Preselected Samples Research Articles

Hydro-chemical characterization and irrigation suitability assessment of a tropical decaying river in India

Water pollution is a major concern for a decaying river. Polluted water reduces ecosystem services and human use of rivers. Therefore, the present study aims to assess the irrigation suitability of the Jalangi River water. A total of 34 pre-selected water samples were gathered from the source to the sink of the Jalangi River with an interval of 10 km and one secondary station’s data from February 2012 to January 2022 were used for this purpose. The Piper diagram exhibits that the Jalangi River water is Na+–HCO3− types, and the alkaline earth (Ca2+ + Mg2+) outperforms alkalises (Na+ + K+) and weak acids (HCO3− + CO32−) outperform strong acids (Cl− + SO42−). SAR values ranging from 0.35 to 0.64 show that water is suitable for irrigation and poses no sodicity risks. The %Na results show that 91.18% of water samples are good and acceptable for irrigation. RSC levels indicate a significant alkalinity hazard, with 94.12% of samples considered inappropriate for irrigation. PI findings show that 91.18% of water samples are suitable for irrigation. Apart from the spatial water samples, seasonal water samples exhibit a wide variations as per the nature of irrigation hazards. Gibbs plot demonstrates that the weathering of rocks determined the hydro-chemical evolution of Jalangi River water. This study identifies very little evaporation dominance for pre- and post-monsoon water. The analysis of variance (ANOVA) test illustrates that there are no spatial variations in water quality while seasonal variations are widely noted (p < 0.05). The results also revealed that river water for irrigation during monsoon is suitable compared to the pre-monsoon season. Anthropogenic interventions including riverbed agriculture, and the discharge of untreated sewage from urban areas are playing a crucial role in deteriorating the water quality of the river, which needs substantial attention from the various stakeholders in a participatory, and sustainable manner.

Assessing spatial distribution of bioindicator elements in various cutaneous tumors using correlative imaging with laser-ablation-based analytical methods

Correlative imaging of cutaneous tumors provides additional information to the standard histopathologic examination. However, the joint progress in the establishment of analytical techniques, such as Laser-Induced Breakdown Spectroscopy (LIBS) and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS) in clinical practice is still limited. Their combination provides complementary information as it is also shown in our study in terms of major biotic (Ca, Mg, and P) and trace (Cu and Zn) elements. To elucidate changes in the elemental composition in tumors, we have compiled a set of malignant tumors (Squamous Cell Carcinoma, Basal Cell Carcinoma, Malignant Melanoma, and Epithelioid Angiosarcoma), one benign tumor (Pigmented Nevus) and one healthy-skin sample. The data processing was based on a methodological pipeline involving binary image registration and affine transformation. Thus, our paper brings a feasibility study of a practical methodological concept that enables us to compare LIBS and LA-ICP-MS results despite the mutual spatial distortion of original elemental images. Moreover, we also show that LIBS could be a sufficient pre-screening method even for a larger number of samples according to the speed and reproducibility of the analyses. Whereas LA-ICP-MS could serve as a ground truth and reference technique for preselected samples.

Clinical Evaluation of a New Chemiluminescence Assay for the Detection of Treponema Pallidum Antibodies.

A new chemiluminescence assay, the Anti-TP-Ⅱ assay, is going to be commercially available in clinical laboratories in China and other countries. This study examined the performance of the new assay for the detection of TP infection and compared it with that of the Anti-TP assay by using large amounts of clinical samples. The precision, accuracy, anti-interference ability, and the clinical sensitivity and specificity of the Anti-TP-Ⅱ assay were evaluated. In addition, compared with those of the Anti-TP assay, the false positive and false negative rates of the Anti-TP-Ⅱ assay were evaluated for 2,436 clinical routine samples and 711 preselected Anti-TP assay reactive samples. Discrepancy of the samples was investigated with the recomLinec Treponema IgM/IgG kit or the Elecsys syphilis assay. The precision, accuracy, and anti-interference ability of the Anti-TP-Ⅱ assay met the national standard of China, and there was an overall agreement of 96.75% (Kappa = 0.91) between the two assays. The sensitivity and specificity of the Anti-TP-Ⅱ assay were 100% (95% CI: 94.13% to 100%) and 99.92% (95% CI: 99.70% to 99.99%), respectively. Compared with the Anti-TP assay, the Anti-TP-Ⅱ assay significantly reduced the number of borderline samples and the false positive rate. Considering its excellent performance, the Anti-TP-Ⅱ assay is a good screening test for high-throughput laboratories and can replace the previous generation of reagents, the Anti-TP assay, with a superior specificity.

