Likelihood Of Events Research Articles

Comparison between coronary calcium score and segment involvement score when used in clinical routine

Abstract Data from a nationwide registry on coronary computer tomography angiography. Background The Coronary Artery Calcium Score (CACS) and segment involvement score (SIS) are crucial factors in assessing the severity of coronary artery disease (CAD) and determining the likelihood of future cardiovascular events. However, there are few large multicenter studies comparing the predictive value of CACS and SIS when used in the clinical routine. Objectives To compare CACS and SIS ability to predict cardiovascular outcomes when used in the clinical routine. Methods This retrospective cohort study included patients who underwent Coronary Computed Tomography Angiography (CCTA) for CAD evaluation between 2006-2022 in 29 different centers in Sweden. CACS was calculated using the Agatston method, and SIS was determined based on the number of coronary segments exhibiting plaque. For SIS, patients were categorized into SIS=0, SIS=1, SIS=2, SIS=3, SIS³4, for CACS patients were categorized into CACS=0, CACS=1-9, CACS=10-99, CACS=100-299, CACS³300. Patients were followed regarding the primary outcome of death or myocardial infarction. Multivariable Cox proportional hazards models were used for adjusting for potential confounders. Results A total of 23034 patients underwent CCTA and were followed for up to ten years. Median age (IQR) was 58 (49–67) years, 50% were women, 9% had diabetes mellitus, 42% had hypertension, 25% had hyperlipidemia, 5% had previously known CAD. There were 955 patients (4.1%) with myocardial infarction (MI) and 409 patients (2.2%) died during follow up. There was an increase in cardiovascular events with increasing SIS. When comparing SIS and presence of obstructive stenosis, SIS was a better predictor of outcome (Figure 1). There was also an increase cardiovascular events with increasing CACS (Figure 2). When adjusted for age, sex, risk factors, previous cardiovascular disease and intervention, both SIS and CACS were independently associated with outcome. When SIS and CACS were compared in a receiver operating characteristic curve, CACS had significantly larger AUC than SIS, (0.70[0.67-0.73] vs 0.62[0.60-0.63]). Conclusion Our findings show that both CACS and SIS are important and independent predictors of cardiovascular outcomes thereby offering a valuable tool for personalized risk stratification and management in clinical settings. When used in the clinical routine, CACS appears to be more strongly associated with outcome than SIS.Figure1 Survival SISFigure 2 Survival CACS

Anthropogenic Exacerbation in Dry‐Hot Probability and Consequential Record‐Shattering Droughts in the Middle and Lower Reaches of the Yangtze River

AbstractIn the year 2019, the middle and lower reaches of the Yangtze River (MLRYR) experienced an unprecedented summer‐autumn drought (SAD) driven by dry‐hot conditions [high near‐surface air temperatures (T) and low precipitation (P)], causing substantial agricultural and economic losses. However, the influence of anthropogenic climate change (ACC) on these dry‐hot conditions and their impacts on SAD occurrences remains uncertain. Here, both observations and simulations show that an ACC‐driven T increase led to the greater likelihood of dry‐hot conditions from August to November 1901–2020 in MLRYR. Using the self‐calibrating Palmer drought index (scPDSI) to assess SAD severity, we find an increasing likelihood of SAD occurrence (from 33.3% in 1901–2000 to 85.7% in 2001–2020) in MLRYR associated with more frequent dry‐hot conditions. Under a business‐as‐usual scenario, future dry‐hot association is projected to be stronger, with exceptional dry‐hot conditions to increase by +10% per century. ACC‐induced increase in dry‐hot conditions would elevate the likelihood of SAD events like the 2019 event from 1.59% (1961–2020) to 17.82% (2041–2100). Therefore, effective measures are needed in MLRYR to adapt to increasing dry‐hot conditions and associated SAD occurrences under anthropogenic warming.

Adverse events after chemodenervation with onabotulinum neurotoxin A in children with hypertonia and sialorrhea.

