Exploratory Analysis Research Articles

Prehospital treatment of severely burned patients: a retrospective analysis of patients admitted to the Berlin burn centre

BackgroundPrehospital management of severely burned patients is extremely challenging. It should include adequate analgesia, decision-making on the necessity of prehospital endotracheal intubation and the administration of crystalloid fluids. Guidelines recommend immediate transport to specialised burn centres when certain criteria are met. To date, there is still insufficient knowledge on the characteristics of prehospital emergency treatment. We sought to investigate the current practice and its potential effects on patient outcome.MethodsWe conducted a single centre, retrospective cohort analysis of severely burned patients (total burned surface area > 20%), admitted to the Berlin burn centre between 2014 and 2019. The relevant data was extracted from Emergency Medical Service reports and digital patient charts for exploratory data analysis. Primary outcome was 28-day-mortality.ResultsNinety patients (male/female 60/30, with a median age of 52 years [interquartile range, IQR 37–63], median total burned surface area 36% [IQR 25–51] and median body mass index 26.56 kg/m2 [IQR 22.86–30.86] were included. The median time from trauma to ED arrival was 1 h 45 min; within this time, on average 1961 ml of crystalloid fluid (0.48 ml/kg/%TBSA, IQR 0.32–0.86) was administered. Most patients received opioid-based analgesia. Times from trauma to ED arrival were longer for patients who were intubated. Neither excessive fluid treatment (> 1000 ml/h) nor transport times > 2 h was associated with higher mortality. A total of 31 patients (34,4%) died within the hospital stay. Multivariate regression analysis revealed that non-survival was linked to age > 65 years (odds ratio (OR) 3.5, 95% CI: 1.27–9.66), inhalation injury (OR 3.57, 95% CI: 1.36–9.36), burned surface area > 60% (OR 5.14, 95% CI 1.57–16.84) and prehospital intubation (5.38, 95% CI: 1.92–15.92).ConclusionWe showed that severely burned patients frequently received excessive fluid administration prehospitally and that this was not associated with more hemodynamic stability or outcome. In our cohort, patients were frequently intubated prehospitally, which was associated with increased mortality rates. Further research and emergency medical staff training should focus on adequate fluid application and cautious decision-making on the risks and benefits of prehospital intubation.Trial registrationGerman Clinical Trial Registry (ID: DRKS00033516).

National 30-Day Readmission Trends in IBD 2014-2020-Are We Aiming for Improvement?

Background: Inflammatory bowel disease (IBD) prevalence in Eastern Europe is increasing. The 30-day readmission rate is a crucial quality metric in healthcare, reflecting the effectiveness of initial treatment and the continuity of care post-discharge; however, such parameters are rarely analyzed. The aim of this study was to explore the trends in 30-day readmissions among patients with inflammatory bowel disease in Latvia between 2014 and 2020. Methods: This is a retrospective trends study in IBD-ulcerative colitis and Crohn's disease (UC and CD)-patients in Latvia between 2014 and 2020, involving all IBD patients identified in the National Health service database in the International Classification of Diseases-10 (ICD) classification (K50.X and K51.X) and having at least one prescription for IBD diagnoses. We assessed all IBD-related hospitalizations (discharge ICD codes K50X and K51X), as well as hospitalizations potentially related to IBD comorbidities. We analyzed hospitalization trends and obtained the 30 day all-cause readmission rate, disease specific readmission rate and readmission proportion for specific calendar years. Trends in readmissions and the mean length of stay (LOS) for CD and UC were calculated. Results: Despite a decrease in admission rates observed in 2020, the total number of readmissions for CD and UC has increased. Female patients prevailed through the study period and were significantly older than male patients in both the CD and UC groups, p < 0.05. We noted that there was no trend for 30 day all-cause readmission rate for CD (p > 0.05); however, there was a statistically significant trend for 30 day all-cause readmission for UC patients (p-trend = 0.018) in the period from 2014 to 2019. There was a statistically significant trend for CD-specific readmission rate (p < 0.05); however, no statistically significant trend was observed for UC-specific readmission (p > 0.05). An exploratory analysis did not reveal any statistically significant differences between treated and not-treated IBD patients (p > 0.05). The increasing trend is statistically significant over the period 2014-2018 (p < 0.05); however, the trend interrupts in 2020, which can be associated with the COVID-19 global pandemic and the related changes in admission flows where the gastroenterology capacity was reallocated to accommodate increasing numbers of COVID-19 patients. More studies are needed to evaluate the long-term impact of COVID-19 pandemic and 30-day readmissions. No significant dynamics were observed in the mean total hospitalization costs over the 2014-2020 period.

