Difference In Time Research Articles

Improvement of stage acoustics in a small circular-shaped recital hall

This paper investigates how stage acoustics can be improved by the installation of on-stage reflectors in a small recital hall with a circular floor plan. The target hall, which is designed as a second floor with a seating capacity of 533, has an average reverberation time of 1.31 seconds in the mid-frequency band at the audience seats when empty, and an average side reflection sound ratio of 0.4. The target hall, assessed as having a circular planar shape with wide left and right sides compared to its depth, is not conducive to performers. Therefore, we measured the stage acoustics according to ISO 3382-1, with a grid spacing of 1 m above the stage. We created a simulation model based on the measurement results. To enhance the stage acoustics, a movable reflector was placed on the stage, and the effective area of the stage surrounded by the reflector was varied and compared through simulation. The results indicated that as the effective area of the stage surrounded by the reflector decreased, STEarly improved. Meanwhile, in the audience, the installation of stage reflectors showed no significant difference in reverberation time or clarity, but the sound pressure level was slightly improved.

Machine learning–based prediction model for hypofibrinogenemia after tigecycline therapy

BackgroundIn clinical practice, the incidence of hypofibrinogenemia (HF) after tigecycline (TGC) treatment significantly exceeds the probability claimed by drug manufacturers.ObjectiveWe aimed to identify the risk factors for TGC-associated HF and develop prediction and survival models for TGC-associated HF and the timing of TGC-associated HF.MethodsThis single-center retrospective cohort study included 222 patients who were prescribed TGC. First, we used binary logistic regression to screen the independent factors influencing TGC-associated HF, which were used as predictors to train the extreme gradient boosting (XGBoost) model. Receiver operating characteristic curve (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA) were used to evaluate the performance of the model in the verification cohort. Subsequently, we conducted survival analysis using the random survival forest (RSF) algorithm. A consistency index (C-index) was used to evaluate the accuracy of the RSF model in the verification cohort.ResultsBinary logistic regression identified nine independent factors influencing TGC-associated HF, and the XGBoost model was constructed using these nine predictors. The ROC and calibration curves showed that the model had good discrimination (areas under the ROC curves (AUC) = 0.792 [95% confidence interval (CI), 0.668–0.915]) and calibration ability. In addition, DCA and CICA demonstrated good clinical practicability of this model. Notably, the RSF model showed good accuracy (C-index = 0.746 [95%CI, 0.652–0.820]) in the verification cohort. Stratifying patients treated with TGC based on the RSF model revealed a statistically significant difference in the mean survival time between the low- and high-risk groups.ConclusionsThe XGBoost model effectively predicts the risk of TGC-associated HF, whereas the RSF model has advantages in risk stratification. These two models have significant clinical practical value, with the potential to reduce the risk of TGC therapy.

Study of speech intelligibility in anechoic and reverberant environments using Slovak language

Binaural aspects play a significant role in speech intelligibility, with listeners demonstrating better performance in scenarios where the signal and noise sources are spatially separated, leveraging interaural time and level differences for improved sound segregation and localization. Thus, the question is: How do binaural aspects influence speech intelligibility in different spatial configurations of signal and noise? In this paper, speech intelligibility is examined in an anechoic and reverberant environment, specifically focusing on three configurations of signal and noise: (1) signal and noise both coming from the front at a distance of 1-meter, (2) signal from the front and noise from the right side (90 degrees) at a 1-meter distance, and (3) signal from the front and noise from the back (180 degrees) at a 1-meter distance. The study employs two different noises-speech-weighted noise and multi-talker noise-during listening tests conducted in the Slovak language. Furthermore, the study compares the outcomes with a similar experiment conducted a few years ago in the Dutch language, providing valuable insights into language-specific variations in speech perception under different acoustic environments.

