Final Analysis Research Articles

Comparison of short term and long term multidrug resistant tuberculosis treatment outcomes in tertiary care settings

IntroductionTuberculosis is a contagious and communicable disease while drug resistant tuberculosis is difficult to treat and requires long duration. Various strategies are focused to treat the drug resistant tuberculosis focusing lesser side effects and shorter duration of treatment. ObjectiveTo compare treatment outcomes between short-term and long-term regimens among patients registered at a tertiary care hospital's Programmatic Management of Drug-Resistant TB (PMDT) site in Pakistan. MethodsA comparative prospective cohort study was conducted at IMBB, The University of Lahore, in collaboration with the Health Research Institute (HRI) TB Research Centre at King Edward Medical University/Mayo Hospital, Lahore. The study included a sample size of 136 patients, with 68 patients in each treatment regimen (long-term and short-term). Adult pulmonary MDR TB patients seeking treatment from the facility were included based on predefined criteria. Data was collected using a pre-designed questionnaire after obtaining ethical approval and informed consent. The rates of patients' cure, treatment completed, treatment failure and death were calculated. ResultsA total of 131 patients were successfully followed up and included in the final analysis. Of these, 66 patients were in the long-term treatment group and 65 patients were in the short-term treatment group. The cure rate was 74.8 %, with 98 patients successfully cured, and 13.8 % of patients completed their treatment successfully. In the long-term treatment group, the cure rate was 75.6 %, with a treatment failure rate of 6.2 %. In the short-term treatment group, the cure rate was 73.8 %, with a treatment failure rate of 6.1 %. The death rate was 4.5 % in the short-term treatment group and 6.2 % in the long-term treatment group. However, these differences in treatment outcomes were statistically insignificant (p-values > 0.05). The newer drugs, bedaquiline and delamanid, did not show significant improvements in the treatment of multidrug-resistant TB patients. Side effects at completion of treatment remained to be significantly lesser (p < 0.05) among short term treatment group as compared to long term treatment group. ConclusionThe findings suggest that short-term treatment regimens are equally effective as long-term treatment regimens, with the added benefit of presenting fewer side effects.

The effects of pre-eclampsia on social and emotional developmental vulnerability in children at age five in Western Australia: A population data linkage study

BackgroundIt is important to explore factors that may hinder early childhood development in AEDC Emotional Maturity and Social Competence domains as these underpin the foundation for health, well-being, and productivity over the life course. No previous study has examined whether, or to what extent, preeclampsia increases the risk of developmental vulnerability in social and emotional domains in early childhood. MethodsWe conducted a retrospective population-based cohort study on the association between preeclampsia and childhood developmental vulnerability in emotional maturity and social competence domains in children born in Western Australia in 2009, 2012 and 2015. We obtained records of births, developmental anomalies, midwives notifications and hospitalisations. These data were linked to the Australian Early Development Census (AEDC), from which developmental vulnerability in emotional maturity and social competence domains at a median age of 5 years was ascertained. Causal relative risks (RR) were estimated with doubly robust estimation. ResultsA total of 64,391 mother-offspring pairs were included in the final analysis. For the whole cohort, approximately 25 % and 23 % of children were classified as developmentally vulnerable or at-risk on AEDC emotional maturity and social competence domains, respectively. Approximately 2.8 % of children were exposed in utero to preeclampsia. Children exposed to preeclampsia were more likely to be classified as developmentally vulnerable or at-risk on the emotional maturity (RR = 1.19, 95%CI:1.11–1.28) and social competence domains (RR = 1.22, 95 % CI:1.13–1.31). ConclusionChildren exposed to pre-eclampsia in utero were more likely to be developmentally vulnerable in emotional maturity and social competence domains in this cohort. Our findings provide new insights into the harmful effect of preeclampsia on childhood developmental vulnerability.

