Individual Signs Research Articles

Investigating the Relative Importance of Tear Homeostatic Signs for the Diagnosis of Dry Eye Disease.

Disease misdiagnosis is more likely if standardised diagnostic criteria are not used. This study systematically examined the effect on diagnosing dry eye disease (DED), when tests for evaluating tear film homeostasis were included/excluded from a multi-test protocol. For 1427 participants across five sites, data for the full suite of diagnostic tests defined in the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report algorithm were evaluated; diagnostic sensitivity was calculated when individual signs were removed, and when different combinations of signs were required. Evaluating just one of the three TFOS DEWS II homeostatic signs resulted in between 12.3% and 36.2% of patients who met the DED diagnostic criteria not being assigned this diagnosis. While comprehensive ocular surface staining evaluation, including corneal, conjunctival and lid margin staining, in combination with symptoms had the highest sensitivity (87.7%) of the three markers, the sensitivity dropped to 44.6% if only corneal staining was evaluated. Omitting either non-invasive tear breakup time or osmolarity each dropped the sensitivity by <5%. The prevalence of DED was substantially reduced if a diagnosis required symptoms and two of the three signs to be present (by 43.7% to 61.2%) and by 65.9% if all three signs indicating a loss of tear film homeostasis were required. The analysis did not change significantly across differing severities of DED symptoms. The TFOS DEWS II diagnostic algorithm of symptoms plus assessing for a tear film or ocular surface sign can be considered a robust and appropriate approach for DED diagnosis.

Diagnosis of Peritonsillar Abscess-A Prospective Study Comparing Clinical with CT Findings in 133 Consecutive Patients.

Background: Peritonsillar abscess (PTA) is relatively common but challenging to diagnose clinically. Several clinical signs may be used, with unknown performances. We evaluated and compared the diagnostic performance of individual and combined clinical signs (trismus, edema, pharynx immobility, uvula deviation, hot potato voice, and overall clinical impression) assessed by an otolaryngologist and of contrast-enhanced computed tomography (CT) to detect acute PTA. Methods: Prospective study in 133 consecutive adult patients (77 males, mean age = 33 years) with suspected clinical PTA and CT obtained in the emergency setting of a tertiary care hospital between November 2020 and October 2022. The standard of reference consisted of surgically proven pus within 24 h of CT or a favorable clinical evolution at 48 h without surgical intervention. Results: PTA was present in 117/133 (88%) patients, with no difference between mean age or sex distribution between the groups with and without PTA. None of the evaluated clinical signs were associated with PTA (OR = 1.26-5.43, p > 0.05), whereas the CT finding "abscess" was significantly associated with PTA (OR = 67.2, p < 0.0001). The sensitivity of individual clinical signs varied between 19.7% and 73.5%, and the sensitivity of CT was significantly higher for all clinical signs (95.7%, p < 0.0001) except for overall clinical impression (97.4%, p = 0.7266). The specificity of clinical signs varied between 12.5% and 93.8%, and the specificity of CT was significantly higher (75%, p < 0.05) for overall clinical impression and edema. All clinical signs together yielded an area under the curve (AUC) = 0.677. Conclusions: In adults, clinical assessment alone using independent clinical signs and overall clinical impression does not allow a reliable diagnosis of PTA, even when performed by an otolaryngologist. CT is reliable in diagnosing PTA and, whenever available, should be the examination method of choice for diagnosing PTA, especially by a non-specialist.

Evaluating case definitions of respiratory disease in dairy calves: a scoping review.