The contribution of dynamic cues to externalization of virtual source in virtual auditory display

It is well known that static virtual auditory display with headphone is inclined to create the auditory perception of in-head-localization, especially for target virtual sources in the median plane. By introducing the dynamic variation of binaural pressures caused by head turning, dynamic virtual auditory display eliminates the in-head-localization effectively. The present work investigates the contributions of dynamic interaural time difference (ITD) and dynamic interaural level difference (ILD) in binaural pressures to the externalization of auditory perception. By modifying the head-related transfer functions used in a dynamic virtual auditory display, binaural signals with dynamic ITD or dynamic ILD alone are created and presented by headphone. A psychoacoustic experiment is conducted to evaluate the extent of perceived externalization. The experiment results prove that, for the target virtual source in the median plane, dynamic ITD and dynamic ILD contribute to the externalization of low and high frequency components of the stimuli respectively. For wideband stimulus with low and high frequency components, both dynamic ITD and dynamic ILD contribute externalization but dynamic ITD contributes more than that of dynamic ILD.

Evaluating on the spatial localization cues of binaural sound pressure recorded via behind-the-ear microphones in a hearing aid

Spatial hearing ability enables people with normal hearing to localize a sound source and utilizes the cocktail party effect to detect the target speech information in a noise environment. Hearing-impairment causes not only hearing loss but also the degradation of spatial auditory ability. Hearing aid is desired to improve the spatial auditory ability of some hearing-impaired people, in addition to compensating hearing loss. However, the microphones for conventional behind-the-ear (BTE) hearing aid are located behind the pinnae rather than in the entrances of ear canal, which may cause distortion in spatial cues in the recorded binaural signals. The present work comprehensively evaluates the spatial hearing cues recorded by BTE-microphones. The head-related transfer functions (HRTF) for a KEMAR artificial head and eight human subjects, at three BTE positions and the entrances of blocked ear-canal, are measured respectively. Analysis from the HRTF data indicates that BTE microphone recording basically reserves the interaural time difference and interaural level difference as lateral-direction information. It also reserves the dynamic cues, but obvious distortions appear in the spectral cues at high frequencies. However, due to the redundancy among different spatial information, it can be inferred that dynamic cues alone may provide appropriate front-back and vertical-direction information.

Importance of station-to-station line orientation in performing coastal acoustic tomography to obtain sea current speed

To perform the coastal acoustic tomography measurement, the locations of stations should be first selected at some appropriate sites on or near the coast. When selecting the locations, it is important to consider vehicle accessibility, the presence of structures such as barges, and the absence of obstructions to sound transmission and reception. Based on these conditions, the five stations were selected for the coastal acoustic tomography observation in Yeosu Bay of South Korea in 2023. In this observation, total six sound propagation lines were used for the inversion of the sea current speed. The sea current speed estimated for each sound propagation line was compared to that from ADCP installed in Yeosu Bay. As a result, when the angle between a line along which the Yeosu Bay's dominant sea current flows and the sound propagation line was small, the estimated current speed was similar to that from ADCP data. This can be considered to be because the smaller the time difference obtained from tomography measurement, the greater the impact of arrival time measurement error on the current speed. This result shows that the orientation of the lines between stations should also be considered important for selecting the locations of stations.

A novel method of cardia visualization and comfort level enhancement during magnetic capsule gastroscopy via sugar-glued tether-assisted technique: a randomized pilot study inspired by a Chinese snack-making process (with video).

Magnetic capsule gastroscopy (MCG) is a non-invasive diagnostic method for the digestive tract. However, its efficiency in visualizing the gastric cardia is often compromised due to the capsule's rapid passage. This study introduces a novel sugar-glued tether-assisted technique inspired by a traditional Chinese snack-making process to enhance cardia visualization and patient comfort during MCG. This pilot, open-label, single-center, randomized controlled, non-inferiority study was conducted at Binzhou Medical University Hospital. Seventy-eight patients were enrolled and divided into three groups: conventional MCG, suction cup tether-assisted MCG, and sugar-glued tether-assisted MCG. The primary outcomes included safety, comfort level, and gastric cardia visualization quality. Secondary outcomes assessed technique-associated performance and clinical factors. The sugar-glued tether-assisted MCG demonstrated comparable cardia visualization quality to the suction cup method, with significantly better results than conventional MCG. Comfort levels were significantly higher in the sugar-glued group compared to the suction cup group. The number of swallow attempts was significantly lower in the sugar-glued group, with no adverse events reported. Secondary outcomes showed no significant differences in MCG assembly time and ingestion-to-detachment period between the suction cup and sugar-glued groups. The sugar-glued tether-assisted MCG is a feasible and safe modification that enhances gastric cardia visualization while improving patient comfort. This technique provides a cost-effective alternative to the suction cup method, warranting further investigation in larger, multi-center studies.

