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Across a broad set of applications, system outcomes may be summarized as probabilities in confusion or contingency tables. In settings with more than two outcomes (e.g., stages of cancer), these outcomes represent multinomial experiments. Measures to summarize system performance have been presented as linear combinations of the resulting multinomial probabilities. Statistical inference on the linear combination of multinomial probabilities has been focused on large-sample and parametric settings and not small-sample settings. Such inference is valuable, however, especially in settings such as those resulting from pilot or low-cost studies. To address this gap, we leverage the fiducial approach to derive confidence intervals around the linear combination of multinomial parameters with desirable frequentist properties. One of the original arguments against the fiducial approach was its inability to extend to multiparameter settings. Therefore, the great novelty of this work is both the derived interval and the logical framework for applying the fiducial approach in multiparameter settings. Through simulation, we demonstrate that the proposed method maintains a minimum coverage of 1 - α $1 - \alpha$ , unlike the bootstrap and large-sample methods, at comparable interval lengths. Finally, we illustrate its use in a medical problem of selecting classifiers for diagnosing chronic allograph nephropathy in postkidney transplant patients., (© 2023 Wiley-VCH GmbH. This article has been contributed to by U.S.)

Researchers can generate bootstrap confidence intervals for some statistics in SPSS using the BOOTSTRAP command. However, this command can only be applied to selected procedures, and only to selected statistics in these procedures. We developed an extension command and prepared some sample syntax files based on existing approaches from the Internet to illustrate how researchers can (a) generate a large number of nonparametric bootstrap samples, (b) do desired analysis on all these samples, and (c) form the bootstrap confidence intervals for selected statistics using the OMS commands. We developed these tools to help researchers apply nonparametric bootstrapping to any statistics for which this method is appropriate, including statistics derived from other statistics, such as standardized effect size measures computed from the t test results. We also discussed how researchers can extend the tools for other statistics and scenarios they encounter., (© 2022. The Psychonomic Society, Inc.)

Missing data is a common occurrence in mediation analysis. As a result, the methods used to construct confidence intervals around the indirect effect should consider missing data. Previous research has demonstrated that, for the indirect effect in data with complete cases, the Monte Carlo method performs as well as nonparametric bootstrap confidence intervals (see MacKinnon et al., Multivariate Behavioral Research, 39(1), 99-128, 2004; Preacher & Selig, Communication Methods and Measures, 6(2), 77-98, 2012; Tofighi & MacKinnon, Structural Equation Modeling: A Multidisciplinary Journal, 23(2), 194-205, 2015). In this manuscript, we propose a simple, fast, and accurate two-step approach for generating confidence intervals for the indirect effect, in the presence of missing data, based on the Monte Carlo method. In the first step, an appropriate method, for example, full-information maximum likelihood or multiple imputation, is used to estimate the parameters and their corresponding sampling variance-covariance matrix in a mediation model. In the second step, the sampling distribution of the indirect effect is simulated using estimates from the first step. A confidence interval is constructed from the resulting sampling distribution. A simulation study with various conditions is presented. Implications of the results for applied research are discussed., (© 2023. The Psychonomic Society, Inc.)

Whenever statistical analyses are applied to multiply imputed datasets, specific formulas are needed to combine the results into one overall analysis, also called combination rules. In the context of regression analysis, combination rules for the unstandardized regression coefficients, the t-tests of the regression coefficients, and the F-tests for testing [Formula: see text] for significance have long been established. However, there is still no general agreement on how to combine the point estimators of [Formula: see text] in multiple regression applied to multiply imputed datasets. Additionally, no combination rules for standardized regression coefficients and their confidence intervals seem to have been developed at all. In the current article, two sets of combination rules for the standardized regression coefficients and their confidence intervals are proposed, and their statistical properties are discussed. Additionally, two improved point estimators of [Formula: see text] in multiply imputed data are proposed, which in their computation use the pooled standardized regression coefficients. Simulations show that the proposed pooled standardized coefficients produce only small bias and that their 95% confidence intervals produce coverage close to the theoretical 95%. Furthermore, the simulations show that the newly proposed pooled estimates for [Formula: see text] are less biased than two earlier proposed pooled estimates.

The goal in stratified medicine is to administer the "best" treatment to a patient. Not all patients might benefit from the same treatment; the choice of best treatment can depend on certain patient characteristics. In this article, it is assumed that a time-to-event outcome is considered as a patient-relevant outcome and a qualitative interaction between a continuous covariate and treatment exists, ie, that patients with different values of one specific covariate should be treated differently. We suggest and investigate different methods for confidence interval estimation for the covariate value, where the treatment recommendation should be changed based on data collected in a randomized clinical trial. An adaptation of Fieller's theorem, the delta method, and different bootstrap approaches (normal, percentile-based, wild bootstrap) are investigated and compared in a simulation study. Extensions to multivariable problems are presented and evaluated. We observed appropriate confidence interval coverage following Fieller's theorem irrespective of sample size but at the cost of very wide or even infinite confidence intervals. The delta method and the wild bootstrap approach provided the smallest intervals but inadequate coverage for small to moderate event numbers, also depending on the location of the true changepoint. For the percentile-based bootstrap, wide intervals were observed, and it was slightly conservative regarding coverage, whereas the normal bootstrap did not provide acceptable results for many scenarios. The described methods were also applied to data from a randomized clinical trial comparing two treatments for patients with symptomatic, severe carotid artery stenosis, considering patient's age as predictive marker., (© 2019 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.)

We propose two measures of performance for a confidence interval for a binomial proportion p: the root mean squared error and the mean absolute deviation. We also devise a confidence interval for p based on the actual coverage function that combines several existing approximate confidence intervals. This "Ensemble" confidence interval has improved statistical properties over the constituent confidence intervals. Software in an R package, which can be used in devising and assessing these confidence intervals, is available on CRAN., (© 2019 John Wiley & Sons, Ltd.)

Background: Erbium lasers safely offer the possibility of reuse for debonded restorations. Since these lasers have a high affinity for water molecules, they are absorbed by resin cement causing explosive ablation of the cement and thus, the restoration debonds. The efficiency of this process depends on many factors, including the ceramic type, its chemical composition and thickness. Therefore, this study was designed to test the time taken to debond ultrathin occlusal veneers made of three types of milled ceramic materials and evaluate the integrity of these restorations after debonding. Methods: Three ceramic types were evaluated in this study: lithium disilicate (IPS Emax CAD), highly condensed lithium disilicate (GC initial®LiSi), and translucent zirconia (Katana zirconia STML). Each group consisted of 8 occlusal veneers of 0.5 mm thickness. The samples were cemented to the occlusal surfaces of the upper molar teeth. An Er; Cr: YSGG laser was applied to the occlusal veneers using the scanning method, and time until debonding was calculated. The debonded samples were then inspected under a stereomicroscope for possible damage. Numerical data are presented as the mean with 95% confidence interval (CI), standard deviation (SD), minimum (min.) and maximum (max.) values. Normality and variance homogeneity assumptions were confirmed using Shapiro-Wilk's and Levene's tests, respectively. Data were normally distributed and were analyzed using one-way ANOVA followed by Tukey's post hoc test. The significance level was set at p < 0.05 for all tests. Statistical analysis was performed with R statistical analysis software version 4.3.2 for Windows (R Core Team (2023). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/). Results: There was no significant difference in debonding time between the different materials (p = 0.995). The longest debonding time was found for Katana STML (87.52 ± 20.45) (seconds), followed by Emax (86.94 ± 20.63) (seconds), while the lowest value was found for LiSi initial (86.14 ± 25.16) (seconds). In terms of damage to the debonded veneers, The Emax and zirconia samples showed no damage. However, 40% of the LiSi samples fractured during debonding, and 20% exhibited cracks. Only 40% of the LiSi samples were sound after debonding. Conclusion: Er; Cr: YSGG laser can be used efficiently to remove ceramic occlusal veneers. However, its effect on LiSi restorations needs further research. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to predict adolescents with untreated dental caries through a machine-learning approach using three different algorithms Methods: Data came from an epidemiological survey in the five largest cities in Mato Grosso do Sul, Brazil. Data on sociodemographic characteristics, consumption of unhealthy foods and behaviours (use of dental floss and toothbrushing) were collected using Sisson's theoretical model, in 615 adolescents. For the machine learning, three different algorithms were used: (1) XGboost; (2) decision tree and (3) logistic regression. The epidemiological baseline was used to train and test predictions to detect individuals with untreated dental caries, through eight main predictor variables. Analyzes were performed using the R software (R Foundation for Statistical Computing, Vienna, Austria). The Ethics Committee approved the study.. Results: For the 615 adolescents, xgboost performed better with an area under the curve (AUC) of 84% versus 81% for the decision tree algorithm. The most important variables were the use of dental floss, unhealthy food consumption, self-declared race and exposure to fluoridated water. Conclusions: Family health teams can improve the work process and use artificial intelligence mechanisms to predict adolescents with untreated dental caries, and, in this way, schedule dental appointments for the treatment of adolescents earlier. [ABSTRACT FROM AUTHOR]

Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD—25.80 [min]; 95% − 34.31– − 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week. [ABSTRACT FROM AUTHOR]

Heat and tropospheric ozone have acute impacts on rates of premature death. Warm temperatures affect the photochemical processes in ozone formation, suggesting ozone as a mediator of the acute health effect of heat on mortality. We assembled a summertime daily time-series data set of 15 French urban areas during 2000–2015 to decompose the acute total effect of heat waves on mortality into natural direct and indirect effects using a regression-based product method under the potential outcomes framework. For each area, we estimated the effect of heat waves on mortality using a quasi-Poisson model with adjustment for covariates such as lagged nitrogen dioxide concentration, and we modeled ozone with a linear regression of heat waves and the same set of covariates. We pooled estimates across areas using random-effects models. We also provide R software code (R Foundation for Statistical Computing, Vienna, Austria) with which to reproduce or replicate our analysis. Most areas demonstrated evidence of mediation by ozone, with the pooled relative risks for natural indirect effects being 1.03 (95% confidence interval (CI): 1.02, 1.05), 1.03 (95% CI: 1.01, 1.04), and 1.04 (95% CI: 1.00, 1.07) for nonaccidental, cardiovascular, and respiratory mortality, respectively. We found evidence of a mediation effect by ozone in the association between heat waves and mortality in France which varied by geographic location and cause of mortality. [ABSTRACT FROM AUTHOR]

Background: Depression in patients with cancer is frequently underestimated and causes major suffering to patients and families. This study purposed to determine the prevalence of, and factors associated with, depressive symptoms among Thai patients with cancer receiving radiotherapy. The results could promote and optimize the quality of life for patients with cancer. Methods: A cross-sectional study explored outpatients with cancer at Songklanagarind Hospital; from May to July 2022. The questionnaires inquired about: (1) demographic and personal data, (2) The Patient Health Questionnaire-9 (PHQ-9) Thai version, (3) Verbal Numerical Rating Scale (VNRS), and (4) The meaning in life questionnaire (MLQ). Patient demographics and depressive symptoms were analyzed using the descriptive statistic method and reported as: proportion, frequency, median and interquartile range (IQR). The analysis of the association between independent variables and depressive symptoms was conducted using multiple logistic regression, and performed by R Foundation for Statistical Computing version 4.1.2. All confidence intervals (CIs) were calculated at the 2-sided, 95% level. Results: There were 113 Thai outpatients with cancer who participated in this study. The majority of them were female (61.1%), and the overall mean age was 56.2 ± 13.6 years. The participants' cancer staging was stage 2 and 3 (31.0%, and 32.7%, respectively). No participants had experienced major depression (PHQ-9 score of nine or greater), and all of them were mild (23.0%) or no/minimal depression (77.0%). Fifty-four participants (47.8%) were free of pain, with half of them (50.4%) having insomnia. Most of them had a high score in all subparts of meaning in life. The factors associated with mild depression were the history of hospitalization, the perception of one's health, the presence of physical symptoms, and pain. Conclusion: In this study, all cancer participants who received radiotherapy had either no/minimal or mild depression. No participants had major depression. Most participants had meaning in their life; however, over half of them still experienced pain and insomnia. To optimize the quality of life, and prevent depression, physical symptoms, and pain should ensure they receive adequate management. Additionally, feeling meaningful in life, and satisfaction in one's health should also be promoted. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. Objective: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. Methods: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. Results: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). Conclusions: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To review experimental peri-implantitis studies using rat models and summarize different peri-implantitis induction techniques and evaluate their effectiveness. Materials and Methods: Electronic searches were conducted by two independent examiners to address the following issues. Meta-analyses explored the marginal bone loss (MBL) of four types of peri-implantitis induction methods in rats. The detailed induction tactics--such as the implant design, implant size, surgical process, time cost, induction methods, and endpoint measurements--were summarized. Results: Of the 18 included studies, 38.9% of the studies placed implants at the maxillary first molar, and 44.4% placed them at the alveolar ridge region anterior to the maxillary first molar. As for the induction method, the numbers of published studies on ligature methods, bacterial inoculation, and bacterial lipopolysaccharide inoculation were equally high among all selected studies. The total implant survival rate at the end was 160 out of 213 implants (75.11%). Eight studies with high pooled heterogeneity (I2 = 98, P < .01) in the meta-analysis reported an overall MBL (µ-CT) of 0.47 mm (95% CI = 0.14 to 0.81). A subgroup analysis estimated an MBL of 0.31 mm (95% CI = 0.12 to 0.50) for bacterial inoculation and 0.66 mm (95% CI = 0.07 to 1.26) for the ligature method. Histopathologic analysis revealed that peri-implantitis in rats was similar to peri-implantitis lesions in humans. Conclusions: Implant placement at the maxillary first molar with bacterial inoculation and the silk ligature method to build peri-implantitis rat models is reliable to use for research on peri-implantitis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this longitudinal investigation was to compare the developmental trajectories of code-related emergent literacy skills of children who are deaf and hard of hearing (DHH) who use amplification and spoken language across the preschool years. Method: Thirty children who are DHH and 31 children with typical hearing completed a language and emergent literacy assessment at 6-month intervals from age 4 through 6 years. Growth curve analysis was used to compare developmental trajectories between groups of the code-related skills of phonological awareness, phonological memory, phonological recoding, alphabet knowledge, and conceptual print knowledge. Results: Growth across the preschool years was observed on all code-related emergent literacy skills across groups. Children who are DHH scored consistently lower than children with typical hearing on phonological awareness, phonological memory, and conceptual print knowledge; no group differences were observed for phonological recoding or alphabet knowledge. No interactions of time and group were significant. Conclusions: Children who are DHH exhibit consistent deficits in phonological awareness, phonological memory, and conceptual print knowledge across the preschool years and begin formal literacy instruction with a weaker foundation in emergent literacy skills. Future work should focus on optimizing emergent literacy interventions for children who are DHH during the preschool years. [ABSTRACT FROM AUTHOR]

Purpose: To assess the implant survival rate in mandibles reconstructed with free fibula flap after oral tumor resection after 1 year of prosthetic loading. A secondary objective was to compare immediate or delayed implant placement protocols in this population. Materials and Methods: Electronic and manual searches were performed on different databases for controlled and prospective trials that indicated implant survival rate. This systematic review followed PRISMA guidelines. Risk of bias was evaluated using Cochrane Collaboration tools. Meta-analyses heterogeneity source assessment and GRADE evaluation were performed among studies with identical follow-ups. Results: Among 305 primarily selected articles, 109 were eligible after reading the title and abstract, and 8 were included after full-text reading: 2 randomized controlled trials and 6 prospective studies comprising 140 patients and 507 implants. Meta-analyses estimated an overall survival rate of 97% (95% CI: 94% to 99%) after 1 year of prosthetic loading. The survival rate was 98% (95% CI: 94% to 100%) with immediate implantation and 97% (95% CI: 90% to 99%) with delayed implantation. Only 3 studies reported radiotherapy treatment, with no real impact on implant survival rate. Overall, 69% of tumors were benign. Conclusions: Implant placement in vascularized fibula flaps in the mandible is recommended for patients undergoing segmental mandibular reconstruction after tumor resection. Within the limitations of this study, no significant difference in survival rates was found between immediate and delayed implant placement. [ABSTRACT FROM AUTHOR]

