Mean Rate Research Articles

Simple Signs for Complex Problem

Objectives: To find simple clinical signs for diagnosing pulmonary embolism on bedside.
 Methodology: This was a hospital based cross sectional observational study conducted in cardiology department Saidu teaching hospital from July 2019 to December 2020. 89 patients of either sex and all age groups with suspected pulmonary embolism (PE) were included. Clinical data and basic tests of all these patients were obtained, then according to ESC diagnostic algorithm patients were divided into low, intermediate and high probability groups. 74 patients with intermediate and high probability went for CTPA, while 15 patients with low probability were exclude from study. In 67 patients pulmonary embolism was confirmed on CTPA. Clinical data of these 67 patients was analyzed for most common presenting symptoms and signs.
 Results: Data was available on 67 patients with confirmed PE, 58.2% were male and 41.8% were female. Mean age of study population was 53.15+/-16.29. Patients from different parts of Malakand division were included. 95.5 % patient presented with new onset dyspnea, 1.5 % presented with isolated chest pain, while 3% presented with other symptoms. 62.7 % patient had provoked and 37.3% had unprovoked PE. Mean heart rate of study population was 99.63. 95% patients had oxygen saturation of less than 96%. Other common findings included normal chest examination, sinus tachycardia on ECG, normal chest X-ray, and some form of right ventricular abnormality on Echo.
 Conclusion: Patient with new onset Dyspnea, resting Tachycardia, oxygen saturation below 95% at rest or mild exertion, and no other explanation for these findings should be evaluated for pulmonary embolism with CTPA.

Examining Principals’ Personnel Management Skills: The Interplay of Human Relations and Instructional Supervision in Delta State Secondary Schools

This study examined principals' personnel management skills: the interplay of human relations and instructional supervision in Delta State secondary schools. It was guided by two research questions and hypotheses respectively. The research employed a correlational survey method within an ex-post-facto design. The study encompassed a population of 15,322 principals and teachers from Delta State Secondary Schools, from which a purposive sample of 380 principals and teachers was selected. The research utilized the Principals' Personnel Management Skills of Human Relations and Instructional Supervision Questionnaire (PPMSHRISQ) as the instrument for data collection. Data analysis involved mean rating to address the research questions, while hypotheses were tested utilizing Pearson's correlation coefficient (r) at a significance level of 0.05. Findings revealed that to a high extent, human relations and instructional supervision contribute significantly to effective personnel management by principals, in Delta State Secondary Schools. In conclusion, this study unveils crucial insights into the dynamics of personnel management by principals in Delta State Secondary Schools. It is evident from the data that both human relations and instructional supervision play substantial roles in contributing to effective personnel management. It was recommended that educational authorities and school leadership should prioritise professional development for principals, as human relations play a significant role in effective personnel management. These programmes should emphasise healthy connections, efficient communication, and a friendly workplace.

Farmer Interest Groups: Paving Its Path Towards Profitability

The current study entailed to ascertain the role that Farmers' Interest Groups played in knowledge transfer as well as in increasing agricultural production, productivity, and in turn leading to profitability for the farm sector in the Boudh district of Odisha. For the impact assessment, six FIGs from a range of villages in the Boudh district, including Baghiapada, Saleising, and Palijhar, were randomly selected. The results of this study depicted that member of Farmer Interest Groups adopted scientific agricultural practices and goatery technologies at a greater mean rate (80.63 MPS and 79.63 MPS, respectively) than non-members (59.12 MPS and 60.12 MPS). The aggregate differences in the adoption of crop and goatery farming technology between FIG members and non-members were calculated to be 21.5 and 19.5 MPS, respectively. It was also found that the crop and goatery production under FIG produced a higher yield than the agricultural practices now employed by farmers. The members became more active in meetings and the adoption of new and scientific farm and goatery technology after learning about the benefits of the FIGs. In addition to enhancing agriculture and animal production, this will also benefit the socioeconomic conditions of the farming community.

Gender and socioecological level differences in stakeholders' perceptions of athlete attrition factors in an Australian high-performance pathway system

ObjectivesThis study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS). DesignMixed methods. MethodsSub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in ‘R’ using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders. ResultsMean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: ‘athlete health’ (M3.33:W3.84 [p 0.012]); ‘performance potential’ (M3.35:W2.57; [p 0.001]), Feasibility: ‘abuse and mismanagement of health’ (M2.97:W3.68; [p 0.000]) and ‘athlete health’ (M2.54:W3.33; [p 0.000]). ConclusionsThis study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes.