To identify the incidence and type of adverse events reported after chemodenervation with onabotulinum neurotoxin A (BoNT-A) in children with hypertonia and sialorrhea and compare adverse events in the on-label or off-label use of BoNT-A with regard to dose, patient's age, and location of the injection. Using a retrospective chart review, we studied BoNT-A injections occurring from January 2017 to December 2020 in patients at a pediatric hospital. The electronic health record was examined to identify adverse events reported within 2 months of the injection. Data included the patient's age, sex, race, and ethnicity, as well as the type of toxin injected, the dose, the location of injection, and the patient's weight. We analyzed 1733 procedures. Adverse events were infrequent (2.5%) and not serious, most commonly reported as pain or discomfort. All adverse events were temporary and there were no deaths. We did not observe a meaningful difference in the frequency of adverse events for injections that exceeded the 2022 US Food and Drug Administration (FDA)-approved maximum dose compared to injections that were within the FDA-approved dose range. The likelihood of adverse events did not increase with higher doses of BoNT-A. More adverse events were reported for injection into the salivary glands (4.37%) than into the extremities (2.26%). Higher doses of injected BoNT-A in a pediatric population may be safe. Further work is needed to investigate the relationship between dose and efficacy.

Frequency and Genotype-Dependence of intrinsic chronotropic insufficiency among patients with congenital long QT syndrome.

Long QT syndrome (LQTS) is a cardiac channelopathy characterized by QT prolongation and a potential for arrhythmic syncope, sudden cardiac arrest or deaths (SCA/SCD). It has been speculated that patients with LQTS might have a primary sinoatrial node (SAN) phenotype of chronotropic insufficiency (CI). This has not been demonstrated convincingly before because of the potentially confounding effects of beta blocker (BB) therapy. Herein, we set out to determine whether untreated patients with LQTS demonstrate intrinsic CI. A retrospective review of all treadmill exercise stress tests (TEST) was performed on patients with one of the three most common LQTS genotypes: LQT1, LQT2, and LQT3. For each patient, the first TEST completed while off BB was analyzed. Patients with prior left cardiac sympathetic denervation (LCSD) therapy were excluded. CI was defined as having an age- and gender-predicted peak heart rate (HR) < 85% and/or a predicted HR reserve (HRR) < 80%. Overall, 463 LQTS patients (245 LQT1, 125 LQT2, and 93 LQT3) were included (267 female [58%]; mean age at time of TEST [29 ± 17 years]). Mean % predicted peak HR for all LQTS patients was 87.6% (range 42.9% - 119.1%) and mean % predicted HRR was 80% (range 19.1% - 153%). Overall, half of all LQTS patients (n = 234; 51%) displayed CI; 64% of patients with LQT1 (n = 157), 37% with LQT2 (n = 46), and 33% with LQT3 (n = 31). Patients with LQT1 were most likely to exhibit CI compared to patients with LQT2 (p < .0001) and LQT3 (p < .0001). CI was significantly more common in LQT1 compared to controls (p < .0001), while there was no difference between LQT2 (p = .5) or LQT3 and controls (p > .9). Presence of CI was not a predictor of LQTS-associated symptoms, BB side effects or likelihood of future breakthrough cardiac events (BCE). Patients with LQTS, particularly LQT1, demonstrate a SAN phenotype of CI. If assessing BB therapy effect by impact on peak HR, the patient's pretreatment peak HR, rather than an age- and gender-predicted maximum HR, should be used.

Serological analysis in humans in Malaysian Borneo suggests prior exposure to H5 avian influenza near migratory shorebird habitats

Cases of H5 highly pathogenic avian influenzas (HPAI) are on the rise. Although mammalian spillover events are rare, H5N1 viruses have an estimated mortality rate in humans of 60%. No human cases of H5 infection have been reported in Malaysian Borneo, but HPAI has circulated in poultry and migratory avian species transiting through the region. Recent deforestation in coastal habitats in Malaysian Borneo may increase the proximity between humans and migratory birds. We hypothesise that higher rates of human-animal contact, caused by this habitat destruction, will increase the likelihood of potential zoonotic spillover events. In 2015, an environmentally stratified cross-sectional survey was conducted collecting geolocated questionnaire data in 10,100 individuals. A serological survey of these individuals reveals evidence of H5 neutralisation that persisted following depletion of seasonal H1/H3 HA binding antibodies from the plasma. The presence of these antibodies suggests that some individuals living near migratory sites may have been exposed to H5 HA. There is a spatial and environmental overlap between individuals displaying high H5 HA binding and the distribution of migratory birds. We have developed a novel surveillance approach including both spatial and serological data to detect potential spillover events, highlighting the urgent need to study cross-species pathogen transmission in migratory zones.

