Cumulative Time Research Articles

Association between Transient-Continuous Hypotension during Mechanical Thrombectomy for Acute Ischemic Stroke and Final Infarct Volume in Patients with Proximal Anterior Circulation Large Vessel Occlusion.

Background/Objectives: Periprocedural blood pressure changes in stroke patients with a large vessel occlusion are a known modifiable risk factor of unfavorable treatment outcomes. We aimed to evaluate the association between pre-revascularization hypotension and the final infarct volume. Methods: In our retrospective analysis, we included 214 consecutive stroke patients with an anterior circulation large vessel occlusion that underwent mechanical thrombectomy under general anesthesia. Noninvasively obtained blood pressure values prior to symptomatic vessel recanalization were analyzed as a predictor of post-treatment infarct size. Linear logistic regression models adjusted for predefined factors were used to investigate the association between blood pressure parameters and the final infarct volume. Results: In our cohort, higher baseline systolic blood pressure (aβ = 8.32, 95% CI 0.93-15.7, p = 0.027), its maximal absolute drop (aβ = 6.98, 95% CI 0.42-13.55, p = 0.037), and >40% mean arterial pressure decrease (aβ = 41.77, CI 95% 1.93-81.61, p = 0.040) were independently associated with higher infarct volumes. Similarly, continuous hypotension measured as intraprocedural cumulative time spent below either 100 mmHg (aβ = 3.50 per 5 min, 95% CI 1.49-5.50, p = 0.001) or 90 mmHg mean arterial pressure (aβ = 2.91 per 5 min, 95% CI 0.74-5.10, p = 0.010) was independently associated with a larger ischemia size. In the subgroup analysis of 151 patients with an M1 middle cerebral artery occlusion, two additional factors were independently associated with a larger ischemia size: systolic blood pressure maximal relative drop and >40% drop from pretreatment value (aβ = 1.36 per 1% lower than baseline, 95% CI 0.04-2.67, p = 0.043, and aβ = 43.01, 95% CI 2.89-83.1, p = 0.036, respectively). No associations between hemodynamic parameters and post-treatment infarct size were observed in the cohort of intracranial internal carotid artery occlusion. Conclusions: In patients with ischemic stroke due to a proximal middle cerebral artery occlusion, higher pre-thrombectomy treatment systolic blood pressure is associated with a larger final infarct size. In patients treated under general anesthesia, hypotension prior to the M1 portion of middle cerebral artery recanalization is independently correlated with the post-treatment infarct volume. In this group, every 5 min spent below the mean arterial pressure threshold of 100 mmHg is associated with a 4 mL increase in ischemia volume on a post-treatment NCCT. No associations between blood pressure and final infarct volume were present in the subgroup of patients with an intracranial internal carotid artery occlusion.

Association of digital device usage and dry eye disease in school children.

To investigate the influence of digital device use (computers, laptops, tablets, smartphones) on dry eye disease (DED) in a pediatric population. This was a cross-sectional study. School children studying in grades 5-9 at two private schools in the city of Ahmedabad, the capital city of Gujarat, India were invited to participate in the study. In this study, 462 children underwent ocular examination including tear film breakup time (TBUT) and Schirmer's test. Questionnaires were administered for collecting information on the type and duration of digital device usage separately for academic and leisure activities and the Ocular Surface Disease Index (OSDI) score. The mean age of participants was 11.2 + 1.4 years, and 63% were boys. The mean OSDI score was 37.2 + 11.8, and 90.5% had symptoms of DED. Children with moderate to severe DED (n = 88, 19%) had longer daily duration of device use and lower Schirmer's test and TBUT values compared to children with mild DED (P = 0.001). A cumulative exposure time of more than 3-3.5 h per day had a significantly increased risk of DED. Multivariable logistic regression analysis showed that increment in computer usage (odds ratio [OR] 1.94 for every half an hour increase, 95% confidence interval [CI] = 1.2-3.1) and children studying in higher grades (OR 1.30, 95% CI = 1.1-1.6) had a higher risk of moderate to severe dry eye. Cumulative device exposure time of more than 3-3.5 h per day had a significantly increased risk of pediatric DED. Children with an increment in computer usage by half an hour per day had a higher chance of experiencing moderate to severe dry eye. Policymakers should aim to restrict the screen time below 3 h on a daily basis.

Continuous Quality Improvement: Utilizing a Novel Education Platform to Enhance Care for the Caregiver in the Neurosciences Intensive Care Unit.

