True Status Research Articles

A new species of <i>Pitcairnia</i> (Bromeliaceae) with nocturnal anthesis from Oaxaca, Mexico

Background: Pitcairnia is the third largest bromeliad genus in Mexico with 57 species and ca. 82.5 % endemism, and is characterized mostly by zygomorphic, ornithophilous flowers of diurnal anthesis in several hues of red, orange, or yellow, whereas white or green flowers are uncommon. Moreover, there are just a few species with nocturnal anthesis in Megamexico. One of them is documented and discussed here. Questions: Is the Pitcairnia with campanulate, fragrant flowers of nocturnal anthesis from Oaxaca different from other species with similar characters native to Mexico and the Neotropics and what is its conservation status? Studied species: Pitcairnia abundans, P. lokischmidtiae, P. zapoteca. Study site and dates: Oaxaca, Mexico, 2016-2024. Methods: Live plants, herbarium material, protologues, and high-resolution images of herbarium specimens, both of the new taxon and of morphologically similar taxa, were studied and compared against each other. The conservation status of the new species was assessed using the IUCN criteria. Results: Pitcairnia zapoteca is similar but different at the species level from P. lokischmidtiae from Jalisco; both share campanulate flowers of nocturnal anthesis and a musky or frutal fragances. The conservation status of the new taxon is assessed as DD. Conclusions: Pitcairnia zapoteca is a new species, only known from the type locality in the state of Oaxaca and only one of three Mexican species with campanulate, white, yellowish or greenish flowers of nocturnal anthesis. The assessment the true conservation status of the new taxon requires detailed exploration of the SE portion of Oaxaca.

Stepwise methods for more nuanced adoption analysis: a case study of harvest and post-harvest mechanization in Bangladesh

The adoption of agricultural harvest and post-harvest mechanization is crucial for addressing drudgery, food losses, climate vulnerability and food security. Despite considerable efforts by government and development partners to prioritize agricultural mechanization, labour-intensive manual (post-)harvest activities continue to dominate in Bangladeshi smallholder systems. Explorations of this has been limited by simplistic binary approaches that ignore the dynamic pathways to usage outcomes. Instead, we apply non-binary analytical methods to district representative data to highlight the value in moving beyond binary adoption analysis. Results highlight that a national (post-)harvest mechanisation rate of 74% is insufficient to capture the true adoption status, given substantial disparity exists across machinery and by district. Deeper exploration of temporal and spatial differences enable the identification of key trends that warrant further in-depth explorations, while only 46% satisfaction with extension systems highlights the need to re-evaluate key information exchange mechanisms. We conclude that there is a clear need for district and machinery specific policy arrangements if Bangladesh is to achieve (post-)harvest mechanisation objectives that aim to reduce food loses and enable greater food security nationwide.

Inter-laboratory comparison of real-time quaking-induced conversion (RT-QuIC) for the detection of chronic wasting disease prions in white-tailed deer retropharyngeal lymph nodes.

The rapid geographic spread of chronic wasting disease (CWD) in white-tailed deer (WTD; Odocoileus virginianus) increases the need for the development and validation of new detection tests. Real-time quaking-induced conversion (RT-QuIC) has emerged as a sensitive tool for CWD prion detection, but federal approval in the United States has been challenged by practical constraints on validation and uncertainty surrounding RT-QuIC robustness between laboratories. To evaluate the effect of inter-laboratory variation on CWD prion detection using RT-QuIC, we conducted a multi-institution comparison on a shared anonymized sample set. We hypothesized that RT-QuIC can accurately and reliably detect the prions that cause CWD in postmortem samples from medial retropharyngeal lymph node (RPLN) tissue despite variation in laboratory protocols. Laboratories from 6 U.S. states (Michigan, Minnesota, Missouri, New York, Pennsylvania, Wisconsin) were enlisted to compare the use of RT-QuIC in determining CWD prion status (positive or negative) among 50 anonymized RPLNs of known prion status. Our sample set included animals of 3 codon 96 WTD genotypes known to affect CWD progression and detection (G96G, G96S, S96S). All 6 laboratories successfully identified the true disease status consistently for all 3 tested codon 96 genotypes. Our results indicate that RT-QuIC is a suitable test for the detection of CWD prions in RPLN tissues in several genotypes of WTD.

Risk factors for introduction of BVDV in the context of a mandatory control program in Dutch dairy herds.

