Real Sets Research Articles

Impact of Audio-Visual Complexity on Symptomatology of Laryngeal Dystonia: A Virtual Reality Study.

Laryngeal dystonia (LD) is an isolated focal dystonia characterized by involuntary spasms in laryngeal muscles selectively impairing speech production. Anecdotal observations reported the worsening of LD symptoms in stressful or vocally demanding situations. To examine the impact of surrounding audio-visual complexity on LD symptomatology for a better understanding of disorder phenomenology. We developed well-controlled virtual reality (VR) environments of real-life interpersonal communications to investigate how different levels of audio-visual complexity may impact LD symptoms. The VR experiments were conducted over five consecutive days, during which each patient experienced 10 h of 4100 experimental trials in VR with gradually increasing audio-visual complexity. Daily reports were collected about patients' voice changes, as well as their comfort, engagement, concentration, and drowsiness from using VR technology. After a weekly VR exposure, 82% of patients reported changes in their voice symptoms related to changes in background audio-visual complexity. Significant differences in voice symptoms were found between the first two levels of the audio-visual challenge complexity independent of study sessions or VR environments. This study demonstrated that LD symptoms are impacted by audio-visual background across various virtual realistic settings. These findings should be taken into consideration when planning behavioral experiments or evaluating the outcomes of clinical trials in these patients. Moreover, these data show that VR presents a reliable and useful technology for providing real-life assessments of the impact of various experimental settings, such as during the testing of novel therapeutic interventions in these patients. Level 3 Laryngoscope, 2024.

FROM CALENDAR TIME TO BUSINESS TIME: THE CASE OF COMMODITY MARKETS

We address the problem of modeling commodity forward curves, while preserving empirical features observed in commodity markets. By letting a commodity market to “ live” in the tempo of a business rather than calendar clock, we create a model with a rich but realistic set of features, such as stochastic volatility, stochastic rate of mean reversion and various shapes of forward curves such as backwardation and contango. The model, when applied to extensive historical datasets of crude oil and natural gas forward curves, shows a remarkably good fit to the observed futures prices, also in periods of high volatility and negative prices. The model is developed in such a way that it can be used for a wide variety of applications, ranging from exotic derivatives pricing to risk management of commodity portfolios.

Clinical characteristics of Ketosis Prone Diabetes: Evaluating diagnosis and management practices in a real-life setting

Clinical characteristics of Ketosis Prone Diabetes: Evaluating diagnosis and management practices in a real-life setting

Clinical Approach to STRIDE-II in Real-Life Settings: Analysis and Practical Recommendations.

We aimed to (1) analyze the applicability of the updated Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) recommendations in real-world clinical practice, (2) identify barriers to their implementation, and (3) propose practical measures to overcome these obstacles. This qualitative study was based on a survey, a literature review, and expert opinions. Nine inflammatory bowel disease (IBD) experts identified 7 areas likely to be controversial or potential implementation barriers in daily clinical practice: endoscopy, histology, ultrasound, quality of life, biomarkers, symptom control, and patient-reported outcomes (PROs). Based on this, a survey was carried out among educational course participants. The experts discussed the literature review and survey results and proposed several statements and practical actions. A total of 55 gastroenterologists answered the survey. The reported difficulty level in reaching STRIDE-II treatment goals in clinical practice was high. Only 22% of participants performed clinical remission assessments using clinical indexes and PROs. Seventy percent of responders did not use fecal calprotectin cutoffs and considered changes from the previous levels instead. Mucosal healing as a long-term therapeutic goal was considered necessary to be individualized in specific patient subgroups (eg, elderly/fragile patients, multiple treatment failures, and last-line therapies). Other barriers, like the lack of access to imaging techniques or insufficient knowledge and skills among healthcare professionals, were detected. The experts suggested adding less stringent treatment goals and measurements, patient stratification, local adaptations, educational activities, and research. STRIDE-II recommendations face various implementation barriers needing careful evaluation in order to enhance their adoption in clinical practice, and ultimately improve outcomes in IBD patients.

Position of Beta-blockers in the Treatment of Hypertension Today: An Indian Consensus.