Cabozantinib plus atezolizumab versus sorafenib for advanced hepatocellular carcinoma (COSMIC-312): final results of a randomised phase 3 study

The aim of the COSMIC-312 trial was to evaluate cabozantinib plus atezolizumab versus sorafenib in patients with previously untreated advanced hepatocellular carcinoma. In the initial analysis, cabozantinib plus atezolizumab significantly prolonged progression-free survival versus sorafenib. Here, we report the pre-planned final overall survival analysis and updated safety and efficacy results following longer follow-up. COSMIC-312 was an open-label, randomised, phase 3 study done across 178 centres in 32 countries. Patients aged 18 years or older with previously untreated advanced hepatocellular carcinoma were eligible. Patients must have had measurable disease per Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1), and adequate marrow and organ function, including Child-Pugh class A liver function; those with fibrolamellar carcinoma, sarcomatoid hepatocellular carcinoma, or combined hepatocellular cholangiocarcinoma were ineligible. Patients were randomly assigned (2:1:1) using a web-based interactive response system to a combination of oral cabozantinib 40 mg once daily plus intravenous atezolizumab 1200 mg every 3 weeks, oral sorafenib 400 mg twice daily, or oral single-agent cabozantinib 60 mg once daily. Randomisation was stratified by disease aetiology, geographical region, and presence of extrahepatic disease or macrovascular invasion. Dual primary endpoints were for cabozantinib plus atezolizumab versus sorafenib: progression-free survival per RECIST 1.1, as assessed by a blinded independent radiology committee, in the first 372 randomly assigned patients (previously reported) and overall survival in all patients randomly assigned to cabozantinib plus atezolizumab or sorafenib. The secondary endpoint was progression-free survival in all patients randomly assigned to cabozantinib versus sorafenib. Outcomes in all randomly assigned patients, including final overall survival, are presented. Safety was assessed in all randomly assigned patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT03755791. Between Dec 7, 2018, and Aug 27, 2020, 432 patients were randomly assigned to combination treatment, 217 to sorafenib, and 188 to single-agent cabozantinib, and included in all efficacy analyses. 704 (84%) patients were male and 133 (16%) were female. 824 of these patients received at least one dose of study treatment and were included in the safety population. Median follow-up was 22·1 months (IQR 19·3-24·8). Median overall survival was 16·5 months (96% CI 14·5-18·7) for the combination treatment group and 15·5 months (12·2-20·0) for the sorafenib group (hazard ratio [HR] 0·98 [0·78-1·24]; stratified log-rank p=0·87). Median progression-free survival was 6·9 months (99% CI 5·7-8·2) for the combination treatment group, 4·3 months (2·9-6·1) for the sorafenib group, and 5·8 months (99% CI 5·4-8·2) for the single-agent cabozantinib group (HR 0·74 [0·56-0·97] for combination treatment vs sorafenib; HR 0·78 [99% CI 0·56-1·09], p=0·05, for single-agent cabozantinib vs sorafenib). Grade 3 or 4 adverse events occurred in 281 (66%) of 429 patients in the combination treatment group, 100 (48%) of 207 patients in the sorafenib group, and 108 (57%) of 188 patients in the single-agent cabozantinib group; the most common were hypertension (37 [9%] vs 17 [8%] vs 23 [12%]), palmar-plantar erythrodysaesthesia (36 [8%] vs 18 [9%] vs 16 [9%]), aspartate aminotransferase increased (42 [10%] vs eight [4%] vs 17 [9%]), and alanine aminotransferase increased (40 [9%] vs six [3%] vs 13 [7%]). Serious adverse events occurred in 223 (52%) patients in the combination treatment group, 84 (41%) patients in the sorafenib group, and 87 (46%) patients in the single agent cabozantinib group. Treatment-related deaths occurred in six (1%) patients in the combination treatment group (encephalopathy, hepatic failure, drug-induced liver injury, oesophageal varices haemorrhage, multiple organ dysfunction syndrome, and tumour lysis syndrome), one (<1%) in the sorafenib group (general physical health deterioration), and four (2%) in the single-agent cabozantinib group (asthenia, gastrointestinal haemorrhage, sepsis, and gastric perforation). First-line cabozantinib plus atezolizumab did not improve overall survival versus sorafenib in patients with advanced hepatocellular carcinoma. The progression-free survival benefit of the combination versus sorafenib was maintained, with no new safety signals. Exelixis and Ipsen.