Background: Timely patient and family communication is fundamental to the delivery of patient and family-centered care in the intensive care unit (ICU). However, repetitive, non-urgent communication with patients and designated patient contacts (DPCs) may lead to workflow disruptions, patient safety concerns and burnout. Implementing media-rich, educational content via a web-app could promote a more communication-friendly environment and reduce redundant communication. This may lower workflow disruptions and save time for more meaningful interactions with providers. The goal of this study was to deliver relevant, high-quality content via a web-app, assess time savings, and patient satisfaction with the web-app. Methods: A pre-implementation survey was distributed to Neurosciences intensive care unit (NSICU) staff to assess the burden of repetitive non-urgent communication and perceived duration of disruptions. Patients admitted to the NSICU from September 2022 to February 2023, n = 221 were included in the study. Patients were enrolled in the web-app. Patients and their DPC were granted access. Demographics including patient diagnosis, age, gender, and race were collected, along with data on weekly patient enrollment, number of DPCs granted access, total, frequency, and average view times of each piece of web-app content, and expected time saved due to review of web-app-based content by patient and/or DPCs to reduce repetitive communication by NSICU caregivers. The time saved for each piece of web-app content was calculated after getting feedback from providers (attendings, fellows, advanced practice providers, nurses) for how long it generally took them to convey each piece of information to patients and families. Results: Based on web-app content reviewed by patients and/or DPCs, the estimated average amount of NSICU caregiver time saved over the study period, based on application content views, was 82 min per week, and the cumulative total provider time saved for all content views was 26 h and 53 min. Twenty-one of 59 applications were rated by patients or their DPC and received five-star reviews (out of 5). Conclusion: The implementation of a web-app to facilitate and increase efficiency in communication leads to time savings for NSICU providers and patient/DPC satisfaction with the media-rich educational content.

The association of a frailty index derived from laboratory tests and vital signs with clinical outcomes in critical care patients with septic shock: a retrospective study based on the MIMIC-IV database

PurposeFrailty is a vulnerable state to stressors due to the loss of physiological reserve as a result of multisystem dysfunction. The physiological and laboratory-based frailty index (FI-Lab), depending on laboratory values and vital signs, is a powerful tool to capture frailty status. The aim of this study was to assess the relationship between FI-Lab and in-hospital mortality in patients with septic shock.MethodsBaseline data for patients with sepsis in the intensive care unit were retrieved from the Critical Care Medicine Database (MIMIC-IV, v2.2). The primary outcome was mortality during hospitalization. The propensity score matching (PSM) method was used to analyze the basic conditions during hospitalization between groups.The FI-Lab was analysed for its relationship with in-hospital mortality using logistic regression according to continuous and categorical variables, respectively, and described using the restricted cubic spline (RCS). Survival was compared between groups using Kaplan-Meier (KM) curves. Subgroup analyses were used to improve the stability of the results.ResultsA total of 9219 patients were included. A cohort score of 1803 matched patients was generated after PSM. The analyses showed that non-surviving patients with septic shock in the ICU had a high FI-Lab index (P<0.001). FI-Lab, whether used as a continuous or categorical variable, increased with increasing FI-Lab and increased in-hospital mortality (P<0.001).Subgroup analyses showed similar results. RCS depicts this non-linear relationship. KM analysis shows the cumulative survival time during hospitalisation was significantly lower as FI-Lab increased (log-rank test, P<0.001).ConclusionElevated FI-Lab is associated with increased in-hospital mortality in patients with septic shock.

Routine Automated Assessment Using Surgical Intelligence Reveals Substantial Time Spent Outside the Patient's Body in Minimally Invasive Gynecological Surgeries