Epistemic beliefs of Norwegian history student teachers: Testing and assessing two measurement instruments

Since teachers’ and students’ epistemic beliefs about history are believed to significantly impact teachers’ practices, students’ performance and the ability to think historically of both, investigating such beliefs is important. Following the seminal works of Maggioni and colleagues (Maggioni, 2010; Maggioni et al., 2004; Maggioni et al., 2009), a number of studies have adapted versions of her Beliefs About Learning and Teaching History Questionnaire (BLTHQ) and Beliefs about History Questionnaire (BHQ) to quantitatively evaluate epistemic beliefs in different national contexts (Mierwald et al., 2016; Miguel-Revilla et al., 2017; Namamba &amp; Rao, 2016; Nitsche, 2019; Stoel, Logtenberg, et al., 2017). However, the validity and reliability of these instruments have mostly been found to be problematic (Mierwald &amp; Junius, 2022; Stoel et al., 2022). We have tested two different questionnaires – Maggioni’s BLTHQ and our own adaptation of the BHQ ¬– in separate surveys, on respectively 176 and 324 Norwegian history student teachers. For both questionnaires, our exploratory analysis showed a three-factor solution, supporting King and Kitchener’s (1994) model, and undermining the two-factor solutions found in many former studies. However, despite both questionnaires showing acceptable consistency and fitness, these levels were not optimal, and confirmed the problem of epistemic inconsistency (or ‘wobbling’) revealed by previous studies. These results encourage further qualitative studies to better understand the problem of wobbling, to design better questionnaires to be tested in the future.

Maternal heart rate variability at 3-months postpartum is associated with maternal mental health and infant neurophysiology

Previous research has demonstrated a critical link between maternal mental health and infant development. However, there is limited understanding of the role of autonomic regulation in postpartum maternal mental health and infant outcomes. In the current study, we tested 76 mother-infant dyads from diverse socioeconomic backgrounds when infants were 3-months of age. We recorded simultaneous ECG from dyads while baseline EEG was collected from the infant; ECG heart rate variability (HRV) and EEG theta-beta ratio and alpha asymmetry were calculated. Dyadic physiological synchrony was also analyzed to better understand the role of autonomic co-regulation. Results demonstrated that lower maternal HRV was associated with higher self-reported maternal depression and anxiety. Additionally, mothers with lower HRV had infants with lower HRV. Maternal HRV was also associated with higher infant theta-beta ratios, but not alpha asymmetry. Exploratory analyses suggested that for mother-infant dyads with greater physiological synchrony, higher maternal HRV predicted increased infant theta-beta ratio via infant HRV. These findings support a model in which maternal mental health may influence infant neurophysiology via alterations in autonomic stress regulation and dyadic physiological co-regulation.

Testing a persuasive health communication intervention (PHCI) for emergency department patients who declined rapid HIV/HCV screening: a randomised controlled trial study protocol

IntroductionPrevious studies have shown that substantial percentages of emergency department (ED) patients in the USA recommended for HIV or hepatitis C (HCV) decline testing. Evidence-based and cost-effective interventions to improve...

Carbon footprint tracing and pattern recognition framework based on visual analytics

With growing concerns about global warming, industrial carbon footprints have garnered increased attention due to the energy-intensive and uninterrupted operation of industrial equipment. Fine-grained modeling and visual analytics of industrial carbon footprints can reveal the mechanisms behind the formation and evolution of carbon chains. However, the mechanisms underlying industrial carbon emissions remain unclear, leading to a lack of accuracy and specificity in current carbon quantification models. To address these gaps, we developed a comprehensive quantitative model that considers specific pathways involved in industrial processes, providing more accurate estimations of carbon emissions. We also designed an innovative visual analytical framework that uncovers implicit patterns and spatiotemporal distributions of industrial carbon footprints. By comparing our approach with state-of-the-art studies, we validated the superiority of our method in terms of its intuitiveness and interactivity. Empirical studies revealed potential emission patterns and spatiotemporal dynamics that traditional studies could not identify. We identified four consistent patterns in industrial carbon emissions: normal, high-emission, low-emission, and dedicated patterns. Our findings also led to optimization suggestions for different emission patterns, highlighting the system’s capability in extracting valuable insights from workshop carbon emission data. Our research showcases a unified visual analytical approach that supports exploratory analysis, and we believe it will uncover implicit knowledge within industrial carbon data, providing valuable insights for optimization.