Accessing the factors that affect the implementation of successful project management for TETFUND-sponsored projects in the South East, Nigeria (2011–2021)

As important as the knowledge acquired via the teaching and learning process in tertiary institutions is the infrastructure in tertiary education. This is the case since infrastructure is one of the facilities that primarily supports the teaching and learning process. In Nigeria, tertiary education has faced and continues to face a number of difficulties throughout the years, one of which is the deterioration of the infrastructure necessary for professional and National University Commission (NUC) accreditation. The improper implementation of project management and the absence of integration of the services of the professional project manager in various TETFund Intervention Projects are two of the biggest difficulties experienced in the implementation of TETFund-Sponsored Projects. The upshot of this is that TETFund-Sponsored Projects have been delivered unsuccessfully. For this study project, the quantitative research method was used. For this study, official documentation of Annual Intervention Projects in 10 public recipient universities in South-East Nigeria was obtained. This study indicates that all the parameters indicated are drivers of successful project management with mean ratings over 2.5 based on the results it has received and assessed. The overall rating was 2.9, which is also higher than the benchmark norm. We reject the null hypothesis and come to the conclusion that there is no significant relationship between the variables of completed within time, not completed within time, completed but delayed, and not completed yet behind schedule. Hypothesis testing revealed that the value of the t-statistics (0.049) was below 0.05. Keywords: Determinants, Implementation, Infrastructure, Project, Management.

Plenoptic imaging of meteorite shape change during plasma wind tunnel experiments

Experimental meteors are produced by exposing samples of meteoritic material to an air plasma flow in an arcjet driven plasma wind tunnel facility, simulating the aerothermal conditions of an entry into the Earth’s atmosphere. A plenoptic camera is used to record sequences of light field images during the tests, allowing for the first time to derive the transient evolution of the ablating and melting surface in three dimensions. Results are presented for samples of various meteorites, which show the potential of this technique for the volumetric analysis of the complex interaction between an extraterrestrial body and the upper atmosphere. Data allow to derive recession rates, heats of ablation and a shape factor, which has been redefined to meet the recorded information. Recession is found to be non-linear, with different rates for different meteorite types, with mean rates between 0.28 and 0.7mm/s. Heats of ablation are not constant, but decrease during the experiment, with mean values between 1.7 and 10.1MJ/kg. A fairly linear correlation is found between the materials’ iron content and both the recession rate and the heat of ablation. Shape factors decrease with time and reach a plateau after about 3s.

Measuring Typographical Errors in Online Catalogs of Academic Libraries Using Ballard’s List: A Case Study from Egypt

Typographical errors in bibliographic records of online library catalogs are a common troublesome phenomenon, spread all over the world. They can affect the retrieval and identification of items in information retrieval systems and thus prevent users from finding the documents they need. The present study was conducted to measure typographical errors in the online catalog of the Egyptian Universities Libraries Consortium (EULC). The investigation depended on Terry Ballard’s typographical error terms list. The EULC catalog was searched to identify matched erroneous records. The study found that the total number of erroneous records reached 1686, whereas the mean error rate for each record is 11.24, which is very high. About 396 erroneous records (23.49%) have been retrieved from Section C of Ballard’s list (Moderate Probability). The typographical errors found within the abstracts of the study’s sample records represented 35.82%. Omissions were the first common type of errors with 54.51%, followed by transpositions at 17.08%. Regarding the analysis of parts of speech, the study found that 63.46% of errors occur in noun terms. The results of the study indicated that typographical errors still pose a serious challenge for information retrieval systems, especially for library systems in the Arab environment. The study proposes some solutions for Egyptian university libraries in order to avoid typographic mistakes in the future.

Enlarged right atrium predicts pacemaker implantation after atrial fibrillation ablation in patients with tachycardia-bradycardia syndrome

IntroductionAlthough catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. MethodsFrom 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). ResultsWhen comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). ConclusionRight atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.

