Continuous Scale Research Articles

Abstract 307: In-Situ Simulation-Based Booster ACLS Training to Increase the Confidence and Performance of Internal Medicine Residents as Code Blue Leaders - A Quality Improvement Project

Background: In the United States, nearly 290,000 adult patients develop in-hospital cardiac arrest (IHCA) every year. Delivery of guideline-based resuscitation has improved patient outcomes. During 2022, our hospital had 68 inpatient i.e., approximately 1 code/resident. Residents have reported desire for more exposure. The 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommended: 1) booster training, 2) in-situ simulation-based resuscitation training, and 3) specific teamwork and leadership training for healthcare providers. We aimed to implement such training to achieve an improvement in resident confidence and performance as code blue leaders. Methods: Pre-intervention, residents completed a 5-item 0-100 continuous scale to assess confidence in major code leader skills (Fig 1-A). Interventions included: 1) Calling residents to patient rooms to run simulation-based codes, and 2) a didactic session that discussed common errors during codes. Time to key ACLS steps was recorded during the simulations. At the end of the project, residents completed the post-intervention survey of confidence and balancing measures. Results: 13 residents led simulation-based codes, 20 attended the didactic session, and 25 completed the survey. Resident confidence in the defined skills increased by an average of 30%. (P<0.05) (Fig 1-A). Residents who led codes after the didactic session had shorter times to key ACLS steps (Fig 1-B). Balancing measures included resident-reported satisfaction and perceived disruption to clinical workflow (100% and 0% of responses, respectively). Conclusions: In-situ simulation-based booster ACLS training was associated with an increase in the confidence and performance of IM residents as code blue leaders. Incorporation of such training in IM residency curriculum should be considered as a practical application to sustain the gains of this QI initiative.

PSV-24 Implementation of Blockchain Technologies in the U.S. Sheep Industry: Producer and Industry Perceptions

Abstract Agricultural product traceability has become increasingly important. Emerging digital technologies, like blockchain technology, can facilitate supply-chain data capture and exchange across all segments of the industry. To better understand stakeholder perceptions and willingness to share digital production records using blockchain technology, a digital survey was conducted across sheep industry stakeholders. During January of 2021-2022, a 25-question, online survey was conducted to capture U.S. sheep industry producer and processor perceptions. Survey data included 66 responses, where 84.8%, (n = 56) were sheep and lamb producers and 15.2%, (n = 10) were involved in wool warehousing and processing. A continuous line scale anchored at 0 (not familiar) and 100 (very familiar) was used to assess familiarity with blockchain technology (Table 1). Lamb and wool producers were somewhat familiar with blockchain technology (mean = 43.00, n = 40 completed responses), while wool warehousers and processors answered similarly (mean = 40.40, n = 9 completed responses). Stakeholders were also asked to determine their desired monetary premium (% over base price) to submit records into a blockchain system. Wool and lamb producers were asked what level of premium they would need to receive in order to submit records into the blockchain system, 89% (n = 75) of wool and lamb producers indicated they would need at least a 4.1% premium over base price, while 60% (n = 6) of wool processing respondents were willing to pay producers a 4.1% or higher premium for access to records on the blockchain system. Producers and wool processors are somewhat familiar with blockchain technology as a traceability mechanism, and they are willing to implement this technology if there is incentive available in the market. A greater understanding of the economic value, opportunity, and implications that blockchain technology brings to the market is important in determining if the right incentives are available to integrate this technology into the U.S. sheep industry.

