Cumulative Score Research Articles

Association of an In-Hospital Desirability of Outcomes Ranking Scale With Postdischarge Health-Related Quality of Life: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation.

To develop a desirability of outcome ranking (DOOR) scale for use in children with septic shock and determine its correlation with a decrease in 3-month postadmission health-related quality of life (HRQL) or death. Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective study. Twelve U.S. PICUs, 2013-2017. Children (1 mo-18 yr) with septic shock. None. We applied a 7-point pediatric critical care (PCC) DOOR scale: 7: death; 6: extracorporeal life support; 5: supported by life-sustaining therapies (continuous renal replacement therapy, vasoactive, or invasive ventilation); 4: hospitalized with or 3: without organ dysfunction; 2: discharged with or 1: without new morbidity to patients by assigning the highest applicable score on specific days post-PICU admission. We analyzed Spearman rank-order correlations (95% CIs) between proximal outcomes (PCC-DOOR scale on days 7, 14, and 21, ventilator-free days, cumulative 28-day Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores, and PICU-free days) and 3-month decrease in HRQL or death. HRQL was measured by Pediatric Quality of Life Inventory 4.0 or Functional Status II-R for patients with developmental delay. Patients who died were assigned the worst possible HRQL score. PCC-DOOR scores were applied to 385 patients, median age 6 years (interquartile range 2, 13) and 177 (46%) with a complex chronic condition(s). Three-month outcomes were available for 245 patients (64%) and 42 patients (17%) died. PCC-DOOR scale on days 7, 14, and 21 demonstrated fair correlation with the primary outcome (-0.42 [-0.52, -0.31], -0.47 [-0.56, -0.36], and -0.52 [-0.61, -0.42]), similar to the correlations for cumulative 28-day PELOD-2 scores (-0.51 [-0.59, -0.41]), ventilator-free days (0.43 [0.32, 0.53]), and PICU-free days (0.46 [0.35, 0.55]). The PCC-DOOR scale is a feasible, practical outcome for pediatric sepsis trials and demonstrates fair correlation with decrease in HRQL or death at 3 months.

Hybrid machine learning approach for trust evaluation to secure MANET from routing attacks

A new era in communication has been ushered in by MANET networks, in which users (nodes) interact with one another through a self-configuring network of handheld devices linked by wireless links. Nodes are capable of participating and enthusiastic about sending packets to other nodes. Consequently, the need for a routing protocol materializes. The most difficult aspect is dealing with the network’s dynamic topology as a result of node mobility. This is because limited resources like storage space, battery life, and bandwidth require a protocol that can quickly adapt to topology changes while periodically updating messages. On the other hand, security is another important aspect of routing since the involvement of attackers will exhaust the network resources. This paper addresses the main issue of designing a routing protocol that handles all the adversaries and achieves better efficiency. For that, we proposed a Hybrid Machine Learning (HyML) model which evaluates the. Initially, the network is segregated by the Secure Stable Clustering (SSC) approach which first verifies the node’s legacy and forms clusters based on stability. The HyML is designed by combining two important ML techniques such as ANN and fuzzy-C Means (FCM) algorithm. The ANN model learns multiple attributes of the trust value and computes the cumulative trust score. Next, FCM determines the node position upon trust score. After the computation of the trust value, optimal route selection is performed by the Spider Monkey Optimization (SMO) technique. The overall work is evaluated through comprehensive simulations based on network longevity, throughput, energy usage, PDR, attack detection efficiency, and delay.

Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis.

Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive acid blockers (P-CAB) are promising alternatives to proton pump inhibitors (PPI). We aimed to compare the efficacy and safety of P-CAB and PPI in healing grade C/D esophagitis to aid clinical decision-making. A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CAB and PPI in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score. Of 5,876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CAB (vonoprazan, tegoprazan, and keverprazan) and 6 PPI (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan q.d. ranked the first among PPI in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPI. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan q.d. was a reasonable choice, considering its moderate efficacy and safety. Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with PPI, with moderate short-term and long-term safety.

