Highest Category Research Articles

Node-RADS: a systematic review and meta-analysis of diagnostic performance, category-wise malignancy rates, and inter-observer reliability.

To perform a systematic review and meta-analysis to estimate diagnostic performance, category-wise malignancy rates, and inter-observer reliability of Node Reporting and Data System 1.0 (Node-RADS). Five electronic databases were systematically searched for primary studies on the use of Node-RADS to report the possibility of cancer involvement of lymph nodes on CT and MRI from January 1, 2021, until April 15, 2024. The study quality was assessed by modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality Appraisal of Diagnostic Reliability (QAREL) tools. The diagnostic accuracy was estimated with bivariate random-effects model, while the pooled category-wise malignancy rates were obtained with random-effects model. Six Node-RADS-CT studies and three Node-RADS-MRI studies covering nine types of cancer were included. The study quality was mainly damaged by inappropriate index test and unknown timing according to QUADAS-2, and unclear blindness during the rating process according to QAREL. The area under hierarchical summary receiver operating characteristic curve (95% conventional interval) was 0.92 (0.89-0.94) for Node-RADS ≥ 3 as positive and 0.91 (0.88-0.93) for Node-RADS ≥ 4 as positive, respectively. The pooled malignancy rates (95% CIs) of Node-RADS 1 to 5 were 4% (0-10%), 31% (9-58%), 55% (34-75%), 89% (73-99%), and 100% (97-100%), respectively. The inter-observer reliability of five studies was interpreted as fair to substantial. Node-RADS presented a promising diagnostic performance with an increasing probability of malignancy along higher category. However, the evidence for inter-observer reliability of Node-RADS is insufficient, and may hinder its implementation in clinical practice for lymph node assessment. Question Node-RADS is designed for structured reporting of the possibility of cancer involvement of lymph nodes, but the evidence supporting its application has not been summarized. Findings Node-RADS presented diagnostic performance with AUC of 0.92, and malignancy rates for categories 1-5 ranged from 4% to 100%, while the inter-observer reliability was unclear. Clinical relevance Node-RADS is a useful tool for structured reporting of the possibility of cancer involvement of lymph nodes with high diagnostic performance and appropriate malignancy rate for each category, but unclear inter-observer reliability may hinder its implementation in clinical practice.

Birthweight charts customised for maternal height optimises the classification of small and large-for-gestational age newborns.

To construct birthweight charts customised for maternal height and evaluate the effect of customization on SGA and LGA classification. Data were extracted (n = 21 350) from the MiCaS project in the Netherlands (2012-2020). We constructed the MiCaS-birthweight chart customised for maternal height using Hadlock's method. We defined seven 5-centimetre height categories from 153 to 157 cm until 183-187 cm and calculated SGA and LGA prevalences for each category, using MiCaS and current Dutch birthweight charts. The MiCaS-chart showed substantially higher birthweight values between identical percentiles with increasing maternal height. In the Dutch birthweight chart, not customised for maternal height, the prevalence of SGA (<p10) decreased with increasing maternal height category, from 19.7% in the lowest height category to 3.4% in the highest category (range 16.3%). Conversely, the prevalence of LGA (>p90) increased with increasing height category, from 1.4% in the lowest height category to 21.8% in the highest category (range 20.4%). In the MiCaS-birthweight chart, SGA and LGA prevalences were more constant across maternal heights, similar to overall prevalences (SGA range 3.3% and LGA range 1.7%). Compared to the current Dutch birthweight chart, the MiCaS-birthweight chart customised for maternal height shows a more even distribution of SGA and LGA prevalences across maternal heights.

