Standard Criteria Research Articles

Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry.

Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair. However, covered stent correction for SVASD is not recognized by regulatory authorities, and in the minds of many pediatric and adult congenital cardiologists and surgeons, the condition is viewed as treatable only by cardiac surgery with cardiopulmonary bypass. In April 2023, all centers identified from international conferences, publications, and colleague networks to be undertaking covered stent correction for SVASD were invited to participate in a retrospective audit of their procedures. Data were received on 381 patients from 54 units over a 12-year period with 90% of procedures being performed over the past 5 years. Balloon-expandable stents (8 types) were used in the majority; self-expanding stents (4 types) were used in 4.5%. The commonest stent was the 10-zig covered Cheatham Platinum stent in 62% of cases. In 10 procedures, the stent embolized requiring surgical retrieval and repair of the defect, resulting in technically successful implantation in 371 of 381 (97.4%). Major complications (surgical drainage of tamponade, pacemaker implantation, surgery for pulmonary vein occlusion, and late stent removal) occurred in 5 patients (1.3%). Repeat catheterization to correct residual leaks was required in 7 patients (1.8%). Thus, 359 of 381 patients (94.2%) had successful correction without major complications or additional catheter interventions. This article details the exponential uptake of covered stent correction for SVASD during the past 5 years. Cardiopulmonary bypass was avoided in the majority of patients, and major complications were infrequent. Prospective registries with standardized definitions, inclusion criteria, and follow-up and comparative studies with surgery are now required to help support the extension of covered stent correction as an alternative standard-of-care option for patients with an SVASD.

European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment.

This second part of the S2k guidelines is an update of the 2015 S1 European guidelines. These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS). The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines. Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach. Suitable therapeutic options while considering HS severity in the therapeutic algorithm according to standardized criteria are aimed at ensuring a proper therapy.

Gripping insights: prevalence of hypertension and its association with relative muscle strength—a cross-sectional study in an adult Indian population

BackgroundHypertension and muscle strength are known to be associated; however, identifying simple clinical indicators of this relationship is challenging. Relative muscle strength (RMS), defined as strength per unit muscle mass, has been proposed as a potential indicator, but its association with hypertension is unclear. This study aimed to estimate the prevalence of hypertension and determine its association with RMS in an adult Indian population attending a tertiary care center in Gujarat.MethodsThis hospital-based cross-sectional study included 430 adults aged 18 years and older who were admitted to outpatient medicine clinics between January and October 2023. Grip strength and appendicular lean muscle mass (ALM), estimated using a validated formula, were measured. The RMS was calculated as grip strength/ALM. Hypertension was defined using standard criteria. Logistic regression was used to analyze the association between RMS (analyzed continuously and categorically in tertiles) and hypertension, adjusting for confounders. A p value of < 0.05 was considered significant.ResultsThe prevalence of prehypertension and hypertension was 187 (43%) and 96 (23%), respectively. Compared to participants in the low RMS tertile (0.00–2.45 kg/kg ALM), those in the high tertile (3.79–6.12 kg/kg ALM) had 26% lower odds of hypertension (OR 0.74, 95% CI 0.59–0.89) and 33% lower odds of prehypertension (OR 0.67, 95% CI 0.49–0.91) after adjusting for confounders. The RMS also showed strong negative correlations with systolic and diastolic blood pressure (r = − 0.559 and − 0.418, respectively; p < 0.001).ConclusionIncreased RMS was significantly protective against prehypertension and hypertension. These findings highlight the potential importance of muscle quality, beyond muscle mass, in blood pressure regulation.

Evaluating the performance of personality-based profiling in predicting physical activity

BackgroundProfiling or clustering individuals based on personality and other characteristics is a common statistical approach used in marketing, medicine, and social sciences. This approach improves data simplicity, supports the implementation of a data-driven decision-making process, and guides intervention strategies, such as personalized care. However, the clustering process involves loss of information owing to the discretization of continuous variables. Although any loss of information may be practically or pragmatically acceptable, the amount of information lost and its influence on predicting external outcomes have not yet been systematically investigated.MethodsWe assessed the accuracy of predicting physical activity using the clustering approach and compared it with the dimensional approach, where variables are used as continuous regressors. This analysis is based on survey data from a sample of 20,573 individuals regarding physical activity and psychological traits, including the Big-Five personality traits.ResultsA four-cluster solution, supported by the standard criterion for determining the number of clusters, achieved no more than 60–70% prediction accuracy of the dimensional approach employing the raw dimensional scale as explanatory variables.ConclusionThe cluster solution suggested by conventional statistical criteria may not be optimal when clusters are used to predict external outcomes.

