Independent Criterion Research Articles

Extinction and Independent Scattering Criterion for Clusters of Spherical Particles Embedded in Absorbing Host Media

In practical applications, the independent scattering approximation (ISA) is widely used to analyze light transfer in nanoparticle systems. However, the traditional independent scattering criterion is obtained under the assumption that the host medium surrounding particles is nonabsorbing, and thus may be invalid in certain circumstances. In this work, to explore the applicability of the ISA for small particles in absorbing host media, we calculate the extinction efficiency of particle clusters by direct solutions of macroscopic Maxwell equations. Using the far-field and distance-independent definitions of extinction, the computational efficiency multi-sphere method is applied for particle clusters in absorbing host, and its accuracy is verified with the discrete dipole approximation method. It is well known that for small particles, the dependent scattering in transparent host always enhances the extinction of the cluster and the criterion for the ISA is nearly independent of the particle refractive index and particle size. We show, however, that when the host medium is absorbing, the dependent scattering between particles can lead to a decreased or even negative extinction, and thus the ISA criterion depends on the particle refractive index, size, and host medium absorption index. In this result, the generalized criteria for absorbing host media may differ significantly from the conventional ones for transparent host media. The results can provide guidance in solving problems related to light transfer in nanoparticle systems, particularly in the presence of absorption in the host medium.

Meningiomas with CNS invasion.

CNS invasion has been included as an independent criterion for the diagnosis of a high-grade (WHO and CNS grade 2 and 3) meningioma in the 2016 and more recently in the 2021 WHO classification. However, the prognostic role of brain invasion has recently been questioned. Also, surgical treatment for brain invasive meningiomas may pose specific challenges. We conducted a systematic review of the 2016-2022 literature on brain invasive meningiomas in Pubmed, Scopus, Web of Science and the Cochrane Library. The prognostic relevance of brain invasion as a stand-alone criterion is still unclear. Additional and larger studies using robust definitions of histological brain invasion and addressing the issue of sampling errors are clearly warranted. Although the necessity of molecular profiling in meningioma grading, prognostication and decision making in the future is obvious, specific markers for brain invasion are lacking for the time being. Advanced neuroimaging may predict CNS invasion preoperatively. The extent of resection (e.g., the Simpson grading) is an important predictor of tumor recurrence especially in higher grade meningiomas, but also - although likely to a lesser degree - in benign tumors, and therefore also in brain invasive meningiomas with and without other histological features of atypia or malignancy. Hence, surgery for brain invasive meningiomas should follow the principles of maximal but safe resections. There are some data to suggest that safety and functional outcomes in such cases may benefit from the armamentarium of surgical adjuncts commonly used for surgery of eloquent gliomas such as intraoperative monitoring, awake craniotomy, DTI tractography and further advanced intraoperative brain tumor visualization.

Love, knowledge (wisdom) and justice: Moral education beyond the cultivation of Aristotelian virtuous character

ABSTRACT There could hardly have been a more influential twentieth-century philosophical essay than Elizabeth Anscombe’s ‘Modern moral philosophy’, in which she condemned the prevailing and competing ethics of duty and utility of her day and urged moral philosophers to abandon the search for any general conception of ‘morality’ in favour of return to Aristotle’s more particular focus on virtue and virtues as powers or qualities of good human character. While moral philosophers have not been slow to rally to this banner—with timely and useful attention to a wide range of character virtues—it was inevitable that moral educationalists would also soon turn towards understanding virtuous character to be a prime if not main concern of moral education. However, without denying that recent moral philosophical attention to virtue and virtues has been worthwhile, it is crucial to appreciate that in and of themselves such qualities mostly fall short of moral status and value and that some independent criterion of the moral cannot, as Anscombe recommended, be renounced. In this spirit, the present paper also attempts to comprehend such moral and educational significance by reference to interlinked concepts of love, knowledge and justice.

Midterm Outcomes of Elective Endovascular Aortic Repair in Octogenarians: When Is It Too Old?

