High Bar Research Articles

Bond of FRP bars in fine‐grained alkali‐activated concrete

AbstractAlkali‐activated cement (AAC) is an alternative binder with a promising potential to replace ordinary Portland cement (OPC) and mitigate its environmental issues. The use of fiber‐reinforced polymer (FRP) reinforcements with AAC concrete enables the development of corrosion‐resistant, environmentally friendly reinforced concrete structures. Bond behavior is critical in reinforced concrete structures and must be thoroughly studied for such new alternative materials. This study employs pullout tests to investigate the bond behavior between FRP bars and fine‐grained AAC concrete. Three fine‐grained AAC concretes with low to high strength, glass and carbon FRP bars and wrapped, milled, and smooth surface treatments were examined. The effect of bar casting position was also investigated. The compressive strength showed a significant influence on the bond strength. An average bond strength of approximately 18 MPa was observed for both glass and carbon FRP bars when used with 65 MPa concrete. Both the glass and carbon FRP bars with wrapping showed a lower bond strength than their milled FRP bars counterparts. The carbon bars without surface preparation (smooth bars) resulted in a much lower bond strength, around 4 MPa. In terms of casting positions, the bars cast in the middle section of the concrete block showed a higher bond strength than those at the bottom and top.

Stochastic modeling of influenza transmission: Insights into disease dynamics and epidemic management

The stochastic SEIR model was employed to investigate the dynamics of influenza transmission. By incorporating transmission rates and prevalence ratios, this model provides the most comprehensive explanation of the virus’s unpredictable dissemination. To simulate the stochastic components of influenza transmission, we implemented conventional Brownian motions and stochastic differential equations. The investigation examines the uniqueness and presence of the solutions to demonstrate the conditions needed for eliminating the infection under random disturbances. The transmission rate coefficient (β) strongly impacts disease transmission speed. as demonstrated by the simulation results.Thus, the proper usage of safe transmission control methods is another decisive factor that determines the outcome of epidemics. Actual data of the Kingdom of Saudi Arabia was used. The results highlighted practicality of stochastic models and their usefulness to address and formulate and even execute the public health related policies. Regarding this, this study sets a high bar for other studies on modeling viral diseases on the grounds that stochastic and dynamic factors are also very important. These subsequent improvements in the model shall enable us to pinpoint the best strategies for the prevention and eradication of influenza and any other subsequent epidemic diseases, with reference to epidemic, epidemiology and public health.

E-Book of One's Own

As we enter a new age of technological innovation and subsequent educational instrumentation change, there is increasing demand for innovative methods that encourage student learning experiences in virtual, online spaces. ePortfolios and e-book projects are designed and owned by students and are centered within the student’s learning. They provide a structured, online space for students to learn new technological skills while intentionally integrating it with their learning experience. We have utilized the content creation platform Pressbooks for our student learners to develop and create their “e-Book of One’s Own” (eBoOO). A simplified derivation of the “Domain of One’s Own” (DoOO) philosophy, our intention with eBoOO was to address the high bar for digital literacy required to get started while staying true to the embodied ideology of Virginia Woolf’s A Room of One’s Own.

On Crafting Effective Theoretical Contributions for Empirical Papers in Economics of Information Systems: Some Editorial Reflections

The terms theory and theoretical contributions evoke mixed reactions in the information systems discipline, especially among empirical researchers in the economics of information systems (Econ-IS) area. Although some see such contributions as the raison d’etre for academic scholars engaged in research, others feel that the discipline has developed a fetish for theory, with reviewers and editors often demanding an unreasonable level of theoretical contributions for empirical manuscripts to succeed in the review process. Moreover, there exists a great deal of diversity in the conception of what constitutes a reasonable theoretical contribution, especially within empirical work, across editors and reviewers, leading to frustration with the review process and disappointment with editorial decisions. Given the different types of theoretical contributions that may be suitable for a given manuscript and recognizing the changing nature of empirical work within Econ-IS, we attempt to shed some light on theoretical contributions within empirical Econ-IS research, paying attention to their nature, types, and impact. Specifically, we start by reflecting on the typical theory-related comments we have seen in review packets that we generalize to a set of critiques often related to empirical papers. Subsequently, we provide a working definition of a theoretical contribution and the components that make up such a contribution. We then propose a taxonomy of theoretical contributions typically observed in Information Systems Research (ISR). Based on this taxonomy of contributions, the typical critiques observed in empirical Econ-IS papers, and a set of published papers, we provide some broad guidelines for how authors may craft an effective theoretical contribution for submission to ISR. We also discuss a pathway for manuscripts that do not (seek to) offer significant theoretical contributions. Such manuscripts are welcome, but we believe that a very high bar of practical impact must be met for them to succeed in the review process. Based on the guidelines and suggestions made here, our hope is that authors and evaluators will participate in the review process with a shared understanding of the elusive notion of theoretical contributions.