Evaluation of the Muara Satu Community Health Center in Lhokseumawe City's outpatient services' quality utilizing the importance-performance analysis approach and possible increase in customer value

A dynamic state of people, processes, environments, goods, and services that either meet or beyond expectations is known as service quality. It is vital to improve services to compete and provide higher-quality services at the Muara Satu Community Health Center through initiatives to enhance human resources and ongoing performance improvement. The Muara Satu Community Health Center has received major accreditation for its services; however, as of yet, no reassessment has been conducted. The management of Puskesmas wishes to refine the accreditation to become plenary so that patient satisfaction can serve as a gauge of the success of the center's health services provided to the community. This study aims to evaluate the degree of agreement between patient interests and satisfaction and the Muara Satu Community Health Center's service quality performance. Additionally, it seeks to identify the attributes that should be given priority for service improvement through the application of the Potential Gain in Customer Value (PGCV) method. Patients' complaints regarding services, such as uncomfortable waiting rooms and a lack of information about the ailments they were suffering from, posed a challenge for this study. Five categories were created based on 17 characteristics of the patient requests made at the health center and were given to 58 pre-selected samples. This category includes Assurance, Empathy, Tangible, Reliability, and Responsive. The Muara Satu Health Center is required to implement seven priority orders for quality improvement based on the IPA and PGCV methods, based on data processing findings. These orders include requiring the Community Health Center staff to inform patients before providing services, having a comfortable waiting area, and having officers act quickly and appropriately when necessary. Facilities in Puskesmas are fully equipped. The types of ailments, their treatments, and how to take medication are all thoroughly explained by the doctor. Furthermore, physicians allot enough time for patient examinations

Corporate social responsibility and the socio-environmental impact of small fast food businesse

Corporate Social Responsibility is the moral commitment that businesses have towards the environment, society, and the economy. The goal is to identify the impact of Corporate Social Responsibility on the socio-environmental dimension of skewers and hamburgers businesses in the Chone canton. The target population for this study consists of businesses engaged in the sale of skewers and hamburgers. This research adopts a mixed approach (qualitative and quantitative), allowing the authors to analyze and interpret data to uncover research facts and determine results in order to comprehend the phenomenon and/or problem under study. Data collection employed interviews, surveys, and observation sheets as research techniques, with the questionnaire serving as the instrument to conduct fieldwork based on a pre-selected sample. Among the most relevant results, it was found that 65% of respondents indicated unfamiliarity with the application of CSR, suggesting that there is much to be done in this area, crucial for the sustainable development of ventures.

Exploiting spatial transcriptomics to investigate the molecular mechanisms involved in cardiac metastasis development

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): IEO-Monzino Foundation Background Cardiac metastasis is considered a relatively rare malignancy, although an increasing prevalence is expected in the future due to the increasing life expectancy. Several cases of cardiac metastases remain untreatable, given the anatomical location that often hampers both surgical eradication and bioptic collection for biological characterization. Here, we use spatial transcriptomics to provide an unbiased molecular characterization of cardiac metastases, and identify novel targets for their treatment. Material and methods We performed spatial transcriptomics on samples of primary tumor, cardiac, and extra-cardiac metastasis from three different patients. First, we checked RNA integrity by means of DV200 analysis. Spatial transcriptomic analysis was performed by using the GeoMX technology (Nanostring), which provides whole-transcriptome data along with spatial distribution information of the preselected samples from the candidate regions of interest (ROIs). ROIs were selected on the formalin-fixed paraffin-embedded sections by means of geometric shapes in combination with cell markers specific for tumor cells, cardiomyocytes and endothelial cells, respectively. Differential gene expression analysis and Gene Set Enrichment Analysis (GSEA) were performed on the entire transcriptome. Cell-cell interactions between cardiac cells and cancer cells were then evaluated by means of InterCellaR. Results Differential expression analysis between cardiac metastases and extra-cardiac tumors (primary tumors + extra-cardiac metastases) identified 92 differentially expressed genes (DEGs). Of these, 53 genes were significantly overexpressed in cardiac metastases, while 39 genes were overexpressed in the extra-cardiac samples, regardless of the site of origin of the tumor. Unsupervised hierarchical clustering of protein-coding genes clearly separated the samples according to their anatomical location, in particular cardiac metastasis from extra-cardiac tumors. GSEA identified several pathways enriched in cardiac metastases compared to the extra-cardiac tumors, including mechanotransduction (e.g. keratinization and cell-matrix interaction) and triglyceride metabolism, suggesting a potential role of these signaling pathways in the development of cardiac metastasis. Interactome analysis revealed a rich plethora of receptor-ligand interactions in cardiac metastasis, especially between tumor cells and cardiomyocytes. Conclusions These results start shedding light on the mechanisms that allow cancer cell growth in the heart and pave the way to the development of novel therapies to treat this malignancy.

