Location History Research Articles

Characteristics of urinary stone composition among patients with urolithiasis: a retrospective study in China

ObjectiveTo present the most recent data on urinary calculi characteristics in the southern region of China and explore the effects of sociodemographic, clinical and laboratory characteristics on stone composition to...

INNV-06. ADULT GLIOBLASTOMA WITH MISMATCH REPAIR DEFICIENCY FORMS A DISTINCT HIGH-RISK MOLECULAR SUBGROUP FOR WHICH TREATMENT WITH IPILIMUMAB-NIVOLUMAB SHOWS SURVIVAL ADVANTAGE

Abstract Glioblastoma is the most frequent and malignant primary brain tumor. Although the survival is generally dismal for glioblastoma patients, risk stratification and the identification of high-risk subgroups is important for prompt and aggressive management. The G1-G7 molecular subgroup classification based on the MAPK pathway activation has offered for the first time a non-redundant, all-inclusive classification of adult glioblastoma. Five patients from the large, 220-patient prospective cohort showed germline mutations in mismatch repair (MMR) genes and significantly worse median survival (3.25 months post-surgery) than those from other subgroups or from the rest of the cohort adjusted for age. These tumors were assigned to a new subgroup, G3/MMR, a spin-off from the major G3/NF1 subgroup, as they generally show genomic alterations leading to RAS activation. An integrated clinical, histological, immunohistochemical and molecular analysis of the G3/MMR tumors showed distinct characteristics as compared to other glioblastomas, including those with iatrogenic high tumor mutation burden (TMB), warranting a separate subgroup. Among these, prior history of cancer, midline location or multifocality, presence of multinucleated giant cells, positive p53 and MMR immunohistochemistry, and specific molecular characteristics, including high TMB, alert to this high-risk G3/MMR subgroup. High TMB constitutes the criterium for treatment with immune checkpoint inhibitors in solid cancers. The FDA-approved first-line therapy for advanced non-small cell lung cancer and high-TMB colorectal cancer is with the dual ipilimumab-nivolumab regimen. One of the five G3/MMR subgroup patients received the dual ipilimumab-nivolumab regimen and survived much longer than the rest of the G3/MMR patients, setting a proof-of-principle example for the treatment of these very aggressive G3/MMR glioblastomas.

Associations of KRAS Mutations and Clinical Characteristics of Colorectal Cancer Patients in Indonesia.

Colorectal cancer (CRC) remains a major burden worldwide, ranking third and second in incidence and mortality respectively. Detection of biomarkers including KRAS mutations can help predict prognosis and response to therapy in CRC, thus this study evaluated the frequency of KRAS mutations among Indonesian patients and their associations with clinicopathologic characteristics. Fifty-three CRC samples were collected from January to September 2022 in the Department of Surgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. KRAS mutations were analyzed using PCR followed by Sanger sequencing. Associations between KRAS mutations were evaluated using binary logistic regression analysis. KRAS mutations were detected in 52.8% of patients (n=28), of which 3.6% were p.Gly12Ser (n=1), 32.1% were p.Gly12Asp (n=9), 7.1% were p.Gly13Asp (n=2), 3.6% were p.Gln61His (n=1), 3.6% were p.Asp126His (n=1), and 3.6% were p.Lys169Glu (n=1). The p.Asp73= polymorphism was detected in 57.1% of the samples (n=16). KRAS mutation status did not differ significantly between the groups based on the age of onset, sex, tumor location, tumor histology, stage, and family history. KRAS mutations are present in high frequency in this cohort of CRC patients in a tertiary hospital in West Java, Indonesia. However, KRAS mutation status is not associated with the age of onset, sex, tumor location, tumor histology, stage, and family history.