Causal effect estimation in survival analysis with high dimensional confounders.

With the ever advancing of modern technologies, it has become increasingly common that the number of collected confounders exceeds the number of subjects in a data set. However, matching based methods for estimating causal treatment effect in their original forms are not capable of handling high-dimensional confounders, and their various modified versions lack statistical support and valid inference tools. In this article, we propose a new approach for estimating causal treatment effect, defined as the difference of the restricted mean survival time (RMST) under different treatments in high-dimensional setting for survival data. We combine the factor model and the sufficient dimension reduction techniques to construct propensity score and prognostic score. Based on these scores, we develop a kernel based doubly robust estimator of the RMST difference. We demonstrate its link to matching and establish the consistency and asymptotic normality of the estimator. We illustrate our method by analyzing a dataset from a study aimed at comparing the effects of two alternative treatments on the RMST of patients with diffuse large B cell lymphoma.

A-005 Comparison of Performance of High Sensitive Troponin I (cTNIH) by “Point of care” (POC) and Automated cTNIH Immunoassays in Patients at Low Risk of Heart Attack in a Chilean Emergency Unit; Impact on E.R Department Efficiency

Abstract Background Most cases of death from Acute Myocardial Infarction (AMI) occur in the first hours after the manifestation of clinical symptoms, constituting 40 to 65% in the first hour and approximately 80% in the first 24 hours. For the safe, effective, and rapid diagnosis of a patient with suspected AMI, international guidelines recommend that it be done based on clinical symptoms, together with electrocardiogram and analysis of biomarkers in the context of suspected of non-ST-elevation myocardial infarction (NSTEMI). Troponins are the biomarkers of choice with level A level evidence and the ability to perform screening in patients complaining of chest pain and refer it to the correct clinical approach based on the 0h/1h algorithm. To date, the successful clinical implementation of these rapid algorithms is restricted to hospitals working with well-defined workflows and a robust central laboratory structure. The Atellica® vTLi analyzer is based on the chemiluminescence methodology for the quantification of hs-cTnI levels with low sample volume, low complexity, and may enable the rapid management of patients with chest pain and application of 0h/1h algorithm. Objectives The aim of the study is to evaluate clinical performance in effectiveness and efficiency of the hs-cTnI Atellica® vTLi point of care test to rule out acute myocardial infarction in subjects with low-risk chest pain established with a validated predictive rule, in an adult-Chilean emergency unit, compared to clinical evaluation and the commonly used ADVIA Centaur® troponin test. Methods Descriptive, observational, longitudinal study. Patients over 18 years of age, consulting with acute chest pain of at least one hour from symptom onset and a HEART SCORE less than or equal to 3 points were recruited. A venous blood sample was requested for hs-cTnI analysis by Atellica® vTLi Siemens Healthineers and ADVIA Centaur® Siemens Healthineers. The time difference between sample collection and start of sample analysis; the time difference between sample collection and release of sample results was recorded and the concordance between the two results was determined. Results 50 subjects were included in the study. The difference between blood sampling and start of sample analysis was 5 minutes with Atellica® vTLi POC and 68 minutes with ADVIA Centaur®. The concordance of hs-cTnI Atellica® vTLi POC and ADVIA Centaur® was 94% for predicting medical discharge and confirmed acute myocardial infarction. Conclusions The study findings support the safety and efficiency of the hs-cTnI POC test by providing faster results than central laboratory tests with the same analytical quality, with direct impact on reducing care times in patients consulting for low-risk chest pain.