Evidence of aberrant anti-epstein-barr virus antibody response, though no viral reactivation, in people with post-stroke fatigue

BackgroundFatigue is a common complication of stroke that has a significant impact on quality of life. The biological mechanisms that underly post-stroke fatigue are currently unclear, however, reactivation of latent viruses and their impact on systemic immune function have been increasingly reported in other conditions where fatigue is a predominant symptom. Epstein-Barr virus (EBV) in particular has been associated with fatigue, including in long-COVID and myalgic encephalomyelitis/chronic fatigue syndrome, but has not yet been explored within the context of stroke.AimsWe performed an exploratory analysis to determine if there is evidence of a relationship between EBV reactivation and post-stroke fatigue.MethodsIn a chronic ischemic stroke cohort (> 5 months post-stroke), we assayed circulating EBV by qPCR and measured the titres of anti-EBV antibodies by ELISA in patients with high fatigue (FACIT-F < 40) and low fatigue (FACIT-F > 41). Statistical analysis between two-groups were performed by t-test when normally distributed according to the Shapiro-Wilk test, by Mann-Whitney test when the data was not normally distributed, and by Fisher’s exact test for categorical data.ResultsWe observed a similar incidence of viral reactivation between people with low versus high levels of post-stroke fatigue (5 of 22 participants (24%) versus 6 of 22 participants (27%)). Although the amount of circulating EBV was similar, we observed an altered circulating anti-EBV antibody profile in participants with high fatigue, with reduced IgM against the Viral Capsid Antigen (2.244 ± 0.926 vs. 3.334 ± 2.68; P = 0.031). Total IgM levels were not different between groups indicating this effect was specific to anti-EBV antibodies (3.23 × 105 ± 4.44 × 104 high fatigue versus 4.60 × 105 ± 9.28 × 104 low fatigue; P = 0.288).ConclusionsThese data indicate that EBV is not more prone to reactivation during chronic stroke recovery in those with post-stroke fatigue. However, the dysregulated antibody response to EBV may be suggestive of viral reactivation at an earlier stage after stroke.

Exploratory Analysis Using Deep Learning for Water-Body Segmentation of Peru's High-Mountain Remote Sensing Images.

High-mountain water bodies represent critical components of their ecosystems, serving as vital freshwater reservoirs, environmental regulators, and sentinels of climate change. To understand the environmental dynamics of these regions, comprehensive analyses of lakes across spatial and temporal scales are necessary. While remote sensing offers a powerful tool for lake monitoring, applications in high-mountain terrain present unique challenges. The Ancash and Cuzco regions of the Peruvian Andes exemplify these challenges. These regions harbor numerous high-mountain lakes, which are crucial for fresh water supply and environmental regulation. This paper presents an exploratory examination of remote sensing techniques for lake monitoring in the Ancash and Cuzco regions of the Peruvian Andes. The study compares three deep learning models for lake segmentation: the well-established DeepWaterMapV2 and WatNet models and the adapted WaterSegDiff model, which is based on a combination of diffusion and transformation mechanisms specifically conditioned for lake segmentation. In addition, the Normalized Difference Water Index (NDWI) with Otsu thresholding is used for comparison purposes. To capture lakes across these regions, a new dataset was created with Landsat-8 multispectral imagery (bands 2-7) from 2013 to 2023. Quantitative and qualitative analyses were performed using metrics such as Mean Intersection over Union (MIoU), Pixel Accuracy (PA), and F1 Score. The results achieved indicate equivalent performance of DeepWaterMapV2 and WatNet encoder-decoder architectures, achieving adequate lake segmentation despite the challenging geographical and atmospheric conditions inherent in high-mountain environments. In the qualitative analysis, the behavior of the WaterSegDiff model was considered promising for the proposed application. Considering that WatNet is less computationally complex, with 3.4 million parameters, this architecture becomes the most pertinent to implement. Additionally, a detailed temporal analysis of Lake Singrenacocha in the Vilcanota Mountains was conducted, pointing out the more significant behavior of the WatNet model.