Management of essential hypertension (HTN) remains challenging, with contemporary control being achieved in <1/10 of the cases, especially when aligned with the recently updated guidelines of American College of Cardiology (ACC) or International Society of Hypertension (ISH). The place and positioning of beta-blockers have been evolving, with recent focused updates, such as the European Society of Hypertension (ESH) 2023 guidelines, that may hold relevance for the Indian phenotypic traits of premature cardiovascular disease (CVD), fragile coronary architecture, and/or high resting heart rate. To further develop consensus on the clinical role and relevance of beta-blockers, including nebivolol, an Indian consensus was evolved with graded recommendations on their clinical role in HTN, HTN with additional cardiovascular (CV) risk, or type 2 diabetes mellitus (T2DM). An expert review panel was constituted, comprising interventional and clinical cardiologists as experts, to synthesize the literature for the development of a validated knowledge, attitude, and practice (KAP) survey questionnaire. Research databases, including Cochrane Systematic Reviews, PubMed, and Google Scholar, were accessed for contemporary information and guidelines on beta-blockers updated until Dec 2023. Delphi rounds were conducted to develop graded recommendations based on the strength, quality of evidence, and the agreement among the panelists (n = 9). Consensus was achieved on the graded recommendations, with ≥70% of national panelists in agreement. Ninety-six percent of respondents opined that the new ESH HTN guidelines (2023) help gain confidence in using beta-blockers, which are considered first-line drugs for the treatment of HTN. Beta-blockers, including nebivolol, can be recommended in patients with HTN with high resting heart rates, including young hypertensive patients under 40 years of age. For people under 60 years old with HTN, regardless of whether they have comorbid diseases, beta-blockers are the recommended drug choice. Ninety-five percent of respondents opined that nebivolol is the preferred beta-blocker in hypertensive patients with T2DM, followed by bisoprolol and metoprolol. More than 90% of respondents opined that the three most commonly preferred beta-blockers by experts in patients with angina were nebivolol, metoprolol, and bisoprolol. Beta-blockers, including nebivolol, can be considered initial-line therapy for HTN management in real-life settings in India and nebivolol is preferred because of its two important properties: highest beta-1 selectivity and endothelial-dependent vasodilation.

A 6-year retrospective study of olanzapine plasma concentration inpatients with schizophrenia CYP1A2 polymorphisms in real-life settings

Aimto investigate the potential influence of CYP1A2 polymorphisms on olanzapine plasma concentration of inpatients with schizophrenia in real-life settings. Methods409 inpatients who received OLA for at least 2 weeks, from June 2016 to March 2022 were included in the retrospective investigation. Moreover, 503 samples of above inpatients receiving OLA was built to investigate the influence of the relevant OLA plasma concentration, polymorphisms CYP1A2 -163C/A on the inpatients outcome. ResultsScale score reduction rate (SSRR) in 1 mutated CYP1A2 -163C/A alleles (CA) was significantly higher than other CYP1A2 alleles (CC+AA) (P = 0.002). Inverse S-curve correlations relationship was between SSRR and plasma concentrations of OLA (r =0.130, P<0.005). When remove ineffective subjects (ineffective group), the results of all CYP1A2 -163C/A genotype showed perfect correlations relationship tendencies with SSRR (r=1.000).The best concentrations of OLA corrected for daily dose (C/D) range and the best concentration range of OLA of all CYP1A2 -163C/A genotype was 3.18-3.53ng/mL/mg and 17.42-57.33ng/mL. The C/D range and concentration range of OLA were 2.722-4.221 ng/mL/mg and 13.61-84.42 ng/mL, which belong CYP1A2 -163C/A CA genotype subjects, was largest. ConclusionsThe best effective C/D range and concentration range of OLA respective were 3.18-3.53ng/mL/mg and 17.42-57.33ng/mL, which range values of CYP1A2 -163C/A CA genotype of inpatients with schizophrenia was largest.

Real-World Data on Brodalumab Treatment in Patients with Moderate-to-Severe Plaque Psoriasis: An Observational Study from the Czech Republic BIOREP Registry.

