Conservative Threshold Research Articles

Abstract 4135517: Echocardiographic Biomarkers Enhance Mortality Predictions in Cirrhosis Patients

Introduction: Cirrhosis, a late-stage liver disease, is associated with numerous systemic complications, making long-term mortality prediction challenging. Traditional models like Child-Pugh and MELD are primarily designed for short-term (3-month) mortality. This study evaluates the impact of incorporating echocardiographic (echo) variables in predicting long-term mortality in cirrhosis patients. Methods: A retrospective cohort study was conducted using data from 60 patients with clinically diagnosed cirrhosis from Hippokration Hospital, Greece, spanning 2018 to 2022. Patients were followed for up to 52 months. Exclusion criteria included pre-existing cardiovascular diseases and significant co-morbidities. Patients were categorized into survived to end of study (n=31) and died during study (n=29) groups. Outcomes were analyzed using multivariate logistic regression and Cox proportional hazards models, and include parameters for age, blood pressure, lab-based biomarkers (potassium, pro-brain natriuretic peptide, hemoglobin, platelet count, aspartate transaminase, gamma-glutamyl transferase, uric acid), and echo/ecg measurements (QT interval, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), left atrial GLS, annulus velocities, and E/A ratio). Results: The multivariate logistic regression model (MELD+) that included echo variables showed a 10% improvement in area under the curve (AUC: 0.901) compared to the MELD model alone (AUC: 0.817). MELD+ improved risk classification accuracy by nearly 10% with a conservative threshold. The Cox proportional hazards model with MELD+ also demonstrated superior performance (AUC: 0.923; C-index: 0.875; Brier Score: 0.097) compared to the MELD model alone (AUC: 0.892; C-index: 0.831; Brier Score: 0.134). The MELD+ model showed less variation in hazard ratio confidence intervals, indicating more consistent risk estimation. Conclusion: Incorporating echocardiographic measurements enhances the accuracy of long-term mortality predictions in cirrhosis patients. These findings suggest that cardiac imaging should be considered in risk assessments for cirrhosis patients, particularly for predicting survival beyond three months.

Abstract 29: Blood Pressure Phenotypes in an Interventional Study of Participants with Heart Failure with Preserved Ejection Fraction

Background: Heart failure (HF) with preserved ejection fraction (HFpEF) affects engenders high morbidity and mortality. Hypertension is a major risk factor for HFpEF progression. We aimed to evaluate the prevalence of and factors associated with abnormal home blood pressure (BP) phenotypes in a trial cohort of individuals with hypertension and HFpEF. Methods: We evaluated baseline office and home BP measurements in 36 participants of BLOCK HFpEF, an ongoing trial of antihypertensive treatment in HFpEF (NCT04434664). Office BP was measured using a standardized approach with the average of 3 seated readings. Home BP was measured for the first 7 days of the trial, prior to initiating the intervention. Participants were asked to perform nocturnal home BP one night, taken 3 times while sleeping. We used a conservative threshold for controlled BPs, defined as office systolic BP (SBP) <140 mmHg, office diastolic BP (DBP) <90 mmHg, home daytime SBP <135 mmHg, and home daytime DBP <85 mmHg. White coat effect was defined as elevated office and controlled home BP. Masked uncontrolled hypertension was defined as controlled office and elevated home BP. Sustained hypertension was defined as controlled office and elevated home BP. Nocturnal hypertension was defined as nighttime SBP ≥120 mmHg or DBP ≥70 mmHg. Results: Of the 36 participants with home BP data, 7 (19%) had controlled hypertension, 6 (17%) had white coat effect, 6 (17%) had masked uncontrolled hypertension, and 17 (47%) had sustained hypertension. 27 participants completed nighttime home BP readings, among whom 23 (85%) had nocturnal hypertension. Of those with nocturnal hypertension, 2 (9%) had controlled hypertension based on their daytime home BPs, 3 (13%) had white coat effect, 5 (22%) had masked uncontrolled hypertension, and 13 (56%) had sustained hypertension. There was no significant difference in age, sex, race, history of atrial fibrillation, and history of diabetes mellitus across BP phenotypes. The mean number of cardiology visits in the two years before enrollment was 4.3 (SD 2.8), which did not differ across home BP phenotypes. Conclusion: Masked uncontrolled hypertension and nocturnal hypertension were common in patients enrolled in the BLOCK HFpEF trial. These home BP phenotypes cannot be determined using office BP alone. While this is a small sample, patients with HFpEF may particularly benefit from careful BP phenotyping using out-of-office monitoring, including nocturnal BP monitoring.