Assembly and characterization of an optical fiber probe for use in a portable Raman spectrometer

This study describes the assembly and testing of an optical fiber Raman probe for use in a portable spectrometer using a 785 nm laser. The Raman probe was tested on edible vegetable oils (extra virgin olive, canola, sunflower, corn, and soybean), with the distal end of the probe immersed in each sample. The spectra of a dipyrone tablet and a mothball were also obtained. The silica peaks were subtracted by taking a spectrum with the probe tip immersed in water. The spectra of the samples exhibited characteristic peaks from vibrations of unsaturated fatty acids between 900 and 1800 cm−1, as well as characteristic peaks of silica from 600 to 1200 cm−1. The spectra of the samples after subtraction of the silica spectrum (probe in water) showed characteristic peaks without alterations in position or relative intensities compared without the probe. Exploratory analysis by principal component analysis was able to identify peaks of the constituent fatty acids in the oils and associate them with the oil type. A classification model based on partial least squares regression allowed for the classification of oil spectra with an accuracy of 77%. This study demonstrated the feasibility of coupling a probe to a portable Raman spectrometer with the goal of monitoring and controlling industrial processes.

Two or More Ischaemic Events Within Seven Days Before Carotid Endarterectomy Increases the Risk of Peri-operative Stroke or Death

The aim of this study was to determine how many pre-operative ischaemic events occurring within a specific timeframe before carotid endarterectomy (CEA) are needed to increase the peri-operative 30 day risk of stroke or death. This was a secondary exploratory analysis based on pooled data from three observational studies sourced from a single centre. Patients with recently symptomatic conventional ≥ 50% carotid stenosis were included. The principal analysis was limited to patients presenting with stroke or transient ischaemic attack (TIA). The primary outcome was 30 day risk of peri-operative stroke or death. Whether one, two, three, or four or more ipsilateral pre-operative ischaemic events within 3, 7, 14, or 30 days before CEA were associated with the primary outcome was assessed. The study included 382 patients who underwent CEA with symptomatic conventional ≥ 50% carotid stenosis with stroke or TIA as the presenting event. Mean patient age ± standard deviation was 72 ± 7 years, 117 (30.6%) were female, and 6% were treated with dual antiplatelet therapy. The primary outcome occurred in 21 patients (5.5%). Two or more events within 7 days before CEA was the most discriminative definition of repeated events, with a 14.3% (8/56) risk of the primary outcome. Those who fell outside this definition of two or more events within 7 days before CEA had a 4.0% (13 of 326; p = .006) risk of experiencing the primary outcome (adjusted odds ratio 4.1, 95% confidence interval 1.6 - 10.5). Several alternative definitions were assessed, but patients with two or more events within 7 days before CEA and negative for these alternatives still had a > 10% risk of the primary outcome. Two or more ipsilateral ischaemic events within 7 days before CEA are associated with an increased risk of peri-operative stroke or death in cases with symptomatic conventional ≥ 50% carotid stenosis and TIA or stroke as the presenting event. Studies assessing whether delayed or immediate CEA is preferable for this patient group are warranted.

Exploring emerald global geochemical provenance through fingerprinting and machine learning methods

Emeralds – the green colored variety of beryl – occur as gem-quality specimens in over fifty deposits globally. While digital traceability methods for emerald have limitations, sample-based approaches offer robust alternatives, particularly for determining the geographic origin of emerald. Three factors make emerald suitable for provenance studies and hence for developing models for origin determination. First, the diverse elemental chemistry of emerald at minor (<1 wt%) and trace levels (<1 to 100’s ppmw) exhibits unique inter-element fractionations between global deposits. Second, minimally destructive techniques, including laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS), enable measurement of these diagnostic elemental signatures. Third, when applied to extensive datasets, machine learning (ML) techniques enable the creation of predictive models and statistical discrimination with adequate characterization of the deposits. This study employs a carefully selected dataset comprising more than 1000 LA-ICP-MS analyses of gem-quality emeralds, enriched with new analyses. This dataset represents the largest available for global emerald deposits. We conducted unsupervised exploratory analysis using Principal Component Analysis (PCA). For machine learning-based classification, we employed Support Vector Machine Classification (SVM-C), achieving an initial accuracy rate of 79%. This was enhanced to 96.8% through the use of hierarchical SVM-C with PCA filters as our modeling approach. The ML models were trained using the concentrations of eight statistically significant elements (Li, V, Cr, Fe, Sc, Ga, Rb, Cs). By leveraging high-quality LA-ICP-MS data and ML techniques, accurate identification of the geographical origin of emerald becomes possible. These models are important for accurate provenance of emerald, and from a geochemical perspective, for understanding the formation environments of beryl-bearing pegmatites and shales.