Barriers and Facilitators to Collecting Surgical Outcome Data in Low- and Middle-Income Countries: An International Survey

Background: Perioperative data are essential to improve the safety of surgical care. However, surgical outcome research (SOR) from low- and middle-income countries (LMICs) is disproportionately sparse. We aimed to assess practices, barriers, facilitators, and perceptions influencing the collection and use of surgical outcome data (SOD) in LMICs. Methods: An internet-based survey was developed and disseminated to stakeholders involved in the care of surgical patients in LMICs. The Performance of Routine Information Systems Management framework was used to explore the frequency and relative importance of organizational, technical, and behavioral barriers. Associations were determined using χ 2 and ANOVA analyses. Results: Final analysis included 229 surgeons, anesthesia providers, nurses, and administrators from 36 separate LMICs. A total of 58.1% of individuals reported that their institution had experience with collection of SOD and 73% of these reported a positive impact on patient care. Mentorship and research training was available in &lt;50% of respondent’s institutions; however, those who had these were more likely to publish SOD (P = 0.02). Sixteen barriers met the threshold for significance of which the top 3 were the burden of clinical responsibility, research costs, and accuracy of medical documentation. The most frequently proposed solutions were the availability of an electronic data collection platform (95.3%), dedicated research personnel (93.2%), and access to research training (93.2%). Conclusions: There are several barriers and facilitators to collection of SOD that are common across LMICs. Most of these can be addressed through targeted interventions and are highlighted in this study. We provide a path towards advancing SOR in LMICs.

Investigation of the effect of flexural strength test damage on compressive strength of construction materials

Concrete, the principal material of the construction sector, has been the subject of many scientific researches for decades. As a result of these investigations, new scientific information has been obtained on the weak points of cement-based products, especially concrete, their behaviour under load, etc. In light of this information, it is recommended that some test methods specified in international standards be revised. In this study, the effect of damage caused by flexural strength test performed on samples prepared with mortar prisms, of dimensions 160 mm x 40 mm x 40 mm within the scope of EN 13813, EN 13888, EN 13279-1, EN 197-1, TS 13566 and TS 13687 standards, on the results of compressive strength test performed on the broken samples was investigated. In the final analysis, some improvement suggestions have been made in the test methods in question.

Soluble Urokinase Plasminogen Activator Receptor (SuPAR) Analysis for Diagnosis of Periprosthetic Joint Infection.

Soluble urokinase plasminogen activator receptors (suPARs) are a biomarker for inflammatory diseases. This study aims to investigate its diagnostic properties regarding periprosthetic joint infections (PJI). This retrospective cohort study included adult patients who underwent joint puncture for suspected PJI. The presence of PJI was determined according to the criteria of the European Bone and Joint Infection Society (EBJIS). Laboratory study analyses included the determination of white blood cells (WBC) in whole blood, C-reactive protein (CRP) in blood plasma, and suPAR in both blood plasma and synovial fluid. Appropriate diagnostic cut-off values were identified utilizing Youden's J, and their diagnostic performance was determined by calculating the positive (PPV) and negative predictive value (NPV) for each marker. Sixty-seven cases were included in the final analysis. Forty-three samples (64%) were identified as periprosthetic joint infection (PJI) and twenty-four specimen (36%) were PJI negative cases. The PPV and NPV were 0.80 and 0.70 for synovial suPAR, 0.86 and 0.55 for CRP, 0.84 and 0.31 for WBC and 1.00 and 0.31 for plasma suPAR. Synovial suPAR showed a solid diagnostic performance in this study and has the potential to be an alternative or complementary biomarker for PJI. Further investigations in larger patient collectives are indicated.