Content Specificity of Interpretation Bias Related to Social and Emotional Loneliness in Emerging Adulthood

Background:According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB.Methods:Sample 1 included an unselected university sample (N= 138, 81.9% female,M= 20.8 years,SD= 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels (N= 315, 69.5% female,M= 23.8 years,SD= 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB.Results:The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness.Conclusions:Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

Abstract 1149: Exploring The Influence Of Plaque Morphology On Drug Delivery With Drug-coated Balloons Via Scanning Electron Microscopy In Peripheral Artery Disease Lesions

Introduction: Drug-coated balloons with Paclitaxel aim to address restenosis in lower extremity interventions, but concerns persist about Paclitaxel's distal embolization and drug delivery efficiency. Hypothesis: "Nodular" calcium exhibits poorer drug transfer than "smooth" surfaces during intervention.Aims:To investigate the impact of plaque morphology on drug transfer in advanced scanning electron microscopy (SEM). Methods: Vessels from amputated legs were sectioned into 5 mm samples, longitudinally halved, air-dried, gold-coated, and examined via high-vacuum SEM. Two preselected samples (one “nodular” and one “smooth” surface) were scanned with 300x300 micron field of views (FOVs), covering the surface for both samples. Drug coverage area was classified per FOV into percentage categories (minimal=0-25%, moderate=26-50%, good=51-75%, 4=76-100%) (Fig1A). Results: SEM analysis provided 104 and 107 300x300 micron FOVs for the “nodular” and “smooth” samples, respectively. Distribution of drug coverage categories differed significantly between “nodular” and “smooth” lesions (p&lt;.001) (Fig1B). "Nodular" sample had lower overall drug coverage than "smooth", with a median of “good” coverage in “nodular” vs. “minimal”-“moderate” coverage in “smooth” sample” (p&lt;.001). For the “nodular” surface, 50% of FOVs had “minimal” drug coverage (vs. 11% of “smooth” surface FOVs, p&lt;.001). “Excellent “coverage was observed in 38.31% of “smooth” sample FOVs compared to 10.58% “nodular” FOVs (p&lt;.001). Most of the drug in "nodular" lesion concentrated on the top of the nodule, while "smooth" exhibited uniform distribution. Conclusions: “Nodular” calcification may impede homogenous drug transfer, while a “smooth” surface allows for more effective drug delivery. Our approach contributes to a better understanding of drug delivery in lower extremity PVIs, ultimately guiding personalized treatment and laying the groundwork for innovative device development.

Automated surveillance of non-ventilator-associated hospital-acquired pneumonia (nvHAP): a systematic literature review

BackgroundHospital-acquired pneumonia (HAP) and its specific subset, non-ventilator hospital-acquired pneumonia (nvHAP) are significant contributors to patient morbidity and mortality. Automated surveillance systems for these healthcare-associated infections have emerged as a potentially beneficial replacement for manual surveillance. This systematic review aims to synthesise the existing literature on the characteristics and performance of automated nvHAP and HAP surveillance systems.MethodsWe conducted a systematic search of publications describing automated surveillance of nvHAP and HAP. Our inclusion criteria covered articles that described fully and semi-automated systems without limitations on patient demographics or healthcare settings. We detailed the algorithms in each study and reported the performance characteristics of automated systems that were validated against specific reference methods. Two published metrics were employed to assess the quality of the included studies.ResultsOur review identified 12 eligible studies that collectively describe 24 distinct candidate definitions, 23 for fully automated systems and one for a semi-automated system. These systems were employed exclusively in high-income countries and the majority were published after 2018. The algorithms commonly included radiology, leukocyte counts, temperature, antibiotic administration, and microbiology results. Validated surveillance systems' performance varied, with sensitivities for fully automated systems ranging from 40 to 99%, specificities from 58 and 98%, and positive predictive values from 8 to 71%. Validation was often carried out on small, pre-selected patient populations.ConclusionsRecent years have seen a steep increase in publications on automated surveillance systems for nvHAP and HAP, which increase efficiency and reduce manual workload. However, the performance of fully automated surveillance remains moderate when compared to manual surveillance. The considerable heterogeneity in candidate surveillance definitions and reference standards, as well as validation on small or pre-selected samples, limits the generalisability of the findings. Further research, involving larger and broader patient populations is required to better understand the performance and applicability of automated nvHAP surveillance.

