Categorical Variables Research Articles

Efficacy and Safety of Platelet-rich Plasma in the Management of Lumbar Disc Herniation: A Systematic Review and Meta-analysis

Background Lumbar radicular discomfort is often induced by mechanical compression of the nerve root and inflammatory reactions. Platelet-rich plasma (PRP) is an efficacious therapy modality, albeit ongoing controversies regarding its effectiveness, and it possesses the advantage of minimal side effects. Therefore, we conducted the current systematic review and meta-analysis to investigate the efficacy and safety of PRP in the treatment of lumbar disc herniation (LDH). Methods We conducted our database searching on PubMed, Scopus, and Web of Science from inception till August 2024 to look for articles that fulfil our aim. The search strategy was based on three main keywords: “Platelet-rich plasma” AND “Lumbar” AND “Hernia*”. We conducted the pooled analysis of continuous variables using mean difference (MD) and we used pooled odds ratio (OR) for dichotomous variables with 95% confidence intervals (CI). Results The use of PRP was statistically significant associated with reduced visual analogue scale (VAS) compared with no PRP with MD of -0.44 (95%CI:-0.76, -0.11, p=0.008), and Oswestry Disability Index (ODI) with MD of -5.36 (95%CI: -8.25, -2.48, p=0.0003). However, no significant difference was observed regarding Japanese Orthopedic Association (JOA) with MD of 2.52 (95%CI:-0.8, 5.84, p=0.14) with non-significant heterogeneity. PRP was also associated with reduced risk of complications with OR of 0.22 (95%CI:0.07, 0.68, p=0.009) and non-significant heterogeneity. Conclusion PRP use in patients with LDH is associated with positive outcomes presented in reduction of pain, and disability (decrease in ODI scale) in addition to being safe with less incidence of complications compared with patients not receiving PRP.

“Increasing body mass index is associated with intensive care unit admission and severe maternal morbidity”

Objective This study aimed to assess the relationship between increased body mass index (BMI) with severe maternal morbidity (SMM). Study Design We obtained data for a retrospective cohort of singleton live births using an electronic birth certificate database from 2010 to 2022 in Central New York. Institutional review board exemption was obtained. Pre-pregnancy BMI was assessed as a continuous variable and a categorical variable with groups of BMI <18.5 kg/m2, 30–39.9 kg/m2, 40–49.9 kg/m2, and ≥50 kg/m2 compared to patients with BMI 18.5–29.9 kg/m2. Primary outcomes were maternal intensive care unit (ICU) admission and composite SMM defined as ICU admission, unplanned hysterectomy, reoperation, eclampsia, and blood transfusion. Secondary outcomes were the individual SMM components, 5-minute APGAR score <7, and neonatal intensive care unit (NICU) admission. ANOVA and χ2 were used to compare continuous and categorical variables respectively, and logistic regression was used to obtain adjusted odds ratios for primary and secondary outcomes. Results There were 223,837 patients with singleton live births with mean BMI 27.86 kg/m2. 54,385 (24.3%) had BMI 30–39.9 kg/m2, 13,299 (5.9%) had BMI 40–49.9 kg/m2, and 1,958 (0.87%) had BMI ≥50 kg/m2. 3,203 (1.4%) patients experienced SMM, and 423 (0.2%) patients were admitted to ICU. For each 1-point increase in BMI the adjusted odds ratio (aOR) of SMM increased by 0.8% (aOR 1.008, 95% CI 1.002–1.013) and ICU admission increased by 2.0% (aOR 1.02, 95% CI 1.005–1.034). Odds of ICU admission for those with BMI 40-49.9 kg/m2 increased by 69% (aOR 1.69, 95% CI 1.16–2.47); BMI ≥50 kg/m2 increased by 300% (aOR 3.01, 95% CI 1.53–5.91), but those with BMI 30-39.9 kg/m2 did not have significantly higher odds of ICU admission (aOR 1.09, 95% CI 0.84–1.42). Conclusion Increasing BMI was significantly associated with increased SMM and maternal ICU admission.