ObjectiveTo demonstrate the use of surgical intelligence to routinely and automatically assess the proportion of time spent outside of the patient's body (out-of-body—OOB) in laparoscopic gynecological procedures, as a potential basis for clinical and efficiency-related insights. DesignA retrospective analysis of videos of laparoscopic gynecological procedures. SettingTwo operating rooms at the Gynecology Department of a tertiary medical center. ParticipantsAll patients who underwent laparoscopic gynecological procedures between January 1, 2021 and December 31, 2022 in those two rooms. InterventionsA surgical intelligence platform installed in the two rooms routinely captured and analyzed surgical video, using AI to identify and document procedure duration and the amount and percentage of time that the laparoscope was withdrawn from the patient's body per procedure. ResultsA total of 634 surgical videos were included in the final dataset. The cumulative time for all procedures was 639 hours, of which 48 hours (7.5%) were OOB segments. Average OOB percentage was 8.7% (SD = 8.7%) for all the procedures and differed significantly between procedure types (p < .001), with unilateral and bilateral salpingo-oophorectomies showing the highest percentages at 15.6% (SD = 13.3%) and 13.3% (SD = 11.3%), respectively. Hysterectomy and myomectomy, which do not require the endoscope to be removed for specimen extraction, showed a lower percentage (mean = 4.2%, SD = 5.2%) than the other procedures (mean = 11.1%, SD = 9.3%; p < .001). Percentages were lower when the operating team included a senior surgeon (mean = 8.4%, standard deviation = 9.2%) than when it did not (mean = 10.1%, standard deviation = 6.9%; p < .001). ConclusionSurgical intelligence revealed a substantial percentage of OOB segments in laparoscopic gynecological procedures, alongside associations with surgeon seniority and procedure type. Further research is needed to evaluate how laparoscope removal affects postoperative outcomes and operational efficiency in surgery.

Long-term outcomes of early exposure to repeated general anaesthesia in children with cystic fibrosis (CF-GAIN): a multicentre, open-label, randomised controlled phase 4 trial

Long-term effects of early, recurrent human exposure to general anaesthesia remain unknown. The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) trial provided an opportunity to examine this issue in children randomly assigned in infancy to either repeated bronchoalveolar-lavage (BAL)-directed therapy with general anaesthesia or standard care with no planned lavages up to 5 years of age when all children received BAL-directed therapy under general anaesthesia. This multicentre, randomised, open-label phase 4 trial (CF-GAIN) used the original ACFBAL trial randomisation at 3·6 months (SD 1·6) to BAL-directed therapy or standard-care groups to assess the impact of general anaesthesia exposures over early childhood. Children who completed the ACFBAL trial, with a mean age of 5·1 (SD 0·18) years, received standardised neurobehavioural and health-related-quality-of-life assessment and brain MRI scans between Oct 8, 2013, and June 30, 2017, at a mean age of 12·8 (SD 1·7) years at three hospitals in Australia and one hospital in New Zealand. The primary outcome was a composite score of performance on a standardised, computer-based assessment of child attention, processing speed, and response inhibition skills (Conners Continuous Performance test, second edition). Secondary outcomes included intellectual function, other neurobehavioural measures, and brain imaging as an exploratory outcome. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000057785) and is completed. At 2 years, the BAL-directed therapy group (n=52) and standard-care group (n=45) had a median of 2·0 (IQR 1·0-3·0) and 0·0 (0·0-0·0) exposures, respectively. At completion of the ACFBAL trial, the BAL-directed therapy group had a median of 6·0 (4·0-9·5) exposures and the standard-care group 2·0 (1·0-4·0) exposures. At CF-GAIN completion, the BAL-directed therapy group had a median of 10·0 (IQR 6·5-14·5) exposures and the standard-care group 4·0 (3·0-7·0) exposures. Cumulative general anaesthesia exposure time was not prospectively collected but, for those with complete cumulative exposure time data to the end of the ACFBAL trial, the median cumulative exposure time for the BAL-directed therapy group (n=29) was 180 (IQR 140-285) min and for the standard-care group (n=32) was 48 (30-122) min. The mean Conners Continuous Performance test, second edition composite score was 51 (SD 8·1) in BAL-directed therapy group and 53 (8·8) in the standard-care group; difference -1·7 (95% CI -5·2 to 1·7; p=0·32) with similar performance on other neurobehavioural measures, including measures of executive function, intellectual quotient scores, and brain imaging. Our findings suggest that repeated general anaesthesia exposure in young children with cystic fibrosis is not related to functional impairment in attention, intellectual quotient, executive function, or brain structure compared with a group with fewer and shorter cumulative anaesthesia durations. National Health and Medical Research Council Australia, Queensland Government Health Service and Clinical Innovation Fellowship, and the Children's Hospital Foundation Queensland.

