Cutoff Rate Research Articles

Expanded CD8+CD38+ T Cell Population in Patients With Systemic Lupus Erythematosus Is Linked to Increased Infection Rates: A Prospective Study.

One of the leading causes of morbidity and mortality among patients with systemic lupus erythematosus (SLE) is infections. The expression of the ectonucleotidase CD38 on the surface of CD8+ T cells has been linked to compromised cytotoxic function. The aim of this prospective study was to assess whether the presence of CD8+CD38+ in the peripheral blood of patients with SLE can serve as a biomarker for infectious complications. A cohort of 80 patients with SLE were recruited over 18 months. The rate of clinically significant infections and presence of CD8+CD38+ T cells in the peripheral blood were monitored at each clinic visit. The patients were classified into high CD38+ and low CD38+ CD8+ T cells using flow cytometry and a previously established cutoff rate of 28.4%. A total of 20 infections were registered over the study period. We observed that the patients with an expanded CD8+CD38+ T cell population in the peripheral blood had a higher rate of recurrent infections and a higher likelihood of infection compared with patients with a low CD8+CD38+ T cell population. The levels of CD38 in CD8+ T cells remained stable over time in the studied subjects. High levels of CD8+CD38+ T cells in the peripheral blood of patients with SLE identify a subgroup prone to infections for whom proper clinical measures should be applied.

Acute diverticulitis: beyond the diagnosis: predictive role of CT in assessing risk of recurrence and clinical implications in non-operative management of acute diverticulitis

PurposeThe aim of the study is to identify CT findings that are predictive of recurrence of acute uncomplicated colonic diverticulitis, to better risk-stratify these patients for whom guidelines recommend a conservative outpatient treatment and to determine the appropriate management with an improvement of health costs.Materials and MethodsOver the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence.ResultsPatients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05–12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT.ConclusionsThe maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.

Device programming and SMART pass algorithm activation in subcutaneous implantable defibrillator patients: data from a remote monitoring database

Abstract Background In subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients, a previous study demonstrated very low rates of delivered shocks and inappropriate shocks on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias &amp;gt;250 bpm. The extent to which this programming approach is adopted in clinical practice has been little studied, as the activation status of the SMART Pass filter, that was implemented to reduce inappropriate shocks and enhanced over time. Purpose We assessed device programming during follow-up and the rate of detected arrhythmias in a cohort of consecutive S-ICD recipients. Methods We analyzed data from 670 S-ICD patients followed on the remote network at 17 Italian centers for a median of 31 months (25th-75th percentile: 16-51). The enhanced SMART Pass version was available for all patients after October 2022. It makes the deactivation monitor less sensitive to premature ventricular contractions or other transient amplitude changes while maintaining arrhythmia sensitivity and specificity, and it was expected to reduce unintentional deactivation rate. Results At the last remote data transmission, the median programmed conditional zone cut-off was set to 210 bpm (25th-75th percentile: 200-220), the shock zone cut-off was 250 bpm (25th-75th percentile: 240-250), and the SMART Pass was enabled in 586 (87%) patients. During follow-up, 194 automatic deactivation events (0.10/patient-year) were reported in 118 (18%) patients. The SMART Pass-disabled time was 13% of the total observation period. Shocks were delivered in 129 (19%) patients (rate: 0.13/patient-year), and untreated arrhythmias were recorded in 136 (20%) patients (rate: 0.14/patient-year). The rate of shocks was lower when SMART Pass was enabled – 0.12/patient-year (95% CI: 0.10-0.14) versus 0.20 (95%CI: 0.15-0.26) (p=0.002), as it was the rate of untreated arrhythmias – 0.12/patient-year (95% CI: 0.11-0.14) versus 0.23 (95%CI: 0.18-0.30) (p=0.001). The enhanced SMART Pass version was associated with a lower rate of deactivations – 0.04/patient-year (95%CI: 0.02-0.05) versus 0.14 (95% CI: 0.12-0.16) (p&amp;lt;0.001), and with a reduction in treated and untreated arrhythmias (Incidence rate ratios: 0.40 (95%CI: 0.28-0.53) and 0.40 (95%CI: 0.30-0.55), respectively (p&amp;lt;0.001)). Conclusions In current clinical practice, S-ICD implantation centers often program high cut-off rates for arrhythmia detection. Most patients have SMART Pass consistently enabled during follow-up. This is associated with significantly lower rates of detected and treated arrhythmias. The enhanced SMART Pass version seems associated with lower deactivation rate, and with further decrease in treated and untreated detected arrhythmias.