Quantifying morphologic variations as an alternate to standard response criteria for unresectable primary liver tumors after checkpoint inhibition therapy.

The aim of this study was to assess the feasibility of quantifying morphologic changes in tumors during immunotherapy, as a reflection of response or survival. A retrospective single-center analysis was performed in patients with unresectable liver cancer previously enrolled in clinical trials combining immunotherapy (tremelimumab ± durvalumab) and locoregional treatment (either ablation or transarterial chemoembolization). Conventional response (RECIST 1.1) was assessed at 6-month follow-up. For morphologic assessment, the largest target lesion was manually segmented on axial slices in two dimensions using contrast-enhanced CT. Solidity and circularity of tumors were calculated at baseline, 3-month follow-up, and at 6-months follow-up. Survival analysis was performed. From the 68 patients enrolled in clinical trials, 28 did not have target lesions separate from lesions treated by locoregional therapies, and 3 had no follow-up imaging. Thirty-seven patients (9 with biliary cancer and 28 with hepatocellular carcinoma) were included. Shape features and shape variation were not correlated with RECIST 1.1 status at 6-month follow-up. However, patients with low solidity tumors at 6-month follow-up showed poorer prognosis compared with patients with high solidity tumors at 6-month follow-up (p = 0.01). Solidity variation analysis confirmed that a decrease of tumor solidity at 6-month follow-up was associated with poorer prognosis (p = 0.01). No association was found between shape features at baseline or shape features at 3-month follow-up with overall survival. Evolution and variation of tumor morphology during treatment may reflect or correlate with outcomes and contribute toward adapted response criteria.

EVALUATION OF EFFICACY AND SAFETY OF AZITHROMYCIN AND DOXYCYCLINE IN TREATMENT OF ACNE VULGARIS WITH DIFFERENT LEVELS OF SERUM TESTOSTERONE: A PROSPECTIVE, RANDOMIZED, CONTROLLED, COST-EFFECTIVE, COMPARATIVE STUDY

Objectives: The objectives of this study are to compare the therapeutic efficacy, safety, quality of life (QoL), and cost-effectiveness of azithromycin and doxycycline in patients with acne vulgaris and the correlation of serum testosterone levels with the severity of acne. Methods: A prospective, randomized, open-label study was conducted at a tertiary care hospital in South India, according to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Guideline for Good Clinical Practice principles. After institutional ethics committee approval, 100 patients aged 15–40 with moderate-to-severe acne were enrolled, excluding those with a history of gastritis, drug hypersensitivity, pregnancy, or under 12 years old. Participants were randomized to receive either oral azithromycin 500 mg daily for three consecutive days each week for 4 weeks, or doxycycline 100 mg daily for 28 days, along with topical treatments. Efficacy was measured by the type and number of acne lesions, graded according to standardized criteria. QoL was assessed using the Cardiff Acne Disability Index (CADI). Serum testosterone levels were correlated with acne severity. Results: Of the 96 patients (42 males, 54 females) who completed the study, 49 were in the azithromycin group and 47 in the doxycycline group. The mean age was 23.5 years in the azithromycin group and 22.1 years in the doxycycline group. Significant reductions in acne severity and number of lesions were observed in both groups (p&lt;0.0001), with azithromycin showing superior improvement (p&lt;0.01). At baseline, most patients had Grade 3 or 4 acne, which improved significantly post-treatment. QoL improvements were also significant in both groups, with mean CADI scores reducing from around 8 to below 4 (p&lt;0.0001). A weak positive correlation (r=0.24) was found between serum testosterone levels and acne severity. Adverse events were mild and did not necessitate discontinuation. To achieve a 1 unit decrease in CADI, azithromycin treatment costed an additional rupees of 264.5 over doxycycline. Conclusion: Azithromycin and doxycycline are effective treatments for moderate-to-severe acne vulgaris, with significant improvements in clinical and QoL outcomes. While azithromycin offers better clinical efficacy, doxycycline provides a more cost-effective option. Further studies could explore long-term outcomes and the impact of hormonal variations on treatment efficacy.

