Inherent Risk Research Articles

Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success.

Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.

CASE SERIES OF DILATED CARDIOMYOPATHY STUDIED WITH WHOLE GENOME SEQUENCING

Objective: The explanation of the genetic aspects of dilatative cardiomyopathy (DCM) is important for at least two major reasons: 1. there is a phenotypic and clinical overlap between the various cardiomyopathies with DCM - thus it might be suggested DCM may be an end phenotype; 2. genetic predisposition to DCM might render the myocardium susceptible to various exogenous factors such as infections, alcohol, toxins, etc. Design and method: We share the results from the Next Gene sequencing of 10 patients with DCM. They were of various ages, with the inclusion requirement to be without coronary or hypertensive disease, and clinical manifestations of the DCM from yearly age. Bioinformatics analysis of the data was done with the appropriate protocol on a Dragen server, as well as VarSeq (Goldenhelix) for all NGS data. Results: This case series of Caucasian patients with DCM presented with mutations in TTN, TTN-AS1, SCN5A, RYR2, DSG2, DSG2-AS1, FLNC, LAMA4, ACTN2, GATA6, DMD genes. All these genes are responsible for structural sarcomere, nucleus proteins or ion transporters. They are common also in arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy, muscular dystrophy and Brugada syndrome. Omim search found them as VUS or weak pathogenic and only a mutation in TTN as likely pathogenic. Nevertheless, the cumulation of data for the genetic aspects of cardiomyopathies is important. The echocardiographic ejection fraction of the patients varied with the medical treatment and could not be used as guiding in their risk assessment. Conclusions: As far as the ejection fraction and left ventricular morphology are modifiable factors, we need a more specific way to assess the inherent risk in our cardiac patients. NGS might provide the necessary information, but we need to accumulate clinical and genetic data to make specific cardiomyopathy risk profiles. These risk profiles should be based on genetic analysis and not on ejection fraction or other morphological criteria, as we have cardiomyopathies’ overlap.

Evaluation of bleeding risk between apixaban and rivaroxaban in patients with gastrointestinal cancer.

e16323 Background: Patients with cancer are at a higher risk for developing venous thromboembolisms (VTEs), leading to further complications. The National Comprehensive Cancer Network (NCCN) guidelines currently recommend using low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) for the treatment of VTEs in oncology patients. Other trials compare DOACs with LMWH to determine the risk of bleeding. The Select-D trial found that rivaroxaban had a higher risk of bleeding in patients with gastrointestinal (GI) cancer as compared to LMWH. However, the Caravaggio trial found that apixaban had no increase of bleeding for patients with GI cancer. Due to the inherent risk of major bleeding shown in the subgroup analysis of the trials above, the guidelines recommend LMWH as the preferred agent for patients with GI cancers. At Winship Cancer Institute, DOACs are used for the treatment of cancer-associated VTE for patients with GI malignancies. The purpose of this study was to assess real-world safety outcomes of patients with GI cancer who were treated with apixaban or rivaroxaban for VTE. Methods: This study is a single-center, retrospective chart review of patients 18 years or older with GI cancer receiving treatment for VTE with either apixaban or rivaroxaban. The study looks to review bleeding outcomes in patients who started their VTE treatment from January 1, 2017 – December 31, 2021. The primary outcome of this study was to evaluate the rates of major bleeding between apixaban and rivaroxaban. Major bleeding was defined as a decrease in hemoglobin of ≥ 2g/dL over 24 hours, transfusion of ≥2 units of red blood cells, bleeding that requires surgical intervention, or bleeding at critical sites. Secondary outcomes included clinically relevant non-major bleeding (CRNMB) defined by bleeding compromising hemodynamics, hematemesis, hemoptysis, rectal bleeding, or hematuria, VTE recurrence, and death from bleeding. Data collected to measure these outcomes included patient characteristics such as renal function, weight, primary cancer site, medication dosing, and duration and indication of treatment. Results: A total of 300 patients qualified for inclusion of this study. Of these, 89 were in the apixaban group and 211 in the rivaroxaban group. Major bleeding occurred in 3 patients in the apixaban group (3.4%) and 18 in the rivaroxaban group (8.5%). CRNMB occurred in 2 patients in the apixaban group (2.2%) and 16 patients in the rivaroxaban group (7.6%). VTE recurrence occurred in 4 patients in the apixaban group (4.5%) and 9 patients in the rivaroxaban group (4.3%). Conclusions: This is the only study to date to evaluate DOACs head to head and their bleeding risk in cancer patients. Apixaban was associated with lower rates of major bleeds and CRNMB, but relatively similar rates of VTE recurrence. The results of this study warrant consideration of using DOACs for patients with GI cancers in the upfront setting.

Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy.

Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase in short-term and long-term mortality. In addition, in recent decades, there has been an exponential increase in the use of diagnostic and therapeutic GI endoscopic procedures. Since endoscopic procedures hold an inherent risk of bleeding that depends on the type of endoscopy and patients' comorbidities, in patients already on antithrombotic therapies, the risk of procedure-related bleeding is further increased. Interrupting or modifying doses of these agents prior to any invasive procedures put these patients at increased risk of thromboembolic events. Although many international GI societies have published guidelines for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures, no Indian guidelines exist that cater to Indian gastroenterologists and their patients. In this regard, the Indian Society of Gastroenterology (ISG), in association with the Cardiological Society of India (CSI), Indian Academy of Neurology (IAN) and Vascular Society of India (VSI), have developed a "Guidance Document" for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures.

The evaluation of supply chain risk management on smallholder layer farms

The layer farming has been a vital element in our economy as the sector does not only provide large number of employments for smallholder farmers but also supply food provision that support our national’s food security and dignity. However, this sector is prone to risk as high uncertainty lies on the production of eggs. Market price volatility, food scarcity, extreme weather, soaring price of raw materials are some risks that can disrupt the sustainability of the supply chain of egg productions. It is essentially important for smallholder farmers to incorporate risk management approach in their egg productions. This research employs a supply chain operational reference (SCOR) and house of risk (HOR) methodology to identify, assess and evaluate the inherent risk that lies on egg productions managed by smallholder farmers. HOR phase I were able to identify 25 risk events and 45 risk agents, while HOR phase II were able to identify 4 risk agents which represented 20% of ARP score. Finally, this research was able to propose 4 preventive actions (PA) to mitigate the risk of egg productions by smallholder farms.

P62: A Unique case of Transcatheter aortic valve replacement dislodgement in the presence of a durable left ventricular assist device

Background: Transcatheter aortic valve replacement [TAVR] for severe pure aortic insufficiency [AI] in the presence of a durable left ventricular assist device [LVAD] is fraught with challenges. We report an interesting case of TAVR valve dislodgement by the LVAD that was treated with redeployment of another TAVR valve, and redo surgery for extraction of the intraventricular TAVR valve. Methods and Results: A 46-year-old man presented to our unit in cardiogenic shock [CS] and severe pulmonary hypertension [PH] of 72/45mmHg. He underwent placement of an Impella 5.5 [Abiomed, Danvers, MA] as a bridging strategy to treat his CS and PH while transplant candidacy was being assessed. However, he remained pulmonary hypertensive with a trans-pulmonary gradient 26mmHg and pulmonary vascular resistance 5.3 wood units, despite 14 days of impella 5.5 therapy combined with aggressive management with milrinone 0.25 mcg/kg/min and bumetanide infusion 1mg/hr. He therefore underwent implantation of heart mate 3 [HM3] LVAD [Abbott Laboratories, Chicago, IL] by a limited left thoracotomy in the 5th intercostal space and upper ‘inverse-T’ hemi-sternotomy into the fourth intercostal space. His postoperative course was complicated by requirement for 31mm percutaneous Protek Duo [LivaNova, London, UK] Right VAD [RVAD] for 32 days, and gastrointestinal bleeding requiring cessation of heparin therapy, which prompted formation of thrombus in the left coronary cusp of the aortic valve. Organization of this thrombus and consequent retraction of the left coronary leaflet led to severe AI and consequent CS, requiring inotropic support and discussion on optimal management strategy. He underwent TAVR with a 29mm Edwards Sapien 3 valve [Edwards Lifesciences, Irvine, CA] with 20% over-sizing, which got dislodged and migrated into the LV. Another 29mm Edwards Sapien 3 TAVR valve was successfully deployed. The patient was then placed on cardiopulmonary bypass via the femoral vessels, and the left thoracotomy was reopened. The LVAD was temporarily stopped, and the latch mechanism on the HM3 was opened. The HM3 was removed from the sewing cuff, and the TAVR valve was ‘fished-out’ from the cavity of the LV. The HM3 was reinserted and restarted after thorough de-airing through the outflow graft. The incisions were closed in a standard manner and the patient was discharged home on the 20th postoperative day. Conclusions: TAVR for severe AI in the presence of a durable LVAD is fraught with challenges due to the constant suction action of the LVAD, and the absence of calcium in the native annulus to anchor the prosthesis. Our case highlights the feasibility of extricating a dislodged TAVR valve through simple redo-surgery. With this approach, we managed to avoid a more conventional redo procedure involving administration of cardioplegia for a surgical AVR or for extricating the prosthesis, with its inherent risk of right ventricular failure requiring RVAD. Figure showing dislodged TAVR on the left and redeployment on the right