72 Investigating Handedness and Cognitive Functions in People with Severe Mental Disorders

Objective:Our objective is to investigate whether handedness is associated with performance on verbal and visual neuropsychological tests in people with severe mental disorders. A recent study, applying a continuous scale of hand preference, reports that handedness is not associated with test performance in people with schizophrenia disorders. Conversely, in a recent large meta-analysis where handedness was applied as a dichotomous variable, right-handers had better performance in spatial ability (but not verbal ability) compared to left-handers, irrespective of gender or health status. We hypothesize that a dichotomous classification of handedness will reveal an advantage of right-handedness on tests of visuospatial functions—but not verbal functions—in people with severe mental disorders. We expect that gender will not be associated with the neuropsychological test results.Participants and Methods:Data from a sample of 385 patients with severe mental disorders, mainly within the schizophrenia spectrum, were analyzed. All participants had Norwegian as their first language. Their mean age was 24.8 years (SD=6.2) and 153 (39.7%) were women. Handedness was evaluated by observation of preferred hand in writing and drawing during neuropsychological assessment. Chi-square tests were used to compare proportions of cases with reported frequencies of handedness in the general population and comparable clinical samples. Raw scores on Semantic Fluency and Line Orientation from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were analyzed using Mann-Whitney U tests, and possible effects of gender with two-way ANOVA. Frequencies of low scores were analyzed using frequency analyses.Results:Overall prevalence of left-handers was 10.4% compared to 10.6% in the general population (χ2=.018, p=.893). Observed prevalence for women was 9.2% compared to expected prevalence of 9.5% (χ2=.026, p=.873) and for men 10.7% and 11.6%, respectively (χ2=.039, p=.844). There was a significant difference in Line Orientation scores (Mdright-handers=18, Mdleft-handers=17; U=5268.0, p=.013) but not Semantic Fluency scores (Mdright-handers=17, Mdleft-handers=18.5; U=7568.5, p=.315). Right-handed men had higher scores on Line Orientation but there was no handedness by gender interaction (F(1)=1.69, p=.194). For Semantic Fluency, left-handed men had higher scores and a gender by handedness interaction was found (F(1)=7.21, p=.008). Using scores corresponding to <5th percentile, 15% of left-handers and 8% of right-handers had scores <5th percentile on Line Orientation, as opposed to 15% and 14% on Semantic Fluency.Conclusions:Right-handers had significantly better performance on a test measuring visuospatial function, irrespective of gender. Left-handers had about twice the number of scores in the impaired range (i.e., <5th percentile) compared to right-handers. Left-handed men had better performance on a test of verbal functions, which was unexpected. A recent study reported no right-hand associated advantage on visuospatial tests in people with schizophrenia disorders when measuring handedness on a continuous scale. This suggests that the classification of handedness as either a dichotomous or as a continuous variable is important in studies of handedness and cognitive functions.

Gate Stack Analysis of Nanosheet FET for Analog and Digital Circuit Applications

This manuscript demonstrates the performance comparison of vertically stacked nanosheet FET with various high-k materials in gate stack (GS) configuration. As the high-k dielectric materials are inevitable to continual scaling, in this paper, various high-k dielectric materials such as Si3N4, Al2O3 and HfO2 are incorporated in the GS, and the performance is studied. Further, DC and Analog/RF performance metrics are discussed in detail, and it is noticed that by using HfO2 in high-k GS, the on current (I ON) is enhanced by 46.7% and off current (I OFF) is decreased by 81.6% as compared to conventional NSFET (C-NSFET) without high-k GS. Also, the switching ratio (I ON/I OFF) is increased by 8× from SiO2 to HfO2, ensuring good logic applications. Moreover, compared to the C-NSFET, GS-NSFET with HfO2 offers better values for analog metrics like transconductance (gm) and transconductance generation factor (TGF). However, as the k value increases, the capacitances are also observed to be increased. As a result, the intrinsic delay (τ) increases by 9%, 6% and 20% from SiO2 to Si3N4, Si3N4 to Al2O3, Al2O3 to HfO2, respectively. On top of that, the circuit level demonstration is also performed for resistive load based inverter and ring oscillator (RO) for both C-NSFET GS NSFET with HfO2 as GS material. From circuit analysis, it is observed that by using the GS, the performance of the inverter is increased in terms of noise margins and DC gain. However, the oscillation frequency (f OSC) of 3-stage RO is decreased by 14.7% with the incorporation of GS owing to the increment in gate capacitance (Cgg). Consequently, the results will give deep insights into the performance analysis of NSFET with various high-k materials in gate stack at both device and circuit levels.