RBIO-10. NEUROMODULATORY EFFECT AND DOSE RESPONSE OF FUNCTIONAL RADIOSURGERY ON CORTICAL NEURONS

Abstract PURPOSE The effects of functional radiosurgery on neuronal circuits remain poorly understood. Neurons of the prefrontal cortex communicate via precisely-timed action potentials that control cognition. Here, we examined the dose response of ablative radiation dose on the patterns of communication of neural circuits in prefrontal acute slices. Materials and METHODS Escalating doses from 20 Gy to 100 Gy of ablative radiation were applied to rodent cortical neurons using the robotic Radiosurgery device (CyberKnife(R) G4). Neuronal communication within irradiated prefrontal slices were compared to control slices (sham radiation); and assessed by plating slices on a multielectrode array that captured high-resolution (18 kHz) extracellular activity across 4,096 channels simultaneously. Comparisons also with recordings of slices treated with a pro-epileptiform solution and finally, correlated with staining for cell death. RESULTS Compared to control slices (mean rate of 0.06 Hz), the post-radiosurgery slices yielded a 40-fold increase in discharge rates (mean rate of 2.87 Hz for 20 Gy, 2.44 Hz for 50 Gy, and 1.95 Hz for 100 Gy radiation). Pearson cross-correlations were computed across all pairs of channels, yielding a matrix of 4,096-by-4,096 interactions. Radiated slices exhibited decreased correlations relative to control slices. A total of 7,446 neuronal interactions were above a threshold correlation of 0.5 in control slices, compared to none following a 20 Gy dose, 50 interactions following a 50 Gy dose and 28 interactions following a 100 Gy dose. Slices treated with pro-epileptiform solution slices yielded large seizure-like events characterized by increased discharge rates and increased pairwise correlations. CONCLUSION Post-radiosurgery slices yielded a unique signature of neuronal activity with increased rates; but with a pronounced decrease in correlations; suggesting diminished communication across neurons to create a neuro-modulatory effect on target tissue; or result in cognitive toxicity on organ-at-risk respectively.

RADT-43. LONG TERM OUTCOMES OF PEDIATRIC AND ADULT CENTRAL NEUROCYTOMA—THE ROLE OF SALVAGE RADIOTHERAPY AND CONSERVATIVE MANAGEMENT

Abstract INTRODUCTION Central Neurocytoma (CN) is a rare, WHO grade 2 brain tumor that predominantly affects young adults. Gross total resection (GTR) is often curative for CN, but the optimal treatment paradigm following subtotal resection (STR) and or scarcer pediatric cases has yet to be established—including the role of radiation therapy (RT). Herein, we reviewed the long-term outcomes of CN patients at our institution. METHODS Patients between the years 2001 and 2021 with a pathologic diagnosis of CN were reviewed. Demographic, treatment, and tumor characteristics (histopathological and molecular) were recorded. Recurrence free survival (RFS) and overall survival (OS) were calculated according to the Kaplan Meier-method. Post-RT tumor volumetric regression analysis was performed. RESULTS Seventeen adults (≥ 18 years old) and 5 children (< 18 years old) met the criteria for data analysis (n = 22). With a median follow-up of 6.9 years (range: 1.2-42.8 years), there was zero tumor-related mortality. Patients who received STR and/or had atypical tumors (criteria = Ki-67 >4%) experienced decreased RFS compared to those who received GTR and/or were without atypical tumors. RFS at 5 years was 67% for typical CNs and 22% for atypical CNs. Every pediatric tumor was atypical and 3/5 recurred within 5 years. Salvage RT following tumor recurrence led to 100% tumor control, with no further recurrences (median post-RT follow-up = 5.79 years); volumetric analysis for 3 recurrent tumors (8.59 cumulative years of serial scans) revealed an ~80% reduction in tumor (range: 76.3%-81.1%), at a mean rate of 2.49% per month. CONCLUSION We provide encouraging evidence that (1) CNs have limited long-term risk of tumor-related mortality and (2) RT after tumor recurrence conveys strong long-term tumor control, including for potentially more aggressive pediatric CNs. Our institutional experience supports the conservative management of CN, including withholding RT until signs of recurrence regardless of resection extent or Ki-67.

Testing Nonmonotonicity in Health Preferences.

