Stratification Variables Research Articles

Refining risk stratification in hypertrophic cardiomyopathy: the role of late gadolinium enhancement and syncope in predicting adverse outcomes

Abstract Background The presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) is recognized as a significant marker of myocardial fibrosis and a predictor of adverse outcomes in hypertrophic cardiomyopathy (HCM). Nevertheless, the specific quantity of LGE that correlates with poor outcomes is still under debate. Therefore, this study sought to assess the combined impact of LGE presence and a history of syncopal events and its association with clinical prognosis. Methods Between May 2018 and June 2023, a total of 230 HCM patients was prospectively enrolled at our Medical University, a tertiary referral center. The primary endpoint was a composite of new-onset ventricular tachycardia (VT), appropriate ICD therapy, and all-cause mortality. Results Median age of enrolled patients was 56 (IQR 44-64) years and 40% (n=94) were female. Median interventricular septal thickness (IVS) was 21 (IQR 18–25) mm and 43 % (n=84) had significant left ventricular outflow tract obstruction (LVOTO). Over a median follow-up of 3.2 years, 30 patients (13%) met the composite endpoint. These patients had a significantly higher LGE quantity compared to the non-event group (1.1 % vs. % 9.0, P=0.012). An LGE threshold of 5.2% was identified as an optimal predictor of the composite endpoint, with an area under the curve of 0.72, which increased to 0.77 when including at least one syncopal event in medical history. LGE > 5.2% and/or syncope were independently associated with adverse outcomes after multivariable adjustment (Adj HR 7.26 [95%CI 2.54-20.72]). Furthermore, NTproBNP and hsTnT were associated with the presence of LGE or syncope (OR for a 1-unit increase in standardized log-transformed biomarker NTproBNP 3.35 [95%CI 1.42-10.85]; hsTnT 3.48 [95%CI 1.48-10.24], respectively). Interestingly, typically used variables for risk stratification, such as age, IVS or LVOT were not significantly associated with these cardiac biomarkers. Conclusion An extent of LGE > 5.2% and the history of at least one syncope are associated with unfavorable clinical outcomes in HCM patients. These findings call for detailed MRI appraisal and suggest adopting a holistic approach to accurately identify high-risk patients.

Health impact of the Serious Accidents Punishment Act in Korean occupational settings

Abstract Background Interrupted time series analysis serves as a valuable study design for assessing the efficacy of public health interventions implemented at a specific moment in time at the population level. We aim to elucidate the effects of the Serious Accidents Punishment Act implemented in February 2021 in Korea by analyzing changes in the incidence rates of occupational diseases. Methods The monthly data from patients with occupational diseases was extracted from the National Health Insurance Service Cohort database from 2011 to 2023. An Interrupted time series analysis with Poisson segmented regression was used to compare the rates before and after the Serious Accidents Punishment Act introduction in both outpatients and inpatients. Adjustments or stratification variables included sex, age, company size, and injury-related international classification of diseases codes (Injury, poisoning, and certain other consequences of external causes, S00-T88). Results Based on injury rates, men’s inpatient injury rates remained stable, but outpatient rates decreased after the act implementation, while women’s injury rates consistently declined in both inpatient and outpatient settings. The Interrupted time series regression analysis indicates that the Serious Accidents Punishment Act led to a significant reduction in both outpatient and inpatient injury rates for men and women, with a marked decline in outpatient rates and hospital admissions among women post-intervention. Conclusions The Interrupted time series regression results suggest that the Serious Accidents Punishment Act has been effective in reducing injury-related healthcare usage, highlighting the necessity of gender-specific interventions and the potential impact on lowering inpatient visits, although causality remains uncertain without further analysis. Key messages • The Serious Accidents Punishment Act significantly reduced occupational injury rates in Korea, especially among women, demonstrating effective public health intervention. • Interrupted time series analysis reveals Serious Accidents Punishment Act’s impact on reducing healthcare usage for occupational injuries, highlighting the need for gender-specific approaches.