Hospitality workers and gentrification processes: Elective belonging and reflexive complicity.

This paper contributes new understandings of the dynamics and processes of gentrification that contribute to wider transformations of class relations. We argue that the hospitality sector, specifically the tastes, dispositions and practices of young hospitality workers, are central in how gentrification processes currently function. We extend concepts of elective and selective belonging, and reflexive complicity, to analyse how young hospitality workers understand their own labouring practices as contributing to gentrification in their local areas. We show how their aesthetic and ethical orientations to place, especially their workplaces, make their experience of hospitality work more palatable. At the same time, their tastes are 'put to work' in venues that contribute to the vibes and aesthetics aimed at middle class consumption practices, while creating symbolic boundaries for long-term residents who are being ostracised in the process. In this way, the high cultural capital bar workers possess thus become spatial bouncers for high economic capital property developers, where reflexive complicity is instrumentalised as a process of symbolic violence. We propose that hospitality labour, and the everyday relationalities and working practices of young workers, are crucial for understanding the contemporary processes of gentrification and class formation.

A Biomechanical Comparison Between a High and Low Barbell Placement on Net Joint Moments, Kinematics, Muscle Forces, and Muscle-Specific Moments in 3 Repetition Maximum Back Squats.

Larsen, S, de Zee, M, Kristiansen, EL, and van den Tillaar, R. A biomechanical comparison between a high and low barbell placement on net joint moments, kinematics, muscle forces, and muscle-specific moments in 3 repetition maximum back squats. J Strength Cond Res 38(7): 1221-1230, 2024-This study aimed to investigate the impact of a high barbell vs. low barbell placement on net joint moments, muscle forces, and muscle-specific moments in the lower extremity joints and muscles during maximum back squats. Twelve recreationally trained men (age = 25.3 ± 2.9 years, height = 1.79 ± 7.7 m, and body mass = 82.8 ± 6.9 kg) volunteered for the study. A marker-based motion capture system and force plate data were used to calculate the net joint moments, and individual muscle forces were estimated using static optimization. Muscle forces were multiplied by their corresponding internal moment arms to determine muscle-specific moments. Statistical parametric mapping was used to analyze the effect of barbell placement as time-series data during the concentric phase. The 3 repetition maximum barbell load lifted by the subjects was 129.1 ± 13.4 kg and 130.2 ± 12.7 kg in the high bar and low bar, which were not significantly different from each other. Moreover, no significant differences were observed in net joint moments, muscle forces, or muscle-specific moments for the hip, knee, or ankle joint between the low- and high bar placements. The findings of this study suggest that barbell placement plays a minor role in lower extremity muscle forces and moment-specific moments when stance width is standardized, and barbell load lifted does not differ between barbell placements among recreationally resistance-trained men during maximal back squats. Therefore, the choice of barbell placement should be based on individual preference and comfort.