Thick endometrium is associated with hypertensive disorders of pregnancy in programmed frozen-thawed embryo transfers: a retrospective analysis of 2,275 singleton deliveries

To investigate whether endometrial thickness (EMT) acts as a contributing factor to adverse perinatal outcomes in programmed frozen-thawed embryo transfer (FET) cycles. Retrospective cohort study. University-based reproductive medical center. The study included singleton live births resulting from programmed FET cycles that took place between January 2017 and April 2022 (N = 2,275 cycles). The EMT measurement conducted on the day of progesterone initiation was utilized. Programmed FET cycles with EMT <7 mm were excluded from consideration. All included subjects were divided into 4 groups on the basis of the 10th, 50th, and 90th percentiles of EMT: group Ⅰ (EMT ≤8 mm, n = 193), group Ⅱ (EMT = 8.1-10 mm, n = 1,261), group Ⅲ (EMT = 10.1-12 mm, n = 615), and group Ⅳ (EMT >12 mm, n = 206). After adjusting for patient demographics and FET parameters, logistic regression analysis and restricted cubic spline were used to investigate the relationship between EMT and perinatal outcomes. The group Ⅱ (EMT = 8.1-10 mm) served as a reference. The primary outcome measure was the hypertensive disorders of pregnancy (HDP). Secondary outcomes included gestational diabetes mellitus, cesarean delivery, placenta previa, premature rupture of membrane, birthweight, preterm birth, low birthweight, macrosomia, small for gestational age, large for gestational age and neonatal morbidity. The incidence of HDP was substantially elevated in group Ⅳ when compared with the other groups (5.7% vs. 4.1% vs. 5.7% vs. 9.7% for groups Ⅰ-Ⅳ, respectively). In addition, group I displayed a higher incidence of cesarean deliveries, whereas both group I and group IV exhibited an elevated prevalence of placenta previa. After adjusting for confounding factors, patients in group IV exhibited a significantly increased risk of HDP (adjusted odds ratio [OR] = 2.03, 95% confidence interval [CI] 1.13-3.67) as compared with patients in the reference group. The restricted cubic spline model revealed a nonlinear association between EMT and the odds of HDP on continuous scales. In comparison to women with an EMT of 9.5 mm, there was no significant change in the risk of HDP in women with EMT between 7 and 11 mm, as indicated by adjusted ORs of 1.37 (95% CI 0.41-4.52), 1.34 (95% CI 0.73-2.47), 1.13 (95% CI 0.79-1.62), 1.04 (95% CI 0.87-1.25), and 1.46 (95% CI 0.81-2.65), respectively. However, the risk of HDP was significantly higher in women with EMT ranging from 12 to 15 mm, with adjusted ORs of 1.86 (95% CI 1.03-3.35), 2.33 (95% CI 1.32-4.12), 2.92 (95% CI 1.52-5.60), and 3.62 (95% CI 1.63-8.04), respectively. This study demonstrated a noteworthy association between EMT and adverse perinatal outcomes during the programmed FET cycles. Specifically, a thick endometrium (EMT >12 mm) was independently associated with an increased risk of developing HDP, whereas the optimal EMT for reducing the risk of HDP was at around 9-10 mm.

Is the best–worst method path dependent? Evidence from an empirical study

The Best–Worst method (BWM) is one of the latest contributions to pairwise comparisons methods. As its name suggests, it is based on pairwise comparisons of all criteria (or possibly other objects, such as alternatives, sub-criteria, etc.) with respect to the best (most important) and the worst (least important) criterion. The main aim of this study is to investigate the path and scale dependency of the BWM. Up to now, it is unknown whether the weights of compared objects obtained by the method differ when the objects are compared first with the best object, and then with the worst, or vice versa. It is also unknown if the outcomes of the method differ when compared objects are presented in a different order, or when different scales are applied. Therefore, an experiment in a laboratory setting is performed with more than 800 respondents university undergraduates from two countries in which the respondents compare areas of randomly generated figures and the relative size of objects is then estimated via the linearized version of the BWM. Last but not least, the accuracy of the BWM is examined with respect to different comparison scales, including Saaty’s nine-point linguistic scale, an integer scale from 1 to 9, and a continuous scale from 1 to infinity.