Abstract PO1-28-09: Rethinking the value of pathologic complete response rate for the survival outcomes of early triple-negative breast cancer treated with neoadjuvant chemotherapy: a systematic review and network meta-analysis

Abstract Background: Neoadjuvant chemotherapy (NACT) has been more frequently used in breast cancer, but it’s controversial whether NACT or adjuvant chemotherapy (ACT) is more effective in improving survival outcomes for triple-negative breast cancer (TNBC) patients. Recent studies also proposed pathologic complete response (pCR) could not be a robust surrogate for survival outcomes in certain types of breast cancer. To address these questions, a general meta-analysis and a network meta-analysis (NMA) were conducted to compare the survival outcomes of patients with pCR, non-pCR after NACT and ACT. The cut-off pCR rate was also declared to indicate when NACT produces equivalent survival outcomes to ACT (Registration: PROSPERO CRD42022336732). Methods: Databases including PubMed, Embase, Web of science and Cochrane library were searched up to June 2023 to investigate studies comparing NACT and ACT, as well as randomized controlled trials (RCTs) comparing different regimens in NACT or ACT settings in early operable TNBC patients. Heterogeneity was assessed using χ² based Q-test and I², combined with hazard ratios (HRs) with 95% confidence intervals (CI) computed for overall survival (OS), and disease-free survival (DFS, or event-free survival). The NMA with a Bayesian framework was conducted using both random and fixed effect model. The Weighted Least Square method and the Least Absolutely Deviation method were used to determine the cut-off pCR rates of OS and DFS. Results: A total of 35 studies involving 21 RCTs and 34143 TNBC patients were included. The general meta-analysis comprised 14 cohort studies. Eight high-quality cohort studies with propensity score matching and 21 RCTs were included in NMA. The pooled pCR rate for NACT was 42.2% (95% CI 37.8%-46.8%). Overall, the NACT cohort showed significantly worse OS and DFS than ACT cohort (HR=1.67, 95% CI 1.22-2.31; HR=1.37, 95% CI 1.14-1.64). However, patients with pCR after NACT showed improved OS than ACT (HR=0.58, 95% CI 0.50-0.66), while the patients without pCR after NACT had pooper OS than ACT (HR=2.03, 95% CI 1.88-2.19). As for DFS, there was no statistically difference between pCR after NACT and ACT groups (HR=1.04, 95% CI 0.63-1.73), while patients without pCR after NACT had significantly worse DFS than ACT (HR=2.65, 95% CI 1.98-3.55). From the NMA, the OS and DFS were better when combining modern target therapy such as Bevacizumab, PARPi, and PD-1/PD-L1 inhibitor (Figure 1), but not achieving pCR completely negated the benefits of newer drugs. Adding adjuvant capecitabine to patients not achieving pCR seemed to favor the OS. It was predicted that when the pCR rates were 64.7% and 46.9% (Figure 2), respectively, the OS and DFS of patients treated with NACT would be the same as those of patients treated with ACT. Conclusions: Higher pCR rate after NACT was associated with improved OS compared with ACT in TNBC patients. However, failure to achieve pCR after NACT resulted in worse survival outcomes than ACT. NACT had similar survival outcomes with ACT only when the pCR rate was at least 46.9%. The development of effective NACT regimens is beneficial for breast cancer patients. Figure 1. Forest plot of the Hazard Ratio for OS and DFS in TNBC patients pCR: pathological complete response; Bev: Bevacizumab; Pt: platinum; NACT: neoadjuvant chemotherapy; ACT: adjuvant chemotherapy; vel: veliparib; PDi:PD1/PDL1 inhibitor; X: capecitabine Figure 2. The cut-off value of pCR when NACT and ACT have the same Hazard Ratio based on OS and DFS. pCR: pathological complete response; Bev: Bevacizumab; Pt: platinum; NACT: neoadjuvant chemotherapy; ACT: adjuvant chemotherapy Citation Format: Xiaoying Qiao, Shu Wang, Taobo Hu, Baosheng Liang. Rethinking the value of pathologic complete response rate for the survival outcomes of early triple-negative breast cancer treated with neoadjuvant chemotherapy: a systematic review and network meta-analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-09.