A Zero Auxiliary Knowledge Membership Inference Attack on Aggregate Location Data

Location data is frequently collected from populations and shared in aggregate form to guide policy and decision making. However, the prevalence of aggregated data also raises the privacy concern of membership inference attacks (MIAs). MIAs infer whether an individual's data contributed to the aggregate release. Although effective MIAs have been developed for aggregate location data, these require access to an extensive auxiliary dataset of individual traces over the same locations, which are collected from a similar population. This assumption is often impractical given common privacy practices surrounding location data. To measure the risk of an MIA performed by a realistic adversary, we develop the first Zero Auxiliary Knowledge (ZK) MIA on aggregate location data, which eliminates the need for an auxiliary dataset of real individual traces. Instead, we develop a novel synthetic approach, such that suitable synthetic traces are generated from the released aggregate. We also develop methods to correct for bias and noise, to show that our synthetic-based attack is still applicable when privacy mechanisms are applied prior to release. Using two large-scale location datasets, we demonstrate that our ZK MIA matches the state-of-the-art Knock-Knock (KK) MIA across a wide range of settings, including popular implementations of differential privacy (DP) and suppression of small counts. Furthermore, we show that ZK MIA remains highly effective even when the adversary only knows a small fraction (10%) of their target's location history. This demonstrates that effective MIAs can be performed by realistic adversaries, highlighting the need for strong DP protection.

Repeated Tree Inventories of Pine Forests in South Florida's Big Cypress National Preserve.

The natural forest ecosystems of South Florida, USA, support a high biodiversity of plant and animal species and provide valuable ecosystem services. However, these ecosystems remain poorly represented in global studies, primarily due to a paucity of standardized data. Here, we present previously unpublished data from 332 censuses of 54 permanent 1-ha tree inventory plots in the Racoon Point area of Big Cypress National Preserve, Florida, USA, including a total of nearly 100,000 measurements (diameter or height) of > 17,000 individual living trees and palms (with additional measurements of nearly 6000 dead pine snags) collected sporadically over a 19-year period (1993-2012). These data, which were originally collected as part of a project to investigate tree responses to different experimental burning regimes, provide unique insight into the diversity, composition, structure, and dynamics of South Florida's unique and endangered pine forest ecosystems. Data files include the species identity, size (dbh = diameter at breast height), and location of all trees ≥ 5 cm dbh in 54 individual tree plots. Additional data are provided about heights of palm trees, and the location and burn history of each plot. These data are freely available for noncommercial scientific use under a Creative Commons license; users are encouraged to cite this paper when using the data.

Evaluation of Salivary Glucose and Salivary Cortisol in Association with Periodontitis in People with Type II Diabetes: A Case-control Study.

The relationship between type II diabetes mellitus (DM) and periodontal disease (PD) has been discussed in recent years and may vary according to the patient's location, sex, age and family history. In view of this possible association between periodontitis and DM, this study aimed to evaluate salivary glucose and salivary cortisol levels with periodontitis (staging and degree) in people with type II diabetes compared to non-diabetic individuals. This was a case-control study, with 60 participants divided into two groups: DM2- people with type II diabetes (n=30) and NDM- non-diabetic individuals (n=30). For both, a clinical form and periogram were filled out, and blood samples (glycemia, glycated hemoglobin, and cortisol) and saliva (glucose and cortisol) were collected. The diagnosis of periodontitis was 100% in the DM2 group and 80% in the NDM group. As for staging and degree, in the DM2 group, 70% of the participants were in stage IV and 86.67% were in grade C, while in the NDM group, 58.3% of the participants were in stage I and 70.8% were in grade A. Significant differences were observed for the following variables: bleeding to probing and clinical attachment level. The laboratory data presented significant results regarding serum glucose, salivary glucose, and glycated hemoglobin. Regarding the influence of salivary glucose and cortisol on periodontal status (staging and degree), these had higher means in the DM2 group when compared to the NDM group. An association of salivary glucose and cortisol levels with the periodontal condition presented by type II diabetic individuals compared to non-diabetic individuals is suggested.

GastricAITool: A Clinical Decision Support Tool for the Diagnosis and Prognosis of Gastric Cancer.