Automated generation of dispatching rules for the green unrelated machines scheduling problem

The concept of green scheduling, which deals with the environmental impact of the scheduling process, is becoming increasingly important due to growing environmental concerns. Most green scheduling problem variants focus on modelling the energy consumption during the execution of the schedule. However, the dynamic unrelated machines environment is rarely considered, mainly because it is difficult to manually design simple heuristics, called dispatching rules (DRs), which are suitable for solving dynamic, non-standard scheduling problems. Using hyperheuristics, especially genetic programming (GP), alleviates the problem since it enables the automatic design of new DRs. In this study, we apply GP to automatically design DRs for solving the green scheduling problem in the unrelated machines environment under dynamic conditions. The total energy consumed during the system execution is optimised along with two standard scheduling criteria. The three most commonly investigated green scheduling problem variants from the literature are selected, and GP is adapted to generate appropriate DRs for each. The experiments show that GP-generated DRs efficiently solve the problem under dynamic conditions, providing a trade-off between optimising standard and energy-related criteria.

Development and validation of animal variant classification guidelines to objectively evaluate genetic variant pathogenicity in domestic animals

Assessing the pathogenicity of a disease-associated genetic variant in animals accurately is vital, both on a population and individual scale. At the population level, breeding decisions based on invalid DNA tests can lead to the incorrect inclusion or exclusion of animals and compromise the long-term health of a population, and at the level of the individual animal, lead to incorrect treatment and even life-ending decisions. Criteria to determine pathogenicity are not standardized, i.e., no guidelines for animal variants are available. Here, we aimed to develop and validate guidelines to be used by the community for Mendelian disorders in domestic animals to classify variants in categories based on standardized criteria. These so-called animal variant classification guidelines (AVCG) were based on those developed for humans by The American College of Medical Genetics and Genomics (ACMG). In a direct comparison, 83% of the pathogenic variants were correctly classified with ACMG, while this increased to 92% with AVCG. We described methods to develop datasets for benchmarking the criteria and identified the most optimal in silico variant effect predictor tools. As the reproducibility was high, we classified 72 known disease-associated variants in cats and 40 other disease-associated variants in eight additional species.

Nebulizers in pulmonary physical therapy: market overview and selection criteria

Aim. To analyze the market of nebulizers used to provide physical therapy for patients with pulmonary diseases in Ukraine. Materials and methods. The study was based on scientific publications, data from the State Register of Medical Devices of Ukraine, data from the websites of pharmacy chains, and the results of a survey of pharmaceutical professionals. The research methods were scientific generalization, comparison, graphical and mathematical analysis, and questionnaires. Results. The data on the technical characteristics of modern nebulizers and the peculiarities of their use in physical therapy of different groups of patients were summarized. The analysis of the range of nebulizers in the pharmaceutical market of Ukraine showed that the dominant models were compressor-type models (almost 68 % of the range). The share of ultrasonic and mesh nebulizers was insignificant – 26 % and 6 %, respectively. Among the manufacturers of compressor nebulizers, the main share in the assortment belonged to models made in Ukraine (28 % of the subgroup assortment). In general, this type of nebulizers was supplied to the market by manufacturers from 10 countries. The share of domestic models in the ultrasonic nebulizer assortment was 23 %, while the remaining 6 countries accounted for 77 % of the range, respectively. Mesh nebulizers were available from 3 countries (Germany, Japan, China). It was found that the inhaler with the best reviews among doctors was the ArhiMED MESH Pro mesh nebulizer model (Poland), the second place was occupied by the B.Well pro-115 ultrasonic model (Switzerland), and the third place was occupied by the Medisana IN 525 compressor-type model (Germany). The analysis of price characteristics of nebulizers showed that the greatest fluctuations in cost indicators were experienced by the Medisana IN 510 compressor-type models (Germany) – the value of the price growth index was 2.4. Based on the calculations of the affordability index, it was determined that the Beurer IH 21 nebulizer (Germany) with an affordability index value of 1.43 was the most affordable during the period of analysis. The results of the survey of pharmacists involved in the selection of nebulizers for pharmacy visitors showed that compressor-type nebulizers were in the greatest demand, and the price category from UAH 1000 to UAH 1500 was acceptable for consumers to purchase this type of medical equipment. Conclusions. The results of the analysis indicate the physical availability and a wide range of nebulizers for providing physical therapy to patients with pulmonary diseases. However, it has been determined that to ensure the affordability of these devices, it is necessary to implement government measures and programs for the relevant groups of patients. In addition, it can be argued that developing and implementing standardization of criteria for assessing the effectiveness of various types of nebulizers, as well as determining the long-term impact of nebulizer therapy on patients with respiratory diseases, is relevant.