U-shaped association between dietary niacin intake and chronic kidney disease among US elderly: a nationwide cross-sectional study

BackgroundIn addition to hypertension or diabetes, elderly people are also considered one of the high-risk groups for chronic kidney disease (CKD). Although niacin is recognized for its renal protective properties, the link between dietary niacin intake and CKD remains uncertain. This study investigated this relationship in the elderly.MethodsWe included participants aged 60 and older from the National Health and Nutrition Examination Survey (NHANES) for the years 2003-2018. Dietary niacin intake was assessed through two non-consecutive 24-hour dietary recalls. CKD was diagnosed in individuals with a urine albumin-to-creatinine ratio exceeding 30 mg/g or an estimated glomerular filtration rate below 60 mL/min per 1.73 m^2. The study cohort comprised 4,649 participants, 1,632 of whom had CKD. Propensity score matching (PSM) was utilized to adjust for baseline differences between the groups.ResultsOur analysis, using smooth curve fitting and generalized additive models both before and after PSM, found a U-shaped curve depicting the relationship between dietary niacin intake and CKD risk, confirmed by a log-likelihood ratio test (P < 0.05). Threshold effect analysis (after PSM) indicated a reduced risk of CKD in older adults with a niacin intake below 38.83 mg per day [odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.97-1.00]. In contrast, higher intake levels significantly increased the risk (OR = 1.03, 95% CI 1.00-1.06). Subgroup analysis indicated that these associations were consistent across different stratification variables (P for interaction > 0.05).ConclusionOur findings suggested a U-shaped association between dietary niacin intake and CKD risk among older Americans. However, further prospective cohort studies are needed to confirm this finding.

Study of the role of abyssal ocean stratification in the rearrangement of potential vorticity through the water column

Abstract. Observations of abyssal variability performed in the Ionian Sea (Mediterranean Sea) have revealed the presence of a dense, stable abyssal layer, whose thermohaline and dynamical properties changed drastically over a decade. Building upon these available observations, we aim to investigate the role that stratification can play in the transmission of vorticity throughout the water column to the abyss and, in turn, in the redistribution of energy stored in the deep sea, with a set of stationary states. A quasi-geostrophic level model equipped with four coupled layers, a free surface, and a mathematical artifice for parameterizing decadal time evolution has been considered, proving that the relative-thickness and relative-density differences among the layers are the two critical factors that determine the dynamical characteristics of this rearrangement. The variability in ocean stratification is a relevant aspect that can activate deep and intermediate dynamics, engaging in the propagation and stabilization of signals throughout the water column. This demonstrates the non-negligible active connection between the dynamics of the bottom layers and the surface. The theoretical framework and parameterization used are based on specific observations made in the Ionian Sea over the last decades but retain general applicability to all ocean basins that are characterized by the presence of a stratified, dense water mass in their deep and intermediate layers.

Population-level effects on crime of recovering firearms from armed prohibited persons: intention-to-treat analysis of a pragmatic cluster-randomised trial in California cities

BackgroundToo little is known about the effectiveness of efforts to prevent firearm violence. We evaluated California’s Armed and Prohibited Persons System (APPS), which identifies legal purchasers of firearms who have...

Инструментальные наблюдения и статистический анализ вертикальных профилей температуры в юго-западной части залива Петра Великого Японского моря

The study is based on data from four moorings stretched out in the north-northwest – south-southeast direction across the isobaths in the southwestern Peter the Great Bay, the Sea of Japan, on 3–14 October, 2022. For this purpose, timeseries of vertical profiles of temperature and its gradient were expanded into empirical orthogonal functions; timescales were estimated using wavelet transform. In all cases, the leading mode captures vertical stratification variability related to the thermocline shoaling or deepening, manifesting itself by concerted oscillations of temperature and its vertical gradient, which occurred on the near-inertial, semi-diurnal and two-diurnal timescales. The near-inertial oscillations were the most intense during most of the time, while the semi-diurnal ones were the most intense on the fourth and fifth days. From the joint wavelet spectra it was found that temperature anomalies moved towards the shallower area and the speed was estimated as equal to 0.44–0.55 and 0.95–1.11 m/s for the near-inertial and semi-diurnal timescales, respectively. The speed on the two-diurnal timescale differs by an order of magnitude between the pairs of two deeper and two shallower moorings, equaling to 1.17 and 0.15 m/s, respectively. The results were interpreted as related to the near-inertial and semi-diurnal internal wave propagation from the continental slope towards the inner shelf and two-diurnal timescale was speculated to be a difference between them caused by non-linearity.