Facilitating new financial services in Latin America: an exploratory analysis of the sandbox model

This paper presents an end-to-end analysis of Fintech-driven sandboxes, with a particular focus on Latin America. Contrary to the procedural approach characterizing sandbox research, our analysis adopted the managerial perspective, and resulted in a theoretical and applicable framework. For this purpose, we initially characterized the motives, the conditions, and expected outcomes that sustain sandbox experimentation. Subsequently, based on the analysis of web resources, we drew comparisons between cases and the literature. Third, an inverted Gioia method is utilized to guide the characterization of sandbox models within our framework. The results indicate the presence of similar patterns in sandbox experimentation, providing justification for the choices made by each model to enable Fintech entrepreneurship. These patterns include the following: Latin America’s fragmented and gradual approach to engagement; the search for market efficiencies around payments, investment, and lending; the primacy of capital flow intermediation, and the participation of both incumbent and new ventures. These findings contribute to the advancement of our knowledge about the influence of sandbox model designs on Fintech development, with practical implications for entrepreneurs and regulators. Furthermore, the framework proposed in this paper may prove beneficial in understanding institutional experimentation and advancing Fintech in other world regions beyond Latin America.

Assessment of transit bus electricity consumption using a random parameters approach

The shift towards sustainable transportation emphasizes the crucial role of electric transit buses in promoting cleaner and more efficient public transit systems. This study conducts an explanatory analysis of electric bus electricity consumption, with a focus on the impacts of detailed driver behavior and vehicle operation. A random parameters ordered probit model is applied to an electric bus dataset collected from Guangzhou, China. Findings indicate that some factors exhibit consistent impacts on electricity consumption across bus fleets, such as the acceleration rate at bus stops and the number of stops induced by traffic conditions. However, variability exists within the bus fleet regarding the effects of other factors, such as the average speed and handbrake usage. These results underscore the need for targeted strategies, such as maintenance, route optimization, driver training, and policy adjustments in bus operations, to decrease electricity consumption and improve the efficiency of public transit systems.

The impact of 30-day antecedent antibiotic exposure on Clostridioidesdifficile ribotype patterns and the relationship with clinical outcomes: A single center study

BackgroundAntibiotic exposure is a known risk factor for Clostridioides difficile infection (CDI) and recurrence and can lead to infection with specific C. difficile strains. In this study, we sought to explore the relationship between antecedent antibiotic exposure and C. difficile antimicrobial resistance, and the impact of resistance on clinical outcomes. MethodsThis was a single center retrospective study evaluating patients with CDI between 2011 and 2021. A logistic regression model was used to evaluate the relationship between antecedent antibiotics in the 30 days prior to CDI and resistance among isolates. In addition, an exploratory analysis using a cause-specific Cox proportional hazards model evaluated the association between resistance and a composite outcome of clinical failure, relapse at 30 days or CDI-related death. Resultswe analyzed one isolate from 510 patients; resistance was noted in 339 (66.5 %) of the isolates. Exposure to fluoroquinolones and macrolides was associated with 2.4 (95 % CI 1.4–4.4) and 4.7 (95 % CI 1.1–20.5) increased odds of having resistance compared to other antibiotic class exposure, respectively. There were 58 (17.0 %) patients in the resistance group who developed the composite outcome and 24 (14.2 %) patients who lacked resistance who developed the composite outcome (HR 1.32, 95 % CI 0.81–2.14). ConclusionThese findings suggest that fluoroquinolone and macrolide exposure were significantly associated with isolating a resistant strain, but we did not find significant differences in clinical outcomes based on the presence of antimicrobial resistance.

Prefrontal cortex activation under stress as a function of borderline personality disorder in female adolescents engaging in non-suicidal self-injury.