Abstract PO5-03-05: Rethinking the value of pathologic complete response rate for the survival outcomes of early triple-negative breast cancer treated with neoadjuvant chemotherapy: a systematic review and network meta-analysis

Abstract Background: Neoadjuvant chemotherapy (NACT) has been more frequently used in breast cancer, but it’s controversial whether NACT or adjuvant chemotherapy (ACT) is more effective in improving survival outcomes for triple-negative breast cancer (TNBC) patients. Recent studies also proposed pathologic complete response (pCR) could not be a robust surrogate for survival outcomes in certain types of breast cancer. To address these questions, a general meta-analysis and a network meta-analysis (NMA) were conducted to compare the survival outcomes of patients with pCR, non-pCR after NACT and ACT. The cut-off pCR rate was also declared to indicate when NACT produces equivalent survival outcomes to ACT (Registration: PROSPERO CRD42022336732). Methods: Databases including PubMed, Embase, Web of science and Cochrane library were searched up to June 2023 to investigate studies comparing NACT and ACT, as well as randomized controlled trials (RCTs) comparing different regimens in NACT or ACT settingsin early operable TNBC patients. Heterogeneity was assessed using χ² based Q-test and I², combined with hazard ratios (HRs) with 95% confidence intervals (CI) computed for overall survival (OS), and disease-free survival (DFS, or event-free survival). The NMA with a Bayesian framework was conducted using both random and fixed effect model. The Weighted Least Square method and the Least Absolutely Deviation method were used to determine the cut-off pCR rates of OS and DFS. Results: A total of 35 studies involving 21 RCTs and 34143 TNBC patients were included. The general meta-analysis comprised 14 cohort studies. Eight high-quality cohort studies with propensity score matching and 21 RCTs were included in NMA. The pooled pCR rate for NACT was 42.2% (95% CI 37.8%-46.8%). Overall, the NACT cohort showed significantly worse OS and DFS than ACT cohort (HR=1.67, 95% CI 1.22-2.31; HR=1.37, 95% CI 1.14-1.64). However, patients with pCR after NACT showed improved OS than ACT (HR=0.58, 95% CI 0.50-0.66), while the patients without pCR after NACT had pooper OS than ACT (HR=2.03, 95% CI 1.88-2.19). As for DFS, there was no statistically difference between pCR after NACT and ACT groups (HR=1.04, 95% CI 0.63-1.73), while patients without pCR after NACT had significantly worse DFS than ACT (HR=2.65, 95% CI 1.98-3.55). From the NMA, the OS and DFS were better when combining modern target therapy such as Bevacizumab, PARPi, and PD-1/PD-L1 inhibitor, but not achieving pCR completely negated the benefits of newer drugs. Adding adjuvant capecitabine to patients not achieving pCR seemed to favor the OS. It was predicted that when the pCR rates were 64.7% and 44.6%, respectively, the OS and DFS of patients treated with NACT would be the same as those of patients treated with ACT. Conclusions: Higher pCR rate after NACT was associated with improved OS compared with ACT in TNBC patients. However, failure to achieve pCR after NACT resulted in worse survival outcomes than ACT. NACT had similar survival outcomes with ACT only when the pCR rate was at least 44.6%. The development of effective NACT regimens is beneficial for breast cancer patients. Citation Format: Xiaoying Qiao, Taobo Hu, Baosheng Liang, Shu Wang. Rethinking the value of pathologic complete response rate for the survival outcomes of early triple-negative breast cancer treated with neoadjuvant chemotherapy: a systematic review and network meta-analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-03-05.

Using Delphi method to address factors contributing to aggressive behaviour in mental health settings.

WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.

Abstract B117: Phase 1 study of CM24 in combination with nivolumab in patients with advanced pancreatic cancer - Survival, potential biomarker and effect on neutrophil extracellular traps (NETs)