Bovine Viral Diarrhea Virus (BVDV) is a common viral disease in cattle, causing economic losses in naive herds where the virus is introduced. In the Netherlands, a BVDV control program has been in place since 1998, evolving from voluntary to mandatory participation for dairy herds since April 2018. Participation in the BVDV control program is not mandatory for non-dairy farms. The aim of this study was to determine risk factors for new introduction of BVDV into certified BVDV-free herds in the context of a national BVDV control program in dairy herds. In this retrospective case-control study, survey data were collected from 149 dairy farms that lost their BVDV-free status (case herds) and 148 matched dairy farms that maintained their BVDV-free status (control herds) between 2018 and 2021. The survey captured information about potential risk factors and herd characteristics in the 2 years leading up to the loss of BVDV-free status (case herds, virus detection in at least one animal or when seroconversion was detected) or remaining BVDV-free (control herds). Descriptive statistics and logistic regression with a backward selection and elimination procedure were used to identify potential risk factors associated with losing BVDV-free status. Risk factors were quantified as an Odds Ratio (OR) with the associated 95% confidence interval (CI). The risk factor with the highest OR for losing BVDV-free status was purchasing cattle from herds without BVDV-free status (OR 1.25, CI 1.10-1.41), followed by the farmer having another profession that resulted in contact with other cattle (OR 1.25, CI 1.06-1.47), housing young calves and adult cows in the same barn (OR 1.22, CI 1.08-1.38), having a permanent employee on the farm (OR 1.17, CI 1.04-1.31), having a group calving pen (OR 1.16, CI 1.03-1.32), escaped cattle from other farms that mingled with own cattle (OR 1.16, CI 1.01-1.33), and nearest distance to a non-dairy farm (OR 1.15, CI 1.03-1.28). Although the BVDV status of most dairy herds can be checked in an open register, approximately half of the farmers indicated that they purchased cattle from BVDV-free herds while they were actually purchasing from non-BVDV-free farms. Farmers should be stimulated to actively check the true BVDV status of the herd from which cattle are purchased to further reduce the risk of introduction. In addition, indirect contact with cattle from other farms through either the farmer or other on-farm staff should be avoided. It is strongly advised to work in these situations with proper biosecurity measures such as changing boots and coveralls. The results can be used to improve BVDV control programs to further decrease the prevalence.

PSLBI-30 SARS-CoV-2 Screening and Detection: Assessment of surrogate virus neutralization test (svNT) diagnostic appropriateness in multispecies SARS-CoV-2 virus screening and detection

Abstract The National Veterinary Services Laboratories (NVSL) have been testing animal samples since the 2020 SARS-CoV-2 outbreak. The current “gold standard” for serodetection of SARS-CoV-2 is the virus neutralization (VN) test. This method requires specialized training, more time to complete, and specialized facilities (BSL 3). Therefore, the SARS-CoV-2 VN test is not widely run outside of NVSL. To facilitate increased testing capacity during the outbreak, the surrogate virus neutralization test (sVNT) was selected mid-2020. This commercially available kit uses an ELISA format, giving a percent inhibition (%I) cut-off value to indicate “negative” or “positive,” allowing for faster testing turnaround. Despite its widespread use in many species, an in-depth, multispecies analysis of the data comparing sVNT to VN results has not been reported. Such an analysis is useful to assess the diagnostic appropriateness of the sVNT test for SARS-CoV-2 virus screening and detection across multiple species. Results were considered from all serological samples submitted to NVSL from March 2020 to May 2023 for routine SARS-CoV-2 diagnostic testing. Of these, samples with results for both VN and sVNT testing were considered for further analysis (n = 942). Samples were sorted by the species and family levels, and were assessed for rates of “true positive,” “false positive,” “true negative,” and “false negative” by sVNT, using paired VN results as the indicator of the true status of the sample. Additionally, the increased sVNT cut-off threshold for %I (20%I to 30%I for “positive”) was assessed for appropriateness by species using mean %I values for VN-positive samples. Increasing sVNT %I cut-off threshold for “positive” results from 20%I to 30%I resulted in 58 samples being correctly re-classified as “negative” by sVNT, rather than “positive” at the 20%I cut-off threshold. The mean %I values for most species fell between 40 to 80%I, except for Felidae, which had a mean %I of 93%I, and a minimum %I of 40.6%I for VN-positive samples. The true negative (sVNT/VN-NEG) rates for most species fell between 97to 100%, with 0 to 3% being false negatives (svNT-NEG, VN-POS), with very few exceptions. However, the least false positive (sVNT-POS;VN-NEG) rate was 8.8%, ranging up to 100% false positives for Equidae and one species of Cervidae. While the mean %I for most species indicates the cut-off value is appropriate (for those species where sVNT is an appropriate diagnostic), overall, the results highlight a lack of precision and specificity of the sVNT for many animal species. This indicates a lack of diagnostic appropriateness of the sVNT as a SARS-CoV-2 screening tool for certain species and a need for refinement in cut-off values for other species. The sVNT as a screening tool varies considerably by species for serodetection of SARS-CoV-2, results should be interpreted with caution, and use of other confirmatory tests is recommended.