Operational Status and Future Plan of Proton Linear Accelerator at KOMAC

Since the second half of 2013, Korea Multi-purpose Accelerator Complex (KOMAC) has been supporting user beam service by using a 100-MeV proton linac and several beam line facilities. Proton beam service fields include various applications and research programs, such as material science, bio-medical science, semiconductor applications as well as nuclear physics and basic science. The 100-MeV linac is composed of an injector based on a 50-keV microwave ion source and two-solenoid LEBT (low energy beam transport), a 3-MeV RFQ with four-vane structure and conventional drift tube linac (DTL), where proton beam is accelerated from 3 MeV to 100 MeV. As the operation period of the proton accelerator exceeds 10 years and the cumulative operating time surpasses 30,000 hours, we judge that it is an opportune time to establish a long-term plan to prepare for the aging of the accelerator. To replace the currently operating RFQ, which shows degradation in performance (especially the beam transmission), we design a new RFQ with some modifications. For DTL, we are supposed to change the quadrupole magnet inside each drift tube from electromagnet type to permanent magnet type because the electromagnet has shown some trouble in view of long term stability. To leap forward in device and utilization technologies, we complete the construction of new facility of a Beam Test Stand (BTS) with a structure similar to the beam injection system (ion source, LEBT, RFQ) of the 100 MeV linear accelerator. We plan to actively conduct beam physics and accelerator research using this facility. Moreover, we are supposed to upgrade the proton linac to 1 GeV for spallation neutron source applications, which will be a long-term plan. In short term, we take phased approach with focusing the first phase at 200 MeV energy upgrade.

A Grey Wolf Optimizer Algorithm for Multi-Objective Cumulative Capacitated Vehicle Routing Problem Considering Operation Time.

In humanitarian aid scenarios, the model of cumulative capacitated vehicle routing problem can be used in vehicle scheduling, aiming at delivering materials to recipients as quickly as possible, thus minimizing their wait time. Traditional approaches focus on this metric, but practical implementations must also consider factors such as driver labor intensity and the capacity for on-site decision-making. To evaluate driver workload, the operation times of relief vehicles are typically used, and multi-objective modeling is employed to facilitate on-site decision-making. This paper introduces a multi-objective cumulative capacitated vehicle routing problem considering operation time (MO-CCVRP-OT). Our model is bi-objective, aiming to minimize both the cumulative wait time of disaster-affected areas and the extra expenditures incurred by the excess operation time of rescue vehicles. Based on the traditional grey wolf optimizer algorithm, this paper proposes a dynamic grey wolf optimizer algorithm with floating 2-opt (DGWO-F2OPT), which combines real number encoding with an equal-division random key and ROV rules for decoding; in addition, a dynamic non-dominated solution set update strategy is introduced. To solve MO-CCVRP-OT efficiently and increase the algorithm's convergence speed, a multi-objective improved floating 2-opt (F2OPT) local search strategy is proposed. The utopia optimum solution of DGWO-F2OPT has an average value of two fitness values that is 6.22% lower than that of DGWO-2OPT. DGWO-F2OPT's average fitness value in the algorithm comparison trials is 16.49% less than that of NS-2OPT. In the model comparison studies, MO-CCVRP-OT is 18.72% closer to the utopian point in Euclidean distance than CVRP-OT.

Experimental Investigation of the Drying Characteristics of Tapioca Under Solar Drying Condition

Agricultural products are subjected to one form of processing or the other, to either improve the shelf life of the products, or as a necessary condition before consumption. Solar drying is one method that helps to increase the shelf life of agricultural products. In this study, an experimental investigation of the drying characteristics of cassava chips popularly called tapioca was carried out for the purpose of improved shelf life and hygiene, under solar drying conditions in the month of December, 2023. An analysis of key parameters was conducted on the experimental data and post-processed in the Microsoft Excel environment. The results suggested that the moisture removal rate of tapioca was 0.2183 % to 6.3829% on dry mass basis, with cumulative drying time of 27hours in three days. The maximum and minimum energy values during the drying period were 15485.14kJ and 9.6243kJ, respectively. Thus, the average value obtained for solar collector efficiency varied from 6.99 % to 16.89 %. The study also established that the colour and texture of the tapioca under the drying conditions could be retained.

Shy and Bold Fish Have the Same Preference for Light Color Selection.

Personality, which matters for animal welfare, demonstrates behavioral differences. Light is one of the most important factors in aquaculture. However, how fish personality affects light color selection is unclear. In this study, we tested the personality of yellow catfish Pelteobagrus fulvidraco juveniles and then quantified the selective behaviors of different personalities under six light colors: violet (410-420 nm), yellow (580-590 nm), green (550-560 nm), red (620-630 nm), blue (470-480 nm), and white. The results showed that juveniles preferred the yellow and green light over the other colors of light, probably due to different reasons. The average cumulative dwell time in yellow (32.81 ± 5.22%), green (21.81 ± 3.58%), and red (26.36 ± 4.89%) lights was significantly longer than the other light colors, and the average visit frequency in green light (32.00 ± 4.93%) was the most. Juveniles had the longest total moved distance in green light. Moreover, the results demonstrated that shy and bold individuals had the same preference for the green light. Bold individuals could find the preferred light colors rapidly and make quick decisions for light color selection. After identifying the preferred light colors, bold individuals reduced the frequency of exploration. This study provides a theoretical basis for the welfare of juvenile yellow catfish in aquaculture.