The main aim of this article is to test monotonicity in life duration. Previous findings suggest that, for poor health states, longer durations are preferred to shorter durations up to some threshold or maximum endurable time (MET), and shorter durations are preferred to longer ones after that threshold. Monotonicity in duration is tested through 2 ordinal tasks: choices and rankings. A convenience sample (n = 90) was recruited in a series of experimental sessions in which participants had to rank-order health episodes and to choose between them, presented in pairs. Health episodes result from the combination of 7 EQ-5D-3L health states and 5 durations. Monotonicity is tested comparing the percentage rate of participants whose preferences were monotonic with the percentage of participants with nonmonotonic preferences for each health state. In addition, to test the existence of preference reversals, we analyze the fraction of people who switch their preference from rankings to choices. Monotonicity is frequently violated across the 7 EQ-5D health states. Preference patterns for individuals describe violations ranging from almost 49% with choices to about 71% with rankings. Analysis performed by separate states shows that the mean rates of violations with choices and ranking are about 22% and 34%, respectively. We also find new evidence of preference reversals and some evidence-though scarce-of transitivity violations in choices. Our results show that there is a medium range of health states for which preferences are nonmonotonic. These findings support previous evidence on MET preferences and introduce a new "choice-ranking" preference reversal. It seems that the use of 2 tasks with a similar response scale may make preference reversals less substantial, although it remains important and systematic. Two procedures based on ordinal comparisons are used to elicit preferences: direct choices and rankings. Our study reports significant rates of nonmonotonic preferences (or maximum endurable time [MET]-type preferences) for different combinations of durations and EQ-5D health states.Analysis for separate health states shows that the mean rates of nonmonotonicity range from 22% (choices) to 34% (rankings), but within-subject analysis shows that nonmonotonicity is even higher, ranging from 49% (choices) to 71% (rankings). These violations challenge the validity of multiplicative QALY models.We find that the MET phenomenon may affect particularly those EQ-5D health states that are in the middle of the severity scale and not so much the extreme health states (i.e., very mild and very severe states).We find new evidence of preference reversals even using 2 procedures of a similar (ordinal) nature. Percentage rates of preference reversals range from 1.5% to 33%. We also find some (although scarce) evidence on violations of transitivity.

A novel technology for heart failure that utilizes the respiratory effort to shift fluids from the lung and alleviate cardiac workloads; feasibility study in sheep

Abstract Introduction Hemodynamic congestion is governed by inflow from RV and drainage through LV. However, ventricle functions are affected by the intrathoracic/pleural pressure: Negative pleural pressure (PPL) increases RV outflow while decreasing LV outflow, and vice versa at high PPL. Cardiac decompensation is associated with an increase in the respiratory effort (the peak-to-peak changes in PPL). We suggest to utilize this respiratory effort to shift fluid out of the lung and alleviate hemodynamic congestion. It is done by pacing the heart when PPL is high and the LV stroke volume is larger than the RV stroke volume. Purpose To test the feasibility of the novel technology in sheep. To verify that it is possible to modify the distribution of the heart beat within the respiratory cycle (slightly modify the rhythm according to the PPL) with insignificant effect on mean heart rate. Methods The utility was validated in sheep (N=9), under spontaneous breathing before and after induction of acute infarction by balloon inflation in the mid-LAD artery. The device senses the intracardiac electrical activity and respiratory effort and paces the right atrium when the PPL is high. The R-R interval of the paced beats was shorter than the sinus R-R interval by less than 10%. The effects of PPL and device pacing on LV and RV stroke-volumes were derived from simultaneous measurements of RV and LV pressure-volume loops, utilizing two impedance catheters (CD-Leycom) within both ventricles. Results The respiratory effort had significant effects on RV and LV outputs before and after infarction. The stroke volumes of the two ventricles were in antiphase! At low PPL the RV output increased while the LV decreased by about 10%, and the opposite occurred at high PPL. The pacing increased cardiac beating probability at high PPL. Sequential pacing for one minute increased the systolic pressure by 5 mmHg while decreasing the pulmonary artery pressure. Based on the pressure-volume loops, each paced breath cycle increased the LV outflow by 1.14 ml and decreased RV outflow by 0.36ml, yielding a shift of 1.5 ml from the lung. Interestingly, it was associated with a decrease in the sinus rate, which further decreased cardiac beating at low PPL and may represent a decrease in sympathetic tone. Conclusions Pacing only 1% of the ∼20,000 daily breath-cycles can shift 300 ml from the lung per day! The technology is agnostic of the heart-failure etiology. Preclinical studies in a model of chronic heart failure are required to further validate the novel approach.

