested this hypothesis using human psychophysics and monkey neurophysiology, in response to parametrically variable naturalistic stimuli. We demonstrate that 1) the neural representation of one feature (the position of a central object) in visual area V4 is orthogonal to those of several background features, 2) the ability of human observers to precisely judge object position was largely unaffected by task-irrelevant variation in those background features, and 3) many features of the object and the background are orthogonally represented by V4 neural responses. Our observations are consistent with the hypothesis that orthogonal neural representations can support stable perception of objects and features despite the tremendous richness of natural visual scenes.

Effects of the "AI-TA" Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial.

Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps' intelligent features in addressing psychological distress with these apps. This study aims to evaluate the effectiveness of a mobile app with intelligent design called "AI-TA" on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants' background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195.

Fragility Index and Fragility Quotient in Statistically Significant Randomized Controlled Trials in Plastic Breast Surgery.

The fragility index (FI) was conceived as an adjunct to the P value, signifying the strength of statistically significant results. The index states the minimal number of patients whose outcome must be changed from "event" to "nonevent" for the results to be statistically nonsignificant. The FI was applied in various medical specialties to assess the robustness of results presented in studies. We aim to assess the robustness of statistically significant results in studies on plastic surgery of the breast and determine factors correlated with studies deemed fragile. A systematic literature review of PubMed databases using designated keywords was performed. Background characteristics were extracted from the studies, alongside the significance of outcomes. FI and fragility quotient were calculated for each analyzed outcome and correlated with various baseline characteristics. FI and fragility quotient were both significantly correlated only with the P value of the analyzed outcomes. However, grouping studies based on the P value into three categories did not demonstrate a difference in FI. Comparisons of fragile and robust studies did not demonstrate a statistically significant change in terms of baseline variables, except for the mean P value of the outcome. Statistically significant results of randomized controlled trials in plastic surgery of the breast suffer from extensive fragility, and researchers should critically implement their conclusions in their practice.

Constraints on inflation with null energy condition violation from advanced LIGO and advanced Virgo's first three observing runs

The null energy condition (NEC) is a cornerstone of general relativity, and its violation could leave observable imprints in the cosmic gravitational wave spectrum. Theoretical models suggest that NEC violations during inflation can amplify the primordial tensor power spectrum, leading to distinct features in the stochastic gravitational wave background (SGWB). In this work, we search for these NEC-violating signatures in the SGWB using data from Advanced LIGO and Advanced Virgo's first three observing runs. Our analysis reveals no statistically significant evidence of such signals, allowing us to place stringent upper limits on the tensor power spectrum amplitude, P T,2, during the second inflationary stage. Specifically, we find that P T,2 ≲ 0.15 at a 95% confidence level. Notably, this upper limit is consistent with constraints derived from pulsar timing array observations, reinforcing the hypothesis that NEC violations during inflation could explain the signal detected by pulsar timing arrays. Our findings contribute to a deeper understanding of the early Universe and highlight the potential of current and future gravitational wave experiments in probing the physics of inflation and NEC violations.

HERD: A multi-centre prospective cohort study to facilitate early detection of relapse in radically treated, high risk head and neck squamous cell carcinoma.

TPS6128 Background: Head and Neck Squamous Cell Carcinoma (HNSCC) is the 7th most common cancer worldwide with more than 660,000 cases diagnosed annually. Many patients present with locally advanced disease, which despite aggressive multi-modality treatment remains associated with poor survival. Approximately 50% of patients relapse within 2 years, mostly occurring in the first year after treatment. Biomarkers predicting relapse are lacking and there remains no consensus on surveillance, with strategies differing according to local guidelines and recurrence too often detected when not amenable to salvage surgery (estimated to improve survival outcomes in relapsed HNSCC by up to 73%). We hypothesize that risk of relapse relies on a dynamic interplay between the immune profile, tumor microenvironment (TME; elucidated by radiology and tissue-based laboratory imaging), genomic background and clinicopathological characteristics. Our primary objectives are to develop and validate a multi-analyte based risk prediction tool and risk-stratified follow up strategy to enhance detection of early relapse and improve survival. Methods: This multi-center study is prospectively collectingsamples across multiple platforms including imaging, blood, saliva, stool, urine, and tissue from patients with newly diagnosed high risk locally advanced HPV-negative HNSCC planned for radical treatment (either surgery or (chemo)radiotherapy). We aim to recruit 200 patients in 2 stages, including discovery and validation cohorts. Three mechanistic (hypothesis-driven) meta-covariates and five working platform meta-covariates will be analysed to test recurrence prediction. Each meta-covariate represents an integrated risk score from covariate subsets. The 3 hypotheses are H1) combining magnetic resonance parameters of hypoxia and stromal composition with TME changes; H2) capturing the interactions between genomic mutations, immune cells and exosomes within the TME H3) understanding the relationship between micro-organisms and TME. The technical platforms include exosomal analyses, multi-parametric MRI including novel elastography (MRE) and quantitative magnetic susceptibility mapping (QSM) techniques, comprehensive circulating tumour and cell-free DNA analyses to aid detection of minimally residual disease, tissue immune profiling, somatic mutation testing and microbiome analysis. Regression Analysis will be performed by machine-learning with advanced mathematical and Bayesian statistical modelling. Accrual began in October 2023. Clinical trial information: NCT05097625 .

Predictors of adherence to follow-up and treatment success in childhood obesity

IntroductionManagement of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. Patients and methodsWe conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. ResultsThe mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. ConclusionsSome family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

The Impact of Second Opinion Expert Pathology Review in Patient Management at the Time of Transurethral Resection of the Bladder

Background and objectivePathological features in non–muscle-invasive bladder cancer specimens are pivotal in determining correct patients’ therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer. MethodsThe study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines. Key findings and limitationsAmong 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found. Conclusions and clinical implicationsThe second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management. Patient summaryWe investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.

Antibody status at delivery and pregnancy outcomes during the first Danish COVID-19 wave.

We aimed to investigate the prevalence of SARS-CoV-2 infection and SARS-CoV-2 antibodies in parturient women and their newborns during the first Danish COVID-19 wave and to identify associations with maternal background characteristics, self-reported symptoms, and pregnancy outcomes. In a single-centre, prospective cohort study from Denmark, we invited 1,883 women with singleton pregnancies giving live birth from 25 May 2020 to 2 November 2020. Hereof, 953 (50.6%) women were included. Nasopharyngeal swabs, maternal and umbilical cord blood samples, and questionnaires were collected. Medical records were available for participants and non-participants. SARS-CoV-2 antibodies were found in 1.3% of the women. All newborns of seropositive women had SARS-CoV-2 antibodies in cord blood. No association was found between SARS-CoV-2 antibodies and pregnancy outcomes. Self-reported loss of smell correlated with seropositivity (p less-than 0.001). No women were hospitalised due to COVID-19 during pregnancy or had a positive nasopharyngeal swab intrapartum. The prevalence of COVID-19 in pregnancy was low during the first wave. Maternal SARS-CoV-2 antibodies were associated with antibodies in cord blood, loss of smell and positive SARS-CoV-2 swab during pregnancy, but not with any adverse pregnancy outcomes. Ferring Pharmaceuticals funded part of the study. The study was approved by the Regional Committee on Health Research Ethics (H-20028002) and the Danish Data Protection Agency (P-2020-264).