Hydrologic Responses to Climate Change and Implications for Reservoirs in the Source Region of the Yangtze River

ABSTRACTUnderstanding the hydrological impacts of climate change is essential for robust and sustainable water management. This study assessed the hydrologic conditions under changing climate in the Jinshajiang River basin, the source region of the Yangtze River, using the hydrological model SWAT with the historical observations and the future climate simulations under two Shared Socioeconomic Pathways (SSP2‐4.5 and SSP5‐8.5). For the historical period, with an increasing trend of precipitation, evapotranspiration, and snowmelt, streamflow increases in upstream region but keeps decreasing in the downstream catchment. For future scenarios, a warmer and wetter climate is projected for the basin throughout the 21st century, leading to an overall increase in mean and extreme streamflow. The streamflow magnitude increases more significantly in the far future than in the near future, and more significant under SSP5‐8.5 than SSP2‐4.5. The projected remarkable increase in precipitation causes the transition in changing trend of streamflow compared with the historical period. The projected warming leads to a continuing decline in snowfall and snow water equivalent, followed by an earlier snowmelt and higher peak streamflow, especially at the upstream catchment. Ultimately, reservoirs in the basin are expected to gain more inflows, however, with greater variability including higher likelihoods of flood and drought events, which impose potential challenges on reservoir operations. These outcomes indicate the importance of adaptive water resources management in the melting water contributed basin to sustain and enhance its services under global warming.

Extending the blended generalized extreme value distribution

AbstractThe generalized extreme value (GEV) distribution is commonly employed to help estimate the likelihood of extreme events in many geophysical and other application areas. The recently proposed blended generalized extreme value (bGEV) distribution modifies the GEV with positive shape parameter to avoid a hard lower bound that complicates fitting and inference. Here, the bGEV is extended to the GEV with negative shape parameter, avoiding a hard upper bound that is unrealistic in many applications. This extended bGEV is shown to improve on the GEV for forecasting heat and sea level extremes based on past data. Software implementing this bGEV and applying it to the example temperature and sea level data is provided.

Venturing Travelers vs. Home Stayers Under Extreme Risk

ABSTRACT This study explores risk-taking during a pandemic, a severe risk condition similar to terrorism and natural disasters. It examines differences in sociodemographics and psychographics between individuals who traveled during the COVID-19 Pandemic and those who stayed home. Conducted as an online survey in 2022, the study used a randomized experiment. T-tests revealed significant differences in only two sociodemographics and two risk-taking factors of probability neglect and proximity-to-self, but not in personality traits of risk-taking, thrill-seeking, or self-confidence. Travelers were more likely to have young children and higher income while non-travelers scored higher in neglecting the probability of bad events happening to them, potentially because they avoided travel as they perceived a high likelihood of bad events happening while traveling.

