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Sodium-glucose cotransporter 2 (SGLT2) inhibitors have previously demonstrated cardioprotective properties in patients with type 2 diabetes, suggesting a preventive effect on heart failure (HF). The Empire Prevent trial program investigates the therapeutic potential for HF prevention by evaluating the cardiac, metabolic, and renal effects of the SGLT2 inhibitor empagliflozin in patients with increased risk of developing HF, but without diabetes or established HF. The Empire Prevent trial program is an investigator-initiated, double-blind, randomized clinical trial program including elderly and obese patients (60-84 years, body mass index >28 kg/m2) with at least one manifestation of hypertension, cardiovascular or chronic kidney disease, but no history of diabetes or HF. The aims are to investigate the effects of empagliflozin on 1) physical capacity and left ventricular and atrial structural changes with peak oxygen consumption and left ventricular mass as primary endpoints (Empire Prevent Cardiac), and 2) cardiac-adipose tissue interaction and volume homeostasis with primary endpoints of changes in epicardial adipose tissue and estimated extracellular volume (Empire Prevent Metabolic). At present, 138 of 204 patients have been randomized in the Empire Prevent trial program. Patients are randomized 1:1 to 180 days treatment with empagliflozin 10 mg daily or placebo, while undergoing a comprehensive examination program at baseline and follow-up. The Empire Prevent trial program will mark the first step towards elucidating the potential of SGLT2 inhibition for HF prevention in an outpatient setting in elderly and obese patients with increased risk of developing HF, but with no history of diabetes or established HF. Furthermore, the Empire Prevent trial program will supplement the larger event-driven trials by providing mechanistic insights to the beneficial effects of SGLT2 inhibition. Both parts of the trial program have been registered on September 13th 2021 (Clinical Trial Registration numbers: NCT05084235 and NCT05042973) before enrollment of the first patient. All patients will provide oral and written informed consent. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Medicines Agency. Data will be disseminated through scientific meetings and peer-reviewed journals irrespective of outcome. [ABSTRACT FROM AUTHOR]

In 1984, 21 years after the first liver transplantation, Thomas Starzl achieved a milestone by performing the world's first combined heart-liver transplantation. While still uncommon, the practice of combined heart-liver transplants is on the rise globally. In this review, the authors delve into the current literature on this procedure, highlighting the evolving landscape and key considerations for anesthesiologists. Over the years, there has been a remarkable increase in the number of combined heart-liver transplantations conducted worldwide. This surge is largely attributed to the growing population of adult survivors with single-ventricle physiology, palliated with a Fontan procedure, who later present with late Fontan failure and Fontan-associated liver disease. Research indicates that combined heart-liver transplantation is an effective treatment option, with reported outcomes comparable with isolated heart or liver transplants. Managing anesthesia during a combined heart-liver transplant procedure is challenging, especially in the context of underlying Fontan physiology. International experience in this field remains somewhat limited, with most techniques derived from expert opinions or experiences with single-organ heart and liver transplants. These procedures are highly complex and performed infrequently. As the number of combined heart-liver transplants continues to rise globally, there is a growing need for clear guidance on periprocedural surgical and anesthetic management. Anesthesiologists overseeing these patients must consider multiple factors, balancing various comorbidities with significant hemodynamic and metabolic shifts. An increase in (multicenter) studies focusing on specific interventions to enhance patient and organ outcomes is anticipated in the coming years. [ABSTRACT FROM AUTHOR]

Management of procedural pain in burn care is challenging. Lidocaine-prilocaine cream 5%, eutectic mixture of local anesthetics (EMLA®), is a widely used, effective local anesthetic cream approved for normal intact skin, genital mucosa for superficial surgical procedures, and debridement of chronic leg ulcers. This comprehensive review aimed to determine the safety, analgesic efficacy, and effects of EMLA on burn pathophysiology to provide evidence-based clinical recommendations for introducing the topical anesthetic into burn care. The PRISMA guidelines were followed for conducting a systematic PubMed search to include all relevant preclinical and clinical studies, according to pre-specified eligibility criteria. Fifteen studies were included in a qualitative synthesis, among which nine were human and six were animal studies. To date, safety and pharmacokinetic data on EMLA application in burns have been limited. Nevertheless, human studies indicated that EMLA is safe and provides adequate procedural-pain relief in adults when applied to smaller burns. Caution should be exercised when using EMLA in younger children, as systemic toxicity, pertaining to prilocaine-induced methemoglobinemia, has been reported owing to overdosing (high doses applied over large burn areas). Furthermore, animal studies demonstrate the potential beneficial effects of EMLA on burn pathophysiology such as anti-inflammatory, decreased capillary permeability to plasma proteins and edema formation, and improved tissue perfusion, which are factors that may impact burn wound progression. Current data on EMLA use in the management of procedural pain in small burns are sparse but suggest that EMLA is safe and effective in adults. Further clinical pharmacokinetic studies are warranted, especially for application on larger burn areas. [ABSTRACT FROM AUTHOR]