The Dynamics of Pheromone Release in Two Passive Dispensers Commonly Used for Mating Disruption in the Control of Lobesia botrana and Eupoecilia ambiguella in Vineyards

Background: Mating disruption (MD) is a worthwhile technique for the control of Lobesia botrana and Eupoecilia ambiguella in central Europe and Mediterranean areas. MD efficacy is affected by the pheromone release (PR), which in turn is influenced by environmental conditions. Methods: The effect of weather conditions on PR was evaluated under four different fields in northern Italy. The PR of two commercial types of MD passive dispensers was correlated with different variables. Results: For both dispensers, the temperature and vapor pressure deficit explained PR in vineyards with diverse weather conditions better than time. The effect of temperature was not linear, and any temperature increase at high temperatures accelerated the PRR more than proportionally. One dispenser type showed a non-linear release trend of the pheromone emission in field conditions with respect to the considered variables; further, the stepwise regression pointed out the importance of the dichotomous variable associated with the vineyard for increasing the goodness-of-fit. Conclusions: The equations developed in this work are dispenser-dependent and can provide information on the PR during the season for each dispenser type, as influenced by weather conditions. These equations could serve as an input for a pheromone concentration model to predict concentrations based on meteorological conditions.

ESG rating, corporate dividends policy, and the moderating role of corporate life cycle: Cross country study

AbstractThis article investigates the link between environmental, social, and governance performance (ESG) and dividend policy, as well as how likely the corporate life cycle might moderate this association. Using cross‐country data from 2010 to 2020, the findings of this study reveal that ESG has a favorable influence on corporate dividend payments as measured by dividend payout ratio, dividend yield, and dichotomous variable. This conclusion holds true when the three ESG pillars are examined independently on dividend policy measurements. Furthermore, this analysis reveals that the firm's life cycle stage moderates the association between ESG and corporate dividend policy, exhibiting a negative moderating impact. This study specifically reveals that the relationship between ESG and dividends is stronger for firms in the early stages of their life cycle than for those in the mature stages. This relationship applies to firms operating in developed economies compared to developing economies. The study findings particularly highlight the dynamic nature of the link between ESG and dividends, underlining that this relationship is dependent on the stage of a company's life cycle. Understanding this relationship may assist stakeholders, such as investors and management, in making educated decisions about dividend expectations and sustainable practices depending on the life cycle of a firm.

The association between dietary dark green vegetable intake and cognitive function in US older adults.

Dark green vegetables include dark green leafy vegetables and broccoli. They are sources of many essential nutrients, including vitamins A, B and C, folate, fibre, carotenoids and flavonoids. This study aimed to explore the association between dietary dark green vegetable intake and cognitive function in US older adults. We included 2344 older adults (≥60 years old) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 cycles. Dark green vegetable consumption was assessed using a continuous variable (cups/day) and two categorical variables. The first categorical variable classified participants into non-consumers and consumers based on whether they consumed dark green vegetables. The second categorical variable grouped participants into four levels of dark green vegetable consumption (non-consumers, consumers with low intakes, consumers with moderate intakes and consumers with high intakes). We used five continuous variables with non-normal distribution to assess cognitive function, including a composite z-score and the standardised scores of four individual cognitive tests. The four cognitive tests included the Immediate Recall Test (IRT), the Delayed Recall Test (DRT), the Animal Mobility Test (AFT) and the Digit Symbol Substitution Test (DSST). The standardised scores of the four cognitive tests were calculated using the mean and standard deviation of each cognitive test score. The composite z-score was calculated by averaging the standardised scores of four cognitive tests to evaluate global cognition. We used multiple linear regression models to examine the association between dietary dark green vegetable intake and cognitive function. Our findings indicated that dark green vegetable intake was positively associated with global cognition (β [95% CI]: 0.17 [0.04, 0.30]; p = 0.016) and IRT (β [95% CI]: 0.26 [0.08, 0.43]; p = 0.009) and DRT (β [95% CI]: 0.21 [0.05, 0.36]; p = 0.012) standardised scores. Individuals with high intake of dark green vegetables showed notably better global cognition (β [95% CI]: 0.16 [0.05, 0.28]; p = 0.010) and showed higher IRT (β [95% CI]: 0.22 [0.07, 0.38]; p = 0.010) and DRT standardised scores (β [95% CI]: 0.21 [0.07, 0.36]; p = 0.007) compared with the non-consumers. Blood neutrophil counts mediated the cognitive benefits of dark green vegetables (Proportion: 9.5%, p = 0.006). In conclusion, our findings suggest that dark green vegetable consumption may have favourable effects on cognitive function in US older adults, especially on immediate and delayed learning abilities. The underlying mechanisms include the ability of dark green vegetables to reduce blood neutrophil levels, an indicator of decreased systemic inflammation. Increasing dietary intake of dark green vegetables may be a beneficial intervention to improve cognitive health in the older US population.