Purpose: To assess the quality of the available evidence on the effect of exercise for the improvement of lung function in healthy children and adolescents. Method: We performed a systematic review and meta-analysis of intervention studies examining the effects of regular exercise on spirometric parameters of healthy children and adolescents aged ≤18 years. Results: Within the exercise groups, there were significant improvements in forced vital capacity (mean difference: 0.17 L; 95% confidence interval, 0.07 to 0.26; P <.05) and forced expiratory volume in the first second (mean difference: 0.14 L; 95% confidence interval, 0.06 to 0.22; P <.05). Results were consistent across different age groups and duration of interventions. In the between-group analysis, forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow were higher in the exercise group compared with the nonexercise group, but the differences did not reach statistical relevance. There was significant statistical heterogeneity between studies. Conclusion: Regular exercise has the potential to improve lung function parameters in healthy children and adolescents; however, the small number of studies and the heterogeneity between them raise concern about the quality of the currently available evidence. These findings bring to attention the need for well-designed trials addressing this important public health issue. [ABSTRACT FROM AUTHOR]

Purpose: To gain knowledge on the beliefs and practices of football practitioners applying high-speed and sprint running exposure programming strategies. Methods: One hundred two football practitioners from 22 different countries participated in a study consisting of a survey including 5 domains: demographic and professional characteristics (Who); importance of high-speed and sprint running exposure for physical-capability development, preparation for competition, and injury-prevention strategies (Why); exposure timing (When); methodological procedures for exposure monitoring and training scheduling (What); and effectiveness of common training practices (How). Data were analyzed using a combination of descriptive statistics, generalized mixed effects, and multinomial logistic regression models. Results: Data revealed 5 main findings: (1) overall agreement on the importance of exposure for physical-capability development, preparation for competition, and injury-prevention strategies; (2) different exposure timing and selective training scheduling for starting and nonstarting players across typical and congested weeks; (3) lack of consensus on the conceptual constructs defining high-speed and sprint running metrics and the methodological procedures used for monitoring; (4) a probable association between match-related outcomes and exposure strategies used in training; and (5) a broad range of training methods considered effective to elicit exposure. Conclusions: This study provides actionable insights into the planning, implementing, and monitoring strategies for high-speed and sprint running exposure in football. While some conform with the evidence on high-speed and sprint running training in football, further research and professional debate are warranted to develop empirical knowledge and provide pragmatic recommendations to help practitioners in adopting evidence-informed decisions. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have raised the possibility of preserved language comprehension in children with developmental language disorder (DLD) in online tasks and within simple sentence structures. Consequently, we evaluated the capacity of children with DLD to comprehend verbal number agreement in simple sentence structures (i.e., verb–object–subject and verb–subject). Method: Using an eye-tracking methodology, we conducted two psycholinguistic experiments with 96 Spanish- and Catalan-speaking participants. The sample was distributed into four groups: 24 children with DLD (age range: 4;6–12;6 [years;months]; average age = 7;8 [years;months]), 24 children with the same chronological age (4;6–12;2, 7;8), 24 children with the same linguistic level (4;6–9;4, 6;8), and 24 university students as language experts (18–30, 22;5). Results: The experimental data indicate that children with DLD can comprehend verbal number agreement at least under the present experimental conditions. Conclusion: The empirical outcomes suggest that number morphology comprehension by children with DLD might be more typical than what it is generally considered to be. [ABSTRACT FROM AUTHOR]

Background: The cost-effectiveness of NALIRIFOX as a potential new standard of care for patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) has yet to be established. Our objective was to evaluate the cost-effectiveness of NALIRIFOX vs. nab-paclitaxel and gemcitabine in this indication from the perspective of U.S. public payers. Methods: A partitioned survival model was constructed from the perspective of U.S. public payers, drawing on baseline patient characteristics and vital clinical data from the NAPOLI-3 trial. Costs and utilities were sourced from publicly accessible databases and literature. A lifetime horizon was applied, with an annual discount rate of 3%. We calculated and compared cumulative costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). To evaluate the model's robustness, sensitivity analyses, scenario analyses, and subgroup analyses were carried out. Additionally, a price simulation for the costly liposomal irinotecan was conducted to inform the pricing strategy at the given willingness to pay (WTP) threshold. Results: In the base-case analysis, NALIRIFOX provided an additional 0.29 QALYs with an ICER of $206,340.69 /QALY compared to nab-paclitaxel and gemcitabine, indicating it is not cost-effective at a $150,000/QALY threshold. Sensitivity analysis showed the model was most sensitive to the costs of liposomal irinotecan, capecitabine, and post-progression care. Probabilistic sensitivity analysis indicated a 17.66% probability of NALIRIFOX being cost-effective at $150,000/QALY, rising to 47.48% at $200,000/QALY. Pricing simulations suggested NALIRIFOX could become cost-effective at $150,000/QALY if the price of irinotecan liposome drops to $53.24/mg (a 14.8% reduction). Conclusions: NALIRIFOX may not be cost-effective at its current price as a first-line treatment for patients with mPDAC in the long term. The cost of liposomal irinotecan has the greatest impact. It may become cost-effective only if its cost is reduced by 14.8%, with a WTP threshold of $150,000 /QALY. [ABSTRACT FROM AUTHOR]

Background: Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session. Methods: In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation. Results: In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014). Conclusions: A lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients. [ABSTRACT FROM AUTHOR]

Background: In spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient's outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery. Methods: We retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications. Results: A total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events. Conclusions: This study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient's safety, without compromising the technical achievement of the procedure. [ABSTRACT FROM AUTHOR]

Background: We aimed to use lactate dehydrogenase (LDH) as a marker of inflammation burden and quantify post-stroke inflammation's direct and indirect effect on functional disability. Methods: We analyzed 5,129 patients with acute ischemic stroke (AIS) admitted to Shenyang First People's Hospital. Stroke recurrence and functional outcome measured by the modified Rankin Scale (mRS) were assessed at 90 days. Functional disability was defined as mRS score > 2. Receiver operating characteristic curve and restricted cubic spline (RCS) analysis were conducted to illustrate the associations between LDH levels and 90-day functional outcomes in patients with AIS. Mediation analyses were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between LDH and functional outcome. Positive correlation between LDH and hs-CRP was found and mediation effects of stroke recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Results: Among 5,129 included AIS patients, the median (IQR) level of LDH was 186 (161-204.4) U/L. Functional disability was seen in 1200 (23.4%) patients and recurrence was observed in 371(7.2%) patients at 90-day follow-up. Each standard deviation increase in the concentration of LDH was linked to an increased risk of functional disability (adjusted odds ratio[aOR], 1.07; 95%CI,1.04-1.09) and stroke recurrence (aOR,1.02; 95%CI, 1.01-1.04) within 90 days. The highest quartile of LDH (>204.2 U/L) had an elevated risk of suffering functional disability (aOR, 1.21; 95%CI, 1.00-1.47) and recurrence (aOR, 1.21; 95%CI,1.00-1.47) compared with the lowest quartile of LDH (<161 U/L). Stroke recurrence during follow-up explained 12.90% (95%CI, 6.22-21.16%) of the relationship between LDH and functional disability. Positive correlation between LDH and hs-CRP was found and mediation effects of recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Conclusion: The relationship between LDH and functional disability at 90 days among AIS patients is partially mediated by stroke recurrence, accounting for less than 20%. LDH deserves equal attention as hs-CRP in predicting recurrence and functional outcome. In addition to traditional secondary prevention measures, innovative anti-inflammatory strategies warrant further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Increasing evidence suggests that air pollution has a significant impact on the development of synucleinopathies, but the potential neurobiological mechanisms are unknown. We aimed to explore the associations of air pollution (including ozone [O3], nitrogen dioxide [NO2], and particulate matter [PM2.5]) with CSF α-syn levels in urban older adults. Methods: We included 933 urban participants from the Chinese Alzheimer's Biomarker and LifestylE study. The 5-year average levels of air pollution exposure were estimated in the areas of residence. Multivariate linear regression was conducted to detect the correlation of air pollution with CSF α-syn levels. Subgroup analyses by age, gender, season, and history of coronary heart disease (CHD) were performed. Moreover, restricted cubic spline (RCS) models were applied to explore the potential nonlinear relationships. Results: We found a significant correlation of CSF α-syn level with PM2.5 in urban participants. Specifically, multiple linear regression showed a significant negative association between PM2.5 and CSF α-syn level (p = 0.029), which was more significant in female, midlife, non-CHD, and cold season subgroups. Besides, RCS models showed that O3 had an inverse J-shaped association with CSF α-syn levels in urban participants (p for nonlinearity = 0.040), and the harmful effect possibly appeared when O3 was above 37.9 ppb. Discussion: Long-term exposure to air pollution was associated with lower CSF α-syn levels, which may offer a new direction for exploring and preventing synucleinopathies. [ABSTRACT FROM AUTHOR]

