Median Value Research Articles

Identify novel inflammation-related prognostic signature in pancreatic cancer patients.

Pancreatic cancer (PC) is a malignant tumor of the digestive system with a poor prognosis. PC patients with pancreatitis have a worse prognosis. But nobody reported the relationship between inflammation and prognosis in PC. Based on this, we are going to explore inflammation-related prognostic signature to predict patients' survival and potential therapeutic target. We screened gene expression profile and corresponding clinical information of patients from The Cancer Genome Atlas (TCGA) database. Gene set enrichment analysis (GSEA) was performed to identify differentially expressed genes (DEGs) between tumor and normal tissues with P value < .05. Univariate and multivariate Cox regression analysis was applied to identify possible prognostic inflammation genes and establish an inflammation-related risk score system, which was validated by Kaplan-Meier and Receiver operating characteristic (ROC) curves. Finally, we used the TISIDB database to predict targeted drugs for up-regulated gene hepatocyte growth factor receptor (MET) and used AUTODOCK software for molecular docking. We built a prognostic model consisted of 3 inflammation-related genes (tumor necrosis factor receptor associated factor 1/TFAR1, tyrosine kinase 2/TYK2, MET). According to the median value of those genes' risk score, PC patients were ranked into high- (88) and low-risk (89) groups. Then, the results of the Kaplan-Meier curves and the area under the curve (AUC) of the ROC curves showed this model had a good predictive power (P < .001, AUC = 0.806). The result of human protein atlas (HPA) database showed the expression of TRAF1 and TYK2 were low in pancreatic cancer, the expression of MET was high. TISIDB database founded brigatinib could target to MET. And AUTODOCK showed brigatinib had a nice docking with MET. Taken together, our study suggested that inflammation-associated prognostic signature might be used as novel biomarkers for predicting prognosis in PC patients and potential therapeutic target of the disease.

Migration mortality in birds

Bird migration is one of the greatest wildlife spectacles, producing massive global changes in the distributions of birds twice each year. To understand the evolution of this phenomenon, it is important to know the costs of these journeys in terms of the mortality they impose. The use of mark/re‐sighting and tracking studies has now made it possible, for some bird species, to separate mortality during migration from mortality during stationary periods. This paper aims to assess this information, based mainly on 31 published studies, most of which concern long‐distance migrations of passerines, large waterfowl and raptors. Most of these studies revealed that mortality rates were greater during migration than at other times – in some species more than 20 times greater. Overall, on the basis of median values, mortality per unit time during autumn journeys was about 3.0 times greater than mortality during stationary periods, during spring journeys about 6.3 times greater, and during autumn and spring journeys combined 4.4 times greater. The greater overall mortality on spring journeys was largely associated with more adverse wind conditions in spring than in autumn. High mortality rates were especially evident in birds crossing large ecological barriers, such as the Sahara Desert or the Gulf of Mexico, and were higher in that part of their journey than when crossing more benign terrain. There was no increase in mortality during migration in the adults of some long‐lived species with high annual survival and predominantly overland journeys; for these birds, much larger samples of year‐round tracked individuals will be needed to reveal any seasonal variations in mortality. Within certain species, birds that travelled long distances experienced greater mortality over the journey than those that travelled short distances, but in other species no such relationship was found. In species in which adults and juveniles were followed over the same journey, juveniles showed greater mortality. To judge from other studies, this difference could be attributed to the inexperience of juveniles, their lower feeding rates and flight efficiency, greater vulnerability to hazards such as weather and predation, or more frequent navigational errors. Broadly speaking, the risks of migration vary with features of the birds themselves, with the terrain to be crossed and with weather at the time. It may be assumed that migration persists in the long term because the costs (in terms of associated mortality) are more than offset by the benefits of breeding and wintering in different areas (in terms of improved overall survival and breeding success). To provide further understanding of migration mortality, suggestions are made on the types of studies required and on how they could best be conducted.