The Super-Turbocharged End-to-Side Abductor Digiti Minimi and Anterior Interosseous Double Nerve Transfer Is Associated With Improved Ulnar Intrinsic Function.

Nerve transfers to reinnervate ulnar intrinsic musculature can restore function in severe ulnar neuropathy, and supercharged end-to-side (SETS) nerve transfers have garnered early adoption. Given the relative expendability of the abductor digiti minimi (ADM), redirecting its axons to more critical components of the ulnar motor nerve (UMN) in a turbocharged end-to-side (TETS) nerve transfer with concomitant anterior interosseous SETS nerve transfer (AIN) as a super-turbocharged end-to-side (STETS) or twin-charged double nerve transfer may improve functional recovery. A retrospective study of patients undergoing the STETS AIN/ADM to UMN double nerve transfer or TETS ADM to UMN nerve transfer for severe ulnar neuropathy between 2020 and 2022 was performed. Primary outcomes were improvement in first dorsal interosseous (FDI) strength and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Dichotomous and continuous variables were compared with χ2 and t tests, respectively. Fifty patients with severe ulnar nerve injuries were identified with at least 1-year surgical follow-up. Preoperative symptom duration was an average of 11.3 months. The STETS cohort (n = 42) reported significantly decreased DASH scores from 58 to 28 (P < .001) and improved FDI Medical Research Council (MRC) score from 0.7 to 3.3 (P < .001). The TETS cohort (n = 8) reported significantly decreased DASH scores from 54 to 23 (P = .016) and improved FDI MRC score from 2.0 to 3.6 (P = .008). Distal transfer of the ADM nerve to the ulnar deep motor branch in a turbocharged fashion is reported. The findings suggest that the STETS double nerve transfer may improve patient outcomes and warrants further investigation with prospective cohort studies.

Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies.

Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations.

Comparison of Therapeutic Effects Between Pulsed Field Ablation and Cryoballoon Ablation in the Treatment of Atrial Fibrillation: A Systematic Review and Meta-analysis

Pulsed field ablation (PFA) is a novel nonthermal ablation technique for the treatment of atrial fibrillation (AF) patients, with safety comparable to traditional catheter ablation surgery. The present study aims to evaluate and compare the procedural efficiency and safety profiles of PFA and cryoballoon ablation (CBA) in the management of AF. We performed a systematic search across PubMed, the Cochrane Library, and Embase databases, encompassing the literature up to February 2024, to inform our systematic review and meta-analysis. When assessing outcome indicators, the risk ratio and its corresponding 95% confidence interval (CI) were calculated for dichotomous variables. For continuous variables, the mean difference (MD) and the associated 95% CI were determined. In this scenario, a relative risk (RR) value of less than 1 and an MD value of less than 0 are deemed favorable for the PFA group. This could translate to a reduced likelihood of procedural complications or enhanced procedural performance within the PFA group. In this analysis, 9 observational studies encompassing 2875 patients with AF were included. Among these, 38% (n = 1105) were treated with PFA, while 62% (n = 1770) received CBA. The results indicated that PFA was associated with a significantly shorter procedural duration compared with CBA, with an MD of −10.49 minutes (95% CI, −15.50 to −5.49; P &lt; 0.0001). Nevertheless, no statistically significant differences were observed when comparing the 2 treatment cohorts concerning fluoroscopy time (MD, 0.71; 95% CI, −0.45 to 1.86; P = 0.23) and the recurrence of atrial arrhythmias during follow-up (RR, 0.95; 95% CI, 0.78–1.14; P = 0.57). In terms of perioperative complications, the PFA group showed a significantly decreased risk of phrenic nerve palsy (RR, 0.15; 95% CI, 0.06–0.39; P &lt; 0.0001) and an increased risk of cardiac tamponade (RR, 3.48; 95% CI, 1.26–9.66; P = 0.02) compared with the CBA group. No significant differences were noted between the PFA and CBA groups regarding the incidence of stroke/transient ischemic attack (RR, 0.99; 95% CI, 0.30–3.22; P = 0.99), vascular access complication (RR, 0.87; 95% CI, 0.36–2.10; P = 0.76), atrial esophageal fistula (RR, 0.33; 95% CI, 0.01–8.13; P = 0.50), and major or minor bleeding events (RR, 0.39; 95% CI, 0.09–1.74; P = 0.22). Our research results indicate that compared with CBA, PFA not only shortens the procedure time but also demonstrates noninferiority in terms of fluoroscopy duration and the recurrence rate of atrial arrhythmias. PFA and CBA have both demonstrated their respective advantages in perioperative complications.