Prediction of Survival in the Elderly Patients with Glioblastoma using Cumulative Inflammatory Markers Score

Abstract Objectives This retrospective study aimed to explore the prognostic effect of cumulative score based on neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and fibrinogen in older adults diagnosed with glioblastoma (GBM). Design Retrospective study. Setting Huashan Hospital. Participants Patients aged over 60 years and diagnosed with GBM between 2010 and 2017. Main Outcome Measures Results of preoperative routine biochemistry and coagulation blood examinations were reviewed from medical records. Overall survival (OS) was considered a period from first resection surgery until death. Progression-free survival (PFS) was considered a period from initial operation until the date of tumor progression demonstrated in brain magnetic resonance imaging or death from any cause. If no event occurred, the last follow-up appointment was the end of the observation for OS or PFS. The Kaplan–Meier method was used to evaluate survival curves, and prognostic factors were analyzed by the Cox proportional hazards model. Results A total of 289 patients were included. Patients with higher levels of fibrinogen, NLR, and PLR had significantly shorter median OS (p = 0.001, p = 0.016, and p = 0.002, respectively) and PFS (p = 0.004, p = 0.022, and p = 0.009, respectively) compared with those with lower levels. Multivariate analyses showed a significant association between higher F-NLR-PLR score and reduced OS (adjusted hazard ratios [aHRs]: 1.356, 95% confidence interval [CI] 1.009–1.822 for scores 1–2 compared with 0; 5.974, 95% CI 2.811–12.698 for score 3 compared with 0). Similarly, a significant association between higher F-NLR-PLR score and reduced PFS was observed (aHR: 1.428, 95% CI 1.066–1.912 for scores 1–2 compared with 0; aHR: 2.860, 95% CI 1.315–6.223 for score 3 compared with 0). Conclusion Higher F-NLR-PLR score is associated with reduced OS and PFS in older adults with GBM, which helps identify patients at high risk and guide the individualized treatment in clinical practice.

Genetic Biomarkers of Sorafenib Response in Patients with Hepatocellular Carcinoma.

The identification of biomarkers for predicting inter-individual sorafenib response variability could allow hepatocellular carcinoma (HCC) patient stratification. SNPs in angiogenesis- and drug absorption, distribution, metabolism, and excretion (ADME)-related genes were evaluated to identify new potential predictive biomarkers of sorafenib response in HCC patients. Five known SNPs in angiogenesis-related genes, including VEGF-A, VEGF-C, HIF-1a, ANGPT2, and NOS3, were investigated in 34 HCC patients (9 sorafenib responders and 25 non-responders). A subgroup of 23 patients was genotyped for SNPs in ADME genes. A machine learning classifier method was used to discover classification rules for our dataset. We found that only the VEGF-A (rs2010963) C allele and CC genotype were significantly associated with sorafenib response. ADME-related gene analysis identified 10 polymorphic variants in ADH1A (rs6811453), ADH6 (rs10008281), SULT1A2/CCDC101 (rs11401), CYP26A1 (rs7905939), DPYD (rs2297595 and rs1801265), FMO2 (rs2020863), and SLC22A14 (rs149738, rs171248, and rs183574) significantly associated with sorafenib response. We have identified a genetic signature of predictive response that could permit non-responder/responder patient stratification. Angiogenesis- and ADME-related genes correlation was confirmed by cumulative genetic risk score and network and pathway enrichment analysis. Our findings provide a proof of concept that needs further validation in follow-up studies for HCC patient stratification for sorafenib prescription.

Association between dietary pattern and frailty among people aged 50 years and over in Shanghai