Metabolic insights at the finish line: deciphering physiological changes in ultramarathon runners through breath VOC analysis

Exhaustive exercise can induce unique physiological responses in the lungs and other parts of the human body. The volatile organic compounds (VOCs) in exhaled breath are ideal for studying the effects of exhaustive exercise on the lungs due to the proximity of the breath matrix to the respiratory tract. As breath VOCs can originate from the bloodstream, changes in abundance should also indicate broader physiological effects of exhaustive exercise on the body. Currently, there is limited published data on the effects of exhaustive exercise on breath VOCs. Breath has great potential for biomarker analysis as it can be collected non-invasively, and capture real-time metabolic changes to better understand the effects of exhaustive exercise. In this study, we collected breath samples from a small group of elite runners participating in the 2019 Ultra-Trail du Mont Blanc ultra-marathon. The final analysis included matched paired samples collected before and after the race from 24 subjects. All 48 samples were analyzed using the Breath Biopsy Platform with GC-Orbitrap™ via thermal desorption gas chromatography-mass spectrometry. The Wilcoxon signed-rank test was used to determine whether VOC abundances differed between pre- and post-race breath samples (adjusted P-value < .05). We identified a total of 793 VOCs in the breath samples of elite runners. Of these, 63 showed significant differences between pre- and post-race samples after correction for multiple testing (12 decreased, 51 increased). The specific VOCs identified suggest the involvement of fatty acid oxidation, inflammation, and possible altered gut microbiome activity in response to exhaustive exercise. This study demonstrates significant changes in VOC abundance resulting from exhaustive exercise. Further investigation of VOC changes along with other physiological measurements can help improve our understanding of the effect of exhaustive exercise on the body and subsequent differences in VOCs in exhaled breath.

Survival Outcomes of Temporal Bone Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis

AbstractObjectiveTemporal bone squamous cell carcinoma (TBSCC) is a rare malignancy with poor prognosis, and optimal treatment for advanced cases is uncertain. Our systematic literature review aimed to assess 5‐year survival outcomes for advanced TBSCC across different treatment modalities.Data SourcesEMBASE, Medline, PubMed, and Web of Science.Review MethodsA systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for articles published between January 1989 and June 2023.ResultsThe review yielded 1229 citations of which 31 provided 5‐year survival data for TBSCC. The final analysis included 1289 patients. T classification data was available for 1269 patients and overall stage for 1033 patients. Data for 5‐year overall survival (OS) was 59.6%. Five‐year OS was 81.9% for T1/2 and 47.5% for T3/4 (P &lt; .0001). OS for T1/T2 cancers did not significantly differ between surgery and radiation (100% vs 81.3%, P = .103). For advanced‐stage disease (T3/T4), there was no statistical difference in OS when comparing surgery with postoperative chemoradiotherapy (CRT) (OS 50.0%) versus surgery with postoperative radiotherapy (XRT) (OS 53.3%) versus definitive CRT (OS 58.1%, P = .767‐1.000). There was not enough data to assess the role of neoadjuvant CRT.ConclusionMost patients will present with advanced‐stage disease, and nodal metastasis is seen in nearly 22% of patients. This study confirms the prognostic correlation of the current T classification system. Our results suggest that OS did not differ significantly between surgery and XRT for early stage disease, and combined treatment modalities yield similar 5‐year OS for advanced cancers.