Neuroimaging studies suggest alterations in prefrontal cortex (PFC) activity in healthy adults under stress. Adolescents with non-suicidal self-injury (NSSI) report difficulties in stress and emotion regulation, which may be dependent on their level of borderline personality disorder (BPD). The aim was to examine alterations in the PFC in adolescents with NSSI during stress. Adolescents (13-17 years) engaging in non-suicidal self-injury (n = 30) and matched healthy controls (n = 29) performed a task with low cognitive demand and the Trier Social Stress Test (TSST). Mean PFC oxygenation across the PFC was measured with an eight-channel near-infrared spectroscopy system. Alongside self-reports on affect, dissociation and stress, BPD pathology was assessed via clinical interviews. Mixed linear-effect models revealed a significant effect of time on PFC oxygenation and a significant time×group interaction, indicating increased PFC activity in patients engaging in NSSI at the beginning of the TSST compared with healthy controls. Greater BPD symptoms overall were associated with an increase in PFC oxygenation during stress. In exploratory analyses, mixed models addressing changes in PFC connectivity over time as a function of BPD symptoms were significant only for the left PFC. Results indicate differences in the neural stress response in adolescents with NSSI in line with classic neuroimaging findings in adults with BPD. The link between PFC oxygenation and measures of BPD symptoms emphasises the need to further investigate adolescent risk-taking and self-harm across the spectrum of BPD, and maybe overall personality pathology, and could aid in the development of tailored therapeutic interventions.

IBS stress reactivity phenotype is associated with blood transcriptome profiles and microstructural and functional brain changes.

Clinical evidence suggests significant interindividual differences in stress reactivity (SR), but biological mechanisms and therapeutic implications of these differences are poorly understood. We aimed to identify the biological basis of increased SR by investigating associations between a psychometric-based phenotype with blood transcriptomics profiles of increased sympathetic nervous system (SNS) activation and brain imaging phenotypes in irritable bowel syndrome (IBS) participants and healthy controls (HCs). A cross-sectional observational study design, transcriptomics profiling, multimodal brain imaging, and psychosocial assessments were obtained in 291 female and male IBS participants and HCs. Prior to analyses, unsupervised clustering was applied to derive high and low SR subgroups across participants based on two measures of SR. General linear models tested for SR group differences in clinical and biological parameters. Exploratory analyses examined associations between SR group-specific brain alterations and gene expression. The high, compared to low SR group showed greater cyclic AMP response element-binding protein (CREB) gene expression consistent with tonic SNS activity and proinflammatory changes in whole blood. Brain imaging showed neuroplastic changes in the high SR group consistent with an upregulation of ascending arousal systems and sensory processing and integration regions, and functional connectivity changes in the central autonomic network. SR moderated the sex difference in extraintestinal symptoms. The findings support a model of tonically increased SNS activity as a plausible risk factor for increased autonomic reactivity to psychosocial stressors and low grade immune activation in both IBS and HCs, with a greater prevalence in IBS. These findings may have important implications for personalized treatment interventions in IBS.

Dynamic modeling studies of basin-scale pressure interference and CO2 plume evolution in multi-well geologic CO2 storage

Large-scale decarbonization through carbon capture and storage (CCS) may likely involve many commercial-scale CO2 storage projects located in proximity. Large volumes of CO2 injected will elevate reservoir pressures and may lead to rapid convergence of fracture pressure thresholds. This analysis employs numerical modeling to analyze how CO2 plumes and pressure fronts evolve when CO2 is injected into a single storage formation from multiple projects located in proximity. This analysis also evaluates the extent to which injection well spacing alleviates pressure buildup in the absence of active pressure management tactics. The simulation approach was based on a single, homogenous saline aquifer in which CO2 injection occurs under a one-injector baseline case and several multi-well cases where well spacing varies. Analysis results show that the extent of pressure buildup is in the range of tens or a few hundreds of kilometers and contingent upon the defining pressure buildup demarcating the front edge. For the geological setting evaluated in this paper, our analysis suggests that without active basin pressure management strategies, commercial-scale projects would likely need to be sited far apart to avoid pressure interference from one another. Analysis results show the radius of CO2 plume varies approximately from 2 to 3 km from injection wells (each injecting 1 Mt/year for 30 years) depending on cases and modeling parameters assumed. Given the pressure interference, this paper thus draws attention to the importance of greater coordination among storage operators and regulatory stakeholders. Because this analysis assumes a very specific geologic situation, this exploratory analysis bears further investigations across other geologic situations.

Right anterior insula ASL hypoperfusion as a diagnostic biomarker of prodromal and mild dementia with Lewy bodies: preliminary evidence using a Bayesian approach.