Bovine respiratory disease (BRD) is one of the most common diseases observed in dairy calves in both the pre- and post-weaning periods. Despite its common occurrence, there has been no formal synthesis (e.g., scoping review) of the scientific literature surrounding diagnosing BRD in dairy calves. As such, the objective of this scoping review was to describe what case definitions for diagnosing BRD in dairy calves have been used in research. An initial search of peer-reviewed journals and the gray literature yielded 12,001 unique articles, of which 307 records containing 358 case definitions were included. Seven categories of diagnostic methods were used to categorize case definitions: (1) clinical scoring systems alone were the most used diagnostic method (n = 148, 41%) followed by (4) physical exam parameters alone (i.e., the study did not provide a detailed description of how the calf was assessed for each component of the physical exam [i.e., no description or scoring options reported]), n = 91, 25%), (5) physical exam parameters in combination with other diagnostic methods (n = 40, 11%), (6) thoracic ultrasound alone (n = 31, 9%), (2) clinical scoring system in combination with other diagnostic methods (n = 23, 7%), (3) clinical scoring system in combination with thoracic ultrasound (n = 10, 3%), and (7) other diagnostic methods (n = 15, 4%). Only 2-thirds of publications provided a citation for their case definition (n = 230, 64%), of which the Wisconsin clinical scoring system was most referenced (n = 100, 43%), followed by the California clinical scoring system (n = 19, 8%). An attempt was made to compare entire case definitions within each diagnostic method; however, they displayed substantial diversity which limited the ability to compare them at this level. Instead, counts of individual factors within each case definition (e.g., individual clinical signs) were reported for each diagnostic method. From all case definitions across the 7 diagnostic method categories (n = 358), common factors assessed included cough (n = 224, 63%), nasal discharge (n = 213, 60%), and body temperature (n = 142, 54%). Across all case definitions, additional parameters such as validity were frequently not reported - only 4 (1.1%) were referred to as validated, 9 (2.5%) were being validated in the study, and 28 (7.8%) modified existing case definitions. Additionally, assessment of severity of disease when present (e.g., mild, moderate or severe) was frequently not reported (n = 336, 93.9%). Further, 106 (29.0%) reported assessments of accuracy, 66 (18.4%) of which were reports of qualitative oversight (e.g., training of assessors) and 40 (11.1%) of which were related to a quantitative assessment of accuracy (e.g., sensitivity and specificity). Parameters surrounding conducting the assessment were also extracted, for example how often (most common: at least daily, n = 120, 33.5%) and who conducted it (most common: information not reported, n = 144, 40.2%). The findings of this scoping review highlighted the need for a validated, standardized set of criteria for BRD diagnosis in dairy calves, achievable through following the methodology of developing a core outcome set.

SIGN LANGUAGE TO TEXT CONVERTOR

Sign language is a vital form of communication for the Deaf and Hard of Hearing community, yet there remains a significant barrier in real time interaction with non-sign language users. This project proposes the development of a Sign Language to Text Converter, an innovative system designed to translate sign language gestures into written text. The goal of the system is to produce an accessible real-time tool that transcends the communication gap between the Deaf people and those who are not familiar with sign language, thus enhancing interaction in diverse spheres such as education, healthcare, and social settings. This system will utilize techniques such as computer vision and machine learning in recognizing and interpreting hand gestures. The system processes real-time video input using OpenCV for image processing and MediaPipe for hand and pose detection, extracting key features such as hand positions, movements, and orientations. These features are then fed into a Convolutional Neural Network (CNN) trained to classify individual sign language gestures. The output is translated to text, which can either be displayed on a screen or used with the text-to-speech systems to provide an auditory output. Key Words: MediaPipe, Convolutional Neural Network (CNN), Text To Speech(TTS), American Sign Language (ASL)

Awareness of Peptic Ulcer Disease among the General Population in Al-Ahsa.

Peptic ulcer disease (PUD) is a condition characterized by discontinuity in the gastrointestinal (GI) tract's inner lining, often caused by factors such as Helicobacter pylori infection and NSAID consumption. PUD can lead to various symptoms, but up to 70% of patients may not experience any symptoms. Diagnosing PUD can be challenging due to the unreliability of individual symptoms and signs. PUD can have serious complications if left untreated. Despite its significance, there is a lack of studies measuring the awareness of PUD among the population in Al-Ahsa, Saudi Arabia. Therefore, this study aimed to assess the level of awareness of PUD among the general population in Al-Ahsa. A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia, from September to December 2023. The study included 399 adult residents of Saudi Arabia who agreed to participate. A convenient nonprobability sampling technique was used to collect data. An online self-administered questionnaire, distributed through social media platforms, was used to gather information on participants' awareness of PUD. The questionnaire included sociodemographic characteristics and questions related to PUD awareness. Data were analyzed using SPSS, and qualitative data were presented as numbers and percentages. The Chi-square test was used to examine qualitative data between the two groups. Of the 399 participants, 71.4% demonstrated a good level of knowledge regarding PUD, whereas 28.6% had a low level of knowledge. The sample consisted of nearly equal numbers of males and females, with participants aged 18-55+ years. The majority of participants had attained a bachelor's degree and were employed. The findings suggest a relatively high level of education among the study population. The study highlights the need for increased public awareness of PUD in Al-Ahsa, Saudi Arabia. While some participants showed good knowledge of PUD, a significant number had low awareness. Educational initiatives are essential to improve understanding and knowledge of PUD among the community. By enhancing awareness, early detection and appropriate management of PUD can be promoted, resulting in improved health outcomes for individuals in Al-Ahsa.