Evaluating the Impact of Hotel Classification on Pool Water Consumption: A Case Study from Costa Brava (Spain)

Swimming pools are key assets in the hotel industry. With climate change and water stress, more sustainable pools are needed in tourist areas. The study examines the relationship between hotel categories and the consumption of water in swimming pools in a Mediterranean coastal region facing water scarcity. The study focuses on the Costa Brava, with a focus on Lloret de Mar, a popular tourist destination. The research employs a combination of data analysis and the utilisation of evaporation models in order to estimate the consumption of water by swimming pools. The findings indicate that hotels in the higher categories, particularly those with three or four stars, contribute a notable proportion of the total water consumption due to their larger pool sizes and higher guest numbers. The study underscores the necessity for the implementation of sustainable water management strategies, particularly in the context of climate change. It recommends the utilisation of pool water-saving technologies as potential solutions. Furthermore, the paper highlights the broader environmental impact of tourism infrastructure on water resources and suggests policy measures to mitigate these effects. The research aligns with global sustainability goals such as the European Green Deal and the 2030 Agenda.

Predicting Acute Oral Toxicity Using AcutoX: An Animal Product-Free and Metabolically Relevant Human Cell-Based Test.

AcutoX is a human in vitro test method for the evaluation of acute oral toxicity, developed using a library of 67 curated test chemicals. These chemicals cover a wide variety of chemistries, industrial sectors, rodent toxicities, and all EPA and GHS hazard categories. The test uses two different cytotoxicity endpoints (Neutral Red uptake and MTT metabolism), performed both in the presence and absence of a pooled human liver extract (S9), to produce four EC50 values. The EC50 values are used in prediction models to assign a "highly toxic" and "low toxicity" category for both EPA and GHS classification, which can be further refined to assign a hazard category. The binary "highly toxic" / "low toxicity" prediction model has an accuracy of 73.8% and 63.1% for EPA and GHS, respectively, with the subsequent hazard categorization offering a protective prediction (correct or higher category) in 90.0% and 93.3% of cases, respectively. Moreover, the AcutoX test can identify chemicals activated or detoxified by liver metabolism.

Assessment of the competency of learner-centered teaching of clinical preceptor using the augmented Stanford Faculty Development Program Questionnaire (SFDPQ): a cross sectional comparative study

BackgroundEducation is an important part of the work of most doctors. Clinical preceptors act as role models and supervisors. Preceptors’ quality of supervision strongly influences the learning quality of clinical interns (Bartlett et al. BMC Med Educ 20:165, 2020). To ensure a consistent approach to every preceptorship experience, the competency of clinical preceptors should be assessed to ensure that the desired outcomes are achieved. This study aims to evaluate clinical preceptors’ competency in learner-centered teaching, to provide constructive feedback to develop the preceptors’ competency and improve supervisory skills and internship quality at Kunming Medical University (KMU) in Kunming of China.MethodsThis is a cross-sectional study with a quantitative self-administered online questionnaire. The convenience sampling technique was employed. In the undergraduate internship stage of KMU, clinical preceptors (N = 340) and interns (N = 487) were invited to use the augmented Stanford Faculty Development Program questionnaire (SFDPQ) (Stalmeijer et al. Med Teach 30:e272–e277, 2008), to (self-) assess the preceptor’s competency of learner-centered teaching on a five-point scale (1 = strongly disagree, 5 = strongly agree).ResultsTwo hundred twenty-eight preceptors and two hundred thirty-six interns completed the questionnaire correctly. Overall, the assessment was positive, but the preceptors’ self-assessment significantly higher than the interns’ (p < 0.00). The overall mean of each category of preceptors’ self-assessment was greater than 4.5, with no difference based on educational qualification. Male preceptors scored significantly higher in two categories than female preceptors. Preceptors under 30 years of age with less than 5 years of teaching experience rated “Teacher’s knowledge and attitude” lower than those over 40 years of age with more than 5 years of experience (p < 0.05). There were statistically significant differences in the four categories across disciplines (p < 0.05). Undergraduate interns rated “Teachers’ knowledge” as the highest category and “Learning climate” as the lowest, and interns of different genders are evaluated without distinction in all categories of SFDPQ.ConclusionsEmploying the augmented SFDPQ to evaluate learner-centered teaching competency of clinical preceptors, offers potentially useful information for delivering constructive feedback. Combining self-evaluations with learner evaluation data can contribute to exploring preceptor competency development framework to guide them in targeted learner-centered teaching skill and acquisition and improvement, finally improving the overall quality of internships.