Зміни у фізичній підготовленості учнів ліцею спортивного профілю

The article examines the indicators of motor abilities of 10th-grade pupils of the sport’s professional college lyceum. The number of respondents was 210 people, the average age of the representatives was 15.46 years. The aim of the study is to determine the level of physical fitness of 10th-grade lyceum pupils and to investigate its dynamics over three years. Research methods and organization. The research was conducted during 2020-2022 on the basis of the Kharkiv Professional College of Sports Lyceum. In order to analyze the level of development of basic motor skills, standard tests of the school physical education program were chosen to determine indicators of speed abilities, agility, strength, power speed abilities and endurance. One-dimensional statistical analysis according to the Student’s t-test was chosen to prove the regularities discovered in the process of research and hypothesis testing. Results. The results of the study showed that the average statistical indicators of physical fitness of 10th-grade students of the Kharkiv Professional College of Sports Lyceum of the 2020-2022 sets are better than the data available in the scientific and methodological periodicals of peers who study in common schools. The average results of the sports lyceum pupils in 60 meters running range from 8.5 to 8.4 s; the results of the 4x9 m shuttle run exercise are within 9.1-9.2 s; pull-up on a high bar 8.2-8.8 times, long jump are in the range from 219 to 222 cm; running 1500 m within 5.29-5.36 min. The results of the exercises correspond to a high level of competence for representatives of this age. Statistical analysis of the obtained data showed that pupils of the 2022 control group compared to representatives of 2020 demonstrated worse results in exercises designed to determine indicators of speed, agility and endurance (p<0.05); indicators of strength and speed-power abilities do not have statistically significant differences. Conclusion. Systematic purposeful sports engagements and an increased level of physical activity allows to ensure a high level of competence in performing standard motor tests. However, during the three years of the study, the indicators of speed, agility and endurance of sports lyceum pupils statistically decreased.

Yuri Petrovich Bocharov and Samara school

A brief biography, stages of scientific and design activity and the decisive role of an outstanding scientist, urban planner and international expert in the development of an architectural school in the city of Kuibyshev, now Samara, are considered. In the process of establishing the Faculty of Architecture, academician Yuri Petrovich Bocharov, with his high competence, professional interest, sharp and at the same time fair and friendly criticism, year after year set a high bar for the Samara School of Architecture, which the modern generation of professors and students - urban planners and architects - is trying to maintain.

Farming non-typical sentient species: ethical framework requires passing a high bar

More widespread farming of species not typically used as livestock may be part of a sustainable approach for promoting human health and economic prosperity in a world with an increasing population; a current example is peccary farming in the Neotropics. Others have argued that species that are local to a region and which are usually not farmed should be considered for use as livestock. They may have a more desirable nutrient profile than species that are presently used as livestock. It may also reduce the pressure from hunting on other wild species, and cause less environmental damage than exotic species. We propose a sentiocentric utilitarian framework that could be used to decide whether species that are local, but generally not used as livestock, should be farmed. To illustrate the use of our decision-making framework, we employ two contrasting neotropical case studies: the Spotted Paca (Cuniculus paca) and the Capybara (Hydrochoerus hydrochaeris). We argue that it may be acceptable to use non-sentient species that are typically not farmed as livestock. However, research should determine whether farming them offers human, environmental or sustainability benefits. In addition, we recommend that if invertebrate species are considered for farming, research should be conducted to determine the likelihood that they are sentient. Finally, given the ethical failings of current livestock farming practices, we argue that a high bar must be met if ‘new’ species that are sentient are to be farmed.

Do 3-dimensional Spinopelvic Characteristics Normalize After THA? A Prospective, Comparative Study Using Motion Capture Analysis.