A generic random field approach for stratification uncertainty quantification

Geological uncertainty is a crucial factor in the reliability design of geotechnical structures, necessitating advanced probabilistic approaches for robust subsurface stratification and uncertainty quantification. However, the spatial existence of geological formations at a specific location is indeed a nominal categorical variable. Unlike the spatial variability of soil properties that has been widely addressed using random field theory or geostatistics, quantifying the spatial correlations of formation existence poses unique challenges. In this study, a generic framework for geological uncertainty quantification is proposed. The spatial existence of each formation is modeled with individual latent random fields, such that the spatial correlation strength of formation existence can be defined in a consistent manner as that in geotechnical random fields. Moreover, an effective distance metric is introduced to accommodate spatial correlations within a distorted random field, allowing for the incorporation of stratigraphic dip naturally. The latent random fields are subsequently input into the generalized linear mixed model (GLMM) to derive the probabilistic distribution of formation existence in the form of discrete random fields. The simulation framework is further formulated as a Bayesian inference problem to incorporate existing information from borehole records of a site. The proposed formulation offers great flexibility and versatility in simulating various complex stratigraphic configurations, which is demonstrated through a hypothetical case study with an inter-layer and a real case study in Perth, West Australia. This study advances rigorous quantification of stratification uncertainty, facilitating more reliable geotechnical design and risk assessment in complex geological environments.

Abstract 4138564: Fitbit-Measured Physical Activity Is Inversely Associated With Incident Atrial Fibrillation Among All Of Us Participants

Background: Studies show that moderate to vigorous physical activity (MVPA) reduces atrial fibrillation (AF) risk. However, these studies used subjective questionnaires or short-term (&lt;1 week) accelerometry assessments. Objective: This study investigated the link between MVPA levels and AF incidence using long-term (1-year) accelerometry data from the NIH All of Us Fitbit database. Methods: The study included All of Us participants who agreed to share electronic health record (EHR) and Fitbit data between January 1, 2016 to July 1, 2022. Among participants without an existing diagnosis of AF, the average weekly minutes of MVPA over the first year of Fitbit use was computed. Incident AF events were identified using validated ICD-10 codes in a five-year follow-up period. The risk of incident AF was evaluated using Cox proportional hazards regression models, for both MVPA as a continuous and a categorical variable (&lt;30, 30-150,151-300, and &gt;300 minutes MVPA per week; aligned with WHO guidelines). Covariates included age, sex, race/ethnicity, BMI, smoking status, and diagnoses of hypertension and diabetes. In a subset of participants with whole genome data, we evaluated if the association between MVPA and AF incidence varied by a participant’s AF genetic risk score (GRS) Results: 6086 participants (mean age 50 years, 71% female, 83% White) had EHR and at least 1 year of Fitbit data. Over the 1-year MVPA assessment period, participants had 41±12 weeks of complete data and a median 202 [241] minutes of MVPA per week. 55 participants (0.9%) experienced incident AF in the five-year follow-up period. In adjusted analysis, every additional hour of MVPA was associated with an 11% reduced risk of AF (HR = 0.89 [0.81,0.98], p = 0.02). There was a step-wise reduction in risk of AF by MVPA category with &lt;30 min/week as the reference: 30-150 (HR = 0.62 [0.24,1.6], p = 0.31), 151-300 (HR = 0.40 [0.15,1.07], p = 0.07), and &gt;300 (HR = 0.35 [0.13,0.95], p = 0.04) ( Figure 1 ). These associations also held after adjusting for GRS. Conclusion: Higher amounts of objectively measured MVPA were inversely associated with risk of incident AF, independent of clinical and genetic risk factors.