Outcomes of Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation Utilizing Extended Criteria Donor Grafts

Background: The deceased donor shortage in the United States has led to increased utilization extended criteria donor (ECD) liver grafts. Centers often utilize ECD grafts in patients with low Model for End-Stage Liver Disease scores, like patients with hepatocellular carcinoma (HCC). However, few studies have directly examined outcomes of using ECD grafts in HCC patients. Methods: Adults receiving liver transplantation (LT) for HCC between 2010-2020 were identified in the Organ Procurement and Transplantation Network database. Recipients were categorized according to donor type: standard criteria (SCD), extended criteria, donation after brain death (ECD-DBD), and donation after circulatory death (DCD). Multivariable Cox regression analysis identified variables associated with overall or graft survival at 3 years post-LT. Results: Most patients received ECD-DBD grafts (51.4%); only 8.3% received DCD grafts. Time on waitlist was similar for ECD and SCD recipients (p=0.79). SCD recipients had higher 5-year overall survival post-LT than ECD-DBD or DCD recipients (79.1%, 77.1%, and 76.8%, respectively, p<0.001). Similarly, 5-year graft survival was also highest in SCD recipients (SCD, 77.8%; ECD-DBD, 75.7%; DCD, 72,.2%; p<0.001). In multivariable analysis, DCD grafts increased mortality risk (HR, 1.33; 95% CI, 1.12-1.57; p=0.001), but ECD-DBD grafts did not (HR, 1.10; 95% CI, 1.00-1.22; p=0.052). Conclusions: DCD and ECD-DBD recipients had significantly lower overall and graft survival. However, the survival benefit of liver transplantation for HCC patients greatly outweighs the small differences in patient and graft survival from using ECD grafts. Further research should investigate whether treatment of ECD grafts with machine perfusion may ameliorate this discrepancy.

EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma.

Liver cancer is the third leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) accounting for approximately 90% of primary liver cancers. Advances in diagnostic and therapeutic tools, along with improved understanding of their application, are transforming patient treatment. Integrating these innovations into clinical practice presents challenges and necessitates guidance. These clinical practice guidelines offer updated advice for managing patients with HCC and provide a comprehensive review of pertinent data. Key updates from the 2018 EASL guidelines include personalised surveillance based on individual risk assessment and the use of new tools, standardisation of liver imaging procedures and diagnostic criteria, use of minimally invasive surgery in complex cases together with updates on the integrated role of liver transplantation, transitions between surgical, locoregional, and systemic therapies, the role of radiation therapies, and the use of combination immunotherapies at various stages of disease. Above all, there is an absolute need for a multiparametric assessment of individual risks and benefits, considering the patient's perspective, by a multidisciplinary team encompassing various specialties.

Strategies for Promoting Timely Palliative Care in Outpatient Clinics

With cancer now the leading cause of death, the importance of palliative care importance is increasingly evident. However, the focus of current policies is on inpatient and home-based care, which neglects the specialized needs of outpatients and results in many not receiving timely palliative care. Integrating palliative care into outpatient clinics using standardized referral criteria and automated systems will allow for timely patient selection and intervention, early symptom management, and psychological support as well as promote patient autonomy in treatment decision-making. Specialized oncology palliative care nurses play a crucial role in related assessment, care planning, and implementation activities. They help patients and families cope with disease progression and end-of-life care through education and support. Early outpatient palliative care benefits many patients and families, realizing a holistic and comprehensive care model.

Characteristics of subjective olfactory dysfunction and imaging features in patients with traumatic olfactory disorders: a retrospective case-control study.