First, to test the feasibility of cerebral blood flow (CBF) estimation using the pulse wave amplitude in flow-related enhancement (FREE) brain MRI in comparison to pseudo-continuous arterial spin labeling (pCASL-MRI). Second, the potential for acceleration was evaluated retrospectively. 24 healthy study participants between 20 and 61 years had cerebral MRI. Perfusion imaging was performed with a balanced steady-state free precession sequence for FREE-MRI and with pCASL-MRI for comparison. The value distribution of the estimated CBF showed a high overlap in the histogram between 0 and 20 mL/100 g/min. However, disparity of the values occurred with more values between 20 and 60 mL/100 g/min using pCASL-MRI and more high values > 60 mL/100 g/min applying FREE-MRI. A Kolmogorov–Smirnov test confirmed a differing probability distribution (P = 0.62). The approximated CBF from FREE-MRI remained stable until only 50% of the acquired data was used. Values from using 40% of the data increased significantly compared to 90% or more (P ≤ 0.05). Values within the white matter presented no significant change after data reduction. The global and voxel-wise correlation coefficients towards pCASL-MRI presented stability during data reduction of FREE-MRI. In conclusion, the proposed technique allows a rough approximation of the CBF compared to pCASL-MRI. Further sequence optimization must be achieved to improve the measurement of relatively lowly perfused tissues. Nevertheless, it offers large potential for imaging speed optimization and enables perfusion-weighted images similarly to the color Doppler mode in ultrasound. [ABSTRACT FROM AUTHOR]

Increased gray matter volume (GMV) following electroconvulsive therapy (ECT) has been well-documented, with limited studies reporting a subsequent decrease in GMV afterwards. This study characterized the reversion pattern of GMV after ECT and its association with clinical depression outcome, using multi-site triple time-point data from the Global ECT-MRI Research Collaboration (GEMRIC). 86 subjects from the GEMRIC database were included, and GMV in 84 regions-of-interest (ROI) was obtained from automatic segmentation of T1 MRI images at three timepoints: pre-ECT (T 0), within one-week post-ECT (T 1), and one to six months post-ECT (T 2). RM-ANOVAs were used to assess longitudinal changes and LMM analyses explored associations between GMV changes and demographical and clinical characteristics. 63 of the 84 ROIs showed a significant increase-and-decrease pattern (RM-ANOVA, Bonferroni corrected p < 0.00059). Post hoc tests indicated a consistent pattern in each of these 63 ROIs: significant increase from T 0 to T 1 in GMV , followed by significant decrease from T 1 to T 2 and no difference between T 0 and T 2 , except for both amygdalae, right hippocampus and pars triangularis, which showed the same increase and decrease but GMV at T 2 remained higher compared to T 0. No consistent relationship was found between GMV change pattern and clinical status. The GEMRIC cohort confirmed a rapid increase of GMV after ECT followed by reversion of GMV one to six months thereafter. The lack of association between the GMV change pattern and depression outcome scores implies a transient neurobiological effect of ECT unrelated to clinical improvement. • A mega-analysis of longitudinal T1-weighted MRI data of patients receiving ECT from eight different sites was performed. • A pattern of gray matter volume (GMV) increase during ECT and a subsequent decrease one to six months thereafter was observed. • Four regions – associated with cognition and emotions – showed sustained higher GMV at one to six months after the ECT-course. • The pattern of GMV change did not correspond with clinical improvement after ECT. [ABSTRACT FROM AUTHOR]

Cleanliness of the mucosa of the upper GI (UGI) tract is critical for performing a high-quality EGD. The aim of this study was to validate a recently developed UGI cleanliness scale (the Polprep: Effective Assessment of Cleanliness in Esophagogastroduodenoscopy [PEACE] system) in the detection of clinically significant lesions (CSLs) in the UGI tract. Patients who underwent a complete diagnostic EGD were prospectively enrolled from August 2021 to October 2022. The UGI tract (esophagus, stomach, and duodenum) cleanliness was scored from 0 to 3 for each segment. The primary outcomes were the detection of CSLs and PEACE scores. Of 995 patients enrolled from 5 centers, adequate cleanliness (AQ; all scores ≥2) was found in 929 patients. In multivariate regression analysis, AQ was associated with the number of diagnosed CSLs (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.06-3.01; P =.03). Other factors related to CSL detection were duration of EGD (OR, 1.29, 95% CI, 1.23-1.35, P <. 001), male sex (OR, 1.33, 95% CI, 1.04-1.71; P =.025), and EGD indication (dyspepsia, alarm symptoms, gastritis surveillance, other indications vs GERD) (OR, 0.43 [95% CI, 0.31-0.6, P <. 001], OR, 0.44 [95% CI, 0.28-0.67, P <. 001], OR, 0.44 [95% CI, 0.25-0.76; P =.004], and OR, 0.44 [95% CI, 0.31-0.62; P <. 001], respectively). Twenty-seven patients were diagnosed with UGI neoplasia, all in patients with adequate cleanliness of the UGI tract. Adequate cleanliness of the UGI tract as assessed with the PEACE system was associated with a significantly higher detection rate of CSLs during EGD. The relationship of this scale with UGI neoplasia detection warrants further investigation. [Display omitted] [ABSTRACT FROM AUTHOR]