Abstract 4127562: Age, Adiposity-Related Anthropometrics, and Clinical Outcomes in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Trials

Background: Age has been shown to modify the population-level association between body mass index (BMI) and mortality. However, whether age modifies the association between adiposity-related anthropometrics and adverse outcomes in heart failure (HF) populations has not been systematically explored. Methods: In this participant-level pooled analysis of five international, multicenter, randomized-controlled trials enrolling adults with HF and either mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), the association between age and adiposity-related anthropometrics (BMI, waist circumference [WC], and waist-to-height ratio [WHtR]) and the primary composite outcome of time-to-first HF hospitalization or cardiovascular (CV) death was evaluated using multivariable adjusted Cox proportional hazards models (stratified by treatment and trial) and restricted cubic splines. Results: Among 21,606 participants in the analysis (mean age, 71±9 years; 49% female; 83% White; mean BMI, 30±6 kg/m 2 ), 5,350 (25%) were aged &lt;65 years, 8,273 (38%) were aged 65-74 years, and 7,983 (37%) were aged ≥75 years at baseline. Older individuals were more likely to be female, have lower BMI and WC, and higher left ventricular ejection fraction. Overall, BMI, WC, and WHtR were steeply and non-linearly associated with the primary outcome ( Figure ). Age, as either a categorical or continuous variable, significantly modified the covariate-adjusted association between all anthropometrics and the primary composite outcome ( P ≤0.001 for all) ( Figure ). A J-shaped relationship, characterized by higher incidence of the primary outcome with lower anthropometric values, was observed only for BMI and was substantially attenuated among younger adults. Irrespective of the anthropometric used, increasing adiposity was most steeply associated with primary events among adults aged &lt;65 years. Conclusions: In this pooled analysis of HFmrEF/HFpEF trials, age was a powerful modifier of the relationship between excess adiposity and HF hospitalization or CV death. An “obesity-survival paradox” – observed only for BMI – was not apparent in younger participants, who exhibited the steepest increase in the rate of clinical events with higher adiposity.

Abstract 4116975: Safety signals with SGLT2 inhibitor use in diabetic males with erythrocytosis, but not in females: Findings from the CANVAS Program and CREDENCE trial

Backgrounds: Mediation analyses have shown that an increase in hematocrit (Hct) levels significantly contributes to the cardiorenal benefits of SGLT2 inhibitors (SGLT2i). However, given the link between erythrocytosis and poor prognosis, concerns remain about whether SGLT2i-induced erythropoiesis in patients with erythrocytosis may increase thromboembolic events (TE) including myocardial infarction (MI). Methods: We conducted a pooled analysis utilizing individual participant data from the CANVAS Program and the CREDENCE trial, both aimed to evaluate the efficacy and safety of canagliflozin versus placebo in diabetic patients. The primary outcome was a composite of MI, stroke, or any other TE. Sex-specific Cox analyses were performed to assess effect modifications by baseline Hct levels, treated as categorical (anemia, normal, and erythrocytosis) or continuous variable. Results: Of the participants for whom baseline Hct values were available (98.5% [14,321/14,543]), 35% were female. Canagliflozin significantly increased the percentage of erythrocytosis from baseline to 1 year in males (5.6% to 16.9%) and females (1.9% to 5.2%), unlike placebo. Overall, canagliflozin did not alter the risk of the primary outcome for either male (HR 0.97; 95% CI, 0.86–1.10) or female (HR 0.95; 95% CI, 0.78–1.15). In males, baseline Hct levels modified treatment effect on the primary outcome, whether treated as categorical or continuous variables (Pinteraction &lt;0.05), with benefits in anemic patients and harm in those with erythrocytosis (Figure). Meanwhile, no effect modifications were noted in females. In analyses for each component of the primary outcome, canagliflozin consistently reduced the risk of MI, stroke, and any TE in anemic male patients (HR 0.53, 0.49, and 0.71, respectively). However, mixed results were observed in those with erythrocytosis (HR 1.77, 0.62, and 1.11, respectively), suggesting detrimental effects on the primary outcome in these patients were primarily driven by MI. No heterogeneity by Hct was found for heart failure hospitalization or kidney outcome in both sexes. Conclusion: Canagliflozin may pose a safety concern regarding the risk of TE in diabetic male patients with erythrocytosis.