Olfactory dysfunction caused by head trauma poses significant challenges in clinical diagnosis and treatment. The primary difficulty arises from direct injuries to olfactory-related brain tissues. Although imaging provides the most direct method to evaluate such injuries, there is no standardized international diagnostic criterion for olfactory dysfunction based on imaging. We designed this study to compare the subjective olfactory function differences and brain gray-matter (GM) and white-matter (WM) volume differences between patients with traumatic olfactory dysfunction and those with other types of olfactory dysfunction and to determine the characteristics of subjective olfactory dysfunction and imaging features in patients with traumatic olfactory disorders. The findings of this study can provide a theoretical basis for the diagnosis of traumatic olfactory disorders. This ethics committee-approved, retrospective case-control study included 56 patients with traumatic olfactory dysfunction (trauma group) and 45 patients with other types of olfactory dysfunction (e.g., postinfection, nasal inflammation, idiopathic disease). The "Sniffin' Sticks" olfactory function test was used to analyze the subjective olfactory function differences between the two groups, and voxel-based morphometry (VBM) was used to compare the GM volume (GMV) and WM volume (WMV) of brain regions between the two groups. (I) There was no statistical difference in age distribution between the trauma group (41.55±11.77 years) and the control group (38.87±14.37 years; P>0.05). (II) The trauma group had significantly lower total scores and subtest scores on the Sniffin' Sticks olfactory test compared to the control group [odor threshold test (OT): 1.04±0.33 vs. 1.67±1.42; odor discrimination test (OD): 2.93±2.25 vs. 5.42±3.66; odor identification test (OI): 2.77±1.94 vs. 6.71±3.55; total scores: 6.74±3.91 vs. 13.81±7.63; all P values <0.05]. (III) Compared with the control group, the trauma group had significantly reduced GMV and WMV in the bilateral orbitofrontal cortex, bilateral anterior cingulate gyrus, bilateral cingulate gyrus, bilateral rectus gyrus, bilateral olfactory cortex, right superior frontal gyrus, bilateral insula, bilateral caudate nucleus, and bilateral thalamus [Pfamily-wise error (FWE)<0.05]. (IV) There was a significant positive correlation between the odor identification function scores and GMV in certain brain regions (PFWE<0.05), and the GMV in these regions was reduced in the trauma group compared to the control group. Compared to patients with other types of olfactory dysfunction, patients with traumatic olfactory dysfunction have poorer subjective olfactory functions and more severe damage to olfactory-related brain regions, including the bilateral orbitofrontal cortex, anterior cingulate gyrus, cingulate gyrus, rectus gyrus, insula, and olfactory cortex. The olfactory nerve damage in these brain regions can be used as a basis for the diagnosis of traumatic olfactory disorders.

Developing standard criteria for robotic process automation candidate process selection

&lt;p&gt;Robotic process automation (RPA) is a cutting-edge technology that provides software robots to repeat and mimic the repeatable tasks that a human user earlier performed. The use of software robots is encouraging because of their cost efficiency and easy implementation. Selecting and prioritizing a candidate process for automation is always challenging as all the business processes in an organization are not equally suitable for RPA implementation. Various studies have highlighted several criteria found in the literature for determining, prioritising, and selecting a business process for RPA. Nevertheless, there are no set standards for evaluating and analyzing a certain process or its tasks to determine whether they may be automated to use RPA. This paper aims to develop standard criteria and propose a consistent model to select and prioritize candidate process for RPA projects. To assess these criteria's applicability in the context of RPA, surveys among subject matter experts (SMEs) are used to validate them. Principal component analysis (PCA) and correlation are used to identify the top 20 criteria. Naïve Bayes algorithm is applied on the collected data for decision-making. The developed multi-criteria model exhibits strong precision and recall measures, with training and validation accuracy of 96% and 90%, respectively.&lt;/p&gt;

Mapping the values of radiology

BackgroundWhile there is an extensive literature on low-value imaging, there is no agreed definition of the concept. However, a clear and consistent definition of low-value imaging is crucial for providing comparable and targeted research, and for increasing the quality, safety, effectiveness, efficiency, and sustainability of imaging services. Accordingly, the purpose of this study is to provide a definition of low-value imaging. Materials and MethodsReview and assessment of definitions of low-value care and of practical measures of low-value imaging in the literature combined with standard concept analysis to elaborate a definition of low-value imaging according to standard criteria for definitions, such as precision, non-circularity, applicability, (theoretical) justification, and distinctability. The applicability of the suggested definition is assessed by testing it on practical tasks and examples ResultsBased on a study of definitions of low value care and practical measures of low value imaging in the literature this study develops a definition of low-value imaging: Low value imaging is imaging that does not contribute to reducing the overall pain, dysfunction or suffering of the person that is examined (compared to alternative actions). Accordingly, low value imaging can result in more harm than benefit, may not change the clinical management of the patient, or not be cost-effective. The suggested definition satisfies general criteria for definition, is able to address practical tasks and examples of imaging, and can differentiate valuable from non-valuable imaging. ConclusionA clear and consistent definition of low-value imaging is provided and is crucial for improving the quality, safety, effectiveness, efficiency, and sustainability of medical imaging. The suggested definition can be used to differentiate between valuable and non-valuable imaging.