Weight loss is reported with oral roflumilast, which is approved for chronic obstructive pulmonary disease (COPD). Recently, the drug has shown efficacy in psoriasis, a disease strongly linked to overweight/obesity. To describe the effects of oral roflumilast on body weight and cardio-metabolic parameters in patients with psoriasis. Posthoc analyses from the PSORRO study, where patients with moderate-to-severe plaque psoriasis were randomized 1:1 to oral roflumilast 500 μg once-daily or placebo for 12 weeks, followed by active, open-label treatment through week 24 in both groups. Changes in body weight, blood pressure, gastrointestinal symptoms, and laboratory tests were registered. No lifestyle or dietary interventions were applied. Forty-six patients were randomized. Baseline characteristics across groups were comparable; mean weight was 103.6 kg. In patients receiving roflumilast, median weight change was −2.6% and −4% at week 12 and 24, respectively. Corresponding numbers were 0.0% and 1.3% in patients initially allocated to placebo. Reduced appetite was more frequent with active therapy. No changes in blood pressure or laboratory tests were observed. Posthoc analyses and low numbers. Oral roflumilast induced weight loss and reduced appetite, which support the growing evidence of roflumilast as an attractive treatment alternative for patients with psoriasis. [ABSTRACT FROM AUTHOR]

Microbiota plays an essential role in maintaining body health, through positive influences on metabolic, defensive, and trophic processes and on intercellular communication. Imbalance in intestinal flora, with the proliferation of harmful bacterial species (dysbiosis) is consistently reported in chronic illnesses, including neurodegenerative diseases (ND). Correcting dysbiosis can have a beneficial impact on the symptoms and evolution of ND. This review examines the effects of microbiota modulation through administration of probiotics, prebiotics, symbiotics, or prebiotics' metabolites (postbiotics) in patients with ND like multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). PubMed, Web of Science, Medline databases and ClinicalTrials.gov registry searches were performed using pre-/pro-/postbiotics and ND-related terms. Further references were obtained by checking relevant articles. Although few compared to animal studies, the human studies generally show positive effects on disease-specific symptoms, overall health, metabolic parameters, on oxidative stress and immunological markers. Therapy with probiotics in various forms (mixtures of bacterial strains, fecal microbiota transplant, diets rich in fermented foods) exert favorable effects on patients' mental health, cognition, and quality of life, targeting pathogenetic ND mechanisms and inducing reparatory mechanisms at the cellular level. More encouraging results have been observed in prebiotic/postbiotic therapy in some ND. The effects of probiotic-related interventions depend on the patients' ND stage and pre-existing allopathic medication. Further studies on larger cohorts and long term comprehensive neuropsychiatric, metabolic, biochemical testing, and neuroimaging monitoring are necessary to optimize therapeutic protocols in ND. [ABSTRACT FROM AUTHOR]

Statistical models for social networks, such as exponential random graphs (ERGMs), have increasingly been used by organizational scholars to study the social interactions inside organizations, departments, and teams. While such models have been successful in providing insights about the local processes that underlie these interactions (such as homophily, reciprocity or transitivity), an additional interesting avenue for research focuses on the role of group-level contextual variables (such as the climate or composition of a team or organization) when considering a multitude of teams or organizations. In this paper we show how, in a team context, integrating team-level factors in a multilevel framework (i.e., a Bayesian hierarchical ERGM) enables us to answer questions about: 1) how team-level contextual factors might provide alternative explanations for the emergence of intra-team ties, and 2) whether any variation in local tendencies between teams might be dependent on such team-level variables (i.e., cross-level interactions). Using data collected among 103 MBA students who were grouped into 18 teams of 5–7 members to work on a project, we study the impact of members' expertise and perceived psychological safety on advice seeking behavior. At a local level, we focus on the effect of these nodal attributes for homophily and differences in advice seeking and giving, while at the team level we incorporate the average expertise and the team's psychological safety climate. Our results show that expert members are more likely to be the recipient of advice ties, but also that this effect is more pronounced in teams where the overall level of expertise is high. For psychological safety, we find that a high psychological safety climate impacts the advice relations among all members in the group, not solely those who themselves perceive a high level of psychological safety, suggesting that the team climate has an impact on all its members. This illustrates how a Bayesian hierarchical ERGM allows us to obtain relevant results even when studying small-sized groups. • This paper discusses how exponential random graph models (ERGMs) can be used to study network relations inside organizations. • We discuss how a Bayesian hierarchical ERGM can be used to simultaneously test local processes and group-level variables. • To illustrate this, we consider the impact of members' expertise and psychological safety on the advice network in 18 teams. • Members are more likely to ask advice from experts and this is more pronounced in teams with a high mean level of expertise. • High psychological safety impacts advice seeking among all team members, not only among members with psychological safety. [ABSTRACT FROM AUTHOR]

Grey cast iron is known for its poor machinability directly after casting, but attains excellent machining performance after ageing. The present work explores the impact of cutting speed on the performance of pcBN machining for non-aged material. Findings suggest that tool wear can be minimized by identifying an optimal cutting speed that supports the formation of a stable Al 2 O 3 and MnS build-up layer (BUL). Insufficient BUL protection accelerates pcBN wear by diffusion, while at very high speeds protective Al 2 O 3 is replaced by weaker (Fe,Mn) 2 SiO 4 and (Fe,Mn)O, and oxidation accelerates tool wear. The higher mechanical properties of aged GCI facilitate generation of high enough temperatures for stable deposition of Al 2 O 3 BUL. [ABSTRACT FROM AUTHOR]