The aim of this observational, multicenter study was to assess the real-world use of brodalumab for the treatment of moderate-to-severe plaque psoriasis in patients in the Czech Republic, using data from the BIOREP registry. The study included 273 patients aged≥18years with moderate-to-severe psoriasis who received brodalumab. Endpoints were drug survival (time from treatment initiation to discontinuation), effectiveness [Psoriasis Area and Severity Index (PASI)], and health-related quality-of-life [Dermatology Life Quality Index (DLQI)]. Predicted drug survival probability was 92.4% [95% confidence interval (CI): 89.1, 95.7%] at 6months and 84.2% (95% CI 79.5, 89.1%) at 12months; this was maintained at 24months [80.4% (95% CI 74.5, 86.8%)]. Younger age, higher body mass index, and no previous biologic treatment were significantly associated with longer drug survival. Absolute PASI≤3 after 3months was achieved by 89.8% of patients; 92.4%, 77.8%, and 59.1% reached PASI 75, PASI 90, and PASI 100, respectively. After 12months, 96.5% of 141 patients had an absolute PASI≤3. The proportion of patients achieving DLQI 0/1 was 87.3% at 12months. This study demonstrated high and sustained drug survival with high rates of skin clearance and improved quality of life in patients with relatively severe disease treated with brodalumab. Improvements were observed as early as 3months post-treatment initiation and were sustained for up to 24months in a real-life setting.

Venous thromboembolism secondary prophylaxis in elderly people (over 75-year-old) with low-dose direct oral anticoagulants: single-center Italian experience

Nowadays, direct oral anticoagulants (DOACs) represent the gold standard for venous thromboembolism (VTE) treatment and VTE secondary prophylaxis; nevertheless, the percentage of elderly patients in major trials and literature data about DOACs usage for VTE secondary prophylaxis in the elderly are scant. Our retrospective study tried to evaluate low-dose DOACs efficacy and safety for elderly VTE secondary prophylaxis in a real-life setting. A cohort of 73 patients (≥ 75 years) considered at high risk of VTE recurrence was treated with apixaban 2.5 mg twice daily (b.i.d.) or rivaroxaban 10 mg daily as VTE secondary prophylaxis. The median low-dose DOACs administration time was 18.40 months. Three (4.1%) VTE recurrence events were observed, with four bleeding events registered (5.5%), including one major bleeding (MB) (1.4%) and two clinically relevant non major bleeding (CRNMB) (2.7%). Our data suggest that low-dose DOACs may be effective and well tolerated for secondary VTE prophylaxis in elderly patients at high risk of VTE recurrence.

Fuel fumes and foliage: the fate of speciated gasoline VOCs during phytoremediation and their impact on the bacterial phenotype

The capacity of indoor plants including green walls to capture, deposit and remediate individual volatile organic compounds (VOCs) has been well documented. However, in realistic settings, plant systems are exposed to a complex mixture of VOCs from highly varied various emission sources. Gasoline vapour is one of the major sources of these emissions, containing high concentrations of the carcinogens benzene, toluene, ethylbenzene and xylene (BTEX). Using both solid phase micro extraction (SPME) and quick, easy, cheap, effective, rugged and safe (QuEChERS) sampling techniques, we assessed the dynamics of individual speciated gasoline VOC phytoremediation from the air and uptake within green wall plant species and growth substrates within a small passive green wall system, along with quantifying the phenotypic changes within the plant-associated bacterial communities resulting from gasoline exposure. Over 8 hours the green wall system achieved 100% removal of atmospheric benzene, 1,2,3-trimethyl, eicosane and hexadecane, benzene 1,3-diethyl-; 1,3,5 cycloheptatriene,7- ethyl and carbonic acid eicosyl vinyl ester. All plant species tested demonstrated the accumulation 45 petrochemical VOCs (pVOCs) with Spathiphyllum wallisii successfully accumulating the majority of pVOC functional groups after 24 h of gasoline exposure. Within the plants phyllospheric bacterial communities, changes in both cellular complexity and granularity appeared to increase as a result of gasoline exposure, while cell size diminished. This work provides novel findings on the VOC removal processes of botanical systems for realistic and highly toxic VOC profiles.