ASSOCIATION OF SMOKING AND BLADDER CANCER: AN UPDATED SYSTEMATIC REVIEW

Introduction: Bladder cancer is the 10th most common global cancer, with increasing incidence, primarily linked to smoking, occupational exposures, and genetic factors. This systematic review explores the association between tobacco use and bladder cancer, emphasizing the importance of understanding its multifactorial etiology for effective prevention. Method: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 18 results. After looking at the titles and summaries, we found several papers that fit our criteria. At first, we excluded few articles because they were written in review and case report style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included two-sample univariable and multivariable Mendelian Randomization (MR) analysis, case control study, prospective cohort study of patients with NMIBC diagnosed from 2015 to 2019, experimental study, and rtrospective study. Conclusion: The systematic review involved Mendelian Randomization analysis, underscores smoking as a significant risk factor for bladder cancer, with no evidence linking alcohol consumption to the disease. In a prospective cohort study on Non-Muscle Invasive Bladder Cancer, the study establishes a dose-dependent relationship, emphasizing the urgency for effective smoking cessation interventions in patients, especially those with prolonged smoking history. Additionally, the investigation into molecular pathways reveals the upregulation of the platelet-activating factor (PAF) pathway by cigarette smoke exposure, suggesting PAF-PAF receptor (PAF-R) interaction as a promising therapeutic target for managing bladder cancer growth.

Surgical Outcome After Treatment of Radiation-Induced Scleral Necrosis in Patients With Uveal Melanoma

Purpose: Surgical repair might be required in patients with uveal melanoma (UM) that develop advanced forms of radiation-induced scleral necrosis (RISN). In this monocentric long-term observational study, we aimed at analyzing the treatment outcome after RISN surgery. Methods: All consecutive cases with UM who underwent surgical intervention for RISN between 1999 and 2020 were included. Achievement of the tectonic stability and evaluation of incidence and the risk factors for a repetitive patch surgery (RPS) were the main endpoints. Results: The final analysis included 57 patients (mean age: 58.7 years; 63.2% female patients), where 55 individuals underwent a patch grafting, and 2 cases were treated with conjunctival reconstructive surgery. The mean follow-up time after grafting was 38.5 months (0.03–221.1 months). Tectonic stability was achieved in 56 (98.3%) patients. Scleral graft (38/55, 69.1%) was the most frequent patching material, followed by Tutopatch (7/55, 12.7%), corneal graft (7/55, 12.7%), dura graft (2/55, 3.6%), and fascia lata (FL) graft (1/55, 1.8%). Eleven patients (20%) underwent RPS after the mean time of 12.9 months (0.3–50.3 months). In the final multivariate Cox regression analysis, the use of Tutopatch (5/7; 71.4%, adjusted hazard ratio = 4.66, P = 0.044) and RISN progression after patch grafting (9/11; 81.8%, adjusted hazard ratio = 9.67, P = 0.008) were independent risk factors for RPS. Conclusions: RISN surgery maintains long-term tectonic stability in most of the cases underwent surgical repair for RISN after brachytherapy for UM. Depending on graft material and, particularly, further RISN progression, an RPS might be necessary in certain cases.

Benzene Exposure and Lung Cancer Risk: A Systematic Review and Meta-Analysis of Human Studies.

Lung cancer is a leading cause of death with nearly 1.8 million deaths estimated worldwide in 2020. Although benzene is classified as a human carcinogen (Group 1) on the basis of its association with acute myeloid/non-lymphocytic leukaemia, there is still limited evidence that it may influence lung cancer risk. This study examined the potential link between benzene exposure and risk of lung cancer using a systematic review of epidemiological studies and meta-analysis. We searched through PubMed, Web of Science and Scopus databases up to 10 February 2023 to identify all articles on the association between benzene exposure and lung cancer (incidence or prevalence) and/or mortality. We extracted the risk estimates of the highest and the lowest reported categories of benzene exposure and conducted a meta-analysis using a random-effects model. Heterogeneity and publication bias were analysed using an I2 test and funnel plots asymmetry, respectively. Twenty-one studies were included in the final analysis, with a total of 10,750 lung cancer cases and 2899 lung cancer deaths. Overall, risk estimates of lung cancer prevalence and mortality in association with benzene exposure were 1.20 (n = 14; 95% CI 1.05-1.37) and 1.15 (n = 13; 95% CI 1.02-1.30), respectively. In all cases, heterogeneity was quite large, while no significant publication bias was observed. When only studies that adjusted for smoking habit were selected, the risk for lung cancer increased by up to 34% (n = 9; 95% CI 1.10-1.64). Our data, which show a strong association between benzene exposure and lung cancer risk, may have important public health implications. However, further studies are needed to identify the lung cancer risk associated with benzene exposure considering different smoking conditions.