Lower mortality following surgical management for distal femur fractures: A cohort study

Introduction Geriatric distal femur fractures pose a difficult problem for orthopaedic surgeons with an aging population. The present study aims to report mortality rates following distal femur fractures from a geriatric population over 60 years old, with a primary emphasis on determining whether surgical management differentially affects mortality rate as compared to conservative management. Methods Patients over 60 years old with distal femur fractures for patients admitted into the New Territories West Cluster from 2012 to 2020 were identified in this retrospective cohort study. Patient demographics, comorbidities, and management characteristics were examined and analyzed. Kaplan-Meier survival analysis was done to delineate differences in mortality rates between surgical and conservative management. Further analysis was done for patients &gt;80 years old using Kaplan-Meier survival analysis to delineate whether surgical intervention still affects the survival in this narrowed geriatric population. Subsequent multivariate cox regression was done to determine variables with significant effect on mortality in this age group. Results Of 168 patients, the 1-year mortality rate is 21.5%. The cumulative median survival time of the surgical group (5.98 years) versus the conservative group (2.32 years). Survival analysis on patients &gt;80 years old revealed age, management type, ambulatory status, place of residence, dementia, chronic pulmonary disease, or chronic kidney disease had statistically different median time of survival. In these patients, a reduction in death hazard by 47% (CI 0.28–1.01, p = 0.05) was seen in those with surgical management. On the other hand, patients with chronic obstructive pulmonary disease (COPD) and moderate chronic kidney disease (CKD) show an increased death hazard by 2.61 times (CI 1.23–5.53, p = 0.01) and 7.17 times (CI 1.47–34.86, p = 0.02), respectively. Conclusion Compared to conservative management, surgical management resulted in higher cumulative survival in geriatric patients with distal femur fractures. Unfavourable factors that may contribute to a lower cumulative survival includes history of COPD and CKD.

Optimal multimodal multi-echelon vaccine distribution network design for low and medium-income countries with manufacturing infrastructure during healthcare emergencies

In the event of routine immunizations for containing disease outbreaks, the Expanded Programme on Immunization (EPI) led Low and Medium-Income Countries (LMICs) follow a four-tier distribution network. Such a network is suitable for LMICs importing vaccines rather than manufacturing and may not be suitable for healthcare emergencies. Recent shift from routine immunizations to pandemic-orientation, calls for large-scale multimodal distribution models. This paper proposes a cold chain network for LMICs with manufacturing hubs during health emergencies, integrating vaccine manufacturers and incorporating multiple transportation modes. The problem is formulated as a Mixed Integer Quadratically Constrained Programming (MIQCP) problem, to minimize ‘Cumulative Transportation Time’ (CTT) with the minimal number of trips. To solve large-scale problems the paper also proposes a novel algorithm that divides certain parts of the network and retains the edges that are likely to give better solutions. The proposed model extends the existing body of the literature by introducing features such as vehicle choice between locations, generalized hierarchical structure, network decomposition, and appropriateness with LMIC networks. We conduct numerical experiments to validate the proposed algorithm using data from India. The results show that the proposed model saves cumulative transportation time along the optimally generated network when compared with the actual vaccine supply network in India during healthcare emergencies. The proposed algorithm is also faster than the formulation giving comparable results while solved in a commercial solver.

Very high-power short duration ablation metrics predictors of successful pulmonary vein isolation in atrial fibrillation ablation