Vocal cord dysfunction: Does laryngeal adduction on laryngoscopy predict disease severity and response to laryngeal retraining therapy?

AbstractIntroductionVocal cord dysfunction (VCD) is a complex disorder characterized by episodic adduction of the vocal folds during inspiration and expiration, which can lead to dyspnea, wheezing, cough, and acute‐onset respiratory distress. Currently, there is a lack of standardized criteria among treating physicians across multiple disciplines, including otolaryngologists, pulmonologists, allergists, and speech and language pathologists, for diagnosis and treatment of VCD, although laryngeal‐respiratory retraining therapy (LRT) has emerged as the preferred treatment modality.ObjectiveIn the present study, we examined the efficacy of LRT in patients presenting with a clinical diagnosis of VCD in the presence and absence of laryngeal adduction on laryngoscopy.ResultsOverall, 74.1% of the cohort showed a response to LRT, of which 62.1% were partial and 12.1% were significant responses. When comparing between patients with and without laryngeal adduction on laryngoscopy, there were no significant differences in the number of sessions of LRT undertaken, mean time to response, and overall response rate between the groups.ConclusionOur findings suggest that LRT should be utilized for all patients presenting with symptoms of VCD, even in the absence of laryngeal adduction on laryngoscopy.

Identifying periods impacted by sewer inflow and infiltration using time series anomaly detection

Accurate diagnosis of sewer inflow and infiltration (I/I) is crucial for ensuring the safe transportation of sewage and the stability of wastewater treatment processes. Identifying periods impacted by I/I is essential for I/I diagnosis, but current methods lack a standard criterion and require adaptation to specific conditions, resulting in low accuracy, complexity, and limited generalizability. This paper proposes a novel approach to distinguish I/I periods from time series of sewer measurements based on anomaly detection theory through an iterative use of a time-series reconstruction model. This method eliminates the need for external data such as rainfalls and avoids intensive manual data analysis. Operating directly on in-sewer data, it enhances accuracy compared to existing approaches and is applicable to various external factors such as rainfall, snowmelt, and seawater intrusion. The method can be applicable to a broad range of monitoring data, including flow rate, temperature, and conductivity. Validated through simulation studies and demonstrated via real-life applications, this method offers an efficient solution for I/I detection, facilitating further I/I diagnosis, including I/I quantification and location identification.

Freedom from infection: enhancing decision-making for malaria elimination

Assessing elimination of malaria locally requires a surveillance system with high sensitivity and specificity to detect its presence without ambiguity. Currently, the WHO standard criteria of observing the absence of...

Validity and Reliability of the Turkish Version of General Practitioner Assessment of Cognition

ABSTRACT The General Practitioner Assessment of Cognition (GPCOG) was explicitly developed as a brief cognitive screening tool for general practitioners. It consists of a patient section testing cognition and an informant section asking historical questions. This study aimed to test the validity and reliability of the Turkish version of GPCOG-Tr on older Turkish adults. The study included two hundred thirty (n = 230) community-dwelling individuals aged at least 55. The GPCOG was translated, back-translated, and revised to determine the final GPCOG-Tr. The sample was divided into the patient group (with memory complaints) and the control group (without memory complaints). The GPCOG-Tr was compared against standard criteria for diagnosis of dementia (Diagnostic and Statistical Manual of Mental Disorders − 5th edition), the Clinical Dementia Rating scale, the Mini-mental State Examination, The Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) subscale, and the Geriatric Depression Scale (GDS). The reliability test was done on 30 participants after two weeks. The two-stage method of administering the GPCOG-Tr had a sensitivity of 85%, a specificity of 92%, a misclassification rate of 11.3%, and a positive predictive value of 92%. The test-retest correlation coefficients ranged from 0.86 to 0.98. The GPCOG-Tr total was at least equivalent to the MMSE and ADAS-Cog in detecting dementia. The GPCOG-Tr displayed solid psychometric properties, offering the general practitioners an efficient cognitive instrument for older Turkish people.

Swallowing and Aspiration: How to Evaluate and Treat Swallowing Disorders Associated with Aspiration Pneumonia in Older Persons.

Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.