Miscellaneous Category Research Articles

Secondary findings in 443 exome sequencing data.

Exome sequencing (ES) may identify and report secondary findings that are unrelated to the primary disease for which the patient underwent genetic testing, but are of potential value in patient care. In this study, we evaluated 81 American College of Medical Genetics (ACMG) medically actionable genes in 443 patients with various neurological disorders. The variants identified were classified and reported following the 2015 ACMG Standards and Guidelines for the interpretation of sequence variants and the ACMG recommendations for reporting secondary findings (v3.2). We detected a total of 17 variants in 17 patients across 9 different genes as secondary findings. Seven heterozygous variants were found in BRCA1, MSH2, and PALB2 which are part of the cancer phenotype category. Nine heterozygous variants were found in MYH7, TTN, LDLR, DSC2, and DSP which are part of the cardiovascular phenotype category. Finally, one heterozygous variant was found in TTR which is part of the miscellaneous phenotype category. Thirteen of above mentioned variants were classified as known pathogenic and four as expected pathogenic. The information collected in our study may lead to the prevention of severe morbidity and mortality and provides additional insight into the genetic background of the Serbian population.

Case Reports of Patients Using Homeopathy in Which Complete Healing Was Observed: A Literature Review

To systematically review the literature for cases using homeopathy in which complete healing was observed. Scielo, Pubmed, CINAHL, and Embase databases were systematically screened for case reports and series of patients successfully cured by homeopathy between 1966 and August 2022. Language limitation was not used. Forty-nine articles, comprising 191 patients, were depicted. Most of them had dermatological conditions (12 papers, 71 patients), followed by infectious (7 papers, 31 patients), neuropsychiatric (10 publications, 11 patients), vascular and hematological (6 manuscripts, 6 patients), and miscellaneous (11 papers, 52 patients) categories. All of them reported cases that were cured of the clinical condition. This article summarizes the case reports in which homeopathy was used and shows the healing of the different treated diseases.

Rapid Lifestyle Recommendations to Improve Urologic, Heart and Overall Health.

This literature review is intended to highlight recent correlations between urologic, heart and overall health by emphasizing healthy eating patterns, physical activity, alcohol minimization and tobacco elimination, healthy sleep, weight, cholesterol, blood sugar, blood pressure management, and mental health awareness. Meta-analyses, systematic reviews, and clinical studies espouse a unified message for prevention, reducing the risk of disease recurrence, progression, complementing conventional medical intervention efficacy, and mitigating treatment side effects. Limiting or eliminating alcohol consumption could be considered an independent recommendation and adding a mental health and miscellaneous (genetic risk and lifestyle, planetary health, HPV or other vaccination awareness, spirituality, etc.) category could allow for individualized educational opportunities, synergism appreciation, and self-improvement. Urologic healthcare professionals have the potential to strengthen the collective public health goal of improving the quality and quantity of the lives of patients able to adhere to these heart healthy recommendations.

Smartphone apps pertaining to aquaculture sector in Bangladesh: Current status and future potentials

In recent years, the aquaculture sector in Bangladesh has experienced significant technological advancements, notably the adoption of smartphone applications. This empirical study evaluates the current status of smartphone apps available in the aquaculture industry of the country using data obtained from the internet and field surveys. The study identified 41 smartphone apps currently used in the sector, where 58.53 % are related to pond-based aquaculture, 14.63 % are designed for biofloc system, 4.87 % pertain to cage aquaculture and 4.87 % marketing-aided corporate-related apps, 9.75 % focus on disease and treatment-related, and 7.31 % fall into miscellaneous categories. The “Poultry Animals and Aqua Index (PAAI)" app, which addresses aquaculture pharmaceutical inputs and fish disease treatment guidelines, emerged as the most downloaded app in this domain. Pearson correlation analysis indicated that app size or user ratings did not influence app downloads. The study also found that approximately 57.66 % of fish farmers are aware of these smartphone apps. Private fisheries professionals were the main driving forces behind the use of these apps, accounting for 52 % of the information spread. Despite mixed levels of satisfaction among farmers, about 25 % expressed a positive experience. Most of the farmers (57.66 %) acknowledged the awareness and beneficial impacts of using these apps in aquaculture. This study enhances the understanding of smartphone apps usage in Bangladesh to promote the aquaculture industry, highlighting its potential to promote industry growth, alleviate poverty, and contribute to economic development.