Basis-Set Limit CCSD(T) Energies for Large Molecules with Local Natural Orbitals and Reduced-Scaling Basis-Set Corrections.

The calculation of density-based basis-set correction (DBBSC), which remedies the basis-set incompleteness (BSI) error of the correlation energy, is combined with local approximations. Aiming at large-scale applications, the procedure is implemented in our efficient local natural orbital-based coupled-cluster singles and doubles with perturbative triples [LNO-CCSD(T)] scheme. To this end, the range-separation function, which characterizes the one-electron BSI in space, is decomposed into the sum of contributions from individual localized molecular orbitals (LMOs). A compact domain is constructed around each LMO, and the corresponding contributions are evaluated only within these restricted domains. Furthermore, for the calculation of the complementary auxiliary basis set (CABS) correction, which significantly improves the Hartree-Fock (HF) energy, the local density fitting approximation is utilized. The errors arising from the local approximations are examined in detail, efficient prescreening techniques are introduced to compress the numerical quadrature used for DBBSC, and conservative default thresholds are selected for the truncation parameters. The efficiency of the DBBSC-LNO-CCSD(T) method is demonstrated through representative examples of up to 1000 atoms. Based on the numerical results, we conclude that the corrections drastically reduce the BSI error using double-ζ basis sets, often to below 1 kcal/mol compared to the reliable LNO-CCSD(T) complete basis set references, while significant improvements are also achieved with triple-ζ basis sets. Considering that the calculation of the DBBSC and CABS corrections only moderately increases the wall-clock time required for the post-HF steps in practical applications, the proposed DBBSC-LNO-CCSD(T) method offers a highly efficient and robust tool for large-scale calculations.

Determining Thresholds for Conservation of Vernal Pools

Determining Thresholds for Conservation of Vernal Pools

Assessing microclimate thresholds for heritage preventive conservation to achieve sustainable and energy efficiency goals in a changing climate

This research addresses the issue of the heritage preventive conservation in the perspective of energy sustainability, for contributing to the achievement of the Sustainable Development Goals (SDGs) and towards the EU Green Deal. The study analyses and compares four cases associated with different microclimate thresholds as suggested by the standard EN 16893:2018 (Cases 1–3) and as derived from the outputs of three degradation models for preserving paper, wood, and canvas paintings (Case 4). Weather-based indices (degree and gram days) were calculated to estimate trends in the potential energy demand of collection facilities in three European cities belonging to different Köppen-Geiger climate zones (Cfb, Csa, and Dfb), under recent past (1981–2010) and near/far future climate scenarios (2021–2050 and 2071–2100) from two Shared Socioeconomic Pathways (SSP2-4.5 and SSP5-8.5). The findings suggest that adapting facilities’ management strategies to focus on collections preservation can facilitate the achievement of 5 out of 17 SDGs, offering a viable alternative to costly energy retrofits and encouraging the development of shared solutions for similar facilities in the same climate zone. The results can contribute to inform the revision of EN 16893 and to face major challenges such as the preservation of paper collections in southern latitudes.

Utility of D-dimer in predicting pulmonary embolism in patients with COVID-19 presenting to the emergency department.