Association of Cardiac Troponin T With Coronary Atherosclerosis in Asymptomatic Primary Prevention People With HIV

BackgroundCoronary plaque is common among people with HIV (PWH) with low-to-moderate traditional atherosclerotic cardiovascular disease (ASCVD) risk. ObjectivesThe purpose of this study was to determine the association of high-sensitivity cardiac troponin T (hs-cTnT) levels with coronary plaque characteristics and evaluate if hs-cTnT improves identification of these features beyond traditional ASCVD risk factors among PWH. MethodsAmong PWH receiving stable antiretroviral therapy with low-to-moderate ASCVD risk and no known history of ASCVD, hs-cTnT levels and measures of plaque by coronary computed tomography angiography were assessed. Primary outcomes included the association of hs-cTnT level with the presence of any plaque, vulnerable plaque, coronary artery calcium (CAC) score, and Leaman score. Assessment of model discrimination of hs-cTnT for plaque characteristics was also performed. ResultsThe cohort included 708 U.S. participants with a mean age of 51 ± 6 years, 119 (17%) females, a median ASCVD risk score of 4.4% (Q1-Q3: 2.5%-6.6%), and a median hs-cTnT level of 6.7 ng/L (detectable level ≥6 ng/L in 61%). Any plaque was present in 341 (48%), vulnerable plaque in 155 (22%), CAC>100 in 68 (10%), and a Leaman score >5 in 105 (15%). After adjustment for ASCVD risk score, participants with hs-cTnT >9.6 ng/L (highest category) versus an undetectable level (<6 ng/L) had a greater relative risk for any plaque (1.37, 95% CI: 1.12-1.67), vulnerable plaque (1.47, 95% CI: 1.16-1.87), CAC>100 (2.58, 95% CI: 1.37-4.83), and Leaman score >5 (2.13, 95% CI: 1.32-3.46). The addition of hs-cTnT level modestly improved the discrimination of ASCVD risk score to identify critical plaque features. ConclusionsIn PWH without known ASCVD, hs-cTnT levels were strongly associated with and improved prediction of subclinical coronary plaque. (Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults [REPRIEVE]; NCT02344290)

Personal and professional development activity tracking in a pharmacy curriculum

Background and purposePersonal and professional development (PPD) is an essential focus of pharmacy school curriculum in developing future pharmacists. This manuscript describes the creation, implementation, and data collection of a PPD Activity Tracker in a pharmacy curriculum. Educational activity and settingPreviously, in “Standards 2016” and currently in “Standards 2025”, colleges of pharmacy are tasked with documenting how students achieve PPD throughout their academic careers. Therefore, the PPD course directors developed a PPD Activities Tracker to provide student pharmacists a central location to document curriculum and co-curricular activities as they matriculate through the pharmacy program. The tracker was created using an electronic survey platform. Eleven activity categories were established, and students noted whether the activity was directed toward personal and/or professional development. The purpose of the tracker was to create a repository for student documentation of their PPD-promoting experiences and to provide a mechanism for individual and cohort reporting for assessment and accreditation. FindingsStudent pharmacists from two class cohorts entered 3254 PPD activities into the tracker over a two-year period. All PPD categories were tracked with the highest attended activities, including personal development & self-care (19%) and self-reflection (19%); the next highest category was interprofessional education/collaboration (15%). Students noted that most PPD activities enhanced their personal and professional development (49%), while personal development only and professional development only were 31% and 19%, respectively. The students “highly recommended” (72%) most tracked PPD activities, while 26% of activities were “recommended.” Individual student and class cohort data were also readily accessible. SummaryThe PPD tracker created a central, easily accessible, and organized storehouse for successfully collecting curricular and co-curricular PPD activities throughout the student pharmacist's career. The data from this tracker could easily be collected and sorted individually as a class cohort or for an individual student pharmacist.

Breast density effect on the sensitivity of digital screening mammography in a UK cohort.