SGLT2i relieve proteinuria in diabetic nephropathy patients potentially by inhibiting renal oxidative stress rather than through AGEs pathway

AimsTo estimate the effects of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) on proteinuria and oxidative stress expression in type 2 diabetes patients.Materials and methods68 patients with type 2 diabetes mellitus (T2DM) were divided into three groups according urinary albumin-to-creatinine ratio (UACR), including T2DM with non-albuminuria group (UACR < 30 mg/g), T2DM with microalbuminuria group (30 ≤ UACR ≤ 300 mg/g), T2DM with macroalbuminuria group (UACR>300 mg/g). They all received SGLT2 inhibitors (SGLT2i) treatment for 12 weeks. The expression of advanced glycation end products (AGEs) in plasma and 8-hydroxy-2-deoxyguanosine (8-OHdG) in urine were measured as indications of oxidative stress. The 24-hour urine samples were collected to measure the concentration of proteinuria and 8-OHdG before and after 12 weeks SGLT2i treatment. Plasma renin activity (PRA), angiotensin II (Ang II) and Aldosterone (ALD) were measured to evaluate renin angiotensin aldosterone system (RASS) levels.ResultsAfter 12 weeks SGLT2 inhibitors treatment, the median values of 24-hour proteinuria decreased in macroalbuminuria compared to baseline (970 vs. 821 mg/d, P = 0.006). The median values of AGEs and 8-OHdG decreased in microalbuminuria and macroalbuminuria groups when compared to baseline, AGEs (777 vs. 136 ug/ml, P = 0.003) and (755 vs. 210 ug/ml, P = 0.001), 8-OHdG (8.00 vs. 1.88 ng/ml, P = 0.001) and (11.18 vs. 1.90 ng/ml, P < 0.001), respectively. Partial correlations showed that 8-OHdG were relevant to the baseline 24-h proteinuria (r = 0.389, p = 0.001), the reduction of OHdG (Δ8-OHdG) were positively correlated with the decrease of 24-h proteinuria (Δ24-h proteinuria) after 12 weeks of SGLT2i treatment (r = 0.283, P = 0.031). There was no significant correlation between 24-h proteinuria and AGEs in baseline (r = −0.059, p = 0.640) as well as between ΔAGEs and Δ24-h proteinuria (r = 0.022, p = 0.872) after12 weeks of SGLT2i treatment in T2DM patients.ConclusionsSGLT2i may reduce proteinuria in diabetic nephropathy patients, potentially by inhibiting renal oxidative stress, but not through the AGEs pathway and does not induce RAAS activation.Trial registrationThis clinical trial was registered on 15/10/2019, in ClinicalTrials.gov, and the registry number is NCT04127084.

Low Mean Perfusion Pressure Indexed to Body Surface Area is a Powerful Predictor of Poor Outcomes After Heart Transplantation in Patients With High Pre-Transplant Venous Pressure: A Clinical Study With Physiological Insights From Mathematical Modelling of Biventricular Heart Failure