Objective: To investigate dietary patterns of individuals aged ≥50 in Shanghai and analyze their association with frailty. Methods: Using data from the third wave of the Study on Global Ageing and Adult Health in Shanghai conducted between 2018 and 2019. We collected the frequency and average intake of food by the food frequency questionnaire. Factor analysis was used to extract dietary patterns, and a frailty index was constructed using the ratio of the cumulative total score of health deficits to 35 health-related variables considered. We used an ordinal multinomial logistic regression model to analyze the association between dietary patterns and frailty. Results: A total of 3 274 participants aged (67.9±9.2) years were included in the study, including 1 971 (60.2%) men and 1 303 (39.8%) women. We extracted four dietary patterns: high-protein-nuts pattern, potato-bean-vegetable-fruit pattern, poultry-meat pattern, and high-oil-salt pattern. After adjusting for confounding factors, the logistic regression analysis showed that compared with the high-oil-salt pattern, the high-protein-nuts pattern was negatively associated with the risk of higher frailty (OR=0.743, 95%CI: 0.580-0.951). We did not find an association between dietary patterns and frailty between the different gender groups. In the age group 50-64, the high-protein-nuts and potato-bean-vegetable-fruit patterns were negatively correlated with a higher degree of frailty than the high-oil-salt pattern. In the low-level physical activity group, the high-protein-nuts pattern was negatively correlated with a higher degree of frailty than the high-oil-salt pattern (OR=0.509, 95%CI: 0.361-0.720). However, we found no significant effect of the high-protein nuts pattern, potato-bean-vegetable-fruit pattern, and poultry-meat pattern on the risk of higher frailty compared to the high-oil-salt pattern in the moderate to high level of physical activity group. Conclusions: Compared to the high-oil-salt pattern, dietary patterns with a higher intake of high-protein nuts, potatoes, legumes, and fruits and vegetables might be associated with a lower risk of higher frailty in residents aged 50-64 years of age than with a high oil and salt pattern. At the same time, it may have a more significant protective effect in people with lower physical activity levels. It is suggested that a diet rich in high-protein foods, nuts, potatoes, beans, vegetables, and fruits may help reduce and delay the risk of frailty.

Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review

BackgroundIncreased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis.MethodA retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol.ResultsOf the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min–max) SLEDAI-2 K scores were 9 (0–38), median (min–max) SLICC/ACR-DI (SDI) score were 1 (1–5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma.ConclusionEstimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.

Inter-tester reliability and agreement of the Cumulated Ambulation Score in acute stroke: The InTRO-CAS-stroke study

TitleInter-Tester Reliability and Agreement of the Cumulated Ambulation Score in Stroke patients: The InTRO-CAS-stroke study ObjectiveTo examine the inter-tester reliability of the total Cumulated Ambulation Score (CAS) and the three activities of the CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with stroke. MethodsAn intertester reliability study. Setting: Participants: 60 participants from a specialized stroke unit with a mean age of 69.10 ± 13.23 years. The CAS describes a patient's independency in three activities – (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability and was assessed by two independent physiotherapists at median day 3 poststroke. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent basic mobility. Relative and absolute reliability was evaluated using weighted kappa, the standard error of measurement (SEM) and minimal detectable change (MDC). ResultsThe weighted kappa for the total CAS score was 0.816 and ranged from 0.733 to 0.904 for the 3 CAS activities. The SEM and the MDC of the total CAS was 0.37 and 1.03 respectively. ConclusionsThe intertester reliability of the CAS is almost perfect, and a change of 1 CAS point for the total CAS indicates a real change in basic mobility, at group level and for an individual patient with stroke Clinicaltrials.gov identifierNCT05601089