Gastric cancer (GC) is a complex disease representing a significant global health concern. Advanced tools for the early diagnosis and prediction of adverse outcomes are crucial. In this context, artificial intelligence (AI) plays a fundamental role. The aim of this work was to develop a diagnostic and prognostic tool for GC, providing support to clinicians in critical decision-making and enabling personalised strategies. Different machine learning and deep learning techniques were explored to build diagnostic and prognostic models, ensuring model interpretability and transparency through explainable AI methods. These models were developed and cross-validated using data from 590 Spanish Caucasian patients with primary GC and 633 cancer-free individuals. Up to 261 variables were analysed, including demographic, environmental, clinical, tumoral, and genetic data. Variables such as Helicobacter pylori infection, tobacco use, family history of GC, TNM staging, metastasis, tumour location, treatment received, gender, age, and genetic factors (single nucleotide polymorphisms) were selected as inputs due to their association with the risk and progression of the disease. The XGBoost algorithm (version 1.7.4) achieved the best performance for diagnosis, with an AUC value of 0.68 using 5-fold cross-validation. As for prognosis, the Random Survival Forest algorithm achieved a C-index of 0.77. Of interest, the incorporation of genetic data into the clinical-demographics models significantly increased discriminatory ability in both diagnostic and prognostic models. This article presents GastricAITool, a simple and intuitive decision support tool for the diagnosis and prognosis of GC.

Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study*

OBJECTIVES: Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning. DESIGN, SETTING, AND PATIENTS: This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58–19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51–29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39–7.99), endocrine (aHR, 13.44; 95% CI, 1.76–102.70), neurologic (aHR, 7.42; 95% CI, 2.91–18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05–15.93), respiratory (aHR, 17.54; 95% CI, 5.48–56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34–182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98–80.90). CONCLUSIONS: Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.

Evolving Pattern of Human Cystic Echinococcosis: A Cross-Sectional Study

Introduction Cystic echinococcosis (CE) poses a considerable public health challenge in many countries. Due to the absence of comprehensive CE surveillance and management guidelines and varying demographic and geographical factors across countries, examining the disease's epidemiology and clinical manifestations within specific regions is essential. The current study aims to investigate CE trends, clinical features, and patient complaints in an endemic area of Iraq. Methods This retrospective cross-sectional study was conducted at Smart Health Tower in Sulaymaniyah, Iraq, from May 2020 to May 2024. It involved patients diagnosed and treated for CE. Data was collected using detailed case forms covering patient demographics, cyst location, presentation, medical and surgical history, and recurrence. Results The study involved 605 CE patients with nearly equal gender distribution and a mean age of 40.1 ± 18.6 years. Most patients, 217(35.9%), were aged 31-50 and lived in urban areas 505(83.5%). The majority, 382(63.1%), were asymptomatic, with liver cysts being the most common 361(59.7%). Single cysts were more prevalent in 513(84.8%) cases, with surgery performed in 222(36.7%) of cases, and recurrence was rare 8(1.3%). Conclusion This study highlights a significant burden of CE in urban areas, where asymptomatic cases often lead to delayed diagnosis. The high prevalence of liver and lung cysts underscores the necessity for targeted public health strategies and enhanced control measures for free-roaming dogs.

Tyrosine-Like Crystalloids Localize to Non-Neoplastic True Vocal Cord and Attachments.

Tyrosine-rich or tyrosine-like crystalloids (TC) were initially described in salivary gland pleomorphic adenoma. The presence of TC in non-neoplastic tissues is rare, and it has been reported exclusively in the larynx. This study aims to characterize the frequency and anatomical localization of TC in total laryngectomy specimens. Review of consecutive laryngectomy specimens in which the cassette summary documented parasagittal section sampling of the right and left vocal folds and the anterior commissure. Data collected included patient demographics, underlying diagnoses, history of radiation therapy, presence, and location of TC. Of 86 laryngectomy specimens, 16 (19%) contained amphophilic to eosinophilic TC. The study cohort included 11 males and 5 females, aged 37 to 85 years (mean 62, median 63). Laryngectomy surgery was performed for advanced untreated squamous cell carcinoma (SCCa) (7/16, 43.75%), recurrent post-treatment SCCa (7/16, 43.75%), previously untreated laryngeal large cell neuroendocrine carcinoma (1/16, 6.25%), and non-functional larynx post-chemoradiation (1/16, 6.25%). According to the macroscopic cassette summary, TC were predominantly found in the anterior commissure Sect.(13/16, 81.25%), with fewer cases in sections containing the left (2/16, 12.5%) or the right (1/16, 6.25%) vocal folds. Microscopically, TC localized to the anterior macula flava and/or adjacent vocal ligament (12/16, 75%) and the anterior commissure tendon (4/16, 25%). TCs are predominantly reported as admixed with a neoplasm, however this study confirms that TC can also occur in non-neoplastic tissues of the larynx. There was no clear relationship between the presence of TC and prior radiation therapy. TC in the specialized connective tissues of the macula flava and true cord tendinous insertions distinct from tumor may form in response to alterations in mechanical stress, though an age-related change within the spectrum of normal laryngeal microanatomy also remains a possibility.