While our understanding of coronavirus disease 2019 (COVID-19) has evolved, uncertainty remains regarding utility of previously established pulmonary embolism (PE) screening guidelines in patients with COVID-19. Many studies have investigated the efficacy of D-dimer (DD) screenings for patients with COVID-19 admitted to inpatient services, but few have evaluated patients in the emergency department (ED). The purpose of this study was to investigate utility of DD threshold for PE screening in patients with COVID-19 presenting to the ED. This was a retrospective, multicenter cohort including patients presenting to three EDs between March 1, 2020 and February 1, 2021 who tested positive for COVID-19 during ED visit or in 60 days prior to presentation and had DD ordered in ED. Patients were grouped by those who underwent computed tomography pulmonary angiogram (CTPA) to evaluate for PE and those who did not, and descriptive statistics were performed. Those who underwent CTPA were further divided into PE-positive and PE-negative groups. The discriminative ability of DD in predicting PE in patients with COVID-19 was analyzed using the receiver operating characteristic (ROC) curve. A total of 570 patients with COVID-19 were included in the study, of which 107 underwent CTPA to evaluate for PE. History of diabetes, elevated glucose, elevated lactate dehydrogenase, elevated white blood cell count, elevated platelets, elevated respiratory rate, and lower temperature were associated with increased risk for PE. Compared to those without PE, patients with PE were significantly more likely to be hospitalized (100%vs. 82%, p=0.020) and admitted to the ICU (64%vs. 24%, p=0.002). Those with PE had a significantly higher median DD value (21,177ng/mL) compared to PE-negative group (952ng/mL, p<0.001). The ROC curve for DD in predicting PE had an area under the curve of 0.91 (95% confidence interval [0.84, 0.98]). In our study population, the optimal DD threshold for predicting PE was 1815ng/mL (sensitivity 93% and specificity 80%). A conservative threshold of 1089ng/mL could be used with sensitivity 100% and specificity 58%. DD is often elevated in patients with COVID-19, regardless of PE. While the classically used DD cutoff is 500ng/mL, our study demonstrated a threshold of 1089ng/mL safely predicted PE in patients withCOVID-19 .

Anti-SARS-CoV-2 Antibodies versus Vaccination Status in CAD Patients with COVID-19: A Prospective, Propensity Score-Matched Cohort Study.

Despite the currently prevailing, milder Omicron variant, coronary artery disease (CAD) patients constitute a major risk group in COVID-19, exhibiting 2.6 times the mortality risk of non-CAD patients and representing over 22% of non-survivors. No data are currently available on the efficacy of antibody levels in CAD patients, nor on the relevance of vaccination status versus antibody levels for predicting severe courses and COVID-19 mortality. Nor are there definitive indicators to assess if individual CAD patients are sufficiently protected from adverse outcomes or to determine the necessity of booster vaccinations. A prospective, propensity-score-matched, multicenter cohort study comprising 249 CAD patients and 903 controls was conducted. Anti-SARS-CoV-2-spike antibodies were measured on hospital admission. Prespecified endpoints were in-hospital mortality, intensive care, and oxygen administration. After adjustment for potential confounders, CAD patients exhibited 4.6 and 6.1-times higher mortality risks if antibody levels were <1200 BAU/mL and <182 BAU/mL, respectively, compared to CAD patients above these thresholds (aOR 4.598, 95%CI 2.426-8.714, p < 0.001; 6.147, 95%CI 2.529-14.941, p < 0.001). Risk of intensive care was 3.7 and 4.0 (p = 0.003; p < 0.001), and risk of oxygen administration 2.6 and 2.4 times higher below these thresholds (p = 0.004; p = 0.010). Vaccination status was a weaker predictor of all three outcomes than both antibody thresholds. Antibody levels are a stronger predictor of outcome in CAD patients with COVID-19 than vaccination status, with 1200 BAU/mL being the more conservative threshold. Measuring anti-SARS-CoV-2 antibodies in CAD patients may ensure enhanced protection by providing timely booster vaccinations and identifying high-risk CAD patients at hospital admission.

Intervention at an early threshold for post-hemorrhagic ventricular dilatation in preterm infants: a systematic review and meta-analysis.