To assess the performance of breast cancer screening by category of breast density and age in a UK screening cohort. Raw full-field digital mammography data from a single site in the UK, forming a consecutive 3-year cohort of women aged 50 to 70 years from 2016 to 2018, were obtained retrospectively. Breast density was assessed using Volpara software. Examinations were grouped by density category and age group (50-60 and 61-70 years) to analyse screening performance. Statistical analysis was performed to determine the association between density categories and age groups. Volumetric breast density was assessed as a binary classifier of interval cancers (ICs) to find an optimal density threshold. Forty-nine thousand nine-hundred forty-eight screening examinations (409 screen-detected cancers (SDCs) and 205 ICs) were included in the analysis. Mammographic sensitivity, SDC/(SDC + IC), decreased with increasing breast density from 75.0% for density a (p = 0.839, comparisons made to category b), to 73.5%, 59.8% (p = 0.001), and 51.3% (p < 0.001) in categories b, c, and d, respectively. IC rates were highest in the densest categories with rates of 1.8 (p = 0.039), 3.2, 5.7 (p < 0.001), and 7.9 (p < 0.001) per thousand for categories a, b, c, and d, respectively. The recall rate increased with breast density, leading to more false positive recalls, especially in the younger age group. There was no significant difference between the optimal density threshold found, 6.85, and that Volpara defined as the b/c boundary, 7.5. The performance of screening is significantly reduced with increasing density with IC rates in the densest category four times higher than in women with fatty breasts. False positives are a particular issue for the younger subgroup without prior examinations. In women attending screening there is significant underdiagnosis of breast cancer in those with dense breasts, most marked in the highest density category but still three times higher than in women with fatty breasts in the second highest category. Breast density can mask cancers leading to underdiagnosis on mammography. Interval cancer rate increased with breast density categories 'a' to 'd'; 1.8 to 7.9 per thousand. Recall rates increased with increasing breast density, leading to more false positive recalls.

High-Sensitivity Troponin T, NT-proBNP, and Cognitive Outcomes in SPRINT.

Hs-cTnT (cardiac troponin T measured with a highly sensitive assay) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) may identify adults with hypertension who derive greater cognitive benefits from lower systolic blood pressure targets. In the SPRINT (Systolic Blood Pressure Intervention Trial) MIND study, participants were categorized as having both hs-cTnT and NT-proBNP in the lower 2 tertiles (n=4226), one in the highest tertile (n=2379), and both in the highest tertile (n=1506). We assessed the effect of intensive versus standard treatment on the composite of mild cognitive impairment (MCI) or probable dementia (PD) across biomarker categories. Over a median follow-up of 5.1 years, 830 of 8111 participants (10.2%) developed MCI or PD. Participants in the highest biomarker category were at higher risk of MCI or PD compared with those in the lowest category (hazard ratio, 1.34 [95% CI, 1.00-1.56]). The effect of intensive treatment on reducing the risk of MCI or PD was greater among participants in the lowest biomarker category (hazard ratio, 0.64 [95% CI, 0.50-0.81]) than those in the intermediate (hazard ratio, 1.01 [95% CI, 0.80-1.28]) or highest categories (hazard ratio, 0.90 [95% CI, 0.72-1.13]; Pinteraction=0.02). The 5-year absolute risk differences in MCI or PD with intensive treatment were -2.9% (-4.4%, -1.3%), -0.2% (-3.0%, 2.6%), and -1.9% (-6.2%, 2.4%) in the lowest, intermediate, and highest biomarker categories, respectively. In SPRINT, the relative effect of intensive systolic blood pressure lowering on preventing cognitive impairment appears to be stronger among participants with lower compared with higher cardiac biomarker levels, though the absolute risk reductions were similar.