(293) Observed Relationship Between Testosterone Levels and Perceived Body Image

Abstract Introduction A positively perceived body image is an important part of one’s conception of oneself and one’s own identity, abilities, and worth. Past research has shown an inverse relationship between testosterone concentration and one’s sense of self, as manifested by increased depression. We hypothesized, therefore, that a subjectively negative self-image would be associated with the objective findings of hypogonadism (low testosterone). Objective To investigate the relationship between one’s own serum testosterone and a personal assessment of one’s body image and satisfaction. Methods An electronic survey was delivered through REDCap to patients at our urology clinic with a recent testosterone value documented in the observation interval 1/1/2020-12/31/2022. The survey included components of the following validated surveys: the Self-Rated Bodily Attractiveness Survey, the Male Body Image Self-Conscious Scale, and the Body Esteem Scale. Specifically, we asked each patient about their perceived bodily attractiveness as it pertains to sexual intercourse as well as specific inquiries about feelings towards specific body parts. Each answer choice corresponded to a five-point Likert-Scale, enabling respondents to indicate their level of agreement or disagreement. We then retrospectively recorded the most recent testosterone value recorded in each respondent’s electronic medical record. T-tests were utilized to compare testosterone values for men with high versus low survey scores using SPSS. Results The men who reported a positive cumulative body image score from the survey had an average testosterone of 749.15 ng/dL, whereas men who had a negative body image score from our survey had an average testosterone of 340.67 ng/dL. Importantly, these testosterone values were statistically significant from each other, as indicated by a t-value of 2.58 and a p-value of .0095. To establish clear distinctions between the positive and negative body image cohorts, we set threshold scores for each group: the positive body image cohort was defined as individuals scoring at least 34 out of 45 (≥ 75%), while the negative body image cohort comprised those with scores no higher than 30 out of 45. Interestingly, there were no respondents whose cumulative scores fell within the range of 30 to 34. The positive body image cohort had an average score of 39.92 out of 45, while the negative body image cohort had an average score of 23.00 out of 45. Conclusions Based on our findings, it appears that men with hypogonadism, as characterized by low testosterone, may be more likely to experience a negative body image. This relationship is supported by this cohort’s response to several questionnaires addressing one’s own assessment of self-worth. Men with low testosterone versus eugonadal controls scored significantly lower in surveys addressing bodily attractiveness, male body image self-consciousness, and body esteem. These results highlight the relationship between low testosterone and body image, contributing to our understanding of the psychological factors that can influence well-being in men. Healthcare professionals should be aware of the potential implications and challenges faced by individuals with hypogonadism, addressing concurrently both their hormonal deficiencies and their negative sense of self. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant).

A Heterogeneity-Aware Car-Following Model: Based on the XGBoost Method

With the rising popularity of the Advanced Driver Assistance System (ADAS), there is an increasing demand for more human-like car-following performance. In this paper, we consider the role of heterogeneity in car-following behavior within car-following modeling. We incorporate car-following heterogeneity factors into the model features. We employ the eXtreme Gradient Boosting (XGBoost) method to build the car-following model. The results show that our model achieves optimal performance with a mean squared error of 0.002181, surpassing the model that disregards heterogeneity factors. Furthermore, utilizing model importance analysis, we determined that the cumulative importance score of heterogeneity factors in the model is 0.7262. The results demonstrate the significant impact of heterogeneity factors on car-following behavior prediction and highlight the importance of incorporating heterogeneity factors into car-following models.

The Psychosocial Effects of Lockdown Due to the COVID-19 Pandemic on Children in 2021.

Objectives The COVID-19 pandemic led to a nationwide lockdown that isolated numerous children and adolescents, significantly affecting their mental well-being. Therefore, this study aimed to assess the challenges faced by children during the pandemic and identify the potential contributing factors. Additionally, given the existing concerns surrounding the mental health of female children and adolescents, our study aimed to investigate the presence of sex-based disparities in children's observed emotional and behavioral difficulties during the COVID-19 lockdown. Methods Participants in this study were parents of children aged 6-17 years. An observational cross-sectional study was conducted through verbal administration of a validated semi-structured questionnaire, the Parent Report Measure, from June 2021 to August 2021 at a nearby community health center. The questionnaire collected socio-demographic details and utilized the Strengths and Difficulties Questionnaire (SDQ), a screening tool to assess children's emotional and behavioral aspects during the six-month lockdown period. The responses were then analyzed using appropriate statistical tools like SPSS statistics, and cumulative SDQ scores were used to categorize participants. Results Out of the total 280 responses analyzed, the prosocial subscale exhibited the highest number of abnormal responses, 73 (26.1%), followed by conduct (42; 15%), hyperactivity (41; 14.6%), and peer (41; 14.6%) subscales. These results indicated that children displayed decreased empathy towards others, restlessness, fidgetiness, reduced attention span, frequent tantrums, and a preference for solitary activities. Furthermore, there was a significant association between abnormal subscale scores and the sex of children. Females showed a considerably higher prevalence of emotional problems (172; 61.5%) than males. Among the behavioral responses, a more significant proportion of females displayed abnormal scores in the conduct subscale (170; 60.7%), while abnormal hyperactivity scores were more frequently observed among males (178; 63.4%). Regarding the peer problems subscale, the proportion of females was slightly higher than males (150; 53.7%) and nearly equal in the prosocial domain. A more significant proportion of females displayed abnormal scores for overall difficulties 144 (51.5%), indicating a notable sex-based disparity. Conclusion Our findings highlight the pandemic's significant impact on many children's psychological well-being. The results emphasize the need for targeted interventions to address the mental health concerns that arose in this population. The observed disparity in emotional and behavioral difficulties among female children is particularly concerning, highlighting the need for gender-sensitive support and care. Various strategies can be helpful, such as virtual support groups, indoor recreational activities, reduced screen time and excessive news consumption, and effective communication with parents. Furthermore, our study also indicates the need to dive deep into such areas of pediatric research to understand and plan timely interventions.

