Score Method Research Articles

Prediction of pulmonary tuberculosis treatment outcome in a sub-Saharan African context.

Failure to treat many pathogens is a concern. Identifying a priori, patients with potential failure treatment outcome of a disease could allow measures to reduce the failure rate. The objectives of this study were to use the Scoring method to identify factors associated with the tuberculosis unsuccessful treatment outcome and to predict the treatment outcome. A total of 1,529 patients with pulmonary tuberculosis were randomly selected in the city of Douala, Cameroon, this sample was randomly split into two parts: one subsample of 1,200 patients (78%) used as the Development sample, and the remaining of 329 patients (22%) used as the Validation sample. Baseline characteristics associated with unsuccessful treatment outcomes were investigated using logistic regression. The optimal score was based on the Youden's index. HIV positive status, active smoker and non-belief in healing were the factors significantly associated with unsuccessful treatment outcomes (P#x003C;0.05). A model used to estimate the risk of unsuccessful treatment outcome was derived. The threshold probability which maximize the area under the ROC curve was 18%. Patients for whom the risk was greater than this threshold were classified as unsuccessful treatment outcome and the others as successful. HIV positive and active smoking status were associated with death; the non-belief in healing, youth and male gender associated with lost-to-follow-up, TB antecedent and not having TB contact associated with therapeutic treatment failure. To increase the tuberculosis treatment success rate, targeted follow-up could be taken during the treatment for TB patients with previous characteristics.

An Integrated Approach for Diabetes Detection Using Fisher Score Feature Selection and Capsule Network

This paper investigates how the Fisher score feature selection approach can be used with capsule networks for diabetes detection. It also evaluates how well this algorithm works based on a number of evaluation parameters. The selected features using Fisher score method was then employed to train a capsule network model. Accuracy (94%), precision (94%0, recall (94%), F1 score (94%), and other performance evaluation metrics were thoroughly analyzed to determine the algorithm's efficacy. The results demonstrated that the combination of Fisher score feature selection and capsule networks yielded promising performance in diabetes detection. The selected features effectively captured the relevant information necessary for accurate classification The capsule network model was very accurate, which shows that it could be a good tool for diagnosing diabetes. Also, the accuracy and recall values showed that the algorithm could correctly place both positive and negative cases of diabetes, minimizing the risk of misdiagnosis. By merging the Fisher score feature selection approach with capsule networks, this research study contributes to advancing diabetes detection.

The how and why of handgrip strength assessment

Introduction: Occupational therapists and physiotherapists routinely assess Hand grip Strength (HGS) to evaluate hand function. This study explored the experiences of clinicians who regularly assess and evaluate HGS including the testing protocol utilised, evaluation methods and the influence of various biological and functional factors. Method: This exploratory survey ( n = 49) was distributed online to members of the Australian Hand Therapy Association. The questionnaire asked recipients to identify HGS testing protocols, evaluation methods, use of normative data, reasons for assessment and the influence of biological and functional factors on HGS. Demographic data was also collected. Results: Sixty-four percent of respondents were occupational therapists and 59% had over 10 years’ experience assessing HGS. The standardised American Society of Hand Therapists (ASHT) testing protocol was consistently adopted by only 67% of respondents . Variations in contraction time, scoring and evaluation methods were identified. Gender, age, employment and lifestyle were considered the functional and biological factors which influence HGS. Conclusion: This study details how and why occupational therapists and physiotherapists in Australia assess and evaluate HGS. Use of the ASHT testing protocol is not universal. Clinicians rely on the reason for assessment, clinical experience and practice context to determine how they assess and evaluate HGS.