Audiovisual Education Techniques on Mothers' Psychomotor Abilities in First Aid for Febrile Seizures in Toddlers

Background: One of the health issues that frequently affect infants is febrile seizures, which are brought on by a fever without any cerebral infection. This could cause death, paralysis, or even damage to the brain. This study aimed to analyze the effect of audio-visual techniques on the psychomotor abilities of mothers in providing first aid for simple febrile seizures in toddlers. Methods: The research design was a pre-experiment, a one-group pretest, and a post-test with a population of 90 mothers and a sample of 30 mothers with toddlers obtained by the purposive sampling technique. The inclusion criteria were mothers who were willing to be respondents, mothers with healthy toddlers, and mothers over 18 years of age. The pre-test was carried out before the intervention, and the intervention was given twice in one week with a duration of 25–30 minutes. A post-test was then carried out. Results: The Wilcoxon signed-rank test was used for statistical analysis (α = 0.05). The results of the study were obtained before the intervention; all respondents had psychomotor abilities in the lower category, and after the intervention, most of the respondents' psychomotor skills were in the higher category. Statistical results obtained a p-value of 0.000 (α = 0.05), which means that there was an effect of audiovisual education techniques on the psychomotor ability of the mother in first aid for simple febrile seizures. Conclusion: Audiovisual education techniques could stimulate the two senses of sight and hearing simultaneously, so that mothers were more focused on the material provided and the material was easier to accept, especially for psychomotor competence. Audiovisual techniques should be used as an alternative learning method for ordinary people because they are more effective in improving psychomotor abilities.

Impact of Poverty on Stroke Recurrence: A Population-Based Study.

Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear. In this population-based study, incident strokes within the Greater Cincinnati/Northern Kentucky region were ascertained during the 2015 study period and followed up for recurrence until December 31, 2018. The primary exposure was neighborhood socioeconomic status (nSES), defined by the percentage of households below the federal poverty line in each census tract in 4 categories (≤5%, >5%-10%, >10%-25%, >25%). Poisson regression models provided recurrence rate estimates per 100,000 residents using population data from the 2015 5-year American Community Survey, adjusting for age, sex, and race. In a secondary analysis, Cox models allowed for the inclusion of vascular risk factors in the assessment of recurrence risk by nSES among those with incident stroke. Of 2,125 patients with incident stroke, 245 had a recurrent stroke during the study period. Poorer nSES was associated with increased stroke recurrence, with rates of 12.5, 17.5, 25.4, and 29.9 per 100,000 in census tracts with ≤5%, >5%-10%, >10%-25%, and >25% below the poverty line, respectively (p < 0.01). The relative risk (95% CI) for recurrent stroke among Black vs White individuals was 2.54 (1.91-3.37) before adjusting for nSES, and 2.00 (1.47-2.74) after adjusting for nSES, a 35.1% decrease. In the secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10-2.76 for lowest vs highest category) and Black race (HR 1.31, 95% CI 1.01-1.70) were both independently associated with recurrence risk, though neither retained significance after full adjustment. Age, diabetes, and left ventricular hypertrophy were associated with increased recurrence risk in fully adjusted models. Residents of poorer neighborhoods had a dose-dependent increase in stroke recurrence risk, and neighborhood poverty accounted for approximately one-third of the excess risk among Black individuals. These results highlight the importance of poverty, race, and the intersection of the 2 as potent drivers of stroke recurrence.

Analysis of staffing of the regional health system by dental surgeons in 2019–2021

BACKGROUND: Providing qualified personnel to medical organizations is one of the priorities of the development of the health system. Improvement of staffing of dentists is relevant, as it enables increased availability and quality of dental care. Accessibility and quality of medical care involves the availability of the required number of medical personnel and level of their qualifications, achieved through the licensing of medical activities and certification and accreditation of medical personnel. AIM: To analyze the staffing of dental surgeons in medical organizations subordinate to the Ministry of Health of the Krasnodar Territory. MATERIALS AND METHODS: This study included dental surgeons of state medical organizations of the Krasnodar Territory in 2019–2021. The present study uses statistical data of reporting forms of medical organizations of Krasnodar Krai «Information about medical organization» (N 30) for the studied period. Statistical processing of the material was performed using the Microsoft Office software package applying analytical, logical, and statistical methods of research. RESULTS: Analysis of the staffing of dental surgeons in medical organizations of the Krasnodar Territory for 2019–2021 showed an increase in established posts in general for organizations and providing medical assistance in ambulatory conditions, a decrease in established posts in the hospital and occupied posts in general by organizations, as in outpatient conditions, and in stationary. Moreover, a decrease was noted in the number of individuals employed as primary workers in general positions in the medical organizations of the province and in outpatient and inpatient medical care and in the number of individuals employed as primary employees, having the highest category and simultaneously increasing with the first and second categories. Further, the study found a decrease in the number of persons in the main occupations with professional certification, an increase in the number of persons with accreditation certificates, and a decrease in the number of physical persons and of employed dental surgeons in medical organizations of the Krasnodar Territory, owing to the reduction in both outpatient and inpatient conditions. CONCLUSION: Analysis of staffing of the regional healthcare system by dental surgeons for 2019–2021 was conducted.