Introduction: Endovascular aortic repair outcomes in octogenarians remain unclear. We aim to investigate whether the results for octogenarians differ from those of the younger population in elective endovascular aortic repair. Materials and Methods: From January 2013 to January 2022, 313 patients were treated with elective endovascular aortic repairs. Patient demographics and perioperative and postoperative features were obtained from the hospital database. The primary goals were to explore the early mortality rates of patients aged 80 years and older and compare them with those under 80. The secondary goal was to analyze the comorbid factors. Results: A total of 245 patients were under 80 years old, and 68 patients were 80 years and older. The early mortality rate was 2.94% in the octogenarians and 0.81% in the rest, and there was no significant difference between the two (p = 0.24). However, being 80 years and older led to a significantly lower survival probability at the five-year follow-ups. The American Society of Anesthesiologists’ score was found to help predict late mortality risk and patient selection for elective endovascular aortic repair. Conclusion: As octogenarians are fragile and sensitive to complications, patient selection, careful consideration of life expectancy, and clinical assessment are key to repair. Furthermore, age should not be an independent exclusion criterion in the endovascular aortic repair treatment decision. Keywords: Aortic Aneurysm, Abdominal; Endovascular Procedure; Octogenarians.

Posttherapeutic quality of life after treatment of salivary gland cancer

In addition to overall survival and recurrence-free interval, posttherapeutic quality of life has been established as an independent criterion for treatment evaluation. Thereby, both the specific changes in the head and neck region and their objectification represent aparticular challenge for the assessment of quality of life. There are different validated questionnaires available. Based on the literature, an overview of the relevant questionnaire instruments is given and the specific aspects in patients with salivary gland cancer are presented. Aselective literature search was conducted to collect publications dealing with the assessment of health-related quality of life in head and neck tumor patients. The papers were critically appraised and summarized. There are some validated questionnaires available to measure quality of life in patients with head and neck tumors as well as afew specific questionnaires for patients after parotidectomy. By assessing quality of life using standardized questionnaire instruments, disease and treatment consequences can be objectified. Thus, the need for supportive measures, e.g., for rehabilitation in facial nerve palsy, can be identified more reliably.

Groups in which the centralizer of any non-central primary element is maximal

Abstract We investigate the structure of finite group G in which the centralizer of each non-central primary element of G is maximal in G. This provides an answer to the question raised in [X. Zhao, R. Chen and X. Guo, Groups in which the centralizer of any non-central element is maximal, J. Group Theory 23 2020, 5, 871–878], and also is a generalization of the result in [A. Mann, Finite groups with maximal normalizers, Illinois J. Math. 12 1968, 67–75]. In particular, we give an independent criterion of simplicity of a group, asserting that a group G is simple if the centralizer of each non-central primary element is maximal in G.

Using the Grooved Pegboard Test as an Embedded Validity Indicator in a Mixed Neuropsychiatric Sample with Varying Cognitive Impairment: Cross-Validation Problems.

Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB's classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65-.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.

Novel Scheme for Robust Confusion Component Selection Based on Pythagorean Fuzzy Set

The substitution box, often known as an S-box, is a nonlinear component that is a part of several block ciphers. Its purpose is to protect cryptographic algorithms from a variety of cryptanalytic assaults. A MultiCriteria Decision Making (MCDM) problem has a complex selection procedure because of having many options and criteria to choose from. Because of this, statistical methods are necessary to assess the performance score of each S-box and decide which option is the best one available based on this score. Using the Pythagorean Fuzzy-based Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method, the major objective of this investigation is to select the optimal S-box to be implemented from a pool of twelve key choices. With the help of the Pythagorean fuzzy set (PFS), the purpose of this article is to evaluate whether this nonlinear component is suitable for use in a variety of encryption applications. In this article, we have considered various characteristics of S-boxes, including nonlinearity, algebraic degree, strict avalanche criterion (SAC), absolute indicator, bit independent criterion (BIC), sum of square indicator, algebraic immunity, transparency order, robustness to differential cryptanalysis, composite algebraic immunity, signal to noise ratio-differential power attack (SNR-DPA), and confusion coefficient variance on some standard S-boxes that are Advanced Encryption Following this, the findings of the investigation are changed into Pythagorean fuzzy numbers in the shape of a matrix. This matrix is then subjected to an analysis using the TOPSIS method, which is dependent on the Pythagorean fuzzy set, to rank the most suitable S-box for use in encryption applications.

Validity of a Smartphone Application in Calculating Measures of Heart Rate Variability.