Integrated Ground-Penetrating Radar and Electromagnetic Induction Techniques for Characterizing Boreal Podzolic Soil in Western Newfoundland

Geophysical methods like ground-penetrating radar (GPR) and electromagnetic induction (EMI) offer non-destructive, high-resolution alternatives for soil sampling. This study aims to understand subsurface stratifications in boreal podzolic soil employing an integrated GPR-EMI technique and soil sampling. The GPR and EMI confirmed each technique's findings. They provided insights into the spatial variability of electrical conductivity, textural changes, and stratification (detected mainly by GPR reflections) in the soil profile. The assessed soil properties revealed the existence of two contrasting layers within 0-0.60 m depth. The study highlights the potential of using integrated GPR-EMI to identify subsurface stratification in boreal podzolic soil.

Incidence of Clinically Diagnosed Psoriatic Arthritis in Sweden.

Prior incidence estimates of psoriatic arthritis (PsA) vary considerably. We aimed to assess the annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016, overall and stratified by age/sex/education/geography, and to investigate potential time trends in incidence in 2006-2018. Use of disease-modifying antirheumatic drugs (DMARDs) during the 2 years after diagnosis was also examined. Patients (aged ≥ 18 years) with incident clinically diagnosed PsA in Sweden were identified from the National Patient Register (NPR) and/or the Swedish Rheumatology Quality Register (SRQ). Population statistics, stratification variables, and DMARD information were retrieved from other nationwide registers. Incidence was estimated according to a base case (BC) definition (ie, ≥ 1 main International Classification of Diseases, 10th revision, diagnosis of PsA [L40.5/M07.0-M07.3] from rheumatology/internal medicine in NPR, or a PsA diagnosis in SRQ during the relevant year, and no prior such diagnoses) and 4 different sensitivity analysis case definitions. The mean annual incidence of clinically diagnosed PsA among adults in Sweden in 2014-2016 was estimated at 21.77 per 100,000 person-years (PYs) at risk, according to the BC definition; 17.41 per 100,000 PYs at risk after accounting for diagnostic misclassification; and 15.78 to 28.83 per 100,000 PYs at risk across all sensitivity analyses. Incidence was slightly higher in female individuals, was lower in those with higher education (aged > 12 years), and peaked during the ages of 50 to 59 years. No apparent increasing or decreasing time trend was observed in 2006-2018. Within 2 years of diagnosis, 71.03% of patients had received DMARD therapy (22.37% biologic or targeted synthetic DMARDs). From 2014 to 2016, the annual incidence of clinically diagnosed PsA in the adult Swedish population was approximately 20 per 100,000 PYs at risk. Two years after diagnosis, almost three-quarters of patients had received DMARD therapy.

청소년의 건강행태와 먹방⋅쿡방 시청이 비만에 미치는 영향: 제18차 청소년건강행태조사 자료를 활용하여

Objectives The purpose of this study was to determine the relationship between adolescents' health behaviors and obesity and their viewing of mukbangs and cooking shows. Methods This study used data from the 18th Youth Health Behavior Survey conducted in 2022, and a total of 51,850 participants were analyzed by reflecting stratification variables, clustering variables, and weights according to the Korean Centers for Disease Control and Prevention's guidelines for composite sample analysis. Composite frequency analysis and composite crosstabulation analysis(Rao-Scott χ2-test) were conducted, and composite logistic regression analysis was performed to analyze the influencing factors. Results The results showed that adolescents' gender, grade level, subjective economic status, breakfast skipping, fruit consumption, fast food consumption, vegetable consumption, late-night snacking, days of physical activity of 60 minutes or more per day during the week, days of strength training during the week, and frequency of watching mukbangs and cooking shows were significantly associated with obesity. Conclusions In order to prevent obesity in teenagers, it is necessary to provide appropriate education and various programs so that people can enjoy watching mukbang and cooking show videos and manage the effects on their own.

Decoding Patient Heterogeneity Influencing Radiation-Induced Brain Necrosis.