Recently, an expert consensus statement proposed indications where implantation of a primary prevention implantable cardioverter-defibrillator (ICD) may be reasonable in patients with mitral valve prolapse (MVP). The objective was to evaluate the proposed risk stratification by the expert consensus statement. Consecutive patients with MVP without alternative arrhythmic substrates with cardiac magnetic resonance imaging (CMR) were included in a single-center retrospective registry. Arrhythmic MVP (AMVP) was defined as a total premature ventricular complex burden ≥5%, non-sustained ventricular tachycardia (VT), VT, or ventricular fibrillation. The end point was a composite of SCD, VT, inducible VT, and appropriate ICD shocks. In total, 169 patients (52.1% male, median age 51.4 years) were included and 99 (58.6%) were classified as AMVP. Multivariate logistic regression identified the presence of late gadolinium enhancement (OR 2.82, 95%CI 1.45-5.50) and mitral annular disjunction (OR 1.98, 95%CI 1.02-3.86) as only predictors of AMVP. According to the EHRA risk stratification, 5 patients with AMVP (5.1%) had a secondary prevention ICD indication, while in 69 patients (69.7%) the implantation of an ICD may be reasonable. During a median follow-up of 8.0 years (IQR 5.0-15.6), the incidence rate for the composite arrhythmic end point was 0.3%/year (95%CI 0.1-0.8). More than half of MVP patients referred for CMR met the AMVP diagnostic criteria. Despite low long-term event rates, in 70% of patients with AMVP the implantation of an ICD may be reasonable. Risk stratification of SCD in MVP remains an important knowledge gap and requires urgent investigation. [Display omitted] [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? This study examined whether the Cortisol Awakening Response (CAR) could be a biomarker for cognitive change during electroconvulsive therapy (ECT). • What is the main finding of this study? We found no significant associations between the CAR and cognitive change during the ECT course in (un)adjusted models. • What is the meaning of the finding? Our results indicate that the CAR is not usable as a biomarker for ECT-induced cognitive change during the ECT course. To test whether the cortisol awakening response (CAR) could be a biomarker for cognitive decline during electroconvulsive therapy (ECT). We studied 50 older patients with depression who were treated with ECT from the MODECT cohort. We used linear regression analyses to examine the association between CAR and cognitive change, assessed by the change in Mini Mental State Examination scores between baseline and 1 week after ECT course. CAR was assessed by the area under the curve of cortisol levels, according to Pruessner's-formula. Associations were adjusted for putative confounders, based on previous literature and availability. We found no significant associations between the CAR and cognitive change during the ECT course in (un)adjusted models. Our results indicate that the CAR is not usable as a biomarker for ECT-induced cognitive decline during ECT course. Further research in cohorts with larger samples is needed. [ABSTRACT FROM AUTHOR]

DISCOVER is a global programme of observational research that includes patients with type 2 diabetes initiating second-line glucose-lowering therapy from 38 countries worldwide, including many with little or no previous epidemiological data available. More than 15,000 patients were followed-up for 3 years, and comprehensive data were collected using a standardized electronic case report form at enrolment, and 6, 12, 24 and 36 months. The study has formed the basis for a long-term registry that is intended to expand the geographic and clinical scope of the study and allow data collection beyond 3 years. In this review, critical aspects of study planning and implementation are summarized, along with challenges that were faced, to provide a resource for researchers planning similar studies. In particular, it is essential to set realistic expectations regarding the degree of study representativeness that can be achieved, allow for sufficient time to obtain ethics committee approval, develop tools to help recruit patients effectively, ensure that data collection systems are robust, user-friendly and adaptable, plan adequate remote and on-site monitoring, maximize patient retention through continuous engagement with study sites and ensure that everyone involved in the study forms a friendly and effective team. Observational studies such as DISCOVER are crucial for understanding disease epidemiology and management in real-world settings. They are also increasingly used by governmental, regulatory and payor agencies for post-marketing surveillance and when considering new drug submissions. The development of future studies of similar scope and ambition to DISCOVER is encouraged. • Observational studies provide insight into disease management in the real world. • Lessons can be learned from DISCOVER, a study of patients with type 2 diabetes. • Studies should consider geographic coverage and regulatory and ethics approval. • Site selection and communications can impact patient recruitment and retention. • Operational aspects and challenges described here may help guide future study plans. [ABSTRACT FROM AUTHOR]