Long-term exposure to air pollution at residential and workplace addresses and breast cancer risk: A case-control study nested in the French E3N-Générations cohort from 1990 to 2011

BackgroundAn increasing evidence links air pollution to breast cancer (BC) risk. Yet, pollutant exposure estimates at the workplace location in pollution exposure assessment have not been considered. ObjectivesThis study investigates the association between particulate matters (PM2·5, PM10) and nitrogen dioxide (NO2) atmospheric concentrations (1990–2011), at the women’s residential and workplace locations, and BC risk. MethodsThis case-control study of 2419 BC cases and 2984 controls, was nested in the French prospective E3N cohort. The annual mean PM2·5, PM10 and NO2 concentrations were estimated using a Land Use Regression model (50 m x 50 m resolution) and assigned to the women’s geocoded residential and workplace locations, from cohort recruitment to their index date (date of case diagnosis). Odds ratios (OR) and 95 % confidence intervals (CI) were estimated using multivariate logistic regression models. ResultsAn increased BC risk was observed for a 10 µg/m3 increase of the 1990–2011 average PM2·5 concentration estimates (OR=1·28; CI 1·00, 1·63). An increased risk was suggested for a 10 µg/m3 increase for PM10 (OR=1·09; CI 0·92, 1·30) and NO2 (OR=1·05; CI 0·97, 1·13). No effect modification by menopausal status, nor difference by hormone receptor status were observed. DiscussionThis study is the first to estimate BC risk and long-term air pollutant exposure from both, residential and workplace location histories. Results suggest that residential PM2·5, PM10 and NO2 concentrations are strongly correlated with workplace ones, indicating that residential data may serve as proxy for overall exposure. Future studies should consider exposure during commuting.

Tunable Social Hierarchies in Self-Organizing Model with Chemotactic Agents

In the Bonabeau model, chemotaxis, which is observed in social insects, such as ants, was introduced into the movement rules of agents to control the collision frequency between agents, and its effect on the mechanism of hierarchical structure formation was investigated. Like an ant, this chemotactic agent makes stochastic decisions regarding its direction of movement depending on the intensity of its released chemicals. Because of this mechanism, the agent depends on its past location history. It can perform different motions from a random walk (RW) and asymmetric attractive or repulsive interactions with other agents via the diffusion of chemotactic substances. When there is an attractive interaction between these agents, they are more likely to aggregate, which increases the effective density; thus, the disparity in the agent winning ratio is more likely to form than in a conventional model with a RW. However, in the case of repulsive interactions, the agents became more distant from each other, the effective density decreased, and a disparity in the winning ratio was less likely to form. This indicates that the disparity in the winning ratio is tunable owing to the interactions between the introduced chemotactic agents.

Smart watch for early heart attack detection and emergency assistance using IoT

This research introduces a Smart Watch equipped with advanced physiological monitoring capabilities for the early detection of heart attacks and automatic initiation of emergency assistance. Cardiovascular diseases, particularly heart attacks, are a leading cause of global mortality. Rapid response during a heart attack significantly improves patient outcomes, emphasizing the need for innovative solutions. The proposed Smart Watch integrates a combination of sensors, including ECG (Electrocardiogram) and PPG (Photoplethysmography), to continuously monitor the user's heart rate, rhythm, and other relevant physiological parameters. Machine learning (Time Series Analysis algorithm) is employed to analyse the collected data in real-time, identifying patterns indicative of a potential heart attack.Upon detecting abnormal cardiac activity, the Smart Watch triggers an immediate response by connecting to a dedicated mobile application. The application utilizes built-in communication features to establish a connection with emergency services, providing vital information about the user's condition, location, and medical history. Simultaneously, the Smart Watch alerts predefined emergency contacts, ensuring a swift response from friends or family members.