The deleterious consequences of chronically elevated venous pressure in patients with profound right ventricular or biventricular dysfunction are well known, including renal and hepatic dysfunction, and volume overload. The only option for these patients, if they fail optimal medical treatment, is a heart transplant, as they are not candidates for left ventricular assist device therapy. Mean perfusion pressure (MPP) is important in the outcomes of critically ill patients with high venous pressure. The question arises whether MPP is important for the outcomes of heart transplants in patients with elevated pre-transplant venous pressure. Medical management of heart failure patients with reduced ejection fraction involves lowering the systemic afterload with vasodilators while awaiting a transplant. We hypothesised that when venous pressure is elevated prior to transplant, a substantial reduction in systemic arterial elastance (Ea) through vasodilation may significantly decrease MPP, resulting in compromised end-organ function and consequent unfavourable outcomes after heart transplantation. This study aims to investigate whether a low MPP serves as a risk factor for adverse outcomes in heart transplant recipients with high venous pressure. A retrospective analysis was conducted on 250 heart transplant recipients undergoing isolated heart transplantation at a single institution from October 2012 to March 2020. Right atrial pressure (RAP) of more than 15 mmHg was considered high. Additionally, Ea calculated as the ratio of end-systolic pressure to stroke volume, and MPP calculated as the difference between mean arterial pressure and RAP were considered in our analysis. The outcomes of transplantation were measured in terms of 90-day mortality and survival up to 7 years. High RAP was a significant risk factor for short-term and medium-term survival if Ea was low (<2.7 mmHg/mL, the median value). This group had 39.39% in-hospital mortality compared to 14.49% for RAP<15 mmHg (p∼0.005). When Ea was high, this difference in survival was not evident: 8% for RAP<15 mmHg vs 4.8% for RAP>15 mmHg (p∼0.550). This effect was mediated through a lower MPP, and the mortality due to lower MPP increased strikingly with higher body surface area (BSA). A negative correlation was observed between MPP indexed to BSA (MPPI) and the Model for End-Stage Liver Disease score (r∼-0.3580, p<0.0001) as well as creatinine (r∼-0.3551, p<0.0001). MPPI less than 40 mmHg/m2 was associated with poorer short-term (23.2% for MPPI<40 mmHg/m2 vs 7.1% for MPPI>40 mmHg/m2, p∼0.001) and medium-term survival. The impact of high RAP and low Ea on survival was evident even on medium-term follow-up; only 30% survival at 7 years follow-up for high RAP and low Ea vs 75% for RAP<15 mmHg (p∼0.0033). The acceptable blood pressure during vasodilator therapy in patients with high RAP needs to be higher, especially in those with higher BSA. MPPI less than 40 mmHg/m2 is a risk factor for survival, in the short and medium-term, after heart transplantation.

Crossed raised arm position improves the flow of contrast medium in torso contrast-enhanced computed Tomography

IntroductionThis retrospective cohort study examined the effects of the crossed raised arm (CRA) position in contrast-enhanced computed tomography (CECT) on contrast medium influx and image quality relative to the conventional position. MethodsContrast medium influx into the collateral veins on CECT images was evaluated in 92 participants. The CT values of the pulmonary artery, descending aorta, and spleen were obtained in both positions and compared. Anatomical changes in the diameters and area of the subclavian vein and costoclavicular distance were also analyzed. ResultsContras 27 and 6 patients in the conventional and CRA positions, respectively. The influx risk ratio in the CRA position versus that in the conventional position was 0.22 (95% confidence interval, 0.10–0.51). Elevations in the median CT value of the pulmonary artery, descending aorta, and spleen in the CRA position were 7.0% (p < .001), 7.4% (p < .001), and 9.8% (p < .001), respectively. Enlargements in the major and minor diameters of the subclavian vein, subclavian vein area, and costoclavicular distance in the CRA position versus those in the conventional position were 19.3% (p < .001), 28.1% (p < .001), 53.6%, and 30.0% (p < .001), respectively. ConclusionThe CRA position effectively prevented contrast medium influx into the collateral veins due to SVS and increased CT values in the target organs in CECT. The diameters and area of the subclavian vein and costoclavicular distance were enlarged at the thoracic outlet, which improved the flow of the contrast medium into the targeted organs. Implications for practiceThe CRA position can contribute to obtaining better CECT images during common clinical assessments at no additional cost.

Mixing studies for lupus anticoagulant: does it matter how we mix?

Although clear and detailed recommendation regarding the lupus anticoagulant mixing test exist, various sources of NPP are used. We decided to inspect the possible differences in mixing studies depending on the mixing media. Four types of mixing media were prepared for 45 random remnant plasma samples: standard human plasma, control plasma N, previously analyzed patient with normal coagulation values, and home-made normal pool plasma (NPP). Samples were analyzed by using Siemens Dade Actin FSL Activated PTT Reagent on BCS XP analyzer. The median aPTT values of mixing studies with commercial lyophilized NPP, with commercial IQC, as well as with a patient did not differ (26.6, 26.3, and 26.8 s, respectively). Median value of a mixing study with home-made NPP was significantly higher from the rest of the group (27.9 s) ( P < 0.05). According to the obtained results, we decided to employ the commercial lyophilized NPP for future lupus anticoagulant mixing studies.