Testing of microsatellite instability is not only used as a triage for possible Lynch syndrome, but also to predict immunotherapy treatment response. The aim of this study was to assess the frequency of mismatch repair deficiency (MMR-D)/microsatellite instability (MSI) in 400 cases of non-endometrioid ovarian tumors (high-grade serous, low-grade serous, mucinous and clear cell), to compare different methodological approaches of testing, and to assess the optimal approach for next generation sequencing (NGS) MSI testing. For all tumors, we evaluated immunohistochemical (IHC) expression of MMR proteins and assessed microsatellite markers by PCR-based method. Except for high-grade serous carcinoma, we correlated the findings of IHC and PCR with NGS-based MSI testing. We compared the results with somatic and germline mutation in MMR genes. Among the whole cohort, seven MMR-D cases, all clear cell carcinomas (CCC), were found. On PCR analysis, 6 cases were MSI-high and one was MSS. In all cases, mutation of an MMR gene was found; in 2 cases, the mutation was germline (Lynch syndrome). An additional 5 cases with a mutation in MMR gene(s) with MSS status and without MMR-D were identified. We further utilized sequence capture NGS for MSI testing. Employing 53 microsatellite loci provided high sensitivity and specificity. Our study shows that MSI occurs in 7% of CCC while it is rare or absent in other nonendometrioid ovarian neoplasms. Lynch syndrome was present in 2% of patients with CCC. However, some cases with MSH6 mutation can evade all testing methods, including IHC, PCR, and NGS-MSI. [ABSTRACT FROM AUTHOR]

Although little information exists on the efficacy of deworming in wild ruminants, gastrointestinal nematodes have been found to demonstrate increasing drug resistance. The spread of drug-resistant strains may be increased by transmission among livestock and susceptible wildlife species, thus posing a potential threat to endangered species, such as the European bison. The aim of the study was twofold: to identify the parasite loads in captive European bison with the use of coprological techniques, and to test the influence of other nearby ungulates on the richness of bison parasitofauna. Additionally, the efficacy of deworming procedures against gastrointestinal nematodes in bison was evaluated. The survey was based on a coprological investigation of 285 fecal samples from 156 European bison in 15 enclosures. The parasitofauna of the captive European bison was consistent with those of free-ranging populations. The highest prevalence was noted for Eimeria spp. oocysts (60.7%), strongyle eggs (50.9%), Fasciola hepatica eggs (13.1%), Dictyocaulus viviparus larvae (12.3%) and Trichuris sp. Eggs (9.47%). Moreover, the close proximity of other ungulate species resulted in a higher diversity of parasite species. In all cases, deworming with albendazole, fenbendazole and ivermectin proved to be ineffective against strongylids and Trichuris sp. The results of fecal egg count reduction test (FECRT) ranged from 37.2 to 99.6% (95% CI <90%) for albendazole; values >95% (95% CI = 41–100) were noted for fenbendazole, and FECRT ranged from 63.2 to 97.5 (95% CI = 0–99) for ivermectin. As the results of anthelmintic treatment are unsatisfactory, it seems justified to continue study in this area. Our study is the first large-scale attempt to evaluate the efficacy of anthelminthics in captive European bison. The potential sharing of parasite species between bison and other ungulates should also be further investigated from the perspective of minimizing the risk of the spread of drug-resistant parasite strains. [Display omitted] • Parasitofauna of captive European bison was similar to that of free-ranging populations. • The highest prevalence was noted for Eimeria spp. oocysts and strongyle eggs. • Close proximity of other ungulate species resulted in a higher diversity of European bison parasitofauna. • Fenbendazole, albendazole and ivermectin were not sufficiently effective against strongylids or Trichuris sp. [ABSTRACT FROM AUTHOR]

• COVID-19 booster uptake is a challenge among nurses. • Partisan self-identification is associated with booster uptake among nurses. • Targeted interventions are needed to increase booster uptake among nurses. Nurses are at the forefront of efforts to contain COVID-19 and are thus at greater risk of infection from the virus than the general population. Unlike the initial vaccination, booster vaccinations are not always required, and some nurses have not received a booster shot. We investigate the predictors of booster uptake among nurses. We developed an original survey to study booster uptake among nurses. Using contact information from the South Dakota Board of Nursing, we contacted nurses in South Dakota in June and July of 2022. We conducted a multivariate logistic regression to analyze the data. One thousand eighty-four nurses participated in our study. We found booster uptake among nurses was associated with their partisan self-identification (OR 0.40, 95% CI 0.31-0.52), age (OR 1.04, 95% CI 1.02-1.05), flu vaccination last season (OR 5.61, 95% CI 2.6-12.1), and positive COVID-19 test in last 12 months (OR 0.51, 95% CI 0.35-0.74). Our results show that COVID-19 booster uptake has been politicized even among nurses. As public health officials continue devising interventions to increase booster uptake among healthcare workers, they should be mindful that they would be viewed through the partisan lens. [ABSTRACT FROM AUTHOR]

