Complete Data Research Articles

Two new species of Dulcicalothrix (Nostocales, Cyanobacteria) from India and erection of Brunnivagina gen. nov., with observations on the problem of using multiple ribosomal operons in cyanobacterial taxonomy.

Two new species of Dulcicalothrix, D. adhikaryi sp. nov. and D. iyengarii sp. nov., were discovered in India and are characterized and described in accordance with the rules of the International Code of Nomenclature for algae, fungi, and plants (ICN). As a result of phylogenetic analysis, Calothrix elsteri is reassigned to Brunnivagina gen. nov. During comparison with all Dulcicalothrix for which sequence data were available, we observed that the genus has six ribosomal operons in three orthologous types. Each of the three orthologs could be identified based upon indels occurring in the D1-D1' helix sequence in the ITS rRNA region between the 16S and 23S rRNA genes, and in these three types, there were operons containing ITS rRNA regions with and without tRNA genes. Examination of complete genomes in Dulcicalothrix revealed that, at least in the three strains for which complete genomes are available, there are five ribosomal operons, two with tRNA genes and three with no tRNA genes in the ITS rRNA region. Internal transcribed spacer rRNA regions have been consistently used to differentiate species, both on the basis of secondary structure and percent dissimilarity. Our findings call into question the use of ITS rRNA regions to differentiate species in the absence of efforts to obtain multiple operons of the ITS rRNA region through cloning or targeted PCR amplicons. The ITS rRNA region data for Dulcicalothrix is woefully incomplete, but we provide herein a means for dealing with incomplete data using the polyphasic approach to analyze diverse molecular character sets. Caution is urged in using ITS rRNA data, but a way forward through the complexity is also proposed.

Evaluation of the i-gel® Plus supraglottic airway device in elective surgery: a prospective international multicentre study.

The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

BackgroundAdvances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China.MethodsThis was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist.ResultsThe study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group.ConclusionThe use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.

Bilateral Matching Method for Business Resources Based on Synergy Effects and Incomplete Data

On the third-party cloud platform, to help enterprises accurately obtain high-quality and valuable business resources from the massive information resources, a bilateral matching method for business resources, based on synergy effects and incomplete data, is proposed. The method first utilizes a k-nearest neighbor imputation algorithm, based on comprehensive similarity, to fill in missing values. Then, it constructs a satisfaction evaluation index system for business resource suppliers and demanders, and the weights of the satisfaction evaluation indices are determined, based on the fuzzy analytic hierarchy process (FAHP) and the entropy weighting method (EWM). On this basis, a bilateral matching model is constructed with the objectives of maximizing the satisfaction of both the supplier and the demander, as well as achieving the synergy effect. Finally, the model is solved using the linear weighting method to obtain the most satisfactory business resources for both supply and demand. The effectiveness of the method is verified through a practical application and comparative experiments.

Antioxidants for Skin Health.

Antioxidants play a pivotal role in maintaining skin health and integrity, combating the deleterious effects of oxidative stress induced by environmental aggressors such as UV ra-diation, pollution, and lifestyle factors. This paper reviews the contributions of key antioxidants, including Vitamin C, Vitamin E, Vitamin A, green tea extract, Coenzyme Q10, Resveratrol, Selenium, and Polyphenols, in skin health care. Vitamin C, known for its collagen synthesis promotion and photoprotection properties, alongside Vitamin E, a lipid-soluble antioxidant, syn-ergistically works to neutralize free radicals and repair damaged skin cells. Vitamin A, in the form of retinol, plays a critical role in skin cell regeneration and the maintenance of skin integ-rity. Green tea extract, rich in Polyphenols, offers anti-inflammatory and anticarcinogenic prop-erties, making it a potent ingredient for skin protection. Coenzyme Q10, a naturally occurring antioxidant in the body, aids in energy production for cell repair and regeneration, while Resveratrol, found in grapes and berries, provides anti-ageing benefits by enhancing skin's re-sistance to oxidative stress. Selenium, an essential mineral, contributes to the protection of skin cells from oxidative damage. The incorporation of these antioxidants in skincare products and dietary sources is discussed, highlighting the importance of a holistic approach in skincare re-gimes. The paper emphasizes the synergy between topical applications and dietary intake of antioxidants, advocating for a comprehensive strategy for promoting skin health and preventing age-related skin alterations. Method: For the review article, a variety of search engines and databases were used to identify relevant articles. Furthermore, for biomedical literature focusing on antioxidants and their ef-fects on skin health, PubMed was used. Moreover, to access a wide range of scholarly articles, including those related to dermatology and skincare, Google Scholar was used. Scopus provides comprehensive coverage of peer-reviewed literature across various scientific disciplines. Web of Science identifies high-impact articles and research on antioxidants in skincare. In addition, for accessing full-text articles on antioxidants and their applications in dermatology, Science Direct was used. The inclusion criteria for the review paper were as follows: only studies pub-lished in peer-reviewed journals were included to ensure the credibility and reliability of the information. Articles published in English were considered, to avoid language-related biases and ensure comprehension. Studies published within the last 10 years were included to provide the most current insights into antioxidant research in skincare. Articles must specifically focus on the role of antioxidants (Vitamin C, Vitamin E, Vitamin A, green tea extract, Coenzyme Q10, Resveratrol, Selenium, Polyphenols) in skin health care. Both experimental studies (in vivo and in vitro) and clinical trials were included to provide a comprehensive overview of the antioxidant effects. Full-text articles were included to allow for thorough data extraction and analysis. The exclusion criteria for the review paper were as follows: Publications that were not peer-re-viewed, such as editorials, opinion pieces, and non-scholarly articles, were excluded. Articles published in languages other than English were excluded due to potential translation challenges and to maintain consistency. Studies that did not focus on the specified antioxidants or their impact on skin health were excluded. Duplicate publications were excluded to avoid redundancy in the review. Articles with insufficient or incomplete data were excluded to ensure the quality and reliability of the review findings.