Value of MUNE versus compound muscle action potential in assessing motor unit loss in patients with carpal tunnel syndrome

BackgroundThe most prevalent nerve entrapment disorder, known as carpal tunnel syndrome (CTS), is brought on by wrist-based median nerve compression. Focal demyelination progresses to axonal dysfunction as the condition worsens. In order to detect motor unit (MU) loos, this study compares two motor unit number estimation (MUNE) techniques with compound muscle action potential (CMAP) amplitude. The CMAP amplitude and MUNE of the median nerve in 137 hands of 70 neurophysiologically approved CTS patients, aged 40.27 ± 10.06 years were examined. Another 90 hands from 56 healthy volunteers who are age- and gender-matched serve the control group.ResultsIn contrast to 192.5 and 248.5 in controls, the median nerve values of incremental and adapted multipoint stimulation (aMPS) MUNE in CTS patients were, respectively, 111 and 133 (p < 0.0001). Patients with severe CTS compared to those with mild CTS using both methods had significantly lower MUNE. MUNE values are the same regardless of gender or hand dominance. In comparison to MUNE methods (cutoff values of 106.5 and 203, respectively), CMAP amplitude had a sensitivity and specificity of more than 60% in detecting MU loss (cutoff value of 6.85 mV). The CTS grading had no effect on the CMAP amplitude. MUNE values had positive with CMAP amplitude and negative with CTS grading and Phalen test positivity.ConclusionsWhen identifying motor nerve involvement in CTS patients, the MUNE technique is more accurate than a standard motor nerve conduction study (NCS). It was emphasized that MUNE evaluation in determining MU loss in the early stages of CTS may be helpful in diagnosis and treatment. There was no correlation between handedness and the number of MUs as determined by MUNE techniques. Both methods almost equally identify MU loss and have the same sensitivity and specificity.

Pharmaceutical Industry Payments to Medical Oncologists in the Netherlands: Trends and Patterns Provided by an Open-Access Transparency Data Set.

Health care expenditure related to oncologic treatments is skyrocketing although many treatments offer marginal, if any, clinical benefit. Financial conflicts of interest (fCOI) resulting from pharmaceutical industry (pharma) payments to physicians is increasingly recognized as a predictive factor for regulatory board approval and guideline incorporation of low-value treatments. We sought to study the extent to which pharma payments to medical oncologists occur in the Netherlands, the amount of money involved, and whether these occur more frequently and are higher for key opinion leaders (KOLs). In our cross-sectional retrospective database study, we used several Dutch open-access databases and extracted data registered between 2019 and 2021. A cumulative amount of €899,863 was paid to 48.8% of the 408 registered medical oncologists. Over time, there was a marked decline in both the proportion of medical oncologists receiving payments (from 40.4% in 2019 to 19.1% in 2021) and the mean annual value of payments (from €2,962 in 2019 to €2,188 in 2021) with the latter mainly resulting from a decline in hospitality-related transactions. KOLs were more likely to receive industry payments and received a higher median payment value. Our findings should contribute to the increasing awareness in the Netherlands of the potential effects of fCOI.

Serum zinc concentration in patients with myocardial infarction: a retrospective study

BackgroundZinc regulates the oxidative stress and inflammatory signaling cascade and affects the development and deterioration of cardiovascular disease. We investigated the prognosis of developing heart failure in patients with myocardial infarction.MethodsPatients with myocardial infarction (n = 243) were divided using the median value of zinc concentration on admission into low (< 66 µg/dL at admission, n = 111) and high zinc group (≥ 66 µg/dL at admission, n = 132). During follow-up (mean ± SD: 734 ± 597 days; median 691 days), admission due to heart failure was observed in 12 patients: 10 and 2 cases in the low and high zinc groups, respectively.ResultsThe risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.0043). Relative to the high zinc group, the hazard ratio for admission due to heart failure was 15.7 (95% confidence interval 1.11–221, P = 0.042) via adjusted Cox proportional hazards analysis. Even after propensity score matching, the risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.048).ConclusionLow serum zinc concentration may be a risk factor for admission due to heart failure after myocardial infarction.