In radiotherapy (RT) for brain tumors, patient heterogeneity masks treatment effects, complicating the prediction and mitigation of radiation-induced brain necrosis. Therefore, understanding this heterogeneity is essential for improving outcome assessments and reducing toxicity. We developed a clinically practical pipeline to clarify the relationship between dosimetric features and outcomes by identifying key variables. We processed data from a cohort of 130 patients treated with proton therapy for brain and head and neck tumors, utilizing an expert-augmented Bayesian network to understand variable interdependencies and assess structural dependencies. Critical evaluation involved a three-level grading system for each network connection and a Markov blanket analysis to identify variables directly impacting necrosis risk. Statistical assessments included log-likelihood ratio, integrated discrimination index, net reclassification index, and receiver operating characteristic (ROC). The analysis highlighted tumor location and proximity to critical structures such as white matter and ventricles as major determinants of necrosis risk. The majority of network connections were clinically supported, with quantitative measures confirming the significance of these variables in patient stratification (log-likelihood ratio = 12.17; P = 0.016; integrated discrimination index = 0.15; net reclassification index = 0.74). The ROC curve area was 0.66, emphasizing the discriminative value of nondosimetric variables. Key patient variables critical to understanding brain necrosis post-RT were identified, aiding the study of dosimetric impacts and providing treatment confounders and moderators. This pipeline aims to enhance outcome assessments by revealing at-risk patients, offering a versatile tool for broader applications in RT to improve treatment personalization in different disease sites.

Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system

BackgroundThe COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.MethodsComparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care.ResultsCompared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited.ConclusionsResults show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises.

Chromosomal copy number based stratification of gastric cancer has added prognostic value to Lauren’s histological classification

BackgroundThe Cancer Genome Atlas (TCGA) recognizes four molecular subgroups of gastric cancer: Epstein-Barr virus (EBV) positive, microsatellite instable (MSI), genomically stable (GS), and chromosomal instable (CIN). Since a GS/CIN classifier is lacking, alternative markers such as Lauren’s histopathology or CDH1/p53 immunohistochemistry are commonly applied. Here we compared survival of gastric cancer subgroups determined by four methods.Methods309 EBV negative and microsatellite stable tumors were included from the Dutch D1/D2 trial and assigned to subgroups by: (i) TCGA’s specific chromosomal copy number aberrations, (ii) genome instability index (GII), (iii) Lauren’s classification, and (iv) CDH1/p53 immunohistochemistry. Subgroups were associated with cancer-related survival (CRS).ResultsFive-year CRS was 42.0% for diffuse and 49.5% for patients with intestinal type tumors, and 57.8% for GS and 41.6% for patients with CIN tumors. Classification by GII or CDH1/p53 IHC did not correlate with CRS. The combination of TCGA and Lauren classifications resulted in four distinct subgroups. Five-year CRS for GS-intestinal (n = 24), GS-diffuse (n = 57), CIN-intestinal (n = 142) and CIN-diffuse (n = 86) was 61.4%, 56.5%, 47.6%, and 31.5%, respectively.ConclusionsTCGA’s GS and CIN subgroups have additional prognostic value to Lauren’s classification in resectable gastric cancer. GS-intestinal, GS-diffuse, CIN-intestinal and CIN-diffuse are suggested stratification variables for future studies.

Polyp detection with colonoscopy assisted by the GI Genius artificial intelligence endoscopy module compared with standard colonoscopy in routine colonoscopy practice (COLO-DETECT): a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial

Increased polyp detection during colonoscopy is associated with decreased post-colonoscopy colorectal cancer incidence and mortality. The COLO-DETECT trial aimed to assess the clinical effectiveness of the GI Genius intelligent endoscopy module for polyp detection, comparing colonoscopy assisted by GI Genius (computer-aided detection [CADe]-assisted colonoscopy) with standard colonoscopy in routine practice. We did a multicentre, open-label, parallel-arm, pragmatic randomised controlled trial in 12 National Health Service (NHS) hospitals (ten NHS Trusts) in England, among adults (aged ≥18 years) undergoing planned colonoscopy for gastrointestinal symptoms or for surveillance due to personal or family history (ie, symptomatic indications), or colorectal cancer screening. Randomisation (1:1) to CADe-assisted colonoscopy or standard colonoscopy was done with a web-based dynamic adaptive algorithm, immediately before colonoscopy, with stratification by age group, sex, colonoscopy indication (screening or symptomatic), and NHS Trust. Recruiting staff, participants, and colonoscopists were unmasked to trial allocation; histopathologists, co-chief investigators, and trial statisticians were masked. CADe-assisted colonoscopy consisted of standard colonoscopy plus the GI Genius module active for at least the entire inspection phase of colonoscope withdrawal. The primary outcome was mean adenomas per procedure (total number of adenomas detected divided by total number of procedures); the key secondary outcome was adenoma detection rate (proportion of colonoscopies with at least one adenoma). Analysis was by intention to treat (ITT), with outcomes compared between groups by mixed-effects regression modelling, in which effect estimates were adjusted for randomisation stratification variables. Data were imputed for outcome measures with more than 5% missing values. All participants who underwent colonoscopy were assessed for safety. The trial is registered on ISRCTN (ISRCTN10451355) and ClinicalTrials.gov (NCT04723758), and is complete. Between March 29, 2021, and April 6, 2023, 2032 participants (1132 [55·7%] male, 900 [44·3%] female; mean age 62·4 years [SD 10·8]) were recruited and randomly assigned: 1015 to CADe-assisted colonoscopy and 1017 to standard colonoscopy. 1231 (60·6%) participants were undergoing screening and 801 (39·4%) had symptomatic indications. Mean adenomas per procedure was 1·56 (SD 2·82; n=1001 participants with available data) in the CADe-assisted colonoscopy group versus 1·21 (1·91; n=1009) in the standard colonoscopy group, representing an adjusted mean difference of 0·36 (95% CI 0·14-0·57; adjusted incidence rate ratio 1·30 [95% CI 1·15-1·47], p<0·0001). Adenomas were detected in 555 (56·6%) of 980 participants in the CADe-assisted colonoscopy group versus 477 (48·4%) of 986 in the standard colonoscopy group, representing a proportion difference of 8·3% (95% CI 3·9-12·7; adjusted odds ratio 1·47 [95% CI 1·21-1·78], p<0·0001). Numbers of adverse events were similar between the CADe-assisted colonoscopy and standard colonoscopy groups (adverse events: 25 vs 19; serious adverse events: four vs six), and no adverse events in the CADe-assisted colonoscopy group were deemed to be related to GI Genius use on independent review. Results of the COLO-DETECT trial support the use of GI Genius to increase detection of premalignant colorectal polyps in routine colonoscopy practice. Medtronic.

Nighttime Phone Use and Past Exposure to Cyberbullying and Their Impact on Sleep and Psychological Wellbeing in Australian Children Aged 7 to 19 Years

Background: Cyberbullying and nighttime phone use are independently detrimental to sleep and psychological wellbeing, but whether in combination they might be more disruptive remains unknown. Methods: Students aged 7–19 years (N = 53,734) completed a survey measuring sleep duration, nighttime phone use, cyberbullying, and psychological distress. Results: Across stratification variables of gender (F/M) and age group (primary/secondary-school-aged children), bivariate ordered probit regression revealed that being cyberbullied and nighttime phone use were independent predictors of both increased psychological distress and obtaining &lt;8 h sleep. Nighttime phone use was observed to moderate the relationship between cyberbullying and sleep in both primary- and secondary-school-aged girls and boys and, likewise, between cyberbullying and psychological distress, especially in secondary-school-aged boys. Notably, the moderation effect was such that the impact of nighttime phone use was lower in children who were compared with those who were not cyberbullied. This may be a ceiling effect due to the high number of cyberbullied children reporting shortened sleep and higher levels of psychological distress. Discussion: The present findings point to a possible role of nighttime phone use as a moderator of the effect of cyberbullying on sleep and psychological wellbeing. There is a need for future studies to better explore more directly the effects of cyberbullying during the nighttime.

Prevalence and Predictors of Domestic Violence in India: Complex Sample Analysis of a Nationally Representative Study Conducted Between 2019 and 2021.

Violence against women has been one of the dreaded social evils that humanity is facing. There have been concerted efforts to eliminate this evil, and sustainable development goals goal 5.2.1 gave it a timeline. The current study was carried out to estimate the burden of domestic violence (DV) against women and to investigate the sociodemographic correlates of DV victims in India. Data were drawn from the fifth National Family Health Survey round. According to Demographic Health Survey guidelines, DV is measured using a 13-item questionnaire in the women's survey. Complex sample analysis was done using a primary sampling unit, sample weight, and stratification variables to estimate the weighted prevalence. Chi-square and multivariate logistic regression determine the unadjusted and adjusted odds ratio. The analysis is carried out using SPSS version 26 (IBM Corp., Armonk, NY). The weighted prevalence of DV against women in India in 2019-2021 was 31.2%. Approximately 28.5%, 13.1%, and 5.7% of women reported experiences of physical, emotional, and sexual violence, respectively. Karnataka was the worst affected state, with 47.3% of women facing DV. Individual factors like education and occupation, household factors like husband'seducation, occupation, drinking habit, wealth index, and community-level factors like caste, religion, and place of residence were significant predictors of DV. Lower levels of education and lower socioeconomic status were essential predictors of DV. The importance of education for both females and males has repeatedly been directly associated with DV, but the interventions have failed to improve the situation and warranta new strategy. Awareness about the legal consequences of DV in lower socioeconomic classes also has the potential to cut down the numbers. Further research into the causality can improve the planning for better intervention modalities.