Evaluasi Manajemen Risiko Proyek Konstruksi Terhadap Biaya Operasional Proyek Menggunakan Metode AHP

Purpose: This study aims to evaluate the risk management of the PT X project in order to reduce the impact of project operational cost overruns. Inherent risk during project implementation at PT X has been managed by implementing risk management referring to ISO 31000:2018. However, there are changes in risks that arise during the implementation of construction projects which cause changes in the risk profile. Methodology/Approach: The uniqueness of this research is a case study with a mixed-method approach which is analyzed using the AHP method. Findings: The results of this study state that there are seven project risk factors consisting of quality risk, economic and financial risk, technical risk, OSH risk, social risk, non-technical risk, and human resource risk. The seven factors are divided into 21 sub-factors of project risk at PT X. Practical and Theoretical Contribution/Originality: This article contributes to the updating of the relevant risk assessments in the project. Research Limitation: The limitation of this research is that the scope is only the risk management of the project implementation phase.

Deep learning and hyperparameter optimization for assessing one’s eligibility for a subcutaneous implantable cardioverter-defibrillator

It is standard cardiology practice for patients suffering from ventricular arrhythmias (the main cause of sudden cardiac death) belonging to high risk populations to be treated via the implantation of Subcutaneous Implantable cardioverter-defibrillators (S-ICDs). S-ICDs carry a risk of so-called T wave over sensing (TWOS), which can lead to inappropriate shocks that carry an inherent health risk. For this reason, according to current practice patients’ Electrocardiograms (ECGs) are manually screened by a cardiologist over 10 s to assess the T:R ratio—the ratio between the amplitudes of the T and R waves which is used as a marker for the likelihood of TWOS—with a plastic template. Unfortunately, the temporal variability of a patient’ T:R ratio can render such a screening procedure, which relies on an inevitably short ECG segment due to its manual nature, unreliable. In this paper, we propose and investigate a tool based on deep learning for the automatic prediction of the T:R ratios from multiple 10-second segments of ECG recordings capable of carrying out a 24-hour automated screening. Thanks to the significantly increased screening window, such a screening would provide far more reliable T:R ratio predictions than the currently utilized 10-second, template-based, manual screening is capable of. Our tool is the first, to the best of our knowledge, to fully automate such an otherwise manual and potentially inaccurate procedure. From a methodological perspective, we evaluate different deep learning model architectures for our tool, assess a range of stochastic-gradient-descent-based optimization methods for training their underlying deep-learning model, perform hyperparameter tuning, and create ensembles of the best performing models in order to identify which combination leads to the best performance. We find that the resulting model, which has been integrated into a prototypical tool for use by clinicians, is able to predict T:R ratios with very high accuracy. Thanks to this, our automated T:R ratio detection tool will enable clinicians to provide a completely automated assessment of whether a patient is eligible for S-ICD implantation which is more reliable than current practice thanks to adopting a significantly longer ECG screening window which better and more accurately captures the behavior of the patient’s T:R ratio than the current manual practice.