Fever of unknown origin in pediatrics: causes and clinical characteristics in a single centre experience

BackgroundFever of unknown origin (FUO) is a common condition worldwide in children that remains a diagnostic challenge. The causes of FUO vary depending on the patient's age, residency, and the time of study. Therefore, this study aimed to identify the common aetiologies of FUO at Alexandria University Children’s Hospital under the current diagnostic abilities and newly emerging diseases.MethodsThe current prospective observational study included all children fulfilling the definition of FUO admitted at Alexandria University Children's Hospital from January 2020 to December 2021 using a steps approach for investigations.ResultsA total of 110 children with fever of unknown origin (FUO) were included in this study; the average duration of fever was 36.76 ± 31.73 days. In most of the enrolled cases 105/110 (95.4%) the definite etiology of FUO was identified. The common causes were collagen vascular diseases (30.9%), infectious diseases (28.2%), miscellaneous conditions (19.1%), and malignancy (17.3%). Among collagen vascular diseases, systemic lupus erythematosus (SLE) (47.1%) and systemic onset juvenile idiopathic arthritis (sJIA) (38.2%) were the most common. In the infectious category, Katayama fever (16.1%), brucellosis (12.9%), and urinary tract infection (UTI) (12.9%) were the most frequently observed. Post-Covid MIS-C (52.4%) was the most common in the miscellaneous category. Children in the infectious category had significantly higher neutrophil [5.76 (2.28–7.92) × 10^3/µl] and lymphocytic counts [ 4.2 (2.04–5.91) × 10^3/µl]; (P < 0.001 and < 0.010 respectively). Moreover, in the collagen category the median lymphocytic count was lower [1.95 (1.47–2.73) × 10^3/µl] with a significantly (P < 0.010) higher neutrophil/ lymphocyte ratio [2.30 (1.53–3.91)].ConclusionCollagen vascular diseases, infectious diseases, miscellaneous, and malignancy were the most common causes of FUO. Katayama fever, urinary tract infections (UTI), and brucellosis were the most common causes in the infectious category. Post-Covid MIS-C and hemophagocytic lymphohistiocytosis were the most common diagnoses in the miscellaneous category.

New fractional classifications of papers based on two generations of references and on the ASJC scopus scheme

This paper presents and evaluates a set of methods to classify individual Scopus publications using their references back to the second generation, where each publication can be assigned fractionally into up to five ASJC (All Science Journal Classifications) categories, excluding the Multidisciplinary area and the miscellaneous categories. Based on proposals by Glänzel et al. (Glänzel et al., Scientometrics 44:427–439, 1999a, Glänzel et al., Scientometrics 46:431–441, 1999b, Glänzel, W., Thijs, B., & Huang, Y. (2021). Improving the precision of subject assignment for disparity measurement in studies of interdisciplinary research. In: W. Glänzel, S. Heeffer, PS. Chi, R. Rousseau (eds), Proceedings of the 18th International Conference of the International Society of Scientometrics and Informetrics (ISSI 2021), Leuven University Press, pp. 453–464. https://kuleuven.limo.libis.be/discovery/fulldisplay?docid=lirias3394551&context=SearchWebhook&vid=32KUL_KUL:Lirias&search_scope=lirias_profile&tab=LIRIAS&adaptor=SearchWebhook&lang=en), some additional parameters are established that allow different results to be obtained depending on how category membership is weighted or how the acceptance thresholds for multiple assignments are established. Various classifications are obtained, and then compared with each other, with the original ASJC Scopus journal classification, and with the AAC (Author’s Assignation Collection) classification of a previous study (Álvarez-Llorente et al., Álvarez-Llorente et al., Profesional de la Información, 2023) in which the papers’ corresponding authors assign them the most appropriate categories. Classifications in which a high threshold is set for allowing assignments to multiple categories, combined with the use of first- and second-generation references and averaging over the number of references, provide the most promising results, improving over other reference-based reclassification proposals in terms of granularity, and over the Scopus classification itself in such aspects as the homogeneity of the publications assigned to a category. They also show greater coincidence with the AAC classification.

Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system.