Assessment of immunoprecipitation with subsequent immunoassays for the blood-based diagnosis of Alzheimer's disease.

The Aβ42/40 ratio and the concentration of phosphorylated Tau181 in blood plasma represent attractive biomarkers for Alzheimer's disease. As a means for reducing potential matrix effects, which may interfere with plasma immunoassays, we have previously developed a pre-analytical sample workup by semi-automated immunoprecipitation. Here we test the compatibility of pre-analytical immunoprecipitations with automated Aβ1-40, Aβ1-42 and phosphorylated Tau181 immunoassays on the Lumipulse platform and compare the diagnostic performance of the respective immunoprecipitation immunoassay approaches with direct plasma measurements. 71 participants were dichotomized according to their Aβ42/40 ratios in cerebrospinal fluid into the diagnostic groups amyloid-positive (n = 32) and amyloid-negative (n = 39). The plasma Aβ1-42/1-40 ratio and phosphorylated Tau181 levels were determined on the Lumipulse G600II platform (Fujirebio) by direct measurements in EDTA-plasma or after Aβ- or Tau-immunoprecipitation, respectively. Pre-analytical immunoprecipitation of Aβ turned out to be compatible with the Lumipulse Aβ assays and resulted in a numerical, yet statistically not significant increase in the area under the ROC curve for plasma Aβ1-42/1-40. Additionally, we observed a significant increase in the standardised effect size (Cohen's D). Pre-analytical immunoprecipitation of Tau resulted in increased differences between the diagnostic groups in terms of median and mean phosphorylated Tau 181 levels. Furthermore, we observed a greater Cohen's d (p < 0.001) and a larger area under the ROC curve (p = 0.038) after Tau-IP. Our preliminary findings in a small, preselected sample indicate that pre-analytical immunoprecipitation may have the potential to improve the diagnostic performance of plasma biomarker immunoassays for Aβ1-42/1-40 and phosphorylated Tau181 to predict brain amyloid deposition.

Another Way to Confuse Motor Control: Manual Technique Supposed to Shorten Muscle Spindles Reduces the Muscular Holding Stability in the Sense of Adaptive Force in Male Soccer Players.

Sensorimotor control can be impaired by slacked muscle spindles. This was shown for reflex responses and, recently, also for muscular stability in the sense of Adaptive Force (AF). The slack in muscle spindles was generated by contracting the lengthened muscle followed by passive shortening. AF was suggested to specifically reflect sensorimotor control since it requires tension-length control in adaptation to an increasing load. This study investigated AF parameters in reaction to another, manually performed slack procedure in a preselected sample (n = 13). The AF of 11 elbow and 12 hip flexors was assessed by an objectified manual muscle test (MMT) using a handheld device. Maximal isometric AF was significantly reduced after manual spindle technique vs. regular MMT. Muscle lengthening started at 64.93 ± 12.46% of maximal voluntary isometric contraction (MVIC). During regular MMT, muscle length could be maintained stable until 92.53 ± 10.12% of MVIC. Hence, muscular stability measured by AF was impaired after spindle manipulation. Force oscillations arose at a significantly lower level for regular vs. spindle. This supports the assumption that they are a prerequisite for stable adaptation. Reduced muscular stability in reaction to slack procedures is considered physiological since sensory information is misled. It is proposed to use slack procedures to test the functionality of the neuromuscular system, which is relevant for clinical practice.