THE RELATIONSHIP BETWEEN UNIVERSITY STUDENTS' CONSCIOUS AWARENESS, HOPE LEVELS, LIFE SATISFIED

The aim of this study is to reveal the relationship between university students' levels of mindfulness, life satisfaction and hope. In the study, the relational survey model was used to examine university students in terms of mindfulness, life satisfaction and hope levels. The study group of the research consists of 201 university students, 138 female and 63 male, studying at Mehmet Akif Ersoy University in the fall semester of the 2022-2023 academic year. Research data were collected using the "Cognitive and Affective Awareness Scale", "Continuous Hope Scale", "Life Satisfaction Scale", and personal information form. As a result of the Pearson Correlation analysis test, it was determined that there was a positive and significant relationship between university students' mindfulness, life satisfaction and hope levels. According to the research findings, it is seen that there is a positive and significant relationship between university students' mindfulness, life satisfaction and hope levels. While it is seen that there is a low level of positive and significant relationship between mindfulness and hope level; There is a significant and positive moderate relationship between mindfulness and life satisfaction. Looking at the results, it can be said that as the level of conscious awareness of university students increases, their life satisfaction and hope levels increase.

Factors associated with quality of life in patients with kidney failure managed conservatively and with dialysis: a cross-sectional study

BackgroundLater stage chronic kidney disease (CKD) is associated with poorer self-perceived health-related quality of life (HRQOL), a major consideration for many patients. Psychological factors such as depression and anxiety have been linked with poorer HRQOL. We aimed to determine if anxiety or depressive symptoms are significantly associated with self-perceived health-related quality of life, in patients with CKD Stage 5. The secondary aim was to determine which patient-associated factors are associated with HRQOL in patients with CKD Stage 5.MethodsThis retrospective cross-sectional study included patients that attended the St George Hospital Kidney Supportive Care (KSC) clinic between 1 and 2015 and 30 June 2022 with CKD Stage 5 (either conservatively-managed or receiving dialysis). Patients completed surveys of their functional ‘domains’ and quality of life (EQ-5D-5L) and symptom surveys (IPOS-Renal) at their first visit. We performed multivariable linear regression analysis with the outcome of interest being HRQOL, measured using the EQ-VAS, a continuous 100-point scale, for patients undergoing conservative management or dialysis. Pre-specified variables included age, sex, eGFR (for those conservatively-managed), “feeling depressed” (IPOS-Renal), “feeling anxious” (IPOS-Renal) and “anxiety/depression” (EQ-5D-5L).ResultsWe included 339 patients. 216 patients received conservative kidney management (CKM) and 123 patients received dialysis. Patients receiving CKM were significantly older than those on dialysis, (median age 83 years vs. 73 years, p < 0.001). For conservatively-managed patients, variables independently associated with poorer EQ-VAS were difficulty performing usual activities (EQ-5D-5L), drowsiness (IPOS-Renal) and shortness of breath (IPOS-Renal). For patients receiving dialysis, variables that were independently associated with poorer EQ-VAS were reduced ability to perform self-care (EQ-5D-5L) and lack of energy (IPOS-Renal). Anxiety and depressive symptoms were not significantly associated with poorer EQ-VAS for either group of patients.ConclusionsSymptoms associated with reduced HRQOL include shortness of breath, drowsiness and impaired functional ability. Optimization of multidisciplinary teams focusing on these issues are likely to be of benefit.

Estimating the association between systemic Interleukin-6 and mortality in the dialysis population. Re-analysis of the global fluid study, systematic review and meta-analysis

BackgroundSystemic inflammation, measured as circulating Interleukin-6 (IL-6) levels, is associated with cardiovascular and all-cause mortality in chronic kidney disease. However, this has not been convincingly demonstrated in a systematic review or a meta-analysis in the dialysis population. We provide such evidence, including a re-analysis of the GLOBAL Fluid Study.MethodsMortality in the GLOBAL fluid study was re-analysed using Cox proportional hazards regression with IL-6 levels as a covariate using a continuous non-logarithmic scale. Literature searches of the association of IL-6 levels with mortality were conducted on MEDLINE, EMBASE, PyschINFO and CENTRAL. All studies were assessed for risk of bias using the QUIPS tool. To calculate a pooled effect size, studies were grouped by use of IL-6 scale and included in the meta-analysis if IL-6 was analysed as a continuous linear covariate, either per unit or per 10 pg/ml, in both unadjusted or adjusted for other patient characteristics (e.g. age, comorbidity) models. Funnel plot was used to identify potential publication bias.ResultsOf 1886 citations identified from the electronic search, 60 were included in the qualitative analyses, and 12 had sufficient information to proceed to meta-analysis after full paper screening. Random effects meta-analysis of 11 articles yielded a pooled hazard ratio (HR) per pg/ml of 1.03, (95% CI 1.01, 1.03), {I}^{2}= 81%. When the analysis was confined to seven articles reporting a non-adjusted HR the result was similar: 1.03, per pg/ml (95% CI: 1.03, 1.06), {I}^{2}=92%. Most of the heterogeneity could be attributed to three of the included studies. Publication bias could not be determined due to the limited number of studies.ConclusionThis systematic review confirms the adverse association between systemic IL-6 levels and survival in people treated with dialysis. The heterogeneity that we observed may reflect differences in study case mix.Systematic Review RegistrationPROSPERO - CRD42020214198.