Using linkage to assess coverage of population estimates

ObjectivesThe Demographic Index (DI) comprises of five linked administrative datasets, used for population estimation. Current linkage methods are not ideal to utilise the power of this asset. Using the 2021 England and Wales Census, we developed an innovative composite linkage method to fully utilise the power of the DI. ApproachUsing non-greedy deterministic and probabilistic linkage methods, we linked the DI to the Census at a composite level where we believe links exist – i.e., linking a Census record with a DI cluster (consisting of linked records from the data sources used to make the DI). Next, pairwise linkage of records within these clusters was performed to ensure that every DI record within the cluster was a link. Clerical review of a sample of the full linkage was performed using clerical resolution and search to resolve uncertain and conflicting links and to inform the quality of our linkage. Due to data quality errors in the administrative data, clerical techniques were not always able to determine true match status, so clerical identified ‘uncertain’ links to estimate precision and recall ranges rather than a set estimate. Results A quality analysis to estimate linkage accuracy was conducted and suggests that the linkage has a precision of between 99.3% and 99.7%, and recall between 99.1% and 99.7%. ConclusionWe have linked the ONS’ composite population-level dataset to the 2021 England and Wales Census. The presentation will showcase the methods developed and how we ensured the highest quality possible. *** Please note that this was subbmited in 2022 but the presenters were unable to present due to the UK Queen's death.

ESG uncertainty, investor attention and stock price crash risk in China: evidence from PVAR model analysis

ESG uncertainty refers to the discrepancies in ratings by multiple third-party ESG rating agencies, challenging investors in assessing a company’s true ESG status. This study integrates ESG rating data from six major Chinese agencies to construct an ESG Uncertainty Index. Using a PVAR model, it explores the bidirectional relationships among ESG uncertainty, investor attention, and stock price crash risk in the Chinese capital market. The findings reveal no direct causal relationship between ESG uncertainty and stock price crash risk. However, there is a bidirectional Granger causality between ESG uncertainty and investor attention, as well as between stock price crash risk and investor attention. This suggests that increased ESG uncertainty and stock price crash risk attract more investor attention, which in turn amplifies these issues. The study implies that investor attention mediates the relationship between ESG uncertainty and stock price crash risk, indirectly affecting the latter. These findings highlight the importance of enhancing information disclosure regarding ESG factors to improve market transparency and stability.

Under the ESG Dome of China

Implementing ESG is crucial for China’s modernization journey and corporate sustainability. To deeply understand the current standing of ESG in China, this study leverages online data richness using text mining techniques, specifically Latent Dirichlet Allocation (LDA) and ego network analysis. LDA is utilized to identify prevalent discussion topics on ESG, while ego network analysis is applied to examine the relationships and influences among key stakeholders. The scientific aim of this research is to identify prevalent ESG discussion topics, examine the relationships and influences among stakeholders, and determine core ESG focus areas on Chinese society. The findings highlight popular discussion topics such as ESG investment, the ESG notion, green finance transformation, and ESG rating. These topics underscore China’s growing concern for environmental protection and social responsibility. The core discussion areas focus on sustainable development, company social responsibility, and eco-friendliness, framing harmonized progress across economic, social, and environmental realms. Interestingly, governance discourse is sparse; the reasons are analyzed. Through the analysis of online discussions on China’s ESG, this study aims to enhance policymakers’ and participants’ understanding of the true status of China’s ESG, being of practical significance for policy formulation and appropriate ESG strategies.