Dynamics of the number and productivity of &lt;i&gt;Hereford&lt;/i&gt; breeding cattle in the Novosibirsk region

The article presents an analysis of the state of the breeding stock of Hereford cattle in the Novosibirsk region in dynamics for 2021–2023. The Hereford breed is one of the most common breeds of beef cattle in Russia and in the world, and its productive qualities and the ability to adapt to different climatic conditions and pasture content allows it to be successfully used to produce high-quality and environmentally friendly meat. The results of zootechnical reports on bonification from breeding farms of the Novosibirsk region were analyzed, a comparison of indicators of productivity and use of herd animals, including own productivity, growth and development of young animals, reproductive qualities and longevity of cows of breeding herds, was carried out. It was found that despite the reduction in the number of breeding farms and breeding stock of Hereford cattle in the Novosibirsk region, is an improvement in both individual signs of productivity of cows and young animals, as well as in the overall class composition of the herd. Nevertheless, the available livestock seems to be insufficient in terms of meeting the needs of farms for breeding animals adapted to the climate conditions of Western Siberia and year-round outdoor maintenance. Currently, the animals produced at Sibirskaya Niva LLC most adequately meet the requirements of the market, but their number is extremely insufficient both for the formation of breeding herds of commodity farms in volumes corresponding to those necessary to fill the beef market, and for the formation of daughter breeding herds in the region.

Acute Quetiapine Intoxication: Relationship Between Ingested Dose, Serum Concentration and Clinical Presentation-Structured Literature Review and Analysis.

Over the past decade, quetiapine has become one of the most commonly used psychotropic drugs in acute intoxication events worldwide. A structured literature review and analysis were conducted to assess the relationship between the kinetic and dynamic profiles in acute quetiapine intoxication. The correlation between dose and peak serum concentration (cmax) was determined using Pearson's correlation coefficient. Binary logistic regression was used to evaluate dose and cmax as predictors of the most common clinical events, signs and symptoms. One hundred and thirty-four cases of acute quetiapine ingestion were included in the analysis, with a median ingested dose of 10 g and a median cmax of 4 mg/L. The typical half-life was estimated to be 16.5 h, significantly longer than at therapeutic doses. For the immediate-release formulation, a biphasic disposition could not be excluded. Dose and cmax demonstrated a weak but significant correlation (r = 0.256; N = 63; p = 0.043). Central nervous system depression and tachycardia were the most common clinical signs. Higher doses and concentrations increased the risk of severe intoxication and were good predictors of intubation, tachycardia, hypotension, QTc prolongation and seizures, but not QRS prolongation, arrhythmia, heart block, hypokalaemia or acidosis. The thresholds for dose and cmax that increased the risk for individual signs and symptoms varied widely. However, doses > 3 g or cmax > 2 mg/L can be considered as alert levels that represent a high risk for severe clinical course of acute quetiapine intoxication.