Spinopelvic stiffness (primarily in the sagittal plane) has been identified as a factor associated with inferior patient-reported outcomes (PROs) and increased dislocation risk after THA. Incorporating preoperative spinopelvic characteristics into surgical planning has been suggested to determine a patient-specific cup orientation that minimizes dislocation risk. Sagittal plane radiographic analysis of static postures indicates that patients exhibit a degree of normalization in their spinopelvic characteristics after THA. It is not yet known whether normalization is also evident during dynamic movement patterns, nor whether it occurs in the coronal and axial planes as well. (1) Does motion capture analysis of sagittal spinopelvic motion provide evidence of normalization after THA? (2) Do changes in coronal and axial plane motion accompany those in the sagittal plane? Between April 2019 and February 2020, 25 patients agreed to undergo motion capture movement analysis before THA for the treatment of hip osteoarthritis (OA). Of those, 20 underwent the same assessment between 8 and 31 months after THA. Five patients were excluded because of revision surgery (n = 1), contralateral hip OA (n = 1), and technical issues with a force plate during post-THA assessment (n = 3), leaving a cohort total of 15 (median age [IQR] 65 years [10]; seven male and eight female patients). A convenience sample of nine asymptomatic volunteers, who were free of hip and spinal pathology, was also assessed (median age 51 years [34]; four male and five female patients). Although the patients in the control group were younger than those in the patient group, this set a high bar for our threshold of spinopelvic normalization, reducing the possibility of false positive results. Three-dimensional motion capture was performed to measure spinal, pelvic, and hip motion while participants completed three tasks: seated bend and reach, seated trunk rotation, and gait on a level surface. ROM during each task was assessed and compared between pre- and post-THA conditions and between patients and controls. Statistical parametric mapping (SPM) was used to assess the timing of differences in motion during gait, and spatiotemporal gait parameters were also measured. After THA, patients demonstrated improvements in sagittal spinal (median [IQR] 32° [18°] versus 41° [14°]; difference of medians 9°; p = 0.004), pelvis (25° [21°] versus 30° [8°]; difference of medians 5°; p = 0.02), and hip ROM (21° [18°] versus 27° [10°]; difference of medians 6°; p = 0.02) during seated bend and reach as well in sagittal hip ROM during gait (30° [11°] versus 44° [7°]; difference of medians 14°; p < 0.001) compared with their pre-THA results, and they showed a high degree of normalization overall. These sagittal plane changes were accompanied by post-THA increases in coronal hip ROM (12° [9°] versus 18° [8°]; difference of medians 6°; p = 0.01) during seated trunk rotation, by both coronal (6° [4°] versus 9° [3°]; difference of medians 3°; p = 0.01) and axial (10° [8°] versus 16° [7°]; difference of medians 6°; p = 0.003) spinal ROM, as well as coronal (8° [3°] versus 13° [4°]; difference of medians 5°; p < 0.001) and axial hip ROM (21° [11°] versus 34° [24°]; difference of medians 13°; p = 0.01) during gait compared with before THA. The SPM analysis showed these improvements occurred during the late swing and early stance phases of gait. When restricted preoperatively, spinopelvic characteristics during daily tasks show normalization after THA, concurring with previous radiographic findings in the sagittal plane. Thus, spinopelvic characteristics change dynamically, and incorporating them into surgical planning would require predictive models on post-THA improvements to be of use. Level II, prognostic study.

Field inversion machine learning augmented turbulence modeling for time-accurate unsteady flow

Field inversion machine learning (FIML) has the advantages of model consistency and low data dependency and has been used to augment imperfect turbulence models. However, the solver-intrusive field inversion has a high entry bar, and existing FIML studies focused on improving only steady-state or time-averaged periodic flow predictions. To break this limit, this paper develops an open-source FIML framework for time-accurate unsteady flow, where both spatial and temporal variations of flow are of interest. We augment a Reynolds-Averaged Navier–Stokes (RANS) turbulence model's production term with a scalar field. We then integrate a neural network (NN) model into the flow solver to compute the above augmentation scalar field based on local flow features at each time step. Finally, we optimize the weights and biases of the built-in NN model to minimize the regulated spatial-temporal prediction error between the augmented flow solver and reference data. We consider the spatial-temporal evolution of unsteady flow over a 45° ramp and use only the surface pressure as the training data. The unsteady-FIML-trained model accurately predicts the spatial-temporal variations of unsteady flow fields. In addition, the trained model exhibits reasonably good prediction accuracy for various ramp angles, Reynolds numbers, and flow variables (e.g., velocity fields) that are not used in training, highlighting its generalizability. The FIML capability has been integrated into our open-source framework DAFoam. It has the potential to train more accurate RANS turbulence models for other unsteady flow phenomena, such as wind gust response, bubbly flow, and particle dispersion in the atmosphere.