The correlation of clinical characteristics of cerebral palsy (CP) and the magnetic resonance imaging classification system (MRICS) for (CP) is inconsistent. Specifically, the variance in rehabilitation potential across MRICS remains underexplored. To investigate the clinical characteristics and potential for rehabilitation in children with CP based on MRICS. Children with CP admitted to the Department of Rehabilitation, Children's Hospital of Chongqing Medical University between 2017 and 2021 were included in the study. Qualified cases underwent a follow-up period of at least one year. The clinical characteristics of CP among different MRICS were analyzed, then the rehabilitation potential was explored by a retrospective cohort study. Among the 384 initially enrolled children, the male-to-female ratio was 2.3:1, and the median age of diagnosis was 6.5 months (interquartile range: 4-12). The most prevalent MRICS categorization was predominant white matter injury (40.6%), followed by miscellaneous (29.2%) and predominant gray matter injury (15.6%). For the predominant white matter injury and miscellaneous categories, spastic diplegia emerged as the leading subtype of CP, with incidences of 59.6% and 36.6%, respectively, while mixed CP (36.7%) was the most common type in children with predominant gray matter. Notably, 76.4% of children with predominant white matter injury were classified as levels I-III on the gross motor function classification system (GMFCS), indicating significantly less severity than other groups (χ2 = 12.438, p = 0.013). No significant difference across MRICS categories was observed for the manual ability classification system (MACS) (H = 8.176, p = 0.085). Rehabilitation potential regarding fine motor function and adaptability based on Gesell assessment was dependent on MRICS over the follow-up period. Children with normal MRI scans exhibited superior rehabilitation outcomes. Commencing rehabilitation at an earlier stage produced consistent and beneficial results in terms of fine motor function and adaptability across all MRICS categories. Moreover, participants below 2 years of age demonstrated enhanced rehabilitation potential regarding fine motor outcomes and adaptability within the MRICS framework. MRICS displayed a significant association with clinical characteristics and rehabilitation efficacy in children with CP.

Validation of the shortened version of the Canine Behavioral Assessment and Research Questionnaire (C-BARQ) using participants from the Dog Aging Project.

The Canine Behavioral Assessment and Research Questionnaire (C-BARQ) is a 100-item owner-completed survey instrument used for assessing behavior and temperament of companion dogs. The shortened version of the C-BARQ (C-BARQ(S)) consists of 42 items of the long C-BARQ. We aimed to validate the shortened C-BARQ(S) by comparing it with the long questionnaire in the same human-dog pair. We examined data from a nationwide cohort of companion dogs enrolled in the large-scale longitudinal Dog Aging Project (DAP) study. Among 435 participating owners who completed both the long and shortened versions of the C-BARQ within 60 days of each other, agreement between individual questions of the long and shortened C-BARQ using an unweighted kappa statistic and percent agreement was examined. Associations between the two questionnaires for mean behavior and temperament domain scores and mean miscellaneous category scores were assessed using Pearson correlation coefficients. Of 435 dogs in the study, the mean (SD) age was 7.3 (4.3) years and 216 (50%) were female. Kappa values between the long and shortened C-BARQ for individual questions within the 14 behavior and temperament domains and a miscellaneous category ranged from fair to moderate (0.23 to 0.40 for 21 items and 0.41 to 0.58 for 26 items, respectively). Pearson correlation coefficients above 0.60 between both questionnaires for 12 of the 14 mean behavior and temperament domain scores and a category of miscellaneous items were observed. Kappa values for individual questions between the long and shortened C-BARQ ranged from fair to moderate and correlations between mean domain scores ranged from moderate to strong.

Auto-verbalizer filtering for prompt-based aspect category detection

Aspect category detection (ACD) is a basic task in sentiment analysis that aims to identify the specific aspect categories discussed in reviews. In the case of limited label resources, prompt-based models have shown promise in few-shot ACD. However, their current limitations lie in the manual selection or reliance on external knowledge for obtaining the verbalizer, a critical component of prompt learning that maps predicted words to final categories. To solve these issues, we propose an ACD method to automatically build the verbalizer in prompt learning. Our approach leverages the semantic expansion of category labels as prompts to automatically acquire initial verbalizer tokens. Additionally, we introduce an indicator mechanism for auto-verbalizer filtering to obtain reasonable verbalizer words and improve the predicting aspect category reliability of the method. In zero-shot task, our model exhibits an average performance improvement of 7.5% over the second-best model across four ACD datasets. For the other three few-shot tasks, the average performance improvement over the second-best model is approximately 2%. Notably, our method demonstrates effectiveness, particularly in handling general or miscellaneous category aspects.