Study on the attenuation relationship of the acceleration envelope parameters for the Wenchuan earthquake aftershocks

The seismic attenuation relationship between ground motion parameters (such as peak acceleration and response spectra value) and seismic parameters (such as magnitude and epicentral distance) is an important foundation for seismic hazard analysis and the core of determining seismic input parameters for seismic resistance engineering. The acceleration envelope parameters, which describe the relationship between ground motion intensity and time variation, are primarily used for artificially synthesizing seismic motion. At present, little research has been performed on the attenuation relationship of acceleration envelope parameters in the Longmenshan fault zone on the eastern side of the Tibetan Plateau in China. Therefore, this study selected the Mw4-6 aftershock records of the 2008 Wenchuan earthquake that occurred on the Longmenshan fault zone and established a commonly used three segment envelope model parameter attenuation relationship. We classified aftershock records based on their source mechanisms and obtained attenuation relationship models for thrust slip aftershocks, thrust and strike slip aftershocks, and strike slip aftershocks. The results are as follows: (1) The thrust slip aftershock records had the longest rising stage which is the time difference from the arrival of P-waves to the beginning of the stable sustained stage of seismic motion. Thrust and strike slip aftershocks records had the longest stable sustained stage period and the slowest attenuation at the tail of the record. (2) The attenuation relationship of the acceleration envelope parameters commonly used in Chinese engineering for artificially synthesizing seismic motion is based on the strong earthquake records in the western United States. But, compared to the attenuation characteristics of the acceleration envelope function in the western United States, the Mw4-6 earthquake records on the Longmenshan fault zone had a slower attenuation rate at the tail of the record. So, accurately artificially synthesizing seismic motion through envelope parameter attenuation model requires the use of attenuation model established by earthquake records in this region.

Analysis of Spatiotemporal Gait Variables before and after Unilateral Total Knee Arthroplasty

This study aimed (a) to evaluate the spatiotemporal gait variables of total knee arthroplasty (TKA) before (pre-) and after the procedure (post-), and (b) to investigate the influence of the surgical side on these variables. Twenty-one volunteers (13 females and 8 males) participated, undergoing assessments pre-surgery and nine to 12 months post-surgery. Clinical tests indicated significant reductions in knee pain and improvements in active and passive extension post-surgery. TKA resulted in decreased pain, extension deficits, and functional assessments, with lower scores on the WOMAC questionnaire. A gait analysis showed post-surgery improvements in gait speed (5.8%), cycle time (−4.8%), step time (4.4%), double limb support time (−11.1%), step (4.4%) and stride (6.3%) lengths, and step (5.1%) and stride (5.0%) cadences. Comparisons between surgical side and limb dominance indicated significant differences in gait speed, stance, swing and step times, double limb support time, step and stride lengths, and step cadence. The non-dominant limb demonstrated greater improvements across most parameters compared to the dominant limb. These findings emphasize the importance of considering the limb dominance of patients with knee osteoarthritis when evaluating post-TKA function. These conclusions can be helpful for personalized rehabilitation programs, allowing tailored interventions for individuals undergoing knee surgery.

D-dimer as a Predictor of ICU Admission and Mortality in COVID-19 Patients: Insights From a Two-Year Retrospective Study From a Tertiary Care Center in South India.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pneumonitis results in a prothrombotic and hypercoagulable state. Prognostic indicators are crucial for identifying patients at risk of complications. D-dimer, a degradation product of cross-linked fibrin, is a specific marker for thrombosis. Elevated D-dimer levels have been strongly correlated with poor prognosis and increased severity of illness in COVID-19 patients. Given D-dimer's eight-hour half-life, periodic measurement is necessary to track disease progression. This study aimed to analyze and derive threshold and peak D-dimer values to predict outcomes in COVID-19 patients, comparing those treated in isolation wards to those requiring intensive care. Methods This two-year retrospective observational study included patients above 18 years with confirmed COVID-19. Patients were categorized into those treated in isolation wards and those admitted to the intensive care unit (ICU). Based on the outcome, they were further divided into survivors and non-survivors. Demographic and outcome-related data were collected from the hospital's laboratory information system. Serial D-dimer measurements were taken at eight time points. Statistical analysis was performed using the Mann-Whitney test for laboratory values and the chi-square test for demographic data. Receiver operating characteristic (ROC) curve analysis was utilized to derive critical D-dimer values. The area under the curve (AUC) was calculated for initial and peak D-dimer values. Results Of 2.149 patients with confirmed COVID-19, 811 (38%) presented with elevated D-dimer levels. ICU admission was required for 239 patients, either due to direct admission or worsening conditions. An initial D-dimer value of ≥0.93 mg/L FEU indicated the need for ICU admission, while a peak D-dimer value of 5.65 mg/L FEU predicted mortality. The AUC for the initial D-dimer was 0.60 (95% CI: 0.55-0.64), indicating moderate discriminatory power. The AUC for the peak D-dimer was 0.58 (95% CI: 0.54-0.62), suggesting lower predictive accuracy for peak values. Sensitivity was high for both initial (0.925) and peak (0.960) D-dimer values, although specificity was lower, especially for the peak D-dimer (0.486), resulting in a higher rate of false positives. Among the ICU patients, the age range was 27-97 years, with a mean of 53.5 years. Males were more affected than females (71% vs. 29%), with a male-to-female ratio of 1.4:1. Of the ICU patients, 64.8% recovered, while 35.2% succumbed to the disease. Younger patients (mean age: 50.5 ± 12 years) recovered faster than older patients (mean age: 64 ± 16 years), with a significant difference in recovery time (p < 0.001). Gender did not significantly impact outcomes (p = 0.743). Survivors spent less time in the ICU (3-7 days) compared to non-survivors (4-14 days) (p = 0.041). Conclusion Serial D-dimer monitoring is essential for predicting outcomes and guiding treatment in COVID-19 patients. Initial and peak D-dimer values can help identify patients requiring intensive care and those at risk of mortality, allowing for timely interventions. D-dimer levels should be integrated into routine clinical assessments for managing COVID-19 patients.