Foregrounding digital realities at the locked down raced margins: a culture-centered case study in Aotearoa

ABSTRACT COVID-19 lockdowns compelled an increased use of information and communication technologies within the home, allowing users to remotely retrieve information and socially connect with one another. However, there was the inherent risk that lockdowns could amplify digital inequalities, especially among low-income ethnic minorities who had higher hesitancy to adopt COVID-19 interventions and poorer clinical outcomes from COVID-19 than the general population. Guided by the culture-centered approach, the present study explores experiences of information and communication technologies and information seeking during a COVID-19 lockdown among Afghan refugee women. We draw from 37 in-depth interviews with community members to show how information and communication technologies offered a means for social connection but simultaneously could (re)produce marginality and communication inequality, with some residents struggling to access information amidst the pandemic. The findings inform a discussion about the role of information and communication technologies as health resources among Afghan refugees that is situated amidst local interplays of culture and structure.

Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors.

Cerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation. The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy. Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging. Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [n = 2/52 (4%)] or an isolated intraventricular hemorrhage [n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation. The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.

Between Scylla and Charybdis: thrombosis in children with hemophilia.

Thromboembolism is an infrequent complication in children with hemophilia that has been traditionally associated with the presence of a central venous access device. Novel rebalancing agents have shown promising results as prophylactic therapies to minimize the risk of bleeding but both thromboembolism and thrombotic microangiopathy have been reported as complications. The management of thrombosis in children with hemophilia is particularly challenging given the inherent risk of bleeding. In this paper, we present clinical vignettes to review the literature, highlight challenges, and describe our approach to managing thromboembolism in children with hemophilia.

Sustained-Release Vildagliptin 100 mg in Type 2 Diabetes Mellitus: A Review.

Dipeptidyl peptidase-4 inhibitors (DPP4Is) were introduced into the management of type 2 diabetes mellitus (T2DM) as they are insulinotropic and have no inherent risk of hypoglycemia and no effect on body weight. Currently, 11 drugs in this class are available for the management of diabetes. Although they have a similar mechanism of action, they differ from one other in their binding mechanisms, which influences their therapeutic and pharmacological profiles. Vildagliptin's overall safety and tolerability profile was comparable to placebo throughout clinical studies, and real-world data in a large group of T2DM patients corroborated this finding. Therefore, DPP4Is like vildagliptin is a secure alternative for treating patients with T2DM. Vildagliptin treatment given as a once-daily (QD) 100 mg sustained release (SR) formulation fits the criteria of adherence and compliance. This SR formulation, given once daily has the potential to provide glycemic control like the vildagliptin 50 mg twice-daily (BD) formulation. This comprehensive review discusses the journey of vildagliptin as 50 mg BD therapy as well as 100 mg SR QD therapy.

Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis.

Pre-conceptual comorbidities, an inherent risk of graft loss, rejection during pregnancy, and the postpartum period in women with thoracic lung transplant may predispose them to increased risk of adverse feto-maternal outcomes. The study aimed to systematically analyze and assess the risk of adverse pregnancy outcomes in women with thoracic organ transplant. MEDLINE, EMBASE, and Cochrane library were searched for publication between January 1990 and June 2020. Risk of bias was assessed using Joanna Briggs critical appraisal tool for case series. The primary outcomes included maternal mortality and pregnancy loss. The secondary outcomes were maternal complications, neonatal complications, and adverse birth outcomes. The analysis was performed using the DerSimonian-Laird random effects model. Eleven studies captured data from 275 parturient with thoracic organ transplant describing 400 pregnancies. The primary outcomes included maternal mortality {pooled incidence (95% confidence interval) 4.2 (2.5-7.1) at 1year and 19.5 (15.3-24.5) during follow-up}. Pooled estimates yielded 10.1% (5.6-17.5) and 21.8% (10.9-38.8) risk of rejection and graft dysfunction during and after pregnancy, respectively. Although 67% (60.2-73.2) of pregnancies resulted in live birth, total pregnancy loss and neonatal death occurred in 33.5% (26.7-40.9) and 2.8% (1.4-5.6), respectively. Prematurity and low birth weight were reported in 45.1% (38.5-51.9) and 42.7% (32.8-53.2), respectively. Despite pregnancies resulting in nearly 2/3rd of live births, high incidence of pregnancy loss, prematurity and low birth weight remain a cause of concern. Focused pre-conceptual counseling to avoid unplanned pregnancy, especially in women with transplant-related organ dysfunctions and complications, is vital to improve pregnancy outcomes. CRD42020164020.