Conventional ultrasonography enabled with augmented reality needle guidance for percutaneous kidney access: An innovative methodologies randomized controlled trial.

Successful needle puncture of the renal collecting system is a critical but difficult procedure in percutaneous nephrolithotomy (PCNL). Although fluoroscopy and ultrasound are the standard imaging techniques to guide puncture during PCNL, both have known limitations. To assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. This study employed a single-center randomized controlled trial (RCT) design to assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. Conducted between May 2021 and November 2021, the trial utilized computer-generated random numbers for participant allocation to control for selection bias. The trial was executed at the *********, which serves as an academic medical center. All patients who met the inclusion criteria were randomly divided into two groups, with 29 patients in each group. One group underwent PCNL procedures using the new navigation system, while the control group underwent standard ultrasound-guided PCNL procedures. Included patients had renal pelvis or caliceal calculi larger than 2.0cm in diameter or had multiple or staghorn stones. The puncture procedure was performed with the support of real-time ultrasound imaging and visual guidance displayed on the screen. The primary outcome was system feasibility and puncture success rate. Secondary outcomes included puncture time, total surgical time, number of attempts, post-procedure complications, and one-year and three-year stone recurrence rates. Stone clearance was defined by postoperative CT. Descriptive statistics summarized patient demographics, stone size, and location. Independent samples t-tests analyzed puncture time and total surgical time. Chi-square or Fisher's exact tests compared stone clearance, complications, socioeconomic status, renal hydronephrosis, stone location, race, and medical history. Linear regression examined the correlation between BMI and puncture time. Significance was set at P<0.05. For all 58 patients undergoing PCNL, needle punctures of the renal collecting system were completed with a success rate of 100%. The average time from planning the puncture protocol to successful puncture was significantly shorter in the AcuSee guidance system group (3.12min, range 0.2-6.88min) compared to the standard ultrasound-guided group (7.58min, range 5.41-10.68min), representing a reduction of approximately 59%. The total surgical time was also shorter in the AcuSee group for patients with no and mild hydronephrosis (P<0.05). Complication rates were lower in the AcuSee group, with no major complications observed. However, 3 patients in the standard ultrasound-guided group have adverse effects after the PCNL procedure. The one-year stone recurrence rate was significantly lower in the AcuSee group (3.4%) compared to the standard group (24.1%), and the three-year recurrence rate was also lower (6.9% vs. 41.4%). Patient-specific factors such as BMI, renal morphology, and prior surgical history did not significantly affect the performance of the AcuSee system. We report the first clinical application of a new navigation system for needle puncture in ultrasound-guided PCNL. It has been demonstrated that it is feasible and safe compared to the standard ultrasound-guided group in percutaneous renal puncture. This technology provides intuitive and easy-to-use visual guidance, which may facilitate safe, accurate and fast needle puncture of the kidney.

Nutritional convergence in plants growing on gypsum soils in two distinct climatic regions.

Soil endemics have long fascinated botanists due to the insights they can provide about plant ecology and evolution. Often, these species have unique foliar nutrient composition patterns that reflect potential physiological adaptations to these harsh soil types. However, understanding global nutritional patterns to unique soil types can be complicated by the influence of recent and ancient evolutionary events. Our goal was to understand whether plant specialization to unique soils is a stronger determinant of plant nutrient composition than climate or evolutionary constraints. We worked on gypsum soils. We analyzed whole-plant nutrient composition (leaves, stems, coarse roots and fine roots) of 36 native species of gypsophilous lineages from the Chihuahuan Desert (North America) and the Iberian Peninsula (Europe) regions, including widely distributed gypsum endemics, as specialists, and narrowly distributed endemics and non-endemics, as non-specialists. We evaluated the impact of evolutionary events and soil composition on the whole-plant composition, comparing the three categories of gypsum plants. Our findings reveal nutritional convergence of widely distributed gypsum endemics. These taxa displayed higher foliar Sulfur and higher whole-plant Magnesium than their non-endemic relatives, irrespective of geographic location or phylogenetic history. Sulfur and Magnesium concentrations were mainly explained by non-phylogenetic variation among species related to gypsum specialization. Other nutrient concentrations were determined by more ancient evolutionary events. For example, Caryophyllales usually displayed high foliar Calcium, whereas Poaceae did not. In contrast, plant concentrations of Phosphorus was mainly explained by species-specific physiology not related to gypsum specialization or evolutionary constraints. Plant specialization to a unique soil may strongly influence plant nutritional strategies, as we described for gypsophilous lineages. Taking a whole-plant perspective (all organs) within a phylogenetic framework has enabled us to gain a better understanding of plant adaptation to unique soils when studying taxa from distinct regions.