Facial Expression Recognition for Probing Students’ Emotional Engagement in Science Learning

AbstractStudent engagement in science classroom is an essential element for delivering effective instruction. However, the popular method for measuring students’ emotional learning engagement (ELE) relies on self-reporting, which has been criticized for possible bias and lacking fine-grained time solution needed to track the effects of short-term learning interactions. Recent research suggests that students’ facial expressions may serve as an external representation of their emotions in learning. Accordingly, this study proposes a machine learning method to efficiently measure students’ ELE in real classroom. Specifically, a facial expression recognition system based on a multiscale perception network (MP-FERS) was developed by combining the pleasure-displeasure, arousal-nonarousal, and dominance-submissiveness (PAD) emotion models. Data were collected from videos of six physics lessons with 108 students. Meanwhile, students’ academic records and self-reported learning engagement were also collected. The results show that students’ ELE measured by MP-FERS was a significant predictor of academic achievement and a better indicator of true learning status than self-reported ELE. Furthermore, MP-FERS can provide fine-grained time resolution on tracking the changes in students’ ELE in response to different teaching environments such as teacher-centered or student-centered classroom activities. The results of this study demonstrate the validity and utility of MP-FERS in studying students’ emotional learning engagement.

Assessing Psychological Remission in Adolescent Anorexia Nervosa: A Comparison of Patient and Parent Report.

The definition and assessment of remission in anorexia nervosa (AN) needs greater consensus. Particularly in adolescents, the use of patient-reported composite indices (such as the Eating Disorder Examination [EDE] Global Score) as the sole measure of psychological remission has the potential to obscure patients' true clinical status, given developmental factors and the propensity towards symptom minimization in AN. End of treatment (EOT) data from a randomized controlled trial comparing two formats of manualized family-based treatment for adolescents with AN (N = 106) were analyzed. Participants completed the EDE, and their parents completed a parent-as-informant version of the EDE (Parent Eating Disorder Examination; PEDE). Rates of remission were compared across indices (i.e., EDE Global Score vs. diagnostic item analysis) and informant (i.e., adolescent vs. parent), both independently and in combination with the achievement of a percent median body mass index (% mBMI) greater than or equal to 95%. For both adolescent and parent reports, there were higher rates of remission when defined by Global Score than when defined by EDE or PEDE diagnostic items. There were no significant differences in remission rates based on informant. In the assessment of remission in AN, the EDE Global Score may not detect some adolescents who continue to exhibit clinically significant psychological symptoms. This study supports a detailed, multidimensional approach to assessing remission in adolescent AN to optimize sensitivity to patients' diagnostic profile. Future research should explore whether parent-child concordance on measures of ED psychopathology varies over the course of treatment.

Assessment of liver fibrosis by transient elastography and procollagen III amino terminal propeptide in rheumatoid arthritis patients treated with methotrexate

BackgroundMethotrexate (MTX) is well known as the first-line therapy for rheumatoid arthritis (RA) patients. Its prolonged usage necessitates frequent assessing for adverse impacts, most importantly hepatotoxicity. Since there are no set standards for verifying liver damage in RA patients; transient elastography (TE) is emerged as a non-intrusive technique for identifying and evaluating liver fibrosis, alongside with serum procollagen III amino terminus propeptide (PIIINP). The objective of this study is to investigate liver fibrosis in 60 patients with RA patients on MTX therapy and 30 healthy individuals by TE and PIIINP, in addition, to recognize the prognostic indicators for liver fibrosis.ResultsThis study compared 60 adult RA patients who had been on MTX for at least 1 year to 30 matched age and sex heathy individuals. Liver fibrosis was measured using TE and PIIINP. A cutoff point of 7.1 kPa was declared abnormal, suggesting substantial liver fibrosis, while PIIINP > 170 ng/ml indicating elevated PIIINP levels. Based on TE results, liver fibrosis was reported in 20 patients (33.3%) with 14 patients (23.3%) who had significant liver fibrosis, 4 patients (6.7%) had advanced liver fibrosis, and 2 patients (3.3%) had liver cirrhosis. Meanwhile, five of the controls had mild liver fibrosis with highly statistically significant difference between patients and controls. The patient group had significantly higher level of PIIINP when compared to the healthy group with a specificity and sensitivity for detecting liver fibrosis of 85% and 82.5%, respectively.ConclusionsMTX usage in RA patients was correlated with an overall increase in liver fibrosis. Cumulative dosage of MTX, the presence of fatty liver and elevated serum PIIINP levels are all significant predictors of liver stiffness in RA. TE is organ specific and could be helpful in assessing true liver status rather than PIIINP level which is not organ specific. TE is superior to serum PIIINP and is recommended as a routine investigation for RA patients on MTX therapy particularly those with fatty liver.