Background: As a novel and time-efficient exercise form, high-intensity interval training (HIIT) has shown great potential in improving health-related physical fitness among diverse populations. However, empirical evidence on its efficacy among the elderly has not been well summarized. This systematic review and meta-analysis aimed to determine the effect of HIIT interventions on the parameters related to physical fitness and health of older adults, including resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiorespiratory fitness (CRF), body mass index (BMI), body fat percent (BF%), waist circumference (WC), muscular endurance (ME), muscular strength (MS), muscular power (MP), balance and flexibility, compared to non-exercise and other-exercise (e.g., moderate-intensity continuous training, resistance training) conditions. Methods: Literature published from January 2000 to May 2023 was collected through extensive searches across eight databases and relevant review papers. Randomized controlled trials (RCTs) featuring a minimum 2-week exercise intervention for older adults (≥ 60 years) were included. The pooled effect size of Hedges'g was estimated using random-effects models in R. Meta-regression was performed for both categorical (health status, duration of training programme, and frequency) and continuous moderators (mean age, male rate, and attrition rate). Results: Forty-four eligible RCTs with 1863 participants (52.1% female; 60.5–81.2 years) were included in the quantitative analysis. Compared to non-exercise condition, HIIT significantly improved resting HR (g = -0.36, 95%CI = [-0.67, -0.05], P = 0.032), SBP (g = -0.29, 95%CI = [-0.54, -0.03], P = 0.008), CRF (g = 0.77, 95%CI = [0.51, 1.04], P < 0.001), BF% (g = -0.26, 95%CI = [-0.41, -0.11], P = 0.006), MS (g = 0.47, 95%CI = [0.23, 0.71], P = 0.004), ME (g = 0.65, 95%CI = [0.10, 1.19], P = 0.036), and balance (e.g., timed-up-and-go) (g = -0.79, 95%CI = [-1.19, -0.40], P = 0.035). Compared to other-exercise condition, HIIT significantly improved resting HR (g = -0.11, 95%CI = [-0.21, -0.01], P = 0.029), SBP (g = -0.14, 95%CI = [-0.28, -0.01], P = 0.038), and CRF (g = 0.23, 95%CI = [0.07, 0.38], P = 0.008). No significant difference was found between HIIT and non-exercise condition for DBP, BMI and WC, as well as between HIIT and other-exercise condition for DBP, BMI, BF%, WC, ME, and balance (all P > 0.05). Meta-regression indicated that mean age moderated the HIIT effect on resting HR (b = -0.02, P = 0.014; HIIT vs. other-exercise condition) and SBP (b = 0.03, P = 0.048; HIIT vs. non-exercise), and attrition rate moderated the effect on CRF (b = 0.03, P = 0.007; HIIT vs. non-exercise). Conclusion: This study supports the efficacy of HIIT in improving resting HR, SBP, CRF, BF%, MS, ME and balance among older adults. More empirical evidence is needed to determine the efficacy of HIIT for MP and flexibility in this population. Trial Registration: PROSPERO CRD42022316246. Key Points: • HIIT is an effective approach for improving older adults' resting heart rate (HR), systolic blood pressure (SBP), cardiorespiratory fitness (CRF), body fat percent (BF%), muscular strength (MS), and balance, compared with non-exercise condition. • HIIT outperformed the other exercise interventions in improving older adults' resting HR, SBP, CRF, and muscular endurance (ME). • Mean age and attrition rate were identified as potential moderators for the HIIT effects on resting HR, SBP and CRF. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence has suggested that sleep disturbances and disorders are common in patients who undergo knee arthroplasty. Revision surgery represents one of the most catastrophic outcomes of knee arthroplasty. However, it remains unclear whether sleep traits are the causes or consequences of knee arthroplasty revision. This study aimed to genetically examine the relationships between sleep traits and knee arthroplasty revision. Methods: To determine the causal relationship between sleep traits and knee arthroplasty revision, we employed two-sample Mendelian randomization (MR) using summary statistics from the largest publicly available genome-wide association studies (GWASs). The MR design uses genetic variants as instrumental variables to help separate causal relationships from non-causal associations. The main analyses included an inverse variance weighted (IVW) meta-analysis to obtain primary effect estimates. Sensitivity analyses involving the weighted median approach and MR-Egger regression were also conducted to check for potential pleiotropic biases. Numerous complementary sensitivity analyses were also performed to identify statistically significant causal correlations when there were horizontal pleiotropy and heterogeneity across variants. Finally, a reverse MR analysis was performed to evaluate the possibility of reverse causation. Results: In the absence of heterogeneity and horizontal pleiotropy, the IVW method revealed that genetically-predicted short sleep duration short sleep duration (average sleep duration of 24 h is 6 h or less) was positively correlated with the risk of knee arthroplasty revision (odds ratio = 1.03, 95% confidence interval = 1.01–1.05, and P = 0.003), while the association between genetically-predicted long sleep duration and knee arthroplasty was negative. The reverse MR analysis did not yield evidence supporting reverse causality relation between knee arthroplasty revision and sleep phenotypes. Conclusion: This research indicated that, of the 10 sleep phenotypes we analyzed, only sleep duration was causally associated with knee arthroplasty revision. These discoveries added to the understanding of the role of sleep traits in the etiology of knee arthroplasty revision, which might further expand our insights into the prevention of knee arthroplasty revision. Highlights: 1. Genetically-predicted short sleep duration increases risk of knee arthroplasty revision. 2. Mendelian randomization used to analyze sleep traits and knee revision relationship. 3. Sleep duration causally linked to lower risk of knee arthroplasty revision. 4. No evidence found for reverse causality between knee revision and sleep traits. 5. Study enhances understanding of sleep's role in knee arthroplasty outcomes. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe salivary flow rate, subjective oral dryness and dental caries 5 years post haematopoietic cell transplantation (HCT). Methods: HCT survivors of a previous longitudinal observational cohort study in the Netherlands (the H-OME study) were invited to participate in this additional follow-up after 5 years (the HOME2 study). During the additional follow-up appointment, stimulated (SWS) and unstimulated whole saliva (UWS) was collected, participants rated subjective oral dryness on a 0 – 10 scale, and caries lesions were assessed. Furthermore, dental records, including treatments and radiographs, were requested for the 5 years preceding and the 5 years following transplantation. Paired t-tests were performed to determine changes in UWS and SWS flow rates and subjective oral dryness from pre-HCT, and to compare the number of caries-related dental treatments (restorations, endodontic treatments or extractions) before and after HCT. Hyposalivation of UWS (< 0.2 mL/min) and SWS (< 0.7 mL/min) at 3 and 12 months, was used to explore the predictive potential of hyposalivation on a high dental treatment need (> 3 treatments) over the 5 years post-HCT. Results: Five years post-HCT, 39 HCT survivors were included. The mean UWS flow rate was 0.36 mL/min (SD 0.26) and the mean SWS flow rate 1.02 (SD 0.57); survivors were diagnosed with a median of 0 dentine lesions (range 0 – 12) and 73% reported a subjective oral dryness score ≥ 1. Survivors underwent a median of 3 (range 0 – 20) dental treatments during the 5 years following transplantation. The mean difference in UWS 5 years post-HCT compared to pre-HCT was 0.03 (95% CI: -0.07 – 10.12), the mean difference for SWS was -0.18 (95% CI: -0.45 – 0.08) and for subjective oral dryness 1.2 (95% CI: 0.2 – 2.1). In the 5 years post-HCT, non-significantly more treatments were performed compared to the 5 years pre-HCT (mean difference: 0.5, 95%CI: -1.2 – 2.2). Seventy eight percent of patients with hyposalivation of SWS at 12 months had a high dental treatment need, compared with 38% with no hyposalivation. Conclusions: Five years post-HCT, mean UWS and SWS flow rates were not significantly different from pre-HCT levels but subjective oral dryness scores were elevated. [ABSTRACT FROM AUTHOR]