Survival characteristics of Wilms Tumor, a reference developed from a longitudinal cohort study

BackgroundWilms tumor (WT) survival has been affected by the evolution in clinical and biological prognostic factors. Significant differences in survival rates indicate the need for further efforts to reduce these disparities. This study aims to evaluate the clinicopathological data impact on survival among patients after Wilm's diagnosis.MethodsThe study utilized the SEERStat Database to identify Wilms tumor patients, applying SEERStat software version 8.3.9.2 for data extraction. Selection criteria involved specific codes based on the International Classification of Diseases for Oncology (ICDO-3), excluding cases with unknown SEER stage, incomplete survival data, unknown size, or lymph node status. Statistical analyses, including Kaplan–Meier estimates and Cox regression models, were conducted using R software version 3.5. Standardized mortality ratios (SMR) were computed with SEER*Stat software, and relative and conditional survival analyses were performed to evaluate long-term survival outcomes.ResultsOf 2273 patients diagnosed with Wilms tumor, (1219 patients, 53.6% were females with an average age group of 3–8 years (50.2%). The overall mean survival after five years of diagnosis was 93.6% (2.6–94.7), and the overall mean survival rate was 92.5% (91.3–93.8) after ten years of diagnosis. Renal cancers were identified as the leading cause of death (77.3%), followed by nonrenal cancers (11%) and noncancer causes (11%). Additionally, robust relative survival rates of 98.10%, 92.80%, and 91.3% at one, five, and ten years, respectively, were observed, with corresponding five-year conditional survival rates indicating an increasing likelihood of survival with each additional year post-diagnosis. Univariate Cox regression identified significant prognostic factors: superior CSS for patients below 3 years (cHR 0.48) and poorer CSS for those older than 15 years (cHR 2.72), distant spread (cHR 10.24), regional spread (cHR 3.09), and unknown stage (cHR 4.97). In the multivariate model, age was not a significant predictor, but distant spread (aHR 9.22), regional spread (aHR 2.84), and unknown stage (aHR 4.98) were associated with worse CSS compared to localized tumors.ConclusionThis study delving into WT survival dynamics reveals a multifaceted landscape influenced by clinicopathological variables. This comprehensive understanding emphasizes the imperative for ongoing research and personalized interventions to refine survival rates and address nuanced challenges across age, stage, and tumor spread in WT patients.

"A Retrospective Evaluation of the Impact of Prenatal Diagnosis of Facial Clefts. Does Prenatal Diagnosis Matter?"