Assessing the predictive capability of N, P, and B diagnosis in cotton crop

The compositional nutrient diagnosis—CND method is a standard tool for evaluating plant nutritional status. Adjustments are crucial to elevate accuracy. The effectiveness of such methodological refinements should be rigorously assessed through accuracy tests that are benchmarked against the prescient diagnostic analysis—PDA methodology. The objective of this investigation was to refine the CND technique for a more precise evaluation of N, P, and B nutrient status in cotton. The study’s database encompasses 144 data points pertaining to crop yield and foliar nutrient concentrations from cotton plantations in the Cerrado biome of Brazil. Subsequently, the CND norms were established through rigorous calibration. Three separate nutrient-dose trials, each featuring four levels of N, P and B, were carried out to assess plant true nutritional status. Adjustments were made to the nutrient responsiveness range—NRr (0.5 and 1.0), while yield response—YR were scrutinized at threshold levels (5% and 10%). The prerequisites for achieving high diagnostic accuracy were nutrient specific. For N, maximal accuracy was linked only to the YR parameter (YR = 10%). For P, the most precise outcomes were attained with a NRr = 0.5 and YI = 5%. For B, highest diagnostic accuracy when the NRr = 1.0 and YI = 10%. These insights highlight the need to fine-tune the CND method for reliable nutritional evaluations and cotton crop productivity optimization.

Power Generation Systems Assessment: A New Approach

Power generation systems have become useful for grid base and off grid electric power generation. Hence, its performance has become critical for sustainable growth and development. Performance evaluation of power generation systems has always been carried out using the independent assessment approach (IAA) whose models are: the reliability, availability, emission characteristics, energy and exergy efficiency. The IAA approach only assesses the system performance in part without recur to other indexes, hence, limiting a holistic view of the true plant state. In this paper, the development of a new performance index using the combined assessment approach (CAA) is explored. This approach (CAA) seeks to combine two relatable traditional measures for the assessment of power generation system. The model combines exergy efficiency and reliability measures for analysis. First Independent Power Limited (FIPL) gas turbine power plant was used to test the model. The plant reliability and availability were evaluated along with its thermal efficiency using the exergy model. The analysis of plant thermal efficiency was carried out using the steady state model. Results of the traditional indexes of the plant were compared with the proposed (Bassy-II index) index. It was seen that the new index provided a new assessment criteria. The exergy efficiency, reliability and availability measures indicated a fairly rated plant state. However, the new index defined a new plant state which is unique and represents the true status of the system in whole. Hence, the proposed index (Bassy-II index) is recommended for use in the holistic assessment of power generation systems.

Selection of Single-Analyte Delta Check Rules with Logistic Regression for Detection of Intravenous Fluid Contamination in a Clinical Chemistry Laboratory.

The conventional single-analyte delta check, utilized for identifying intravenous fluid contamination and other preanalytical errors, is known to flag many specimens reflecting true patient status changes. This study aimed to derive delta check rules that more accurately identify contamination. Results for calcium, creatinine, glucose, sodium, and potassium were retrieved from 326 103 basic or comprehensive metabolic panels tested between February 2021 and January 2022. In total, 7934 specimens showed substantial result changes, of which 1489 were labeled as either contaminated or non-contaminated based on chart review. These labeled specimens were used to derive logistic regression models and to select the most predictive single-analyte delta checks for 4 common contaminants. Their collective performance was evaluated using a test data set from October 2023 comprising 14 717 specimens. The most predictive single-analyte delta checks included a calcium change by ≤-24% for both saline and Plasma-Lyte A contamination, a potassium increase by ≥3.0 mmol/L for potassium contamination, and a glucose increase by ≥400 mg/dL (22.2 mmol/L) for dextrose contamination. In the training data sets, multi-analyte logistic regression models performed better than single-analyte delta checks. In the test data set, logistic regression models and single-analyte delta checks demonstrated collective alert rates of 0.58% (95% CI, 0.46%-0.71%) and 0.60% (95% CI, 0.49%-0.74%), respectively, along with collective positive predictive values of 79% (95% CI, 70%-89%) and 77% (95% CI, 68%-87%). Single-analyte delta checks selected by logistic regression demonstrated a low false alert rate.