The immunoreactivity of GLI1 and VEGFA is a potential prognostic factor in kidney renal clear cell carcinoma

Kidney renal clear cell carcinoma (KIRC) is the most common type of kidney cancer and its pathogenesis is strongly associated with VHL–HIF–VEGF signaling. SHH ligand is the upstream SHH pathway regulator, while GLI1 is its major effector that stimulates as a transcription factor, i.a. expression of VEGFA gene. The aim of present study was to assess the prognostic significance of SHH, GLI1 and VEGFA immunoreactivity in KIRC tissues. The analysis included paired tumor and normal samples from 34 patients with KIRC. The immunoreactivity of SHH, GLI1 and VEGFA proteins was determined by immunohistochemical (IHC) renal tissues staining. The IHC staining results were assessed using the immunoreactive score (IRS) method which takes into account the number of cells showing a positive reaction and the intensity of the reaction. Increased GLI1 protein immunoreactivity was observed in KIRC tissues, especially in early-stage tumors, according to the TNM classification. Elevated expression of the VEGFA protein was noted primarily in high-grade KIRC samples according to the Fuhrman/WHO/ISUP scale. Moreover, a directly proportional correlation was observed between SHH and VEGFA immunoreactivity in TNM 3 + 4 and Fuhrman/ISUP/WHO 3 + 4 tumor tissues as well as in samples of patients with shorter survival. We also observed an association between shorter patient survival as well as increased and decreased immunoreactivity, of the VEGFA and GLI1, respectively. The aforementioned findings suggest that the expression pattern of SHH, GLI1 and VEGFA demonstrates prognostic potential in KIRC.

Association of coffee and caffeine consumption with risk and prognosis of endometrial cancer and its subgroups: a Mendelian randomization.

Previous studies have not established potential causal associations between coffee and caffeine consumption in endometrial cancer (EC) and its subgroups. Therefore, we used a two-sample MR method to assess the causal association between coffee and caffeine consumption and EC risk. We also evaluated the association between these genetically predicted exposures and EC prognosis. This study used 12 and two independent single-nucleotide polymorphisms (SNPs) associated with coffee and caffeine consumption as instrumental variables at a genome-wide significance level of p < 5 × 10-8. The EC Association Consortium (ECAC) performed a genome-wide association study (GWAS) analysis of 12,906 cases and 108,979 controls. FinnGen Consortium performed a GWAS analysis of 1,967 EC cases and 167,189 controls. The primary technique we employed was inverse-variance weighted, followed by the weighted median, MR-Egger regression, and MR robust adjusted profile score methods. We used the MR pleiotropy residual sum, Outlier test, and MR-Egger regression to assess Outlier and pleiotropic variants. We also conducted a sensitivity analysis through the leave-one-out method. Genetically predicted coffee consumption was not associated with EC and its subgroups in the ECAC, and the association was consistent in the FinnGen consortium. After excluding eight SNPs with confounding factors, the study performed sensitivity analyses, delivering consistent results. We also observed that caffeine consumption was not correlated with EC risk. As confirmed by MR analysis, selected SNPs determined that most do not significantly impact the likelihood of developing EC. Our study indicated no convincing evidence supports coffee and caffeine consumption causing EC or impacting its prognosis. More studies are needed to validate the results.

Influence of antibiotic therapy with hemodynamic optimization on 30-day mortality among septic shock patients cared for in the prehospital setting