Digital family bonds are strengthened through effective communication dynamics on YouTube in Indonesia

General Background: Family communication plays a critical role in maintaining healthy relationships among family members, promoting openness, support, and understanding. Effective communication strengthens family bonds, especially during shared moments such as gatherings. Specific Background: Fadil Jaidi's YouTube channel provides an intriguing case study of family communication, showcasing how members interact and resolve issues. These video interactions offer valuable insights into the dynamics of family communication, particularly in the digital age. Knowledge Gap: Despite the extensive focus on communication in family studies, few have explored how family interactions are represented in social media content, especially YouTube channels, where family moments are broadcast to the public. The role of these platforms in influencing family communication patterns remains underexplored. Aims: This study aims to describe and explain the family communication patterns that occur on Fadil Jaidi's YouTube channel, focusing on openness, support, empathy, positiveness, and equality through content analysis. Results: A qualitative content analysis of five selected videos revealed that family communication on Fadil Jaidi’s channel runs smoothly. The interactions were characterized by 24 scenes: 8 scenes showing openness, 5 scenes of support, 2 scenes of empathy, 6 scenes of positiveness, and 3 scenes of equality. These categories were identified using thematic and syntactic analysis. Novelty: This study is among the first to analyze family communication within a public YouTube context, applying Eriyanto's content analysis framework. It highlights how online platforms can both reflect and influence real-life family dynamics. Implications: The findings suggest that public displays of family communication on social media platforms, like YouTube, can serve as examples for fostering positive interactions in real-life family settings. This research contributes to the understanding of how digital platforms can be used to promote healthy communication in family contexts. Highlights: Family communication on YouTube shows openness, support, empathy, positiveness, equality. Fadil Jaidi’s videos highlight effective family interactions in everyday scenarios. The study reveals digital platforms’ role in shaping family communication dynamics. Keywords: family communication, YouTube analysis, content analysis, social media, qualitative research

Closed-loop workload input–output control of production systems: A hybrid simulation study

Workload Control (WLC) is a method of adjusting the overall workload in the production system by controlling the input of production orders and the output of produced items. It contributes to the predictability of lead times and more accurate delivery date commitments in make-to-order manufacturing. Input control relates to order release and output control to capacity adjustment. In a recent previous work, a novel approach to integrated input–output control has been proposed: a dynamic closed-loop model where automatic feedback control is added and where order release and capacity decisions are based on the observed shop floor state. In this paper, this approach is further investigated in a more realistic hybrid simulation setting, combining discrete-time controllers and a discrete-event model of a manufacturing shop. The hybrid model was applied to two different systems: an elementary 4-machine shop floor (as a proof of concept) and a more complex real system, a manufacturing cell of cylinder liners. The results show that simultaneous input–output control is effective and enables the systems to maintain WIP balance, absorb demand fluctuations, and effectively reject disturbances. The simulations of the complex system showed that it might be advantageous to provide more local or more global information to the controllers, depending on the variability of the processing times and on the managerial focus. Closed-loop discrete-event models for WLC production control are unprecedented. Also, a simultaneous input and output control setting is much less reported in WLC literature than settings with input control only (i.e., order release only). This paper contributes in both ways.

One-year employment outcome prediction after traumatic brain injury: A CENTER-TBI study

BackgroundTraumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work. ObjectivesThis study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: 1 How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? 2 Which predictors are required to make accurate predictions? 3 Are predictions accurate enough for use in clinical practice? MethodsThis study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N = 586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created. ResultsFull models without follow-up achieved an area under the curve (AUC) of about 81 %, which increased up to 88 % with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90 %. ConclusionThe addition of three-month follow-up data causes a notable increase in model performance. The reduced model - containing Glasgow Outcome Scale Extended, pre-injury job class, pre-injury employment status, length of stay and age - matched the predictive performance of the full models. Accurate predictions on post-TBI vocational outcomes contribute to realistic prognosis and goal setting, targeting the right interventions to the right patients.