Correlation between early intracranial pressure and cerebral perfusion pressure with 28-day intensive care unit mortality in patients with hemorrhagic stroke.

Hemorrhagic stroke may cause changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP), which may influence the prognosis of patients. The aim of this study was to investigate the relationship between early ICP, CPP, and 28-day mortality in the intensive care unit (ICU) of patients with hemorrhagic stroke. A retrospective study was performed using the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD), including hemorrhagic stroke patients in the ICU with recorded ICP monitoring. The median values of ICP and CPP were collected for the first 24 h of the patient's monitoring. The primary outcome was 28-day ICU mortality. Multivariable Cox proportional hazards models were used to analyze the relationship between ICP, CPP, and 28-day ICU mortality. Restricted cubic regression splines were used to analyze nonlinear relationships. The study included 837 patients with a 28-day ICU mortality rate of 19.4%. Multivariable analysis revealed a significant correlation between early ICP and 28-day ICU mortality (HR 1.08, 95% CI 1.04-1.12, p < 0.01), whereas early CPP showed no correlation with 28-day ICU mortality (HR 1.00, 95% CI 0.98-1.01, p = 0.57), with a correlation only evident when CPP < 60 mmHg (HR 1.99, 95% CI 1.14-3.48, p = 0.01). The study also identified an early ICP threshold of 16.5 mmHg. Early ICP shows a correlation with 28-day mortality in hemorrhagic stroke patients, with a potential intervention threshold of 16.5 mmHg. In contrast, early CPP showed no correlation with patient prognosis.

Recharge Assessment in Greek Karst Systems: Methodological Considerations and Implications

The recharge of karst aquifers is significant for the effective management of groundwater resources, and its estimation should be tailored to accommodate their specific hydrogeological characteristics. This study provides a two-step methodological approach for the determination of karst aquifer recharge. Initially, mean annual recharge rates were estimated in the karst system of Ziria (Southern Greece) utilizing the APLIS and modified APLIS methods in order to decipher which was the most suitable version for recharge assessments. The results indicated similar mean recharge rate values at 42.7% and 41.4%, respectively, but significant differences in the spatial distribution. The modified methodology emerged as a more accurate and realistic approach, mainly due to the incorporation of permeability assessments. The final phase of the methodological approach involved the application of modified APLIS in two additional karst hydrosystems, Planitero and Xiromero, while a quantitative cross-comparison of the recharge rates was obtained for a deeper understanding of the factors controlling the groundwater recharge process. In Ziria, recharge rates exhibit a relatively uniform distribution throughout the area, with a median value of 46.7%. Conversely, in Planitero, High recharge rates (60–80%) occupy 56.8% of the surface, while in Xiromero, Moderate recharge rates (40–60%) dominate, representing 53.4% of the land coverage. These variations underscore the spatial heterogeneity of recharge within the karst systems, highlighting the importance of considering local geological and hydrological conditions in its assessments. The methodological approach of this study is flexible and can be adapted to different karst sites for the determination of recharge regimes, contributing to the alleviation of the groundwater depletion issue.

Diagnostic performance of shear wave measurement in the detection of hepatic fibrosis: A multicenter prospective study.