Cumulative Genetic Scores Interact with Maternal and Paternal Parenting in Predicting Parent-Adolescent Cohesion and Conflict.

Previous research concerning the interplay between genetics and parenting in the development of the parent-child relationship during adolescence has been extremely scarce, predominantly adopting single-gene designs. This limited body of work has largely overlooked the distinct effects of maternal and paternal roles, as well as potential gender differences. Additionally, existing gene-by-environment (G × E) studies have mainly concentrated on adverse environmental factors and associated negative outcomes, somewhat neglecting positive environments and outcomes. The present study examined the interactions of cumulative genetic scores (CGS, dopamine receptor D2 TaqIA and oxytocin receptor gene rs53576 polymorphisms) with both positive and negative parenting on parent-adolescent cohesion and conflict. Furthermore, this study aimed to ascertain with which gene-environment model the potential G × E interactions would align. A total of 745 Chinese Han adolescents (Mage = 13.36 ± 0.96 years; 46.8% girls) from grades 7 to 9 participated in this study. Results revealed a significant effect of CGS and negative maternal parenting on mother-adolescent conflict among males, consistent with the weak differential susceptibility model. As CGS increased, the effects of negative maternal parenting on mother-son conflict were magnified. These findings have implications for the timing and focus of interventions aimed at improving parent-adolescent relationships.

Mapping Cumulative Risk in Delaware: Approach and Implications for Health Equity.

Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware. This cross-sectional study used choropleth maps to visualize the distribution of environmental, social, and cumulative risks and Moran's I statistics to assess spatial clustering of cumulative risk across the county and among individual block groups. Findings indicate that environmental risk rarely occurs without social risk and that environmental and social risks co-occur in distinct areas, resulting in large-scale clustering of cumulative risk. Areas of higher cumulative risk had more Black residents and people of lower socioeconomic status. Replicable measures of cumulative risk can show how environmental and social risks are inequitably distributed by race and socioeconomic status, as seen here in New Castle County. Such measures can support upstream approaches to reduce health disparities resulting from histories of environmental racism.

Groundtruthing cumulative impact assessments with biodiversity data: Testing indicators and methods for marine ecosystem condition assessments in South Africa

Abstract Accurate assessments of ecosystem condition are needed to inform management processes such as systematic conservation planning and protected area expansion, marine spatial planning and other effective area‐based conservation measures. Yet measuring the condition of dynamic and often largely inaccessible marine ecosystems is extremely difficult and presents a global challenge. Broad‐scale cumulative impact assessments have been used in South Africa as a proxy for marine ecosystem condition in national assessments and reporting because the data are more readily available, and knowledge exists on the impacts of various human activities (or pressures) on marine ecosystems. While useful for national reporting, assessments based on in situ ecological data are also needed at finer scales relevant to management. Applying the HELCOM BEAT approach, this study used in situ ecological data to identify potential methods and indicators that can be applied in South Africa to conduct integrated ecosystem assessments and to assess the suitability of current cumulative impact assessments as a proxy for condition. Aggregated fish indicators demonstrated greater sensitivity to varying human pressures compared with benthic community indicators, with responsiveness differing by location. Notably, site‐level differences in empirical condition emerged that broad‐scale cumulative assessments often missed. The study thus highlighted the varying suitability of cumulative impact scores as proxies for condition, indicating their reliability for fish communities. However, this is also dependent on the pressure types included, the biotic indicators used and the area of focus. Conservation decisions based solely on cumulative impact scores could misrepresent the actual condition of the environment, which makes it difficult to make management decisions, especially at finer scales. As such, conservation initiatives need to be regionally adapted to effectively address the unique pressures and conditions of each area and should be tailored to account for fine‐scale variability, instead of adopting a one‐size‐fits‐all approach.