7165 A Case of Severe Myxedema Coma with Levothyroxine Allergy

Abstract Disclosure: A. Rothstein Costris: None. A. Yaseen: None. S. Levy: None. Introduction: Myxedema coma is a life threatening condition with a mortality rate of 25-60%. Untreated, it can lead to fatal physiological changes. The treatment is thyroid hormone replacement therapy, alongside supportive care for complications. Clinical Case: A 65-year-old woman, who has been dealing with untreated hypothyroidism since 2012 and reported allergies to various levothyroxine brands, presented with falls, weakness, and exacerbated leg numbness. During the examination, she exhibited periorbital edema, non-pitting edema in the lower extremities, bradycardia, and hypothermia. The blood work revealed an elevation in TSH levels at 301 uIU/L (0.45-5.33 uIU/mL). The patient was administered IV Synthroid (200 mcg), Atropine, and Hydrocortisone due to concerns about myxedema coma. After four hours, the patient experienced angioedema and hypotension, necessitating intubation. This situation was complicated by a pulseless electrical activity (PEA) arrest. Following cardiopulmonary resuscitation and the administration of epinephrine, the patient achieved return of spontaneous circulation. The allergy team assessed the patient for potential anaphylactic shock from IV Synthroid. Subsequently, the patient was initiated onIV Liothyronine and Hydrocortisone, leading to improvement in mental status over a period of a few weeks, and no adverse effects were reported. Thyroid labs improved to TSH of 53 (0.45-5.33 uIU/mL), FT3 of 3.3 (2.5-4.4 pg/mL) and total T3 of 133 (87-178 ng/dl). Upon discharge, the patient was prescribed Liothyronine, with plans to perform a Levothyroxine desensitization test in the outpatient setting. Conclusion: Myxedema coma is an endocrine emergency. Patients usually present with deteriorating mental status, hypothermia, and multiple organ system abnormalities. The diagnosis relies more on the clinical presentation and physical examination than on laboratory results. Thyroid replacement therapy serves as the cornerstone of treatment, with a preference for T4 due to its greater availability and lower likelihood of adverse events compared to Liothyronine, which may increase the risk of mortality at higher doses. Despite associated risks, incorporating low doses of Liothyronine is still considered in treatment plans, driven by concerns about reduced T4 to T3 conversion in myxedema patients. Hypersensitivity reactions to Levothyroxine are uncommon but may manifest as widespread hives, swelling, eczema-like skin rashes, elevated body temperature, and compromised liver function, with only one case reporting an anaphylactic reaction to Levothyroxine. In summary, the potential for experiencing an anaphylactic reaction to Levothyroxine exists, highlighting the need to contemplate alternative treatments, such as Liothyronine. Desensitization methods can be considered once the patient's condition is stable. Presentation: 6/2/2024

Player and match characteristics associated with head acceleration events in elite-level men’s and women’s rugby union matches

ObjectiveTo examine the likelihood of head acceleration events (HAEs) as a function of previously identified risk factors: match time, player status (starter or substitute) and pitch location in elite-level men’s...

Criticality of preparation and equipment in hiking and trekking activities: a systematic review

Outdoor activities like hiking and trekking require appropriate preparation and equipment. However, many adventurers underestimate the importance of these factors, leading to increased risk and adverse events. This study aims to deliver a comprehensive review of existing literature on preparation and equipment requirements for hiking and trekking and to identify prevalent challenges during these activities. The review considered papers with English full-text, listed in MEDLINE/PubMed or Google Scholar, published between January 2000 and June 2023. The search method focuses on potential obstacles during the trip and equipment preparation and risks during hiking and trekking. Following the PRISMA 2021 guidelines, 14 papers were considered for detailed review. Two articles investigated hiking experts whereas the other studies included experts and beginners. The following preparative measures and equipment were identified as crucial: appropriate clothing, maps, compass, first aid kit, extra food and water, good physical fitness, and outdoor-related skills (e.g., orientation and medical proficiency). The reviewed studies had methodological flaws and were susceptible to bias. This review identifies common risks and best practices with respect to preparation and equipment for hiking and trekking. It contributes to outdoor adventure safety, potentially reducing risks and the likelihood of adverse events and enriching outdoor experiences. Keywords: Hiking, Trekking, Equipment Requirements, Preparedness, Outdoor Activities, Risk Management, Safety Practices, Adventure Tourism, Literature Review.

Forest Dieback Alters Nutrient Pathways in a Temperate Headwater Catchment

ABSTRACTForested headwater catchments ensure good water quality for downstream ecosystems and human consumption. Climate change and the exacerbating likelihood of extreme events elevate the risk of severe forest dieback. However, the effects of forest dieback on the quantity and quality of stream water are not fully understood. Here, we analyse high‐frequency observations of discharge, electrical conductivity (EC), dissolved organic carbon (DOC) and nitrate (NO3N) obtained before, during and after a drought‐induced forest dieback in a headwater stream in the German Harz Mountains. We focus on the characteristics of concentration‐discharge (C‐Q) relationships at the scale of runoff events to assess the effects of forest dieback on the sources, mobilisation and pathways of EC, DOC and NO3N. When comparing pre‐ and post‐dieback conditions, we found a significant increase in runoff efficiency and a doubling of DOC loads exported from the catchment, while DOC concentrations increased only moderately and their C‐Q patterns did not change. EC exhibit no changes in concentrations but a steepening of C‐Q dilution patterns. We explain these findings with a dieback‐induced decrease in evapotranspiration, which leads to more intensive drainage of the upper organic soil layers in the riparian zone. In contrast, we observed a strong increase in NO3N concentrations and fluxes by a factor of ~5, while C‐Q patterns at the event scale changed from enrichment to dilution. We argue that the dieback led to an excess of NO3N on the hillslopes that connect to the stream via surficial flowpaths. In this way, NO3N bypasses the riparian zone, reducing the catchment's efficiency in attenuating this nutrient. Our study emphasises the pivotal role of riparian zones in mediating water quality in headwater streams. Different configurations of the riparian zone and its connection to the hillslopes and the stream network may be a missing piece in explaining differences in water quality responses of catchments to forest dieback.