Abstract Background: The monoclonal antibody CM24 blocks the activity of carcinoembryonic antigen cell adhesion molecule 1 (CEACAM1), which is known to have several important roles in cancer progression, immune evasion, and metastasis. The homophilic interaction of CEACAM1 on tumor cells and tumor infiltrating lymphocytes (TILs) silences the anti-tumor immunity. Additionally, CEACAM1 is part of the neutrophil extracellular trap (NET) complex. NETs are regarded as an important component in the tumor microenvironment, which contribute to metastasis and immune evasion. Previously we have demonstrated direct binding of CM24 to NETs and inhibition of NET-induced cancer cell migration and tumor metastasis by the antibody. Here, we present the results from the dose escalation part of a Phase 1/2 study of CM24 and nivolumab (NCT 04731467) and the findings of exploratory studies that were conducted as part of this trial. Methods: In the dose escalation part of the study, 11 pancreatic ductal adenocarcinoma (PDAC) patients who received 2 prior lines of therapy were administered CM24 at 10, 15 and 20mg/kg q2w and nivolumab at 480mg q4w. Levels of CEACAM1 and myeloperoxidase (MPO) were measured in serum by ELISA. Pretreatment biopsies from 8 evaluable PDAC patients were analyzed, along with pretreatment and on treatment serum samples. Quantitative multiplex IF and immunohistochemistry (IHC) were used to evaluate CEACAM1, PDL1, TIM3 and CEACAM1-positive TILs in patient biopsies. Results: Nine PDAC patients were evaluable for exploratory efficacy assessment with a median OS of 4.5 (95% CI 2.0-11.1) months, including 1 confirmed PR and 2 pts with SD for a disease control rate of 33%. Percentage of CEACAM1+TILs in patient biopsies ranged between 0% and 10%, and a cutoff rate to define low (0-5%) vs. high (&amp;gt; 5%) expression was used to stratify the patient survival data. High CEACAM1+TILs (median of 10%) were measured in 3/8 PDAC patients with median survival of 11.1 months (range: 9.6-14.6 months) compared to 5/8 patients with low CEACAM1+TILs (median 2%) who exhibited shorter survival (range: 2-4.5 months), suggesting positive association (p=0.017). IHC analysis of CEACAM1 further revealed CEACAM1-positive NETs in the biopsies of all PDAC patients. In serum, enhanced levels of the NET biomarker MPO were detected in PDAC patients (n=10) as compared to healthy volunteers (n=30), demonstrating a 3-fold difference in the mean value (p&amp;lt;0.01). Interestingly, MPO levels decreased by an average of 40% (p&amp;lt;0.05) across all dose levels within 2 weeks of CM24 therapy. Additional findings will be presented at the conference. Conclusions: CM24 in combination with nivolumab shows promising initial activity results and a favorable safety profile in PDAC patients who have progressed after second-line therapy. The positive association between the level of CEACAM1+TILs and OS as well as CM24 effects on NETs, advocate for the role of CM24 in controlling immune evasion. These 2 potential biomarkers are being investigated in the ongoing randomized Phase 2 study. Citation Format: Erkut Borazanci, Shubham Pant, Ruth Perets, Talia Golan, Mohammed Najeeb Al Hallak, Michael Cecchini, Tomer Maierson, Hava Ben David, Michael Schickler, Hadas Reuveni. Phase 1 study of CM24 in combination with nivolumab in patients with advanced pancreatic cancer - Survival, potential biomarker and effect on neutrophil extracellular traps (NETs) [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B117.

The Effect of Information Entropy Analysis in Computer-Assisted English Translation on Improving Translation Naturalness

Abstract This paper borrows the concept of entropy and refers the information entropy to the computer-aided English translation to build up the information entropy assessment and evaluation model and the information entropy-based English translation optimization model. The information entropy operation formula is used to calculate the fuzziness between the original text and the target translated text, and at the same time, the segmentation function is utilized to find the approximation value of the information entropy value obtained in a sufficiently fine segmentation of the translated text. Obtain the rectangular window function of semantic Gaussian marginalization, project the information entropy data, add the semantic correlation factors of words, identify the features of semantic information, and realize the optimization of English translation. Simulation experiments are carried out to verify the performance of the model. The information entropy evaluation and analysis model in this paper can achieve convergence after 45 iterations. In contrast, the word error rate and the cut-off error rate of the English translation optimization model are both lower than 10%, and the feature recognition and classification are higher than 80%. The fuzzy statements in Chinese writer Lao She’s work “Teahouse” are selected to explore the naturalness of translation. The information entropy value of the translation optimization model in this paper is closer to the original text, and the English translation’s naturalness is better than that of the GLR model.

Retrospective analysis of the outcomes of endoscopic transsphenoidal surgery for Cushing's disease.