Inter-rater reliability of a novel objective endpoint for benign central airway stenosis interventions: Segmentation-based volume rendering of computed tomography scans.

To evaluate the reliability of a novel segmentation-based volume rendering approach for quantification of benign central airway obstruction (BCAO). A retrospective single-center cohort study. Data were ascertained using electronic health records at a tertiary academic medical center in the United States. Patients with airway stenosis located within the trachea on two-dimensional (2D) computed tomography (CT) imaging and documentation of suspected benign etiology were included. Four readers with varying expertise in quantifying tracheal stenosis severity were selected to manually segment each CT using a volume rendering approach with the available free tools in the medical imaging viewing software OsiriX (Bernex, Switzerland). Three expert thoracic radiologists were recruited to quantify the same CTs using traditional subjective methods on a continuous and categorical scale. The interrater reliability for continuous variables was calculated by the intraclass correlation coefficient (ICC) using a two-way mixed model with 95% confidence intervals (CI). Thirty-eight patients met the inclusion criteria, and fifty CT scans were selected for measurement. The most common etiology of BCAO was iatrogenic in 22 patients (58%). There was an even distribution of chest and neck CT imaging within our cohort. The average ICC across all four readers for the volume rendering approach was 0.88 (95% CI, 0.84 to 0.93), suggesting good to excellent agreement. The average ICC for thoracic radiologists for subjective methods on the continuous scale was 0.38 (95% CI, 0.20 to 0.55), suggesting poor to fair agreement. The kappa for the categorical approach was 0.26, suggesting a slight to fair agreement amongst the raters. In this retrospective cohort study, agreement was good to excellent for raters with varying expertise in airway cross-sectional imaging using a novel segmentation-based volume rendering approach to quantify BCAO. This proposed measurement outperformed our expert thoracic radiologists using conventional subjective grading methods.

On a Special Two-Person Dynamic Game

The asymptotical properties of a special dynamic two-person game are examined under best-response dynamics in both discrete and continuos time scales. The direction of strategy changes by the players depend on the best responses to the strategies of the competitors and on their own strategies. Conditions are given first for the local asymptotical stability of the equilibrium if instantaneous data are available to the players concerning all current strategies. Next, it is assumed that only delayed information is available about one or more strategies. In the discrete case, the presence of delays has an effect on only the order of the governing difference equations. Under continuous scales, several possibilities are considered: each player has a delay in the strategy of its competitor; player 1 has identical delays in both strategies; the players have identical delays in their own strategies; player 1 has different delays in both strategies; and the players have different delays in their own strategies. In all cases, it is assumed that the equilibrium is asymptotically stable without delays, and we examine how delays can make the equilibrium unstable. For small delays, the stability is preserved. In the cases of one-delay models, the critical value of the delay is determined when stability changes to instability. In the cases of two and three delays, the stability-switching curves are determined in the two-dimensional space of the delays, where stability becomes lost if the delay pair crosses this curve. The methodology is different for the one-, two-, and three-delay cases outlined in this paper.