Diagnostic and prognostic significance of serum lncRNA MBNL1-AS1 expression in patients with atherosclerosis.

Atherosclerosis (AS) is the pathological basis of many cardiovascular and cerebrovascular diseases. To further the investigation of treatments for AS, this research analyzed the role of lncRNA MBNL1-AS1. MBNL1-AS1 expression in the serum of AS patients and healthy controls were detected by qPCR. Its diagnostic value in AS was assessed by receiver operating characteristic curve (ROC). Additionally, the link between MBNL1-AS1, carotid intima-media thickness (CIMT) and C-reactive protein (CRP) was examined using the Spearman correlation coefficient. The prognostic value of MBNL1-AS1 in AS was assessed using the Kaplan-Meier survival curve and univariate and multivariate Cox regression analysis. The present study consisted of 103 patients with AS and 92 healthy patients (HC) and comparison of baseline data between the two groups revealed no remarkable difference (P>0.05) except for CRP (P<0.0001). The serum of AS patients exhibited a considerably higher expression of MBNL1-AS1 in comparison to the HC group. Furthermore, MBNL1-AS1 was highly expressed in patients following higher CIMT and CRP values, which was positively linked with both, respectively (r>0.5, P<0.001). Meanwhile. MBNL1-AS1 has enhanced diagnostic accuracy in AS patients (AUC=0.893) and can be utilized as an independent prognostic factor for AS. Patients with high MBNL1-AS1 expression have a higher likelihood of cardiovascular events. (log rang P=0.0025). Elevated MBNL1-AS1p can be used as a potential marker for the clinical diagnosis of AS and is linked to a poor prognosis of AS.

A Novel Spatial-Aware Deep Learning Approach for Exploring the Environmental Context of Terrorist Attacks and Armed Conflicts

The quantitative assessment of terrorist attacks and armed conflicts (TAACs) is a crucial component of global public safety research and is vital for societal stability and national security. This study addresses the spatial dependency of such events, i.e., the relationship between the outbreak of an event and its environment. Based on geographic big data and artificial intelligence (AI), we propose a spatial feature utilization pattern that takes into account the impact of the event environment, and established a deep learning (DL) framework of features within the joint event location and space neighborhood to improve the precision of the quantitative assessment. The results demonstrate that in scenarios under a combination of 14 social, natural, and geographic driving factors, models that incorporate spatial features outperform those that only use location features during both the training and testing phases. Furthermore, models that consider both location and spatial features outperform models using only a single feature across various evaluation metrics. Global attribution analysis further confirms the spatial dependency of events, manifested in the mutual influence on the likelihood of events occurring among adjacent cities and the correlation with various environmental factors, particularly elements related to human activities and living environments. We find that both prosperous urban centers and underdeveloped rural areas are hotspots for TAACs, and that such events more likely to occur in harsh climatic patterns characterized by high temperatures and low precipitation. This enhances our understanding and preparedness for managing and preventing such events.

A bayesian approach for the continuous monitoring of the prediction of the physiological evolution of a crisis victim: A decision support system

Catastrophic events like earthquakes demand innovative tools for crisis management. Mathematical modeling and decision support systems (DSSs) have proved crucial for understanding, predicting and mitigating disaster impact. The quantification of complex phenomena through probabilistic models, to estimate the likelihood of events, provides actionable insights that are essential for disaster risk reduction (DRR).The present work stems from research conducted within the framework of the Search & Rescue (S&R) project (H2020-SU-SEC-2019), in particular from the development of the PHYSIO DSS module, the medical component of the S&R Decision Support System (DSS). The PHYSIO DSS focuses on predicting the physiological evolution of crisis victims: using a Bayesian approach, it incorporates real-time field observations to forecast patient conditions. This enables the prediction of the evolution of physiological compensation, allowing efficient resource allocation and timely interventions. By providing real-time insights into victim severity, PHYSIO DSS empowers medical personnel to prioritize treatment, potentially saving lives. Its adaptability allows integration into different platforms, from crisis management systems to apps to personal health devices.This tool has the potential to substantially enhance emergency response capability and overall disaster resilience by offering real-time, data-driven decision support.