BackgroundIn order to reduce septic shock mortality, international guidelines recommend early treatment implementation, antibiotic therapy (ABT) and hemodynamic optimisation, within 1-h.This retrospective multicentric study aims to investigate the relationship between prehospital ABT delivered within 1st hour and mean blood pressure (MAP) ≥ 65 mmHg at the end of the prehospital stage, and 30-day mortality among patients with septic shock. MethodsFrom May 2016 to December 2021, patients with septic shock requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To assess the relationship between 30-day mortality and prehospital ABT delivered within 1st hour and/or MAP ≥ 65 mmHg at the end of the prehospital stage, Inverse Probability Treatment Weighting (IPTW) propensity score method was performed. ResultsAmong the 530 patients included, 341 were male gender (64%) with a mean age of 69 ± 15 years. One-hundred and thirty-two patients (25%) patients received prehospital ABT, among which 98 patients (74%) were treated with 3rd generation cephalosporin.Suspected pulmonary, urinary and digestive infections were the cause of sepsis in respectively 43%, 25% and 17%. The 30-day overall mortality was 31%.A significant association was observed between 30-day mortality rate and (i) ABT administration within the first hour: RRa = 0.14 [0.04–0.55], (ii) ABT administration within the first hour associated with a MAP ≥ 65 mmHg: RRa = 0.08 [0.02–0.37] and (iii) ABT administration within the first hour in the prehospital setting associated with a MAP < 65 mmHg at the end of the prehospital stage: RRa = 0.75 [0.45–0.85]. Patients who received prehospital ABT after the first hour have also a 30-day mortality rate decrease: RRa = 0.87 [0.57–0.99], whereas patients who did not received ABT had an increased 30-day mortality rate: RRa = 2.36 [1.89–2.95]. ConclusionIn this study, we showed that pre-hospital ABT within the first hour and MAP≥65 mmHg at the end of prehospital stage are both associated with 30-day mortality decrease among patients suffering from septic shock cared for by a MICU. Further prospective studies are needed to confirm these preliminary results.

Analisis Perbedaan Tingkat Kebangkrutan Menggunakan Metode Altman Z-Score dan S-Score Springate pada Perusahaan Pariwisata Sebelum dan Selama Pandemi Covid-19

The purpose of this study is to determine the difference in bankruptcy rates in tourism companies before and during the Covid-19 pandemic.The results showed that there were different results in predicting bankruptcy before and after the pandemic. The results of this study indicate the potential for financial distress using Altman's Z"-Score method that in 2018 there were 11 companies experiencing financial distress, 2 companies in the gray area, and 2 non-financial distress companies. In 2019 there were 10 companies experiencing financial distress, 3 companies in the gray area, and 2 non-financial distress companies. In 2020 there are 8 companies experiencing8 companies experiencing the gray area and 4 non-financial distress companies. In 2021 there are 10 companies experiencing financial distress, 1 company in the gray area, and 4 non-financial distress companies. Potential financial distress using the Springate S-Score method that in 2018 there were 11 companies experiencing financial distress and 4 non-financial distress companies. In 2019 there were 11 companies experiencing financial distress and 4 non-financial distress companies. In 2020 14 companies were experiencing financial distress, and 1 was in the non-financial distress category. In 2021 there are 15 companies experiencing financial distress and no companies in the non-financial distress category. This potential financial distress is a signal of self-quality that the company informs external parties which is useful in making future decisions.

Measuring social value orientation by model-based scoring

This study proposes a method of measuring social value orientation using model-based scoring and a task suitable for such scoring. We evaluated this method by means of parameter recovery simulation (Study 1), and we examined its retest reliability (Study 2) and its predictive validity (Study 3). The results indicate that the proposed method has low bias and sufficient predictive validity. While the improvement in predictive validity of altruism was negligible and comparable to previous scoring methods in terms of confidence intervals, the measurement of equality using the proposed model and task combination produced a moderate correlation that was not observed with other methods. Although SVO is a concept used primarily in psychology, the model assumed in this study is mathematically equivalent to a well-known economics model. We, therefore, suggest that this method may lead to cross-disciplinary research.

BIOS-01. EFFICACY AMONG THERAPEUTICALLY EFFECTIVE ABSORBED DOSE PATIENTS IN RESPECT-GBM PHASE I OF RHENIUM-186 NANOLIPOSOME (186RNL) IN RECURRENT GLIOBLASTOMA (RGBM) COMPARED TO AN EXTERNAL CONTROL ARM (ECA)