Deep Learning Side-Channel Collision Attack

With the breakthrough of Deep Neural Networks, many fields benefited from its enormously increasing performance. Although there is an increasing trend to utilize Deep Learning (DL) for Side-Channel Analysis (SCA) attacks, previous works made specific assumptions for the attack to work. Especially the concept of template attacks is widely adapted while not much attention was paid to other attack strategies. In this work, we present a new methodology, that is able to exploit side-channel collisions in a black-box setting. In particular, our attack is performed in a non-profiled setting and requires neither a hypothetical power model (or let’s say a many-to-one function) nor details about the underlying implementation. While the existing non-profiled DL attacks utilize training metrics to distinguish the correct key, our attack is more efficient by training a model that can be applied to recover multiple key portions, e.g., bytes. In order to perform our attack on raw traces instead of pre-selected samples, we further introduce a DL-based technique that can localize input-dependent leakages in masked implementations, e.g., the leakages associated to one byte of the cipher state in case of AES. We validated our approach by targeting several publicly available power consumption datasets measured from implementations protected by different masking schemes. As a concrete example, we demonstrate how to successfully recover the key bytes of the ASCAD dataset with only a single trained model in a non-profiled setting.

High Cognitive Ability and Mental Health: Findings from a Large Community Sample of Adolescents.

Whereas it has sometimes been asserted that the intellectually gifted would be more prone to develop mental health problems, empirical studies generally do not seem to support such claims. However, much of the available research has relied on preselected samples, introducing risks for sample selection bias. This study scrutinized the relationship between intellectual giftedness (defined as high cognitive ability) and mental health in a large, non-selective sample of early adolescents (n = 3409; 49.6% boys; Mage = 12.5 years). Using a standardized intelligence test (CoVaT-CHC) to identify participants with a high cognitive ability (IQ ≥ 120; n = 403), we compared self- and parent-reported levels of emotional problems, conduct problems, hyperactivity/inattention, and self-reported worry and global self-esteem between high and average ability adolescents. Findings indicated that adolescents with a high cognitive ability were not at increased risk of psychological maladjustment; if any, differences were in favor of the high ability group. However, adolescents who had been formally identified as gifted (i.e., who had received a gifted label) did report worse adjustment for a number of outcomes.

Spatial dispersion hot spots of contamination and human health risk assessments of PTEs in surface sediments of streams around porphyry copper mine, Iran.

This comprehensive research has been conducted to consider the distribution of PTEs in the surface sediments of a recently developed Dar-e-Allo copper mine in dependence on the potential ecological and human health risks. Field sampling was carried out discreetly at preselected sampling spots including the natural background, the streams around the mine, waste rock drainages, evaporative deposits, sediments containing Fe oxy-hydroxides and secondary phases. Distribution of target elements (Al, As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, S, Sb, Se, and Zn) showed high levels of crustal elements. As regards, Fe, Al, and S are identified to exist as the most copious elements in the earth's crust, so have the major portion of potentially toxic elements (PTEs) in the sediment concentrations. Evaluating environmental indices reflected that in general, Cu, S, and Mo have a higher quota of contamination in sedimentary systems. the pollution load index (PLI), modified contamination degree (mCd), Contamination factor (Cf), Sediment potential index (SPI), Geo-accumulation index (Igeo) and Contamination degree (Cd) confirm that sedimentary systems of mining area are heavily contaminated by PTEs and were not found within the guideline acceptable values. The potential ecological risk index (PERI) displayed a high or severe risk level for Cu with a peak in green-blue sediments containing secondary minerals. The results of total carcinogenic risk (TCRs) show that As has high toxicity level and carries a risk of carcinogenicity among children and adults. The TCRs for Cd, Cr, Ni, and Pb with carcinogenic potential are found only in children and they are classified as the prime concern elements that have serious dangers to children's public health. The results of contamination source presumed that the sources of PTEs contamination were principally geogenic along with the anthropogenic sources in the study area. Therefore, the present study has highlighted the implication of human health risks of PTEs in sedimentary systems of copper mining, also will grant advice for prime stakeholders, including mine managers, Environmental Protection Agency, the government and public organizations in connection to protecting the environment, aquatic biota and consumer's health.

Quantitative analysis of MGMT promoter methylation status changes by pyrosequencing in recurrent glioblastoma.