Development and internal-external validation of a prediction model for premature ventricular contraction unresponsive to the medical treatment

Abstract Background Ventricular premature contractions (PVCs) are the most common ventricular arrhythmias. However, to date, no risk stratification tool exists to assess response to medical therapy in patients with frequent PVCs (>5% per 24 hours). We aimed to develop and validate a clinical prediction model evaluating response to medical therapy in frequent PVCs. Methods We conducted a retrospective cohort study of patients with frequent PVCs who were considered for medical treatment. The study outcome was unresponsiveness to the medical treatment (24-hour PVC count not diminishing by at least 80%) in patients with frequent PVCs at 3-6 months follow-up. Potential predictors were, age (years), PVC burden (%), LVEF % (<55, ³55), PVC QRS width (msec), mean heart rate (beat/min), sinus beat QTc (msec), PVC coupling interval, gender, presence of multifocal PVC and Non-sustained VT. Binary logistic regression analyses were performed to develop and internally validate the model. Finally, we used internal-external cross validation using leave-one-out center. Results 1644 patients were included in the study (mean age 52.2±13.5 years and 56.3% male). The frequency of unresponsiveness to the medical treatment in patients with frequent PVC was 31.2% (n=513). In the model, PVC burden (%), LVEF% (<55, ³55) and PVC QRS width were found to be the three strongest predictors. The apparent and internal validation discriminations of the model (C-statistics in internal validation 0.910) were quite satisfactory. Model discriminations and calibration metrics with internal-external cross validation were similar to the apparent model and were deemed acceptable (https://demonoreflow.shinyapps.io/dynnomapp/). Conclusions We developed and validated a model that accurately predicts unresponsiveness to medical treatment in patients with frequent PVC. Our model, once externally validated, has the potential to facilitate management decisions by providing individualized risk estimates in patients with frequent PVC for whom ablation may be suggested as a first line treatment modality.Figure-1Figure-2

Episode-level characteristics of atrial fibrillation are associated with symptomatic events

Abstract Background Symptoms related to Atrial Fibrillation (AF) can be debilitating are the main driver to seek hospital attention. However, many patients do not experience any symptoms and intra-subject variation is also seen. The reasons for this variability are unclear and a better understanding of the features associated with symptomatic AF episodes may improve stratification and personalisation of care. Purpose To evaluate the features associated with symptomatic versus asymptomatic AF episodes recorded using an insertable cardiac monitor (ICM). Methods We linked a deidentified database of aggregated electronic health records from 2007-2021 to a manufacturer’s device data warehouse with continuous diagnostic monitoring data. ICM-detected AF episodes of a minimum of one hour duration were retrospectively analysed. Symptomatic AF was defined as episodes temporally correlated with patient activation of a handheld symptom activator device. Episode- level comparison of mean heart rate at detection and during the entire AF episode, AF episode duration, activity index and AF evidence score (a linear scale based on episode irregularity) between symptomatic and asymptomatic patients was performed. Data was reported as mean ± standard deviation or median (inter-quartile range) if non-normally distributed. Wilcoxon Signed-Rank test was used for per-subject paired analysis. Multi-variate logistic regression model with binomial distribution and exchangeable correlation structure was used to identify factors associated with symptomatic episodes. A Generalized Estimating Equations model was used to account for multiple AF episodes within a subject. Results 417,432 unique episodes were recorded in 11,436 patients. 6,190 (1.48%) episodes from 1776 patients were marked as symptomatic. These were longer (5.5 (12.1) hours vs 3.7 (9.3) hours), had a higher mean HR at onset (105.7±29.3bpm vs 89.1+-24.6bpm) and a greater AF evidence score (97.6+-26.9 vs 82.1+-24.4). On multi- variate logistic regression, AF evidence score, and mean HR was independently associated with symptomatic AF (table 1). Per subject analysis of 1589 patients with both symptomatic and asymptomatic episodes also suggested significantly higher AF evidence scores. (-3.64±22.0). Discussion: This is the largest episode-level characterisation of AF episodes in patients with an ICM. The AF evidence score, a marker of ventricular rate variability, may be useful for the remote stratification of AF episodes. Prospective study of stratification based on this parameter would be of value.Regression model of symptomatic AF

Development and Acceptability of Cookie Product Made from Marang (Artocarpus Odoratissimus) Seed Flour