Development and characterization of high nutritional value snack bar as a complementary source of nutrients in supporting the growth of pregnant women: chemical, physical, and sensory properties

Developing high nutritional value pregnant bar products as a source of different nutrients to support daily-consumed poor is considered a practical goal to increase pregnant crucial nutrient intake. This research aims to develop high nutritional snack bar as a complementary to support the nutrient requirements in pregnant women using a mixture of grains (chickpea and quinoa flours) along with wheat flour in addition to chia seeds, inulin, moringa leaves powder, anise, mastic and stevia. This study was conducted in two stages. Seven treatments of quinoa and chickpea flour levels in the ratio of (1:2) with wheat flour were produced. Proximate analysis, physical proprieties, color analysis, and sensory evaluation tests were determined. This highly nutritional snack bar has larger contents of protein, fiber, lipids, and ash, as well as lower amounts of moisture and carbohydrate content compared to wheat flour control. Moreover, physical properties: snack bar samples’ weight, diameter and thickness decreased as the concentration of chickpea and quinoa flours increased. The results of the color analysis showed that there were significant differences in lightness (L*), redness (a*), and yellowness (b*) values between the control and the seven snack bar treatments, which showed lower lightness (L*) and yellowness (b*) color values and higher redness (a*) color values. Regarding the sensory evaluation, the most accepted treatment was treatment 7, which had 47.5% wheat flour, 35% chickpea flour, and 17.5% quinoa flour. Developing a high-nutrient-value snack bar as a complementary source of nutrients to support and cover most pregnant women’s nutrient requirements, maintaining necessary daily needs with controlled calorie intake and high quality and acceptability.

Blood Urea Nitrogen to Serum Albumin Ratio as A New Prognostic Indicator in Critically Ill Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study.

To investigate the predictive value of the blood urea nitrogen to serum albumin ratio for in-hospital and out-of-hospital mortality in critically ill patients with diabetic ketoacidosis. Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC III) database, and all eligible participants were categorized into two groups based on the BAR cutoff value. Multiple logistic regression analysis was conducted to determine the association between BAR and in-hospital mortality. The Kaplan-Meier (K-M) analysis was performed to evaluate the predictive performance of BAR. Propensity score matching (PSM) was applied to control confounding factors between the low and high BAR groups. A total of 589 critically ill patients with diabetic ketoacidosis were enrolled. Patients with diabetic ketoacidosis with a higher BAR level were associated with higher in- and out-hospital mortality (all p<0.001). A significant 4-year survival difference was observed between the low and high BAR groups (p<0.0001). After PSM analysis, two PSM groups (202 pairs, n=404) were generated, and similar results were observed in the K-M curve (p<0.0001). Elevated BAR levels were associated with an increased risk of in-hospital mortality in critically ill patients with diabetic ketoacidosis, and BAR could serve as an independent prognostic factor in in-hospital and out-of-hospital mortality for patients diagnosed with diabetic ketoacidosis.

Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in type 2 diabetes mellitus patients with chronic kidney disease

Chronic kidney disease (CKD) is often a common comorbidity in critically ill patients with type 2 diabetes mellitus (T2DM). This study explored the relationship between blood urea nitrogen to serum albumin ratio (BAR) and mortality in T2DM patients with CKD in intensive care unit (ICU). Patients were recruited from the Medical Information Mart database, retrospectively. The primary and secondary outcomes were 90-day mortality, the length of ICU stay, hospital mortality and 30-day mortality, respectively. Cox regression model and Kaplan–Meier survival curve were performed to explore the association between BAR and 90-day mortality. Subgroup analyses were performed to determine the consistency of this association. A total of 1920 patients were enrolled and divided into the three groups (BAR < 9.2, 9.2 ≤ BAR ≤ 21.3 and BAR > 21.3). The length of ICU stay, 30-day mortality, and 90-day mortality in the BAR > 21.3 group were significantly higher than other groups. In Cox regression analysis showed that high BAR level was significantly associated with increased greater risk of 90-day mortality. The adjusted HR (95%CIs) for the model 1, model 2, and model 3 were 1.768 (1.409–2.218), 1.934, (1.489–2.511), and 1.864, (1.399–2.487), respectively. Subgroup analysis also showed the consistency of results. The Kaplan–Meier survival curve analysis revealed similar results as well that BAR > 21.3 had lower 90-day survival rate. High BAR was significantly associated with increased risk of 90-day mortality. BAR could be a simple and useful prognostic tool in T2DM patients with CKD in ICU.