Abstract BACKGROUND ReSPECT-GBM is a Phase 1/2 study of 186RNL administered by convection enhanced delivery (CED) in patients with rGBM. In Phase I, 15 of 24 patients have achieved a therapeutic absorbed dose defined as &amp;gt; 100 Gy. Based on prior work establishing the comparability of a bevacizumab (Bev) comparator to inform early-phase CED study results, OS of the 15 TAD patients were compared to a Bev ECA. METHODS Recent Bev-treated rGBM clinical trial patients meeting the same eligibility criteria as patients in the ReSPECT-GBM study were identified from the Medidata Enterprise Data Store of aggregated and deidentified patient-level historical clinical trial data. Propensity score (PS) methods were used to select the ECA and align the baseline characteristics of the Bev patients to the ReSPECT TAD cohort. OS estimates were generated using the weighted Kaplan-Meier method and compared with a weighted 2-sample 2-sided log-rank test at α = 0.05 based on a data cut-off of December 2022. RESULTS Baseline characteristics of the ReSPECT TAD and ECA patients were well-aligned after PS modeling. Although not achieving statistical significance due to small sample sizes (median OS 12.2 vs 10.1 months, hazard ratio 0.63, 95% CI: 0.26, 1.52), comparison of OS between the ReSPECT TAD and ECA patients demonstrate consistently longer OS at each 6-month interval: 6 months: 85.1% vs 73.3%, 12 mos: 51.1% vs 30.3%, 18 months: 30.6% vs 25.4%, 24 months: 30.6% vs 3.5%. CONCLUSIONS Single-arm studies can be challenging to interpret. By comparing the ReSPECT-GBM outcomes to an ECA of similar patients with balanced baseline characteristics, we can better appreciate the treatment effect of 186RNL administered via CED. The current results are encouraging, and updated results reflecting current follow-up will be presented at the meeting.

CTNI-16. USE OF PREDICTIVE SCORE-BASED HISTORICAL CONTROL DATA IN SINGLE-ARM TRIALS

Abstract Even though the randomized controlled trials (RCTs) are still the preferred approach to evaluate the effects of treatments, single-arm study designs have been traditionally used in Phase II oncology clinical trials. The single-arm studies using historical control or external control might be inevitable and even fatal when concurrent controls are impractical or unethical in rare and high-risk diseases. Due to recruiting difficulty, ethical and economic reasons, the single-arm trials can be a good option to test the experimental efficacy with the external control data of historical control rates for early efficacy phase 2 trials in glioblastoma. The FDA guidelines on external control data focus on the use of patient-level data from other clinical trials or real-world data (RWD), and so there is no guidance for summary-level historical control. Furthermore, there exist methodological issues to use historical data like identification of relevant data, amount of discounting (time difference and dissimilarity), prior robustness or operating characteristics. In this study, we propose a synthetic data based predictive scoring method optimally to match the historical control data with the characteristic conditions of the experimental studies. We consider both a binary (PFS on six months) and survival (median PFS) endpoints as surrogates for Phase 2 single-arm trials in newly diagnosed and recurrent glioblastoma patients. We perform meta-analysis to summarize the endpoints and the related socio-demographic, treatment and genetic factors from the summary-level historical data. Then we generate the synthetic patients based on the meta-summarized data. The generalized boosted regression models will be used to identify significant characteristics affecting the survival of GBM patients using the synthetic data. Finally the predictive score-based historical data model will be developed to provide the optimal matching with the characteristics of the experimental studies. This study will be validated using existing patient-level data as well as cross-validation methods.

Progression of enlarged perivascular spaces contributes to occurrence of silent lacunar infarction in the elderly.

This study aims to assess the effect of enlarged perivascular spaces (EPVS) in patients using the methods of scale score and 3D volume quantification and to determine whether EPVS progression is related to the occurrence of silent lacunar infarction (SLI). Three hundred sixty-seven elderly patients with EPVS were screened by MRI on the day of admission and 2 years later; 295 patients were included in the final study, among which 136 patients had EPVS with SLI (EL); and 159 patients had EPVS without SLI (EOL). Both scale score and 3D volume quantification method were used to evaluate EPVS. The 295 patients were divided into three groups based on EPVS progression state: Group 1 (no progression), Group 2 (0-50% EPVS progression), and Group 3 (≥ 50% EPVS progression). Multiple logistic regression analysis was used to analyze the risk of occurrence of SLI. The EPVS scores and ΔEPVS scores were not significantly different between the EL and EOL groups (p > 0.05). EPVS volumes and their progression were significantly higher in EL compared with EOL (p < 0.001). The incidence of SLI was increased in Groups 2 and 3 compared with those in Group 1, and the trend test showed statistically significant (p = 0.032). Multiple logistic regression analysis showed that the risk of occurrence of SLI was significantly increased in Group 2 (OR 2.24; p = 0.024) and Group 3 (OR 3.31; p = 0.037) versus that in Group 1. 3D volume quantification allows for a more sensitive assessment of EPVS changes, and the progression of EPVS volume may contribute to the occurrence of SLI.