Impact of prescribed opioid use on development of dementia among patients with chronic non-cancer pain

We aimed to examine the association between opioid use and the development of dementia in patients with chronic non-cancer pain in South Korea. Data were extracted from the National Health Insurance Service database in South Korea. Adult patients diagnosed with musculoskeletal diseases with chronic non-cancer pain between 2010 and 2015 were included in the analysis. Patients who were prescribed opioids regularly and continuously for ≥ 90 days were classified as opioid users. In total, 1,261,682 patients with chronic non-cancer pain were included in the final analysis, of whom 21,800 (1.7%) were opioid users. From January 1, 2016 to December 31, 2020, 35,239 (2.8%) patients with chronic non-cancer pain were newly diagnosed with dementia. In the multivariable model, opioid users showed a 15% higher risk of developing dementia than the control group. Additionally, opioid users showed a 15% and 16% higher risk of developing Alzheimer’s disease and unspecified dementia, respectively, than the control group, but did not show any significant differences for vascular dementia. Among adult patients with chronic non-cancer pain, opioid users were at a higher risk of developing dementia than the control group; the risk was significantly higher for Alzheimer’s disease but not for vascular dementia in this study. Our results suggest that in patients with CNCP, public health strategies should target opioid users for early dementia detection and intervention.

Magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a tertiary hospital in Eastern Ethiopia: a cross- sectional study

IntroductionSeveral studies conducted worldwide revealed the magnitude of early relaparotomy and its outcome among patients undergoing laparotomy. However, there was very little evidence on the magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in Ethiopia, especially in the study area.Objectivethis study aimed to the assess magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a Tertiary Hospital in Eastern Ethiopia.MethodsA retrospective cross-sectional study was conducted. All patients who underwent laparotomy during the data retrieval period were included. Data were collected using a data abstraction checklist from patients’ medical records. The collected data were entered, cleaned, and analyzed by using SPSS version 23. Descriptives statistics were generated where by continuous variables were summarized into means and standard deviation and categorical variables were summarized as the frequency with proportions.ResultThe magnitude of relaparotomy was 6.8%. Among 82 patients included in the final analysis, 53 (64.6%) were males and the mean (± SD) age of patients was 33.32 ± 16.63 years. The major indications for relaparotomy were intra-abdominal collection (26.8%) and anastomotic leak (24.4%). Among 82 patients who underwent relaparotomy, 52(63.4%) were developed post relaparotomy complications, and 30(36.6%) patients died.ConclusionThe magnitude of early relaparotomy was 6.8%. The magnitude of in-hospital mortality was high in comparison to earlier study findings from developing countries. About three fourth of patients who underwent relaparotomy were developed postoperative complications.

Long-Term Follow-Up of the Anthracyclines in Early Breast Cancer Trials (USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 [NRG Oncology]).