Very few adequately powered studies exploring early thresholds for intervention in the management of post-hemorrhagic ventricular dilatation (PHVD) in preterm infants have identified consistent neurodevelopmental advantages at 12-30months. We aimed to conduct a meta-analysis on the efficacy and safety of early versus conservative thresholds for intervention, primarily aimed at normalizing cerebrospinal fluid (CSF) pressure, in the management of PHVD in preterm infants. Multiple databases were searched for eligible papers, and prospective randomized trials involving preterm infants were selected. The results are expressed as relative risks (RRs) with 95% confidence intervals (CIs). The main outcome was survival without moderate-to-severe neurodevelopmental impairment at 12-30months. Ten articles representing seven randomized trials comparing early versus conservative thresholds for interventions were included. Five trials (n = 545 infants) reported no difference in the main outcome between early and conservative groups [RR 0.99 (0.71, 1.37)]. Sensitivity analysis excluding data from a medication trial did not alter the main outcome [RR 1.15 (0.95, 1.39)]. Infants in the early threshold group received significantly more interventions [RR 1.48 (1.05, 2.09)]. Deaths before discharge/during the initial study period [RR 1.04 (0.70, 1.54)] or a composite of death or shunt insertion [RR 1.04 (0.86, 1.27)] were comparable between the two groups. Early intervention for PHVD, before a clinical or ultrasound threshold is met, leads to additional clinical procedures but does not improve survival without moderate-severe neurodevelopmental impairment at 12-30months. Caution should be exercised in interpreting these results due to significant variation between the studies. Supplementary file 3 (MP4 131172kb).

Adaptive stacked species distribution modelling: Novel approaches to large scale quantification of blue carbon to support marine management

This study introduces a novel concept of ‘Adaptively Stacked’ Species Distribution Models (AS-SDMs) to predict blue carbon habitat distribution, abundance, carbon stocks, and carbon sequestration potential in Orkney. AS-SDMs are built from Weighted Boosted Regression Trees (WBRTs) that adaptively stack blue carbon sediment thickness, sediment carbon content, and sequestration potential to predicted abundance. A novel method to describe substrate types by relative inputs of mud, sand, and gravel is detailed that better characterises the determining factors of seagrass, maerl, and horse mussel abundance. This study also introduces a novel use of indexes to mitigate double counting issues of mixed species distribution models.Seagrass, maerl, horse mussel, and mixed seagrass and maerl (SGM) habitats are estimated to cover a maximum area of 657 km2 in Orkney, have a total sediment carbon stock of 16 Mt. C, and sequester 6000 t C yr−1. Applying a conservative threshold of 50 % abundance to habitat predictions, six key potential areas of blue carbon offset projects are identified. These areas cover just over 9 km2, have a total carbon stock of 330,000 t C, and sequester 330 t C yr−1. When applied to UK carbon credit value, assuming integration with voluntary markets and compliance with accreditation criteria, the habitats in these areas have a potential value of £24.5 million. If applied as annual values, these areas have carbon stocks with a potential value of £0.93 million yr−1 and a carbon sequestration potential value of £24,000 yr−1.

The Identification of Manure Spreading on Bare Soil through the Development of Multispectral Indices from Sentinel-2 Data: The Emilia-Romagna Region (Italy) Case Study.

Satellite remote sensing is currently an established, effective, and constantly used tool and methodology for monitoring agriculture and fertilisation. At the same time, in recent years, the need for the detection of livestock manure and digestate spreading on the soil is emerging, and the development of spectral indices and classification processes based on satellite multispectral data acquisitions is growing. However, the application of such indicators is still underutilised and, given the polluting impact of livestock manure and digestate on soil, groundwater, and air, an in-depth study is needed to improve the monitoring of this practice. Additionally, this paper aims at exposing a new spectral index capable of detecting the land affected by livestock manure and digestate spreading. This indicator was created by studying the spectral response of bare soil and livestock manure and digestate, using Copernicus Sentinel-2 MSI satellite acquisitions and ancillary datasets (e.g., soil moisture, precipitation, regional thematic maps). In particular, time series of multispectral satellite acquisitions and ancillary data were analysed, covering a survey period of 13 months between February 2022 and February 2023. As no previous indications on fertilisation practices are available, the proposed approach consists of investigating a broad-spectrum area, without investigations of specific test sites. A large area of approximately 236,344 hectares covering three provinces of the Emilia-Romagna Region (Italy) was therefore examined. A series of ground truth points were also collected for assessing accuracy by filling in the confusion matrix. Based on the definition of the spectral index, a value of the latter greater than three provides the most conservative threshold for detecting livestock manure and digestate spreading with an accuracy of 62.53%. Such results are robust to variations in the spectral response of the soil. On the basis of these very encouraging results, it is considered plausible that the proposed index could improve the techniques for detecting the spreading of livestock manure and digestate on bare ground, classifying the areas themselves with a notable saving of energy compared to the current investigation methodologies directly on the ground.