The Association Between Overall, Healthy, and Unhealthy Plant-Based Diet Index and Risk of Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies.

The global incidence of prediabetes and type 2 diabetes mellitus (T2DM) has increased substantially in recent years. Among the established, modifiable lifestyle factors associated with favorable prediabetes and T2DM risk, healthy dietary patterns have attracted considerable attention. The association between adherence to plant-based dietary pattern indices (PDIs), including the overall PDI (O-PDI), healthy PDI (H-PDI), and unhealthy PDI (U-PDI), and the risk of prediabetes and T2DM was investigated in this study. A literature search was conducted of the PubMed/Medline, Scopus, and Web of Sciences databases from their inception to February 2024. A systematic review and meta-analysis were conducted using random effects models and dose-response analyses. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity between studies. A total of 16 publications, with data on a total of 721 012 participants, were identified for the meta-analysis. According to a pooled analysis, compared with the lowest category of O-PDI and H-PDI adherence, the highest category was associated with a 14% and 19% reduction in T2DM risk, respectively, for O-PDI (effect size [ES] = 0.86; 95%CI, 0.82-0.90; I2 = 57.7) and H-PDI (ES = 0.81; 95%CI, 0.75-0.88; I2 = 82.6). Greater adherence to U-PDI was significantly associated with an 10% increase in the risk of T2DM (ES = 1.10; 95%CI, 1.04-1.16). Consistent associations were found within the predetermined subgroups. As well, there was a nonlinear inverse association between O-PDI, H-PDI, and T2DM risk. No significant association was found between adherence to O-PDI (ES = 0.87; 95%CI, 0.75-1.01; I2 = 68%), H-PDI (ES = 0.99; 95%CI, 0.87-1.13; I2 = 0.0%), and U-PDI (ES = 1.09; 95%CI, 0.94-1.21; I2 = 22.9%) and risk of prediabetes. These findings underscore the importance of dietary selections within the framework of a plant-based dietary pattern, particularly when incorporating healthful, plant-based foods, which may have potential benefits in reducing the T2DM risk. PROSPERO registration no. CRD42023459851.

Physical training and external load management for young athletes

Football today is more intense and demanding than ever before and these increasing physical demands have a direct impact on grassroots players, leading to ever greater interest in determining the external load variables using GPS in lower categories. The objective of this study is to observe and analyse the mean figures for the variables Distance(m), High Acc(m) and High Dec(m), HSR Abs(m), HMLD(m) and MAX Speed (km·h-1) per player aged 15, 16 and 17 based on their position in a competitive match. We also aim to determine if U16 players are able to compete in a U17 and U18 category team. A total of 57 male players, between 15 and 17 years old, participated in the study, divided by team corresponding to their age, and members of farm teams of a professional football club in the Community of Madrid. The results obtained for the mentioned variables show that some players could play at a higher category, specifically U16 Centre-Backs and Forwards and U17 Wing-Backs, Midfielders and Wingers. However, it must be noted that these results may be influenced by factors such as biological age of the players, the minutes of play, the style of play, the rival in the match, the pitch conditions and weather. Keywords: Grassroots Football, External Load, GPS, Distance(m), High Acc(m)/Dec(m), HSR Abs(m), HMLD(m), MAX Speed(km·h-1)