Thoracic irrigation for traumatic hemothorax: A systematic review and meta-analysis.

Traumatic hemothoraces (HTXs) are common, and tube thoracostomy (TT) insertion is generally the initial management. However, a retained HTX can develop into a fibrothorax or empyema requiring secondary intervention. We hypothesized that irrigation of the thoracic cavity at the time of TT may prevent retained HTX. Pubmed, EMBASE, and Scopus were searched from inception to May 2024. Studies with adult trauma patients with traumatic HTX who received a TT and had patients who underwent thoracic irrigation were included. The primary outcome was failure rate, defined as retained HTX requiring a second intervention. Cumulative analysis was performed with χ2 for dichotomous variables and unpaired t test for continuous variables. A fixed-effects model was applied for meta-analysis. Six studies were included in the analysis; two retrospective and four prospective observational studies. These studies included 1,319 patients (513 irrigated TT, 837 nonirrigated TT). The mean age of patients was 45 years, 81% were male, mean Injury Severity Score was 21, and 42% had penetrating trauma. Failure rate was significantly lower in the irrigation group on cumulative analysis (10.7% vs. 18.2%, p < 0.001) and meta-analysis (effect size, 0.704; 95% confidence interval, 0.218-1.190; I2 = 0.4; p < 0.001]. In addition, on meta-analysis, the irrigation group had a shorter TT duration and hospital and ICU length of stay (all p < 0.05). There were no differences in overall infectious complications, readmission, or mortality; however, all the models favored the irrigation group. Patients who undergo simultaneous TT and thoracic irrigation have a lower rate of retained HTX and require fewer secondary interventions. Thoracic irrigation for traumatic HTX should be considered; however, randomized studies are needed prior to development of guidelines. Systematic Review/Meta-analysis; Level III.

Acceptance and Perceptions of COVID-19 Booster Dose; A Survey among Residents of Rawalpindi

Objectives: To determine public acceptance of COVID-19 booster dose, to know about perceptions and possible barriers regarding the vaccine. Study design: Analytical cross sectional study. Place and Duration of Study: conducted regarding the acceptance and perception of the vaccine booster dose among the residents of Rawalpindi Pakistan. The duration of study was 3 months i.e. from Jun till Aug 2022 Methodology: The sample size was 320 and collected using convenient sampling technique. The study included residents of Rawalpindi between ages 18 and 65. Google forms based on Health Belief Model were used for data collection. Data analysis was done using SPSS version 28 and summary statistics were produced using frequencies, percentages and mean. Chi-square test was also used to determine associations between categorical variables. Results: The results revealed that 74% of the participants’ primary reason for getting booster dose was their own safety while major barrier to booster dose vaccination was side effects related to vaccine - 62%. 81.3% people were willing to get the booster dose and 87.9% people agreed to receive booster dose for free. Chi-square test indicated a significant association between acceptance and perceived susceptibility, benefits and severity. Conclusion: In conclusion, our findings reveal that majority of people were willing to get booster dose primarily for own safety. However, counselling is required to decrease the perceived barriers to vaccination regarding side effects of the vaccine.

Decompressive craniectomy versus craniotomy for acute subdural hematoma: A systematic review and meta-analysis with an adjusted subgroup analysis.

Acute subdural hematomas are major causes of morbidity which warrant immediate treatment. If surgical intervention is warranted, craniotomy (CO) and decompressive craniectomy (DC) are employed, largely based on a loosely defined criteria and the neurosurgeon's best judgment. The primacy of one approach over another is a matter of dispute. We attempt to further clarify any advantages in the two techniques, and include a propensity score matched (PSM) subgroup analysis to eliminate bias. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature review was conducted on PubMed/Medline, Cochrane Central, and Google Scholar from inception to September 2023. 15 studies were extracted, and three outcomes were meta-analyzed: Mortality, Glasgow Outcome Scale (GOS) scores and patients undergoing re-operations/revisions. Odds Ratios (OR) and Mean Difference (MD) were used in dichotomous and continuous variables respectively. PSM data was used wherever possible. A subgroup analysis was conducted with 5 PSM studies and a trial. Heterogeneity was addressed if above 40% and the P-value is significant (≤ .05). A total of 15 studies were meta-analyzed with a total of 2327 and 2171 patients undergoing CO and DC respectively. Patients undergoing DC had a significantly worse GOS 5 outcome (OR: .63 [95% CI: .45-.87]; P = .005; I2 = 0%) and higher mortality (OR: 1.58 [95% CI: 1.20-2.08]; P = .001; I2 = 67%). In subgroup analysis of adjusted studies, DC still had significantly higher mortality. (OR: 1.50 [95% CI: 1.03-2.18]; P = .001; I2 = 83%). This meta-analysis determines that CO is more viable than DC as a surgical option due to its less invasive nature. DC can be employed, albeit under strict preprocedural patient selection and for highly specific indications.