Evaluating foliar insecticides and economic thresholds for Tychius picirostris (Coleoptera: Curculionidae) management in Oregon white clover seed production.

The clover seed weevil, Tychius picirostris Fabricius (Coleoptera: Curculionidae), is a major pest in Oregon white clover seed crops. Reliance on synthetic pyrethroid insecticides and limited availability of diverse modes of action (MoAs) has increased insecticide resistance selection in regional T. picirostris populations, emphasizing the need to evaluate novel chemistries and rotational strategies for effective insecticide resistance management (IRM). The efficacy of 8 foliar insecticide formulations for managing T. picirostris adult and larval life stages was determined in small and large-plot field trials across 2 crop years. In both years, bifenthrin (Brigade 2EC), the grower's standard, showed negligible adult and larval suppression. Insecticide formulations with isocycloseram and cyantraniliprole active ingredients reduced adult and larval populations when applied at BBCH 59-60 (prebloom) and BBCH 65-66 (full bloom) growth stages, respectively. While differences in T. picirostris abundance were observed among insecticide treatments, seed yield differences were not detected in large-plot trials. Larval abundance was correlated with reduced seed yield, and an economic threshold of ≥3 larvae per 30 inflorescences was determined as a conservative larval threshold to justify foliar applications of diamide insecticides. Additional commercial white clover seed fields were surveyed to compare larval scouting techniques, including a standard Berlese funnel and a grower's do-it-yourself funnel. Both larval extraction techniques were correlated and provided similar estimates of larval abundance. These findings demonstrate new MoAs, optimal insecticide application timing, and larval monitoring methods that can be incorporated into an effective T. picirostris IRM program in white clover seed crops.

Sex-specific effects of birth weight on longitudinal behavioural outcomes in children and adolescents: findings from the raine study.

Previous cross-sectional studies suggest that birth weight (BW) is associated with aggression-, social- and attention problems differently in boys and girls. We sought to test if these differences could be confirmed in a longitudinal study. The 1989 Raine Study provided prospectively collected data on perinatal variables and repeated child behaviour checklist assessments from ages 5 to 17. Linear mixed effects models provided crude and adjusted relationships between BW and childhood behaviour at a conservative significance threshold using prenatal maternal covariables in adjusted models. Sensitivity analyses included an age10 teacher assessment. Data on behaviour, BW and sex, was available in 2269 participants. Male sex was associated with increased aggression problems at lower BW compared to females in the crude model (Interaction B: -0.436, 98.3%CI: [-0.844, -0.0253]), but not the adjusted model (Interaction B: -0.310, 98.3%CI: [-0.742, 0.140]). Male sex was associated with increased attention problems at lower BW compared to females in both the crude model (Interaction B: -0.334, 98.3%CI: [-0.530, -0.137]) and the adjusted model (Interaction B: -0.274, 98.3%CI: [-0.507, -0.0432]). Male sex was associated with increased social problems at lower BW compared to females in both the crude model (Interaction B: -0.164, 98.3%CI: [-0.283, -0.0441]) and the adjusted model (Interaction B: -0.148, 98.3%CI: [-0.285, -0.00734]). Using repeated measures from ages 5-17 we were able to show a crude and adjusted male vulnerability to lower BW in the development of attention problems and social problems. We did not find a BW x sex interaction for the development of aggressive behaviour.

Safety and Efficacy of Para-Aminohippurate Coinfusion for Renal Protection During Peptide Receptor Radiotherapy in Patients with Neuroendocrine Tumors.