Background: The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain. Objectives: The aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI. Methods: For this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI < 98), and no risk (GNRI ≥ 98). Multivariate analysis was used to evaluate the relationship between GNRI and outcomes. Results: Patients with higher nutrition-related risk tended to be older, female, had lower blood pressure, lower body mass index, and more comorbidities. Multivariate analysis showed GNRI scores were associated with in-hospital mortality. (Major risk vs. No risk: OR, 95% CI: 1.90, 1.54–2.33, P < 0.001, P for trend < 0.001). Moreover, increased nutrition-related risk was negatively associated with the length of hospital stay (Coefficient: -0.033; P < 0.001) and the length of ICU stay (Coefficient: -0.108; P < 0.001). The association between GNRI scores and the risks of in-hospital mortality was consistent in all subgroups. Conclusions: GNRI serves as a significant nutrition assessment tool that is pivotal to predicting the prognosis of critically ill patients with AKI. [ABSTRACT FROM AUTHOR]

Background: The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. Methods: CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6–9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. Results: Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21–10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05–0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87–19.68) compared to those living closer (OR 1.43, 0.27–7.54). Conclusions: Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to determine the relationship between the perceptual measure of speech naturalness and objective measures of pitch, loudness, and rate control as a potential tool for assessment of ataxic dysarthria. Method: Twenty-seven participants with ataxia and 29 age- and sex-matched control participants completed the pitch glide and loudness step tasks drawn from the Frenchay Dysarthria Assessment-Second Edition (FDA-2) in addition to speech diadochokinetic (DDK) tasks. First, group differences were compared for pitch variability in the pitch glide task, loudness variability in the loudness step task, and syllable duration and speech rate in the DDK task. Then, these acoustic measures were compared with previously collected ratings of speech naturalness by speech-language pathology graduate students. Results: Robust group differences were measured for pitch variability and both DDK syllable duration and speech rate, indicating that the ataxia group had greater pitch variability, longer DDK syllable duration, and slower DDK speech rate than the control group. No group differences were measured for loudness variability. There were robust relationships between speech naturalness and pitch variability, DDK syllable duration, and DDK speech rate, but not for loudness variability. Conclusions: Objective acoustic measures of pitch variability in the FDA-2 pitch glide task and syllable duration and speech rate in the DDK task can be used to validate perceptual measures of speech naturalness. Overall, speechlanguage pathologists can incorporate both perceptual measures of speech naturalness and acoustic measures of pitch variability and DDK performance for a comprehensive evaluation of ataxic dysarthria. [ABSTRACT FROM AUTHOR]

Purpose: To understand how best to assess the language abilities of pretermborn children, this study: (a) compared preterm- and term-born children's language skills using standardized testing and language sample analysis (LSA), (b) investigated how executive function skills and the language sampling context respectively affect standardized test and LSA scores, and (c) examined the pattern of associations between standardized test and LSA scores among preterm-/term-born groups. Method: Twenty-five term-born and 23 preterm-born 2-year-old singletons were administered the language scales of the Bayley Scales of Infant and Toddler Development-Third Edition (receptive communication, expressive communication, language composite scores). Parent-child free-play recordings were used to quantify the (para)linguistic features of the children's speech. Executive function was measured via parent report. Results: The preterm-born group obtained significantly lower scores than the term-born group on all Bayley language measures (though differences were not consistently observed when using cutoff scores). Few preterm-term differences in LSA measures were found. The preterm-term differences in Bayley scores were not explained by between-group differences in executive function. Some preterm-term differences in LSA scores were moderated by the language sampling context. The preterm- and term-born groups exhibited different patterns of Bayley-LSA correlations. Conclusions: Preterm language difficulties were more apparent on standardized test than LSA scores. Nonetheless, the Bayley-LSA correlations indicate that poor test performance (linked with preterm birth) is associated with functional communication difficulties. The discussion outlines the complementary utility of standardized tests and LSA while acknowledging the limited utility of cutoff scores and the confounding influence of the language sampling context. [ABSTRACT FROM AUTHOR]

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascularity, which depends on the process of angiogenesis and affects tumour response to treatment. Our study explored the associations between DCE-MRI parameters and the expression of plasma angiogenic factors in human papilloma virus (HPV)-negative oropharyngeal cancer, as well as their predictive value for response to concurrent chemoradiotherapy (cCRT). Twenty-five patients with locally advanced HPV-negative oropharyngeal carcinoma were prospectively enrolled in the study. DCE-MRI and blood plasma sampling were conducted before cCRT, after receiving a radiation dose of 20 Gy, and after the completion of cCRT. Perfusion parameters ktrans, kep, Ve, initial area under the curve (iAUC) and plasma expression levels of angiogenic factors (vascular endothelial growth factor [VEGF], connective tissue growth factor [CTGF], platelet-derived growth factor [PDGF]-AB, angiogenin [ANG], endostatin [END] and thrombospondin-1 [THBS1]) were measured at each time-point. Patients were stratified into responders and non-responders based on clinical evaluation. Differences and correlations between measures were used to generate prognostic models for response prediction. Higher perfusion parameter ktrans and higher plasma VEGF levels successfully discriminated responders from non-responders across all measured time-points, whereas higher iAUC and higher plasma PDGF-AB levels were also discriminative at selected time points. Using early intra-treatment measurements of ktrans and VEGF, a predictive model was created with cut-off values of 0.259 min−1 for ktrans and 62.5 pg/mL for plasma VEGF. Early intra-treatment DCE-MRI parameter ktrans and plasma VEGF levels may be valuable early predictors of response to cCRT in HPV-negative oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Purpose: Automatic speech analysis (ASA) and automatic speech recognition systems are increasingly being used in the treatment of speech sound disorders (SSDs). When utilized as a home practice tool or in the absence of the clinician, the ASA system has the potential to facilitate treatment gains. However, the feedback accuracy of such systems varies, a factor that may impact these gains. The current research analyzes the feedback accuracy of a novel ASA algorithm (Amplio Learning Technologies), in comparison to clinician judgments. Method: A total of 3,584 consonant stimuli, produced by 395 American English-speaking children and adolescents with SSDs (age range: 4-18 years), were analyzed with respect to automatic classification of the ASA algorithm, clinician-ASA agreement, and interclinician agreement. Further analysis of results as related to phoneme acquisition categories (early-, middle-, and lateacquired phonemes) was conducted. Results: Agreement between clinicians and ASA classification for sounds produced accurately was above 80% for all phonemes, with some variation based on phoneme acquisition category (early, middle, late). This variation was also noted for ASA classification into acceptable, unacceptable, and unknown (which means no determination of phoneme accuracy) categories, as well as interclinician agreement. Clinician-ASA agreement was reduced for misarticulated sounds. Conclusions: The initial findings of Amplio's novel algorithm are promising for its potential use within the context of home practice, as it demonstrates high feedback accuracy for correctly produced sounds. Furthermore, complexity of sound influences consistency of perception, both by clinicians and by automated platforms, indicating variable performance of the ASA algorithm across phonemes. Taken together, the ASA algorithm may be effective in facilitating speech sound practice for children with SSDs, even in the absence of the clinician. [ABSTRACT FROM AUTHOR]