Weight loss trends in Korean adolescents (2005-2021): Exploring the impact of measured and self-perceived weight status

ObjectiveThis study aims to assess the trends in the proportions of weight loss efforts among Korean adolescents aged 10–18 years from 2005 to 2021, examining variations based on weight status, to examine factors related to weight loss efforts by weight status, and to evaluate weight loss efforts based on the combination of measured and self-perceived weight status. MethodsComplex sample design analyses were conducted on a dataset comprising 10,760 adolescents, utilizing information from the Korea National Health and Nutrition Examination Survey, a nationally representative dataset. Participants were categorized into non-overweight and overweight groups using a BMI percentile threshold of 85. Results22–29 % of non-overweight adolescents and 54–77 % of adolescents with overweight engaged in weight loss efforts. Among adolescents who attempted to lose weight from 2005 to 2017, 39.5–57.1 % tried both of diet and exercise, 22.7–47.4 % tried exercise alone, and 10.2–26.7 % tried diet alone. Female gender, older age, and higher self-perceived weight status were associated with increased odds of weight loss efforts, irrespective of actual weight status. For adolescents perceiving themselves as obese, the odds of attempting weight loss were 8.32 for non-overweight boys, 2.02 for non-overweight girls, 15.28 for overweight boys, and 5.77 for overweight girls compared to controls who were non-overweight and perceived themselves as not obese. ConclusionWeight loss efforts among Korean adolescents aged 10 to 18 remained consistent irrespective of their actual weight over 16 years. Throughout this period, adolescents who perceived themselves as obese were more likely to attempt weight loss, independent of their true weight status. Hence, subjective weight perception plays a significant role in influencing weight loss behaviors among adolescents.

Real-world evaluation of novel eye drop bottle sensors: Cloud-based AI support for eye drop adherence

PurposeTo understand real-world eye drop adherence among glaucoma patients and evaluate the performance of our proposed cloud-based support for eye drop adherence (CASEA). DesignProspective, observational case series. MethodsSetting: The Department of Ophthalmology at Tsukazaki Hospital.Patient or study population: Glaucoma patients treated at the hospital from May 2021 to September 2022, with 61 patients initially enrolled.Intervention or observation procedures: Pharmacists guided eye drop administration before the study. Changes in bottle orientation were detected using an accelerometer attached to the container, and acceleration waveforms and date/time data were recorded. Patients visited the clinic during the 4th and 8th weeks to report their eye drop administration, and the data were uploaded to the cloud.Main outcome measures: Two AI models (B-LSTM) were created to analyze the eye drop bottle movement time-series data for patients treating one or both eyes. The models were evaluated by comparing the true administration status with the AI model judgment. ResultsFour of the 61 study subjects dropped out. The remaining 57 patients achieved recall, precision, and accuracy values of 98.6 %, 98.6 %, and 95.9 %, respectively, for the two-eyes model and 95.8 %, 98.8 %, and 95.6 % for the one-eye model. Three low-accuracy participants (77.1 %, 71.0 %, and 81.0 %) improved to 100 %, 99.1 %, and 100 %, respectively, after undergoing an additional 8-week performance validation using an aid-type container designed to ensure that the bottle was fully inverted during instillation. ConclusionsCASEA precisely monitored daily eye drop adherence and enhanced treatment efficacy by identifying patients with difficulty self-medicating. This system has the potential to improve glaucoma patient outcomes by supporting adherence.

A 29-mRNA host-response classifier identifies bacterial infections following liver transplantation – a pilot study

PurposeInfections are common complications in patients following liver transplantation (LTX). The early diagnosis and prognosis of these infections is an unmet medical need even when using routine biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT). Therefore, new approaches are necessary.MethodsIn a prospective, observational pilot study, we monitored 30 consecutive patients daily between days 0 and 13 following LTX using the 29-mRNA host classifier IMX-BVN-3b that determine the likelihood of bacterial infections and viral infections. True infection status was determined using clinical adjudication. Results were compared to the accuracy of CRP and PCT for patients with and without bacterial infection due to clinical adjudication.ResultsClinical adjudication confirmed bacterial infections in 10 and fungal infections in 2 patients. 20 patients stayed non-infected until day 13 post-LTX. IMX-BVN-3b bacterial scores were increased directly following LTX and decreased until day four in all patients. Bacterial IMX-BVN-3b scores detected bacterial infections in 9 out of 10 patients. PCT concentrations did not differ between patients with or without bacterial, whereas CRP was elevated in all patients with significantly higher levels in patients with bacterial infections.ConclusionThe 29-mRNA host classifier IMX-BVN-3b identified bacterial infections in post-LTX patients and did so earlier than routine biomarkers. While our pilot study holds promise future studies will determine whether these classifiers may help to identify post-LTX infections earlier and improve patient management.Clinical trial notationGerman Clinical Trials Register: DRKS00023236, Registered 07 October 2020, https://drks.de/search/en/trial/DRKS00023236