Para-aminohippurate, also known as p-aminohippuric acid (PAH), is used clinically to measure effective renal plasma flow. Preclinically, it was shown to reduce 177Lu-DOTATOC uptake in the kidneys while improving bioavailability compared with amino acid (AA) coinfusion. We report the safety and efficacy of PAH coinfusion during peptide receptor radiotherapy in patients with neuroendocrine tumors. Methods: Twelve patients with metastatic or unresectable gastroenteropancreatic neuroendocrine tumors received 177Lu-DOTATOC in 33 treatment cycles. Either 8 g of PAH or a mixture of 25 g of arginine and 25 g of lysine were coinfused. Safety was assessed by monitoring laboratory data, including hematologic and renal data, as well as electrolytes obtained before and 24 h after treatment. For radiation dosimetry, whole-body scans were performed at 1, 24, and 48 h and a SPECT/CT scan was performed at 48 h, along with blood sampling at 5 min and 0.5, 2, 4, 24, and 48 h after administration. Absorbed dose estimations for the kidneys and bone marrow were performed according to the MIRD concept. Results: In 15 treatment cycles, PAH was coinfused. No changes in mean creatinine level, glomerular filtration rate, and serum electrolytes were observed before or 24 h after treatment when using PAH protection (P ≥ 0.20), whereas serum chloride and serum phosphate increased significantly under AA (both P < 0.01). Kidney-absorbed dose coefficients were 0.60 ± 0.14 Gy/GBq with PAH and 0.53 ± 0.16 Gy/GBq with AA. Based on extrapolated cumulative kidney-absorbed doses for 4 cycles, 1 patient with PAH protection and 1 patient with AA protection in our patient group would exceed the 23-Gy conservative threshold. The bone marrow-absorbed dose coefficient was 0.012 ± 0.004 Gy/GBq with PAH and 0.012 ± 0.003 Gy/GBq with AA. Conclusion: PAH is a promising alternative to AA for renal protection during peptide receptor radiotherapy. Further research is required to systematically investigate the safety profile and radiation dosimetry at varying PAH plasma concentrations.

Could paramedics use the HEART Pathway to identify patients at low-risk of myocardial infarction in the prehospital setting?

In the Emergency Department, patients with suspected myocardial infarction can be risk stratified using the HEART pathway, which has recently been amended for prehospital use and modified for the incorporation of a high-sensitivity cardiac troponin test. In a prospective analysis, the performance of both HEART pathways in the prehospital setting, with a high-sensitivity cardiac troponin test using 3 different thresholds, was evaluated for major adverse cardiac events at 30 days. We found that both low-risk HEART pathways, when using the most conservative cardiac troponin thresholds, approached but did not reach accepted rule-out performance in the Emergency Department.

Organohalogen compounds in a hotspot for chemical pollution: Assessment in free-ranging Atlantic spotted dolphins (Stenella frontalis)

The assessment of chemical pollution in free-ranging living mammals is viable using remote biopsies and portrays a comprehensive scenario of environmental health. The Southwestern Atlantic Ocean holds incredible biodiversity, but it is under the constant and invisible threat of persistent organic pollutants (POPs) of anthropogenic origin, such as pesticides, brominated flame retardants, and industrial-use compounds (e.g., PCBs). Thus, this study aimed to assess the bioaccumulation of POPs (PCBs, DDTs, HCB, mirex and PBDEs) and natural organobromine compounds (MeO-BDEs) using gas-chromatography coupled to mass spectrometry in biopsy samples of Atlantic spotted dolphins (Stenella frontalis, n = 20) that inhabit and forage both inside and in adjacent areas to degraded (Guanabara Bay) and conserved (Ilha Grande Bay) coastal bays in the Southeastern Brazil. Among the studied compounds, PCBs were predominant in the contamination profile with median concentration of 97.0 μg.g-1 lipid weight (lw), followed by the sum of the p,p’ isomers of DDT, DDD, and DDE of 11.0 μg.g-1 lw, the brominated flame retardants PBDEs of 1.6 μg.g-1 lw, and the other organochlorine pesticides mirex of 0.78 μg.g-1 lw, and HCB of 0.049 μg.g-1 lw. The MeO-BDEs were detected with a median concentration of 22.8 μg.g-1 lw. 85 % of the Atlantic spotted dolphins analyzed in this study presented PCB concentration that exceeded even the less conservative threshold limits for adverse health effects (41 μg.g-1 lw). This study shows that despite the conservation status of preserved bays, cetacean species foraging in these locations are still under increased threat. Hence chemical pollution demands local and global efforts to be mitigated.