Muscle strength and power are important determinants of soldiers' performance in modern warfare. Here, we compare the efficacy of 22 weeks of whole-body resistance training with high load (HL, 10 repetitions maximum/RM) and low load (LL, 30RM) for developing maximal muscle strength and power, performance, and muscle mass in moderately trained cadets (20 ± 1 year, f; n = 5, m; n = 22). Outcome measures were assessed at baseline and at week 22, in addition to a mid-intervention assessment at week 10. Twenty-two weeks of HL led to greater increases in muscle strength (upper limb, Δ 10%, 95% CI [2.8, 17.1], p = 0.01; lower limb, Δ 9.9%, CI [1.1,18.6], p = 0.029), jump height (Δ 5.5%, CI [1.4,9.6], p = 0.011), and upper limb lean mass (Δ 5.2%, CI [1,9.4], p = 0.018) compared with LL. HL and LL led to similar changes in agility, muscle endurance performance, lower limb muscle mass, and cross-sectional area in m. vastus lateralis. For all variables, training-associated changes occurred primarily during the initial 10 weeks of the intervention, including the differential responses to HL and LL. In conclusion, although 22 weeks of HL led to greater increases in lower and upper limb muscle strength, power, and upper limb lean mass than LL, the 2 load conditions led to similar improvements in agility performance and lower limb muscle mass. Our results thus indicate that both loading regimes elicit multifaceted physiological improvements important for military readiness. [ABSTRACT FROM AUTHOR]

Background: This study aimed to conduct a meta-analysis to assess the differences in the performance of root coverage between collagen matrix and subepithelial connective tissue. Methods: A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published systematic reviews. Three major electronic databases (Medline via PubMed, Cochrane database, and Embase) were searched up to October 2023. Results: Initially, five hundred and seventy-six articles were identified, but only nine studies met the criteria for inclusion in the meta-analysis. Meta-analysis showed that the pooled mean difference in mean root coverage of collagen matrix compared with subepithelial connective tissue was −0.48 (95% confidence interval of −0.69 to −0.26). The relative risk of complete root coverage of collagen matrix compared with subepithelial connective tissue was 0.68 (95% confidence interval, 0.49 to 0.94). The pooled mean difference in width of keratinized tissue of collagen matrix compared with subepithelial connective tissue was −0.75 (95% confidence interval of −1.25 to −0.26). Conclusions: The outcomes of this study revealed that subepithelial connective tissue generally exhibited superior performance. Nonetheless, the utilization of the coronally advanced flap with collagen matrix may yield comparable results in terms of the percentage of complete root coverage. [ABSTRACT FROM AUTHOR]

Background: Lifestyle choices significantly affect health outcomes in Saudi Arabia, but the relationship between health behaviors and satisfaction is unclear. This study aimed to assess lifestyle choices and associated satisfaction levels among residents in the Jazan region of Saudi Arabia. Methods: A cross-sectional study was conducted in Jazan, Saudi Arabia, with 3411 participants. Sociodemographic, lifestyle, and satisfaction data were collected using a questionnaire that was completed during interviews. Logistic regression analyses were implemented to examine the relationships between the study variables and factors related to weight, physical activity, and eating satisfaction. Results: The study found that 38.3% of participants were inactive and 77% rarely ate fruits and vegetables. A total of 47.6% were overweight or obese. Weight (71.12%) and eating (71.59%) satisfaction were high despite these health concerns. The satisfaction-behavior paradox was especially evident in diet. Higher income, physical activity, and healthy eating habits were significantly associated with higher satisfaction (OR = 1.49, 95% CI: 1.15–1.93, p = 0.003 for weight satisfaction, OR = 34.74, 95% CI: 25.42–48.35, p < 0.001 for physical activity satisfaction, and OR = 2.08, 95% CI: 1.67–2.61, p < 0.001 for fruit and vegetable consumption). Conclusions: Lifestyle behaviors and satisfaction in Jazan, Saudi Arabia, are complex. The satisfaction-behavior paradox, especially in diet, reveals a major gap between perceived and actual health. These findings highlight the need for targeted, culturally sensitive interventions that address behavioral change and perception alignment to improve regional public health. [ABSTRACT FROM AUTHOR]

Background: Current clinical guidelines support family-centered care in Neonatal Intensive Care Units (NICUs). This implies parents should also be involved in the most critical patient safety measures. Hand hygiene is the single most important tool to prevent healthcare-associated infections and related long-term effects. Although often studied in healthcare workers, the hand hygiene compliance of parents is rarely assessed. The aim of this study was to evaluate the effectiveness of an educational video, available in ten different languages, in teaching parents hand hygiene techniques in a NICU, lowering the burden on the staff. Methods: Parents in the intervention group were educated through a video; the control group received personal instruction from healthcare workers. The primary outcome parameter was the predicted probability of passing a subsequent hand scan. Results: The quality of hand hygiene among parents educated through the video was at least as good as that of those who received instruction from a healthcare worker, demonstrated by a higher predicted probability of passing the hand scan (43.8% vs. 57.1% in male and 67.9% vs. 75.9% in female participants). The feedback from the intervention group was predominantly positive, with most parents (62%) expressing a preference for video-based education. Conclusion: Implementing a video-based approach seems to be effective for educating parents about hand hygiene in a NICU and was well accepted by the parents. This method offers a consistent standard of hand hygiene education, helps to overcome language barriers, and can also be used as regular reminder of the importance and proper technique of hand hygiene. [ABSTRACT FROM AUTHOR]