Myocardial Scarring and Sudden Cardiac Death in Young Patients With Hypertrophic Cardiomyopathy

The ability to predict sudden cardiac death (SCD) in children and adolescents with hypertrophic cardiomyopathy (HCM) is currently inadequate. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) imaging is associated with SCD events in adults with HCM. To examine the prognostic significance of LGE in patients with HCM who are younger than 21 years. This multicenter, retrospective cohort study was conducted from April 8, 2015, to September 12, 2022, in patients with HCM who were younger than 21 years and had undergone CMR imaging across multiple sites in the US, Europe, and South America. Observers of CMR studies were masked toward outcomes and demographic characteristics. Natural history of HCM. The primary outcome was SCD and surrogate events, including resuscitated cardiac arrest and appropriate discharges from an implantable defibrillator. Continuous and categorical data are expressed as mean (SD), median (IQR), or number (percentage), respectively. Survivor curves comparing patients with and without LGE were constructed by the Kaplan-Meier method, and likelihood of subsequent clinical events was further evaluated using univariate and multivariable Cox proportional hazards models. Among 700 patients from 37 international centers, median (IQR) age was 14.8 (11.9-17.4) years, and 518 participants (74.0%) were male. During a median (IQR) [range] follow-up period of 1.9 (0.5-4.1) [0.1-14.8] years, 35 patients (5.0%) experienced SCD or equivalent events. LGE was present in 230 patients (32.9%), which constituted an mean (SD) burden of 5.9% (7.3%) of left ventricular myocardium. The LGE amount was higher in older patients and those with greater left ventricular mass and maximal wall thickness; patients with LGE had lower left ventricular ejection fractions and larger left atrial diameters. The presence and burden of LGE was associated with SCD, even after correcting for existing risk stratification tools. Patients with 10% or more LGE, relative to total myocardium, had a higher risk of SCD (unadjusted hazard ratio [HR], 2.19; 95% CI, 1.59-3.02; P < .001). Furthermore, the addition of LGE burden improved the performance of the HCM Risk-Kids score (before LGE addition: 0.66; 95% CI, 0.58-0.75; after LGE addition: 0.73; 95% CI, 0.66-0.81) and Precision Medicine in Cardiomyopathy score (before LGE addition: 0.68; 95% CI, 0.49-0.77; after LGE addition: 0.73; 95% CI, 0.64-0.82) SCD predictive models. In this retrospective cohort study, quantitative LGE was a risk factor for SCD in patients younger than 21 years with HCM and improved risk stratification.

The effect of transcutaneous electrical acupoint stimulation on postoperative awakening after general anaesthesia: a systematic review and meta-analysis.