Evaluation of Dexmedetomidine Withdrawal and Management After Prolonged Infusion

Dexmedetomidine is often used for longer than its labeled indication of 24 hours, raising concerns for potential withdrawal. Data are limited regarding this syndrome in adult patients. This study aimed to further characterize dexmedetomidine withdrawal in critically ill adult patients after prolonged use. This was an institutional review board-approved, single-center, retrospective chart review conducted at a tertiary academic medical center. Adult intensive care unit (ICU) patients on dexmedetomidine for ≥72 hours in 2019 were screened for inclusion. Exclusion criteria were interruption of dexmedetomidine for >6 hours, indications for dexmedetomidine other than sedation, or patients with neurological or burn injury. The major end point was the incidence of dexmedetomidine withdrawal, defined as meeting ≥2 of the following criteria within 24 hours of discontinuation: newly positive Confusion Assessment Method for ICU, Richmond Agitation Sedation Scale score of ≥+2, hypertension, and tachycardia. Minor end points were incidence of individual withdrawal signs as previously described, additional sedatives or antipsychotics required, dose and duration of dexmedetomidine infusion, length of ventilation, ICU and hospital length of stay, and new onset of the following: fever, vomiting, loose stools/diarrhea, diaphoresis, or seizure. Of the 152 patients included, dexmedetomidine withdrawal occurred in 54 patients (35.5%). Rebound hypertension was the most common withdrawal sign (47 patients [87.0%]). In the withdrawal group, significantly more patients required additional β-blockers (29 [53.7%] vs 10 [10.2%]; P < 0.01), were reinitiated on dexmedetomidine (16 [29.6%] vs 10 [10.2%]; P < 0.01), and required a start or increased dose of clonidine (6 [11.1%] vs 3 [3.1%]; P = 0.04). There was no significant difference in the cumulative dose or duration of dexmedetomidine between the groups. Length of ventilation was longer in the withdrawal group (171 hours [83.7-280.8 hours] vs 159 hours [149.0-335.7 hours]; P < 0.01), but there was no difference in ICU or hospital length of stay. Prolonged use of dexmedetomidine was associated with withdrawal syndrome in 35.5% of patients in our study. Larger trials are needed to confirm the risk factors for dexmedetomidine withdrawal and identify measures to prevent withdrawal.

Motif discovery in hospital ward vital signs observation networks

Vital signs observations are regular measurements used by healthcare staff to track a patient’s overall health status on hospital wards. We look at the potential in re-purposing aggregated and anonymised hospital data sources surrounding vital signs recording to provide new insights into how care is managed and delivered on wards. In this paper, we conduct a retrospective longitudinal observational study of 770,720 individual vital signs recordings across 20 hospital wards in South Wales (UK) and present a network modelling framework to explore and extract behavioural patterns via analysis of the resulting network structures at a global and local level. Self-loop edges, dyad, triad, and tetrad subgraphs were extracted and evaluated against a null model to determine individual statistical significance, and then combined into ward-level feature vectors to provide the means for determining notable behaviours across wards. Modelling data as a static network, by aggregating all vital sign observation data points, resulted in high uniformity but with the loss of important information which was better captured when modelling the static-temporal network, highlighting time’s crucial role as a network element. Wards mostly followed expected patterns, with chains or stand-alone supplementary observations by clinical staff. However, observation sequences that deviate from this are revealed in five identified motif subgraphs and 6 anti-motif subgraphs. External ward characteristics also showed minimal impact on the relative abundance of subgraphs, indicating a ‘superfamily’ phenomena that has been similarly seen in complex networks in other domains. Overall, the results show that network modelling effectively captured and exposed behaviours within vital signs observation data, and demonstrated uniformity across hospital wards in managing this practice.

Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus. The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses. We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%). Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital). Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

Impact of self-reported race on Villalta Scale postthrombotic syndrome scores and correlation with venous disease-specific quality of life: an exploratory analysis of the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis Trial

BackgroundThe Villalta Scale (VS) to diagnose postthrombotic syndrome (PTS) consists of 5 patient-reported leg symptoms and 6 clinician-rated leg signs. It is unknown how the scale performs across racial groups. ObjectivesOur study explored if there were differences in VS scores, particularly clinician-rated signs components, according to self-reported race. MethodsExploratory analysis of the ATTRACT trial, a randomized controlled trial conducted at 56 US sites that investigated pharmacomechanical catheter-directed thrombolysis to prevent PTS after proximal deep vein thrombosis (DVT). At the 6-month visit after randomization, we compared self-reported Black (n = 123) and White (n = 541) participants for mean total VS score, VS symptoms score, VS signs score, individual signs scores, and correlation coefficients between VS signs and VS symptoms scores and between VS signs and Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) scores (a self-reported venous disease-specific quality of life measure). ResultsMean total VS score (4.67 vs. 4.12, P = .54),VS signs score (1.66 vs. 2.00, P = .07), and VS symptoms score (2.83 vs. 2.04, P = .10) were similar between Black and White participants. The mean score for one individual VS sign, venous ectasia, was lower in Black vs. White participants (0.24 vs. 0.63, P< .01). There was similar, modest correlation in Black and White participants between VS signs and VS symptoms scores (rblack = 0.19; rwhite = 0.23) and between VS signs and VEINES-QOL scores (rblack = −0.32; rwhite = −0.30). Results were adjusted for ATTRACT trial treatment group, age, sex, body mass index, DVT extent, hypertension, diabetes, dyslipidemia, and congestive heart failure. ConclusionThe findings suggest that some differences in VS scores exist according to self-reported race. It is unclear whether these reflect clinicians’ underrating of some VS signs and/or differences in PTS severity. Further work is needed to understand how the VS performs across racial groups.