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The primary joint efficacy analysis of the Anthracyclines in Early Breast Cancer (ABC) trials reported in 2017 failed to demonstrate nonanthracycline adjuvant therapy was noninferior to anthracycline-based regimens in high-risk, early breast cancer. Full analyses of the studies had proceeded when the prespecified futility boundary was crossed at a planned futility analysis for the ability to demonstrate noninferiority of a nonanthracycline regimen with continued follow-up. These results were presented with 3.3 years of median follow-up. This manuscript reports results of the final analyses of the study efficacy end points conducted with 6.9 years of median follow-up. Long-term analysis of invasive disease-free survival (IDFS), the primary end point of the ABC trials, remains consistent with the original results, as noninferiority of the nonanthracycline regimens could not be declared on the basis of the original criteria. The secondary end point of recurrence-free interval, which excluded deaths not due to breast cancer as events, favored anthracycline-based regimens, and tests for heterogeneity were significant for hormone receptor status (P = .02) favoring anthracycline regimens for the hormone receptor-negative cohorts. There was no difference in overall survival, and review of the type of IDFS events in the groups suggested reductions in cancer recurrences achieved with anthracycline regimens were offset by late leukemias and deaths unrelated to breast cancer.

Using Remote Sensing Multispectral Imagery for Invasive Species Quantification: The Effect of Image Resolution on Area and Biomass Estimation

This study assesses the applicability of different-resolution multispectral remote sensing images for mapping and estimating the aboveground biomass (AGB) of Carpobrotus edulis, a prominent invasive species in European coastal areas. This study was carried out on the Cávado estuary sand spit (Portugal). The performance of three sets of multispectral images with different Ground Sample Distances (GSDs) were compared: 2.5 cm, 5 cm, and 10 cm. The images were classified using the supervised classification algorithm random forest and later improved by applying a sieve filter. Samples of C. edulis were also collected, dried, and weighed to estimate the AGB using the relationship between the dry weight (DW) and vegetation indices (VIs). The resulting regression models were evaluated based on their coefficient of determination (R2), Normalised Root Mean Square Error (NRMSE), p-value, Akaike information criterion (AIC), and the Bayesian information criterion (BIC). The results show that the three tested image resolutions allow for constructing reliable coverage maps of C. edulis, with overall accuracy values of 89%, 85%, and 88% for the classification of the 2.5 cm, 5 cm, and 10 cm GSD images, respectively. The best-performing VI-DW regression models achieved R2 = 0.87 and NRMSE = 0.09 for the 2.5 cm resolution; R2 = 0.77 and NRMSE = 0.12 for the 5 cm resolution; and R2 = 0.64 and NRMSE = 0.15 for the 10 cm resolution. The C. edulis area and total AGB were 3441.10 m2 and 28,327.1 kg (with an AGB relative error (RE) = 0.08) for the 2.5 cm resolution; 3070.04 m2 and 29,170.8 kg (AGB RE = 0.08) for the 5 cm resolution; and 2305.06 m2 and 22,135.7 kg (AGB RE = 0.11) for the 10 cm resolution. Spatial and model differences were analysed in detail to determine their causes. Final analyses suggest that multispectral imagery of up to 5 cm GSD is adequate for estimating C. edulis distribution and biomass.

Sex-Specific Association of Body Mass Index with Hippocampal Subfield Volume and Cognitive Function in Non-Demented Chinese Older Adults.

Recent research suggests a possible association between midlife obesity and an increased risk of dementia in later life. However, the underlying mechanisms remain unclear. Little is known about the relationship between body mass index (BMI) and hippocampal subfield atrophy. In this study, we aimed to explore the associations between BMI and hippocampal subfield volumes and cognitive function in non-demented Chinese older adults. Hippocampal volumes were assessed using structural magnetic resonance imaging. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). A total of 66 participants were included in the final analysis, with 35 females and 31 males. We observed a significant correlation between BMI and the hippocampal fissure volume in older females. In addition, there was a negative association between BMI and the RBANS total scale score, the coding score, and the story recall score, whereas no significant correlations were observed in older males. In conclusion, our findings revealed sex-specific associations between BMI and hippocampal subfield volumes and cognitive performance, providing valuable insights into the development of effective interventions for the early prevention of cognitive decline.