Loss of C1q alters the auditory brainstem response.

Neural circuits in the auditory brainstem compute interaural time and intensity differences used to determine the locations of sound sources. These circuits display features that are specialized for these functions. The projection from the ventral cochlear nucleus (VCN) to the medial nucleus of the trapezoid (MNTB) body travels along highly myelinated fibers and terminates in the calyx of Held. This monoinnervating synapse emerges during development as multiple inputs are eliminated. We previously demonstrated that elimination of microglia with a colony stimulating factor-1 inhibitor results in impaired synaptic pruning so that multiple calyceal terminals reside on principal cells of MNTB. This inhibitor also resulted in impaired auditory brainstem responses (ABRs), with elevated thresholds and increased peak latencies. Loss of the microglial fractalkine receptor, CX3CR1, decreased peak latencies in the ABR. The mechanisms underlying these effects are not known. One prominent microglial signaling pathway involved in synaptic pruning and plasticity during development and aging is the C1q-initiated compliment cascade. Here we investigated the classical complement pathway initiator, C1q, in auditory brainstem maturation. We found that C1q expression is detected in the MNTB by the first postnatal week. C1q levels increased with age and were detected within microglia and surrounding the soma of MNTB principal neurons. Loss of C1q did not affect microglia-dependent calyceal pruning. Excitatory and inhibitory synaptic markers in the MNTB and LSO were not altered with C1q deletion. ABRs showed that C1q KO mice had normal hearing thresholds but shortened peak latencies. Altogether this study uncovers the developmental time frame of C1q expression in the sound localization pathway and shows a subtle functional consequence of C1q knockdown.