With the advent of improved prenatal detection, some patients with facial clefting are diagnosed prenatally while others are diagnosed postnatally. There is limited data regarding the utility of prenatal diagnosis and how this affects care of patients with facial clefts. A retrospective chart review was performed. Children with incomplete demographic data and those with syndromic conditions were excluded. The data were analyzed via Fisher's exact tests and Kruskal-Wallis tests (p < 0.05). 106 patients met inclusion criteria. Facial clefting was diagnosed prenatally at different frequencies depending on type of facial cleft- patients with cleft palate alone were less likely to be identified prenatally (p < 0.0001). Patients diagnosed prenatally were seen by craniofacial specialists at an earlier age compared to those diagnosed after birth (0.27 months vs 0.7 months, p < 0.001). Similarly, those with prenatal diagnosis underwent surgery at a younger age compared to those who were diagnosed postnatally (median: 3.6 months vs 10.67 months, p < 0.001) and experienced shorter lag time (median: 3.4 months vs 8.4 months, p = 0.027) from consultation to surgery. Importantly, prenatal diagnosis resulted in pre-surgical therapy more often than in children diagnosed postnatally (86% vs 22.2%, p < 0.001). Our data suggests that patients with prenatal diagnosis of facial clefts were more likely to undergo pre-surgical therapy, presented to a craniofacial specialist at an earlier age, underwent surgery at an earlier age, and experienced less lag time between initial visit and surgery. More study is warranted to improve protocols for prenatal diagnoses to improve surgical outcomes.

Comparison of Brain Function and Structure in Patients with Major Depression: A Systematic Review and Meta-Analysis of MRI-Based Data

Background: Depression is a common mental illness worldwide. Neuroimaging techniques, such as magnetic resonance imaging and functional magnetic resonance imaging, play an essential role in diagnosing and evaluating depression. This study is based on magnetic resonance imaging (MRI)-related research to explore the comparison of brain function and structure between patients with severe depression and normal individuals, and to conduct meta-analysis. Methods: We conducted searches in various databases such as PubMed, Web of Science, Embase, and Cochrane Library to obtain research data on comparing brain function and structure between patients with severe depression and healthy individuals. The search keywords included “Major Depressive Disorder”, “Brain Function”, “Brain Structure”, “Depression”, “MRI”, and “Magnetic Resonance”. The quality assessment was conducted using the bias risk assessment tool recommended by the Cochrane Collaborative Network. Literature was screened following the predetermined inclusion and exclusion criteria, and Anisotropic Effect-Size Seed-Based Differential Mapping (AES-SDM) was used for systematic meta-analysis. Regression analysis was performed on age, gender, disease duration, years of education, and treatment status. Results: After a thorough screening process, 10 documents were selected for subsequent analysis. These studies consisted of 477 study subjects, including 231 depression patients and 246 healthy individuals. The proportion of women was 36%–75%, and the disease duration was 3–60 months. The patients in 4 documents had first attacks, and the patients in the other 6 documents had multiple attacks. The baseline conditions of the 10 included documents were consistent and comparable. None of the studies reported blinding methods, and none of the results had incomplete data. The Regional homogeneity (ReHo) levels in the left precuneus (BA7), lentiform nucleus (BA48), and left prefrontal lobe (BA32) were significantly increased in the depression group, with voxel numbers of 358, 116, and 181, respectively. Conversely, the left postcentral gyrus (BA4), left cerebellar area (hemispheric lobule I, IV/V, lingual gyrus, fusiform gyrus), left fusiform gyrus (BA30), and right cingulate gyrus (BA23) were significantly reduced, with voxel numbers of 17, 50, and 124, respectively. Furthermore, regression analysis showed that gender, age, disease duration, years of education, and disease severity were potential influencing factors, and the disease duration demonstrated the most significant impact on the left cingulate gyrus (SDM = 2.777). Conclusion: There are significant differences in brain function and structure between patients with major depression and healthy individuals. Furthermore, our findings reveal a substantial correlation between the severity of depressive symptoms and brain function and structure indicators. These findings provide novel research directions and ideas for the diagnosis and treatment of depression.

Assessing the integration of refugee health data into national health information systems in Jordan, Lebanon, and Uganda

BackgroundWith the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators.MethodsThe study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria.ResultsOur analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees’ well-being and access to healthcare services.ConclusionThe current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

Characteristics and career outcomes of dermatology-focused medical student research grant recipients

Although several dermatology-focused research grants for medical students exist, studies have yet to evaluate the outcomes of grant recipients, such as entry into dermatology residency and academic careers. We have described the characteristics of recipients of dermatology-focused medical student research grants and outcomes, including entry into dermatology residency and academic careers, and we have focused on seven dermatology-focused national and regional research grants eligible for U.S. medical students. Data were obtained from publicly available online sources for grants from 2004 to 2023. Of the 235 medical student recipients of dermatology research grants between 2004 and 2023, 45.5% attended one of the top 20 medical schools funded by National Institutes of Health research. Of those who completed medical school, 68.3% advanced to a dermatology residency (n=123/180). Among board-certified dermatologists, 44.7% held an academic position (n=34/76); among those who attended a top 20 medical school, 50% held an academic position (n=23/46) compared to 36.7% who did not (n=11/30). Limitations of this study include selection bias and incomplete data availability. Medical student research grants allow students to thoughtfully engage in dermatology research early in medical education. They may facilitate entry into dermatology residency and academic careers and lead to continued research endeavors.