The purpose of the current study was to determine the concurrent validity of the Elite HRV smartphone application when calculating heart rate variability (HRV) metrics in reference to an independent software criterion. A total of 5 minutes of R−R interval and natural log of root mean square of the successive differences (lnRMSSD) resting HRV data were simultaneously collected using two Polar H10 heart rate monitors (HRMs) in both the seated and supine positions from 22 participants (14 males, 8 females). One H10 HRM was paired with a Polar V800 watch and one with the Elite HRV application. When no artifact correction was applied, significant, but small, differences in the lnRMSSD data were observed between the software in the seated position (p = 0.022), and trivial and nonstatistically significant differences were observed in the supine position (p = 0.087). However, significant differences (p > 0.05) in the lnRMSSD data were no longer identifiable in either the seated or the supine positions when applying Very Low, Low, or Automatic artifact-correction filters. Additionally, excellent agreements (ICC3,1 = 0.938 − 0.998) and very strong to near-perfect (r = 0.889 − 0.997) relationships were observed throughout all correction levels. The Elite HRV smartphone application is a valid tool for calculating resting lnRMSSD HRV metrics.

Image Translation by Ad CycleGAN for COVID-19 X-Ray Images: A New Approach for Controllable GAN.

We propose a new generative model named adaptive cycle-consistent generative adversarial network, or Ad CycleGAN to perform image translation between normal and COVID-19 positive chest X-ray images. An independent pre-trained criterion is added to the conventional Cycle GAN architecture to exert adaptive control on image translation. The performance of Ad CycleGAN is compared with the Cycle GAN without the external criterion. The quality of the synthetic images is evaluated by quantitative metrics including Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Peak Signal-to-Noise Ratio (PSNR), Universal Image Quality Index (UIQI), visual information fidelity (VIF), Frechet Inception Distance (FID), and translation accuracy. The experimental results indicate that the synthetic images generated either by the Cycle GAN or by the Ad CycleGAN have lower MSE and RMSE, and higher scores in PSNR, UIQI, and VIF in homogenous image translation (i.e., Y → Y) compared to the heterogenous image translation process (i.e., X → Y). The synthetic images by Ad CycleGAN through the heterogeneous image translation have significantly higher FID score compared to Cycle GAN (p < 0.01). The image translation accuracy of Ad CycleGAN is higher than that of Cycle GAN when normal images are converted to COVID-19 positive images (p < 0.01). Therefore, we conclude that the Ad CycleGAN with the independent criterion can improve the accuracy of GAN image translation. The new architecture has more control on image synthesis and can help address the common class imbalance issue in machine learning methods and artificial intelligence applications with medical images.

Attention Performance as an Embedded Validity Indicator in the Cognitive Assessment of Early Retirement Claimants

The assessment of performance validity is essential in any neuropsychological evaluation. However, relatively few measures exist that are based on attention performance embedded within routine cognitive tasks. The present study explores the potential value of a computerized attention test, the Cognitrone, as an embedded validity indicator in the neuropsychological assessment of early retirement claimants. Two hundred and sixty-five early retirement claimants were assessed with the Word Memory Test (WMT) and the Cognitrone. WMT scores were used as the independent criterion to determine performance validity. Speed and accuracy measures of the Cognitrone were analyzed in receiver operating characteristics (ROC) to classify group membership. The Cognitrone was sensitive in revealing attention deficits in early retirement claimants. Further, 54% (n = 143) of the individuals showed noncredible cognitive performance, whereas 46% (n = 122) showed credible cognitive performance. Individuals failing the performance validity assessment showed slower (AUC = 79.1%) and more inaccurate (AUC = 79.5%) attention performance than those passing the performance validity assessment. A compound score integrating speed and accuracy revealed incremental value as indicated by AUC = 87.9%. Various cut scores are suggested, resulting in equal rates of 80% sensitivity and specificity (cut score = 1.297) or 69% sensitivity with 90% specificity (cut score = 0.734). The present study supports the sensitivity of the Cognitrone for the assessment of attention deficits in early retirement claimants and its potential value as an embedded validity indicator. Further research on different samples and with multidimensional criteria for determining invalid performance are required before clinical application can be suggested.

Kidney Transplantation and Obesity: Are There Any Differences in Outcomes?

Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Obesity is a strong risk factor for developing cardiovascular disease, chronic kidney disease, and ESRD. This study aimed to investigate the outcomes of kidney transplantation in obese recipients. We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of a kidney allograft with BMI ≥ 30 were compared with the outcomes in recipients with 30 < BMI. A total of 467 consecutive kidney transplantation recipients' files were studied. 213 (45.6%) allograft recipients had a BMI ≥ 30, and 254 (54.4%) allograft recipients had a BMI < 30. DGF rate was 29.1% in the BMI ≥ 30 and 30.7% in the BMI < 30 group (P = 0.41). On the other hand, 30days readmission rate also did not show a significant difference between the BMI ≥ 30 and BMI < 30 allograft recipients (37 vs. 33.8%, P = 0.46). The mean overall costs of transplantation in the BMI ≥ 30 group was $254,395, and it was $256,029 in the BMI < 30 group (P = 0.84). Our study shows that the outcomes of renal allograft transplant were comparable between recipients with BMI ≥ 30 and BMI < 30 in terms of DGF, LOS, 30days readmission, acute rejection rate, and survival rates, and BMI should not be a single independent criterion for decision making to select an optimal recipient.

Znaczenie grożącej oskarżonemu surowej kary w podejmowaniu decyzji w przedmiocie tymczasowego aresztowania

This article is of a scientific nature, that employs a dogmatic method. The aim of the study is to establish the status and function of the severity of penalty under Article 258 § 2 of the Code of Criminal Procedure (hereinafter: the CCP) in making decisions on the application of pre-trial detention. This issue is controversial both in doctrine and jurisprudence. The text presents a new approach that Article 258 § 2 of the CCP does not set out a specific premise for the imposition of pre-trial detention. This provision cannot express an independent criterion for imposing the most severe preventive measure as Article 258 § 2 of the CCP is of auxiliary character. It expresses an auxiliary criterion for determining whether the special premises for imposing pre-trial detention under Article 258 § 2 of the CCP have been realized. The proposals contained in the article are intended to facilitate the interpretation of national provisions on coercive measures and to facilitate their application in the practice of the judiciary. The article indicates the factors that are important in assessing whether the likelihood of imposing severe punishment crystalizes the risk of fleeing, hiding or obstructing justice. For the application of pre-trial detention there may be arguments, i.a., pertaining to the nature of the offense alleged. In this context, it should be important whether the potential perpetrator is charged with a crime with a use of violence or threat thereof. His posture in the course of criminal proceedings so far is also not without significance. It may be, however, that the likelihood of imposing severe penalty may give rise to the fear of obstruction of justice even in a situation where the accused, who knew about the pending criminal case, did not take any unlawful action. Nevertheless, the correct posture of the accused in the course of criminal proceedings will often be a significant factor against the use of pre-trial detention.

A strong construction of S-box using Mandelbrot set an image encryption scheme.

The substitution box (S-box) plays a vital role in creating confusion during the encryption process of digital data. The quality of encryption schemes depends upon the S-box. There have been several attempts to enhance the quality of the S-box by using fractal chaotic mechanisms. However, there is still weakness in the robustness against cryptanalysis of fractal-based S-boxes. Due to their chaotic behavior, fractals are frequently employed to achieve randomness by confusion and diffusion process. A complex number-based S-box and a chaotic map diffusion are proposed to achieve high nonlinearity and low correlation. This study proposed a Mandelbrot set S-box construction based on the complex number and Chen chaotic map for resisting cryptanalytic attacks by creating diffusion in our proposed algorithm. The cryptosystem was built on the idea of substitution permutation networks (SPN). The complex nature of the proposed S-box makes it more random than other chaotic maps. The robustness of the proposed system was analyzed by different analysis properties of the S-box, such as nonlinearity, strict avalanche criterion, Bit independent criterion, and differential and linear probability. Moreover, to check the strength of the proposed S-box against differential and brute force attacks, we performed image encryption with the proposed S-box. The security analysis was performed, including statistical attack analysis and NIST analysis. The analysis results show that the proposed system achieves high-security standards than existing schemes.