• IMP was evaluated in COVID-19 patients at different stages of treatment. • The Test of Incremental Respiratory Endurance (TIRE) was used to assess IMP. • This study describes longitudinal symptomatology in patients with COVID-19. • This study identified a significant reduction in IMP in patients with COVID-19. The two most common symptoms associated with COVID-19 are dyspnea and fatigue. One possible cause of such symptoms may be inspiratory muscle weakness. The purpose of this study was to examine inspiratory muscle performance (IMP) from intensive care unit discharge (ICUD) to hospital discharge (HD) in patients with COVID-19 hypothesizing that IMP would be markedly depressed at both ICUD and HD. IMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. 30 patients (19 men, 11 women) with COVID-19 were included. The mean±SD age, BMI, and length of ICU and hospital stay was 71±11 yrs, 27.9 ± 6.3 kg/m, 9 ± 6 days, and 26±16 days, respectively. The mean±SD MIP, SMIP, ID, and FIT of the entire cohort at ICUD vs HD were 36±21 vs 40±20 cm H2O, 231±157 vs 297±182 PTU, 8.8 ± 4.2 vs 9.5 ± 4.6 s, and 9.0 ± 9.4 vs 13.1 ± 12.3, respectively, with only SMIP and FIT significantly greater at HD (p =.006 and 0.03, respectively). SMIP at HD was significantly related to resting dyspnea at HD (r =-0.40; p =.02). The SMIP and FIT of men were found to increase significantly from ICUD to HD, but no measure of IMP in the women increased significantly from ICUD to HD. At least one COVID-19-related symptom was present 1 month after HD with the most persistent symptoms being fatigue, cough, and dyspnea in 47%, 40%, and 37% of the patients, respectively. A significant reduction in IMP exists in patients with COVID-19 at both ICUD and HD and no measure of IMP in women was observed to increase significantly from ICUD to HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD. [ABSTRACT FROM AUTHOR]

Deep brain stimulation of the internal globus pallidus (GPi DBS) is an invasive therapeutic modality intended to retune abnormal central nervous system patterns and relieve the patient of dystonic or other motor symptoms. The aim of the presented research was to determine the neuroanatomical signature of GPi DBS modulation and its association with the clinical outcome. This open-label fixed-order study with cross-sectional validation against healthy controls analysed the resting-state functional MRI activity changes induced by GPi DBS in 18 dystonia patients of heterogeneous aetiology, focusing on both global (full brain) and local connectivity (local signal homogeneity). Compared to the switched-off state, the activation of GPi DBS led to the restoration of global subcortical connectivity patterns (in both putamina, diencephalon and brainstem) towards those of healthy controls, with positive direct correlation over large-scale cortico-basal ganglia-thalamo-cortical and cerebellar networks with the clinical improvement. Nonetheless, on average, GPi DBS also seemed to bring local connectivity both in the cortical and subcortical regions farther away from the state detected in healthy controls. Interestingly, its correlation with clinical outcome showed that in better DBS responders, local connectivity defied this effect and approached healthy controls. All in all, the extent of restoration of both these main metrics of interest towards the levels found in healthy controls clearly correlated with the clinical improvement, indicating that the restoration of network state towards more physiological condition may be a precondition for successful GPi DBS outcome in dystonia. • GPi DBS restores subcortical global connectivity in dystonia. • On average, GPi DBS brings local connectivity farther from healthy controls. • However, in good DBS responders, local connectivity approaches healthy controls. • Connectivity normalisation correlates with clinical improvement in dystonia. [ABSTRACT FROM AUTHOR]

This project aims to develop an innovative, open multi-domain early warning platform to monitor adverse events in water bodies and streams, such as salinity increase, acidification, temperature rise, chlorophyll content, etc. The platform involves monitoring dispersed measurement points, acquiring data from measurement stations in the form of autonomous buoys equipped with sensor sets tailored to individual needs. The platform enables remote and distributed monitoring of key locations in lakes and rivers for stakeholders, such as local governments, water managers, and businesses impacting water reservoirs. The open data aggregation system and the universal technological solution in the form of a measurement buoy will allow the acquisition of desired chemical and biological parameters, in line with the Water Framework Directive, using market-available and industry-recognized sensors. The planned buoy construction will accommodate both wired sensors directly connected to the measurement station and data acquisition from locally dispersed measurement points communicating wirelessly with the measurement station-buoy. With built-in machine learning and data analysis mechanisms, the platform will utilize a minimal number of measurement stations to achieve the desired level of data acquisition. The dispersion of sensors and the autonomy of measurement stations will ensure flexibility and scalability of measurements. [ABSTRACT FROM AUTHOR]

Automatic decision support systems focused on credit risk assessment based on scoring or similar methods are often used by financial institutions. Default prediction is a very important issue. This problem is often analyzed by researchers, but products offered by banks are mainly considered. However, additional attributes of fixed assets should be used for developing the method for default prediction of leasing contracts. The aim of this paper was to develop and compare machine learning methods to increase the level of default prediction in leasing companies. We focused mainly on Random Forest Classifier, AdaBoostClassifier, GradientBoostingClassifier, and Deep Neural Networks. The main contribution is the comparison of different developed machine-learning methods using data acquired from leasing companies. The results of the experiments show the precision of the prediction of defaults was from 72,8% to 75%, and the recall of the prediction of defaults was from 76,3% to 81,6%. The precision of non-default prediction, in turn, was from 71,9% to 79,1%, and the recall of prediction of defaults from 69,7% to 71,9%. The conclusion is that the models proposed in this research may be a helpful tool in the current operations of various financial institutions. Although the functionality of the models was presented in the example of a selected leasing company, due to their flexible and universal nature, they can be successfully used in the activities of other financial institutions. [ABSTRACT FROM AUTHOR]