The cancer inflammation prognostic index is a valuable biomarker for predicting the survival of patients with stage I–III colorectal cancer

This study aimed to assess the relationship between the Cancer-Inflammation Prognostic Index (CIPI) and disease-free survival (DFS) and overall survival (OS) in patients with stage I–III colorectal cancer (CRC). The relationship between the CIPI and survival was evaluated using restricted cubic splines. Survival curves were established using the Kaplan–Meier method and the log-rank test. Cox proportional hazards models were used to explore independent prognostic factors for CRC. Meaningful variables from the multivariate analysis were used to construct prognostic nomograms. The relationship between the CIPI values on a continuous scale and the risk of DFS/OS mortality was an inverted L-shape. Patients with a high CIPI had significantly lower DFS (53.0% vs. 68.5%, p < 0.001) and OS (55.5% vs. 71.7%, p < 0.001) than those with a low CIPI. The CIPI can also serve as an effective auxiliary tool to further distinguish the prognosis of patients with CRC at the same pathological stage, especially for stages II and III. After multivariate adjustment, a high CIPI was found to be an independent risk factor for DFS (HR 1.443, 95% CI 1.203–1.730, p < 0.001) and OS (HR 1.442, 95% CI 1.189–1.749, p < 0.001) in CRC patients. These nomograms have the advantage of integrating individual profiles, tumour characteristics, and serum inflammatory markers, providing favourable discrimination and calibration values. Compared with traditional TNM staging, nomograms have a better predictive performance. The CIPI is an effective and easy-to-use clinical tool for predicting the recurrence and overall mortality of patients with stage I–III CRC.

Intermediate and high-temperature oxidation behavior of an equiatomic TaTiCr RCCA from 800 °C to 1400 °C

This study explores the oxidation behavior of a TaTiCr refractory complex concentrated alloy (RCCA) in the temperature regime of 800–1400 °C. The oxidation kinetics were found to be proportional with temperature. However, a mechanistic shift from linear oxidation kinetics at 800 °C and 1000 °C to sub-parabolic kinetics at 1200 °C and 1400 °C was observed. This was attributed to the establishment of continuous external scales of TiO2 and Cr2O3, with fairly continuous underlying complex oxide layers at the higher temperatures. While there were morphological differences in the oxide scales depending on exposure temperature, the oxide species were all similar, primarily consisting of an outer layer of TiO2, an intermediate layer of Cr2O3, and an inner layer of rutile-structured (Cr,Ta,Ti)O2. Internal nitridation was observed in all cases, with a severe degree of internal reaction at 1400 °C, reaching a depth of 750 μm. Overall, the best performance was observed at 1200 °C, where a favorable balance of kinetics and thermodynamics promoted the most continuous oxide layers, thereby enhancing oxidation resistance.

Factors influencing time management skills among nurses in North West Bank, Palestine

BackgroundIn today’s companies, time management abilities have grown as a significant predictor of nurses’ success. Organizations have simplified their internal operations and flattened their organizational structures in an effort to increase productivity and cut expenses. As a result, successful time management skills are particularly crucial for nurses in recently restructured healthcare organizations. This study aimed at exploring factors influencing time management skills among Palestinian nurses.MethodsCross-sectional quantitative study of all nurses (715) working in private and government hospitals and primary healthcare centers in north Palestine was conducted. Time management skills were measured on a continuous scale using the Nursing Time Management Scale (NTMS), Arabic version. The scale measures various aspects of time management including goal setting, planning, scheduling, and organizing activities. The relationship between time management skills and background variables was assessed using the multivariate linear regression.ResultsThe average total score for NTMS scale was 63.39 out of a total score of 90. This score indicates relatively good time management skills among the respondents. The multivariate linear regression results showed that females obtained slightly lower scores than males, coefficient = -2.36, p = 0.043. Nurses in primary care centers had significantly higher scores than nurses who work at hospitals, coefficient = 4.47, p = 0.004. The type of healthcare organization emerged as a significant factor predicting time management skills. Nurses in private hospitals had worse time management skills than nurses in government hospitals, coefficient = -12.27, p < 0.001. Nurse supervisors had better time management skills than staff nurses, coefficient = 4.01, p = 0.023. Nurses working in non-teaching hospitals had worse time management skills than nurses in teaching hospitals, coefficient = − 3.86, p = 0.001. Nurses who did not attend a time management course had worse time management skills than nurses who attended time management course, coefficient = − 4.05, p = p < 0.001.ConclusionsHealthcare institutions should consider organizational and individual factors to improve the time management skills of their staff. Time management training interventions are proven and effective policies that are recommended to be adopted by all healthcare centers.