MGMT promoter methylation status can change in response to several factors, treatment with alkylating therapy being the mechanism more commonly cited in the literature. Some authors have attempted to quantify these alterations, with inconsistent results. This study aims to determine changes in MGMT promoter methylation status by pyrosequencing, which quantitatively yields results, in a cohort of patients reoperated for recurrent glioblastoma and having previously completed the Stupp protocol. Methylation status of the MGMT promoter gene of a total of 24 pairs of glioblastoma preselected tumor samples was retrospectively analyzed using pyrosequencing and depicted as percentages or categories (hypermethylated, intermediate methylation, unmethylated). Matched samples were compared using Wilcoxon signed-rank test, and log-rank test was used to establish a correlation with survival data. The median value of MGMT promoter methylation status declined after adjuvant treatment from 20.35% to 14.25% (p= 0.346). A significant correlation between methylation in primary samples and overall survival (p= 0.05) and progression-free survival (p= 0.024) was found. Intermediate methylation status at recurrence was linked to greater survival after progression, without reaching statistical significance (post-progression survival [PPS]) (p= 0.217). Although treatment with alkylating chemotherapy was a common feature in all patients of our cohort, switching in both directions was observed when MGMT promoter methylation status was analyzed as a continuous variable. These data suggest that the dynamics of epigenetics may be very complex and not entirely explained by clonal selection influenced by temozolomide.

ANALYSIS OF ABNORMAL RETURN AND TRADING VOLUME ACTIVITY BEFORE AND AFTER THE LQ45 COMPANY CASH DIVIDEND ANNOUNCEMENT FOR THE 2020 PERIOD

An increase in the trading volume of dividend-declaring shares at a particular moment may indicate that the company is performing well and has promising prospects. The dividend announcement includes crucial information for investors seeking abnormal returns. This study seeks to determine and assess whether there is a difference between AR and TVA before to and following the release of cash dividends. This study's data analysis method is a parametric statistical data analysis method. This method is used to statistically evaluate population parameters, or in other words, to test population size using pre-selected sample data and a significance level () of 0.05 or 5%. A data set is considered regularly distributed if asym.sig is less than 0.05. Sig. 0.277 &gt; 0.05 indicates that there is no change in the average abnormal return before and after the declaration of cash dividends for LQ45 Company 2020. The findings of evaluating the sample data for trading volume activity indicate, with a significance level of 0.000 &lt; 0.05, that there is a difference in trading volume activity before and after the release of cash dividends for LQ45 Company 2020. A significant negative abnormal return value at t-4, t-1, t0, t+3, t+4, and t+5 conveyed bad news, therefore investors overreacted to alter stock prices, resulting in disparities in trading volume activity before to and following the announcement of cash distributions. Indirectly, the declaration of cash dividends can impact the trading volume activities of LQ45 Index-listed businesses.

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

BackgroundAntenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME.MethodsThe primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally.Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only.All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter.Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol.DiscussionTrial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere.Trial registrationhttps://doi.org/10.1186/ISRCTN10833250. Registered 09/03/2020

Current expert opinion and attitudes to optimize telemedicine and achieve control in patients with asthma in post-pandemic era: The COMETA consensus

ObjectiveTo collect perspectives and explore consensus for expert recommendations related to asthma control and the use of telemedicine among professionals who manage patients with asthma. DesignA Delphi-like questionnaire was designed to analyse the level of agreement about several recommendations formulated by an expert scientific committee about asthma control and the use of telemedicine with this purpose. A dedicated scientific committee validated the questionnaire, which included questions about the participants’ profile and the use of technological tools at a personal level or in clinical practice.The experts expressed their agreement with a Likert-scale of 9 values: 1–3 was considered no agreement, 4–6 neutral, and 7–9 agreement. A rate ≥70% with the same answer was considered consensus. SiteThe questionnaire was programmed and distributed as an internet-based survey. ParticipantsA pre-selected sample of 75 experts with experience in telemedicine (pulmonology, allergology, family medicine, nursing and community pharmacy) responded to a Delphi-like questionnaire composed by six questions and 52 items. InterventionsConsultation was performed in two consecutive waves: the first wave was carried out from 12th of July to 8th of September of 2021; the second wave, from 25th of October to 12th of November of 2021. Main measurementsThree questions about asthma control (actions for achieving or maintaining control of asthma at every visit, current problems that affect asthma control, and potential solutions to offset such problems), and three questions about the impact of telemedicine in asthma control (potential benefits of telemedicine, and potential reticence about telemedicine among both patients and healthcare professionals) were included. ResultsFrom the 52 items inquired, 35 were agreed by consensus. The actions for achieving or maintaining control of asthma, the problems that affect asthma control, and their potential solutions were agreed by consensus. The potential benefits of telemedicine were validated by consensus. None of the potential reservations of patients about telemedicine were validated, while five out of 14 potential reservations of healthcare professionals were agreed by consensus. ConclusionsThe COMETA consensus provides a current picture of the main problems for achieving asthma control, the benefits and the reservations about the use of telemedicine in the Spanish setting, and offers solutions. A wide interest in implementing telemedicine has been observed, although current limitations need to be overcome.