Functional modelling is an essential part of systematic design approaches and is often prescribed in engineering design textbooks. However, function models created with current function modelling techniques often lack formal and repeatable representation, limiting their use in computational reasoning. Therefore, this paper presents a new functional modelling method to support function models' creation with formal and repeatable representation. The key element of the proposed method is a Function Class – a function-modelling element that categorises defined functions on a function block level by specifying operating flow, input and output flows, and integrates primary rules for functional modelling such as conservation law. The formalisation on a function block level reduces the number of morphological errors and provides a theoretical framework for future computational processing of function models. This paper proposes a protocol for developing Function Classes and defines a theoretical function modelling framework through Function Class Method. The development and use of the Function Class Method are demonstrated through the development of Function Classes for the Design for Additive Manufacturing domain as the first step toward a universal function modelling approach. [ABSTRACT FROM AUTHOR]

Present work focuses on analysis of the stress and strain fields inside and around the individual {10–12} twin in magnesium alloy. The 3D crystal plasticity model represents twin as an ellipsoidal inclusion surrounded by the matrix. Five different twin thicknesses and three different lateral twin lengths are used for stress/strain analysis. The simulations are complemented with experimental observations using high-resolution electron backscattered diffraction. The simulations and experiments show a similar distribution of the shear stress and the spatial activity of individual slip systems (basal, prismatic, pyramidal). Plasticity induced inside the twin is dominantly caused by the prismatic dislocations slip and does not influence twin back stress which is identical to pure elastic twin. The twin with larger lateral dimension requires lower equilibrium stress which suggests anisotropic twin propagation and increased thickness of such twins. The lateral twin propagation is mostly influenced by prismatic and pyramidal slip in the twin vicinity. The twin thickness can reach a maximal level that is driven by the critical resolved shear stress values for dislocation slip with the significant influence of basal slip. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to confirm the findings reported by Kim et al. They stated that the tumor's distance to the base of the skull was predictive of injury to the cranial nerves and their branches during carotid body tumor resection in an Austrian cohort. In the present retrospective observational trial, we included all consecutive patients who had been discharged from our tertiary care teaching hospital with the diagnosis of a carotid body tumor (CBT) between January 2004 and December 2019. Tumor-specific parameters were measured from the preoperative contrast-enhanced computed tomography or magnetic resonance imaging studies. Patient-specific data were obtained from the patients' medical records. The effect of these parameters on the occurrence of cranial nerve injuries was calculated using univariate logistic regression analysis. Parameters significant on univariate analysis were included in a multivariate model. A total of 48 CBTs had been resected in 43 patients (29 women [67.4%] and 14 men [32.6%]), with a mean age of 55.6 years (95% confidence interval, 51.8-58.5). The mean distance to the base of the skull was 43.2 mm (95% confidence interval, 39.9-46.5). A total of 18 injuries to the cranial nerves and their branches in 10 CBTs were detected. The tumor-specific parameters that were significant on univariate analysis were the distance to the base of the skull (P =.009), craniocaudal tumor diameter (P =.027), and tumor volume (P =.036). Stepwise multivariate logistic regression analysis revealed that the distance to the base of the skull was the only parameter that remained statistically significant. We found that the distance to the base of the skull is a highly predictive parameter for injuries to the cranial nerves and their branches during CBT resection and should be included in the surgical risk assessment and patient information. [ABSTRACT FROM AUTHOR]

The process of assigning bugs to particular programmers is called bug assignment in software engineering. The programmer can fix the bugs by applying their knowledge. This research article presents an Ant colony optimization-based programmer recommendation model (ProRE) to manage software bugs precisely. The proposed ProRE model performs four operations: data pre-processing, i.e., data Pre-processing, extraction, feature selection, and programmer recommendation process. The feature selection stage utilized the Ant colony optimization (ACO) method to determine the appropriate subsets of features from all features. In the programmer recommendation stages, three programmer metrics, i.e., functionality ranking, bug occurrence, and mean Bug fixing time, are utilized for the recommendation assignment. The effectiveness of the proposed programmer recommendation system is assessed using datasets from Mozilla, Eclipse, Firefox, JBoss, and OpenFOAM. It is noted that the proposed model offers a better recommendation strategy over the other available systems. The simulation findings of the proposed ProRE model are also analyzed with well-known available ML methods, i.e., SVM, NB, and C4.5. It is observed that the recommendation results have improved by an average of 4%, 10%, and 12% compared to SVM, C4.5, and NB-based models. Programmer recommendation software is implemented for allocating the bugs to accurate programmers. It has been found that the proposed ProRE model generates more optimistic outcomes than existing ones. [ABSTRACT FROM AUTHOR]