Energy conversion in pole vaulting using finite element analysis

The article examines pole vaulting as a demanding track and field discipline, where athletes use a flexible pole to clear a high bar. The study explores the research challeng-es associated with this discipline, including the impact of pole material, the physical capabilities of the vaulter, and the vaulting technique on performance. The paper pre-sents a new Finite Element Analysis in ANSYS, focusing on energy conversion in the pole-vaulter interaction. Simulation results highlight the influence of pole stiffness and length for jump height, as well as the impact of synchronization between pole and pole positions on performance. Finally, the article highlights that pole vault performance is intrinsically linked to the pole vaulter's specific movement and ability to optimize interac-tion with the pole. This deeper understanding can help improve individual performance in this demanding athletics discipline.

MODEL CHARACTERISTICS OF PHYSICAL FITNESS OF PROFESSIONAL SOLDIERS OF TWO AGE GROUPS

The purpose of the work is to analyze the integration and interaction of various components of the structure of the physical condition of professional servicemen of the military unit of the West Pomeranian Voivodeship. 50 professional soldiers aged 26-30 and 50 professional soldiers aged 36-40 took part in the study. The scope of the study included the registration of 12 parameters of physical (FD) and motor (MD) development. Mathematical analysis of the obtained research results was carried out with the help of statistics and graphics programs Statistics 13.5 and Excel-16. The results show that the age of the two groups of servicemen does not affect the value of the FD indicators. However, in the group of servicemen over 30 years old, the indicators of FD are integrated more strongly. Among the parameters of MD, the biggest changes occurred in the parameters of the 3000 m run and body inclinations in the age group of servicemen under 30 years of age. Studies have shown that most indicators of FD and MD are interrelated and depend on each other. Among the FD indicators, the following indicators have the largest number of strong relationships: BMI, water content in the body (%), ratio of body weight to body surface area (kg/m2) and body surface area (S) in m2. Among the MD indicators in the group of military personnel under the age of 30, the largest number of strong interrelationships is manifested in the parameters of running 3000 m (s), body tilts 2', pull-ups on a high bar. However, in the group of servicemen over 30 years of age, the strongest relationships are observed for the parameters of pull-ups and 2' trunk bends. As a result of factor, regression and canonical analysis, the main factors and information indicators of the structure of the physical condition of military personnel were determined. Models of their interaction were developed and the specifics of the mutual influence of the group of FD indicators and the group of MD indicators were investigated. The MD scores of professional soldiers have a greater effect on the FD scores than the FD scores on the MD scores.

Depositional facies controls on reservoir rock typing and heterogeneity: Devonian siliciclastic succession, south central Ghadames basin, Libya

The Devonian sedimentary succession hosts the most potential reservoir targets in Ghadames Basin, Northwest Libya. This succession consists of a complex pattern of siliciclastic facies deposited during successive episodes of sea level fall and rise, thereby leading to a large scale heterogeneity in sandstone facies connectivity and distribution. The present study integrates core sedimentology, wireline logs, and routine and special core analysis to establish a framework for predicting the distribution of the best Devonian reservoir rock types (RRTs). A lowstand amalgamated fluvial sandstone bars only exist in the Lower Devonian Tadrart Formation; the other Devonian rock units consist of transgressive and highstand tidally-influenced estuarine and deltaic facies. The pore system characteristics are controlled by initial depositional attributes where open, megapores with entry displacement pressures <10 psi occur in the quartzose, high energy fluvial sandstone bars, delta distributary channels and mouth bars. These facies are classified as RRTI and are mostly associated with lowstand and late highstand facies. In contrast, the other RRTs display tight pore system with elevated irreducible water content >20%. RRTI rocks account for greater than 90% of the fluid flow capacity in the Devonian reservoirs. A link between the facies depositional setting, RRT distribution, vertical amalgamation and lateral compartmentalization of flow conduits, barriers and baffles zones has been proposed, thereby promoting the predictability of the best reservoir targets.