Vaccine Confidence Among Young Adults During COVID-19: A Cross-Sectional Study from Turkey.

A lack of confidence in vaccination is a threat to public health and undermines vaccine uptake at national and global levels. Unfortunately, COVID-19 vaccine confidence among Turkish young adults is poorly known. This study aims to understand COVID-19 vaccine confidence among Turkish young adults aged 18-29 and the barriers to and facilitators of vaccine uptake. The present research is a cross-sectional study. Survey data were collected in May and June 2022 (n = 1066) during the COVID-19 vaccination campaign. Results were expressed in frequencies and percentages for dichotomous variables and mean with standard deviation for continuous variables. To assess COVID-19 vaccine confidence based on selected sociodemographic characteristics, a one-way ANOVA analysis and an independent-sample t-test were used. Almost half of the sample (43.9%) underestimated the risk of contracting COVID-19 disease. 65.9% of participants believed that getting vaccinated against COVID-19 was important, while 47.8% thought the vaccine was safe and not dangerous or harmful. Concerns about vaccine effectiveness (58.3%)were the primary reported reason for vaccination. The percentage of participants who reported barriers to vaccine access was generally low (8.7%). Importantly, 63.9% believed getting vaccinated is their responsibility to their community. 33.8% of participants reported encountering inaccurate, misleading, and unfavorable information about COVID-19 vaccines, while 22.9% said they were unsure. Addressing concerns about COVID-19 vaccine safety and efficacy, emphasizing the role of vaccination in societal benefits, ensuring easy access to vaccines, and providing access to up-to-date and accurate information from reliable sources might help increase coverage among young adults. Perhaps the most crucial advice is to instill the correct comprehension of vaccination and make lifelong vaccination a reality before individuals develop false beliefs that are challenging to rectify.

CHI-SQUARE TESTS: A QUICK GUIDE FOR HEALTH RESEARCHERS

Pearsons chi-square (Χ²) tests are essential nonparametric statistical tools for analyzing associations among categorical data, making them crucial for research involving non-numeric variables. These tests are widely utilized in various research fields due to their independence from normal distribution assumptions. Chi-square tests are utilized to assess whether there is a significant association between groups, populations, or criteria, and to examine how closely observed data distributions align with expected ones. The three primary types of chi-square tests are: the Goodness-of-Fit test, which checks if the distribution of categorical data in a sample conforms to a predefined distribution the Test of Independence, which investigates whether there is a relationship between categorical variables within a single sample and the Test of Homogeneity, which compares the frequency counts of a categorical variable across multiple populations to see if their distributions are similar.For valid and reliable results, it is crucial to consider factors such as random sampling, adequate cell counts, sufficient sample size, and mutually exclusive variables. In healthcare research, chi-square tests are essential for analyzing risk factors, evaluating AYUSH treatments, assessing nursing interventions, and studying health behavior trends. This review underscores their importance in statistical analysis and evidence-based decision-making.

What Is My Plaza for? Implementing a Machine Learning Strategy for Public Events Prediction in the Urban Square