This study aimed to establish the shear wave measurement (SWM) cut-off value for each fibrosis stage using magnetic resonance (MR) elastography values as a reference standard. We prospectively analyzed 594 patients with chronic liver disease who underwent SWM and MR elastography. Correlation coefficients (were analyzed, and the diagnostic value was evaluated by the area under the receiver operating characteristic curve. Liver stiffness was categorized by MR elastography as F0 (<2.61kPa), F1 (≥2.61kPa, <2.97kPa, any fibrosis), F2 (≥2.97kPa, <3.62kPa, significant fibrosis), F3 (≥3.62kPa, <4.62kPa, advanced fibrosis), or F4 (≥4.62kPa, cirrhosis). The median SWM values increased significantly with increasing fibrosis stage (p<0.001). The correlation coefficient between SWM and MR elastography values was 0.793 (95% confidence interval 0.761-0.821). The correlation coefficients between SWM and MR elastography values significantly decreased with increasing body mass index and skin-capsular distance; skin-capsular distance values were associated with significant differences in sensitivity, specificity, accuracy, or positive predictive value, whereas body mass index values were not. The best cut-off values for any fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis were 6.18, 7.09, 8.05, and 10.89kPa, respectively. This multicenter study in a large number of patients established SWM cut-off values for different degrees of fibrosis in chronic liver diseases using MR elastography as a reference standard. It is expected that these cut-off values will be applied to liver diseases in the future.

Association of Socioeconomic Status With Worse Overall Survival in Patients With Bone and Joint Cancer.

The effect of socioeconomic status (SES) on the outcomes of patients with metastatic cancer to bone has not been adequately studied. We analyzed the association between the Yost Index, a composite geocoded SES score, and overall survival among patients who underwent nonprimary surgical resection for bone metastases. This population-based study used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results database (2010 to 2018). We categorized bone and joint sites using International Classification of Disease-O-3 recodes. The Yost Index was geocoded using a factor analysis and categorized into quintiles using census tract-level American Community Service 5-year estimates and seven measures: median household income, median house value, median rent, percent below 150% of the poverty line, education index, percent working class, and percent unemployed. Multivariate Cox regression models were used to calculate adjusted hazard ratios of overall survival and 95% confidence intervals. A total of 138,158 patients were included. Patients with the lowest SES had 34% higher risk of mortality compared with those with the highest SES (adjusted hazard ratio of 1.34, 95% confidence interval: 1.32 to 1.37, P < 0.001). Among patients who underwent nonprimary surgery of the distant bone tumor (n = 11,984), the age-adjusted mortality rate was 31.3% higher in the lowest SES patients compared with the highest SES patients (9.9 versus 6.8 per 100,000, P < 0.001). Patients in the lowest SES group showed more racial heterogeneity (63.0% White, 33.5% Black, 3.1% AAPI) compared with the highest SES group (83.9% White, 4.0% Black, 11.8% AAPI, P < 0.001). Higher SES patients are more likely to be married (77.5% versus 59.0%, P < 0.0001) and to live in metropolitan areas (99.6% versus 73.6%, P < 0.0001) compared with lower SES patients. Our results may have implications for developing interventions to improve access and quality of care for patients from lower SES backgrounds, ultimately reducing disparities in orthopaedic surgery.

Estimated plasma volume status is a simple and quick tool that could help define the severity of patients with infection on arrival at the emergency department

BackgroundInfectious states are subtle and rapidly evolving conditions observed daily in the emergency department (ED), and their prognostic evaluation remains a complex clinical challenge. Recently, estimated plasma volume status (ePVS) has been suggested to have a prognostic role in conditions where volemic alteration is central to the pathophysiology. The aim of this study was to verify whether ePVS recorded at ED admission can provide prognostic indications of 30-day mortality in patients with infection. MethodsA prospective observational study was performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital. All patients with infection were enrolled. ePVS values were derived from haemoglobin and haematocrit measured on the immediate arrival of patients in the ED. The predictive power of ePVS for 30-day mortality was assessed using a multivariate model adjusted for severity, comorbidity and urgency. Kaplan–Meier analysis was also performed. ResultsOf the 949 patients with infection enrolled in the study (47.9%, SOFA ≥2), 8.9% (84/949) died at 30 days. The median ePVS value was higher in patients who died at 30 days than in patients who survived (5.83 vs. 4.61, p < 0.001). Multivariate analysis revealed that ePVS in both continuous and categorical form around the median was an independent risk factor for 30-day mortality even after adjusting for severity, comorbidity and urgency. Kaplan–Meier analysis confirmed an increased risk of death in patients with high ePVS values. ConclusionsePVS recorded on ED admission of patients with infection was an independent predictor of risk for 30-day mortality.