Simple Summary: Sarcopenia refers to a progressive and systemic reduction in skeletal muscle mass and strength and is a primary component of cancer cachexia. This retrospective study examined the impact of the rate of muscle loss between two time points during the pretreatment period with concurrent chemoradiotherapy on the clinical outcomes during subsequent durvalumab maintenance treatment. As the results showed, patients who experienced psoas muscle loss during chemoradiotherapy had a shorter progression-free survival and experienced reduced effectiveness of durvalumab treatment. This study highlights the importance of monitoring psoas muscle changes during chemoradiotherapy to predict the success of subsequent durvalumab therapy better in non-small cell lung cancer patients. Sarcopenia assessed at a single time point is associated with the efficacy of immunotherapy, and we hypothesized that longitudinal changes in muscle mass may also be important. This retrospective study included patients with non-small cell lung cancer (NSCLC) who received durvalumab treatment after concurrent chemoradiotherapy (CCRT) between January 2017 and April 2023. Muscle loss and sarcopenia were assessed based on the lumbar skeletal muscle area. Patients with a decrease in muscle area of 10% or more during CCRT were categorized into the muscle loss group, while those with a decrease of less than 10% were categorized into the muscle maintenance group. We evaluated the relationship between muscle changes during CCRT and the efficacy of durvalumab treatment. Among the 98 patients, the muscle maintenance group had a significantly longer PFS of durvalumab treatment compared to the muscle loss group (29.2 months [95% confidence interval (CI): 17.2—not reached] versus 11.3 months [95% CI: 7.6–22.3]; p = 0.008). The multivariable analysis confirmed that muscle change was a significant predictor of a superior PFS (HR: 0.47 [95% CI: 0.25–0.90]; the p-value was less than 0.05). In contrast, the OS between the groups did not differ significantly (not reached [95% CI: 21.8 months—not reached] and 36.6 months [95% CI: 26.9—not reached]; p = 0.49). Longitudinal muscle changes during CCRT are a predictor of durvalumab's efficacy in patients with NSCLC after CCRT. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung carcinoids are known to be less malignant than other types of lung cancers. However, atypical lung carcinoids are more prone to recur after radical surgery than typical lung carcinoids. The aim of our retrospective study was to assess the rate of recurrence of low-stage atypical and typical carcinoids when accounting for competing events. We confirmed that atypical carcinoids recurred more often than typical carcinoids within 5 and 10 years after radical surgery. Atypical carcinoids at a low stage are more prone to recur after radical surgery, suggesting that all patients operated for atypical carcinoid should undergo close follow-up care after surgery. Atypical lung carcinoid (AC) is widely accepted to recur more often after radical resection than typical lung carcinoid (TC). However, their recurrence rates have never been compared in a multi-state competing risks model. We retrospectively reviewed files from patients with AC and TC who had been radically resected at our European Neuroendocrine Tumor Society Center of Excellence between 2009 and 2020. We estimated the recurrence rates between the AC and TC patients counting unrelated death as a competing event using Aalen–Johansen estimates and compared them using a multi-state Cox model. Finally, we analyzed all AC and TC recurrences as to resection type, pathological stage, resection margin, recurrence site, and time to recurrence. The study included 217 patients, of whom 194 had TC and 23 had AC. The median follow-up was 9.4 years. The AC patients experienced recurrence at a higher rate (hazard ratio [HR] 16.0, 95% confidence interval [CI] 5.3–47.9, p < 0.001). Correspondingly, the 5- and 10-year recurrence rates were 18% and 32% for AC and merely 1.0% and 2.4% for TC. In patients without nodal involvement, AC recurred at a considerably higher rate (HR 41.2, 95% CI 8.7–194.8, p < 0.001) than TC. In both AC and TC, most recurrences were distant and occurred in patients with a resection margin less than 2 cm. We conclude that AC recurs more often than TC, even in patients without nodal involvement at surgery, suggesting that all AC patients regardless of their pathological stage should undergo close follow-up care after surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: Survivors of childhood cancer are predisposed to a range of late effects of treatment, including high symptom burden. Symptom burden may vary over time. The aim of this prospective pilot study was to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer using mobile health (mHealth) technology to evaluate symptom fluctuation and associations with future health-related quality of life (HRQOL). The 41 survivors included in this study had high adherence to symptom reporting (83%) and HRQOL reporting (95%). Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Additionally, a higher symptom burden was associated with poorer HRQOL in the future. Daily assessment of symptoms using mHealth technology revealed fluctuations in symptomology and the association between symptom burden and HRQOL. This method of symptom assessment is valuable for improving our understanding of symptom dynamics and sources of variability. Background: Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL). Methods: This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates. Results: Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10–9.02), depression (6.32; 95% CI: 3.18–9.47), fatigue (7.93; 95% CI: 5.11–10.80), sleep (6.07; 95% CI: 3.43–8.70), pain (5.16; 95% CI: 2.11–8.22), and cognitive function (–6.89; 95% CI: –10.00 to –3.79) in the third month. Conclusions: Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability. [ABSTRACT FROM AUTHOR]

Simple Summary: With the aim of offering precision medicine to our patients, accurate lymph node staging of head and neck (HN) cancer patients is a major challenge, as it determines whether neck dissection is indicated. For many years, the indication for this surgery has been histological predictors from the primary tumor only, and efforts are converging to develop non-invasive techniques to exclude occult metastases with certainty. FDG PET-CT plays a dominant role in this respect. The aim of our systematic review and meta-analysis was to determine the overall diagnostic performance of FDG PET-CT for the detection of LN metastases from HN squamous cell carcinoma (HNSCC) in patients with clinically node-negative necks. Because of an estimated 20–30% prevalence of occult lymph node (LN) metastases in patients with head and neck squamous cell carcinoma (HNSCC), neck dissection is often proposed, despite its potential morbidity. In this systematic review and meta-analysis, the diagnostic performance of FDG PET-CT in detecting occult LN metastases was evaluated in patients with clinically negative necks (cN0) and in whom histopathology of a neck dissection specimen served as gold standard. Overall, 16 studies out of 2062 screened on PubMed and EMBASE fulfilled the inclusion criteria (n = 1148 patients). Seven of these sixteen studies were split into two or three studies because they contained data that could be processed distinctly in our meta-analysis. For this reason, a total of 25 studies were identified and included in the analysis (n total = 1918 patients). The overall prevalence of metastatic nodes per patient was 22.67%. The pooled sensitivity, specificity, diagnostic odds ratios, and negative predictive value (NPV) were 0.71 (95%CI: 0.66–0.75), 0.90 (95%CI: 0.84–0.93), 20.03 (95%CI: 13.51–29.70), and 0.92 (95%CI: 0.89–0.95), respectively. The main causes of inter-study heterogeneity included different reference standards (evaluation per patient, per neck side, or per neck level). The current meta-analysis showed that FDG PET-CT has a high specificity and NPV for ruling out nodal involvement in cN0 necks, but a limited sensitivity. [ABSTRACT FROM AUTHOR]

Background: The conventional double-lumen tube (DLT) insertion method requires a rotatory maneuver that was developed using direct laryngoscopy and may not be optimal for video laryngoscopy. This study compared a new non-rotatory maneuver with the conventional method for DLT insertion using video laryngoscopy. Methods: Patients scheduled for thoracic surgery requiring one-lung ventilation were randomly assigned to either the rotating (R) or non-rotating (NR) method groups. All patients were intubated using a customized rigid J-shaped stylet, a video laryngoscope, and a left-sided silicone DLT. The conventional rotatory maneuver was performed in the R group. In the NR group, the stylet was inserted with its tip oriented anteriorly (12 o'clock direction) while maintaining the bronchial lumen towards the left (9 o'clock direction). After reaching the glottic opening, the tube was inserted using a non-rotatory maneuver, maintaining the initial orientation. The primary endpoint was the intubation time. Secondary endpoints included first-trial success rate, sore throat, hoarseness, and airway injury. Results: Ninety patients (forty-five in each group) were included. The intubation time was significantly shorter in the NR group compared to the R group (22.0 [17.0, 30.0] s vs. 28.0 [22.0, 34.0] s, respectively), with a median difference of 6 s (95% confidence interval [CI], 3–11 s; p = 0.017). The NR group had a higher first-attempt success rate and a lower incidence of sore throats. Conclusions: The non-rotatory technique with video laryngoscopy significantly reduced intubation time and improved first-attempt success rate, offering a viable and potentially superior alternative to the conventional rotatory technique. [ABSTRACT FROM AUTHOR]