The impact of high rainfall events on the submesoscale salinity field in a coastal sea: Greater Cook Strait, New Zealand

ABSTRACT River inflow into the coastal oceanic environment can result in low salinity submesoscale features (LSMFs). The enhanced water column stability sustained within these coherent structures affects local biological productivity. With-event and seasonal variability of LSMFs were investigated in a coastal sea -- Greater Cook Strait -- that is characterised by strong tidal and wind forcing as well as being forced at the land-sea boundary by several major rivers. A combination of ocean glider and satellite observations revealed the existence of seasonal variability in temperature, chlorophyll and stratification in LSMFs. High rainfall from ex-cyclone enhanced production of LSMFs in seasons when they would otherwise be less frequent. Stronger stratification was observed at the end of spring, in summer and at the beginning of autumn both in ambient shelf conditions and within LSMFs. Subsurface chlorophyll-a maxima were found associated with summer and spring LSMFs, when temperature had a stronger contribution to vertical stratification. In the available samples, LSMFs were advected seawards when river discharges exceeded 600 m 3 s − 1 . When river flows were lower than this threshold, other drivers such as wind or currents were required to advect the observed LSMFs offshore.

Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables.

Psychological Well-being and the Structure of the teacher’s Agency

Introduction. In positive psychology, psychological well-being is associated with personal resources that ensure creative processes and positive changes in a person’s life and activities. Considering agency as the main professional and personal resource of a teacher for positive transformations in modern education, we assume that agency acts as such a resource provided that the teacher perceives himself as a psychologically prosperous person. Psychological well-being in the study is considered within the framework of the PERMA model and represents the teacher’s self-representation of the main resources of positive functioning (positive emotions, involvement in relationship activities, meaning and achievement in activities) and his experience of happiness and life satisfaction. The purpose of the study is to study the characteristics of the psychological well-being of a modern teacher and the relationship between the components of well-being and the structure of the teacher’s agency.Materials and Methods. The severity of the components of teachers’ subjectivity was studied using the “Structure of agency” questionnaire (E. N. Volkova, I. A. Seregina). To study psychological wellbeing, the Russian version of the PERMA-Profiler questionnaire was used (O. M. Isaeva, A. Yu. Akimova, E. N. Volkova). 447 people participated in the study, of which 376 people. (84.1 %) – women, 71 people. (15.9 %) – men. The average age of study participants was 37.2 years (standard deviation SD=12.5). Work experience – from 1 year to 47 years.Results. The results of the study showed that the general level of well-being, as well as the values of the main components of well-being among modern teachers, is in the range of average values, however, all components of psychological well-being are expressed among teachers to a lesser extent than among representatives of other professional groups and in general among respondents of the Russian sample. Stratification variables that influence the psychological well-being of school teachers are the characteristics of age, work experience, and qualification category. The psychological wellbeing of teachers corresponds to older age, decreased work experience, and a low qualification category (or lack thereof). Psychologically well-off teachers are characterized by a balanced structure of agency, which presupposes uniform and high expression of all its components. Among the components of agency, psychological well-being is most determined by the teacher’s ability to make personal choice and the development of reflection.Discussion and Conclusions. The teacher’s psychological well-being can be considered as a characteristic of his/her professional socialization connected with the level of students' well-being. The actual level of teacher’s psychological well-being is lower than in the general Russian sample and in the sample of other professional pedagogical groups - preschool teachers. The low level of the teacher's psychological well-being can hinder the teacher's professional development. The teacher's psychological well-being is correlated with the teacher’s agency, in particular, with the teacher's activity, choices and responsibility, reflection. A balanced structure of agency is correlated the psychological well-being of teachers and the understanding another person is expressed to a significant extent.

How to Balance Prognostic Factors in Controlled Phase II Trials: Stratified Permuted Block Randomization or Minimization? An Analysis of Clinical Trials in Digestive Oncology.