Intensity and Variation of Health Navigator Support: Addressing Medical and Social Needs of Diabetes Patients in East Oakland.

Healthcare systems are increasingly screening and referring patients for unmet social needs (e.g., food insecurity). Little is known about the intensity of support necessary to address unmet needs, how this support may vary by circumstance or time (duration), or the factors that may contribute to this variation. Describe health navigator services and the effort required to support patients with complex needs at a community health center in East Oakland, CA. Retrospective analysis of de-identified patient contact notes (e.g., progress notes). Convenience sample of patients (n = 27) enrolled in diabetes education and referred to health navigators. Navigators provide education on managing conditions (e.g., diabetes), initiate and track medical and social needs referrals, and navigate patients to medical and social care organizations. Descriptive statistics for prevalence, mean, median, and range values of patient contacts and navigation services. We described patterns and variation in navigation utilization (both contacts and navigation services) based on types of need. We identified 811 unmet social and medical needs that occurred over 710 contacts with health navigators; 722 navigation services were used to address these needs. Patients were supported by navigators for a median of 9months; approximately 25% of patients received support for > 1year. We categorized patients into 3 different levels of social risk, accounting for patient complexity and resource needs. The top tertile (n = 9; 33%) accounted for the majority of resource utilization, based on health navigator contacts (68%) and navigation services (75%). The required intensity and support given to meet patients' medical and social needs is substantial and has significant variation. Meeting the needs of complex patients will require considerable investments in human capital, and a risk stratification system to help identify those most in need of services.

Subsurface hydrological connectivity controls nitrate export flux in a hilly catchment

Subsurface runoff represents the main pathway of nitrate transport in hilly catchments. The magnitude of nitrate export from a source area is closely related to subsurface hydrological connectivity, which refers to the linkage of separate regions of a catchment via subsurface runoff. However, understanding of how subsurface hydrological connectivity regulates catchment nitrate export remains insufficient. This study conducted high-frequency monitoring of shallow groundwater in a hilly catchment over 17 months. Subsurface hydrological connectivity of the catchment over 38 rainfall events was analyzed by combining topography-based upscaling of shallow groundwater and graph theory. Moreover, cross-correlation analysis was used to evaluate the time-series similarity between subsurface hydrological connectivity and nitrate flux during rainfall events. The results showed that the maximum subsurface hydrological connectivity during 32 out of 38 rainfall events was below 0.5. Although subsurface flow paths (i.e., the pathways of lateral subsurface runoff) exhibited clear dynamic extension and contraction during rainfall events, most areas in the catchment did not establish subsurface hydrological connectivity with the stream. The primary pattern of nitrate export was flushing (44.7%), followed by dilution (34.2%), and chemostatic behavior (21.1%). A threshold relationship between subsurface hydrological connectivity and nitrate flux was identified, with nitrate flux rapidly increasing after the subsurface connectivity strength exceeded 0.121. Moreover, the median value of cross-correlation coefficients reached 0.67, which indicated subsurface hydrological connectivity exerts a strong control on nitrate flux. However, this control effect is not constant and it increases with rainfall amount and intensity as a power function. The results of this study provide comprehensive insights into the subsurface hydrological control of catchment nitrate export.