Optimizing Recharge Area Delineation for Small- to Medium-Sized Groundwater Systems through Coupling Methods and Numerical Modeling: A Case Study of Linfen City, China

In previous investigations, the demarcation of capture zones within a specific research area predominantly relied on a singular method, leading to pronounced limitations and uncertainties. To address this challenge, an extensive field survey was conducted, focusing on the systematic classification of water sources in the Linfen City region. Building upon this classification, an intricate fusion of a hydrogeological analysis and formulaic methodology was employed. This integrated approach, coupled with independent numerical simulation methods, was applied to delineate recharge areas for both alluvial fan pore water in piedmont regions and exposed karst water in small- to medium-sized water sources. Simultaneously, precise spatial interpolation was carried out on water quality monitoring data from supply wells within the water source area for the year 2020. This meticulous analysis facilitated the determination of the spatial distribution characteristics of hydrochemical elements. To assess the water quality within the capture zone, the class III groundwater quality standards of China were employed as a pivotal tool for validating the results of the delineation of water source recharge areas. In the final analysis, a comparative study between the integrated coupling method and numerical simulation outcomes revealed the successful delineation of the boundaries for the water supply areas of Tumen and Caojiapo in Linfen City, covering areas of 5.5 km2 and 22.29 km2, respectively. Simultaneously, the combination of the three methods accurately outlined the boundary of the Hexi water supply area, encompassing an area of 2.5224 km2. These results vividly illustrate that the amalgamation of various methodologies proves more beneficial for the precise delineation of capture zones, particularly in diverse types and scales of groundwater sources. The synergy exhibited by these three methods underscores their collective efficacy, providing a more comprehensive and intuitive delineation of the recharge areas for small- to medium-sized water sources. Consequently, these findings significantly enhance the practical application value of the study and hold promise in making substantial contributions to local groundwater security and management initiatives.

Pharmacist‐led intervention to reduce inappropriate continuation of targeted medications initiated in the acute care setting at hospital and ICU discharge

AbstractPharmacist‐led interventions may reduce the inappropriate continuation of acid‐suppressive agents and antipsychotics temporarily initiated in the intensive care unit (ICU), but limited data exist for other medications. This study evaluated the impact of a pharmacist‐led intervention on the number of medications inappropriately continued upon ICU and hospital discharge. This was a single‐center, pre‐post intervention analysis conducted in the medical and surgical ICUs at a tertiary academic medical center. The pre‐ and post‐intervention groups included adults who were newly initiated on medications used for stress ulcer prophylaxis, delirium, agitation, wakefulness, sedation, and insomnia from December 1, 2021 to January 31, 2022 and December 12, 2022 to February 13, 2023, respectively. In the post‐intervention group, pharmacists identified patients who were newly initiated on a medication of interest and documented in patients' charts via an electronic handoff tool utilizing a standardized template. The appropriateness of those medications was assessed daily, and pharmacists intervened when necessary. The number of medications inappropriately continued at ICU and hospital discharge and ICU and hospital lengths of stay were compared. Overall, 399 encounters were included in the final analysis, and a total of 459 medications were newly initiated in the ICU. There was no significant difference in the number of medications inappropriately continued at hospital discharge [22 (8.4%) vs. 10 (5.1%); p = 0.17]. Significantly fewer medications were inappropriately continued at ICU discharge in the post‐intervention group [85 (32.3%) vs. 37 (18.9%); p &lt; 0.01]. The median ICU length of stay was significantly greater in the post‐intervention group [4 (2–8) vs. 2 (1–6) days; p &lt; 0.01]. No significant difference was found in the median hospital length of stay [14 (7–26.5) vs. 16 (9–33.75) days; p = 0.08]. Use of an electronic handoff tool was associated with a significant reduction in the number of medications inappropriately continued at ICU discharge.

A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program

BackgroundOpioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing.MethodsParticipants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing.ResultsOf the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment.ConclusionMore than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.

Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials.

Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74-19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45-60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes. Level of evidence: I.