B-031 A new Ready to use Bio-Rad Quality Control to Streamline Daily Workflow

Abstract Background A comprehensive Quality Management System starts with performing a daily Quality Control (Q.C.) process. The daily Q.C. process monitors the Instrument’s optimal performance and detects shifts and trends. However, the existing traditional daily Q.C. process is not only prone to manual errors, but also time consuming, costly and labor intensive. We evaluated a Bio-Rad InteliQTM Load and go Quality Control that comes in a barcoded tube ready to be loaded. We monitored the workflow efficiency gained in comparison to the traditional quality control material that comes in glass vials. Methods We evaluated the new quality control material ready to load on the instrument. This new Q.C. (Bio-Rad InteliQ Assayed Multiqual Control - 3 levels) were processed in parallel with our routine Q.C. (Bio-Rad Assayed Chemistry Lyphocheck vials - 2 levels). We performed the evaluation on Abbott Architect c8000 Chemistry analyzers in our central Laboratory (NGHA-Jeddah). The Q.C. was stored frozen. Before testing it was thawed at room temperature as per the insert instruction. Over a 5 days period, in parallel with our routine quality control, we run the new Q.C. Two times per day for 33 analytes. We monitored the processing time difference between the new and current approaches. We monitored the stability of all the analytes in the tube after Two days and again after Five days. We also monitored the cost effectiveness, labor intensiveness, probability of operator error and the overall improvement in workflow and Turn Around Time. Results Over the evaluation period, we observed the following: - Saving 40 minutes in average per week only for chemistry Q.C (time spent in reconstituting, mixing and aliquoting old Q.C) - 100% reduction in waste of plastic consumables such as pipette and plastic tubes. - Save an average of 1.0 ml dead volume in every 5.0 ml old Q.C. vial (20% of the volume, hence saving 20% of the total Q.C. cost). The dead volume wasted due to aliquoting step using the old Q.C. - 100% Eliminated delays caused by operator error such as wrong reconstitution, inadequate mixing and wrong Q.C. aliquoting. Not needed for the InteliQ. - High score of staff satisfaction. - Stability of the 32 analytes was excellent except that of Co2, which deteriorated by 14% after Two days as indicated in the insert package. Co2 day five result deteriorated by 34%. Conclusions Bio-Rad InteliQ is easy to use. It saves time and cost. When combined with Unity Q.C. data management solution it can streamline Q.C. workflow, eliminate operator errors, reduce T.A.T. and increase the overall laboratory performance. It may also work optimally with Instruments that have on-board fridge for Q.C.

Patient factors associated with early vs late referral to supportive oncology.

202 Background: ASCO guidelines recommend early palliative care (PC) for patients with advanced cancer, defined as referral within 8 weeks of diagnosis. Early referral has been associated with improved quality of life, survival and a reduction in healthcare utilization at the end of life. We sought to determine the role of sociodemographic and clinical patient factors on timing of referral to an embedded supportive oncology (SO) practice and impact on utilization. Methods: Patients ≥18 years with advanced cancer who first received a SO visit between 01/01/2021-06/30/2023 were included. Data on patient demographics, cancer treatment and mortality were extracted from the electronic health record. Early referral to SO was defined as a visit &lt;3 months after diagnosis of advanced cancer. We used descriptive statistics to summarize patients’ sociodemographics, clinical characteristics, and healthcare utilization, and multivariable linear regression analysis to identify factors associated with the timing of referrals. Results: Of the 782 patients, 39.1% were referred early. Poorer functional status (p&lt;0.001) and certain cancer types (p&lt;0.01) were associated with earlier referrals. There were significant differences in timing of referral by cancer type with highest early rates among Head and Neck (53%,) GI (48%), Lung (46%) and GYN (43%) and lowest among GU (29%) and Breast (11%; p &lt; 0.001). Those with Medicare as the primary insurance had an increase in referral time (138 days) compared to Medicaid patients (p&lt;0.001). Patients whose primary symptom was pain were referred earlier than patients with other non-pain symptoms although this did not reach statistical significance (p=0.084). Patients with an earlier referral had more ED visits and hospitalizations both before (p=0.001 and p&lt; 0.001, respectively) and after (p=0.186 and p=0.007, respectively) referral compared to those referred later. Overall, there was no difference in mean referral times between 2021 (483d) and 2023 (533d). Conclusions: There remains significant disparities in the timing of referrals to SO based on sociodemographic and clinical factors. While early SO referral is associated with several benefits, the variability in referral timing underscores the need for targeted strategies to promote timely access to PC. Moving forward, efforts should focus on developing standardized referral protocols and addressing barriers to early PC access to ensure equitable and optimal patient outcomes. Patient demographics and characteristics. Category Overall N=782 Early N=306 Late N=476 p-value Age (mean] 63.3 63.6 63.1 0.689 Race (%) 0.736 Asian 88 (11) 39 (13) 49 (10) Black or African-American 194 (25) 72 (24) 122 (26) Hispanic 192 (25) 80 (26) 112 (24) White 260 (33) 95 (31) 165 (35) Other/Patient Declined 48 (6) 20 (7) 28 (6) Insurance (%) 0.080 Commercial 197 (28) 73 (26) 124 (29) Medicaid 175 (25) 83 (27) 92 (19) Medicare 330 (47) 123 (40) 207 (44) Other 6 (0) 1 (0) 5 (1)

Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial

Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure. EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany. Eligible patients (aged 18years or older) had heart failure, with New York Heart Association class IIor more and NT-proBNP concentrations greater than or equal to 400pg/mL. Patients were randomly assigned (1:1) to receive EIPC with standard cardiac care or standard cardiac care alone. Randomisation was computer-generated with allocation concealment, variable block sizes, and stratification by investigational site. The primary endpoints were health status and mood, measured every 3months over 12months using the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-PAL) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), analysed by intention to treat. This trial is registered with DRKS.de, DRKS00013922. Between May 21, 2019, and Nov 15, 2021, 843patients were assessed for eligibility, 205of whom were enrolled (100 assigned to EIPC and 105assigned to standard cardiac care). 143 (70%) patients were male and 62 (30%) were female. Over 12months, both groups significantly improved in FACIT-PAL and KCCQ Overall Summary Score(OSS) with no significant differences between the groups (FACIT-PAL adjusted mean difference 0·98points [95% CI -1·28to 3·23]; p=0·40; KCCQ-OSS adjusted mean difference -2·06points [-7·89to 3·78]; p=0·49). Nine (9%) patients in the EIPC group and seven (7%) patients in the standard cardiac care group died from any cause, with no significant differences in time to death between the two groups (hazard ratio [HR] 1·32 [95% CI 0·49 to 3·54]; p=0·58). 22 (22%) patients in the EIPC group and 21 (21%) patients in the standard cardiac care group were hospitalised at least once due to heart failure, with no significant differences in time to heart-failure-related hospitalisation between the two groups (HR 1·09 [0·61 to 1·98]; p=0·77). 70 (70%) patients in the EIPC group and 62 (59%) in the standard cardiac care group had any adverse events (p=0·10). In this open-label, randomised clinical trial, standard cardiac care, featuring guideline-directed optimisation of medical therapy and regular 3-monthly follow-ups was found to be as effective as when combined with EIPC in improving health status and mood in patients with non-terminal heart failure. Future clinical practices should consider EIPC based on individual patient needs. Federal Ministry of Education and Research.

What explains differences in average wait time in the emergency department among different racial and ethnic populations: A linear decomposition approach.

Non-Hispanic Black (NHB) and Hispanic/Latino (Hispanic) patients wait longer in the emergency department (ED) to see practitioners when compared with non-Hispanic White (NHW) patients. We investigate factors contributing to longer wait times for NHB and Hispanic patients using a linear decomposition approach. This retrospective observational study included patients presenting to one tertiary hospital ED from 2019 to 2021. Median wait times among NHW, NHB, and Hispanic were calculated with multivariable linear regressions. The extent to which demographic, clinical, and hospital factors explained the differences in average wait time among the three groups were analyzed with Blinder‒Oaxaca post-linear decomposition model. There were 310,253 total patients including 34.7% of NHW, 34.7% of NHB, and 30.6% of Hispanic patients. The median wait time in NHW was 9 min (interquartile range [IQR] 4‒47 min), in NHB was 13 min (IQR 4‒59min), and in Hispanic was 19 min (IQR 5‒78 min, p<0.001). The top two contributors of average wait time difference were mode of arrival and triage acuity level. Post-linear decomposition analysis showed that 72.96% of the NHB‒NHW and 87.77% of the Hispanic‒NHW average wait time difference were explained by variables analyzed. Compared to NHW patients, NHB and Hispanic patients typically experience longer ED wait times, primarily influenced by their mode of arrival and triaged acuity levels. Despite these recognized factors, there remains 12%‒27% unexplained factors at work, such as social determinants of health (including implicit bias and systemic racism) and many other unmeasured confounders, yet to be discovered.