The first-line surgical management of an adrenocorticotropic hormone (ACTH)--secreting pituitary adenoma causing Cushing's disease (CD) is endoscopic transsphenoidal resection of the tumor. This study was performed to assess postoperative (postop) complications and remission in endoscopic surgically resected cases of CD. Data of patients who underwent endoscopic transsphenoidal surgery (ETSS) for CD were collected from the neurosurgery department at a tertiary care center in a retrospective manner from January 2015 to February 2022 and analyzed. Postoperative remission was categorized as - early morning serum cortisol <138 nmol/L within 7 days of the surgery, as per the Endocrine Society Guidelines, with significant clinical improvement in features of hypercortisolism in the operated patient and strict cutoff rate of <50 nmol/L at postop day 3 was also utilized, to look for the early identification of remission. A total of 41 patients were identified who underwent 44 ETSS during the same timeframe. Preoperative magnetic resonance imaging localized an adenoma in all 41 patients, out of which 32 were microadenoma, and nine were macroadenoma (2 with cavernous sinus invasion). Intrapetrosal sinus sampling was performed in 35 (85%) patients. The rate of remission for the initial surgery was 85.4% using the standard criteria and 68.3% using strict criteria. Three patients underwent early repeat surgery for the persistent disease as the day 3 cortisol was high (306-555 nmol/L). Once the outcome of this surgery was also included, the overall rate of remission was 90.2% (37/41). None of the patients had meningitis, cerebrospinal fluid leakage, visual deterioration, or vascular injury. Permanent and transient diabetes insipidus (DI) occurred in 9.75% and 26.8% following the first ETSS, respectively. We also noted a single case of CD recurrence in 9 months during the total follow-up period of 84 months. ETSS has satisfactory rates of remission for the primary treatment of CD, with rates being higher for microadenomas. A long follow-up period is needed to assess the rates of recurrence. Patients must be counseled regarding the risk of postop DI, whether transient or permanent, as a possible complication.

Usability enhancement model for unstructured text in big data

The task of insights extraction from unstructured text poses significant challenges for big data analytics because it contains subjective intentions, different contextual perspectives, and information about the surrounding real world. The technical and conceptual complexities of unstructured text degrade its usability for analytics. Unlike structured data, the existing literature lacks solutions to address the usability of unstructured text big data. A usability enhancement model has been developed to address this research gap, incorporating various usability dimensions, determinants, and rules as key components. This paper adopted Delphi technique to validate the usability enhancement model to ensure its correctness, confidentiality, and reliability. The primary goal of model validation is to assess the external validity and suitability of the model through domain experts and professionals. Therefore, the subject matter experts of industry and academia from different countries were invited to this Delphi, which provides more reliable and extensive opinions. A multistep iterative process of Knowledge Resource Nomination Worksheet (KRNW) has been adopted for expert identification and selection. Average Percent of Majority Opinions (APMO) method has been used to produce the cut-off rate to determine the consensus achievement. The consensus was not achieved after the first round of Delphi, whereas APMO cut-off rate was 70.9%. The model has been improved based on the opinions of 10 subject matter experts. After second round, the analysis has shown majority agreement for the revised model and consensus achievement for all improvements that validate the improved usability enhancement model. The final proposed model provides a systematic and structured approach to enhance the usability of unstructured text big data. The outcome of the research is significant for researchers and data analysts.

Identification of antibiotic consumption targets for the management of Clostridioides difficile infection in hospitals- a threshold logistic modelling approach

ABSTRACT Background This study aims to demonstrate the utility of a threshold logistic approach to identifying thresholds for specific antibiotic use associated with Clostridioides difficile infection (CDI) in an English teaching hospital. Methods A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-onset, healthcare-associated (HOHA) CDI cases. Results Using a threshold logistic regression approach, an incidence greater than 0.2645 cases/1000 occupied bed-days (OBD; 85th percentile) was determined as the cutoff rate to define a critical (high) incidence rate of HOHA CDI. Fluoroquinolones and piperacillin-tazobactam were found to have thresholds at 84.8 and 54 defined daily doses (DDD)/1000 OBD, respectively. Analysis of data allowed calculating risk scores for HOHA CDI incidence rates exceeding the 85th percentile, i.e. entering critical incidence level. The threshold-logistic model also facilitated performing ‘what-if scenarios’ on future values of fluoroquinolones and piperacillin-tazobactam use to understand how HOHA CDI incidence rates may be affected. Conclusion Using threshold logistic analysis, critical incidence levels and antibiotic use targets to control HOHA CDI were determined. Threshold logistic models can be used to inform and enhance the effective design and implementation of antimicrobial stewardship programs.