Background/Aims: We investigated how interactions between humans and computer-aided detection (CADe) systems are influenced by the user’s experience and polyp characteristics. Methods: We developed a CADe system using YOLOv4, trained on 16,996 polyp images from 1,914 patients and 1,800 synthesized sessile serrated lesion (SSL) images. The performance of polyp detection with CADe assistance was evaluated using a computerized test module. Eighteen participants were grouped by colonoscopy experience (nurses, fellows, and experts). The value added by CADe based on the histopathology and detection difficulty of polyps were analyzed. Results: The area under the curve for CADe was 0.87 (95% confidence interval [CI], 0.83 to 0.91). CADe assistance increased overall polyp detection accuracy from 69.7% to 77.7% (odds ratio [OR], 1.88; 95% CI, 1.69 to 2.09). However, accuracy decreased when CADe inaccurately detected a polyp (OR, 0.72; 95% CI, 0.58 to 0.87). The impact of CADe assistance was most and least prominent in the nurses (OR, 1.97; 95% CI, 1.71 to 2.27) and the experts (OR, 1.42; 95% CI, 1.15 to 1.74), respectively. Participants demonstrated better sensitivity with CADe assistance, achieving 81.7% for adenomas and 92.4% for easy-to-detect polyps, surpassing the standalone CADe performance of 79.7% and 89.8%, respectively. For SSLs and difficult-to-detect polyps, participants' sensitivities with CADe assistance (66.5% and 71.5%, respectively) were below those of standalone CADe (81.1% and 74.4%). Compared to the other two groups (56.1% and 61.7%), the expert group showed sensitivity closest to that of standalone CADe in detecting SSLs (79.7% vs 81.1%, respectively). Conclusions: CADe assistance boosts polyp detection significantly, but its effectiveness depends on the user’s experience, particularly for challenging lesions [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to assess non‐inferiority of the unique approach used in our institution of combined 10 IU IM (intramyometrial) and 10 IU IV (intravenous) oxytocin to carbetocin IV in preventing severe postpartum blood loss in elective cesarean sections. The design was a prospective controlled phase IV non‐inferiority interventional trial. The setting was a tertiary center at University Hospital, Zurich, Switzerland. Material and Methods: The population consisted of 550 women undergoing elective cesarean section after 36 completed weeks of gestation at low risk for postpartum hemorrhage (PPH). Participants were assigned to either combined oxytocin regimen (10 IU IM and 10 IU IV) or carbetocin (100 μg IV). Non‐inferiority for oxytocin for severe PPH was assessed with a 0.05 margin using the Newcombe–Wilson score method. The main outcome measures were severe postpartum blood loss defined as delta hemoglobin (∆Hb, Hb prepartum—Hb postpartum) ≥30 g/L. Results: Non‐inferiority of combined oxytocin (IM/IV) in preventing severe postpartum blood loss was not shown (17 women in the oxytocin group vs. 7 in the carbetocin group). The number needed to treat when using carbetocin was 28. The risk difference for ∆Hb ≥30 g/L was 0.04 (oxytocin 0.06 vs. 0.03), 95% confidence interval (CI) (0.00–0.08). No significant difference was observed for ∆Hb (median 12 [IQR 7.0–19.0] vs. 11 [5.0–17.0], p = 0.07), estimated blood loss (median 500 [IQR 400–600] vs. 500 [400–575], p = 0.38), or the PPH rate defined as estimated blood loss ≥1000 mL (12[4.5] vs. 5 [2.0], risk difference 0.03, 95% CI (−0.01 to 0.06), p = 0.16). More additional uterotonics were administered in the oxytocin group compared to the carbetocin group (15.2% vs. 5.9%, p = 0.001). Total case costs were non‐significantly different in the oxytocin group (US $ 10 146 vs. 9621, mean difference 471.4, CI (−476.5 to 1419.3), p = 0.33). Conclusions: Combined (IM/IV) oxytocin is not non‐inferior to carbetocin regarding severe postpartum blood loss defined as postpartum Hb decrease ≥30 g/L in elective cesarean sections. We recommend carbetocin for use in clinical practice for elective cesarean sections. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013–2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923–934. https://doi.org/10.2105/AJPH.2024.307730) [ABSTRACT FROM AUTHOR]

*OBJECTIVE: To evaluate the effect of a workplace injury prevention and wellness program compared to no intervention (control) on musicians' playing-related musculoskeletal pain intensity. The hypothesis was that musicians who completed the program would have a greater reduction in pain intensity than the control group. *DESIGN: Pragmatic parallel randomized controlled trial. *METHODS: Sixty-five orchestra musicians were recruited and completed patient-reported outcome measures (primary outcome: pain intensity over 11 months, using the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians; range: 0-40; lower is better) at baseline, 14 weeks (T1), and 11 months (T2). Following baseline assessment, participants were randomly assigned to the intervention (n = 33) or control (n = 32) groups, stratified by instrument and pain prevalence. The intervention group received a 14-week injury prevention and wellness program including education and exercise; the control group received no intervention. *RESULTS: Pain intensity means (standard deviation) were 7.8 (6.2), 8.0 (7.5), and 8.6 (5.7) in the control group, and 9.0 (6.6), 5.0 (4.2), and 6.7 (6.6) in the intervention group at T0, T1, and T2, respectively. Using intention-to-treat analyses (3 dropouts, n = 65 analyzed), between-group differences in pain intensity (95% confidence interval) were T1-T0: -4.2 (-7.5, -0.9); T2-T0: -3.7 (-7.1, -0.3), type III (overall) P = .03, favoring the intervention group. No adverse events were reported. *CONCLUSION: A workplace injury prevention and wellness program may have a clinically meaningful effect on reducing orchestra musicians' pain intensity. [ABSTRACT FROM AUTHOR]

Background: Little is known about differences in patient characteristics before and after implementation of the new definition of sepsis (Sepsis-3) and whether the new definition is affecting clinical practice in intensive care units. Objective: To examine and compare the clinicoepidemiologic characteristics of patients with sepsis or septic shock before and after implementation of Sepsis-3. Methods: In this population-based cohort study, a nationwide registration database in South Korea was used to identify patients with sepsis or septic shock. Patients admitted to hospitals from 2012 to 2015 constituted the Sepsis-2 group, and patients admitted from 2017 to 2020 constituted the Sepsis-3 group. Results: The study involved 443 217 patients, of whom 170 660 (38.5%) were in the Sepsis-2 group and 272 557 (61.5%) were in the Sepsis-3 group. The mean (SD) age was 73.3 (14.5) years in the Sepsis-2 group and 75.5 (14.5) years in the Sepsis-3 group. The intensive care unit admission rate was higher in the Sepsis-2 group (34.6%, 59 081 of 170 660) than in the Sepsis-3 group (21.3%, 57 997 of 272 557). Multivariable Cox regression analysis showed that 1-year all-cause mortality was 21% lower in the Sepsis-3 group than in the Sepsis-2 group (hazard ratio, 0.79; 95% CI, 0.78–0.79; P <.001). Conclusions: Implementation of the Sepsis-3 definition was associated with an increased number of patients with sepsis. Other findings suggested that patients in the Sepsis-2 group had more severe illness, with increased 1-year all-cause mortality, compared with those in the Sepsis-3 group. [ABSTRACT FROM AUTHOR]

Background: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied. Objectives: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance. Methods: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated. Results: In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09–1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01–1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59–1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14–2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04–2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30–1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39–0.49), delirium (AOR, 0.63; 95% CI, 0.59–0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79–0.92), physical restraints (AOR, 0.74; 95% CI, 0.68–0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68–0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance. Conclusions: Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance. [ABSTRACT FROM AUTHOR]

Objective: AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care and medication for people living with HIV (PLWH) in the United States. In October 2021, the federal policy requiring that clients recertify for the program every 6 months was repealed, giving states the authority to set their own recertification policies. However, little data exist on the costs and health effects of alternative recertification schedules. We assessed the cost of changing the legacy 6-month recertification to a 12-month schedule in Washington State to inform policy decisions on recertification. Methods: We used a Markov model to simulate the population of PLWH in Washington State who are eligible or enrolled in ADAP. We obtained model inputs and validation data from the Washington State Ryan White database. We estimated the cost of 12-month and 6-month criteria over a 5-year time horizon. Model outputs included annual program costs, population sizes, and number of people virally suppressed, by scenario. Results: Under a continuation of the legacy 6-month recertification criteria, the annual cost of Washington ADAP would be $37 663 000 (95% CI, $34 570 000-$41 686 000) during the next 5 years, with a per-client cost of $7966 (95% CI, $7478-$8494). Under 12-month criteria, the annual cost would be $40 217 000 (95% CI, $36 243 000-$44 401 000) and the per-client cost would be $7543 (95% CI, $7084-$8042). Under the 12-month scenario, 245 more people will have been virally suppressed by the end of 2025. Conclusions: Switching to a less frequent recertification process may improve health outcomes at a modest increase in cost in Washington State. [ABSTRACT FROM AUTHOR]

Objective: To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting: The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients: Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures: Association between self-reported BP and 10 self-report lifestyle-related variables. Results: Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion: In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension. KEY POINTS: Associations between daily home blood pressure (BP) and self-reports of lifestyle and symptoms have not been previously well explored. Self-reported higher wellbeing, lower restlessness, less stress, and higher medication adherence were significantly associated with lower same-day BP levels. Physical activity was significantly associated with same-day BP for men, but not for women. Using a hypertension management system may be a valuable tool for communication between the patient and physician. [ABSTRACT FROM AUTHOR]