Abstract Background Previous studies have shown that very high-power short duration (vHPSD) is a safe ablation modality, with similar rate of first pass isolation (FPI) but faster ablation times compared to standard CLOSE protocol guided ablation. While CLOSE protocol uses ablation index to guide energy titration no such index exists for vHPSD ablations yet. Purpose Our aim was to evaluate ablation metrics as predictors of FPI in atrial fibrillation ablation (AF) using vHPSD ablation modality. Methods In a single centre retrospective analysis, we analysed consecutive patients treated for paroxysmal (PAF) or persistent atrial fibrillation (PeAF) with PVI using vHPSD ablation from May 2021 to January 2023. We excluded patients with previous PVI procedures. The analysis was done via a cloud-based commercially available ablation analysis tool CARTONET. We analysed catheter stability, average contact force, absolute impedance drop, number of ablations and cumulative ablation time in relation to first pass isolation (FAAVI – first attempt all veins isolated). Results This is the first larger data study to evaluate ablation metrics in vHPSD using commercially available CARTONET (Figure 1). Based on the inclusion criteria 150 patients were included in the analysis. Baseline characteristics and procedural metrics are presented in Figure 2 - Table. We observed a numerical trend towards higher FAAVI rate with increasing patients number (p=0.10). Complication rate was low (1 pericardial effusion requiring drainage and 1 vascular access site complication). Ablation metrics analysis yielded statistical differences between FAAVI and no FAAVI groups (Figure 2 - Table). Multivariate analysis identified average contact force (odds ratio (OR) 1.001; 95% confidence interval (CI): 0.999-1.003; p=0.047) and catheter stability (OR 0.985; 95% CI: 0.973-0.997; p=0.019) to be independent predictors of FAAVI. Additionally, number of applications (OR 1.000; 95% CI: 0.999-1.000; p=0.042) and total ablation time (OR 0.995; 95% CI: 0.991-0.999; p=0.021) were also independent predictors of FAAVI, possibly indicating larger vein and/or ablation circumferent line to be predictive of no FAAVI. Catheter stability of less than 1.16mm (AUC 0.61; p=0.015) was shown to be discriminative of FAAVI, however discrimination value was poor. Average contact force was not discriminative of FAAVI (AUC 0.58; p=0.105) in our patient cohort. Conclusion Average contact force and catheter stability were predictive of first pass isolation, however only catheter stability was discriminative of FAAVI. Larger data with standardised ablation protocol (interlesion distance) and wider range of ablation metrics is needed to corroborate and further build on these early findings.

#1657 Impact of cumulative fluid and sodium imbalance exposure on cause-specific mortality in hemodialysis

Abstract Background and Aims Even mild fluid overload and prolonged exposure to salt excess showed to be associated with all-cause mortality in hemodialysis patients. This analysis aims to estimate the effect of fluid and sodium imbalance on cause-specific mortality. Method The study followed 68,196 incident hemodialysis patients from 875 clinics in 25 countries for a decade (2010-2020) using the European Clinical Database 5. Fatal events (21,644) were classified through ICD10- codes and free text descriptions into different endpoints: cardiac death (7,926 events)—with subcomponents sudden cardiac death (2,815 events), coronary death (1,705 events) and heart failure death (3,248 events); cerebrovascular death (1,516 events), non-cardiovascular death (10,898 events)—with subcomponents death by sepsis (2,054) or other infection (1,217 events), cancer death (2,095), other non-cardiovascular death (5,532 events) and death of unknown origin (1,304 events). Time-varying cumulative exposure times (in months) of relative fluid overload/-depletion, hypo-/hypernatremia and low dialysate sodium (≤ 138) were assessed and hazard ratios (HR) were calculated using a multivariate Cox model. Results Fluid overload showed the most consistent exposure risk associations for cardiovascular endpoints with strongest associations in cardiac causes (arrythmia death: HR peak at 7.5 (95% CI: 4.2-3.6), heart failure death: HR peak at 4.2 (95% CI: 3.3-5.4) and sudden cardiac death: HR peak at 3.8 (95% CI: 2.6-4.5)). Fluid depletion was less important but consistently associated with all causes of death. By contrast, Hyponatremia showed heterogeneity of cause specific effects. We found slightly stronger associations for non- cardiovascular causes: Death by sepsis (HR peak at 2.3 (95% CI: 1.8-2.8)) or death by other infections (HR peak at 2.1 (95% CI: 1.6-2.7)) showed the strongest cumulative exposure risk association pattern. Hypernatremia was less important with substantially smaller effects and slightly higher associations for non-cardiovascular endpoints. For low dialysate sodium, we observed evidence of heterogeneity in cause specific effects. The risk of death due to heart failure was notably pronounced with low dialysate sodium (HR peak at 5.8 (95% CI: 1.9-17.9)), while other endpoints did not show this effect. Sensitivity analysis in patients with 48 or more months of follow-up indicated that HR in higher exposure categories might be biased downwards due to non-survival of high-risk individuals. Conclusion Cause-specific hazard models confirm the role of fluid and sodium imbalance as independently acting risk factors for mortality. Fluid overload has the most pronounced effect on cardiac death, especially death by heart failure, arrhythmia, or sudden death. In contrast, hyponatremia is a more critical risk factor for non-cardiovascular death, particularly death caused by sepsis or other infections. The significantly increased risk in patients on low dialysate sodium prescriptions is primarily driven by a dramatic increase in risk of death by heart failure.