АНАЛИЗ ПРЕДСТАВЛЕНИЯ ВРАЧЕЙ АКУШЕРОВ-ГИНЕКОЛОГОВ О КАЧЕСТВЕ ОРГАНИЗАЦИИ МЕДИЦИНСКОЙ ПОМОЩИ В УЧРЕЖДЕНИЯХ РОДОВСПОМОЖЕНИЯ

The purpose of the study: to analyze the ideas of obstetricians and gynecologists about the quality of medical care in maternity institutions. Materials and methods. In accordance with the objectives of this study, a sociological survey was conducted of 286 obstetrician-gynecologists who carry out their work in the Samara region. The average age of the interviewed specialists was 33.7±9.1 years. Among the respondents, people who have worked in the healthcare system for more than 25 years prevailed – 32.1 %. The total length of service from 15 to 25 years was 22.8 % of the respondents, from 10 to 15 years – 20.4 %. Among certified obstetricians and gynecologists, specialists with the first category prevailed (44.1 %). One fifth (22.8 %) of doctors had the highest category, 27.6 % had the second and 5.5 % of the respondents had no qualifications. Results. There was a great interest in improving the quality of medical care provided, as well as in issues of additional professional education in terms of familiarization with regulatory documents and acquiring skills in communicating with patients, ethical analysis of the clinical situation and their own activities. Assessing the overall positive state of affairs in the team, doctors note quite a lot of factors that lead to the development and preservation of a conflict situation. The opinions of doctors characterizing the activities of obstetric and gynecological institutions can be an addition to improving the quality of medical care in the subjects of the Russian Federation.

Back-to-back high category atmospheric river landfalls occur more often on the west coast of the United States

The catastrophic December 2022-January 2023 nine atmospheric rivers in California underscore the urgent need to better understand such high-risk weather extremes. Here we applied a machine learning clustering tool to understand the activity of atmospheric river clusters. Reanalysis results show that clusters with high density, that is the time fraction under atmospheric river conditions within a cluster, exhibit more frequent high-category atmospheric rivers, alongside an increased likelihood for extreme precipitation and severe land surface responses. The key circulation patterns of atmospheric river clusters are primarily attributed to subseasonal variability. Furthermore, the occurrence and density of atmospheric river clusters are modulated by the daily variability of the geopotential height field. Climate model projections suggest that atmospheric river clusters with higher density and higher categories will be more frequent as warming level increases. Our findings emphasize the important role of atmospheric river clusters in the development of climate adaptation and resilience strategies.

Real world insights for psoriasis: the association of severity of skin lesions with work productivity, medical consumption costs and quality of life

Background Psoriasis is a prevalent, chronic skin disease with a potential impact on work productivity, medical consumption costs, and quality of life. The influence of the extent of skin lesions on these outcomes is not well known. Objective We determined associations of self-reported skin lesions with self-reported work productivity, medical consumption costs, and health-related quality of life in respondents with psoriasis. Methods In this cross-sectional study, we included respondents with self-reported psoriasis in the Netherlands in an online questionnaire. We assessed the self-reported percentage body surface area (BSA) of psoriasis lesions. We used validated instruments to assess work productivity (WPAI-PsO), medical consumption costs (iMCQ), and health-related quality of life (EQ-5D-5L and the DLQI). We used ordinal logistic regression to associate BSA categories >1% versus 0-1% with outcomes adjusted for multiple confounders. Results We included 501 respondents with a mean age of 43 ± 12 years; 64% were men. Median BSA was 2% (interquartile range 1–5%). A higher BSA was associated with higher overall work impairment due to psoriasis (common odds ratio [cOR] 2.44, 95% confidence interval [CI] 1.40–4.29; n = 205), higher medical consumption costs (cOR 2.06, 95% CI 1.45–2.94) and lower health-related quality of life. Associations were strongest with a BSA cutoff of 0% or 1% compared to 2% or higher categories. Discussion In our study, having few to no lesions in psoriasis was associated with lower overall work impairment due to psoriasis, lower medical consumption costs, and higher health-related quality of life.