Validation of the Investigator Global Assessment of Chronic Hand Eczema (IGA–CHE): a new clinician reported outcome measure of CHE severity

The Investigator Global Assessment of Chronic Hand Eczema (IGA–CHE) is a novel Clinician-Reported Outcome measure that allows investigators to assess cross-sectional CHE global disease severity using clinical characteristics of erythema, scaling, lichenification/hyperkeratosis, vesiculation, oedema, and fissures as guidelines for overall severity assessment. This study aimed to evaluate the psychometric properties of the IGA–CHE for use as an outcome measure in CHE clinical trials and clinical practice. Psychometric analyses were performed using data from a sample of 280 patients with moderate to severe CHE from a phase 3 trial of delgocitinib cream, pooled across treatment groups. Test–retest reliability results were moderate to strong with kappa coefficients ranging from 0.63 to 0.76. Correlations with measures assessing related concepts were moderate or strong (range 0.65–0.72) and exceeded a priori hypotheses, providing evidence of convergent validity. Known-groups validity was supported by statistically significant differences between severity groups (< 0.001). Within-group effect sizes were consistently larger for improved groups compared to stable groups, providing evidence of ability to detect change. Anchor-based analyses generated within-subject meaningful change estimates ranging from – 0.8 to – 2.3. A correlation weighted average suggested a single value of – 1.7 in change from baseline. These findings provide evidence the IGA–CHE scale has strong reliability, construct validity, and ability to detect change, supporting its use as an endpoint in CHE clinical trials and clinical practice. Based on the evidence, 2-level changes in IGA–CHE score are considered a conservative meaningful change threshold; however, findings also indicate 1-level change in IGA–CHE scores reflects a clinically meaningful improvement for patients.Clinical trial registration: NCT04871711.

Preoperative Visual Acuity Thresholds in Pars Plana Vitrectomy for Epiretinal Membrane: A Systematic Review.

This review consolidates findings from studies that used a preoperative visual acuity (VA) threshold as an indication for epiretinal membrane (ERM) surgery. The literature was systematically searched using Ovid MEDLINE, EMBASE, and Cochrane Library from January 2000 to October 2022 to select studies reporting on pars plana vitrectomy (PPV) for ERM that used a preoperative VA threshold as an inclusion criterion. Primary outcomes were final best-corrected visual acuity (BCVA) and change in BCVA relative to baseline. Secondary outcomes included risk of intra- and postoperative complications. A total of 639 eyes from seven studies were included. The most liberal preoperative VA threshold was 20/28.5 or worse, whereas the most conservative threshold was worse than 20/60. The mean preoperative BCVA was 0.55 logarithm of the minimum angle of resolution (logMAR) (∼20/70), and the mean postoperative BCVA was 0.35 logMAR (∼20/45). Generally, VA improved relative to baseline, regardless of the preoperative VA threshold. The smallest improvement in VA was observed in a study where the pre-operative VA to consider surgery was liberal (20/30 or worse), whereas the greatest VA improvement was observed in a study that used a conservative preoperative VA threshold (worse than 20/60). The greatest improvement in BCVA was observed in studies where a conservative pre-operative VA threshold was used. The decision to operate should involve a patient-centered approach with a thorough discussion of the risks and benefits of PPV, regardless of the preoperative VA threshold used. [Ophthalmic Surg Lasers Imaging Retina 2024;55:400-407.].

Conservation genetics of the white-bellied pangolin in West Africa: A story of lineage admixture, declining demography, and wide sourcing by urban bushmeat markets.