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To evaluate the intraoperative visual effect of treatment with GnRH-analogues and Dienogest in endometriosis. Retrospective observational study. Every laparoscopy from all the different disciplines in our hospital is documented on video and stored in a database. The study was approved by the local ethics committee. A total of 193 patients with histological proven endometriosis from 2007 to 2021 were included, who underwent 2-step surgical procedure. Indications were endometrioma before CO2-Laser therapy, missing consent because of emergencies or other surgeries from other disciplines, or high active and extended disease. When endometriosis was suspected in a surgery conducted by other disciplines, a gynecological surgeon was called during the surgery. Data and intraoperative videos were reviewed by 2 independent reviewers at one referral center. Only cases with available video of first and second look laparoscopy were included. We excluded patient who had prior hormonal treatment in the last 6 months. Lesions were classified according to the description of Khan et al. Statistical analysis was performed using SPSS (Version 27.0, IBM). Mann-Whitney U test (nonparametric analysis) and χ2 tests were applied. Percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. Significance level was set to p <.05. Seventy-seven received GnRH-analogues and 116 Dienogest for preoperative hormone down-regulation. The median duration of down-regulation with GnRH-analogues or Dienogest was 3 months. The mean age was 32.3 (SD 6.3) years for GnRH-analogues and 32.6 (SD 6.3) years for Dienogest, p =.619 respectively. The visible intraoperative effect will be demonstrated in the video. The effect of a hormonal treatment can be observed macroscopically in endometriosis. This can help to understand the in vivo response to the administrated treatment. This video is showing our past experience, as performing second-look laparoscopy is not state of the art anymore. [Display omitted] [ABSTRACT FROM AUTHOR]

Although the significance of red deer (Cervus elaphus) and roe deer (Capreolus capreolus) as hosts and their role in the circulation of vector-borne pathogens in Europe is well described, the trypanosomes of moose (Alces alces) are poorly known. As heat sensitive ungulates, moose might be especially vulnerable to the effects of climate change and the associated rise in parasite pressure. Therefore, the aim of our study was to determine the prevalence of trypanosomes in moose in Poland, this being one of the largest populations in Central Europe since the 2001 hunting ban. Molecular analysis revealed the presence of Megatrypanum trypanosomes in almost half of the studied moose. As the population of moose in Central Europe has been recently growing, it is crucial to determine their role in the circulation of vector-borne pathogens in environment. This is the first study of the detection and molecular identification of Trypanosoma theileri complex in moose in central Europe. [Display omitted] • Morphological and molecular identification of Trypanosoma sp. in European moose. • Two trypanosomes haplotypes belonging to the genus Megatrypanum. • Similarity of sequences to trypanosomes isolated from cervids and tabanids. [ABSTRACT FROM AUTHOR]

Preoperative total shoulder arthroplasty (TSA) planning tools use a three-dimensional (3D) model of the full scapula based on computed tomography (CT) images with a scan length covering the complete scapula with a given radiation exposure for patients. The aim of this study is to investigate whether full scapular models can be reconstructed from partial CT data. In this retrospective cohort study, bone models representing 5 scan lengths with decreasing levels of scapular coverage (level 1-5) were created. All the models were reconstructed with a validated statistical shape model (SSM) allowing automatic 3D measurements of glenoid version, inclination, scapular offset, and center point position. Radiation exposure between 2 patient groups (group 1 = corresponding to L1, group 2 = complete scapula) was compared. In terms of inclination and version, we found a mean absolute difference between the complete model and the different partial scan models of 0.5° (SD 0.4°). The maximum difference was 3° for inclination and 2° for version. For scapular offset and center point position, the mean difference was 0 mm (max 1 mm). The mean radiation exposure was 4 mSv (SD 2 mSv) for group 1 and 13 mSv (SD 6 mSv) for group 2 (P =.009). An SSM-based reconstruction technique can accurately reconstruct complete scapular bone models based on partial CT scan data. Incorporation of an SSM-based reconstruction technique in software tools for preoperative TSA planning would lead to decreased radiation exposure (9 mSv) for patients without influencing its accuracy. [ABSTRACT FROM AUTHOR]

Objective: Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures.Methods: This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively.Results: We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality.Conclusions: Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted. [ABSTRACT FROM AUTHOR]

Aim: To examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not.Methods: This retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws).Results: No differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64-47%, P < 0.001), eye fundus check-ups (39-37%, P = NS), neurologist check-ups (28-25%, P = NS) and FMP check-ups (382-321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7-2.4 mmol/L, P < 0.001) and eGFR (83-80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period.Conclusion: According to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters. [ABSTRACT FROM AUTHOR]

The presence of autoreactive antibodies is a hallmark of many autoimmune diseases. The effector functions of (auto)antibodies are determined by their constant domain, which defines the antibody isotype and subclass. The most prevalent isotype in serum is IgG, which is often the only isotype used in diagnostic testing. Nevertheless, autoantibody responses can have their own unique isotype/subclass profile. Because comparing autoantibody isotype profiles may yield new insights into disease pathophysiology, here we summarize the isotype/subclass profiles of the most prominent autoantibodies. Despite substantial variation between (and within) autoantibody responses, this unprecedented comparison shows that autoantibodies share distinctive isotype patterns across different diseases. Although most autoantibody responses are dominated by IgG (and mainly IgG1), several specific diseases are characterized by a predominance of IgG4. In other diseases, IgE plays a key role. Importantly, shared features of autoantibody isotype/subclass profiles are seen in clinically unrelated diseases, suggesting potentially common trajectories in response evolution, disease pathogenesis, and treatment response. Isotypes beyond IgG are scarcely investigated in many autoantibody responses, leaving substantial gaps in our understanding of the pathophysiology of autoimmune diseases. Future research should address isotype/subclass profiling in more detail and incorporate autoantibody measurements beyond total IgG in disease models and clinical studies. [ABSTRACT FROM AUTHOR]