Quantifying urban park use in the USA at scale: empirical estimates of realised park usage using smartphone location data

A large body of evidence connects access to greenspace with substantial benefits to physical and mental health. In urban settings where access to greenspace can be limited, park access and use have been associated with higher levels of physical activity, improved physical health, and lower levels of markers of mental distress. Despite the potential health benefits of urban parks, little is known about how park usage varies across locations (between or within cities) or over time. We estimated park usage among urban residents (identified as residents of urban census tracts) in 498 US cities from 2019 to 2021 from aggregated and anonymised opted-in smartphone location history data. We used descriptive statistics to quantify differences in park usage over time, between cities, and across census tracts within cities, and used generalised linear models to estimate the associations between park usage and census tract level descriptors. In spring (March 1 to May 31) 2019, 18·9% of urban residents visited a park at least once per week, with average use higher in northwest and southwest USA, and lowest in the southeast. Park usage varied substantially both within and between cities; was unequally distributed across census tract-level markers of race, ethnicity, income, and social vulnerability; and was only moderately correlated with established markers of census tract greenspace. In spring 2019, a doubling of walking time to parks was associated with a 10·1% (95% CI 5·6-14·3) lower average weekly park usage, adjusting for city and social vulnerability index. The median decline in park usage from spring 2019 to spring 2020 was 38·0% (IQR 28·4-46·5), coincident with the onset of physical distancing policies across much of the country. We estimated that the COVID-19-related decline in park usage was more pronounced for those living further from a park and those living in areas of higher social vulnerability. These estimates provide novel insights into the patterns and correlates of park use and could enable new studies of the health benefits of urban greenspace. In addition, the availability of an empirical park usage metric that varies over time could be a useful tool for assessing the effectiveness of policies intended to increase such activities. Google.

Radiotherapy protocol compliance in routine clinical practice for patients with stages I-III non-small-cell lung cancer.

Despite the availability of radiotherapy treatment protocols forlung cancer, considerable treatment variation occurs in clinical practice. This study assessed compliance with a radiotherapy protocol for the treatment of patients with stages I-III non-small-cell lung cancer (NSCLC) in routine clinical practice and to identify factors that were associated with compliance. The Cancer Institute New South Wales eviQ treatment protocol for external beam radiotherapy of stages I-III NSCLC was taken as the reference to measure compliance. All inoperable patients with stages I-III NSCLC and documented ECOG performance status treated with radiotherapy between 2007 and 2019 at two radiotherapy facilities were available for analysis. Protocol compliance rates were calculated. Univariate and multivariate logistic regression models with 23 input factors were used to determine factors significantly associated with compliance. Survival analysis was conducted for both compliant and non-compliant treatments. Overall, 656 patients met the inclusion criteria. Protocol compliance was 16%. Alternative dose/fractionation was responsible for 49% of non-compliant treatments with 30% receiving an alternative curative fractionation. Five of 23 factors (age at the start of radiotherapy, stage group, ECOG performance status, tumour location and alcoholism history) showed significant associations with protocol compliance on multivariate analysis. There was no significant difference in median survival between patients receiving protocol compliant treatment (15.1 months) and non-compliant treatment (15.6 months). Adherence to the eviQ curative radiotherapy protocol for stages I-III NSCLC was low. Alternative dose/fractionation schemes were the main reason for non-compliance. Protocol compliance was not associated with outcome.