Evidence-Based Treatment of Severe Psoriasis by Individualised Homoeopathy: Case Reports

AbstractPsoriasis is a chronic skin disease with manifestations in skin, nails and joints. The disease usually runs a long course of remission and relapses, and is usually worse in winters. Psoriasis Area and Severity Index (PASI) score above 15 is considered to be an independent criterion for classifying a case as severe psoriasis. The conventional systemic therapy controls the symptoms but is costly and has known adverse effects. Individualised homoeopathic treatment has a potential role in providing safe and cost-effective treatment in psoriasis. In this article, three cases of severe psoriasis vulgaris treated with Homoeopathy at Bakson Homoeopathic Medical College and hospital are presented. Two cases were under treatment for a period of 20 months and one case received treatment for 24 months. Significant reduction (60–100%) in PASI score was observed with individualised homoeopathic treatment.

A-227 A Story Told in Four Parts: Embedded Validity Indicators’ Effectiveness in Predicting Dot Counting Test Validity Classification

Abstract Objective: Combining multiple embedded performance validity tests (PVTs) can produce similar classification accuracy to freestanding PVTs. However, there is a lack of research on the incremental predictive power of various combinations of PVTs. Thus, we compared eight embedded PVTs to assess those that best predict classification accuracy on the Dot Counting Test (DCT). Method: Sample included 225 patients (mean age=45.96; mean education=13.96; 56% female, 44% male; 35% White, 40% Black, 17% Hispanic, 5% Asian, 2% Other) undergoing neuropsychological evaluation that included multiple embedded PVTs, including: Brief Visuospatial Memory Test-Revised Recognition Discrimination (BVMT-R RD), Stroop Color and Word Test Word Reading T-Score (Stroop-T), Trail Making Test Part A T-Score (TMT-A), Rey Auditory Verbal Learning Test (RAVLT) Forced Choice, RAVLT Effort Score, Digit Span Age Corrected Scaled Score, Reliable Digit Span, and Letter Fluency T-Score. Patients were classified into valid/invalid groups based on four independent criterion PVTs. Results: A forward stepwise logistic regression was performed to predict DCT pass/fail using the aforementioned embedded PVTs as predictors. The model was achieved in three steps (p&amp;lt;.05); Step 1: BVMT-R RD (Classification Accuracy=87.6%; Nagelkerke R2 =.30), Step 2: BVMT-R RD + Stroop-T (Classification Accuracy=89.6%; Nagelkerke R2 =.44); Step 3: BVMT-R RD + Stroop-T + TMT-A (Classification Accuracy=90.1%; Nagelkerke R2 =.49). Conclusion: BVMT-R RD + Stroop-T + TMT-A reliably predicted the DCT pass/fail group. Thus, this combination of embedded PVTs may be reliable predictors of validity classification when time prohibits delivery of freestanding PVTs, such as the DCT.

How should ICU beds be allocated during a crisis? Evidence from the COVID-19 pandemic

BackgroundThe first wave of the COVID-19 pandemic overwhelmed healthcare systems in many countries, and the rapid spread of the virus and the acute course of the disease resulted in a shortage of intensive care unit (ICU) beds. We studied preferences of the public in the Netherlands regarding the allocation of ICU beds during a health crisis.MethodsWe distributed a cross-sectional online survey at the end of March 2020 to a representative sample of the adult population in the Netherlands. We collected preferences regarding the allocation of ICU beds, both in terms of who should be involved in the decision-making and which rationing criteria should be considered. We conducted Probit regression analyses to investigate associations between these preferences and several characteristics and opinions of the respondents.ResultsA total of 1,019 respondents returned a completed survey. The majority favored having physicians (55%) and/or expert committees (51%) play a role in the allocation of ICU beds and approximately one-fifth did not favor any of the proposed decision-makers. Respondents preferred to assign higher priority to vulnerable patients and patients who have the best prospect of full recovery. They also preferred that personal characteristics, including age, play no role.Conclusion“Our findings show that current guidelines for allocating ICU beds that include age as an independent criterion may not be consistent with societal preferences. Age may only play a role indirectly, in relation to the vulnerability of patients and their prospect of full recovery. Allocation of ICU beds during a health crisis requires a multivalue ethical framework.”