Marang, known for its distinctive flavor and texture, is a tropical fruit hailing from Southeast Asia, featuring sweet, custard-like flesh and a fragrant scent. This study aimed to create Marang seed (Artocarpus odoratissimus) flour and cookies, establishing the optimal ingredient ratios to deliver a delightful flavor. Employing both quantitative and qualitative approaches, this research enlisted consumer respondents and food professionals to assess sensory qualities using the DOST’s 9-point hedonic scale. Statistical analysis, including mean and standard deviation, was employed to evaluate cookie acceptability based on qualitative criteria encompassing appearance, aroma, taste, and texture. Phyto-chemical analysis revealed the presence of alkaloids, naturally occurring substances with potential pharmacological effects, in Marang extract. Quaternary bases and amin e oxides, organic compounds featuring positively charged nitrogen atoms, were identified, alongside steroids with diverse biological functions. The grading system denoted the relative concentration of alkaloids. While 2-deoxysugars were detected, unsaturated steroids were absent. Flavonoids, known for their antioxidant properties, and saponins, foaming agents with potential health benefits, were also present. Tannins, recognized for their astringency, appeared with different colors indicating condensed and hydrolyzable tannins. Marang seed flour exhibited a chemical composition with 18.2% oil content, 16% moisture content, 10.7% crude protein content, and notable levels of manganese and copper at 31.8 ppm and 7.5 ppm, respectively, along with 161 ppm of phosphorus. The overall acceptability of the developed cookie was moderately liked, with a grand mean rating of 7.76. Taste held the greatest influence on overall acceptability, followed by texture, appearance, and aroma. This study recommends further investigation into the pharmacological effects and potential health benefits of Marang extract components, potentially leading to pharmaceutical or functional product development. Utilizing Marang seed flour in various food products can leverage its nutritional value and meet potential commercial demand. Improving and standardizing the Marang cookie recipe for uniform quality and flavor is advisable. The development of packaging and branding to highlight the unique qualities and health benefits of Marang cookies can cater to health-conscious consumers.

Predicting aortic stenosis progression using a video-based deep learning model of aortic stenosis built for single-view two-dimensional echocardiography

Abstract Background We have recently described a deep learning (DL) model that relies on 2-dimensional parasternal long axis (PLAX) videos from transthoracic echocardiography (TTE) without Doppler imaging to identify severe aortic stenosis (AS) at the point-of-care. However, the timely diagnosis of AS has traditionally required skilled examination with Doppler imaging at regular time intervals. Purpose To explore the role of a DL model previously trained to detect severe AS based on 2D-PLAX videos in predicting the rate of AS progression among patients with no, mild, or moderate AS. Methods In this retrospective cohort study, a random sample of 2354 individuals undergoing serial monitoring with at least two separate TTEs and available Doppler parameters of AS severity (peak aortic valve velocity, AV Vmax) between 2016 and 2021 in the Yale-New Haven Health system were included. Eligible participants had a left ventricular ejection fraction (LVEF) >=50% and no evidence of severe AS at baseline. After automated selection of PLAX videos using an automated view classifier, the baseline deep learning-based AS probability index (DL-ASi) was calculated for each patient. The absolute change in the AV Vmax was divided by the time difference between each pair of consecutive TTE studies, and then averaged to derive the mean rate of AS progression. The association between the baseline DL-ASi and the mean rate of AS progression was assessed using ordinary least squares regression with adjustment for the patient’s sex, age, and baseline LVEF and AV Vmax. To visualize the interaction between the baseline DL-ASi and AV Vmax in predicting the rate of AS progression, an interaction term was included and a contour plot was plotted for both men and women. Results We included 8473 TTE studies from 2354 unique individuals (mean age 70±14 years, n=1138 [48.3%] women) performed over a median 2.5 (IQR 1.4-3.7) years (A). Higher DL-ASi at baseline was independently associated with a more rapid rate of AS progression (βadj 0.27 [95% CI 0.20-0.33, P<0.001]). The rates of AV Vmax progression ranged from 0.06±0.01 m/sec/year in the <0.2 DL-ASi group, to 0.29±0.04 m/sec/year in the ≥0.8 DL-ASi group (B). Contour plots illustrate how, for a given AV Vmax value, DL-ASi stratified the risk of AS progression in women and men (C). Conclusion In individuals with mild to moderate AS or no AS, a DL model trained to detect features of severe AS identifies individuals with a higher rate of AS severity progression, as assessed by the mean rate of AV Vmax change. This represents a promising approach for the longitudinal, point-of-care monitoring of patients with non-severe AS outside specialized centers.