Development and Preliminary Validation of a Central Venous Access Device-Associated Skin Impairment Classification Tool Using Modified Delphi and Clinimetric Methods.

An evidence and consensus-based instrument is needed to classify central venous access device-associated skin impairments. The aim of this study was to design and evaluate the central venous access device-associated skin impairment classification tool. A two-phase modified Delphi study. This two-phase study consisted of a literature review, followed by the development and validation of a classification instrument, by experts in the fields of central venous access devices and wound management (Phase 1). The instrument was tested (Phase 2) using 38 clinical photographs of a range of relevant skin impairments by the same expert panel. The expert panel consisted of registered nurses who were clinical researchers (n = 4) and clinical experts (n = 3) with an average of 24 years of nursing and research experience and 11 years of experience in wound management. Measures to assess preliminary content validity and inter-rater reliability were used. The instrument consists of five overarching aetiological classifications, including contact dermatitis, mechanical injury, infection, pressure injury and complex clinical presentation, with 14 associated subcategory diagnoses (e.g., allergic dermatitis, skin tear and local infection), with definitions and signs and symptoms. High agreement was achieved for preliminary scale content validity and item content validity (I-CVI = 1). Inter-rater reliability of aetiologies was high. The overall inter-rater reliability of individual definitions and signs and symptoms had excellent agreement. The development and preliminary validation of this classification tool provide a common language to guide the classification and assessment of central venous access device-associated skin impairment. The comprehensive and validated classification tool will promote accurate identification of central venous access device-associated skin impairment by establishing a common language for healthcare providers. The availability of this tool can reduce clinical uncertainty, instances of misdiagnosis and the potential for mismanagement. Consequently, it will play a pivotal role in guiding clinical decision-making, ultimately enhancing the quality of treatment and improving patient outcomes. The Guidance on Conducting and Reporting Delphi Studies (CREDES) was adhered to. No patient or public contribution.

Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.

This work was undertaken to inform a National Institute for Health and Care Excellence guideline on the initial assessment of adults with suspected acute respiratory infection. To undertake a rapid evidence synthesis of systematic reviews and cost-effectiveness studies of signs, symptoms and early warning scores for the initial assessment of adults with suspected acute respiratory infection. MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for systematic reviews and MEDLINE, EMBASE, EconLit and National Health Service Economic Evaluation Database were searched for cost-effectiveness studies in May 2023. References of relevant studies were checked. Clinical outcomes of interest included escalation of care, antibiotic/antiviral use, time to resolution of symptoms, mortality and health-related quality of life. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool or the National Institute for Health and Care Excellence economic evaluations checklist. Results were summarised using narrative synthesis. Nine systematic reviews and one cost-effectiveness study met eligibility criteria. Seven reviews assessed several early warning scores for patients with community- acquired pneumonia, one assessed early warning scores for nursing home-acquired pneumonia and one assessed individual signs/symptoms and the Centor score for patients with sore throat symptoms; all in face-to-face settings. Two good-quality reviews concluded that further research is needed to validate the CRB-65 in primary care/community settings. One also concluded that further research is needed on the Pneumonia Severity Index in community settings; however, the Pneumonia Severity Index requires data from tests not routinely conducted in community settings. One good-quality review concluded that National Early Warning Score appears to be useful in an emergency department/acute medical setting. One review (unclear quality) concluded that the Pneumonia Severity Index and CURB-65 appear useful in an emergency department setting. Two poor-quality reviews concluded that early warning scores can support clinical judgement and one poor-quality review found numerous problems with using early warning scores in a nursing home setting. A good-quality review concluded that individual signs and symptoms have a modest ability to diagnose streptococcal pharyngitis, and that the Centor score can enhance appropriate prescribing of antibiotics. The cost-effectiveness study assessed clinical scores and rapid antigen detection tests for sore throat, compared to delayed antibiotic prescribing. The study concluded that the clinical score is a cost-effective approach when compared to delayed prescribing and rapid antigen testing. Several early warning scores have been evaluated in adults with suspected acute respiratory infection, mainly the CRB-65, CURB-65 and Pneumonia Severity Index in patients with community-acquired pneumonia. The evidence was insufficient to determine what triage strategies avoid serious illness. Some early warning scores (CURB-65, Pneumonia Severity Index and National Early Warning Score) appear to be useful in an emergency department/acute medical setting; however, further research is required to validate the CRB-65 and Pneumonia Severity Index in primary care/community settings. The economic evidence indicated that clinical scores may be a cost-effective approach to triage patients compared with delayed prescribing. Only systematic reviews were eligible for inclusion in the synthesis of clinical evidence. There was a great deal of overlap in the primary studies included in the reviews, many of which had significant limitations. No studies were undertaken in remote settings (e.g. NHS 111). Only one cost-effectiveness study was identified, with limited applicability to the review question. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159945.