Interactions of platelets with obesity in relation to lung cancer risk in the UK Biobank cohort

BackgroundPlatelet count (PLT) is associated positively with lung cancer risk but has a more complex association with body mass index (BMI), positive only in women (mainly never smokers) and inverse in men (mainly ever smokers), raising the question whether platelets interact with obesity in relation to lung cancer risk. Prospective associations of platelet size (an index of platelet maturity and activity) with lung cancer risk are unclear.MethodsWe examined the associations of PLT, mean platelet volume (MPV), and platelet distribution width (PDW) (each individually, per one standard deviation increase) with lung cancer risk in UK Biobank men and women using multivariable Cox proportional hazards models adjusted for BMI and covariates. We calculated Relative Excess Risk from Interaction (RERI) with obese (BMI ≥ 30 kg/m2), dichotomising platelet parameters at ≥ median (sex-specific), and multiplicative interactions with BMI (continuous scale). We examined heterogeneity according to smoking status (never, former, current smoker) and antiaggregant/anticoagulant use (no/yes).ResultsDuring a mean follow-up of 10.4 years, 1620 lung cancers were ascertained in 192,355 men and 1495 lung cancers in 218,761 women. PLT was associated positively with lung cancer risk in men (hazard ratio HR = 1.14; 95% confidence interval (CI): 1.09–1.20) and women (HR = 1.09; 95%CI: 1.03–1.15) but interacted inversely with BMI only in men (RERI = − 0.53; 95%CI: − 0.80 to − 0.26 for high-PLT-obese; HR = 0.92; 95%CI = 0.88–0.96 for PLT*BMI). Only in men, MPV was associated inversely with lung cancer risk (HR = 0.95; 95%CI: 0.90–0.99) and interacted positively with BMI (RERI = 0.27; 95%CI = 0.09–0.45 for high-MPV-obese; HR = 1.08; 95%CI = 1.04–1.13 for MPV*BMI), while PDW was associated positively (HR = 1.05; 95%CI: 1.00–1.10), with no evidence for interactions. The associations with PLT were consistent by smoking status, but MPV was associated inversely only in current smokers and PDW positively only in never/former smokers. The interactions with BMI were retained for at least eight years of follow-up and were consistent by smoking status but were attenuated in antiaggregant/anticoagulant users.ConclusionsIn men, PLT was associated positively and MPV inversely with lung cancer risk and these associations appeared hindered by obesity. In women, only PLT was associated positively, with little evidence for interaction with obesity.

Exploring the factor structure of the adolescent form of the Francis Psychological Type and Emotional Temperament Scales (FPTETSA) among Canadian Baptist youth: full form and short form

ABSTRACT The Francis Psychological Type and Emotional Temperament Scales (FPTETS) operationalise the four components of the psychological-type model of personality alongside the fifth component of emotional temperament. The ten-item scales have been employed in research as continuous variables that explain individual differences in a wide range of religious beliefs and attitudes. The present study tested the factor structure of the adolescent form of the instrument (FPTETSA) and proposes a short form (FPTETSA-S) in which each of the five scales comprises six items, drawing on data provided by 360 Canadian Baptist youth. Both the full scales and the short scales are commended for use where the need is for continuous scale scores rather than generating psychological type categories.

The Relationship Between Parental and Family Functioning and Post-Concussive Symptoms After Pediatric Mild Traumatic Brain Injury: A Scoping Review.

This scoping review aimed to address the following questions: (1) Does mild traumatic brain injury (mTBI) result in more parental distress or poorer family functioning than other injuries? (2) Does pre-injury or acute parental distress and family functioning predict post-concussive symptoms (PCS) after mTBI? and (3) Do acute PCS predict later parental distress and family functioning? The subjects of this review were children/adolescents who had sustained an mTBI before age 18 and underwent assessment of PCS and parent or family functioning. MEDLINE®, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and CENTRAL databases were searched to identify original, empirical, peer-reviewed research published in English. PCS measures included parent- and child-reported symptom counts and continuous scales. Parent and family measures assessed parental stress, psychological adjustment, anxiety, psychiatric history, parent-child interactions, family burden, and general family functioning. A total of 11,163 articles were screened, leading to the inclusion of 15 studies, with 2569 participants (mTBI = 2222; control = 347). Collectively, the included articles suggest that mTBI may not result in greater parental distress or poorer family functioning than other types of injuries. Pre-injury or acute phase parental and family functioning appears to predict subsequent PCS after mTBI, depending on the specific family characteristic being studied. Early PCS may also predict subsequent parental and family functioning, although findings were mixed in terms of predicting more positive or negative family outcomes. The available evidence suggests that parent and family functioning may have an important, perhaps bidirectional, association with PCS after pediatric mTBI. However, further research is needed to provide a more thorough understanding of this association.