Enhanced Skin Assessment Methodology to Detect Early Tissue Damage and Prevent Pressure Injuries.

The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs) in critically ill adults. This was a retrospective, descriptive, comparative research study. The sample comprised 69 critically ill adults; their mean age was 58.8years (SD 18.1years). The majority were male (n=40, 58%), 29 (42%) were African American (AA), and 36 (52%) were White. The study setting was a surgical trauma intensive care unit (STICU) in a southern US Gulf Coast academic level I trauma hospital. Data were collected from September to November 2021. We conducted a retrospective medical record review of subjects who had undergone SEM assessment. We also collected demographic and pertinent clinical information, including Braden Scale cumulative scores and subscale scores, documented PI prevention interventions, and PI occurrence and characteristics if developed within 7days of SEM measurement. We also evaluated whether PI prevention interventions were appropriate. To examine nurse perception of the SEM device, we conducted a web-based survey of nurses providing care in our facility's STICU. Comparison of responses was done using Fisher's test or Chi-square test, and the mean responses from groups were compared using t test. Thirty-five (57%) subjects had a sacral SEM delta ≥0.6; 14 (40%) were AA; 20 (57%) were White; and 11 (31%) had a hospital-acquired PI (HAPI) or present-on-admission (POA) PI. Among the 14 HAPI and POA PI subjects with sacral SEM delta, 11 (79%) had sacral SEM delta ≥0.6. Among 26 AA subjects with sacral SEM delta, 5 had a HAPI or POA PI, and of those, 4 (80%) had sacral SEM delta ≥0.6. A significant and negative correlation was observed between cumulative Braden Scale scores on day 2 and sacral SEM delta (r =-0.28, P =.03) and R heel delta (r =-0.29, P =.03) scores, indicating higher PI risk. Of the 35 patients with a sacral SEM delta ≥0.6, 24 (69%) subjects did not have appropriate PI prevention interventions. Nurses (n=13) indicated that the SEM device was easy to use and helped them perform an accurate skin assessment on patients with darker skin tones. This study demonstrates that SEM technology is beneficial to address racial disparities in skin assessment, enhance skin assessment accuracy beyond existing PI care, improve the accuracy of risk assessment, and promote appropriate location-specific PI prevention interventions.

Social Media Use among Orthopedic Trauma Fellowship-trained Surgeons.

Objective: To quantify the use of social media platforms by orthopedic traumatologists with an emphasis on demographic, practice-based, and regional differences. Materials and Methods: Using the Orthopaedic Trauma Association (OTA) membership database, online searches were performed to identify professional profiles on numerous social media platforms. This presence was then quantified by a cumulative social media score which was correlated to the demographic information collected. Results: In total, 1,262 active fellowship-trained orthopedic traumatologists were identified. Surgeons practicing in an academic setting were found to be more likely to use numerous social media platforms and to present an overall greater social media score than those in private practices. No significant differences in use were found based on practice region. Conclusion: Social media platforms are currently underused by orthopedic traumatologists. Level of Evidence: IV.