Choosing the optimal combination of lungs lobe evaluation during focused pulmonary ultrasonography in calves

Bovine respiratory disease (BRD) poses significant challenges on beef and dairy farms, impacting mortality rates, animal welfare, and production efficiency. Although pulmonary ultrasonography is highly sensitive and specific for monitoring lung lesions and diagnosing BRD, its practical application could be optimized by focusing on the most commonly affected lung lobes. This study first evaluated the efficacy of focused lung ultrasonography for diagnosing BRD in calves, examining individual lung lobes and their associations versus the extensive lung scanning under various disease prevalence scenarios. Then, the relationship between individual and combined clinical respiratory signs vs lung consolidation was analyzed. In a combined analysis, 193 Holstein calves from a longitudinal study and 112 Angus calves from a cross-sectional study underwent a total of 1265 complete bilateral thoracic ultrasonographic evaluations from 1 to 6 mo of age. Then, it was assessed the agreement and sensitivity of specific lung lobe combinations compared with the findings from total lung ultrasonography. The Classification and Regression Tree (CART) algorithm was used to suggest an optimal examination sequence, and logistic regression was applied to associate specific clinical signs with the presence of lung consolidation adjusting for breed and calf age. Findings reveal that the most sensitive areas are cranial (K: 0.867; Se: 84.7%) and the caudal (K: 0.433; Se: 40.3%) portions of the right cranial lobe, the caudal portion (K: 0.235; Se: 20.6%) of the left cranial lobe, and the middle lobe (K: 0.25; Se: 22%). The optimal lobe combinations for focused lung ultrasonography were identified as the right cranial lobe paired with either the left cranial lobe or the middle lobe. Focused techniques achieved sensitivity over 94% and maintained good agreement. Using these focused techniques were relatively robust to various true lung consolidation scenarios. CART analysis recommended initiating examinations with the right cranial lobe, proceeding to the left cranial lobe, and concluding with the middle lobe. While spontaneous cough was linked to pneumonia presence, reliance on a single clinical sign is not advised due to low sensitivity (26.8%) and high specificity (85.4%); it should merely prompt further ultrasound assessment. In conclusion, focused lung ultrasonography, especially utilizing the right cranial lobe in conjunction with the left cranial lobe or the middle lobe, emerged as effective strategies for focused pulmonary ultrasonography, preserving the accuracy of the results.

Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson's disease: a blinded randomized feasibility trial.

Deep brain stimulation (DBS) is a widely used therapy for Parkinson's disease (PD) but lacks dynamic responsiveness to changing clinical and neural states. Feedback control might improve therapeutic effectiveness, but the optimal control strategy and additional benefits of 'adaptive' neurostimulation are unclear. Here we present the results of a blinded randomized cross-over pilot trial aimed at determining the neural correlates of specific motor signs in individuals with PD and the feasibility of using these signals to drive adaptive DBS. Four male patients with PD were recruited from a population undergoing DBS implantation for motor fluctuations, with each patient receiving adaptive DBS and continuous DBS. We identified stimulation-entrained gamma oscillations in the subthalamic nucleus or motor cortex as optimal markers of high versus low dopaminergic states and their associated residual motor signs in all four patients. We then demonstrated improved motor symptoms and quality of life with adaptive compared to clinically optimized standard stimulation. The results of this pilot trial highlight the promise of personalized adaptive neurostimulation in PD based on data-driven selection of neural signals. Furthermore, these findings provide the foundation for further larger clinical trials to evaluate the efficacy of personalized adaptive neurostimulation in PD and other neurological disorders. ClinicalTrials.gov registration: NCT03582891 .