During the last 40 years, the volumes of African pangolins feeding the illegal wildlife trade have dramatically increased. We conducted a conservation genetics survey of the most traded African species, the white bellied pangolin (WBP; Phataginus tricuspis), across three West African countries including Guinea, Côte d'Ivoire, and Ghana. Our study combining mitochondrial DNA sequencing and microsatellite genotyping is the first to reveal a wide pattern of admixture between two of the six mitochondrial lineages as previously delimited within WBP. We found a signature of isolation by distance but a lack of population genetic structuring, supporting the idea that WBP may have underestimated dispersal abilities. Levels of genetic diversity were low in West African lineages (WAfr and Gha) compared to Central Africa, reinforcing the picture of genetic pauperization shared by West African WBP. We observed a 85%-98% decline in the effective population size of WBP occurring c. 3200 to 400 ya, with current numbers (520-590) at the lower end of the conservative thresholds for minimum viable population size. The microsatellite markers were powerful enough to differentiate between individuals and identify replicated samples, confirming the utility of this approach in tracing the pangolin trade. Genetic diversity estimates confirmed that Yopougon, the main bushmeat market from Abidjan (Côte d'Ivoire), was fed by a large trade network as confirmed by vendors reporting 10 different sources situated 62-459 km away from the market. We conclude that WBP distributed in the Upper Guinean Block should be considered a single management unit of high conservation concern, as impacted by genetic diversity erosion, drastic decline in effective population size, and wide range sourcing for feeding urban bushmeat markets. Given the genetic admixture pattern detected within WBP from West Africa, we advocate for a multi-locus strategy to trace the international trade of the species.

3D printed pyrography: Using wood filament and dynamic control of nozzle temperature for embedding shades of color in objects

Colors enhance the esthetic and functional aspects of three-dimensional (3D) printed objects via material extrusion (MEX). However, existing 3D printing techniques require additional materials and hardware that are either challenging to calibrate or too costly for average 3D printing users. This paper presents a fabrication technique we call 3D printed pyrography, which enables printing multiple shades of color and gradients using a wood filament and a single-nozzle extruder. We investigate the effects of printing temperature and speed on the color properties of wood filament (ColorFabb). Using Euclidean distance in CIELAB color space, we employed perceptual metrics to quantify color differences between samples with different print temperatures (minimum: 195°C, maximum: 300°C, and 5°C increment). As a result, we identified all samples had perceivable discrete colors (ΔE ≥ 1), and, by applying a more conservative threshold, we can refine the count to sixteen distinct colors (ΔE ≥ 2.3). This approach underscores the sensitivity of color perception to printing parameters and highlights the utility of ΔE in CIELAB parameters in discerning color differences in 3D printed objects. Furthermore, we encapsulate this information in a custom software interface. This tool allows users to specify shades or map photographic images directly onto 3D surfaces, and generates the G-code that modulates the nozzle temperature and achieves the desired shading. We demonstrate 3D printed pyrography through 11 applications, such as enhancing visual esthetics, offering visual guidance, and embedding markers to merge digital information with physical objects.

A systematic review of the patient reported outcomes that affect patients with muscle invasive bladder cancer after radical cystectomy and urinary diversion.

To determine the functional domains and symptom scales that affect patients most following radical cystectomy (RC) and urinary diversion (UD), and if a single instrument (or combination) adequately captures these bothersome symptoms. It is unclear whether current patient reported outcome (PRO) instruments that have been used to assess quality of life in patients following RC and UD adequately cover the most bothersome symptoms affecting patients. A systematic search of MEDLINE, EMBASE, PubMed, Cinahl and Cochrane was conducted from January 2000 to May 2023 for original articles of patients who had RC and UD since 2000 for muscle invasive bladder cancer. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process was followed. Extracted data included the PRO measures used, domains reported and scores in the first 12 months post-surgery (short-term) and after 12 months (long-term). A conservative threshold of <70 for functional domains and >30 for symptom domains was used to determine which PRO domains were potentially concerning to patients in each study. Quality assessment was performed using the QUALSYST appraisal tool. Thirty-five studies met the inclusion criteria, including a total of eight unique PRO instruments. The main findings indicated that physical function was the most concerning PRO for patients with both neobladder (NB) and ileal conduit (IC) in the short and long term. Additionally, bowel, urinary and sexual bother were concerning symptoms for patients with NB in the long-term, but only in the short-term for those with IC. The main issues are adequately addressed using the combination of EORTC QLQ-C30 and QLQ-BLM30 instruments.