A Phase I trial of Non-invasiveVentilationand seizure prophylaxis with levetiracetam InChildren withCerebral Malaria Trial (NOVICE-M Trial).

African children with cerebral malaria and seizures caused Plasmodium falciparum are at greater risk of poor outcomes including death and neurological sequelae. The agonal events are severe hypoventilation and respiratory arrest often triggered by seizures. We hypothesised that prophylactic anti-seizure medication (ASM) could avert 'spikes' of intracranial pressure during or following seizures and that adequate ventilation could be supported by biphasic Cuirass Ventilation (BCV) which requires no intubation. A Phase I trial conducted in Kilifi, Kenya designed to provide data on safety, feasibility and preliminary data on seizure control using prophylactic ASM (levetiracetam) and BCV as non-invasive ventilatory support in children with cerebral malaria. Children aged 3 months to 12-years hospitalised with P falciparum malaria (positive rapid diagnostic test or a malaria slide), a Blantyre Coma Score ≤2 and a history of acute seizures in this illness are eligible for the trial. In a phased evaluation we will study i) BCV alone for respiratory support (n=10); ii) prophylactic LVT: 40mg/kg loading dose then 30mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10) and; iii) prophylactic LVT: 60mg/kg loading dose then 45mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10). Primary outcome measure: cumulative time with a clinically detected seizures or number of observed seizures over 36 hours. Secondary outcomes will be assessed by feasibility or ability to implement BCV, and recovery from coma within 36 hours. Safety endpoints include: aspiration during admission; death at 28 days and 180 days; and de-novo neurological impairments at 180 days. This is a Phase I trial largely designed to test the feasibility, tolerability and safety of using non-invasive ventilatory support and LVT prophylaxis in cerebral malaria. ISRCTN76942974 (5.02.2019); PACTR202112749708968 (20.12.2021).

Standardising and simplifying the Global Leadership Initiative on Malnutrition (GLIM) for its more general application

BackgroundMalnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass. AimsTo explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application. Methods(1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies. Results(1) Participants’ mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m2. In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST “1” were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%*, 73%, 98%* and 95%*; and with prior MUST “2”, 44%*, 69%*, 98%*, 95%*. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST “1”. (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 seconds without prior screening, and was increased by 2-3% with prior MUST “1”, by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST “2”. ConclusionsPreceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; “gold standard” muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition.*Indicates statistically significant difference from use of GLIM without prior screening.

Developing a combined rotating and air-circulating system for improving radio frequency heating uniformity and controlling Aspergillus in almond kernels

It is important to improve radio frequency (RF) heating uniformity for developing effective pathogen control protocols before storage of almonds. The purpose of this study was to design a combined rotating and air-circulating system (CRACS) in the RF cavity for improving sample temperature uniformity during pasteurization, drying, and cooling of almond kernels. The results showed that the optimal rotating speed of 15 r/min and loading volume ratio of 60% of CRACS were determined to achieve the required RF pasteurization level. The pasteurization protocol was developed based on the above selected parameters of CRACS, RF heating/drying, and forced air cooling. Compared to the five-layer container (five single layers stacked vertically) used for RF pasteurization of almond kernels, the RF heating uniformity in almond kernels using CRACS was clearly improved, resulting in moisture content reduction of only 0.70% wet basis (w.b.). The pasteurization validation curve of almond kernels in CRACS was closer to the predicted survival one based on the cumulative thermal lethal time model, suggesting that CRACS was suitable for the effective RF pasteurization of almond kernels. The moisture content and color values of almond kernels after RF pasteurization were beneficial for maintaining their long-term storage and stable quality. This CRACS in the RF system may provide a practical and effective technology for pasteurizing almond kernels.

Continual Release of Differentially Private Synthetic Data from Longitudinal Data Collections

Motivated by privacy concerns in long-term longitudinal studies in medical and social science research, we study the problem of continually releasing differentially private synthetic data from longitudinal data collections. We introduce a model where, in every time step, each individual reports a new data element, and the goal of the synthesizer is to incrementally update a synthetic dataset in a consistent way to capture a rich class of statistical properties. We give continual synthetic data generation algorithms that preserve two basic types of queries: fixed time window queries and cumulative time queries. We show nearly tight upper bounds on the error rates of these algorithms and demonstrate their empirical performance on realistically sized datasets from the U.S. Census Bureau's Survey of Income and Program Participation.