In controlled phase II trials, major prognostic factors need to be well balanced between arms. The main procedures used are SPBR (Stratified Permuted Block Randomization) and minimization. First, we provide a systematic review of the treatment allocation procedure used in gastrointestinal oncology controlled phase II trials published in 2019. Second, we performed simulations using data from six phase II studies to measure the impacts of imbalances and bias on the efficacy estimations. From the 40 articles analyzed, all mentioned randomization in both the title and abstract, the median number of patients included was 109, and 77.5% were multicenter. Of the 27 studies that reported at least one stratification variable, 10 included the center as a stratification variable, 10 used minimization, 9 used SBR, and 8 were unspecified. In real data studies, the imbalance increased with the number of centers. The total and marginal imbalances were higher with SBR than with minimization, and the difference increased with the number of centers. The efficiency estimates per arm were close to the original trial estimate in both procedures. Minimization is often used in cases of numerous centers and guarantees better similarity between arms for stratification variables for total and marginal imbalances in phase II trials.

Diazoxide for Severe or Recurrent Neonatal Hypoglycemia

Neonatal hypoglycemia is an important preventable cause of neurodevelopmental impairment, but there is a paucity of evidence to guide treatment. To evaluate whether early, low-dose oral diazoxide for severe or recurrent neonatal hypoglycemia reduces time to resolution of hypoglycemia. This 2-arm, placebo-controlled randomized clinical trial was conducted from May 2020 to February 2023 in tertiary neonatal units at 2 New Zealand hospitals. Participants were neonates born at 35 or more weeks' gestation and less than 1 week of age with severe hypoglycemia (blood glucose concentration <22 mg/dL or <36 mg/dL despite 2 doses of dextrose gel) or recurrent hypoglycemia (≥3 episodes of a blood glucose concentration <47 mg/dL within 48 hours). Newborns were randomized 1:1 to receive diazoxide suspension (loading dose, 5 mg/kg; maintenance, 1.5 mg/kg every 12 hours) or placebo, titrated per protocol. The primary outcome was time to resolution of hypoglycemia, defined as enteral bolus feeding without intravenous fluids and normoglycemia (blood glucose concentration of 47-98 mg/dL) for at least 24 hours, compared between groups using adjusted Cox proportional hazards regression. Hazard ratios adjusted for stratification variables and gestation length are reported. Prespecified secondary outcomes, including number of blood glucose tests and episodes of hypoglycemia, duration of hypoglycemia, and time to enteral bolus feeding and weaning from intravenous fluids, were compared by generalized linear models. Newborns were followed up for at least 2 weeks. Of 154 newborns screened, 75 were randomized and 74 with evaluable data were included in the analysis (mean [SD] gestational age for the full cohort, 37.6 [1.6] weeks), 36 in the diazoxide group and 38 in the placebo group. Baseline characteristics were similar: in the diazoxide group, mean (SD) gestational age was 37.9 (1.6) weeks and 26 (72%) were male; in the placebo group, mean (SD) gestational age was 37.4 (1.5) weeks and 27 (71%) were male. There was no significant difference in time to resolution of hypoglycemia (adjusted hazard ratio [AHR], 1.39; 95% CI, 0.84-2.23), possibly due to increased episodes of elevated blood glucose concentration and longer time to normoglycemia in the diazoxide group. Resolution of hypoglycemia, when redefined post hoc as enteral bolus feeding without intravenous fluids for at least 24 hours with no further hypoglycemia, was reached by more newborns in the diazoxide group (AHR, 2.60; 95% CI, 1.53-4.46). Newborns in the diazoxide group had fewer blood glucose tests (adjusted count ratio [ACR], 0.63; 95% CI, 0.56-0.71) and episodes of hypoglycemia (ACR, 0.32; 95% CI, 0.17-0.63), reduced duration of hypoglycemia (adjusted ratio of geometric means [ARGM], 0.18; 95% CI, 0.06-0.53), and reduced time to enteral bolus feeding (ARGM, 0.74; 95% CI, 0.58-0.95) and weaning from intravenous fluids (ARGM, 0.72; 95% CI, 0.60-0.87). Only 2 newborns (6%) treated with diazoxide had hypoglycemia after the loading dose compared with 20 (53%) with placebo. In this randomized clinical trial, early treatment of severe or recurrent neonatal hypoglycemia with low-dose oral diazoxide did not reduce time to resolution of hypoglycemia but reduced time to enteral bolus feeding and weaning from intravenous fluids, duration of hypoglycemia, and frequency of blood glucose testing compared with placebo. ANZCTR.org.au Identifier: ACTRN12620000129987.