Early Life and Childhood Environmental Exposures, More Than Genetic Predisposition, Influence Age of Diagnosis in a Diverse Cohort of 2952 Patients With IBD

Background and AimsInflammatory bowel disease (IBD) develops from a combination of genetic and environmental factors. The aim of this study was to determine the contribution of established environmental risk factors and genetic risk on age of IBD diagnosis in a diverse cohort. MethodsIBD patients in clinic completed detailed questionnaires. Blood was drawn for genetic analysis. Environmental risk factors and age of diagnosis were analyzed by ethnicity (Hispanic/Latinx or non-Hispanic White [NHW] individuals) and IBD subtype (ulcerative colitis or Crohn’s disease [CD]). Weighted genetic risk scores and environmental risk scores were developed. We examined the relationship between environmental risk scores, genetic risk scores, and age of diagnosis. ResultsA total of 2952 patients were included: 58.9% had CD. A total of 46.83% were of Hispanic background. Early life exposures like cesarean delivery and being born in a developed country were associated with a younger age of IBD diagnosis. Childhood exposures such as frequent plastic water bottle use and having more than 1 bathroom at home were associated with a younger age of IBD. Hispanic and NHW individuals shared similar susceptibilities to environmental exposures. Environmental factors explained 21% of the variance in age of CD diagnosis and 39% in ulcerative colitis. In models incorporating genetic risk score and environmental risk score, the environment was the only significant factor associated with younger age of IBD diagnosis in all groups. ConclusionsEarly life and childhood exposures impact IBD diagnosis and influence Hispanic and NHW individuals similarly. A cumulative environmental risk score contributes more to age of IBD diagnosis than genetic risk.

Efficacy and safety of adjunctive oral therapy in Parkinson’s disease with motor complications: a systematic review and network meta-analysis

BackgroundThe aim of this manuscript is to review the evidence and compare the efficacy and safety of catechol-O-methyltransferase inhibitors (COMT-Is), dopamine receptor agonists (DRAs) and monoamine-oxidase B inhibitors (MAOB-Is) as...

Delineation of selection indices for identification of asiatic cotton (Gossypium arboreum L.) genotypes for drought tolerance ability

Categorization of genotypes under low moisture conditions is essential for the identification and development of drought tolerant genotypes in cotton. In the present study, 48 diverse Asiatic cotton genotypes were categorized for drought tolerance ability using two different techniques. The significant interaction between genotypes and drought treatment indicates that the studied genotypes were significantly affected by imposed treatment for measured drought tolerance related traits. The categorization of genotypes based on the cumulative score assigned for each genotype revealed the linear relationship between biomass production and drought tolerance ability. The categorization of genotypes based on comprehensive drought tolerance measurement is the finest way to identify the contrast cotton genotypes for drought tolerance ability. The Asiatic cotton genotypes NDLA 2963, NDLA 2965, NDLA 3113, NDLA 3139-3 and NDLA 2708 are identified as drought tolerant, which can be exploited for the improvement of drought tolerance ability in Asiatic cotton breeding programs.

Tapping into long term value: a comprehensive overview of BIST 30 index companies future potential

Purpose - This article aims to establish a correlation between the valuation potential of companies listed on the Borsa Istanbul 30 index and their enduring competitive advantage, focusing on microeconomic Key Performance Indicators (KPIs) and corporate governance dimensions. Methodology - The study conducted an extensive analysis of the financial statements of BIST 30 companies spanning three years. Employing a unique approach utilizing Triangular Spherical Fuzzy Sets, it assessed the significance of these KPIs and corporate dimensions, chosen for their capacity to handle imprecise data. Three experts were consulted over three years to assign importance scores to each indicator, which were then used to calculate cumulative scores for individual stocks. Findings - The application of the Triangular Spherical Fuzzy Sets method provided a comprehensive understanding of these indicators, ena-bling a nuanced evaluation of the cumulative score for each stock. Notably, a clear distinction emerged between service and manufacturing companies, suggesting a potential glass ceiling effect that favors production-oriented enterprises. The observed patterns in certain stocks aligned with the framework developed in this study. Conclusion - This study illustrates the use of fuzzy logic in evaluating stock valuation potential, revealing insights into their sustained growth prospects. Aligned with Warren Buffett's value investing principles, it advances modeling approaches within the Turkish public stock exchange. Offering a unique perspective on BIST 30 stocks' long-term valuation potential, it provides valuable insights for investors, stakeholders, and analysts in the dynamic finance landscape. Emphasizing the understanding of companies' enduring competitive strength in an evolving market is pivotal. Keywords: Value investing, triangular spherical fuzzy sets, long term competitive advantage, corporate governance.