Apolipoprotein C3-rich low-density lipoprotein (AC3RL) increases BBB permeability and deteriorates cerebral ischemic stroke injury

Abstract Background Ischaemic stroke causes disability due to brain damage resulting from blood supply obstruction or increased permeability of the blood-brain barrier (BBB) that exposes the blood to toxic substances during reperfusion. Apolipoprotein C3 is a crucial triglyceride transport modulator, and its overexpression raises the risk of dyslipidemia and cardiovascular disease. Clinically, we observed that stroke patients have higher levels of apolipoprotein C3-rich low-density lipoprotein (AC3RL) expression than healthy individuals, and they also have worse prognoses. Simultaneously, we found that an increase in AC3RL is involved in endothelial cell apoptosis and inflammatory response, which may be linked to the occurrence of brain injury after stroke. Purpose This study aimed to explore whether the high expression of AC3RL would increase the permeability of the blood-brain barrier, and aggravate brain damage. Methods The intraluminal monofilament model of middle cerebral artery occlusion (MCAO) experiment was carried out using C57BL/6 and apolipoprotein E gene knockout mice (ApoE-/-). WT receive an IV injection of AC3RL, which was separate from stroke patients' plasma. APOE-/- was fed a high-fat diet to promote AC3RL higher expression. We performed 60-minute ischaemic and 7-day reperfusion. The modified neurological severity score (mNSS) method was used to assess motor and neurological scores. Evans blue dye was injected through the tail vein one hour before euth (A) AC3RL, which was separated from stroke patients' plasma. (B) AC3RL concentration in individuals. (C) The white portion of the mice brains TTC stain indicates the site of the injury. (D) Evans blue dye leakage study in mice brains exhibited BBB permeability changes. (E) Assessment of mice's motor and neurological performance using the mNSS. anasia to assess BBB permeability. TTC staining of brain tissue after euthanasia to pinpoint the site of brain damage. Results Evans blue dye leakage was observed in the brain tissues of the group with high AC3RL expression, indicating that the BBB permeability has expanded. The mNSS method revealed a significant rise in mice with high levels of AC3RL expression, which suggested a decline in motor and nervous function. Conclusions Whether endogenous or exogenous, increased expression of AC3RL leads to more severe cerebral ischemic injury and motor dysfunction, which we believe may be due to increased BBB permeability caused by AC3RL. Therefore, AC3RL can be used as a disease predictor in the future, reducing AC3RL will be the main indicator for reducing severe brain injury.Figure 1.Figure 2.

Association between implanted cardioverter-defibrillator and mortality for patients with left ventricular ejection fraction near 35%