Prospective study of 100 infertile couples: does infertility lead to sexual dysfunction

Background: There is a correlation between infertility and serious mental, emotional, and social difficulties reported in the literature. Sexual dysfunction (SD) is quite common in both males and females and often are linked with infertility among couples. Aim and objective: The purpose of this study is to investigate whether or not there is a correlation between infertility and SD in couples who are having treatment for infertility at an infertility clinic. Materials and methods: Total of 100 couples were included in this study and were given the Changes in Sexual Functioning Questionnaire (CSFQ) questionnaire. The data thus obtained were recorded and analyzed using SPSS software. Result: The present study finding indicated that the mean CSFQ score was significantly lower in infertile females compared with the males, indicating that females suffered from SD more. The mean of CSFQ among males was 48.37, and for CSFQ among females; the average was 40.32, which was below the cut-off rate indicating SD is more common in females compared with males. However, our study showed no positive correlation between the lower CSFQ score between both genders with the place of living. As maximum of the study participants were Hindu we have not performed any correlation analysis with religion. Further, this study showed no such differences in duration of the infertility with the CSFQ score. Conclusion: This study thus concluded that SD is more common in infertile couples. The prevalence of SD is more in females compared with males.

Design and Test of Single-Disc Opener for No-Till Planter Based on Support Cutting

To solve the problem of low straw-cutting efficiency of single-disc openers of no-till planters under conditions of high soil moisture content, a single-disc furrowing and straw-cutting device was designed based on the support-cutting principle. To improve the straw-cutting ability of the disc opener when it operates under high-moisture-content soil conditions and to make sure that the straw that is not cut by the disc coulter can be cut smoothly by the disc opener, the support shovel was designed, and the operation mechanism of the support shovel device was analyzed. The soil moisture content, the support shovel’s entry angle, the support shovel’s entry gap angle, and the support shovel’s tip margin were identified as the factors influencing the device design through the theoretical analysis of the furrowing and straw-cutting device. Through the discrete element method (DEM), a single-factor simulation test was first conducted to analyze how different soil moisture contents affected the device’s ability to cut straw, and the results showed that the number of broken bonds was lowest when the soil moisture content was 20 ± 1%, and the time taken for the straw to be wholly cut off was also the longest. Then, a quadratic orthogonal simulation test was conducted to construct a regression model and optimize the parameters at the soil moisture content of 20 ± 1%, and the results revealed that the significant order of each factor’s influence on the number of broken bonds is as follows: entry gap angle, entry angle, and shovel tip margin. In addition, the device’s overall operation quality was better when the entry angle was 49°, the entry gap angle was 0°, and the shovel tip margin was 10 mm. At this time, the number of broken bonds was predicted to be 506. Finally, the simulation validation test was run, and the number of broken bonds was obtained to be 478, with a relative error of 5.6% from the predicted value. According to the optimal parameters to complete the device trial production and field test, the results show that the average cut-off rate of the device is 71.7%, the stability coefficient of the furrowing depth is 90.87%, and the performance of the furrow opening is excellent, which meets the requirements of a no-tillage seeding operation. This study can provide a reference for the design and improvement of no-tillage seeding machines under conditions of high soil moisture content.

Decision-making in the capital budgeting context: effects of type of decision aid and increases in information load

This paper sheds light on the question of whether a rules-based or general principles-based decision aid is preferable in the context of increased information load by experimentally investigating how different types of decision aids interact with increases in information load in a structured capital budgeting decision-making task. The experiment employed a 2 × 2 between-subjects design and was run in a course on management control systems with 136 master’s degree students at a German university. Subjects were tasked with reviewing investment proposals that contained differing amounts of information (low vs. high information load, i.e., irrelevant information cues in addition to those relevant for the decision). The second manipulation referred to the type of decision aid—either a detailed, rules-based capital budgeting guideline with clear cut-off rates, or the advice to employ generally accepted criteria for investment decision-making. The dependent variables investigated were perceived task complexity, decision accuracy, and decision confidence. Increases in information load and provision of a decision aid based on general principles led to an increase in perceived task complexity. There was only limited evidence for experimental conditions affecting decision accuracy, but the group of subjects relying on the rules-based capital budgeting guideline reported significantly higher decision confidence.