Identifying and validating a biomarker with high specificity in early-stage dementia with Lewy bodies (DLB) using a feasible method is crucial to enhance the current suboptimal diagnostic procedure. Previous research revealed abnormalities, including hypoperfusion in the right anterior insular cortex at group level, in prodromal DLB. Exploring hypoperfusion of the right anterior insula, at an individual-level and assessing its relevance as a potential imaging biomarker in early DLB, has, to our knowledge, not been investigated. Our preliminary study aims to assess the feasibility of the technique and to provide a methodological framework for further investigation. We assessed the feasibility and accuracy of the hypoperfusion of the right anterior insula per arterial spin labelling magnetic resonance imaging (ASL-MRI) as a diagnostic biomarker in early DLB and provided rough estimates of its sensitivity and specificity. Defining the region of interest based on previous research, we established the biomarker as the hypoperfusion of the right anterior insula. Discriminative and analytical performances were assessed in comparison to a control group of treatment-resistant depression patients. Bayesian diagnostic reasoning was employed to assess the biomarker diagnostic usability in early DLB in two scenarios: healthy elderly controls and mild cognitive impairment. Additionally, we updated probabilities by integrating data from the Mayo-clinic cognitive fluctuations scale and real-time quaking-induced conversion (RT-QuIC) α-synuclein data. Lastly, a whole-brain perfusion analysis of DLB patients was conducted to identify further brain regions with discriminative abilities. We successfully replicated the right anterior insular hypoperfusion (RAI-Hypo) in all DLB patients at the individual level. The overall sensitivity of the biomarker was 96%, and the specificity was 92%. Bayesian testing revealed the biomarker's highest performance in early-stage DLB with cognitive fluctuations, showcasing a diagnostic potential associated with a high precision and moderate accuracy. In a cognitively non-impaired population, the RAI-Hypo showed a limited usability and lacked in selectivity to qualify as a screening tool. The exploratory whole-brain analysis revealed perfect discriminative capacities in the bilateral anterior insulae and the left inferior parietal lobule. Further studies are needed to confirm our preliminary results. If performance is maintained in subsequent studies and is compared to a more suitable control population, the proposed biomarker may be eventually sufficient to discriminate early-stage DLB from non-DLB.

Mothers with low incomes view both individual and structural interventions as potentially helpful for supporting early child development

Many developmental psychologists aspire to conduct research that informs interventions and policies to prevent income-related disparities in child development. Among growing researcher discussion about the value of interventions that target “structural” and resource-related correlates of income inequality and child development (e.g., housing, food, material goods, cash), rather than individual, person-centered correlates (e.g., parenting behaviors), the perspectives of mothers with low incomes may provide important context. 281 mothers with young children and low incomes rated various structural and individual interventions, framed as having minimal costs and entry barriers, for their perceived helpfulness. Analyses were pre-registered. Overall, mothers rated all interventions very highly, though they rated structural interventions as slightly more helpful than individual interventions. Mothers rated interventions they used in the past as less helpful than those they hadn’t previously used. An exploratory qualitative analysis revealed mothers’ desires for supports in other intervention domains beyond those addressed in our survey. Together, mothers’ responses indicated that they did not see individual interventions as inherently unhelpful due to a focus on individual states, knowledge, and skills. Implications for developmental psychology and intervention science are discussed.

Dynamic path analysis for exploring treatment effect mediation processes in clinical trials with time-to-event endpoints.

Why does a beneficial treatment effect on a longitudinal biomarker not translate into overall treatment benefit on survival, when the biomarker is in fact a prognostic factor of survival? In a recent exploratory data analysis in oncology, we were faced with this seemingly paradoxical result. To address this problem, we applied a theoretically principled methodology called dynamic path analysis, which allows us to perform mediation analysis with a longitudinal mediator and survival outcome. The aim of the analysis is to decompose the total treatment effect into a direct treatment effect and an indirect treatment effect mediated through a carefully constructed mediation path. The dynamic nature of the underlying methodology enables us to describe how these effects evolve over time, which can add to the mechanistic understanding of the underlying processes. In this paper, we present a detailed description of the dynamic path analysis framework and illustrate its application to survival mediation analysis using simulated and real data. The use case analysis provides clarity on the specific exploratory question of interest while the methodology generalizes to a wide range of applications in drug development where time-to-event is the primary clinical outcome of interest.