Frequency and types of pre-analytical errors in a clinical laboratory of a specialized healthcare hospital.

The pre-analytical phase, encompassing all preparatory steps leading to the analytical process, represents a critical stage prone to laboratory errors. An assessment of the occurrence and categories of laboratory errors, specifically within the pre-analytical phase of laboratory procedures, can guide in taking timely actions for rectifying errors responsible for damage and loss of samples. This study aimed to assess the frequency and types of pre-analytical errors within a clinical laboratory at the Multan Institute of Kidney Diseases over two years. This research took place at the Multan Institute of Kidney Diseases. Data was extracted from the hospital laboratory records of the period from 1st January 2021 to 31st December 2022. After data compilation, a retrospective cross-sectional methodology was adopted to assess frequency and types of pre-analytical errors within a clinical laboratory. The records underwent a thorough examination to identify pre-analytical errors, which were classified according to their type and occurrence rate. Among the 254810 specimens received during the data collection period, a total of 1,722 specimens (0.67% of all collected samples) were found unsuitable for further processing. Amongst the rejected specimens, 718 (41.6%) displayed indications of hemolysis, 388 (22.5%) exhibited clotting, 217 (12.6%) had an insufficient volume and the remaining specimens fell into other miscellaneous categories such as insufficient quantity, unlabeled samples etc. The overall percentage of sample rejections in the laboratory was 0.67%. This study provided valuable insights into various reasons, and causes that require improvements to enhance the efficiency and quality of laboratory processes.

Adult perioperative cardiac arrest: An overview of 684 cases reported to webAIRS.

There were 684 perioperative cardiac arrests reported to webAIRS between September 2009 and March 2022. The majority involved patients older than 60 years, classified as American Society of Anesthesiologists Physical Status 3 to 5, undergoing an emergency or major procedure. The most common precipitants included airway events, cardiovascular events, massive blood loss. medication issues, and sepsis. The highest mortality rate was 54% of the 46 cases in the miscellaneous category (this included 34 cases of severe sepsis, which had a mortality of 65%). This was followed by cardiovascular precipitants (n = 424) in which there were 147 deaths (35% mortality): these precipitants included blood loss (53%), embolism (61%) and myocardial infarction (70%). Airway and breathing events accounted for 25% and anaphylaxis 8%. A specialist anaesthetist attended the majority of these cardiac arrests. As webAIRS is a voluntary database, it is not possible to determine the incidence of perioperative cardiac arrest and only descriptive information on factors associated with cardiac arrest can be obtained. Nevertheless, the large number of reports includes a wide range of cases, precipitants, demographics and outcomes, providing ample opportunity to learn from these events. The data also provide rich scope for further research into further initiatives to prevent cardiac arrest in the perioperative period, and to improve outcomes, should a cardiac arrest occur.

Funding of research & innovation in the field of medical technologies and biomedical engineering over the different European framework programmes.

To demonstrate the role of the European Framework Programmes for Research & Innovation in supporting the field of Medical Technologies and Biomedical Engineering and to show which types of medical technologies and which funding instruments are the preferred ones. Based on data available in the European Commission data warehouse for the past two Framework Programmes, funded projects addressing a Medical Technology were identified. This enabled to categorize the projects according to the intended use and to classify into different types. Moreover, the main instruments in the Framework Programme acting as funding sources were explored. The increase in R&I support led to 1961 projects and a total financing of € 3.2 bllion under the last Framework Programme. The categorization showed a balanced funding in terms of intended use, the detailed classification revealed that in-vitro-diagnostics and imaging equipment prevail in the diagnostic category, tissue-engineering products, implants and robotics in the therapeutic domain and ICT or software-based technologies in the miscellaneous category. As to funding sources, the classical health-oriented collaborative research scheme was on top, followed by instruments like the European Research Council, the Future and Emerging Technologies activities and the European Innovation Council, and completed by the Public-Private Partnerships. The European Framework Programmes are key on the global landscape for financing Research & Innovation of Medical Technology and the breadth of supported technologies is equally reflected by the different funding instruments involved.

Genetic selection for reduced health treatment costs in Holstein cows: implications from a long-term study.