A standardized protocol using clinical adjudication to define true infection status in patients presenting to the emergency department with suspected infections and/or sepsis

In absence of a “gold standard”, a standardized clinical adjudication process was developed for a registrational trial of a transcriptomic host response (HR) test. Two physicians independently reviewed clinical data to adjudicate presence and source of bacterial and viral infections in emergency department patients. Discordant cases were resolved by a third physician. Agreement among 955 cases was 74.1% (708/955) for bacterial, 75.6% (722/955) for viral infections, and 71.2% (680/955) overall. Most discordances were minor (85.2%; 409/480) versus moderate (11.7%; 56/480) or complete (3.3%; 16/480). Concordance levels were lowest for bacterial skin and soft tissue infections (8.2%) and for viral respiratory tract infections (4.5%). This robust adjudication process can be used to evaluate HR tests and other diagnostics by regulatory agencies and for educating clinicians, laboratorians, and clinical researchers. Clinicaltrials.gov NCT04094818. SummaryWithout a gold standard for evaluating host response tests, clinical adjudication is a robust reference standard that is essential to determine the true infection status in diagnostic registrational clinical studies.

External validation of a model using health administrative data to predict acetabular fracture probability: Brief report.

Analyses using population-based health administrative data can return erroneous results if case identification is inaccurate ("misclassification bias"). An acetabular fracture (AF) prediction model using administrative data decreased misclassification bias compared to identifying AFs using diagnostic codes. This study measured the accuracy of this AF prediction model in another hospital. We calculated AF probability in all hospitalizations in the validation hospital between 2015 and 2020. A random sample of 1000 patients stratified by expected AF probability was selected. Patient imaging studies were reviewed to determine true AF status. The validation population included 1000 people. The AF prediction model was very discriminative (c-statistic 0.90, 95% CI: 0.87-0.92) and very well calibrated (integrated calibration index 0.056, 95% CI: 0.039-0.074). AF probability can be accurately determined using routinely collected health administrative data. This observation supports using the AF prediction model to minimize misclassification bias when studying AF using health administrative data.

Judicial precedent in the Romano-Germanic legal family

The article is devoted to the study of the institution of judicial precedent in the Romano- Germanic legal family. It is established that the countries of the Romano-Germanic legal family, unlike the countries of the Anglo-Saxon legal family under the influence of Roman law, in the context of codification of law, have determined for themselves the priority source of law - law, not precedent. However, there is a gradual increase in the role of judicial precedent in continental law countries due to a number of factors that contribute to the intensification of judicial rulemaking. First, in these countries, there are still branches of law that, for various reasons, either do not have legal regulation or are regulated only by general reference rules or framework provisions. For objective reasons, the legislator cannot foresee the entire variety of real-life phenomena. This pushes the courts to adopt legal provisions that can fill in the gaps in the legal regulation of social relations. Secondly, there is a noticeable lag between legislation and dynamically changing social relations, resulting in the formation of large segments of social life regulated by legal acts that have lost their relevance. The current realities, which are largely full of unpredictable events, highlight the need for legal systems to adapt. All of this contributes to the use of judicial precedents, which serve not only as a tool for resolving specific disputes, but also as a means of developing law, allowing to fill existing «gaps in law». In the Romano-Germanic legal family, the real legal force of a judicial precedent is determined not so much by its formal enshrinement in legal acts as by actual life circumstances. Real-life situations, as well as the practical necessity and demand for precedent as a source of law, play a key role in determining its true legal status and legal force. Judicial precedent in continental law countries is becoming increasingly important, becoming an integral element of dynamic and adaptive legal regulation over time, and the rules establishing the generally binding force of precedents and the discretionary powers of authorized bodies are increasingly common in both public and private law in these countries. Judicial precedent in these countries should be considered as a source of law from a practical point of view, focusing on solving problems arising in the process of law enforcement.