Risk analysis of petroleum storage tank based on uncertain data incorporated into mapped Bow-tie to Bayesian network

The petroleum industry has an important impact on the environment, which is why risk analysis for a petroleum storage tank is required in the process industry. However, conducting an exhaustive study is frequently complicated due to the incomplete data based on historical system information, feedback, or test results. The main goal of this study is to develop an innovative framework that integrates the Bow-tie method with MIMAH (Methodology for the Identification of Major Accident Hazards). This approach specifically aims to identify the most critical accident scenario and comprehensively list all realistic causes (basic events) associated with petroleum storage tanks. Acquiring historical data on basic events poses challenges due to the lack, insufficiency, and imprecision of failure data. To address this obstacle and predict the system’s evolution, a combination of established methods for handling uncertainty and multi-criteria decision-making has been proposed. This combination incorporates a modified Fuzzy Analytical Hierarchy Process with Chang’s Extent Analysis Method (FAHP-EAM), fuzzy set theory, and expert elicitation, contributing to an extensive approach for managing uncertainty and making informed decisions in the absence of comprehensive historical data. Furthermore, the Bow-tie model is converted into a dynamic Bayesian network to improve risk analysis by integrating probabilistic reasoning and capturing the dynamic interactions among multiple risk factors. This integrated approach is validated on real scenarios. The utilization of dynamic Bayesian networks further facilitates the suggestion of scenarios to assess the contribution of basic events to the critical event and evaluate the resulting environmental impacts. Finally, the prediction of threat zones for various hazardous effects, such as toxicity, thermal radiation, and overpressure linked to chemical releases following the occurrence of the critical event, is carried out. The risk analysis outcomes from this study offer valuable data for assessment, enabling managers to improve the quality of risk management and formulate effective risk mitigation strategies.

Adrenal gland injury in trauma patients and its impact on clinical outcomes.

Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI. All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates. A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality. Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.

PanPIERS: A tool for risk prediction of adverse maternal outcomes for patients with pre-eclampsia using incomplete data

panPIERS: A tool for risk prediction of adverse maternal outcomes for patients with pre-eclampsia using incomplete data

Associated bacterial and fungal infections in burn wounds: Common factors, distribution in etiology, age groups, bacterial and fungal strands – Evaluation of a single burn center experience of 20 years

IntroductionBurn intensive care unit (BICU) patients suffer from reduced immunological competence. Often bacterial and fungal infections occur as single or associated infection of the burn site. However, common factors in associated infections are discussed controversially. In this study we evaluated factors common in associated occurrence of bacterial and fungal infection in the burn population. Patients and methodsIn total 213 patients, admitted to the ICU of Cologne Merheim Clinical Center between 1988 and 2011, with associated infections were included in this study. Exclusion criteria were no bacterial, or no fungal infection, or incomplete data. Data evaluated were sex, age, type of burn injury, total body surface area (TBSA), abbreviated burn severity index (ABSI) score, 3rd degree burn, inhalation injury, length of BICU stay, antibiotic therapy, bacterial strand, fungal strand, incidence of bacteria and fungus infection, single or associated occurrence and bacteria species associated with fungus species. Statistical analysis comprised of univariate, Chi-square and Fischer Exact test, multivariate analysis, positive and negative predictive value, logistic regression analysis with the Nagelkerke, Cox/ Snell R-square. Results196 patients were included into the study, 147 male and 49 female. Total mean age was 47 years, in the fire burn group 47 years, in scalding 53 years, in electrical burn 29 years and in chemical burn 62 years. 123 male and 45 female were combusted, 15 male and 3 female scalded, 9 male had an electrical burn and 1 female a chemical burn. The mean TBSA in fire burns was 41 %, in scalding 42 %, in electrical burns 46 %, and in chemical burn 16 %. The mean ABSI in fire burn and scalding was 9, in electrical burn 8 and in chemical burn 7. The 3rd degree burns were 16 % in fire burn and 13 % in scalding and electrical burn and 0 % in chemical burn. The length of BICU stay was 49 days for fire burn, 47 days for scalding, 58 days in electrical burn and 21 days in chemical burn patients.The gram-positive bacterial strands most often found were Staphylococcus strands, gram negative Pseudomonas and Acinetobacter strands. Candida albicans was the most often present fungal strand. There was no difference in incidence between gram positive and gram-negative bacteria. In patients suffering from fire burns the most common bacteria were Staphylococcus and Pseudomonas, in scalding Acinetobacter, and in chemical burns Staphylococcus. In electrical burns no predominant bacterial strand was found. The associated occurrence of Staphylococcus and Candida albicans and Pseudomonas and Candida albicans was predominant. In patients with fire burn, 48% showed an associated infection, in scalding 21%, in electrical burn 33% and in chemical burn 100%.Combusted patients had the highest incidence of associated infection in age group 80–89 years, in scalding 40–49, 50–59 and 70–79 years, in electrical burn 20–29 years and in chemical burn 60–69 years. Most common factors of associated infections were higher age, high TBSA with 3rd degree burns and bacterial infections. Interestingly inhalation injury was highly inversely correlated to associated infection. ConclusionThe associated occurrence of bacterial and fungal wound infection is highest in burn patients with infections with Staphylococcus or Pseudomonas, the incidence is mainly found in fire burn and electrical burns. The use of oxygen in inhalation injury might prevent associated bacterial and fungal infections.