The existing body of research concerning the impact of transcutaneous electrical acupoint stimulation (TEAS) on early postoperative recovery is marked by a lack of consensus. This meta-analysis, encompassing a systematic review of randomised controlled trials, seeks to critically assess the efficacy of TEAS in relation to awakening from general anaesthesia in the postoperative period. The inclusion criteria for this study were peer-reviewed randomised controlled trials that evaluated the influence of TEAS on the process of regaining consciousness following general anaesthesia. A comprehensive search was conducted across several reputable databases, including PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, the VIP Database, the SinoMed Database, and the WANFANG Medical Database. The search was not limited by date, extending from the inception of each database up to December 2023. The methodological quality and risk of bias within the included studies were appraised in accordance with the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1, and its associated tool for assessing risk of bias. The analysis encompassed 29 studies involving a total of 2,125 patients. Participants in the TEAS group demonstrated a significantly shorter duration to achieve eye-opening [mean difference (MD), -3.16 min; 95% confidence interval (CI), -3.93 to -2.39], endotracheal extubation (MD, -4.28 min; 95% CI, -4.79 to -3.76), and discharge from the post-anaesthesia care unit (MD, -8.04 min; 95% CI, -9.48 to -6.61) when compared to the control group receiving no or sham stimulation. Additionally, the TEAS group exhibited markedly reduced mean arterial blood pressure (MD, -9.00 mmHg; 95% CI, -10.69 to -7.32), heart rate (MD, -7.62 beats/min; 95% CI, -9.02 to -6.22), and plasma concentrations of epinephrine (standardised MD, -0.81; 95% CI, -1.04 to -0.58), norepinephrine (MD, -47.67 pg/ml; 95% CI, -62.88 to -32.46), and cortisol (MD, -110.92 nmol/L; 95% CI, -131.28 to -90.56) at the time of extubation. Furthermore, the incidence of adverse effects, including agitation and coughing, was considerably lower in the TEAS group relative to the control group (odds ratio, 0.30; 95% CI, 0.22-0.40). The findings of this study indicate that TEAS may hold promise in facilitating the return of consciousness, reducing the interval to awakening post-general anaesthesia, and enhancing the awakening process to be more tranquil and secure with a diminished likelihood of adverse events. However, caution must be exercised in interpreting these results due to the notable publication and geographical biases present among the studies under review. There is an imperative for further high-quality, low-bias research to substantiate these observations. The review protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42022382017).

Communicating uncertainty in intelligence forecasts using verbal expressions of probability and confidence

ABSTRACT The National Intelligence Council provides guidelines for how to interpret expressions of uncertainty in analytic reports, including verbal expressions of both probability (e.g. ‘likely’ or ‘unlikely’) and confidence (i.e. ‘low’, ‘moderate’, and ‘high’). This study examined how people interpret intelligence forecasts made with these expressions. 1315 participants provided quantitative and qualitative interpretations of forecasts in two studies.. The results indicated that participants used expressions of confidence to interpret the likelihood of events and that the inclusion of expressions of confidence did not improve interpretations of forecasts. Recommendations were made for research exploring alternative methods to convey uncertainty.

Cardiovascular risk in individuals with kidney disease

The worldwide prevalence of chronic kidney disease (CKD) is estimated to exceed 700 million persons, with the incidence steadily increasing due to factors such as an aging population and the growing prevalence of chronic diseases such as diabetes and hypertension. Cardiovascular disease is the primary cause of illness and mortality in persons with nephropathy. Effectively treating nephropathy and cardiovascular risk in individuals with kidney disease is a major challenge in clinical practice. Every patient requires a comprehensive assessment and tailored therapy. In order to reduce the likelihood of cardiovascular events in patients with nephropathy, it is necessary to avoid and rapidly address cardiovascular risk factors. In order to enhance the overall well-being and longevity of individuals with kidney disease, it is essential to identify and address any cardiovascular issues.

Recent advancements in targeting the immune system to treat hypertension

Hypertension is the key leading risk factor for death globally, affecting ∼1.3 billion adults, particularly in low- and middle-income countries. Most people living with hypertension have uncontrolled high blood pressure, increasing their likelihood of cardiovascular events. Significant issues preventing blood pressure control include lack of diagnosis, treatment, and response to existing therapy. For example, monotherapy and combination therapy are often unable to lower blood pressure to target levels. New therapies are urgently required to tackle this issue, particularly those that target the mechanisms behind hypertension instead of treating its symptoms. Acting via an increase in systemic and tissue-specific inflammation, the immune system is a critical contributor to blood pressure regulation and is considered an early mechanism leading to hypertension development. Here, we review the immune system's role in hypertension, evaluate clinical trials that target inflammation, and discuss knowledge gaps in pre-clinical and clinical data. We examine the effects of anti-inflammatory drugs colchicine and methotrexate on hypertension and evaluate the blockade of pro-inflammatory cytokines IL-1β and TNF-α on blood pressure in clinical trials. Lastly, we highlight how we can move forward to target specific components of the immune system to lower blood pressure. This includes targeting isolevuglandins, which accumulate in dendritic cells to promote T cell activation and cytokine production in salt-induced hypertension. We discuss the potential of the dietary fibre-derived metabolites short-chain fatty acids, which have anti-inflammatory and blood pressure-lowering effects via the gut microbiome. This would limit adverse events, leading to improved medication adherence and better blood pressure control.