The objective of this study was to estimate genetic parameters of health treatment cost of Holstein cows from producer-recorded health treatments in 8 herds over an 8-yr period of time. Genetic parameters of health treatment cost were estimated in first (n = 2,214), second (n = 1,487) and third (n = 800) parities of US Holstein cows. The health treatments were uniformly defined and consistently recorded by 8 high-performance dairy herds in Minnesota from 2008 to 2015. A fixed treatment cost was assigned to 14 types of health treatments, and the cost included the mean veterinary expense obtained from the veterinary clinics that serviced the 8 herds, pharmaceuticals, and labor cost. The labor cost was $18/h, and the time incurred for each type of health treatment was determined from interviews with the herd owners. The 14 types of health treatment costs were partitioned into 5 categories: mastitis (including mastitis diagnostic test), reproduction (cystic ovary, retained placenta, and metritis), lameness (hoof treatments), metabolic (milk fever, displaced abomasum, ketosis, and digestive), and miscellaneous (respiratory, injury, and other). Health treatment cost for each cow was summed by category within lactation and also across categories within lactation. The estimates of heritability for health treatment cost were 0.13, 0.04, 0.10, 0.12, and 0.04 for the mastitis, reproduction, lameness, metabolic, and miscellaneous categories, respectively, in first parity. Genetic correlations between categories of health treatment cost in first parity were greatest for mastitis and reproduction (r = 0.85); however, phenotypic correlations between all categories were small (r < 0.16). Total health treatment cost had a large genetic correlation with somatic cell score (0.93) and 305-d milk production (0.44) in first parity; however, the genetic correlation (-0.60) between total health treatment cost and udder depth in first parity indicated a genetic relationship exists between shallow udders and less total health treatment cost. Total health treatment cost across categories had a heritability estimate of 0.25 in first parity, 0.16 in second parity, and 0.17 in third parity. Consequently, genetic selection for reduced health treatment cost should be possible by using producer-recorded health treatment records supplemented with treatment costs.

Applications of Deep Learning Algorithms to Ultrasound Imaging Analysis in Preclinical Studies on In Vivo Animals.

Ultrasound (US) imaging is increasingly preferred over other more invasive modalities in preclinical studies using animal models. However, this technique has some limitations, mainly related to operator dependence. To overcome some of the current drawbacks, sophisticated data processing models are proposed, in particular artificial intelligence models based on deep learning (DL) networks. This systematic review aims to overview the application of DL algorithms in assisting US analysis of images acquired in in vivo preclinical studies on animal models. A literature search was conducted using the Scopus and PubMed databases. Studies published from January 2012 to November 2022 that developed DL models on US images acquired in preclinical/animal experimental scenarios were eligible for inclusion. This review was conducted according to PRISMA guidelines. Fifty-six studies were enrolled and classified into five groups based on the anatomical district in which the DL models were used. Sixteen studies focused on the cardiovascular system and fourteen on the abdominal organs. Five studies applied DL networks to images of the musculoskeletal system and eight investigations involved the brain. Thirteen papers, grouped under a miscellaneous category, proposed heterogeneous applications adopting DL systems. Our analysis also highlighted that murine models were the most common animals used in in vivo studies applying DL to US imaging. DL techniques show great potential in terms of US images acquired in preclinical studies using animal models. However, in this scenario, these techniques are still in their early stages, and there is room for improvement, such as sample sizes, data preprocessing, and model interpretability.

Clinical Accuracy Of Dermatologists And Nondermatologists In The Diagnosis Of Dermatological Diseases.

To compare the clinical diagnostic accuracy of dermatologists and non- dermatologists in the diagnosis of dermatological diseases. The descriptive, cross-sectional study was conducted at the Dermatopathology department of a tertiary healthcare hospital in the Punjab province of Pakistan from January 1 to December 31, 2019, and comprised biopsy specimens of patients with diseases of the skin and subcutaneous tissue. The clinical diagnoses of general surgeons, otolaryngologists, dental/maxillofacial surgeons, plastic surgeons and gynaecologists were noted and compared with those of dermatologists in the light of histopathological findings. Data was analysed using SPSS 16. Of the 386 specimens submitted, 113(29.3%) were sent by dermatologists and 273(70.7%) by non-dermatologists. Clinical diagnostic accuracy of dermatologists 92(81.4%) compared to non-dermatologists 137(50.2%) (p<0.005). The dermatologists diagnosed significantly more cases belonging to inflammatory and miscellaneous cutaneous diseases category accurately than non-dermatologists (p<0.005). Similarly, the dermatologists diagnosed significantly more cases of neoplastic disorders accurately than the non-dermatologists (p= 0.018). There was no significant difference in the clinical diagnostic accuracy of dermatologists and non-dermatologists in cases of cystic lesions (p>0.05). In the neoplastic category, no significant difference was found in the clinical accuracy of dermatologists and plastic surgeons (p=0.347). The specialised skills of dermatologists could not be matched by any other group of physicians.