Smart Educational Resource Management: A QR Code-Enabled System with Notification and Alerting Capabilities

Effective management of educational resources is crucial for ensuring the quality of learning outcomes. However, traditional systems often rely on manual processes, leading to inefficiencies, errors, and delays. This paper presents a novel QR Code-Enabled Educational Resource Management System that leverages Quick Response (QR) codes to streamline these processes. The proposed system uses QR codes to track the availability and location of resources such as textbooks and equipment. Students and teachers can scan these codes with mobile devices to access relevant information, including resource availability, location, and usage history. Additionally, the system features notifications and alerting capabilities that remind users when resources are due or inform them of changes in availability. The system was evaluated using the ISO/IEC 25010 Model Quality Characteristics Framework, which includes functional suitability, performance efficiency, compatibility, usability, reliability, portability, and maintainability. Results indicate high levels of quality in use, with excellent performance efficiency, security, compatibility, reliability, and maintainability. This study demonstrates the potential of the QR Code-Enabled Educational Resource Management System to enhance the effectiveness and efficiency of educational institutions. The system's notification and alerting capabilities can further improve student engagement and motivation by providing timely reminders and updates on resource availability.

Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel.

Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are syndromes commonly used as medical diagnoses. Since the existing literature has a mixture of diagnostic approaches, developing consensus-based recommendations would be helpful for clinicians, researchers, and patients. A modified Delphi process was performed from October 2022 to July 2023, involving 4 rounds of online surveys and 2 live video conferences. The panel comprised international experts recruited based on peer-reviewed published publications and studies. Among 50 invited experts, 26 (52.0%) agreed to participate. Twenty-three panelists completed round 1 of the survey, 21 completed rounds 2 and 3, 20 completed round 4, and 7 participated in round 5 live video discussions. Of the participants, 18 (78.3%) were academic-based clinicians and researchers, 5 (21.7%) practiced in a community-based hospital, and 6 (26.1%) were female. Consensus was reached on 5 themes: (1) incorporating epidemiologic factors, such as geographic location and travel history; (2) updated criteria for classifying FUO or IUO; (3) initial evaluation approaches; (4) a classification system for diagnoses; and (5) recommendations for judicious limitation of empiric therapies. Experts strongly disagreed with using 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography as part of the diagnostic criteria for FUO. There were mixed opinions about the importance of the temperature measurement site, the 3-week minimum illness criterion, the need for a standard definition of relapsing fevers, and the use of similar evaluation strategies for FUO and IUO. These Delphi-generated consensus-based recommendations offer potential improvements compared with earlier definitions and a guide for clinical practice and future research.

Machine learning based prediction models for analyzing risk factors in patients with acute abdominal pain: a retrospective study.

Acute abdominal pain (AAP) is a common symptom presented in the emergency department (ED), and it is crucial to have objective and accurate triage. This study aims to develop a machine learning-based prediction model for AAP triage. The goal is to identify triage indicators for critically ill patients and ensure the prompt availability of diagnostic and treatment resources. In this study, we conducted a retrospective analysis of the medical records of patients admitted to the ED of Wuhan Puren Hospital with acute abdominal pain in 2019. To identify high-risk factors, univariate and multivariate logistic regression analyses were used with thirty-one predictor variables. Evaluation of eight machine learning triage prediction models was conducted using both test and validation cohorts to optimize the AAP triage prediction model. Eleven clinical indicators with statistical significance (p < 0.05) were identified, and they were found to be associated with the severity of acute abdominal pain. Among the eight machine learning models constructed from the training and test cohorts, the model based on the artificial neural network (ANN) demonstrated the best performance, achieving an accuracy of 0.9792 and an area under the curve (AUC) of 0.9972. Further optimization results indicate that the AUC value of the ANN model could reach 0.9832 by incorporating only seven variables: history of diabetes, history of stroke, pulse, blood pressure, pale appearance, bowel sounds, and location of the pain. The ANN model is the most effective in predicting the triage of AAP. Furthermore, when only seven variables are considered, including history of diabetes, etc., the model still shows good predictive performance. This is helpful for the rapid clinical triage of AAP patients and the allocation of medical resources.