Plazas are an essential pillar of public life in our cities. Historically, they have been seen as public fora, hosting public events that fostered trade, interaction, and debate. However, with the rise of modern urbanism, city planners considered them as part of a larger strategic development scheme overlooking their social importance. As a result, plazas have lost their function and value. In recent years, awareness has risen of the need to re-activate these public spaces to strive for social inclusion and urban resilience. Geometric and urban features of plazas and their surroundings often suggest what kinds of usage the public can make of them. In this project, we explore the application of machine learning to predict the suitability of events in public spaces, aiming to enhance urban plaza design. Learning from traditional urbanism indicators, we consider factors associated with the features of the public space, such as the number of people and the high degree of comfort, which are evolved from three subcategories: external factors, geometric shape, and design factors. We acknowledge that the predictive capability of our model is constrained by a relatively small dataset, comprising 15 real plazas in Madrid augmented digitally to 2025 fictional scenarios through self-organising maps. The article details the methods to quantify and enumerate quantitative urban features. With a categorical target variable, a classification model is trained to predict the type of event in the urban space. The model is then evaluated locally in Grasshopper by visualising a parametric verified geometry and deploying the model on other existing plazas worldwide regarding geographical proximity to Madrid, where to share or not the same cultural and environmental conditions. Despite these limitations, our findings offer valuable insights into the potential of machine learning in urban planning, suggesting pathways for future research to expand upon this foundational study.

Serotonin and adrenaline as inhibitors of neutrophil extracellular traps formation (experimental study)

Regulation of the NETosis can provoke cancer, inflammatory and autoimmune diseases and become a basis for effective targeted therapy. The aim: to study the modifying effects of serotonin and adrenaline on NETosis during phagocytosis in rats.Materials and methods.Wistar rats were divided into control (solvent, 0.9% NaCl solution) and experimental (serotonin and adrenaline 1.43 and 0.143 mg/kg body weight, respectively) groups. Intraperitoneal injection of test substances was carried out 90 minutes before blood sampling, in which phagocytic activity (PhA), phagocytic index (PhI) and degree of suicidal neutrophil NETosis were determined: with total and partial chromatin decondensation (TCD, PCD, accordingly). A paired Student’s t test was used to compare groups with numerical values and McNemar’s test (for dichotomous variables). Pearson’s linear correlation coefficient (rxy) was assessed to measure a linear relationship between time points.Results.The administration of adrenaline contributed to NETosis inhibition by 41.5% compared to control group (p 0.001), serotonin — by 27.6% (p 0.001). The ratio of neutrophils with total and partial chromatin decondensation for control group was 1.0:0.9; for serotonin and adrenaline it changed to 1.0:1.7 and 1.0:1.4, respectively. Relative to control group, phagocytic index after serotonin administration increased by 4.9%, in case of adrenaline, on the contrary, it decreased by 12.4% (p 0.01). A high positive correlation was revealed between NETosis and phagocytic index for control group and experimental group with adrenaline: rxy= 0.823–0.997. For phagocytic index and NETosis in these groups there was a high negative (rxy= –0.714–(–0.871)) and a noticeable positive correlation for serotonin (rxy= 0.638).Conclusion.Serotonin and adrenaline in therapeutic dosages have a pronounced inhibitory effect on NETosis, which may pave the avenue for increasing the effectiveness of therapy for immunoinflammatory and oncological diseases. The use of serotonin is preferable because it has additional immunomodulatory effects and cause no direct stimulation ofα- andβ-adrenergic receptors.

Comparative efficacy of microwave ablation and radiofrequency ablation for treating metastatic liver cancer: a systematic review and meta-analysis.

This study aims at evaluating and juxtaposing the efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for hepatic metastases treatment. We undertook an extensive literature search across the Cochrane Library, Web of Science, Embase, PubMed, CNKI, and databases for studies published up to December 2023, assessing the outcomes of RFA versus MWA in hepatic metastases treatment. Studies were included or excluded based on established criteria. Continuous variables were analyzed with the aid of the weighted mean difference (WMD) and its 95% confidence interval (CI), while the odds ratio (OR) with its 95% CI was utilized for dichotomous variables. Data were processed by use of STATA 17.0 software. Key outcomes assessed included ablation time, post-operative local tumor progression (LTP), disease-free survival (DFS), and post-operative complications (POCs). Seven studies, comprising 357 patients undergoing MWA and 452 patients undergoing RFA, fulfilled the inclusion criteria. As unveiled by the meta-analysis, RFA and MWA did not significantly differ in ablation time, DFS, and POCs. Nonetheless, MWA resulted in a strikingly reduced rate of post-operative LTP versus RFA. MWA offers superior control over post-operative LTP, suggesting better overall efficacy in hepatic metastases treatment compared with RFA. https://www.crd.york.ac.uk/prospero/, identifier CRD42023385201.