Abstract Background Consensus guidelines support the use of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death in patients with either non-ischemic or ischemic cardiomyopathy with left ventricular ejection fraction ≤ 35%. Despite that class 1 recommendation, evidence from trials for efficacy specifically for patients with left ventricular ejection fraction (LVEF) near 35% is weak. Past trials are underpowered for this population and future trials are unlikely to be performed. As such, we aimed to use a large longitudinal echocardiography database linked to mortality to assess the comparative effectiveness of ICD therapy near the conventional primary prevention LVEF threshold. Methods Patients with lowest LVEF between 33-38% without an ICD prior to the lowest-LVEF echo (defined as "time zero") were identified by querying echocardiography data from November 28, 2001 until July 9, 2020 at large general hospital-based echocardiography registry linked to ICD treatment status. These data were then linked to mortality and comorbidity data. After inclusion and exclusion criteria were applied, 6,144 patients remained for the analytic cohort. Given evidence of covariate imbalance around the LVEF = 35% threshold, fuzzy regression discontinuity methods were considered but not used. Instead, to assess the association between ICD and mortality, multiple propensity score methods including matching and inverse probability of treatment weighting (IPTW) were used to create synthetic reference groups. Survival was then assessed with Cox proportional hazards models considering treatment status as a time-dependent covariate. Results In bivariate unadjusted comparisons, patients who received ICDs were substantially more often male (85.6% vs. 64.9%, p &amp;lt; 0.0001), more often white (87.3% vs. 82.9%, p &amp;lt; 0.048), and more often had a history of ventricular tachycardia (41.1% vs. 12.1%, p &amp;lt; 0.0001) and myocardial infarction (42.1% vs. 34.7%, p = 0.008). In the propensity matched sample, after accounting for time-dependence, there was no association between ICD and mortality (HR 1.09, 95% CI 0.86-1.39, p = 0.474). In the IPTW analysis, there also was no association between ICD and mortality (HR 1.09, 95% CI 0.91-1.30, p = 0.3672). Conclusions ICD therapy was not associated with reduced mortality near the conventional LVEF threshold of 35%. Although this treatment design cannot definitively demonstrate lack of efficacy, our results are concordant with available prior trial data. A definitive, well-powered trial is needed to answer the common and important clinical question of primary prevention ICD efficacy near the threshold of LVEF = 35%.

Combining Human and Automated Scoring Methods in Experimental Assessments of Writing: A Case Study Tutorial

In a randomized trial that collects text as an outcome, traditional approaches for assessing treatment impact require that each document first be manually coded for constructs of interest by human raters. An impact analysis can then be conducted to compare treatment and control groups, using the hand-coded scores as a measured outcome. This process is both time and labor-intensive, which creates a persistent barrier for large-scale assessments of text. Furthermore, enriching one’s understanding of a found impact on text outcomes via secondary analyses can be difficult without additional scoring efforts. The purpose of this article is to provide a pipeline for using machine-based text analytic and data mining tools to augment traditional text-based impact analysis by analyzing impacts across an array of automatically generated text features. In this way, we can explore what an overall impact signifies in terms of how the text has evolved due to treatment. Through a case study based on a recent field trial in education, we show that machine learning can indeed enrich experimental evaluations of text by providing a more comprehensive and fine-grained picture of the mechanisms that lead to stronger argumentative writing in a first- and second-grade content literacy intervention. Relying exclusively on human scoring, by contrast, is a lost opportunity. Overall, the workflow and analytical strategy we describe can serve as a template for researchers interested in performing their own experimental evaluations of text.

Abstract 14605: Association of SGLT-2 Inhibition With Size of Myocardial Infarction in Patients With Type 2 Diabetes Mellitus