Influence of light absorption rate on the astaxanthin production by the microalga Haematococcus pluvialis during nitrogen starvation

Large amounts of astaxanthin (about 4% DW) can be produced under nitrogen starvation of Haematococcus pluvialis in photobioreactors (PBRs) exposed to high light conditions to induce a light stress. However, in PBR, the large biomass concentration usually achieved leads to strong light attenuation conditions, which makes complex the analysis of this “light stress”. This study aims to elucidate the role of light transfer in astaxanthin cell content and productivity from the microalga Haematococcus pluvialis during nitrogen starvation. Haematococcus pluvialis was cultivated in a flat-panel PBR in a batch mode with sudden nitrogen starvation conditions and an incident photon flux density (PFD) of 250 µmolhν m−2 s−1. Different initial biomass concentrations ({C}_{{x}_{0}}) were evaluated, 0.21, 0.52, 1.39 and 2.21 kg m−3. As a result, spectral mass absorption cross-sections of Haematococcus pluvialis were measured at different times during nitrogen starvation, and were used to relate the mean rate of photon absorption (MRPA) to the astaxanthin productivity. A minimum initial MRPA of 7000 ± 500 µmolhν kgx−1 s−1 was found necessary to trigger large accumulation of astaxanthin in Haematococcus pluvialis cells (up to 3.21% DW) during nitrogen starvation conditions. The results also demonstrated the link between the MRPA and the daily astaxanthin productivity of Haematococcus pluvialis cultures, introducing then the MRPA as a physical quantity of interest for a rational optimization of the light culture conditions in PBRs.Graphical

Combined Age with Mean Decrease Rates of Total Bilirubin and MELD Score as a Novel and Simple Clinical Predictor on 90-Day Transplant-Free Mortality in Adult Patients with Acute Liver Failure Undergoing Plasma Exchange: A Single-Center Retrospective Study.

Acute liver failure (ALF), previously known as fulminant hepatic failure, has become a common, rapidly progressive, and life-threatening catastrophic hepatic disease in intensive care unit (ICU) due to the continuous increase in drug abuse, viral infection, metabolic insult, and auto-immune cause. At present, plasma exchange (PE) is the main effective alternative treatment for ALF in ICU clinical practice, and high-volume plasma exchange (HVP) has been listed as a grade I recommendation for ALF management in the American Society for Apheresis (ASFA) guidelines. However, no existing models can provide a satisfactory performance for clinical prediction on 90-day transplant-free mortality in adult patients with ALF undergoing PE. Our study aims to identify a novel and simple clinical predictor of 90-day transplant-free mortality in adult patients with ALF undergoing PE. This retrospective study contained adult patients with ALF undergoing PE from the Medical ICU (MICU) in the Second Affiliated Hospital of Harbin Medical University between January 2017 and December 2020. Baseline and clinical data were collected and calculated on admission to ICU before PE, including gender, age, height, weight, body mass index (BMI), etiology, total bilirubin, direct bilirubin, indirect bilirubin, prothrombin activity, model for end-stage liver disease (MELD) score, and sequential organ failure assessment (SOFA) score. Enrolled adult patients with ALF undergoing PE were divided into a survival group and a death group at discharge and 90 days on account of medical records and telephone follow-up. After each PE, decreased rates of total bilirubin and MELD score and increased rates of prothrombin activity were calculated according to the clinical parameters. In clinical practice, different patients underwent different times of PE, and thus, mean decrease rates of total bilirubin and MELD score and mean increase rate of prothrombin activity were obtained for further statistical analysis. A total of 73 adult patients with ALF undergoing 204 PE were included in our retrospective study, and their transplant-free mortality at discharge and 90 days was 6.85% (5/73) and 31.51% (23/73), respectively. All deaths could be attributed to ALF-induced severe and life-threatening complications or even multiple organ dysfunction syndrome (MODS). Most of the enrolled adult patients with ALF were men (76.71%, 56/73), with a median age of 48.77 years. Various hepatitis virus infections, unknown etiology, auto-immune liver disease, drug-induced liver injury, and acute pancreatitis (AP) accounted for 75.34%, 12.33%, 6.85%, 4.11%, and 1.37% of the etiologies in adult patients with ALF, respectively. Univariate analysis showed a significant difference in age, mean decrease rates of total bilirubin and MELD score mean increase rate of prothrombin activity, decrease rates of total bilirubin and MELD score, and increase rate of prothrombin activity after the first PE between the death group and survival group. Multivariate analysis showed that age and mean decrease rates of total bilirubin and MELD score were closely associated with 90-day transplant-free mortality in adult patients with ALF undergoing PE. The 90-day transplant-free mortality was 1.081, 0.908, and 0.893 times of the original value with each one-unit increase in age and mean decrease rates of total bilirubin and MELD score, respectively. The areas under the receiver operatingcharacteristic (ROC) curve of age, mean decrease rates of total bilirubin and MELD score, and the three combined were 0.689, 0.225, 0.123, and 0.912, respectively. The cut-off values of age, mean decrease rates of total bilirubin and MELD score, and the three combined were 61.50, 3.12, 1.21, and 0.33, respectively. The specificity and sensitivity of combined age with mean decrease rates of total bilirubin and MELD score for predicting 90-day transplant-free mortality in adult patients with ALF undergoing PE were 87% and 14%. Combined age with mean decrease rates of total bilirubin and MELD score as a novel and simple clinical predictor can accurately predict 90-day transplant-free mortality in adult patients with ALF undergoing PE, which is worthy of application and promotion in clinical practice, especially in the identification of potential transplant candidates.