Does Agricultural Support Help with Climate Change Mitigation Efforts?

Total support to the agricultural sector arising from public policies reached a record USD 817 billion per year in 2019–2021 for the 54 countries1 covered in the OECD Agricultural Policy Monitoring and Evaluation 2022 report (Figure 1). However, only a small share of this support was directed at longer-term efforts to combat climate change and other food system challenges. Breakdown of agricultural support, total of 54 countries, 2019–2021 Note: The potentially most distorting forms of support exclude those payments for variable inputs (such as fertiliser) that require constraints to their use (USD 1.7 billion per year). Source: OECD (2022), Producer and Consumer Support Estimates, OECD Agriculture statistics (database), https://doi.org/10.1787/agr-pcse-data-en. Of the total support, USD 500 billion per year was paid by taxpayers from public budgets, with the remaining USD 317 billion per year being transferred by consumers through higher prices (market price support). In a small number of countries, policies also suppress prices for some or all commodities, generating a transfer (an implicit tax) of USD 117 billion away from agricultural producers. In total, USD 391 billion per year was transferred to producers in the potentially most distorting forms of support (market price support and payments based on output or the unconstrained use of variable inputs). Along with forestry and other land use, agricultre represents around 22 per cent of anthropogenic GHG emissions; mainly methane and nitrous oxide from livestock, rice cultivation and fertiliser use, and carbon dioxide emissions through land use change, such as deforestation and carbon losses in agricultural soils. Lower GHG emissions can result from increasing productivity and efficiency in input use, adopting production techniques that reduce emissions, increasing soil carbon sequestration, afforestation and restoration of degraded lands, reducing food losses in the field and on the farm, and providing information and incentives to consumers to choose food with lower emissions intensities and reduce food waste. Current policies include subsidies for the use of variable inputs such as fertilisers, feed and fuel, amounting to USD 60 billion per year in 2019–2021 and directly contributing to GHG emissions. Moreover, support tied to specific commodities still accounts for a large share of gross farm receipts in some countries (Figure 2). Support for livestock products, which tend to have high GHG emissions intensities, amounted to USD 111 billion per year across the 54 countries, and exceeded 10 per cent of gross farm receipts in 5 countries. Breakdown of transfers to specific commodities, 2019–2021 Source: OECD (2022), Producer and Consumer Support Estimates, OECD Agriculture statistics (database), https://doi.org/10.1787/agrpcse-data-en. Despite their importance for achieving food security, climate and other food systems goals, investments in these areas have been falling relative to the size of the sector for most of the past two decades. Overall, support to general services accounted for 13 per cent of total support for the sector in 2019–2021, down from 16 per cent in 2000–2002 (Figure 3). There is therefore considerable scope for reforms that support both food systems objectives and ensure that agriculture contributes to ambitious emissions reduction targets. Public investments in general services, 2019–2021 (percentage of total support to agriculture) Note: ‘Other’ includes the marketing and promotion, cost of public stockholding, and miscellaneous categories of the General Services Support Estimate (GSSE). Source: OECD (2022), “Producer and Consumer Support Estimates”, OECD Agriculture statistics (database), https://doi.org/10.1787/agr-pcse-data-en. The opinions expressed and arguments employed herein are those of the authors and do not necessarily reflect the official views of the OECD or of its Member countries.

Clinical Classification of Urethrocutaneous Fistulas Developing after Hypospadias Repair.