Introduction: Preclinical data suggest that sodium-glucose-cotransporter-2 inhibitors (SGLT-2i) reduce the size of myocardial infarction (MI). This study aimed to assess the association of SGLT-2i use with the size of MI and clinical outcome. Methods: In a retrospective single center cohort study, patients with diagnosed diabetes mellitus type 2 who were admitted for MI and treated with PCI between November 2015 and November 2022 were analyzed and grouped according to SGLT-2i use. Following PCI, serial high sensitivity troponin T (cTn, Roche) measurements were performed according to in-house protocol. The primary outcome was the size of MI determined by the peak cTn normalized on the endangered myocardial area (EMA) calculated according to culprit lesion localization and coronary arterial dominance. Secondary outcomes were in-hospital adverse events (i.e. in-hospital death or stroke) and length of intensive care unit (ICU) treatment. The propensity score method was used to assess the association with outcomes. Results: 631 patients were identified: 85 with ongoing SGLT-2i therapy and 537 with other antidiabetic medication. Patients using SGLT-2i were younger (median age [years]: 67 [interquartile range, IQR 59-73] vs. 73 [64-79], p&lt;0.01) and had a higher eGFR at admission (75 [57-91] vs. 68 [49-88] ml/min/1.73m 2 , p=0.03). The median cTn samples per patient was 6 (5-8). There was no significant difference in the peak cTn levels between the two groups (SGLT-2i use vs. no SGLT-2i use: 53 (12-173) vs. 65 (20-174) х the upper limit of normal [ULN], p=0.26). After augmented inverse-probability weighted propensity score matching, ongoing SGLT-2i therapy was significantly associated with a reduced MI size (difference between means: -2.19 [95% confidence interval, -4.07 to -0.31] x ULN/EMA (1/%), p=0.02). SGLT-2i use was associated with less in-hospital adverse events (-4.69 [-8.70 to -0.69] %, p=0.02) and with less days on ICU (-0.27 [-0.53 to -0.01] days, p=0.045). Conclusion: In this retrospective cohort study of patients with DM presenting with MI, prior prescription of SGLT-2i was associated with reduced MI size and fewer adverse events during hospitalization. This might indicate that SGLT2i reduces the size of MI.

Abstract 11322: Comparative Outcomes of Impella and Intra-Aortic Balloon Pump for Left Ventricular Unloading Among Patients With Cardiogenic Shock on Veno-Arterial Extracorporeal Membrane Oxygenation

Background: Cardiogenic shock (CS) is associated with high morbidity and mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with CS. Although Impella or Intra-aortic balloon pump (IABP) is frequently used for left ventricular (LV) unloading for increased afterload during VA-ECMO therapy, there are scarce comparative outcomes data for these devices. Aims: To compare short-term outcomes of Impella and IABP in patients on VA-ECMO for CS. Methods: Using the Nationwide Readmissions Database between 2016 and 2020, we analyzed outcomes of CS patients requiring VA-ECMO based on multivariable regression and propensity score methods. Results: Of 15,980 patients on VA-ECMO, IABP and Impella were used in 19.4% and 16.4% patients, respectively. The proportion of patients managed with Impella for LV unloading significantly increased from 2016 to 2020 (6.5% vs. 25.8%; P-trend&lt;0.001). In-hospital mortality was higher in Impella group (54.8%) compared with ECMO only (50.4%) and IABP (48.4%) groups. After adjustment, LV unloading using IABP vs ECMO only was associated with lower in-hospital mortality (OR, 0.83; 95% CI, 0.70-0.98). LV unloading using Impella vs ECMO only had similar in-hospital mortality (OR, 1.09; 95% CI, 0.91-1.31) but was associated with more bleeding (OR, 1.21; 95% CI, 1.04-1.41) and more acute kidney injury (AKI) requiring hemodialysis (HD) (OR, 1.42; 95% CI, 1.13-1.77). LV unloading with Impella vs IABP was associated with greater risk of AKI requiring HD (OR, 1.49; 95% CI, 1.13-1.97), higher in-hospital mortality (OR, 1.32; 95% CI, 1.10-1.60), and high 40-day mortality (HR, 1.25; 95% CI, 1.17-1.32). Conclusions: LV unloading using Impella, compared with IABP, was not associated with improved survival at 40 days in patients treated with VA-ECMO for CS, but was associated with increased adverse events. These findings suggest a need for further studies to guide clinical practice of LV unloading in CS.

Implementation of Digital Image Analysis in Assessment of Ki67 Index in Breast Cancer.

The clinical utility of the proliferation marker Ki67 in breast cancer treatment and prognosis is an active area of research. Studies have suggested that differences in pre-analytic and analytic factors contribute to low analytical validity of the assay, with scoring methods accounting for a large proportion of this variability. Use of standard scoring methods is limited, in part due to the time intensive nature of such reporting protocols. Therefore, use of digital image analysis tools may help to both standardize reporting and improve workflow. In this study, digital image analysis was utilized to quantify Ki67 indices in 280 breast biopsy and resection specimens during routine clinical practice. The supervised Ki67 indices were then assessed for agreement with a manual count of 500 tumor cells. Agreement was excellent, with an intraclass correlation coefficient of 0.96 for the pathologist-supervised analysis. This study illustrates an example of a rapid, accurate workflow for implementation of digital image analysis in Ki67 scoring in breast cancer.