CSR as a framework for sustainability in SMEs: The relationship between company size, industrial sector, and triple bottom line activities

Theoretical backgroundCorporate Social Responsibility (CSR) is a very topical issue for companies around the world. In the European context, CSR is especially significant due to legislative demands for its reporting. CSR can positively impact organisations in terms of competitiveness, employer branding, and financial performance. The theoretical background of this study is based on the CSR pillars, which are social, economic, and environmental CSR activities. PurposeThe research aimed to investigate the awareness of CSR among Czech companies and to report the frequency of CSR activities. The purpose of the investigation was to analyse the relationship between the characteristics of companies and the realisation of CSR activities. Research methodologyA quantitative study among 1703 Czech companies focused on their knowledge of CSR, its implementation in corporate strategy, and the realisation of individual CSR activities. Analysis of variance and logistic regression were used with predictors: company size, industry in which it operates, and differences in time between data collection rounds. Main resultsThe results showed the effect of company size and industry sector on both the knowledge of CSR issues and the number of activities realized in the individual CSR pillars. The results further describe in detail the relationship between company characteristics and specific CSR activities. Originality/valueCSR practices in Czech SMEs have not been adequately covered in existing studies. This study provides a comprehensive analysis of the frequency of implementation of CSR activities among Czech companies. Research limitationsThe present study provides a large sample of companies selected proportionally to their representation in the Czech Republic, which resulted in an imbalance in the individual characteristics of the companies in the sample. The study is also limited by three main independent variables and cannot provide extensive insight into all influences. Practical implicationsThe results can be used by companies to benefit from comparing themselves with other market participants or with the average situation in the monitored markers. They are also useful for further comparison between countries and for analysing the development of CSR activities over time.© 2023 The Authors. Published by Elsevier B.V. on behalf of the College of Management, National Cheng Kung University. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

An investigation of scattered light integrating collector technology for rapid blood culture sensitivity testing.

Introduction. Sepsis rates are increasing, with Gram-negative organisms representing a large proportion of bloodstream infections. Rapid antibiotic administration, alongside diagnostic investigations, is required for the effective management of these patients.Gap statement. Current diagnostics take ~48 h for a final report; therefore, rapid diagnostics are required.Aim. This study investigated a novel antibiotic sensitivity method, the scattered light integrating collector (SLIC), combined with a rapid identification method using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technology to determine if an accurate identification and susceptibility result can be provided within 4 h of a positive blood culture report.Methodology. A total of 47 blood cultures containing Gram-negative bacteria from 46 patients were processed using the MALDI-TOF Biotyper Sepsityper for identification directly from the blood and the SLIC instrument for susceptibility testing. All organisms were also tested using the current standard workflow used in the host laboratory. Categorical agreement (CA), major errors (MaEs) and very major errors (VMEs) were determined.Results. SLIC produced susceptibility results with a 71.9% CA, 30.6% MaE and 17.5% VME. The median difference in time to the final result was 44.14 (43 : 05-45 : 15) h earlier compared to the current method.Conclusion. We conclude that SLIC was unable to consistently provide sufficiently accurate antibiotic susceptibility results compared to the current standard method.

Predicting the Timing and Cause of Microvascular Free Flap Failure: An Australian Study of 1569 Free Flaps.

The aim of the study is to assess the possible predictors of microvascular free flap failure and determine the critical postoperative timing of flap failure, thereby minimizing this adverse outcome. This is a retrospective single-institutional review of 1569 free flap operations. All free flaps with outcome status recorded were analyzed for possible predictors in the development of microvascular compromise. Compromised cases were then analyzed for differences in time to compromise and time to theater takeback between salvaged versus failed free flaps. Of the assessable 1569 free flaps, 31 developed microvascular compromise (2.0%); the salvage rate was 20.0%, and overall failure rate was 1.5%. Osteocutaneous free flaps in head and neck had increased risk of developing free flap failure compared to other flaps (odds ratio = 3.8, 95% confidence interval: 1.2-12.7). Among breast patients, previous radiotherapy had a significant association with flap failure ( P < 0.001). Free flap salvage rates dropped from 38.5% to 7.7% for compromises detected after 24 hours ( P = 0.160), and from 57.1% to 11.1% for free flaps taken back to theater greater than 3 hours after compromise detection ( P = 0.032). Delays in compromise detection and flap takeback to theater resulted in reduced salvage rates, with the critical timing of takeback being under 3 hours. Standardized flap monitoring protocols and incorporation of newer technologies could see faster detection and improved salvage rates. Additional care is required when reconstructing: osteocutaneous head and neck free flaps and previously irradiated breast patients.