Prevalence of Frank's sign in healthy young individuals, morphological characteristics, and its association with family history of chronic disease.

Frank's sign (FS, earlobe crease) is known to be associated with many chronic diseases i.e. coronary, cerebrovascular, and peripheral vascular diseases. The objective of this study is to investigate the presence and grade of FS in healthy, young-adult individuals aging between 18 and 25. Furthermore, to evaluate the relationship between FS and the chronic disease history of first-degree family members. 853 healthy people with a mean age of 20.09 years were imvolved in the research on a voluntary basis. Of 853 individuals, 85.3% (n:728) had no FS, whereas 14.7% (n:125) had. Of the 125 people observed FS, 41.6% (n:52) were female and 58.4% (n:73) were male. Of the 125 people diagnosed with FS, 32.8% (n:41) had no family history of any chronic disease, and 67.2% (n:84) had at least 1 family history of chronic disease as well. It was determined that there was a statistically significant (p < 0.05) relationship between FS identified in healthy individuals and familial chronic disease history. In this study, while no FS was observed in 85.3% of the participants, grade 1 was detected in 12.4% (n:105), grade 2a in 1.9% (n:16), grade 2b in 0.2% (n:2), and grade 3 in 0.2% (n:2). To the best of our knowledge, this study investigated the relationship between the presence and grade of FS in the healthy, young, Turkish population and the presence/absence of chronic disease in the first-degree relatives of individuals for the very first time. As a result of larger studies, being aware of the presence of FS, especially in young healthy individuals, may help predict some chronic diseases, and caution may be taken to avoid these diseases at an early age in at-risk individuals.

Evaluating associations between patient-to-nurse ratios and mortality, process of care events and vital sign documentation on paediatric wards: a secondary analysis of data from the EPOCH cluster-randomised trial

ObjectiveTo describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.DesignSecondary analysis of data from the evaluating processes of care and...

Automated Sign Language Vocabulary Assessment: Comparing Human and Machine Ratings and Studying Learner Perceptions

ABSTRACT Although automated spoken language assessment is rapidly growing, such systems have not been widely developed for signed languages. This study provides validity evidence for an automated web application that was developed to assess and give feedback on handshape and hand movement of L2 learners’ Swiss German Sign Language signs. The study shows good machine-internal and human-machine agreement through many-facet Rasch analysis. Learner perceptions examined through questionnaire responses indicate that the automated system occasionally generated ratings which impacted the quality of feedback at the level of individual signs for individual learners. Implications are discussed from a learning-oriented assessment perspective.

Prevention of Remote Theft Victimization and its Scope of Impact

Both scientists and government officials are actively searching for the most effective measures of victimological prevention and protection of victims of remote theft. At the same time, there is no single terminological approach among Russian scientists to the phenomena under study: cybercrime, digital victimization, and remote theft. Foreign researchers in specialized victimological journals pay considerable attention to the methods of implementation and content of restorative justice. However, there is little research in the field of victimological prevention of remote theft. A significant amount of foreign research in the field of cybersecurity is aimed at implementing general criminological measures to protect both personal and corporate information. Research in recent years has drawn attention to the need for context-oriented microlearning for users of information resources and technologies as a method of teaching cybersecurity. The study conducted by the author and other Russian scientists on the methods of victimization of victims of remote theft allowed us to identify typical victimological situations that are most common in 2023 and predict their development in the future . The victimization scenarios identified are becoming increasingly common and therefore require rapid preventive measures by the state. Most researchers come to the conclusion that victims of remote theft do not have individual victimogenic signs, therefore, it is more necessary to develop measures of general victimological prevention aimed at mass victimization of victims of remote theft. Based on previously conducted Russian and foreign studies, the author proposes to carry out preventive measures in the following areas of general prevention: economic, regulatory, theoretical, practical, technical (technological), informational.

Development of a national maternity early warning score: centile based score development and Delphi informed escalation pathways

ObjectiveTo derive a new maternity early warning score (MEWS) from prospectively collected data on maternity vital signs and to design clinical response pathways with a Delphi consensus exercise.DesignCentile based score...