Use of virtual reality to facilitate engineer training in the aerospace industry

This work concerns automation of the training process, using modern information technologies, including virtual reality (VR). The starting point is an observation that automotive and aerospace industries require effective methods of preparation of engineering personnel. In this context, the technological process of preparing operations of a CNC numerical machine has been extracted. On this basis, a dedicated virtual reality environment, simulating manufacturing of a selected aircraft landing gear component, was created. For a comprehensive analysis of the pros and cons of the proposed approach, four forms of training, involving a physical CNC machine, a physical simulator, a software simulator, and the developed VR environment were instantiated. The features of each training form were analysed in terms of their potential for industrial applications. A survey, using the Net Promoter Score method, was also conducted among a target group of engineers, regarding the potential of use of each training form. As a result, the advantages and disadvantages of all four training forms were captured. They can be used as criteria for selecting the most effective training form.

New Urbanism in Ardabil City, Iran

ABSTRACT The City of Ardabil was studied from the perspective of New Urbanism to identify implementation strategies for solving its problems and improving its overall condition. To achieve this goal, the Analytical Hierarchy Process (AHP), Strengths, Weaknesses, Opportunities, and Threats (SWOT), and the average scores methods by the 45 experts have been used. The result of AHP is to recognize the priorities of the 10 principles of New Urbanism. The results of the SWOT are as follows: 1) The strengths will overcome the weaknesses. 2) Opportunities will overcome threats. 3) The dominant strategy with a score of 2.9 for weaknesses and strengths, and a score of 2.6 for opportunities and threats is a combination of strengths and opportunities. The result of the average scores (2.288 out of 4) shows the “bad” state of the city for New Urbanism. Finally, three implementation strategies for the city were selected using an attractiveness questionnaire.

Soil health assessment under different soil and irrigation types in the agro-pastoral ecotone of northern China

Soil health indexes (SHIs) are widely used methods on a regional or national scale to evaluate the status of soils. However, how to unbiasedly select appropriate indicators and score these indicators to obtain comprehensive SHI is still a big issue, due to the multiformity and complexity of soil. The goal of the study was to assess various cropland soil and irrigation types soil health using two scoring methods (linear and nonlinear scoring) and three indexes choosing methods (minimum data set MDS, revised minimum data set RMDS and total data set TDS) in loess plateau. Soil and irrigation types were Kastanozems soil and irrigation farming (KA-IL), Kastanozems soil and rainfed farming (KA-RL), Regosols soil and irrigation farming (RE-IL), Regosols soil and rainfed farming (RE-RL). Twenty-four soil indexes of soil chemical, physical and biological properties were determined from the top soil layer (0–20 cm). One-way ANOVA and PCA were used to select the MDS, RMDS and TDS. The finding results demonstrated that fifteen soil indicators were incorporated into TDS. In addition, the six soil indicators were selected to establish the RMDS (BD, EC, TN, MBC, LAP and ALP) and MDS (BD, SOC, TN, NO3--N, MBN and BG), respectively. The consistency in SHIs of the nonlinear scoring was better than that of the linear scoring method. The nonlinear scoring method with MDS was considered the optimal method to calculate the SHI due to its maximum values of CV, F and highest correlation coefficient with TDS. The SHI values of the different soil and irrigation types showed the following order: RE-IL > RE-RL > KA-IL > KA-RL. This study demonstrated that different soil and irrigation types noticeably affected the soil health in cropland of an agro-pastoral ecotone of northern China, and the SHI-NLM method was a sensitive and accurate model for quantitative assessment of soil health in this region.