Efficacy and Tolerance of First-Line Afatinib in Elderly NSCLC Patients with EGFR Mutations in Vietnam: A Multicenter Real-World Study.

Afatinib, a second-generation epidermal growth factor receptor(EGFR) tyrosine kinase, has proven effective for non-small-cell lung cancer (NSCLC) patients with EGFR mutations through randomized controlled trials and real-world studies. Elderly patients exhibit unique characteristics in terms of physical condition and comorbidities, leading to differences in clinical practice for selecting the initial dosage and making dose adjustments compared to younger patients. This study aims to evaluate the effectiveness and adverse effects of first-line Afatinib treatment in elderly patients with NSCLC harboring EGFR mutations in Vietnam in a real-world context. We conducted a retrospective analysis of 135 patients, aged 65 years and older, across nine cancer centers in Vietnam. These patients, who harbored drug-sensitive EGFR mutations (excluding de novo T790M), received first-line Afatinib treatment between April 2018 and June 2022. The primary endpoints, time to treatment failure (TTF), and overall survival (OS) were assessed using the Kaplan-Meier method, and comparisons were conducted using the log-rank test. Secondary endpoints included the overall response rate (ORR) according to RECIST 1.1 and adverse effects as classified by CTCAE 4.0. The median age was 71.2 years (SD ± 5.3). Comorbidities included cardiovascular disease (20.7%), diabetes (5.2%), chronic obstructive pulmonary disease (2.2%), and hepatitis B (0.7%). Common mutations constituted 71.9% of cases, with uncommon mutations representing 28.1%. Brain metastases were observed in 24.4% of patients. Initial treatment doses were 40 mg for 35.6% of patients and 30 mg for 62.2%. With a median follow-up of 34.3 months, the median TTF was 16.3 months (95% CI: 15.4-19.5), and the median OS was 32.9 months (95% CI: 28.9-37.5). Factors associated with decreased OS included poor performance status, current smoking, and the presence of uncommon mutations. The ORR was 77.8%, with a complete response of 11.1% and a disease control rate of 94.1%. The most common toxicities were dermatologic and mucosal, including diarrhea (55.6%), rash (48.9%), and stomatitis (40.7%), predominantly in grades 1 and 2. Initiating treatment at doses below 40 mg significantly reduced most toxicities compared to the 40 mg dose. The presence of brain metastases did not significantly affect ORR, TTF, or OS. Starting treatment at doses below 40 mg significantly lowered the response rate but did not impact TTF or OS. First-line treatment with Afatinib in elderly patients with NSCLC and EGFR mutations demonstrates significant efficacy and manageable toxicity in a Vietnamese multicenter real-life setting. The effectiveness of Afatinib was confirmed, with known and well-controlled adverse effects, supporting its use in this patient population.

Identifying older adults at risk for dementia based on smartphone data obtained during a wayfinding task in the real world.

Alzheimer's disease (AD), as the most common form of dementia and leading cause for disability and death in old age, represents a major burden to healthcare systems worldwide. For the development of disease-modifying interventions and treatments, the detection of cognitive changes at the earliest disease stages is crucial. Recent advancements in mobile consumer technologies provide new opportunities to collect multi-dimensional data in real-life settings to identify and monitor at-risk individuals. Based on evidence showing that deficits in spatial navigation are a common hallmark of dementia, we assessed whether a memory clinic sample of patients with subjective cognitive decline (SCD) who still scored normally on neuropsychological assessments show differences in smartphone-assisted wayfinding behavior compared with cognitively healthy older and younger adults. Guided by a mobile application, participants had to find locations along a short route on the medical campus of the Magdeburg university. We show that performance measures that were extracted from GPS and user input data distinguish between the groups. In particular, the number of orientation stops was predictive of the SCD status in older participants. Our data suggest that subtle cognitive changes in patients with SCD, whose risk to develop dementia in the future is elevated, can be inferred from smartphone data, collected during a brief wayfinding task in the real world.

Penile curvature severity in patients with Peyronie's disease does not correlate with dynamic color doppler duplex ultrasound parameters: findings from a real-life cross-sectional study.