Preparing students for primary dental care in the Republic of Ireland

There are two dental schools in the Republic of Ireland, graduating approximately 90 new dentists annually following successful completion of a five-year undergraduate course. Currently, once these graduates have been awarded their degree, they have no legal requirement to complete post-graduation training, foundation training or continuing professional development. While the vast majority will do this voluntarily, it sets a high bar for dental educators to prepare these students to practice independently in primary dental care. As in other jurisdictions, there can often be a disconnect between the ethos taught to students for delivering primary dental care in dental schools and remuneration systems once graduates enter the workforce. Changing demographics will need to be reflected in our undergraduate curricula with explicit teaching in the area of gerodontology.

Physicians, know thy patient.

Person-centered care is presently the standard healthcare model, which emphases shared clinical decision-making, patient autonomy and empowerment. However, many aspects of the modern-day clinical practice such as the increased reliance on medical technologies, artificial intelligence, and teleconsultation have significantly altered the quality of patient-physician communications. Moreover, many countries are facing an aging population with longer life expectancies but increasingly complex medical comorbidities, which, coupled with medical subspecialization and competing health systems, often lead to fragmentation of clinical care. In this article, I discuss what it truly means for a clinician to know a patient, which is, in fact, a highly intricate skill that is necessary to meet the high bar of person-centered care. I suggest that this can be achieved through the implementation of a holistic biopsychosocial model of clinical consultation at the physician level and fostering coordinated and continuity of care at the health systems level.

Blood urea nitrogen to serum albumin ratio is associated with all-cause mortality in patients with AKI: a cohort study.

This study aims to investigate the relationship between blood urea nitrogen to serum albumin ratio (BAR) and all-cause mortality in patients with acute kidney injury (AKI) and evaluate the effect of BAR on the prognosis of AKI. Adult patients with AKI admitted to the ICU in the Medical Information Mart for Intensive Care IV (MIMIC-IV) were selected in a retrospective cohort study. BAR (mg/g) was calculated using initial blood urea nitrogen (mg/dl)/serum albumin (g/dl). According to the BAR, these patients were divided into quartiles (Q1-Q4). Kaplan-Meier analysis was used to compare the mortality of the above four groups. Multivariate Cox regression analysis was used to evaluate the association between BAR and 28-day mortality and 365-day mortality. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated, and the subgroup analysis was finally stratified by relevant covariates. A total of 12,125 patients with AKI were included in this study. The 28-day and 365-day mortality rates were 23.89 and 39.07%, respectively. Kaplan-Meier analysis showed a significant increase in all-cause mortality in patients with high BAR (Log-rank p < 0.001). Multivariate Cox regression analysis showed that BAR was an independent risk factor for 28-day mortality (4.32 < BAR≤7.14: HR 1.12, 95% CI 0.97-1.30, p = 0.114; 7.14 < BAR≤13.03: HR 1.51, 95% CI 1.31-1.75, p < 0.001; BAR>13.03: HR 2.07, 95% CI 1.74-2.47, p < 0.001; Reference BAR≤4.32) and 365-day mortality (4.32 < BAR≤7.14: HR 1.22, 95% CI 1.09-1.36, p < 0.001; 7.14 < BAR≤13.03: HR 1.63, 95% CI 1.46-1.82, p < 0.001; BAR>13.03: HR 2.22, 95% CI 1.93-2.54, p < 0.001; Reference BAR ≤ 4.32) in patients with AKI. The AUC of BAR for predicting 28-day mortality and 365-day mortality was 0.649 and 0.662, respectively, which is better than that of blood urea nitrogen and sequential organ failure assessment. In addition, subgroup analysis showed a stable relationship between BAR and adverse outcomes in patients with AKI. BAR is significantly associated with increased all-cause mortality in patients with AKI. This finding suggests that BAR may help identify people with AKI at high risk of mortality.