Patients, healthcare providers, and general population preferences for hemodialysis vascular access: a discrete choice experiment.

A patient-centered dialysis treatment option requires an understanding of patient preferences for alternative vascular accesses and nephrologists often face difficulties when recommending vascular access to end-stage kidney disease (ESKD) patients. We aimed to quantify the relative importance of various vascular access characteristics to patients, healthcare providers and general population, and how they affect acceptability for patients and healthcare providers. In a discrete choice experiment, patients with maintenance hemodialysis (MHD), healthcare providers, and individuals from the general population were invited to respond to a series of hypothetical vascular access scenarios that differed in five attributes: cumulative patency, infection rate, thrombosis rate, cost, and time to maturation. We estimated the respondents' preference heterogeneity and relative importance of the attributes with a mixed logit model (MXL) and predicted the willingness to pay (WTP) of respondents via a multinomial logit model (MNL). Healthcare providers (n = 316) and the general population (n = 268) exhibited a favorable inclination toward longer cumulative patency, lower access infection rate and lower access thrombosis rate. In contrast, the patients (n = 253) showed a preference for a 3-year cumulative patency, 8% access infection rate, 35% access thrombosis rate and 1.5 access maturity time, with only the 3-year cumulative patency reaching statistical significance. Among the three respondent groups, the general population found cumulative patency less important than healthcare providers and patients did. Patients demonstrated the highest WTP for cumulative patency, indicating a willingness to pay an extra RMB$24,720(US$3,708) for each additional year of patency time. Patients and healthcare providers had a strong preference for vascular access with superior patency. While the general population preferred vascular access with lower thrombosis rates. These results indicate that most patients prefer autogenous arteriovenous fistula (AVF) as an appropriate choice for vascular access due to its superior patency and lower complications than other vascular access types.

Membrane fouling during the harvesting of microalgae using static microfiltration

A challenge in the filtration of algal suspensions is the reduction in filtrate flow rate with time, associated with membrane fouling and filtercake formation. These two fouling mechanisms may occur simultaneously and have different effects on the scaling relationship of filtration rate with time, making quantitative predictions of the filtration behaviour complex. The foulants include suspended microalgal cells and their presumed Extracellular Polymeric Substances (EPS). To investigate this problem, we perform static microfiltration experiments to harvest oil-rich marine microalgae Nannochloropsis oculata. Batch filtration experiments of microalgal suspensions using glass-fibre membranes are conducted under filtration pressures varying between 0.5 and 200 kPa. Here we investigate the relative importance of potential fouling mechanisms, including pore plugging, entrance blocking, and filtercake formation. We examine variations in filtrate flux, using a novel approach involving numerical differentiation of the filtrate volume to identify how its scaling relationship with time and compare with the traditional root-time behaviour. These results are analysed with reference to the blocking filtration laws to determine the potential fouling mechanism. Rheology tests of both filtration feeds and filtrate are performed, and both optical and scanning electron microscopy are used to observe the filtercake. Our results show a significant drop in the filtrate flux after a spurt loss phase under pressure. The scaling analysis demonstrates a power law relationship between cumulative filtrate volume and time in the post-spurt phase. We show here, for the first time, that the scaling exponent varies with time, approaching a value close to 0.5 (i.e. the root-time behaviour) after a long period of time. Using the analysis, we conclude that the filtration process can be divided into various stages; a spurt loss phase when the pressure is initially applied, followed by a stage in which both internal and external filtercake formation occurs, and a final stage which is dominated by external filtercake formation (at which point root-time behaviour is observed). Furthermore, our findings suggest that fresh microalgal suspensions experienced a larger spurt loss compared to aged suspensions in microfiltration. This difference may be attributed to the limited production of EPS and microalgal debris during shorter cultivation periods. The microscopic observations reveal the invasion of microalgal cells into the membrane, which verifies the formation of an internal filtercake suggested by our scaling analysis. The contamination of the membrane increases with higher filtration pressures. Finally, we demonstrate that Fe3+ coagulant can be used to increase the microalgal particulate size before filtration, resulting in a much higher filtrate flux compared to uncoagulated suspensions. This result provides opportunities to reduce membrane contamination to a negligible level.