Comparison of ultrasound risk stratification systems for pediatric thyroid nodules.

There is currently insufficient data to validate adult-based US risk stratification systems (RSSs) for the identification of malignant thyroid nodules in a pediatric population. From October 2016 and May 2023, 173 thyroid nodules of pediatric patients (age ≤ 18 years) with definitive pathology results and ultrasound (US) examination within 1 month before surgery or fine-needle aspiration (FNA) biopsy in our institution were enrolled in this study. The clinical and US characteristics of these nodules were retrospectively reviewed and categorized according to the ACR-TIRADS, C-TIRADS, and ATA guidelines. The diagnostic performance of US-based FNA criteria (original and simulating) of the three guidelines in thyroid cancer detection was estimated. The three RSSs had similar AUC according to the categories(0.849-0.852, all P > 0.05). When combined with the original FNA criteria of the three RSSs to manage the nodules, the FNA rate of ACR-TIRADS and C-TIRADS were significantly less than ATA guidelines (53.18% vs. 64.63%, P < 0.05, and 52.60% vs. 64.63%, P < 0.05). The missed malignancy rate (MMR) and unnecessary FNA rate (UFR) of ATA guidelines (50.00%, 35.85%) was highest among the three RSSs, followed by the C-TIRADS (37.80%, 19.57%) and the ACR-TIRADS (37.04%, 19.57%). When nodules < 1cm with the highest category in each RSS biopsied, that is when using the simulating FNA thresholds, the MMR was reduced overall (all P < 0.001), without a change in the UFR (all P > 0.05). All the three RSSs showed a substantial improvement in accuracy and malignant detection rate (all P < 0.05). The ACR-TIRADS, C-TIRADS, and ATA guidelines showed high missed malignancy rates when using their original recommended FNA criteria. When nodules < 1cm with the highest category in each RSS biopsied, the missed malignancy rate of each RSS was decreased. Decreasing the FNA thresholds for highly suspicious malignant nodules may therefore be an effective means of managing malignant thyroid nodules in pediatric patients.

On straightening for Segal spaces

The straightening–unstraightening correspondence of Grothendieck–Lurie provides an equivalence between cocartesian fibrations between $(\infty, 1)$-categories and diagrams of $(\infty, 1)$-categories. We provide an alternative proof of this correspondence, as well as an extension of straightening–unstraightening to all higher categorical dimensions. This is based on an explicit combinatorial result relating two types of fibrations between double categories, which can be applied inductively to construct the straightening of a cocartesian fibration between higher categories.

Survival benefit of adjuvant chemotherapy in patients with resected gallbladder adenocarcinoma: An updated retrospective cohort analysis

BackgroundThe rarity yet high malignancy of gallbladder adenocarcinoma (GBA) endows it with a distinctive nature. Radical resection remains the foremost therapeutic approach for GBA, while the impact of early recurrence and metastasis on patient prognosis necessitates the utilization of adjuvant chemotherapy (AC). Despite numerous previous studies on this topic, a consensus regarding the authentic efficacy of AC has yet to be reached. MethodsWe conducted an updated retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2010 to 2020 to explore the association between AC and survival outcomes in patients with resected GBA. ResultsOur study included 2782 patients from the SEER database, with further evaluation of 843 patients in each cohort following meticulous execution of a 1:1 propensity score matching. Remarkably, the AC cohort exhibited a significant survival advantage when juxtaposed against the non-AC cohort. Multivariable Cox regression analysis identified age at diagnosis, year at diagnosis, grade, AJCC T stage, AJCC N stage as well as AC as independent prognostic factors. Furthermore, our findings unveiled that poor/undifferentiated tumor histology, pathological T2 or higher category and pathological N1 category were significantly associated with improved survival when treated with AC while simultaneously observing improved survival across all age categories. ConclusionThese results provide additional evidence supporting the survival benefits of AC and offer guidance for personalized therapy in patients with resected GBA.