Understanding oxidation resistance of Pt-based alloys through computations of Ellingham diagrams with experimental verifications

Thermodynamic calculations of Ellingham diagrams and the forming oxides have been performed relevant to the Pt-based alloys Pt82Al12M6 (M = Cr, Hf, Pt, and Ta). The predicted Ellingham diagrams indicate that the elements Hf and Al are easy to oxidize, followed by Ta and Cr, while Pt is extremely difficult to oxidize. Oxidation experiments characterized by X-ray diffraction (XRD) and electron probe micro-analyzers verify the present thermodynamic predictions, showing that the best alloy with superior oxidation resistance is Pt82Al12Cr6, followed by Pt88Al12 due to the formation of the dense and continuous α-Al2O3 scale on the surface of alloys; while the worse alloy is Pt82Al12Hf6 followed by Pt82Al12Ta6 due to drastic internal oxidation and the formation of deleterious HfO2, AlTaO4, and Ta2O5. The present work, combining computations with experimental verifications, provides a fundamental understanding and knowledgebase to develop Pt-based superalloys with superior oxidation resistance that can be used in ultra-high temperatures.

High‐resolution patterning on LTCC by transfer of photolithography‐based metallic microstructures

AbstractThe growing applications and constant miniaturization of electronic devices and of low‐temperature co‐fired ceramics (LTCC) in various fields, such as aviation, telecommunications, automotive, satellite communications, and military, have led to an increase in the demand for LTCC. Such prospects arise due to the continuous scaling down of components and high‐density interconnection in electronics packaging. This paper reports a technique for the transfer of high‐resolution microstructures from silicon substrates to LTCC. In this method, gold and copper patterns were formed by photolithography, electrodeposition, and residual layer stripping on silicon substrate. Lithography provides the opportunity to create and transfer complex patterns for use in several different applications and electroplating enables the use of pure metal for excellent electrical properties. The developed structures were transferred onto a top layer of LTCC tape using hot embossing. Then, the subsequent layers were stacked, laminated, and sintered. A resolution of 1.5 μm after free sintering and 4.5 μm after pressure‐assisted sintering was achieved. This distinctive method can be useful for several applications requiring high‐resolution and superior electrical properties.

The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies.

Combining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated. We used the SEER database (N = 49,350) and a retrospective cohort from China (N = 1,440). A normal CEA level was staged as C0 and an elevated CEA level was staged as C1. Restricted cubic spline analysis was used to examine the dose-response relationship between the CEA level and survival. The Kaplan-Meier method with the log-rank test was used to plot survival curves. Multivariable Cox proportional hazards regression models with forward stepwise variable selection were used to estimate the hazard ratios and 95% confidence intervals. Patients with C1 were more likely to have advanced disease than those with C0. CEA on a continuous scale was positively associated with mortality risk. Compared with patients with C0 stage, those with C1 stage had significantly lower survival rates. In the SEER dataset, C1 was independently associated with poor prognosis in patients with CRC, with an approximately 70% increased risk of mortality. Patients with C1 stage had significantly lower survival than those with C0 stage at all clinical stages. Incorporating the C stage into the TNM staging refined the prediction of prognosis of patients with CRC, with a gradual decline in prognosis from stage I C0 to stage IV C1. A similar pattern was observed in the present retrospective cohort study. At each lymph node stage, patients with C1 had significantly lower 5-year survival rates than patients with C0. Compared with lymph node positivity, CEA positivity may have a stronger correlation with a worse prognosis. Our findings not only validated the independent prognostic significance of CEA in CRC but also demonstrated its enhanced prognostic value when combined with TNM staging. Our study provides evidence supporting the inclusion of C stage in the TNM staging system.