Background Clinical classification of the urethrocutaneous fistulas (UCFs) was designed to help the surgeons in (1) categorizing the fistulas, (2) selecting appropriate treatments, (3) keeping record at presentation and discharge, and (4) transferring information while referring a patient with recurrent fistula to a higher center. Methods This retrospective study comprised of 68 patients with UCFs who reported in the "Hypospadias and VVFs Clinic" between 2004 and 2016. The study was performed to determine the incidence or etiology of the UCFs. It was rather performed to classify fistulas into different categories depending on the number of fistulas: A (5 fistulas), B (16 fistulas), C-a (28 fistulas), C-b (4 fistulas), D (4 fistulas), and E (11 fistulas). Category A fistulas healed conservatively. Category B fistulas underwent transection of the fistula tracts (tractotomy), purse-string closure, or multilayered closure (fistulorrhaphy). Category C-a fistulas were reenforced by preputial or penile skin flaps or waterproofing flaps. Category C-b fistulas underwent re-tubularization of their neourethral plates and eccentric closure of peno-preputial skin. The urethral plates of category D fistulas were re-tubularized after 3 to 6 months and cover was provided by the Cecil-Culp procedure. Category E fistulas had associated hairy urethra, stricture distal urethra, stricture with diverticulum, perifistular scar-induced chordee, long narrow urethral plate, balanitis xerotica obliterans (BXO), and short reconstructed neourethra. Accordingly, appropriate corrective measures were taken. Miscellaneous category F was excluded from the study. Results Except for one in category D, none of the patients had any recurrence of fistula. One patient of category E had residual diverticulum. Conclusion The designed clinical classification of UCFs is simple. Treatment was in accordance with reconstructive ladder wherein complexity of treatment paralleled with increasing complexity of fistulas.

Investigator-Determined Categories for Fever of Unknown Origin (FUO) Compared With International Classification of Diseases-10 Classification of Illness: A Systematic Review and Meta-analysis With a Proposal for Revised FUO Classification.

Classifying fever of unknown origin (FUO) into categorical etiologies (ie, infections, noninfectious inflammatory, oncologic, miscellaneous, and undiagnosed disorders) remains unstandardized and subject to discrepancies. As some disease classifications change, a systematic review of studies would help physicians anticipate the frequency of illness types they may encounter that could influence care. We systematically reviewed prospective FUO studies published across the Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022. We performed a meta-analysis to estimate associated pooled proportions between the investigator-determined choice of disease category and those determined by the International Classification of Diseases, 10th edition (ICD-10), methodology. The proportion of patients with a difference between the investigator and ICD-10-adjusted noninfectious inflammatory disorder category was 1.2% (95% CI, 0.005-0.021; P < .001), and the proportion was similar for the miscellaneous category at 1.5% (95% CI, 0.007-0.025; P < .001). The miscellaneous and noninfectious inflammatory disorders categories demonstrated significant across-study heterogeneity in the proportions of patients changing categories, with 52.7% (P = .007) and 51.0% (P = .010) I2 , respectively. Adjusting FUO-associated diagnoses by ICD-10 methodology was associated with a statistically significant risk of over- or underestimation of disease category frequency approximation when using a 5 FUO category system. An FUO diagnostic classification system that better reflects mechanistic understanding would assist future research and enhance comparability across heterogenous populations and different geographic regions. We propose an updated FUO classification scheme that streamlines categorizations, aligns with the current understanding of disease mechanisms, and should facilitate empirical decisions, if necessary.

Large mass strandings of selected odontocete species: statistics, locations, and relation to earth processes

Larger mass strandings of open ocean odontocetes (toothed whales) of 10+ animals are examined with a compilation of 710 worldwide events. Sixspecies form 96% of events (false killer, long-finned pilot, melon-headed, short-finned pilot, sperm and white whales), with beaked, killer, andpygmy killer whales forming 4%. Site type was determined for 630 events – three-quarters (76%) are in bays, 14% in shallow topographicallycomplex areas (estuarine environments, straits, keys, reef and coastal lagoons), 8% on relatively unindented coasts, with ice entrapment (of killerwhales) and miscellaneous categories being 2%. For the 76% of events in bays, sites with headland-bay character make up 42%, spit-bays 20%(even though there are only four of them), indented bays 9% and unspecified bay types 5%. Headland-bays and spit-bays become stranding sitesthrough the properties endowed them by their mechanisms of formation and maintenance, but these mechanisms differ greatly for the two.Breakwaters, groyne series, tides, partial burial, and violent storms also appear as themes. Nearshore slopes are less than 1° for 94 of 105 siteshaving bathymetry information, with only two reaching or exceeding 3°. Some types of potential stranding sites can be identified by simplequantitative specifications for planform, sediment size, and seabed slope, although strandings will not necessarily occur there. There is an indicationthat larger strandings are globally correlated with areas of higher oceanic primary productivity near landmasses and oceanic islands, but quantitativestudies are needed to clarify any such possible relationship. There is also an indication that larger strandings are associated with plate tectonics,with few events being seen on the steeper swell resistant active western margins of South America and South Island (New Zealand) in particular.In contrast several larger events are recorded for the relatively older passive margins of the south-eastern sides of these two landmasses, putativelybecause waves and swell have had time to construct stranding sites on them. Similarly, few larger events are seen for steeper shores adjacent tocoastal highlands, such as those of South Africa and Brazil. These observations indicate previously unsuspected relations between the phenomenonof odontocete mass strandings and global scale earth and ocean processes, but they are essentially hypotheses in need of more quantitativeexamination.