Evaluation of the Ei SMART training programme in the UK

IntroductionEarly intervention (Ei) is recommended for infants at high risk of neurodevelopmental challenges. Ei SMART is an evidence-based clinical reasoning framework supporting infant development by integrating Sensory, Motor, Attention and regulation, and Relational development through healthcare professionals (HCPs) and parents working Together. Aim: To evaluate learning outcomes following Ei SMART training. Methods34 staff members from one UK neonatal operational delivery network participated in face-to-face training, co-produced and co-presented by parents and HCPs via online modules/tutorials. Participants completed pre/post-training surveys. Questions quantified self-perceived understanding of Infant Development & Well-Being, Parent/Family Support and Engagement, and Staff Engagement & Well-Being. Total and Domain scores were compared pre/post-training. Results33/34(97%) respondents completed both pre-and post-training surveys; one respondent was excluded (incomplete data). Median (IQR) post-training score was significantly increased (152(22) v 108(26) (p < 0.001), as were domain scores. ConclusionEi SMART training provided measurable improvements in perceived learning for HCPs.

Association of dietary carbohydrate intake with bone mineral density, osteoporosis and fractures among adults without diabetes: Evidence from National Health and Nutrition Examination Survey

BackgroundThe impact of dietary carbohydrate intake on bone health remains a subject of controversy, potentially influenced by individuals with diabetic osteoporosis who exhibit normal or elevated bone mineral density (BMD). The cross-sectional study was conducted to explore the association between carbohydrate intake and BMD, osteoporosis and fractures among adults without diabetes, based on the National health and nutrition examination survey (NHANES). MethodsParticipants were from the NHANES 2005–2010, excluding individuals with diabetes and those with incomplete data. The association between carbohydrate intake and BMD was analyzed using Spearman correlation, linear regression analysis and subgroup analysis, respectively. The association between carbohydrate intake and osteoporosis/fractures was analyzed using weighted logistic regression analysis. ResultsA total of 7275 adult participants were included and their dietary carbohydrate intake was inversely associated with BMD in the total femur [β = −0.20 95%CI (−0.30, −0.10); p < 0.001], femoral neck [β = −0.10 95%CI (−0.20, −0.00); p = 0.002], and lumbar spine [β = −0.10 95%CI (−0.20, −0.00); p = 0.004]. Stratified analysis indicated that individuals aged 65 and over, women, and non-Hispanic whites were more likely to have lower BMD. Furthermore, a higher intake of dietary carbohydrates was associated with an increased risk of osteoporosis [OR = 1.001 95%CI (1.001, 1.001); p < 0.001] and fractures at the hip [OR = 1.005 95%CI (1.005, 1.005); p < 0.001], wrist [OR = 1.001 95%CI (1.001, 1.001), p < 0.001], and spine [OR = 1.003 95%CI(1.003, 1.003); p < 0.001]. ConclusionsA higher carbohydrate diet is associated with lower BMD and a higher risk of osteoporosis and fractures among adults without diabetes, and a higher carbohydrate consumption show a stronger effect in individuals aged 65 and over, women, and non-Hispanic whites.