There is inconsistent data regarding the possible inaccuracies in dynamic penile color Doppler duplex ultrasound (CDDU) measurements in men with penile curvature because of Peyronie's disease (PD). We sought to explore the relationship between the degree of penile curvature and CDDU parameters in men with PD. Comprehensive data from 154 consecutive men presenting with PD as their primary complaint at a single academic center were prospectively collected and analyzed. All men underwent CDDU. Penile curvature was measured using a goniometer at time of maximum erection during CDDU. Patients were grouped based on CDDU parameters into-normal (average peak systolic velocity [PSV] ≥ 35cm/s and resistance index [RI] ≥ 0.85) and pathological CDDU (average PSV<35cm/s and/or RI<0.85). Descriptive statistics was used to compare the two subcohorts. Linear regression models were fitted to explore the association between the degree of penile curvature and dynamic CDDU parameters. Overall, the median interquartile range (IQR) age was 56 (48-63) years. The median (IQR) PSV and degree of penile curvature were 48.8cm/s (37.9-58.5) and 40 degrees (30-60), respectively. At CDDU, the degrees of penile curvature were as follows: 10-30 degrees in 63 (40.9%) men, 30-70 degrees in 70 (45.5%) men, and 70-90 degrees in 21 (13.6%) men, respectively. Of all, 116 (75.3%) patients showed a PSV>35cm/s and RI ≥ 0.85. Patients with pathologic vs. normal CDDU parameters did not differ in median (IQR) curvature (32.5° [30°-58.7°] vs. 40° [30°-65°], p=0.5) or in the distribution across curvature range groups. Linear regression analysis revealed that the degree of penile curvature did not significantly correlate with PSV at CDDU (coefficient: 0.06, p=0.3). Our study confirms the lack of a significant correlation between the severity of penile curvature and CDDU parameters in men presenting with PD. These findings emerge to be relevant in terms of a more accurate management work-up for PD patients and hold insightful medicolegal implications and in the real-life setting.

Response predictors of a topical corticosteroid-based regimen for dry eyes: A real-life study.

To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting. Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (NMG) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression. A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), NMG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (ΔOSDI, ΔDEQ5, ΔOSS, ΔFBUT, ΔNMG, ΔMQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, NMG, MQ). The remaining tests did not show statistically significant changes. Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study.

A Comprehensive Monte Carlo Simulation Study on Multiple Comparison Methods after ANOVA

Multiple comparison methods are applied to control the type I error rate at the nominal level. In this study, we investigate the performance of multiple comparison methods after analysis of variance (ANOVA) is implemented under different conditions. We include Bonferroni, Holm, Hochberg, Hommel, Benjamini-Hochberg (BH), and Benjamini-Yekutieli (BY) correction methods. Monte-Carlo simulation study is applied to assess their performances under different patterns, including sample size and group number combinations. Wide inferences are drawn on considered methods, and suggestions are provided for selecting appropriate methods. Moreover, the methods are implemented on three different types of real-life data sets to emphasize the importance of these correction methods in the research.

Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study.