Keyword Analysis: Identifying Interdisciplinary Improvement Opportunities for Sepsis Response

Background: Boston Children’s Hospital has implemented an enterprise-wide sepsis initiative to manage pediatric sepsis, one of the leading causes of mortality in pediatrics.1 To sustain and improve early sepsis identification and treatment, ongoing review of our process and outcomes data highlighted system gaps focusing on interdisciplinary communication and engagement at the bedside. Objectives: We conducted a qualitative assessment for 4 inpatient medicine units with nurses, attendings, residents, and NPs to understand pain points for escalation of concerns and communication methods among the caregivers and inform enterprise-level problem-solving. Methods: We conducted 16 focus group discussions with nurses, candy round interviews with 11 attending physicians, and surveys for 3 nurse practitioners and 47 resident physicians. Over 6 weeks, we collected 406 unique responses across all of our interactions. We then identified basic themes for interdisciplinary improvement in each phase of sepsis recognition and response. We executed a keyword analysis to quantitatively evaluate the responses and highlight opportunities for improvement. Figure 1 illustrates the keywords used in analysis. These specific keywords were identified most frequently throughout our initial thematic analysis. For instance, in our focus group discussions, Orderset and STAT popped up 16 and 20 times, respectively, when evaluating individual responses. We then used Excel’s Wildcard Function to search for multiple keywords at a time from each phase in our sepsis response. This function allowed us to analyze multiple keywords related to each phase of sepsis recognition and response.Fig. 1.: Keywords identified and utilized during data analysis.Results: Figure 2 highlights the improvement themes identified for different phases of sepsis clinical workflow for nurses and prescribers. We identified that the phases of highest uncertainty were during the sepsis huddle, plan of care, and ordering of antibiotics. We noted that in these stages of the care process, our keyword analysis pointed to a limited understanding in the sepsis huddle, lack of communication regarding IV access, and underutilization of our sepsis orderset as areas for improvement. Consequentially, we were able to develop improvement themes based on a Pareto chart developed from the frequency distribution of our keywords.Fig. 2.: Phases identified with opportunities for improvement. *Note that 116 responses for nurses and 24 responses from Residents, Attendings and NPs fell into miscellaneous categories that were not used in developing interventions.Conclusions: The keyword analysis helped illustrate the interaction of human behavior, technology, and working environments influencing our interdisciplinary workflows surrounding sepsis response. With data as our driver, we partnered with the frontline staff to develop and operationalize our new huddle checklist, IV algorithm triage resource, and sepsis orderset while continuing to monitor both our process and outcome measures. The result was a continuous increase in sepsis bundle utilization for critical sepsis patients with a center line shift from 41% to 70%. One of our biggest drivers of this shift was the centerline shift in sepsis orderset utilization increase from 36% to 61% across all sepsis patients. Finally, in response to our results, we are also working diligently to develop a simulation experience focusing on the huddle process. ACKNOWLEDGMENTS Monica Kleinman, MD, Medical/Surgical Intensive Care, Boston Children’s Hospital; Matthew Eisenberg, MD, Division of Emergency Medicine, Boston Children’s Hospital; Daniel Kelly, MD, Division of Medicine Critical Care, Boston Children’s Hospital; Kate Madden, MD, Medical/Surgical Intensive Care, Boston Children’s Hospital; Teresa Shannon, MSN, RN, CPN; Sue Dixon, RN; and Marlena Smith-Millman, MPH.