Multivariable analysis of the relative utility and additive value of eight embedded performance validity tests for classifying invalid neuropsychological test performance

ABSTRACT Introduction This study investigated a combination of eight embedded performance validity tests (PVTs) derived from commonly administered neuropsychological tests to optimize sensitivity/specificity for detecting invalid neuropsychological test performance. The goal of this study was to evaluate what combination of these common embedded PVTs that have the most robust predictive power for detecting invalid neuropsychological test performance in a single diverse clinical sample. Method Eight previously validated memory- and nonmemory-based embedded PVTs were examined among 231 patients undergoing neuropsychological evaluation. Patients were classified into valid/invalid groups based on four independent criterion PVTs. Embedded PVT accuracy was assessed using standard and stepwise multiple logistic regression models. Results Three PVTs, the Brief Visuospatial Memory Test-Revised Recognition Discrimination (BVMT-R-RD), Rey Auditory Verbal Learning Test Forced Choice, and WAIS-IV Digit Span Age Corrected Scaled Score, predicted 45.5% of the variance in validity group membership. BVMT-RD independently accounted for 32% of the variance in prediction of independent, criterion-defined validity group membership. Conclusions This study demonstrated the incremental predictive power of multiple embedded PVTs derived from common neuropsychological measures in detecting invalid test performance and those measures accounting for the greatest portion of the variance. These results provide guidance for evaluating the most fruitful embedded PVTs and proof of concept to better guide selection of embedded validity indices. Further, this offers clinicians an efficient, empirically derived approach to assessing performance validity when time restraints potentially limit the use of freestanding PVTs.

Nonlinearity of nonbalanced and nearly bent boolean functions based on Galois ring

Designing of nonlinear confusion component of block cipher is one of the most important and inevitable research problem. Nowadays mostly heuristic search schemes were utilized for the construction of these confusion component. To construct, a cryptographically secure confusion component several algebraic structures were utilized. The thirst for new algebraic structure for the construction of these nonlinear confusion component has always been a point of interest. In this communication, we have utilized a maximal cyclic subgroup of unit of Galois ring. The offered algorithm is more general as compared to Galois field. The class of Boolean functions over Galois ring fall in mixed category which are not completely balanced. Boolean functions having higher nonlinearity and others cryptographic aspects added an inevitable significance in the construction of modern block ciphers. The primary idea of this article is to structure non-balanced Boolean functions on n variables, where n is an even integer, sustaining strict avalanche criterion (SAC) and bit independent criterion (BIC). By comparing SAC with available cryptographic Boolean functions, the constructed multivalued Boolean function acquire highest nonlinearity which does not follow the existing nonlinearity bound of Boolean functions. These newly proposed S-boxes consists of n basic Boolean functions which satisfy the balancedness and non-balancedness criterion. Therefore, these S-box structure lies within a less balanced and more bent Boolean function categories.

Revisiting the Timeline of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: Toward a Temporal Risk Profile

BackgroundDelayed cerebral ischemia (DCI) is one of the main determinants of clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). The classical description of risk for DCI over time is currently based on the outdated concept of angiographic vasospasm. The goal of this study was to assess the temporal risk profile of DCI, defined by extended clinical and radiological criteria, as well as the impact the time point of DCI onset has on clinical outcome.MethodsAll patients with aneurysmal SAH referred to a single tertiary care center between 2010 and 2018 were considered for inclusion. This study was designed as a retrospective cohort analysis and data were extracted from existing patient files. In conscious patients, DCI was diagnosed clinically, and in unconscious patients, diagnosis was based on perfusion computed tomography imaging and multimodal neuromonitoring. Extended Glasgow Outcome Scale scores were assessed after 12 months and compared between patients with early (< day 7) and late (≥ day 7) DCI onset.ResultsThe median delay from day of the hemorrhage (day 0) until detection of the first DCI event was 7.0 days, with an interquartile range of 5 days. The probability of DCI development over time demonstrated a bimodal distribution with a peak risk on day 5 (0.084; confidence interval 0.05.5–0.122) and a second peak on day 9 (0.077; confidence interval 0.045–0.120). A total of 27 patients (15.6%) suffered dominant hemispheric or severe bilateral DCI-related infarctions, resulting in the withdrawal of technical life support. Of those, the majority (20 patients, 22.2%) presented with early DCI onset (vs. late onset: 7 patients, 8.4%; p = 0.013).ConclusionsThe risk profile of DCI over time mirrors the description of angiographic vasospasm; however, it comes with an added timely delay of 1 to 2 days. Early occurrence of DCI (before day 7) is associated with a higher infarct load and DCI-related mortality. Although the exact causal relationship remains to be determined, the time point of DCI onset may serve as an independent prognostic criterion in decision-making.