Diagnostic performance of automated plasma amyloid-β assays combined with pre-analytical immunoprecipitation

BackgroundMeasurements of the amyloid-β (Aβ) 42/40 ratio in blood plasma may support the early diagnosis of Alzheimer’s disease and aid in the selection of suitable participants in clinical trials. Here, we compared the diagnostic performance of fully automated prototype plasma Aβ42/40 assays with and without pre-analytical sample workup by immunoprecipitation.MethodsA pre-selected clinical sample comprising 42 subjects with normal and 38 subjects with low cerebrospinal fluid (CSF) Aβ42/40 ratios was studied. The plasma Aβ42/40 ratios were determined with fully automated prototype Elecsys® immunoassays (Roche Diagnostics GmbH, Penzberg, Germany) by direct measurements in EDTA plasma or after pre-analytical Aβ immunoprecipitation. The diagnostic performance for the detection of abnormal CSF Aβ42/40 was analyzed by receiver operating characteristic (ROC) analysis. In an additional post hoc analysis, a biomarker-supported clinical diagnosis was used as a second endpoint.ResultsPre-analytical immunoprecipitation resulted in a significant increase in the area under the ROC curve (AUC) from 0.73 to 0.88 (p = 0.01547) for identifying subjects with abnormal CSF Aβ42/40. A similar improvement in the diagnostic performance by pre-analytical immunoprecipitation was also observed when a biomarker-supported clinical diagnosis was used as a second endpoint (AUC increase from 0.77 to 0.92, p = 0.01576).ConclusionsOur preliminary observations indicate that pre-analytical Aβ immunoprecipitation can improve the diagnostic performance of plasma Aβ assays for detecting brain amyloid pathology. The findings may aid in the further development of blood-based immunoassays for Alzheimer’s disease ultimately suitable for screening and routine use.

WEWNĄTRZGRUPOWE PORÓWNANIE SKUTECZNOŚCI APARATÓW SŁUCHOWYCH W SZUMIE NA PODSTAWIE CZASÓW ODPOWIEDZI WERBALNEJ VRT

BackgroundVerbal response times (VRTs) are among the suggested markers for cognitive load during word recognition tasks. Measurements of VRT during hearing aid fitting can be a useful tool to obtain information about listening effort with different amplification parameters.Material and methodsA software program was developed to easily measure VRTs in speech recognition tests. The system plays 50 randomly chosen recorded words out of a set of 700 disyllables. Speech material can be presented together with pre-selected noise samples at different speech-to-noise ratios and processed with low-pass filters with selectable cut-off frequencies. The test is carried out in free field. A voice activity detector measures the time between the offset of the presented word and the onset of the repetition by the subject, which allows VRT and speech recognition scores to be quickly assessed. Tests were carried out with a group of 8 normal-hearing subjects to evaluate the effect of different filter parameters and a second group of 8 normal-hearing people to evaluate the effect of different speech-to-noise ratios on VRT. Finally, a group of 15 adult hearing-impaired subjects who used hearing aids were fitted under different conditions and the VRTs were compared between fittings.ResultsReducing the low-pass filter cutoff frequency or adding noise to the speech signal increased VRTs in normal hearing people, suggesting an inverse relationship between VRT and ease of listening. In the hearing-impaired group, VRTs with different fittings of the hearing aid showed differences that can be used as an indicator of listening effort.ConclusionsAdding a measurement of VRT to a regular word recognition test during hearing aid fitting could be useful for adjusting parameters or deciding between models or processing strategies, especially if recognition scores are high.