A challenging decision for emergency physicians: Routine repeat computed brain tomography of the brain in head trauma in infants and neonates.

Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain. Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package. Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay. Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.

Digital twin and fuzzy framework for supply chain sustainability risk assessment and management in supplier selection

Risks in the supply chain can damage many companies and organizations due to sustainability risk factors. This study evaluates the supply chain risk assessment and management and then selects the best supplier in a gas company in Egypt. A comprehensive methodology can use the experts' opinions who use the linguistic variables in the spherical fuzzy numbers (SFNs) to evaluate the criteria and suppliers in this study based on their views. Selecting the best supplier is a complex task due to various criteria related to supply chain risk assessment, such as supply risks, environmental risks, financial risks, regularity risks, political risk, ethical risks, and technology risks and their sub-criteria. This study suggested a new combined model with multi-criteria decision-making (MCDM) under a spherical fuzzy set (SFS) environment to overcome uncertainty and incomplete data in the assessment process. The MCDM methodology has two methods: the Entropy and COmbinative Distance-based Assessment (CODAS) methods. The SFS-Entropy is used to compute supply chain risk assessment and management criteria weights. The SFS-CODAS method is used to rank the supplier. The main results show that supply risks have the highest importance, followed by financial and environmental risks, and ethical risks have the lowest risk importance. The criteria weights were changed under sensitivity analysis to show the stability and validation of the results obtained from the suggested methodology. The comparative analysis is implemented with other MCDM methods named TOPSIS, VIKOR, MARCOS, COPRAS, WASPAS, and MULTIMOORA methods under the SFS environment. This study can help managers and organizations select the best supplier with the lowest sustainability risks.

Missed Follow-up is associated with worse survival in stage I lung cancer: results from a large multi-site academic hospital system

The purpose of this study is to examine the effect of early incomplete follow-up on overall survival among stage I lung cancer patients. Patients with clinical stage I lung cancer at our institution between 2007 and 2016 were identified (N = 1111). Exclusions included < 18 years of age (N = 2), missing stage or demographics (N = 56), incomplete appointment data or had only one scheduled appointment (N = 351), or did not survive for at least 1 year after diagnosis (N = 120). Missed appointments were defined as unattended follow-up appointments within the first year of diagnosis without an attended appointment in the subsequent 60 days. The primary outcome was the hazard ratio (HR) for death associated per 10% increase in missed oncology follow-up appointments. Univariable and descriptive statistics were performed, and a multivariable landmark Cox regression model was created to examine the effect of missed oncology follow-up on survival. A total of 582 patients were analyzed with median follow-up of 3.2 years and median age of 69 years. On multivariable analysis controlling for age, sex, race, insurance status, and definitive treatment type the HR for death was 1.44 (95% CI 1.05–1.97) for every 10% increase in missed appointments. Incomplete oncologic follow-up may negatively impact overall survival among survivors of early-stage lung cancer.

Data Completion-Guided Unified Graph Learning for Incomplete Multi-View Clustering

Due to its heterogeneous property, multi-view data has been widely concerned over single-view data for performance improvement. Unfortunately, some instances may be with partially available information because of some uncontrollable factors, for which the incomplete multi-view clustering (IMVC) problem is raised. IMVC aims to partition unlabeled incomplete multi-view data into their clusters by exploiting the heterogeneity of multi-view data and overcoming the difficulty of data loss. However, most existing IMVC methods like BSV, MIC, OMVC, and IVC tend to conduct basic completion processing on the input data, without taking advantage of the correlation between samples and information redundancy. To overcome the above issue, we propose one novel IMVC method named data completion-guided unified graph learning (DCUGL), which could complete the data of missing views and fuse multiple learned view-specific similarity matrices into one unified graph. Specifically, we first reduce the dimension of the input data to learn multiple view-specific similarity matrices. By stacking all view-specific similarity matrices, DCUGL constructs a third-order tensor with the low-rank constraint, such that sample correlation within and between views can be well explored. Finally, by dividing the original data into observed data and unobserved data, DCUGL can infer and complete the missing data according to the view-specific similarity matrices, and obtain a unified graph, which can be directly used for clustering. To solve the proposed model, we design an iterative algorithm, which is based on the alternating direction method of multipliers framework. The proposed model proves to be superior by benchmarking on six challenging datasets compared with state-of-the-art IMVC methods.