Governing fiduciary relationships or building up a governance model for trust in AI? Review of healthcare as a socio-technical system

ABSTRACT ‘: Fiduciary law aims to mitigate the inherent risk of ‘trust’, which helps restore interpersonal trust. It remains to be answered how trust should be governed in an AI-driven socio-technical system where technical and social factors are involved including interpersonal relationships and AI-human interactions. Taking interpersonal trust as the backdrop of analysis, this article seeks answers to this question focusing on healthcare. It firstly draws a conceptual framework regarding 'trust' and investigates its interplay with AI as well as examines how it is governed under the fiduciary law. Subsequently, it upholds a socio-technical system perspective, examining how to enable and sustain trust in an AI-driven socio-technical system. A governance model is then developed to elicit ‘intrinsic’, ‘dynamic’ and ‘ethical’ values of trust attributed to various elements under a tri-partite framework. It is recognised that findings of the literature as to trust, its trajectory and implications can be implemented within the proposed framework. Furthermore, it brings novelty by re-conceptualising the elements of 'trust' and associated values, marking distinction to its interpersonal roots and fiduciary relationships. It is considered this governance model, by upholding a holistic viewpoint, provides a generalisable framework that can construct, maintain and restore trust in AI-driven socio-technical systems.

Application of machine learning tools and integrated OMICS for screening and diagnosis of inborn errors of metabolism

Tandem mass spectrometry (TMS) has emerged an important screening tool for various metabolic disorders in newborns. However, there is inherent risk of false positive outcomes. Objective To establish analyte-specific cutoffs in TMS by integrating metabolomics and genomics data to avoid false positivity and false negativity and improve its clinical utility. TMS was performed on 572 healthy and 3000 referred newborns. Urine organic acid analysis identified 23 types of inborn errors in 99 referred newborns. Whole exome sequencing was performed in 30 positive cases. The impact of physiological changes such as age, gender, and birthweight on various analytes was explored in healthy newborns. Machine learning tools were used to integrate demographic data with metabolomics and genomics data to establish disease-specific cut-offs; identify primary and secondary markers; build classification and regression trees (CART) for better differential diagnosis; for pathway modeling. This integration helped in differentiating B12 deficiency from methylmalonic acidemia (MMA) and propionic acidemia (Phi coefficient=0.93); differentiating transient tyrosinemia from tyrosinemia type 1 (Phi coefficient=1.00); getting clues about the possible molecular defect in MMA to initiate appropriate intervention (Phi coefficient=1.00); to link pathogenicity scores with metabolomics profile in tyrosinemia (r2=0.92). CART model helped in establishing differential diagnosis of urea cycle disorders (Phi coefficient=1.00). Calibrated cut-offs of different analytes in TMS and machine learning-based establishment of disease-specific thresholds of these markers through integrated OMICS have helped in improved differential diagnosis with significant reduction of the false positivity and false negativity rates.

Research on the Classification of Inherent Risks of Cranes Based on Interval Laminar Analysis Method-Index Method

In order to ensure the safe operation of cranes, from the perspective of the definition of inherent risk, the evaluation index of inherent risk of cranes was established. The interval hierarchy analysis method with better fuzziness was used to determine the index weights, determine the index scores of different levels, and use the integrated index method to establish a grading model, which was divided into four inherent risk levels according to the risk critical value. Application of the model to two cranes for example analysis, the results show that the model has good accuracy. The model provided a more scientific method for grading the inherent risk of cranes, which in turn provided a method of reference for grading the inherent risk of other types of special equipment.

C-36 | Comparison of Systemic Thrombolysis and Mechanical Thrombectomy in COVID-19–Related Pulmonary Embolism

Pulmonary embolism (PE) is a complication that can occur in individuals with COVID-19 because of the inherent thrombogenic risk. Systemic thrombolysis and mechanical thrombectomy are treatment modalities employed for PE with hemodynamic instability. Data were extracted from the National Inpatient Sample (NIS) 2020 Database. The NIS was searched for hospitalizations for PE and co-existing COVID infection. Systemic thrombolysis and mechanical thrombectomy were identified using appropriate ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are shown in Figure 1. Multivariable logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Of 46,965 patients with PE related to COVID, 1260 received systemic thrombolysis, and 320 had mechanical thrombectomy. The mechanical thrombectomy group had lower odds of inpatient mortality (0.06, 95% CI 0.02 – 0.15, p<0.001), cardiac arrest (0.08, 95% CI 0.01 – 0.52, p=0.008), vasopressor use (0.07, 95% CI 0.02 – 0.25, p<0.001) and acute renal failure (0.27, 95% CI 0.13 – 0.53, p<0.001) compared to systemic thrombolysis group. The odds of intracranial hemorrhage were the same between the two groups (p=0.565). Patients having mechanical thrombectomy had shorter hospital stay (mean difference 3.6 days, p<0.001) and lower hospital charge (mean difference 104,395 USD, p<0.001). Mechanical thrombectomy in COVID-related PE leads to better patient outcomes; especially inpatient mortality, cardiac arrest, vasopressor use, and acute renal failure compared to systemic thrombolysis.