A comparison of next-generation turbulence profiling instruments at Paranal

ABSTRACT A six-night optical turbulence monitoring campaign has been carried at Cerro Paranal observatory in 2023 February and March to facilitate the development and characterization of two novel atmospheric site monitoring instruments – the ring-image next-generation scintillation sensor (RINGSS) and 24-h Shack Hartmann image motion monitor (24hSHIMM) in the context of providing optical turbulence monitoring support for upcoming 20–40 m telescopes. Alongside these two instruments, the well-characterized Stereo-SCIDAR and 2016-MASS-DIMM were operated throughout the campaign to provide data for comparison. All instruments obtain estimates of optical turbulence profiles through statistical analysis of intensity and wavefront angle-of-arrival fluctuations from observations of stars. Contemporaneous measurements of the integrated turbulence parameters are compared and the ratios, bias, unbiased root mean square error, and correlation of results from each instrument assessed. Strong agreement was observed in measurements of seeing, free atmosphere seeing, and coherence time. Less correlation is seen for isoplanatic angle, although the median values agree well. Median turbulence parameters are further compared against long-term monitoring data from Paranal instruments. Profiles from the three small-telescope instruments are compared with the 100-layer profile from the stereo-SCIDAR. It is found that the RINGSS and SHIMM offer improved accuracy in characterization of the vertical optical turbulence profile over the MASS-DIMM. Finally, the first results of continuous optical turbulence monitoring at Paranal are presented which show a strong diurnal variation and predictable trend in the seeing. A value of 2.65 arcsec is found for the median daytime seeing.

Анализ и прогнозирование трафика современных телекоммуникационных систем на основе методов искусственного интеллекта

In recent years, artificial intelligence technologies have demonstrated significant success in solving the problem of traffic analysis and forecasting in various telecommunication systems. Forecasting allows the telecom operator to know about the future behavior of the network, take timely necessary measures to improve the quality of customer service, and decide on the need to install or upgrade equipment. Using data collected from IoT mobile devices as an example, this article provides an overview and analysis of various time series forecasting models describing the traffic behavior of telecommunication systems. Forecasting models such as the exponential smoothing method, linear regression, the autoregressive integrated moving average (ARIMA) method, the support vector machine regression method, the N-BEATS method, which uses fully connected layers of a neural network for forecasting a one-dimensional time series, are discussed; the features of some of them are briefly outlined. For a specific data array, data preparation operations are described: removing unused columns, replacing missing data on transaction durations with their median values, and describing the main statistical characteristics of the data array. A preliminary data analysis is presented, which consists of using smoothing methods: moving average and exponential smoothing. The process of training models and a comparative analysis of the quality of their training are described. For this data set, it was concluded that for the UDP protocol the ARIMA model has the best learning quality, for the TCP protocol - linear regression and the Theta model, for the HTTPS protocol – linear regression, ARIMA and N-BEATS.

Long-Term Exposure to PM10 Air Pollution Exaggerates Progression of Coronary Artery Disease

(1) Background: The increase in cardiovascular risk related to air pollution has been a matter of interest in recent years. The role of particulate matter 2.5 (PM2.5) has been postulated as a possible factor for premature death, including cardiovascular death. The role of long-term exposure to PM10 is less known. The aim of the study was to assess the individual relationship between air pollution in habitation and the development of coronary artery disease. (2) Methods: Out of 227 patients who underwent coronary angiography, 63 (38 men and 25 women) with a mean age of 69 (63–74) years, with nonsignificant atherosclerotic changes at the initial examination, were included in the study. The baseline and repeated coronary angiography were compared to reveal patients with atherosclerotic progression and its relation to demographic and clinical factors and exposure to air pollution in the habitation place. (3) Results: In the performed analysis, we found a significant correlation between Syntax score in de novo lesions and BMI (Spearman’s rho −0.334, p = 0.008). The significant and strong correlation between median annual PM10 values of 20 µg/m3 and at least 25 µg/m3 in air pollution and the risk of de novo coronary disease was noticed (Spearman’s rho = 0.319, p = 0.011 and Spearman’s rho = 0.809, p &lt; 0.001, respectively). (4) Conclusions: There is a positive correlation between long-term exposure to PM10 air pollution and coronary artery disease progression, demonstrated by the increase in Syntax score. The presented analysis revealed increased morbidity at lower PM10 concentrations than generally recommended thresholds. Therefore, further investigations concerning air pollution’s influence on cardiovascular risk should be accompanied by promoting lifestyle changes in the population and revisiting the needs for environmental guidelines.

Current practice of intracranial pressure monitoring in children with severe traumatic brain injury-a nationwide prospective surveillance study in Germany.

For management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations. Anonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort. Out of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%). In children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.