We aimed to determine the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and to identify clinical factors associated with their use in patients with heart failure (HF) in a real-life setting. Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study is a multicentre, cross-sectional and observational study that included HF patients in the outpatient setting regardless of ejection fraction from 19 cardiology centres between August 2023 and December 2023. The study population consisted of 1923 patients with HF, predominantly men (61.2%), with a median age of 66 (range: 19-101) years. Overall, 925 patients (48.1%) were receiving SGLT2is. Among the study population, 22.1% had HF with preserved ejection fraction, 21.5% had HF with mildly reduced ejection fraction, 56.4% had HF with reduced ejection fraction and the use of SGLT2is was 42.0%, 47.9% and 50.6% in each group, respectively (P=0.012). The use of SGLT2is was 76.6% in patients with HF and diabetes, 19.8% in patients with HF and chronic kidney disease and 26.8% in patients without diabetes and chronic kidney disease (P<0.001). Higher education level [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.06-3.05; P=0.027], higher household income (OR: 3.46; 95% CI: 1.27-9.42; P=0.015), New York Heart Association functional class IV (OR: 2.72; 95% CI: 1.16-6.35; P=0.021), diabetes (OR: 9.42; 95% CI: 6.72-13.20; P<0.001), the use of angiotensin receptor-neprilysin inhibitors (ARNis) (OR: 4.09; 95% CI: 2.39-7.01; P<0.001), the use of mineralocorticoid receptor antagonists (MRAs) (OR: 2.02; 95% CI: 1.49-2.75; P<0.001), the use of loop diuretics (OR: 1.62; 95% CI: 1.18-2.22; P=0.003) and the use of thiazide diuretics (OR: 1.72; 95% CI: 1.30-2.29; P<0.001) were independently associated with the use of SGLT2is. Conversely, atrial fibrillation (OR: 0.63; 95% CI: 0.45-0.88; P=0.008), chronic kidney disease (OR: 0.53; 95% CI: 0.37-0.76; P=0.001), the use of dihydropyridine calcium channel blockers (OR: 0.68; 95% CI: 0.48-0.98; P=0.042) and the use of statins (OR: 0.67; 95% CI: 0.49-0.91; P=0.010) were independently associated with the non-use of SGLT2is. The RED-HEART study provided comprehensive real-world data about implementing SGLT2is in patients with HF. These results suggest that there is a need for organized action and close collaboration between healthcare providers to improve the implementation of SGLT2is, especially in patients with HF with preserved ejection fraction and chronic kidney disease.

Misinformation and higher-order evidence

This paper uses computational methods to simultaneously investigate the epistemological effects of misinformation on communities of rational agents, while also contributing to the philosophical debate on ‘higher-order’ evidence (i.e. evidence that bears on the quality and/or import of one’s evidence). Modelling communities as networks of individuals, each with a degree of belief in a given target proposition, it simulates the introduction of unreliable mis- and disinformants, and records the epistemological consequences for these communities. First, using small, artificial networks, it compares the effects, when agents who are aware of the prevalence of mis- or disinformation in their communities, either deny the import of this higher-order evidence, or attempt to accommodate it by distrusting the information in their environment. Second, deploying simulations on a large(r) real-world network, it observes the impact of increasing levels of misinformation on trusting agents, as well as of more minimal, but structurally targeted, unreliability. Comparing the two information processing strategies in an artificial context, it finds that there is a (familiar) trade-off between accuracy (in arriving at a correct consensus) and efficiency (in doing so in a timely manner). And in a more realistic setting, community confidence in the truth is seen to be depressed in the presence of even minimal levels of misinformation.

Assessing Cardiovascular Target Attainment in Type 2 Diabetes Mellitus Patients in Tertiary Diabetes Center in Romania.

Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) share a bidirectional link, and the innovative antidiabetic molecules GLP-1 Ras and SGLT-2is have proven cardiac and renal benefits, respectively. This study aimed to evaluate CV risk categories, along with lipid-lowering and antidiabetic treatments, in patients with T2DM from a real-life setting in Romania. A cross-sectional evaluation was conducted on 405 consecutively admitted patients with T2DM in an ambulatory setting, assessing them according to the 2019 ESC/EAS guidelines for moderate, high, and very high CV risk categories. The average age of the group was 58 ± 9.96 years, with 38.5% being female. The mean HbA1C level was 7.2 ± 1.7%. Comorbidities included HBP in 88.1% of patients, with a mean SBP and DBP of 133.2 ± 13.7 mm Hg and 79.9 ± 9 mm Hg, respectively, and obesity in 66.41%, with a mean BMI of 33 ± 6.33 kg/m2. The mean LDL-C levels varied by CV risk category: 90.1 ± 34.22 mg/dL in very high risk, 98.63 ± 33.26 mg/dL in high risk, and 105 ± 37.1 mg/dL in moderate risk. Prescribed treatments included metformin (100%), statins (77.5%), GLP-1 Ras (29.4%), and SGLT-2is (29.4%). In Romania, patients with T2DM often achieve glycemic control targets but fail to meet composite targets that include glycemic, BP, and lipid control. Additionally, few patients benefit from innovative glucose-lowering therapies with proven cardio-renal benefits or from statins.