Abstract 13175: Association of Heart Rate Variability and Electrolyte Changes During Hemodialysis in Patients With Chronic Kidney Disease

Introduction: Autonomic neuropathy commonly arises as a long-term complication in chronic kidney disease (CKD) and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. Hypothesis: There is limited data about HRV using real-time ECG according to electrolyte levels during hemodialysis (HD) in patients with CKD. Methods: Total of 50 patients (62.1±10.7 years) with CKD underwent continuous real-time ECG monitor (237.4±15.3 mins) during HD for HRV using remote monitoring system and checked electrolyte levels before/after HD. And we compared HRV according to electrolyte levels. Results: During the monitor, we checked total 2374 times of ECG and electrolyte level simultaneously of all patients. Both time and frequency domain HRV were higher when the patients had lower K + level change before/after HD (<0.5mEq/L) as compared with those with higher K + level change (>0.5mEq/L) in Table. In addition, there were higher incidence of arrhythmic events including atrial/ventricular premature complexes, even though no difference of mean heart rate in patients with lower K+ level change group (P<0.001). Conclusions: Poor controlled K+ level during hemodialysis was independently associated with higher HRV in patients with CKD. This is further substantiated by independent continuous associations between real-time measures of K+ level and higher HRV. These data strongly suggest that cardiac autonomic dysfunction can be caused by lower change before/after hemodialysis alone.

Recreational handball-based training for people with type 2 diabetes: a feasibility trial

Introduction Type 2 diabetes mellitus (T2DM) is recognized as a serious public health concern with a considerable impact on people suffering from the disease and the society. The benefit of physical activity in the prevention and treatment of T2DM are well documented, however, a considerable proportion of individuals with T2DM have an inactive and sedentary lifestyle. Although most people with T2DM are aware of the importance of exercise, many are not interested in joining traditional exercise options, and long-term adherence is poor for those who do. Thus, we aim to investigate the feasibility of recreational handball-based training (HBT) for people diagnosed with T2DM. Methods This single-arm feasibility trial included adults (over 30 years) with a clinical diagnosis of T2DM. They were invited to participate in a 12-week HBT consisting of two weekly 60-minute exercise sessions. The outcome was feasibility, determined by adherence, exercise intensity, adverse events, dropout rate, and metabolic parameters. Results From September to December 2021, 10 people were included in the study. One participant dropped out because of illness and one participant dropped out due to suspected atrial fibrillation. Eight participants concluded the intervention and participated on average 86% (range 14–23) of the HBT sessions exercising with a mean heart rate of 73.4% (standard deviation (SD) 10.2) of individual maximum heart rate. Conclusions HBT for people diagnosed with T2DM was found feasible with a high attendance rate and clinically relevant exercise intensities. However, future randomized controlled trials about the effects of the handball intervention are needed. Trial registration This trial was registered in ClinicalTrials.gov (NCT05015946) on 23/08/2021.