Does explanatory language convey the auditor’s perceived audit risk? A study using a novel big data analysis metric

PurposeThe purpose of this study is to examine the relationship between explanatory language, audit fees and audit hours to demonstrate that auditors use explanatory language in audit reports to explain perceived audit risk.Design/methodology/approachThe authors construct the sentiment value, a novel audit risk proxy derived from audit reports, using big data analysis. The relationship between sentiment value and explanatory language is then investigated. The authors present the validity of their new metric by examining the relationship between sentiment value and accounting quality, taking audit fees and hours into account.FindingsThe authors first find that reporting explanatory language is positively related to audit fees. More importantly, the authors provide an evidence that explanatory language in audit reports is indicative of increased audit risk as it is negatively correlated with sentiment value. As a positive (negative) sentimental value means that the audit risk is low (high), the results indicate that auditors describe explanatory language in a negative manner to convey the inherent audit risk and receive higher audit fees from the risky clients. Furthermore, the relationship is strengthened when the explanatory language is more severe, such as reporting the multiple numbers of explanatory language or going-concern opinion. Finally, the sentiment value is correlated with accounting quality, as measured by the absolute value of discretionary accruals.Originality/valueContrary to previous research, the authors’ findings suggest that auditors disclose audit risks of client firms by including explanatory language in audit reports. In addition, the authors demonstrate that their new metric effectively identifies the audit risk outlined qualitatively in audit report. To the best of the authors’ knowledge, this is the first study that establishes a connection between sentiment analysis and audit-related textual data.

Easy does it: pressing the right buttons in public access to documents of the EU

This article makes two claims regarding what is relevant in 2022 to the future of Regulation 1049/2001. The first is that an about-turn in the case law of the Court of Justice of the European Union (CJEU) has partly altered the formal scope of the EU policy concerning public access to documents (PAD) from document to information (PAI). This change in scope affects documents included in digital databases or other documents held in digital form but not the acquis regarding printed-on-paper documents. Second, we observe an uncomfortable stasis currently affecting both the EU judiciary and the Ombudsman. On the one hand, the judiciary remains imprisoned, without an alternative, within the bounds of insufficient remedial depth, i.e., concerning the action for annulment. Conversely, regarding the Ombudsman’s role, classical recommendations have proved insufficient to drive EU access policy. Interestingly, in reaction to suggestions that binding powers be considered for the Ombudsman, even the current head of this institution demurs. Such a proposal carries an inherent serious risk of cognitive dissonance between the EU framework and national frameworks.

Electromagnetic Sensing Techniques for Monitoring Atopic Dermatitis-Current Practices and Possible Advancements: A Review.

Atopic dermatitis (AD) is one of the most common skin disorders, affecting nearly one-fifth of children and adolescents worldwide, and currently, the only method of monitoring the condition is through an in-person visual examination by a clinician. This method of assessment poses an inherent risk of subjectivity and can be restrictive to patients who do not have access to or cannot visit hospitals. Advances in digital sensing technologies can serve as a foundation for the development of a new generation of e-health devices that provide accurate and empirical evaluation of the condition to patients worldwide. The goal of this review is to study the past, present, and future of AD monitoring. First, current medical practices such as biopsy, tape stripping and blood serum are discussed with their merits and demerits. Then, alternative digital methods of medical evaluation are highlighted with the focus on non-invasive monitoring using biomarkers of AD-TEWL, skin permittivity, elasticity, and pruritus. Finally, possible future technologies are showcased such as radio frequency reflectometry and optical spectroscopy along with a short discussion to provoke research into improving the current techniques and employing the new ones to develop an AD monitoring device, which could eventually facilitate medical diagnosis.