Application of Guessing to Sequential Decoding of Polarization-Adjusted Convolutional (PAC) Codes

Despite the extreme error-correction performance, the amount of computation of sequential decoding of the polarization-adjusted convolutional (PAC) codes is random. In sequential decoding of convolutional codes, the cutoff rate denotes the region between rates whose average computational complexity of decoding is finite and those which is infinite. In this paper, by benefiting from the polarization and guessing techniques, we prove that the required computation in sequential decoding of pre-transformed polar codes polarizes, and this polarization determines which set of bit positions within the rate profile may result in high computational complexity. Based on this, we propose a technique for taming the Reed-Muller (RM) rate-profile construction, and the performance results demonstrate that the error-correction performance of the PAC codes can achieve the theoretical bounds using the tamed-RM rate-profile construction and requires a significantly lower computational complexity than the RM rate-profile construction.

Motor Evoked Potential

Motor evoked potential(MEP)is the most widely used intraoperative neurophysiological monitoring measure. It includes cortical direct stimulation MEP(dMEP), which directly stimulates the primary motor cortex of the frontal lobe identified by short-latency somatosensory evoked potentials, and transcranial MEP(tcMEP), which involves high-current or high-voltage transcranial stimulation using cork-screw electrodes installed in the scalp. dMEP is performed in brain tumor surgery close to the motor area. tcMEP is simple, safe, and widely used in spinal and cerebral aneurysm surgeries. The increase in sensitivity and specificity with compound muscle action potential(CMAP)after peripheral nerve stimulation normalization performed in MEP to remove the effect of muscle relaxants is unclear. However, tcMEP for decompression in compressive spinal and spinal nerve diseases may predict the recovery of postoperative neurological symptoms with CMAP normalization. The anesthetic fade phenomenon can be avoided with CMAP normalization. The cutoff rate of loss of amplitude that causes postoperative motor paralysis in intraoperative MEP monitoring is 70%-80%, and setting an alarm at each facility based on this is necessary.

A Tree Pruning Technique for Decoding Complexity Reduction of Polar Codes and PAC Codes

Sorting operation is one of the main bottlenecks for the successive-cancellation list (SCL) decoding. This paper introduces an improvement to the SCL decoding for polar and pre-transformed polar codes that reduces the number of sorting operations without visible degradation in the code’s error-correction performance. In an SCL decoding with an optimum metric function we show that, on average, the correct branch’s bit-metric value must be equal to the bit-channel capacity, and on the other hand, the average bit-metric value of a wrong branch can be at most zero. This implies that a wrong path’s partial path metric value deviates from the bit-channel capacity’s partial summation. For relatively reliable bit-channels, the bit metric for a wrong branch becomes very large negative number, which enables us to detect and prune such paths. We prove that, for a threshold lower than the bit-channel cutoff rate, the probability of pruning the correct path decreases exponentially by the given threshold. Based on these findings, we presented a pruning technique, and the experimental results demonstrate a substantial decrease in the amount of sorting procedures required for SCL decoding. In the stack algorithm, a similar technique is used to significantly reduce the average number of paths in the stack.

Probing the particle size dependence of nonhomogeneous degradation in nickel-rich cathodes for high-energy lithium-ion batteries

Increasing the loading and calendering density of Ni-rich cathodes by adopting a mixture of small to large particles is a practical way to create high-energy lithium-ion batteries. However, high-energy lithium-ion batteries using this type of Ni-rich electrode still suffer from rapid capacity degradation. In this work, the nonhomogeneous degradation of a Ni-rich cathode is characterized by particle size using a commercial 320 Wh kg−1 pouch cell. The correlation between the volume change (ΔV) and state-of-charge (SOC) of the cathode particles with different diameters (D) is determined using in situ transmission X-ray diffraction and numerical simulations. At 0.2 C, minor differences occur in the SOC between the small (D = 5 μm) and large (D = 25 μm) particles. However, at 3 C, the SOC and ΔV of the small particles are 1.03 and 1.11 times higher than those of the large particles, respectively. This work demonstrates that size-dependent nonhomogeneity is undesirable because it promotes the performance decay of Ni-rich cathodes, especially at high cutoff voltages and rates.

Reduction in inappropriate therapies through device programming in subcutaneous implantable defibrillator patients: data from clinical practice.

In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies. We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks. In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD. URL: http://clinicaltrials.gov/Identifier: NCT02275637.

Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression.

Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression.