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4. A compact start time counter using plastic scintillators readout with MPPC arrays for the WASA-FRS HypHI experiment

Author

Liu, E., Drozd, V., Ekawa, H., Escrig, S., Gao, Y., He, Y., Kasagi, A., Nakagawa, M., Ong, H., Rappold, C., Sekiya, R., Saito, T.R., Tang, X., Tanaka, Y.K., Wang, H., Yanai, A., Achenbach, P., Alfaki, H. Alibrahim, Amjad, F., Armstrong, M., Behr, K.-H., Benlliure, J., Brencic, Z., Dickel, T., Dubey, S., Feijoo-Fontán, M., Fujioka, H., Geissel, H., Goldenbaum, F., González, A. Graña, Haettner, E., Harakeh, M.N., Heggen, H., Hornung, C., Hubbard, N., Itahashi, K., Iwasaki, M., Kalantar-Nayestanaki, N., Kavatsyuk, M., Kazantseva, E., Khreptak, A., Kindler, B., Knoebel, R., Kollmus, H., Kostyleva, D., Kraft-Bermuth, S., Kurz, N., Lommel, B., Minami, S., Morrissey, D.J., Moskal, P., Mukha, I., Muneem, A., Nakazawa, K., Nociforo, C., Pietri, S., Pochodzalla, J., Purushothaman, S., Rocco, E., Rodríguez-Sánchez, J.L., Roy, P., Ruber, R., Schadmand, S., Scheidenberger, C., Schwarz, P., Serdyuk, V., Skurzok, M., Streicher, B., Suzuki, K., Szczepanczyk, B., Tortorelli, N., Vencelj, M., Weber, T., Weick, H., Will, M., Wimmer, K., Yamamoto, A., Yoshida, J., and Zhao, J.

Published
2024
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6. Functional medium entropy alloys for joint replacement: An atomistic perspective of material deformation and a correlation to wear, corrosion, and biocompatibility.

Author

Chavan, Avinash, Avula, Indu, Sahoo, Satyabrata Nigamananda, Biswal, Sankalp, Mandal, Santanu, Musthafa, Madud, Roy, Subhasis, Nandi, Samit Kumar, Mukherjee, Sankha, and Roy, Mangal

Subjects
ARTHROPLASTY, JOINTS (Anatomy), EDGE dislocations, BONE regeneration, SLIDING wear
Abstract

The present study adopts a multi-facet approach to design bio inspired concentrated alloys for potential application as articulating surfaces in joint replacements. A series of equiatomic, Nb rich and Ti rich TiMoNbZr based medium entropy alloys (MEAs) were processed via arc melting and their mechanical, in-vitro corrosion, wear, and in vitro and in vivo biocompatibility were investigated. Equiatomic MEA had primarily bcc with minor hcp phases where the single bcc was achieved with the addition of Nb. The single bcc Nb rich alloy resulted in 13 % elongation, much higher than equiatomic or Ti rich alloy. All the MEAs showed comparatively higher yield strength due to the climb of edge dislocations which is the main rate limiting mechanism at 300 K, as evident molecular dynamics (MD) simulation. The locally fluctuating energy landscape promotes kinks on edge dislocation, and at local minima nanoscale segments gets pinned. Upon yielding the entangled kink leaves a trail of vacancies/interstitials and escapes via climb motion to render high yield strength. The higher corrosion and pitting resistance of Nb enriched alloys can be attributed to the stable ZrO 2 , Nb 2 O 5 , TiO 2 , and MoO 3 oxides, high polarization resistance (106–105 Ωcm−2), and low defect densities (1016–1018). In vitro cell-materials interaction using MC3T3-E1 showed bioinert but cytocompatible nature of the MEAs. The wear rate of the MEAs was in the range of 7–9 × 10−5 mm3N−1m−1. The wear debris did not show any tissue necrosis when implanted in rabbit femur rather new bone regeneration can be seen around the particles. In the present work, a noble Nb enriched MEAs with superior mechanical, in vitro wear, corrosion and cytocompatibility properties was designed for articulating surfaces in joint replacement. • Single bcc in Nb enriched MEAs resulted in 13 % elongation with high hardness and yield strength. • Climb of entangled edge segment is the rate limiting mechanism in controlling high yield strength of MEAs at 300 K. • High polarization resistance (106–105 Ωcm−2), and low defect densities (1016–1018) attributes to ZrO 2 , Nb 2 O 5 , TiO 2 , and MoO 3 oxides enriched passive film. • Wet sliding wear rate ranged in order 7–9 × 10−5 mm3N−1m−1. In-situ generated wear debris when implanted in rabbit femur did not show any tissue necrosis rather new bone regeneration was observed around debris. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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8. The WASA-FRS project at GSI and its perspective

Author

Saito, T.R., Achenbach, P., Alfaki, H. Alibrahim, Amjad, F., Armstrong, M., Behr, K.-H., Benlliure, J., Brencic, Z., Dickel, T., Drozd, V., Dubey, S., Ekawa, H., Escrig, S., Feijoo-Fontán, M., Fujioka, H., Gao, Y., Geissel, H., Goldenbaum, F., González, A. Graña, Haettner, E., Harakeh, M.N., He, Y., Heggen, H., Hornung, C., Hubbard, N., Itahashi, K., Iwasaki, M., Kalantar-Nayestanaki, N., Kasagi, A., Kavatsyuk, M., Kazantseva, E., Khreptak, A., Kindler, B., Knoebel, R., Kollmus, H., Kostyleva, D., Kraft-Bermuth, S., Kurz, N., Liu, E., Lommel, B., Metag, V., Minami, S., Morrissey, D.J., Moskal, P., Mukha, I., Muneem, A., Nakagawa, M., Nakazawa, K., Nociforo, C., Ong, H.J., Pietri, S., Pochodzalla, J., Purushothaman, S., Rappold, C., Rocco, E., Rodríguez-Sánchez, J.L., Roy, P., Ruber, R., Schadmand, S., Scheidenberger, C., Schwarz, P., Sekiya, R., Serdyuk, V., Skurzok, M., Streicher, B., Suzuki, K., Szczepanczyk, B., Tanaka, Y.K., Tang, X., Tortorelli, N., Vencelj, M., Wang, H., Weber, T., Weick, H., Will, M., Wimmer, K., Yamamoto, A., Yanai, A., Yoshida, J., and Zhao, J.

Published
2023
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9. Storage, accumulation and deceleration of secondary beams for nuclear astrophysics

Author

Glorius, J., Litvinov, Yu. A., Aliotta, M., Amjad, F., Brückner, B., Bruno, C.G., Chen, R., Davinson, T., Dellmann, S.F., Dickel, T., Dillmann, I., Erbacher, P., Forstner, O., Geissel, H., Griffin, C.J., Grisenti, R., Gumberidze, A., Haettner, E., Hess, R., Hillenbrand, P.-M., Hornung, C., Joseph, R., Jurado, B., Kazanseva, E., Knöbel, R., Kostyleva, D., Kozhuharov, C., Kuzminchuk, N., Langer, C., Leckenby, G., Lederer-Woods, C., Lestinsky, M., Litvinov, S., Löher, B., Lorenz, B., Lorenz, E., Marsh, J., Menz, E., Morgenroth, T., Mukha, I., Petridis, N., Popp, U., Psaltis, A., Purushothaman, S., Reifarth, R., Rocco, E., Roy, P., Sanjari, M.S., Scheidenberger, C., Sguazzin, M., Sidhu, R.S., Spillmann, U., Steck, M., Stöhlker, T., Swartz, J.A., Tanaka, Y.K., Törnqvist, H., Varga, L., Vescovi, D., Weick, H., Weigand, M., Woods, P.J., Yamaguchi, T., and Zhao, J.

Published
2023
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10. Production and separation of positron emitters for hadron therapy at FRS-Cave M

Author

Haettner, E., Geissel, H., Franczak, B., Kostyleva, D., Purushothaman, S., Tanaka, Y.K., Amjad, F., Boscolo, D., Dickel, T., Graeff, C., Hessler, C., Hornung, C., Kazantseva, E., Kuzminchuk, N., Morrissey, D., Mukha, I., Pietri, S., Rocco, E., Roy, P., Roesch, H., Schuy, C., Schütt, P., Weber, U., Weick, H., Zhao, J., Durante, M., Parodi, K., and Scheidenberger, C.

Published
2023
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13. The DESPEC setup for GSI and FAIR

Author

Mistry, A.K., Albers, H.M., Arıcı, T., Banerjee, A., Benzoni, G., Cederwall, B., Gerl, J., Górska, M., Hall, O., Hubbard, N., Kojouharov, I., Jolie, J., Martinez, T., Podolyák, Zs., Regan, P.H., Tain, J.L., Tarifeno-Saldivia, A., Schaffner, H., Werner, V., Ağgez, G., Agramunt, J., Ahmed, U., Aktas, O., Alcayne, V., Algora, A., Alhomaidhi, S., Amjad, F., Appleton, C., Armstrong, M., Balogh, M., Banerjee, K., Bednarczyk, P., Benito, J., Bhattacharya, C., Black, P., Blazhev, A., Bottoni, S., Boutachkov, P., Bracco, A., Bruce, A.M., Brunet, M., Bruno, C.G., Burrows, I., Calvino, F., Canavan, R.L., Cano-Ott, D., Chishti, M.M.R., Coleman-Smith, P., Cortés, M.L., Cortes, G., Crespi, F., Das, B., Davinson, T., De Blas, A., Dickel, T., Doncel, M., Ertoprak, A., Esmaylzadeh, A., Fornal, B., Fraile, L.M., Galtarossa, F., Gottardo, A., Guadilla, V., Ha, J., Haettner, E., Häfner, G., Heggen, H., Herrmann, P., Hornung, C., Jazrawi, S., John, P.R., Jokinen, A., Jones, C.E., Kahl, D., Karayonchev, V., Kazantseva, E., Kern, R., Knafla, L., Knöbel, R., Koseoglou, P., Kosir, G., Kostyleva, D., Kurz, N., Kuzminchuk, N., Labiche, M., Lawson, J., Lazarus, I., Lenzi, S.M., Leoni, S., Llanos-Expósito, M., Lozeva, R., Maj, A., Meena, J.K., Mendoza, E., Menegazzo, R., Mengoni, D., Mertzimekis, T.J., Mikolajczuk, M., Million, B., Mont-Geli, N., Morales, A.I., Morral, P., Mukha, I., Murias, J.R., Nacher, E., Napiralla, P., Napoli, D.R., Nara-Singh, B.S., O’Donnell, D., Orrigo, S.E.A., Page, R.D., Palit, R., Pallas, M., Pellumaj, J., Pelonis, S., Pentilla, H., Pérez de Rada, A., Pérez-Vidal, R.M., Petrache, C.M., Pietralla, N., Pietri, S., Pigliapoco, S., Plaza, J., Polettini, M., Porzio, C., Pucknell, V.F.E., Recchia, F., Reiter, P., Rezynkina, K., Rinta-Antila, S., Rocco, E., Rösch, H.A., Roy, P., Rubio, B., Rudigier, M., Ruotsalainen, P., Saha, S., Şahin, E., Scheidenberger, Ch., Seddon, D.A., Sexton, L., Sharma, A., Si, M., Simpson, J., Smith, A., Smith, R., Söderström, P.A., Sood, A., Soylu, A., Tanaka, Y.K., Valiente-Dobón, J.J., Vasileiou, P., Vasiljevic, J., Vesic, J., Villamarin, D., Weick, H., Wiebusch, M., Wiederhold, J., Wieland, O., Wollersheim, H.J., Woods, P.J., Yaneva, A., Zanon, I., Zhang, G., Zhao, J., Zidarova, R., Zimba, G., and Zyriliou, A.

Published
2022
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14. Appropriateness and outcomes of hospitalized patients telemetry monitored for cardiac arrhythmias in accordance with the American Heart Association Practice Standards–A multicenter study.

Author

Holm, Marianne Sætrang, Fålun, Nina, Pettersen, Trond Røed, Bendz, Bjørn, Nilsen, Roy Miodini, Langørgen, Jørund, Larsen, Alf Inge, Sørensen, Marianne Laastad, Sandau, Kristin E., and Norekvål, Tone Merete

Abstract

• The highest percentage of monitoring and arrhythmias among in-hospital telemetry monitored patients at three Norwegian University Hospitals was observed in AHA Class I. • Arrhythmic events occurred in 18 % of patients within Class III (no indication). • Changes in management occurred in 22 % of patients due to clinical alarms. • There should be a daily re-assessment to judge each patient's telemetry indication. To the best of our knowledge, no prospective research studies have compared clinical practice to the American Heart Association (AHA) updated practice standards for in-hospital telemetry monitoring. Our aims were therefore (1) to investigate how patients were assigned to telemetry monitoring in accordance with the AHA's updated practice standards, (2) to determine the number and type of arrhythmic events, and (3) to describe subsequent changes in clinical management. This prospective multicenter study included 1154 patients at three university hospitals in Norway. Data were collected 24/7 over a four-week period, with follow-up measurements from telemetry admission until hospital discharge. Of patients assigned to telemetry, 67 % (n = 767) met practice standards, corresponding to AHA Class I or II. Patients were predominantly men (65 %, n = 748), and the mean age was 65 years (SD ±16). The study included both patients with cardiac and non-cardiac diagnoses from various medical and surgical departments throughout the hospitals. Ninety-one percent of the patients in Class III were monitored based on indications that were reclassified from Class II to Class III (not indicated) in the updated practice standards (patients admitted with chest pain or post-percutaneous coronary intervention (PCI) without complications). Overall, arrhythmic events occurred in 37 % (n = 424) of patients, and they occurred in all classes. Eighteen percent (n = 59) of arrhythmic events occurred in Class III. Of all arrhythmias, 3 % (n = 14) were life threatening, and all of them occurring within Class I. Telemetry monitoring led to changes in clinical management in 22 % (n = 257) of patients due to clinical alarms, of which 71 % (n = 182) were related to medication management. Most patients were appropriately monitored according to the AHA practice standards, meeting Class I and II. Arrhythmias occurred in all classes, but life-threatening arrhythmias only occurred in patients in Class I. However, a daily re-assessment of each patient's telemetry indication is warranted. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Evaluation of Hepatocellular Carcinoma Surveillance with Contrast-enhanced MRI in a High-Risk Western European Cohort.

Author

Fiduzi, Federico I.F., Willemssen, François E.J.A., de Braak, Céline van, de Lussanet de la Sablonière, Quido G., IJzermans, Jan N.M., Bos, Daniel, de Man, Robert A., and Dwarkasing, Roy S.

Abstract

• One in five cirrhotic patients in a western European cohort developed HCC. • The one, three- and five-year HCC cumulative incidence is 1%, 10% and 17%. • In non-cirrhotic chronic hepatitis patients one in forty two (2%) developed HCC. • Follow up MRI of up to 10 months may suffice for detection of very early HCC. • Advanced stages of HCC are seen with prolonged time intervals (median 21 months). To investigate the utilization of MRI using a MRI liver protocol with extracellular contrast-enhanced series for hepatocellular carcinoma (HCC) surveillance in high-risk patients. Consecutive high-risk patients of a western European cohort who underwent repeated liver MRI for HCC screening were included. Lesions were registered according to the Liver Reporting & Data System (LIRADS) 2018. HCC was staged as very early stage HCC (BCLC stage 0) and more advanced stages of HCC (BCLC stage A-D). Differences in time interval between MRI's for BCLC stage 0 and stage A-D were calculated with the Mann-Whitney U test. The HCC cumulative incidence at one-, three- and five years was calculated with the Kaplan Meier estimator. From 2010 to 2019 a total of 240 patients were included (71% male; median age: 57 years; IQR: 50-64 years) with 1350 MRI's. Most patients (83 %) had cirrhosis with hepatitis C as the most common underlying cause. Patients underwent on average four MRI's (IQR: 3-7). Forty-two patients (17.5%) developed HCC (52 HCC lesions: 43 LIRADS-5, eight LIRADS-4, and one LIRADS-TIV). Eighteen patients (43%) had BCLC stage 0 HCC with a significant shorter screening time interval (10 months; IQR: 6-21) compared to patients with BCLC stage A-D (21 months; IQR: 10-32) (p = 0.03). Thirty seven percent of patients with a LIRADS-3 lesion (n=43) showed HCC development within twelve months (median: 7.4 months). One, three- and five-year HCC cumulative incidence in cirrhotic patients was 1%, 10% and 17%, respectively. High-risk patients who underwent surveillance with contrast-enhanced MRI developed HCC in 17.5 % during a follow up period of over 4 years median. Very early stage HCC was seen in compensated cirrhosis after a median time interval of 10 months. Later stages of HCC were related to prolonged screening time interval (median 21 months). [ABSTRACT FROM AUTHOR]

Published
2024
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16. Effectiveness of Balance Exercise and Brisk Walking on Alleviating Nonmotor and Motor Symptoms in People With Mild-to-Moderate Parkinson Disease: A Randomized Clinical Trial With 6-Month Follow-up.

Author

Mak, Margaret K.Y., Wong-Yu, Irene S.K., Cheung, Roy T.H., and Ho, Shu-Leong

Abstract

• We conducted a 6-month exercise randomized controlled trial on Parkinson disease. • The program consisted of balance exercise and brisk walking with 6-month follow-up. • This program alleviates nonmotor and motor symptoms posttraining. • It also improves motor symptoms, walking capacity, and functions at follow-up. To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up. Two-arm, assessor-blinded randomized controlled trial University research laboratory and the community Ninety-nine eligible individuals with mild-to-moderate PD Participants were randomized to balance and brisk walking group (B&B, n=49) or active control group (n=50). B&B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1-6: weekly, week 7-26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2-3 times/wk during intervention and continued at follow-up. Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score. Eighty-three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19-2.81) at 6 months and 1.09 (−0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69-6.80) at 6 months and 4.57 (1.05-8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B&B group in mini-BEST score, CGS, 6MWT, and DTUG time. This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Nursing students' blended learning satisfaction, self-efficacy, and work readiness: A structural equation modeling study.

Author

Go, Cheyene Franchesca M., Gonzales, Francis Roy S., Gonzales, Millena Maia T., Gonzales, Sweetheart Angela C., Gregorio, Andrea H., Guerra, Mari Anne Estefani G., Guillermo, J-Ross E., Gumapos, Nelsie Faith M., Malong-Consolacion, Charito P., Chua, Rowena L. Escolar, and Berdida, Daniel Joseph E.

Abstract

• Graduate nursing students demonstrated high levels of blended learning satisfaction, self-efficacy, and work efficacy. • Graduate nursing students' self-efficacy increases if they are satisfied with the blended learning setup. • Self-efficacy directly influences nursing students' work readiness. • Blended learning satisfaction mediates the influence on nursing students' work readiness via self-efficacy. To determine the relationship between blended learning satisfaction with self-efficacy and the work readiness of nursing graduates. Blended learning is an educational approach to ensuring quality nursing education during the COVID-19 pandemic. However, examining the nursing students' blended learning satisfaction and its association with self-efficacy and work readiness remains underreported during the pandemic. A descriptive-correlational design using a structural equation modeling (SEM) approach. This study was participated by 208 nursing graduates recruited through consecutive sampling. Four self-report tools were used to collect data (Student Learning Satisfaction in a Blended Learning Satisfaction Tool [BLST], Nursing Self-Efficacy Tool [NSET], and Nursing Work Readiness Tool [NWRT]). Data analysis included descriptive statistics and SEM. The results indicated high levels of blended learning satisfaction (M = 2.88; SD = 0.45), self-efficacy (M = 3.25; SD = 0.35), and work readiness (M = 3.34; SD = 0.34). The emerging model demonstrated acceptable model fit indices, with self-efficacy increasing with blended learning satisfaction (p = 0.16) and a direct impact on work readiness (p = 0.73). In addition, blended learning satisfaction does not directly influence work readiness (p = −0.03) but has a mediating effect on work readiness through self-efficacy (p = 0.009). Nursing students who underwent blended learning in their senior year reported high levels of blended learning satisfaction, self-efficacy, and work readiness. Nursing students in a blended learning environment have the potential to be work-ready if they consider themselves self-efficacious and have the support of a suitable blended learning set-up. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial.

Author

Singh, Kavita, Nikhare, Kalyani, Gandral, Mareesha, Aithal, Kiran, Patil, Satish G., MP, Girish, Gupta, Mohit, Madan, Kushal, Sawhney, J.P.S., Ali, Kamar, Kondal, Dimple, Jindal, Devraj, Mendenhall, Emily, Patel, Shivani A., Narayan, K.M. Venkat, Tandon, Nikhil, Roy, Ambuj, Huffman, Mark D., and Prabhakaran, Dorairaj

Abstract

Quality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. The C-QIP is a clinic-based, open randomized trial of a multicomponent intervention vs usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained nonphysician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (ie, dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. We recruited 410 socio-demographically diverse patients with CVD from 4 hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. This study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Clinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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19. Patient Demographic Factors Affect Response Rates to Patient-Reported Outcome Measures for Total Hip Arthroplasty Patients.

Author

Tong, Yixuan, Rajahraman, Vinaya, Gupta, Rajan, Davidovitch, Roy I., Schwarzkopf, Ran, and Rozell, Joshua C.

Abstract

The Hip Disability and Osteoarthritis Outcome Score (HOOS JR) is a widely used patient-reported outcome measures questionnaire for total hip arthroplasty (THA). However, not all patients choose to complete HOOS JR, and thus, a subset of the THA population may be underrepresented. This study aims to investigate the association between patient demographic factors and HOOS JR response rates. This was a retrospective cohort study of adult, English-speaking patients who underwent primary THA by a fellowship-trained arthroplasty surgeon between 2017 and 2023 at a single, high-volume academic institution. The HOOS JR completion status—complete or incomplete—was recorded for each patient within 90 days of surgery. Standard statistical analyses were performed to assess completion against multiple patient demographic factors. Of the 2,908 total patients, 2,112 (72.6%) had complete and 796 (27.4%) had incomplete HOOS JR questionnaires. Multivariate analysis yielded statistical significance (P <.05) for the distribution of patient age, race, insurance, marital status, and income quartile with respect to questionnaire completion. Patient sex or religion did not affect response rates. Failure to complete HOOS JR (all P <.001) was associated with patients aged 18 to 39 (59.8%), who identified as Black (36.4%) or "other" race (39.6%), were never married (38%), and were in the lower half income quartiles (43.9%, 35.9%) when compared to the overall incomplete rate. Multiple patient demographic factors may affect the HOOS JR response rate. Overall, our analyses suggest that older patients who identify as White and are of higher socioeconomic status are more likely to participate in the questionnaire. Efforts should focus on capturing patient groups less likely to participate to elucidate more generalizable trends in arthroplasty outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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20. The Financial Burden of Patient Comorbidities on Total Hip Arthroplasties—A Matched Cohort Analysis of High Comorbidity Burden and Non–High Comorbidity Burden Patients.

Author

Ashkenazi, Itay, Thomas, Jeremiah, Katzman, Jonathan, Meftah, Morteza, Davidovitch, Roy, and Schwarzkopf, Ran

Abstract

The impact of increased patient comorbidities on the cost-effectiveness of total hip arthroplasty (THAs) is lacking. This study aimed to compare revenue, costs, and short-term (90 days) surgical outcomes between patients who have and do not have a high comorbidity burden (HCB). We retrospectively reviewed 14,949 patients who underwent an elective, unilateral THA between 2012 and 2021. Patients were stratified into HCB (Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiology scores of 3 or 4) and non-HCB groups, and were further 1:1 propensity matched based on baseline characteristics. Perioperative data, revenue, costs, and contribution margins (CMs) of the inpatient episode were compared between groups. Also, 90-day readmissions and revisions were compared between groups. Of the 11,717 patients who had available financial data (n = 1,017 HCB, n = 10,700 non-HCB), 1,914 patients were included in the final matched analyses (957 per group). Total (P <.001) and direct (P <.001) costs were significantly higher for HCB patients. Comparable revenue between cohorts (P =.083) resulted in a significantly decreased CM in the HCB patient group (P <.001). The HCB patients were less likely to be discharged home (P <.001) and had significantly higher 90-day readmission rates (P =.049). Increased THA costs for HCB patients were not matched by increased revenue, resulting in decreased CM. Higher rates of nonhome discharge and readmissions in the HCB population add to the additional financial burden. Adjustments to the current reimbursement models should better account for the increased financial burden of HCB patients undergoing THA and ensure access to care for all patient populations. III. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Full-arch rehabilitation of severely atrophic maxilla with additively manufactured custom-made subperiosteal implants: A multicenter retrospective study.

Author

Vaira, Luigi Angelo, Biglio, Andrea, Roy, Marco, Salzano, Giovanni, Troise, Stefania, Abbate, Vincenzo, Mayo-Yanez, Miguel, Lechien, Jerome R., Piombino, Pasquale, and De Riu, Giacomo

Subjects
BONE resorption, GINGIVAL hemorrhage, MAXILLOFACIAL surgery, ORAL surgery, DENTAL implants
Abstract

The aim of this retrospective study was to analyze a series of patients who underwent full-arch rehabilitation of the atrophic maxilla using additively manufactured subperiosteal implants, between August 2018 and January 2023, at the Universities of Sassari and Poznan. In total, 36 patients and 72 implants were included, with no implants lost during follow-up, and a success rate of 90.3%. Seven (9.7%) of the implants showed class 1 exposure. Bleeding on probing was detected in 10.4% of the abutments at 6 months, 7.9% at 1 year, 10% at 2 years, 7% at 3 years, and 11.4% at 4 years. No significant bone resorption under the abutments was detected during the whole observation period. Based on the findings from this study, additively manufactured subperiosteal implants could represent a safe and reliable technique for full-arch rehabilitation in patients with severe maxillary atrophy. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Sulfated vitamin D metabolites represent prominent roles in serum and in breastmilk of lactating women.

Author

Reynolds, Carmen J., Dyer, Roy B., Oberhelman-Eaton, Sara S., Konwinski, Brianna L., Weatherly, Renee M., Singh, Ravinder J., and Thacher, Tom D.

Abstract

Concentrations of vitamin D (VitD) and 25-hydroxyvitamin D (25OHD) in breastmilk are low despite the essential role of VitD for normal infant bone development, yet additional metabolic forms of vitamin D may be present. This study evaluates the contribution of sulfated vitamin D metabolites, vitamin D 3 -sulfate (VitD 3 -S) and 25-hydroxyvitamin D 3 -sulfate (25OHD 3 -S) for lactating women and assesses the response to high-dose VitD 3 supplementation. Serum and breastmilk were measured before and after 28 days with 5000 IU/day VitD 3 intake in 20 lactating women. Concentrations of VitD 3 -S and 25OHD 3 -S in milk, and 25OHD 2 , 25OHD 3 , 25OHD 3 -S, VitD 3 and VitD 3 -S in serum were determined by mass spectrometry. Baseline vitamin D status was categorized as sufficient (mean ± SD serum 25OHD 3 69 ± 19 nmol/L), and both serum VitD 3 and 25OHD 3 increased following supplementation (p < 0.001). 25OHD 3 -S was 91 ± 19 nmol/L in serum and 0.47 ± 0.09 nmol/L in breastmilk. VitD 3 -S concentrations were 2.92 ± 0.70 nmol/L in serum and 6.4 ± 3.9 nmol/L in breastmilk. Neither sulfated metabolite significantly changed with supplementation in either serum or breastmilk. Sulfated vitamin D metabolites have prominent roles for women during lactation with 25OHD 3 -S highly abundant in serum and VitD 3 -S distinctly abundant in breastmilk. These data support the notion that 25OHD 3 -S and VitD 3 -S may have physiological relevance during lactation and nutritional usage for nursing infants. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Simultaneous Versus Staged Bilateral Total Hip Arthroplasty: A Matched Cohort Analysis of Revenue and Contribution Margin.

Author

Rajahraman, Vinaya, Ashkenazi, Itay, Thomas, Jeremiah, Bosco, Joseph, Davidovitch, Roy, and Schwarzkopf, Ran

Abstract

Though previous studies have demonstrated improved cost benefits associated with simultaneous versus staged bilateral total hip arthroplasty (simBTHA and staBTHA), further investigation is needed regarding the revenues and contribution margins (CMs) of these procedures. In this study, we compared revenue, CM, and surgical outcomes between simBTHA and staBTHA. All patients who underwent simBTHA (both procedures completed the same day) and staBTHA (procedures completed on different days within one year) between 2011 and 2021 at a single high-volume orthopedic specialty hospital were identified. Of the 1,517 identified patients (n = 139 simBTHA, n = 1,378 staBTHA), 232 were included in a 1:1 propensity match based on baseline demographics (116 per cohort). Revenue, costs, CM, and surgical outcomes were compared between cohorts. Compared to staBTHA, simBTHA procedures had significantly lower total costs (P <.001), direct costs (P <.001), and patient revenue. There was no significant difference in CM between groups (P =.361). Additionally, there were no significant differences in length of stay (P =.173), operative time (P =.438), 90-day readmissions (P =.701), 90-day revisions (P =.313), or all-cause revisions (P =.701) between cohorts. Though simBTHA procedures have lower revenues than staBTHA, they also have lower costs, resulting in similar CM between procedures. As both procedures have similar postoperative complication rates, further research is required to evaluate specifically which patients may benefit from simBTHA versus staBTHA regarding clinical and patient-reported outcomes. III. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Trends in Revenue, Cost, and Contribution Margin of Patients Who Have a High Comorbidity Burden Undergoing Total Hip Arthroplasty From 2013 to 2021.

Author

Ashkenazi, Itay, Katzman, Jonathan, Thomas, Jeremiah, Davidovitch, Roy, Meftah, Morteza, and Schwarzkopf, Ran

Abstract

With the increasing utilization of total hip arthroplasty (THA) in patients who have a high comorbidity burden (HCB), coinciding with modifications to reimbursement models over the past decade, an evaluation of the financial impact of HCB on THA over time is warranted. This study aimed to investigate trends in revenue and cost associated with THA in HCB patients. Of 13,439 patients who had primary, elective THA between 2013 and 2021 at our institution, we retrospectively reviewed 978 patients considered to have HCB (Charlson comorbidity index ≥ 5 and American Society of Anesthesiology scores 3 or 4). We collected patient demographics, perioperative data, revenue, cost, and contribution margin (CM) of the inpatient episode. We analyzed changes as a percentage of 2013 values over time for these financial markers. Linear regression determined trend significance. The final analysis included 978 HCB patients who had complete financial data. Between 2013 and 2021, direct costs increased significantly (P =.002), along with a nonsignificant increase in total costs (P =.056). While revenue remained steady during the study period (P =.486), the CM decreased markedly to 38.0% of 2013 values, although not statistically significant (P =.222). Rates of 90-day complications and home discharge remained steady throughout the study period. Increasing costs for HCB patients undergoing THA were not matched by an equivalent increase in revenue, leading to dwindling CMs throughout the past decade. Re-evaluation of reimbursement models for THA that account for patients' HCB may be necessary to preserve broad access to care. III. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Do therapeutic exercises impact supraspinatus tendon thickness? Secondary analyses of the combined dataset from two randomized controlled trials in patients with rotator cuff-related shoulder pain.

Author

Dubé, Marc-Olivier, Ingwersen, Kim Gordon, Roy, Jean-Sébastien, Desmeules, François, Lewis, Jeremy, Juul-Kristensen, Birgit, Vobbe, Jette, Jensen, Steen Lund, and McCreesh, Karen

Abstract

The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability). This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises and 2) low-load strengthening with or without motor control exercises. In 1 trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline. Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (P <.001) and Group × Time interaction (P <.001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (P =.63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% confidence interval {CI}: 0.09-0.19]), decreased in the "Reactive" subgroup (−0.11 [95% CI: −0.16 to −0.06]), and remained unchanged in the "Normal" subgroup (−0.01 [95% CI: −0.04 to 0.02]). There was no Time (P =.21), Group (P =.61), or Group × Time interaction (P =.66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (P =.25) or change in SSTT ratio (P =.40) and change in disability score. Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Robotic-assisted esophagectomy with total mesoesophageal excision enhances R0-resection in patients with esophageal cancer: A single-center experience.

Author

Hoelzen, Jens P., Fortmann, Lukas, Roy, Dhruvajyoti, Szardenings, Carsten, Holstein, Martina, Eichelmann, Ann-Kathrin, Rijcken, Emile, Frankauer, Brooke E., Barth, Peter, Wardelmann, Eva, Pascher, Andreas, and Juratli, Mazen A.

Abstract

The focus of this research is to examine the growing use of robotic-assisted minimally invasive esophagectomy. Specifically, it evaluates the immediate clinical and cancer-related results of combining robotic-assisted minimally invasive esophagectomy with a systematic approach to total mesoesophageal excision, as opposed to traditional open transthoracic esophagectomy methods that do not employ a structured total mesoesophageal excision protocol. A propensity score–matched analysis of 185 robotic-assisted minimally invasive esophagectomies and 223 open transthoracic esophagectomies after standardized Ivor Lewis esophagectomy was performed. After 1:1 nearest neighbor matching to account for confounding by covariates, outcomes of 181 robotic-assisted minimally invasive esophagectomy and 181 open transthoracic esophagectomy were compared. The patient characteristics showed significant differences in the age distribution and in comorbidities such as coronary heart disease, arterial hypertension, and anticoagulant intake. The R0-resection rate of robotic-assisted minimally invasive esophagectomy (96.7%) was significantly higher than open transthoracic esophagectomy (89.0%, P =.004). Thirty-day mortality and hospital mortality showed no significant differences. Postoperative pneumonia rate after robotic-assisted minimally invasive esophagectomy (12.7%) was significantly reduced (open transthoracic esophagectomy 28.7%, P <.001). Robotic-assisted minimally invasive esophagectomy had a significantly shorter intensive care unit stay (P <.001) and shorter hospital stay (P <.001). This single-center, retrospective study employing propensity score matching found that combining robotic-assisted minimally invasive esophagectomy with structured total mesoesophageal excision results in better short-term clinical and oncologic outcomes than open transthoracic esophagectomy. This finding is significant because the increased rate of R0 resection could indicate a higher likelihood of improved long-term survival. Additionally, enhanced overall postoperative recovery may contribute to better risk management in esophagectomy procedures. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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27. Characteristics of contemporary atrial fibrillation clinical trials and their association with industry sponsorship.

Author

Lan, Roy H., Paranjpe, Ishan, Saeed, Mohammad, and Perez, Marco V.

Abstract

Industry sponsorship is an important source of funding for atrial fibrillation (AF) clinical trials, the implications of which have not been analyzed. The purpose of this study was to determine the characteristics of contemporary AF clinical trials and to evaluate their association with funding source. We systematically assessed all completed AF trials registered in the ClinicalTrials.gov database between conception to October 31, 2023, and extracted publicly available information including funding source, trial size, demographic distribution, intervention, location, and publication status. Trial characteristics were compared using the Wilcoxon rank-sum test and Fisher exact test for continuous and categorical variables, respectively. Of the 253 clinical trials assessed, 171 (68%) reported industry funding. Industry funding was associated with a greater median number of patients enrolled (172 vs 80; P <.001), publication rate (56.7% vs 42.7%; P =.04), probability of being product-focused (48.0% vs 24.4%; P <.001), and multicontinental recruitment location (25.2% vs 2.4%; P <.001) when compared to nonindustry-funded trials. However, industry funding was not associated with a significant difference in median impact factor (7.7 vs 7.7; P =.723). The overall proportion of industry-funded trials did not change over time (P = 1). Industry-funded clinical trials in AF often are larger, more frequently published, multicontinental, and product-focused. Industry funding was found to be associated with significant differences in study enrollment and publication metrics. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Tracking of invader drone using hybrid unscented Kalman-Continuous Ant Colony Filter (HUK-CACF).

Author

Mandal, Priti, Roy, Lakshi Prosad, and Das, Santos Kumar

Subjects
RADAR antennas, RADAR cross sections, ANTENNA arrays, ANT colonies, DOPPLER effect
Abstract

Splendid Unmanned Aerial Vehicle (UAV) applications upshot its enormous use in densely inhabited areas, which is a matter of concern. In such areas, a proper tracking system is required to track an unauthorized/invader drone to ensure safety. With the flexibility of reaching inaccessible places, an Unmanned Aerial Vehicle Mounted Adaptable Radar Antenna Array (UAVMARAA) could be used. In this regard, a Hybrid Unscented Kalman-Continuous Ant Colony Filter (HUK-CACF) is proposed to estimate the position of the invader drone efficiently. Simulation results demonstrate the efficiency and robustness of the proposed filter for tracking system compared to the existing filters in terms of success rate. Further, for various Adaptable Radar Antenna Array (ARAA) patterns such as Uniform Linear Array (ULA), Uniform Rectangular Array (URA), and Uniform Circular Array (UCA), analysis is done for pertaining actual tracking effect for various parameters such as bearing, Doppler shift, ranging, and Radar Cross Section (RCS) by considering wobbling and mutual coupling (MC) effect. The result shows that the proposed filter outperforms in all the scenarios. Among the various ARAA, URA performs better than the other configurations. • The UAVMARAA patrols to track invading drones precisely while smartly navigating its surroundings. • ULA, URA, and UCA configurations are considered for ARAA, which re-tunes itself for better invader drone information, accounting for wobbling and MC effects. • A new filter is proposed to reduce tracking error, analyzed for various parameters including bearing. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Technological advancements in the pretreatment of lignocellulosic biomass for effective valorization: A review of challenges and prospects.

Author

Chakraborty, Prasenjit, Kumar, Ramesh, Chakrabortty, Sankha, Saha, Shouvik, Chattaraj, Sujoy, Roy, Somagni, Banerjee, Avishek, Tripathy, Suraj K., Kumar Ghosh, Alak, and Jeon, Byong-Hun

Subjects
LIGNOCELLULOSE, TECHNOLOGICAL innovations, BIOMASS energy, BIOMASS, ENERGY development, CLEAN energy
Abstract

[Display omitted] Potential green energy systems can be explored using competent waste lignocellulosic (LC) biomass transformation to energy, a promising and sustainable substitute for energy resources. The intrinsic recalcitrance caused by inhibitory components, primarily lignin, significantly inhibits biofuel production from LC biomass. LC biomass pretreatment facilitates its disintegration via surface area solubility enhancement and reduction of lignin concentration and cellulose crystallinity. Various pretreatment techniques that promote sustainable LC biomass conversion to valuable organic chemicals and biofuels have been employed to rapidly disintegrate the components (lignin, cellulose, and hemicellulose). Herein, we elucidate recent biomass pretreatment strategies and optimum values of their operating parameters that effectively utilize LC biocomponents. Considering economic feasibility and scale-up possibilities, microwave-assisted deep-eutectic solvent pretreatment can be one of the sustainable schemes for delignification (∼87 %) and biofuel production. This study offers insights into the selection of a highly effective and appropriate biomass pretreatment method for green and sustainable energy development. [ABSTRACT FROM AUTHOR]

Published
2024
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31. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic : a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Author

Schumacher, A. E., Kyu, H. H., Antony, C. M., Aravkin, A. Y., Azhar, G. S., Bisignano, C., Burkart, K., Cercy, K. M., Chung, E., Coberly, K., Comfort, H., Cousin, E., Culbreth, G. T., Cunningham, M., Weaver, N. D., Degenhardt, L., Deitesfeld, L., Dirac, M. A., Estep, K., Feigin, V. L., Flaxman, A. D., Flor, L. S., Force, L. M., Fuller, J. E., Gakidou, E., Hay, S. I., Ikuta, K. S., Jones, D. P., Kassebaum, N. J., Kassel, M. B., Keller, C., Kinzel, K. E., Krohn, K. J., Lozano, R., May, E. A., McKowen, A. W., McLaughlin, S. A., Mehlman, M. L., Mestrovic, T., Mokdad, A. H., Mosser, J. F., Mougin, V., Naghavi, M., Nesbit, O. D., Novotney, A., Ozten, Y., Pease, S. A., Pigott, D. M., Reiner, R. C., Robinson-Oden, H. E., Shaw, D. H., Slepak, E. L. N., Sorensen, R. J. D., Verghese, N. A., Vollset, S., Vongpradith, A., Vos, T., Wang, D., Watson, S., Weaver, M. R., Wells, K. M., Wilson, S., Wool, E. E., Zheng, P., Lim, S. S., Murray, C. J. L., Boyko, E. J., Chahine, Y., Kalani, R., Krishnamoorthy, V., Khalil, I. A., Minja, N. W., Morrison, S. D., Nafukho, F. M., Olivas-Martinez, A., Orellana, E., Tram, K., Aali, A., Rahnavard, N., Ahmadzade, A., Mohammad-Pour, S., Morovatdar, N., Pourali, G., Zafari, N., Abbafati, C., Cattaruzza, M. S., Abbas, J., Phillips, M. R., Abbasgholizadeh, R., Emamverdi, M., Friedman, J., Abbasi, M. A., Daneshvar, S., Dashti, M., Ghasemzadeh, A., Mirza-Aghazadeh-Attari, M., Doshmangir, L., Ghafourifard, M., Lotfi, M., Hosseini, M., Jadidi-Niaragh, F., Kalankesh, L. R., Karimi, S., Mohammad-Alizadeh-Charandabi, S., Khalafi, M., Mirghafourvand, M., Mirinezhad, S., Heris, R. M., Mousavi, S., Kafil, H. S., Abbasian, M., Momenzadeh, K., Santos, F. C. D., Carr, S., Chi, G., Elgendy, I. Y., Feroze, A. H., Kempen, J. H., Kubeisy, C. M., Li, Z., Rohloff, P., Liu, X., Natto, Z. S., Olanipekun, T. O., Pigeolet, M., Pradhan, P. M. S., Zweck, E., Sharfaei, S., Sheikh, A., Abtahi, D., Salimi, S., Shakeri, A., Tajbakhsh, A., Aghamiri, S., Ahmadzade, M., Hashemi, M. B., Ajami, M., Asgary, S., Ghasemi, M., Hassanian-Moghaddam, H., Kolahi, A., Nikoobar, A., Heidari-Foroozan, M., Montazeri, F., Nejadghaderi, S., Rahmani, S., Ziaeefar, P., Hesami, H., Zahir, M., Jahankhani, K., Rasouli-Saravani, A., Jahanmehr, N., Kashani, H. K., Nasiri, M., Raee, P., Rezaee, M., Safi, S., Shool, S., Tabatabai, S., ElHafeez, S. A., Tantawi, M. E., Elmeligy, O. A. A., Ghazy, R. M., Talaat, I. M., Abdelmasseh, M., Sanabria, J., Abd-Elsalam, S., Abdelwahab, A., Abdollahi, M., Abolhassani, H., Rezaei, N., Saghazadeh, A., Ala, M., Noroozi, N., Bahri, R. A., Khatami, F., Ayyoubzadeh, S., Azadnajafabad, S., Keykhaei, M., Momtazmanesh, S., Mousavi, P., Behnoush, A., Farrokhpour, H., Karimi, H., Khalaji, A., Khanmohammadi, S., Mayeli, M., Mohammadi, S., Eskandarieh, S., Sahraian, M., Fahimi, S., Malekzadeh, R., Mansouri, V., Sepanlou, S. G., Ghassemi, F., Haddadi, M., Kazemian, S., Khadembashiri, M., Khamesipour, F., Khavandegar, A., Khormali, M., Salamati, P., Kompani, F., Larijani, B., Mirdamadi, N., Seyedi, S., Malazy, O. T., Mahmoudi, E., Rashedi, S., Rad, E. M., Mansournia, M., Nasab, E. M., Mohammadshahi, M., Mostafavi, H., SeyedAlinaghi, S., Shafie, M., Shahbandi, A., Vahdani, A. M., Sharifan, A., Shirkoohi, R., Sohrabi, H., Tavangar, S., Heidari-Soureshjani, R., Abdoun, M., Abdullahi, A., Awotidebe, A. W., Borodo, S. B., Gadanya, M. A., Ladan, M., Ali, M. U., Tyrovolas, S., Abdurehman, A. M., Debele, A. T., Getachew, T., Gudeta, M. D., Misgana, T., Sertsu, A., Abebe, M., Ayele, G. M., Afework, A., Lerango, T. L., Tebeje, T. M., Sibhat, M. M., Tesfaye, S. H., Abedi, A., Gholamrezanezhad, A., Salehi, S., Athari, S., Hanifi, N., Abegaz, T. M., Kifle, Z. D., Zuñiga, R. A. A., Abhilash, E. S., Abiodun, O. O., Aboagye, R. G., Amu, H., Ayanore, M. A., Dowou, R. K., Immurana, M., Klu, D., Orish, V. N., Carrero, J. J., Cederroth, C. R., Deuba, K., Laflamme, L., Fereshtehnejad, S., Kauppila, J. H., Abouzid, M., Abreu, L. G., Malta, D. C., Prates, E. J. S., Nascimento, B. R., Abrha, W. A., Weldemariam, A. H., Girmay, A., Abrigo, M. R. M., Rumeileh, S. A., Abu-Rmeileh, N. M., Aburuz, S., Ahmed, L. A., Alam, Z., Elbarazi, I., Grivna, M., Nauman, J., Khan, G., Khan, M. A., Zaki, N., Ahmad, M. M., Abu-Zaid, A., Temsah, R. M. H., Zand, R., Acuna, J. M., Gautam, P., Chowdhury, R., Adair, T., Jiang, H., Babu, A. S., Borschmann, R., Meretoja, A., Wijeratne, T., Addo, I. Y., Okeke, S. R., Dai, Z., Xu, X., Huda, M., Mitchell, P. B., Peden, A. E., Resnikoff, S., Sharma, S., Si, Y., Sitas, F., Ye, P., Adebayo, O. M., Aladelusi, T. O., Salami, A. A., Ilesanmi, O. S., Owolabi, M. O., Adegboye, O. A., Adekanmbi, V., AlBataineh, M. T., Almahmeed, W., Aden, B., Adepoju, A. V., Adetunji, C. O., Adeyeoluwa, T. E., Oyeyemi, I. T., Oyeyemi, O. T., Udoakang, A. J., Adeyomoye, O. I., Anuoluwa, I. A., Bello, O. O., Oluwafemi, Y. D., Ekundayo, T. C., Idowu, O. O., Oluwatunase, G. O., Afolabi, A. A., Ekholuenetale, M., Fagbamigbe, A. F., Olufadewa, I. I., Ibitoye, S. E., Okekunle, A. P., Adha, R., Adikusuma, W., Adibi, A., Chen, M., Hossain, M., Rasali, D. P., Pashaei, A., Adnani, Q. E. S., Postma, M. J., Adra, S., Barqawi, H. J., Dash, N. R., Halwani, R., Maghazachi, A. A., Saber-Ayad, M. M., Sharif-Askari, N. S., Ahmad, F., Saddik, B., Saleh, M. A., Alzoubi, K. H., Omar, H. A., Arumugam, A., Bustanji, Y., Elemam, N. M., Faris, M. E. M., Karim, A., Qaisar, R., Semreen, M. H., Soliman, S. S. M., Altirkawi, K. A., Afraz, A., Ilaghi, M., Nematollahi, M., Afyouni, S., Amindarolzarbi, A., Zandieh, G. G. Z., Columbus, A., Kamireddy, A., Shafaat, O., Kazemi, F., Vervoort, D., Zhang, H., Jamshidi, E., Afzal, S., Agasthi, P., Agodi, A., Barchitta, M., D'Amico, E., Maugeri, A., Veroux, M., Biondi, A., Isola, G., Vacante, M., Falzone, L., Libra, M., Agyemang-Duah, W., Nikpoor, A., Ahinkorah, B. O., Demant, D., Ahmad, A., Mustafa, G., Pathan, A. R., Tabish, M., Ahmad, D., Bagheri, N., Burns, R. A., Cherbuin, N., Ahmad, T., Ahmadi, K., Saxena, S., Beaney, T., Palladino, R., Rawaf, S., Mossialos, E., Rawaf, D. L., Ahmed, A., Siddig, E. E., Ahmed, H., Ahmed, M. B., Shiferaw, D., Ashemo, M. Y., Gerema, U., Getachew, M. E., Bayileyegn, N. S., Mohamed, A. I., Eshetie, T. C., Tiruye, T. Y., Ahmed, S., Ali, H., Bodunrin, A. O., Tumurkhuu, M., Tung, K., Ubah, C. S., Aruleba, R. T., Aji, B., Ajumobi, O., Akalu, G. T., Beyene, H. B., Deribe, K., Ijo, D., Kassaw, N. A., Akara, E., Akinosoglou, K., Akkala, S., Asaad, M., Hassan, A. M., Bleyer, A., Akyirem, S., Bell, M. L., Song, Y., Etaee, F., Goldust, M., Li, W., Pawar, S., Hamad, H. A., Sathian, B., Hasan, S. A., Homsi, A. A., Almidani, O., Göbölös, L., Qadire, M. A., AL-Ahdal, T. M. A., Chen, S., Moazen, B., Alalalmeh, S. O., Hegazi, O. E., Shahwan, M. J., Shamsi, M. A., Zyoud, S. H., Al-Aly, Z., Wang, C., Alam, K., Alam, M., Al-Amer, R. M., Naik, G. R., Alanzi, T. M., Bah, S., Menezes, R. G., Alanezi, F. M., Albashtawy, M., Aldridge, R. W., Chung, S., Hossain, S., Kim, J., Kivimäki, M., Sunkersing, D., Umar, T., Zumla, A., Alemi, S., Al-Eyadhy, A., Temsah, M., Alhabib, K. F., ElGohary, G. M. T., Meo, S. A., Al-Gheethi, A. A. S., Kiross, G. T., Alhalaiqa, F. A. N., Al-Maweri, S. A. A., Alomari, M. A., Mohammed, M., Al-Hanawi, M. K., Binmadi, N., Malik, A. A., Samargandy, S., Ali, A., Khan, I., Sawyer, S. M., Ali, B. A., Ali, R., Ali, S. S., Ali, Z., Samakkhah, S. A., Alicandro, G., Alif, S. M., Maharjan, P., Rai, P., Hasan, M., Thapa, R., Thrift, A. G., Aligol, M., Alimi, R., Aliyi, A. A., Jema, A., Al-Jumaily, A., Hankey, G. J., Kujan, O., Mansour, A., Aljunid, S. M., Al-Sabah, S. K., Al-Marwani, S., Almazan, J. U., Poddighe, D., Al-Mekhlafi, H. M., Ariffin, H., Lim, L., Bandyopadhyay, S., Basnyat, B., Maude, R. J., Bennett, D. A., Browne, A. 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A., Zaman, S., Zamora, N., Zanghì, A., Zare, I., Zeng, Y., Zhai, C., Zhang, Y., Zhao, H., Zhao, Y., Zhou, J., and Zhu, B.

Abstract

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, ant

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2024
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32. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

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V Bhattacharjee, N, E Schumacher, A, Aali, A, Habtegiorgis Abate, Y, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abd-Elsalam, S, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdullahi, A, Abebe, M, Shawel Abebe, S, Abiodun, O, Abolhassani, H, Abolmaali, M, Abouzid, M, Beressa Aboye, G, Guimarães Abreu, L, Aberhe Abrha, W, M Abrigo, M, Abtahi, D, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Me Abu-Rmeileh, N, Girum Girum Adal, T, Molla Adane, M, Atanda Adeagbo Adeagbo, O, Adesoji Adedoyin, R, Adekanmbi, V, Aden, B, Victor Adepoju, A, O Adetokunboh, O, Bunmi Adetunji, J, Adedayo Adeyinka, D, Israel Adeyomoye, O, Estiningtyas Sakilah Adnani, Q, Adra, S, Felix Afolabi, R, Afyouni, S, Sohail Afzal, M, Afzal, S, Aghamiri, S, Agodi, A, Agyemang-Duah, W, Opoku Ahinkorah, B, J Ahlstrom, A, Ahmad, A, Ahmad, D, Ahmad, F, M Ahmad, M, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, H, A Ahmed, L, Saleh Ahmed, M, Anees Ahmed, S, Ajami, M, Aji, B, Taddesse Akalu, G, 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O Obamiro, Ismail A Odetokun, Nkechi Martina Odogwu, Martin James O'Donnell, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, James Odhiambo Oguta, In-Hwan Oh, Sylvester Reuben Okeke, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Patrick Godwin Okwute, Andrew T Olagunju, Omotola O Olasupo, Matthew Idowu Olatubi, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Gideon Olamilekan Oluwatunase, Hany A Omar, Goran Latif Omer, Obinna E Onwujekwe, Michal Ordak, Orish Ebere Orisakwe, Verner N Orish, Doris V Ortega-Altamirano, Alberto Ortiz, Esteban Ortiz-Prado, Wael M S Osman, Uchechukwu Levi Osuagwu, Olayinka Osuolale, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia, Guoqing Ouyang, Mayowa O Owolabi, Yaz Ozten, Mahesh Padukudru P A, Mohammad Taha Pahlevan Fallahy, Feng Pan, Hai-Feng Pan, Adrian Pana, Paramjot Panda, Songhomitra Panda-Jonas, Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh, Seoyeon Park, Ashwaghosha Parthasarathi, Ava Pashaei, Roberto Passera, Hemal M Patel, Jay Patel, Shankargouda Patil, Dimitrios Patoulias, Venkata Suresh Patthipati, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Minjin Peng, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Gavin Pereira, Mario F P Peres, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Richard G Pestell, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Daniela Pierannunzio, Manon Pigeolet, David M Pigott, Evgenii Plotnikov, Dimitri Poddighe, Peter Pollner, Ramesh Poluru, Maarten J Postma, Ghazaleh Pourali, Akram Pourshams, Naeimeh Pourtaheri, Disha Prabhu, Sergio I Prada, Pranil Man Singh Pradhan, Manya Prasad, Akila Prashant, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar, Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki, Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi, Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim, Md Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Vahid Rahmanian, Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo, Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram, Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana, Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao, Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi, Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad, Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard, Reza Rikhtegar, Hannah Elizabeth Robinson-Oden, Célia Fortuna Rodrigues, Jefferson Antonio Buendia Rodriguez, Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani, Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Manjula S, Chandan S N, Aly M A Saad, Zahra Saadatian, Maha Mohamed Saber-Ayad, Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik, Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe, Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Marwa Rashad Salem, Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M Samy, Juan Sanabria, Nima Sanadgol, Francesca Sanna, Milena M Santric-Milicevic, Haaris Saqib, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi, Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Anudeep Sathyanarayan, Abu Sayeed, Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Pallav Sengupta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Edson Serván-Mori, Yashendra Sethi, SeyedAhmad SeyedAlinaghi, Seyed Arsalan Seyedi, Allen Seylani, Mahan Shafie, Jaffer Shah, Pritik A Shah, Ataollah Shahbandi, Samiah Shahid, Moyad Jamal Shahwan, Ahmed Shaikh, Masood Ali Shaikh, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Mohammad Anas Shamsi, Mohd Shanawaz, Abhishek Shankar, Mohammed Shannawaz, Medha Sharath, Sadaf Sharfaei, Amin Sharifan, Javad Sharifi-Rad, Manoj Sharma, Rajesh Sharma, Ujjawal Sharma, Vishal Sharma, Rajesh P Shastry, Amin Shavandi, David H Shaw, Amir Mehdi Shayan, Maryam Shayan, Amr Mohamed Elsayed Shehabeldine, Aziz Sheikh, Rahim Ali Sheikhi, Manjunath Mala Shenoy, Pavanchand H Shetty, Peilin Shi, Desalegn Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Aminu Shittu, Velizar Shivarov, Farhad Shokraneh, Sina Shool, Seyed Afshin Shorofi, Kanwar Hamza Shuja, Kerem Shuval, Emmanuel Edwar Siddig, João Pedro Silva, Luís Manuel Lopes Rodrigues Silva, Soraia Silva, Biagio Simonetti, Anjali Singal, Abhinav Singh, Balbir Bagicha Singh, Jasvinder A Singh, Md Shahjahan Siraj, Georgia Smith, Bogdan Socea, Anton Sokhan, Ranjan Solanki, Shipra Solanki, Hamidreza Soleimani, Sameh S M Soliman, Yonatan Solomon, Yimeng Song, Reed J D Sorensen, Michael Spartalis, Chandrashekhar T Sreeramareddy, Vijay Kumar Srivastava, Muhammad Haroon Stanikzai, Vladimir I Starodubov, Antonina V Starodubova, Simona Cătălina Stefan, Paschalis Steiropoulos, Mark A Stokes, Vetriselvan Subramaniyan, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Abida Sultana, Jing Sun, Chandan Kumar Swain, Bryan L Sykes, Lukasz Szarpak, Mindy D Szeto, Miklós Szócska, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Ozra Tabatabaei Malazy, Seyed-Amir Tabatabaeizadeh, Shima Tabatabai, Karen M Tabb, Mohammad Tabish, Moslem Taheri Soodejani, Jabeen Taiba, Ardeshir Tajbakhsh, Iman M Talaat, Ashis Talukder, Mircea Tampa, Jacques Lukenze Tamuzi, Ker-Kan Tan, Haosu Tang, Derbie Alemu DA Tareke, Mengistie Kassahun Tariku, Vivian Y Tat, Seyed Mohammad Tavangar, Mojtaba Teimoori, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Masayuki Teramoto, Dufera Rikitu Terefa, Riki Tesler, Enoch Teye-Kwadjo, Ramna Thakur, Pugazhenthan Thangaraju, Kavumpurathu Raman Thankappan, Rekha Thapar, Samar Tharwat, Rasiah Thayakaran, Nihal Thomas, Ales Tichopad, Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye, Mariya Vladimirovna Titova, Marcello Tonelli, Marcos Roberto Tovani-Palone, Eugenio Traini, Jasmine T Tran, Nghia Minh Tran, Indang Trihandini, Samuel Joseph Tromans, Thien Tan Tri Tai Truyen, Aristidis Tsatsakis, Evangelia Eirini Tsermpini, Munkhtuya Tumurkhuu, Stefanos Tyrovolas, Sayed Mohammad Nazim Uddin, Aniefiok John Udoakang, Arit Udoh, Atta Ullah, Saeed Ullah, Sana Ullah, Srikanth Umakanthan, Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay, Jibrin Sammani Usman, Marco Vacante, Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Jef Van den Eynde, Elena Varavikova, Orsolya Varga, Priya Vart, Shoban Babu Varthya, Tommi Juhani Vasankari, Balachandar Vellingiri, Deneshkumar Venugopal, Nicholas Alexander Verghese, Madhur Verma, Massimiliano Veroux, Georgios-Ioannis Verras, Dominique Vervoort, Jorge Hugo Villafañe, Manish Vinayak, Francesco S Violante, Mukesh Vishwakarma, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Simona Ruxandra Volovat, Theo Vos, Isidora S Vujcic, Hatem A Wafa, Yasir Waheed, Elias Bekele Wakwoya, Cong Wang, Denny Wang, Fang Wang, Shu Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward, Emebet Gashaw Wassie, Stefanie Watson, Marcia R Weaver, Kosala Gayan Weerakoon, Daniel J Weiss, Katherine M Wells, Yi Feng Wen, Ronny Westerman, Taweewat Wiangkham, Dakshitha Praneeth Wickramasinghe, Nuwan Darshana Wickramasinghe, Peter Willeit, Yohannes Addisu Wondimagegene, Felicia Wu, Juan Xia, Hong Xiao, Gelin Xu, Suowen Xu, Xiaoyue Xu, Ali Yadollahpour, Shirin Yaghoobpoor, Tina Yaghoobpour, Sajad Yaghoubi, Zwanden Sule Yahaya, Danting Yang, Lin Yang, Yuichiro Yano, Habib Yaribeygi, Pengpeng Ye, Renjulal Yesodharan, Subah Abderehim Yesuf, Saber Yezli, Amanuel Yigezu, Paul Yip, Dong Keon Yon, Naohiro Yonemoto, Yuyi You, Mustafa Z Younis, Zabihollah Yousefi, Chuanhua Yu, Yong Yu, Chun-Wei Yuan, Nima Zafari, Fathiah Zakham, Nazar Zaki, Giulia Zamagni, Milad Zandi, Ghazal G Z Zandieh, Moein Zangiabadian, Mikhail Sergeevich Zastrozhin, Haijun Zhang, Meixin Zhang, Yunquan Zhang, Chenwen Zhong, Juexiao Zhou, Bin Zhu, Lei Zhu, Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud, Christopher J L Murray, Amanda E Smith, and Stein Emil Vollset

Abstract

Background: Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in

Published
2024

33. Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review.

Author

Van Belle, Travis A., King, Emily C., Roy, Meghla, Michener, Mel, Hung, Vivian, Zagrodney, Katherine A.P., McKay, Sandra M., Holness, D. Linn, and Nichol, Kathryn A.

Abstract

Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses. • Organizational, environmental, and individual factors impact nurses' FPE adherence. • FPE access, policy clarity, and organizational support promote an adherence culture. • Adherence promotion strategies should focus on newer and emergency department staff. • Education should focus on FPE knowledge, infection transmission, and risk perception. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Use of an Artificial Intelligence Device for Evaluating Blood Loss in Complex Major Orthopaedic Surgery Procedures.

Author

Whiteside, Leo A. and Roy, Marie E.

Abstract

An artificial intelligence algorithm that analyzes the pulse oximeter waveform in the fingertip can be used to determine the compensatory reserve index (CRI) in trauma patients. This measurement shows the remaining cardiovascular capacity and is known to be more specific and sensitive in detecting blood loss than are routine vital signs. We hypothesized that the CRI measurement could predict loss of reserve cardiovascular capacity in patients undergoing major orthopaedic surgery, and therefore could help in their management. A total of 304 patients undergoing lower extremity arthroplasty consented to participate in waveform monitoring. Pulse oximeter waveforms were sensed with a fingertip probe and processed with a tablet computer that remained with the patient during surgery and recovery in the hospital. The CRI, systolic blood pressure, and heart rate were evaluated throughout the postoperative period. The CRI measurement identified a group of patients who were significantly more likely to require transfusions and emergency medical care (P =.000021). Patients who had morbid obesity were especially likely to have low CRI results and a high percentage of clinical events. A CRI of 0.40 or more was evaluated retrospectively as the criterion for withholding transfusion in 54 patients, but that group had a significantly higher incidence of transfusion later in treatment than did the cohort as a whole. The systolic blood pressure and heart rate were not useful in predicting the need for transfusion until late in treatment. This study suggests that the CRI measurement can identify patients at risk for transfusion and the need for urgent medical care and may aid in the management of blood loss and transfusion in major orthopedic surgery. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Implementation considerations for the adoption of artificial intelligence in the emergency department.

Author

Cheng, R., Aggarwal, A., Chakraborty, A., Harish, V., McGowan, M., Roy, A., Szulewski, A., and Nolan, B.

Abstract

Artificial intelligence (AI) has emerged as a potentially transformative force, particularly in the realm of emergency medicine (EM). The implementation of AI in emergency departments (ED) has the potential to improve patient care through various modalities. However, the implementation of AI in the ED presents unique challenges that influence its clinical adoption. This scoping review summarizes the current literature exploring the barriers and facilitators of the clinical implementation of AI in the ED. We systematically searched Embase (Ovid), MEDLINE (Ovid), Web of Science, and Engineering Village. All articles were published in English through November 20th, 2023. Two reviewers screened the search results, with disagreements resolved through third-party adjudication. A total of 8172 studies were included in the preliminary search, with 22 selected for the final data extraction. 10 studies were reviews and the remaining 12 were primary quantitative, qualitative, and mixed-methods studies. Out of the 22, 13 studies investigated a specific AI tool or application. Common barriers to implementation included a lack of model interpretability and explainability, encroachment on physician autonomy, and medicolegal considerations. Common facilitators to implementation included educating staff on the model, efficient integration into existing workflows, and sound external validation. There is increasing literature on AI implementation in the ED. Our research suggests that the most common barrier facing AI implementation in the ED is model interpretability and explainability. More primary research investigating the implementation of specific AI tools should be undertaken to help facilitate their successful clinical adoption in the ED. [ABSTRACT FROM AUTHOR]

Published
2024
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36. AI Versus MD: Evaluating the surgical decision-making accuracy of ChatGPT-4.

Author

Palenzuela, Deanna L., Mullen, John T., and Phitayakorn, Roy

Abstract

ChatGPT-4 is a large language model with possible applications to surgery education The aim of this study was to investigate the accuracy of ChatGPT-4's surgical decision-making compared with general surgery residents and attending surgeons. Five clinical scenarios were created from actual patient data based on common general surgery diagnoses. Scripts were developed to sequentially provide clinical information and ask decision-making questions. Responses to the prompts were scored based on a standardized rubric for a total of 50 points. Each clinical scenario was run through Chat GPT-4 and sent electronically to all general surgery residents and attendings at a single institution. Scores were compared using Wilcoxon rank sum tests. On average, ChatGPT-4 scored 39.6 points (79.2%, standard deviation ± 0.89 points). A total of five junior residents, 12 senior residents, and five attendings completed the clinical scenarios (resident response rate = 15.9%; attending response rate = 13.8%). On average, the junior residents scored a total of 33.4 (66.8%, standard deviation ± 3.29), senior residents 38.0 (76.0%, standard deviation ± 4.75), and attendings 38.8 (77.6%, standard deviation ± 5.45). ChatGPT-4 scored significantly better than junior residents (P =.009) but was not significantly different from senior residents or attendings. ChatGPT-4 was significantly better than junior residents at identifying the correct operation to perform (P =.0182) and recommending additional workup for postoperative complications (P =.012). ChatGPT-4 performed superior to junior residents and equivalent to senior residents and attendings when faced with surgical patient scenarios. Large language models, such as ChatGPT, may have the potential to be an educational resource for junior residents to develop surgical decision-making skills. [ABSTRACT FROM AUTHOR]

Published
2024
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37. A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences.

Author

Reynolds, Kristin A., Sommer, Jordana L., Roy, Rachel, Kornelsen, Jennifer, Mackenzie, Corey S., and El-Gabalawy, Renée

Abstract

We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Assessment of finger dexterity through the DIGITS joint tracking web application—An evaluation study with comparison to the nine-hole pegboard test.

Author

Kuchtaruk, Adrian, Dong, Hongdao, Jin, Helen, Kang, Justin, Wilson, Claire, Davidson, Jacob, Eagleson, Roy, and Symonette, Caitlin

Subjects
FINGER physiology, MOTOR ability, CROSS-sectional method, STATISTICAL correlation, QUESTIONNAIRES, SCIENTIFIC observation, RESEARCH methodology evaluation, EVALUATION of medical care, DESCRIPTIVE statistics, RESEARCH, COMPARATIVE studies, AUGMENTED reality
Abstract

Hand dexterity is an important clinical marker after hand surgery as it can greatly impact one's ability to perform their day-to-day activities. With the increased focus on remote patient monitoring after hand surgery, new technologies are required to remotely monitor hand dexterity. The purpose of this study is to identify dexterity outcomes using the web application "DIGITS" and compare these outcomes to the nine-hole-pegboard test (NHPT). Cross-sectional observational study. This was a two-part study with a pilot of our remote dexterity design using DIGITS followed by a validation study comparing DIGITS to a gold-standard metric of dexterity, NHPT. The pilot study recruited 42 healthy subjects between the ages of 18–65 to perform a remote finger tapping exercise using DIGITS. The second part of the study included 50 subjects between the ages of 18–65. Participants completed a demographic questionnaire and then completed three finger tapping sequences for 20 seconds using DIGITS and three trials of the NHPT with each hand. Correlational analyses were done to compare the DIGITS dexterity test with the NHPT. Four outcome measures to assess dexterity were identified, which included (1) total sequences completed in 20 seconds, (2) time to complete 10 sequences, (3) average frequency per sequence, and (3) sequence accuracy. Significant negative correlations were found with the NHPT and total sequences completed in 20 seconds in both dominant and non-dominant hand trials. Additionally, significant negative correlations were found between the NHPT and the time to complete 10 sequences and average frequency in the non-dominant hand trials. This study shows promising results for the use of DIGITS as a remote measure of hand dexterity. The total number of sequences completed significantly correlates with the NHPT and should be further explored in representative patient populations. • DIGITS outcomes included total sequences completed, average frequency, and accuracy. • Several DIGITS outcomes significantly correlated with NHPT scores. • Dexterity was found to worsen as patients get older in the NHPT and DIGITS test. [ABSTRACT FROM AUTHOR]

Published
2024
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39. RNA in cardiovascular disease: A new frontier of personalized medicine.

Author

Abdul-Rahman, Toufik, Lizano-Jubert, Ileana, Bliss, Zarah Sophia Blake, Garg, Neil, Meale, Emily, Roy, Poulami, Crino, Salvatore Antonio, Deepak, Bethineedi Lakshmi, Miteu, Goshen David, Wireko, Andrew Awuah, Qadeer, Abdul, Condurat, Alexandra, Tanasa, Andra Diana, Pyrpyris, Nikolaos, Sikora, Kateryna, Horbas, Viktoriia, Sood, Aayushi, Gupta, Rahul, and Lavie, Carl J.

Abstract

Personalized medicine has witnessed remarkable progress with the emergence of RNA therapy, offering new possibilities for the treatment of various diseases, and in particular in the context of cardiovascular disease (CVD). The ability to target the human genome through RNA manipulation offers great potential not only in the treatment of cardiac pathologies but also in their diagnosis and prevention, notably in cases of hyperlipidemia and myocardial infarctions. While only a few RNA-based treatments have entered clinical trials or obtained approval from the US Food and Drug Administration, the growing body of research on this subject is promising. However, the development of RNA therapies faces several challenges that must be overcome. These include the efficient delivery of drugs into cells, the potential for immunogenic responses, and safety. Resolving these obstacles is crucial to advance the development of RNA therapies. This review explores the newest developments in medical studies, treatment plans, and results related to RNA therapies for heart disease. Furthermore, it discusses the exciting possibilities and difficulties in this innovative area of research. [ABSTRACT FROM AUTHOR]

Published
2024
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40. 2024 update: European consensus statement on gene therapy for spinal muscular atrophy.

Author

Kirschner, Janbernd, Bernert, Günther, Butoianu, Nina, De Waele, Liesbeth, Fattal-Valevski, Aviva, Haberlova, Jana, Moreno, Teresa, Klein, Andrea, Kostera-Pruszczyk, Anna, Mercuri, Eugenio, Quijano-Roy, Susana, Sejersen, Thomas, Tizzano, Eduardo F., van der Pol, W Ludo, Wallace, Sean, Zafeiriou, Dimitrios, Ziegler, Andreas, Muntoni, Francesco, and Servais, Laurent

Subjects
SPINAL muscular atrophy, GENE therapy, GENETIC vectors, OLDER patients, NEWBORN screening, GENETIC disorders
Abstract

Spinal muscular atrophy (SMA) is one of the most common genetic diseases and was, until recently, a leading genetic cause of infant mortality. Three disease-modifying treatments have dramatically changed the disease trajectories and outcome for severely affected infants (SMA type 1), especially when initiated in the presymptomatic phase. One of these treatments is the adeno-associated viral vector 9 (AAV9) based gene therapy onasemnogene abeparvovec (Zolgensma®), which is delivered systemically and has been approved by the European Medicine Agency for SMA patients with up to three copies of the SMN2 gene or with the clinical presentation of SMA type 1. While this broad indication provides flexibility in patient selection, it also raises concerns about the risk-benefit ratio for patients with limited or no evidence supporting treatment. In 2020, we convened a European neuromuscular expert working group to support the rational use of onasemnogene abeparvovec, employing a modified Delphi methodology. After three years, we have assembled a similar yet larger group of European experts who assessed the emerging evidence of onasemnogene abeparvovec's role in treating older and heavier SMA patients, integrating insights from recent clinical trials and real-world evidence. This effort resulted in 12 consensus statements, with strong consensus achieved on 9 and consensus on the remaining 3, reflecting the evolving role of onasemnogene abeparvovec in treating SMA. • Updated European consensus on the use of onasemnogene abeparvovec for SMA treatment. • Emphasis on the importance of early intervention for improved patient outcomes. • Recommendations include considerations for older and heavier patients. • Data collection for safety and effectiveness is critical for treatment optimization. • New statement advocating for newborn screening implementation for SMA. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study.

Author

Holbert, Maleea D., Duff, Jed, Wood, Fiona, Holland, Andrew J.A., Teague, Warwick, Frear, Cody, Crellin, Dianne, Phillips, Natalie, Storey, Kristen, Martin, Lisa, Singer, Yvonne, Dimanopoulos, Tanesha A., Cuttle, Leila, Vagenas, Dimitrios, McPhail, Steven, Calleja, Pauline, De Young, Alexandra, Kimble, Roy M., and Griffin, Bronwyn R.

Abstract

Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022. • Adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burns. • Despite the demonstrated efficacy, this treatment has not been implemented as part of acute pediatric burn care. • A determinant framework was used to explore barriers to the implementation of adjunctive NPWT and develop matched strategies. • To implement NPWT into clinical practice, additional resources, education, training, and updates to policies are required. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Examining the impact of a paediatric trauma family support service on the quality of life of injured children: A longitudinal cohort study.

Author

Griffin, Bronwyn R., Harvey, Lauren, Dimanopoulos, Tanesha A., Curtis, Kate A., Gillen, Tona, and Kimble, Roy M.

Abstract

We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital. A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t -test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings. Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services." The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury. Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma. • Family Support Services can improve paediatric trauma recovery. • Quality of life and psychosocial improvements up to 12 months post-injury. • Emphasises the necessity for continuous, family-centred psychosocial support. • Future research must focus on tailored care and diverse family needs. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Modified indigenous nasal elevator for cleft lip and palate patient: A novel clinical innovation.

Author

Thapa, Amrit, Antil, Amit, Ray, Saugat, Roy, Indranil Deb, and Walia, B.S.

Subjects
PALATE surgery, CLEFT lip, CLEFT palate, ELEVATORS, LIP surgery, ALVEOLAR process
Abstract

Pre-nasoalveolar molding (PNAM) was developed to reduce the severity of the initial cleft alveolar and nasal deformity. The nasoalveolar moulding appliance (NAM) consists of an intraoral moulding plate with nasal stents to mould the alveolar ridge and nasal cartilage concurrently. Use of the NAM technique also reduces surgical columella reconstruction and the resultant scar tissue in bilateral cleft lip and palate. The nasoalveolar moulding technique has been shown to significantly improve the surgical outcome of the primary repair in cleft lip and palate patients compared to other techniques of presurgical orthopaedics. But the adaptability of nasal stent with support from NAM plate is cumbersome for many cleft patients due to its bulkiness, interfere with feeding and difficult for parents to manage at home. The Modified Indigenous Nasal Elevator (MINE) is a novel innovation for nasal correction for cleft lip and palate patients. This innovative design, non-invasive, precision, fewer visits, cost effective and adaptability make it a valuable tool to help surgeons to achieve optimal correction in lip repair surgeries in cleft lip & palate patients. MINE's innovative design allows for customization based on the patient's specific nasal anatomy. This adaptable feature ensures optimal fit and function for each patient, maximizing the surgical outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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44. The role of patient specific implants in the oral and maxillofacial region.

Author

Roy, Indranil Deb, Desai, Ajay Premanand, Ramyasri, M., and Mukesh, K.

Subjects
BONE grafting, OSTEOARTHRITIS, ARTHROPLASTY, TECHNOLOGICAL innovations, TEMPOROMANDIBULAR joint, COMPUTER-aided design
Abstract

Reconstructing maxillofacial defects is quiet challenging due to the region's complex anatomy, and cosmetic and functional effects on patients. With the help of developing technologies, patient-specific implants (PSIs) using virtual surgical planning based on a Computer aided designing (CAD)/Computer aided manufacturing (CAM) platform is an evolving treatment option. PSIs can be used in patients with maxillofacial defects and reconstruction. PSIs are also being used in the form of preformed plates for virtually planned orthognathic surgeries. Customized temporomandibular joint (TMJ) prosthesis is being routinely used in the debilitating/degenerative joint disease as a part of alloplastic joint replacement. The reconstruction of the maxillofacial region using autogenous tissue will always be gold standard due to near match of the recipient site. However, autogenous bone grafts positioned using PSIs or in certain areas such as the TMJ complex and the orbital region the PSIs are being offered with advantage of reduced donor-site morbidity. The future research is focussed towards the development of PSIs being used as a scaffold for engineering of the recipient tissue to restore the lost anatomy of specific region. This article reviews the varied aspects of this new technology of PSI for correction of various deformities/defects during the maxillofacial reconstruction. [ABSTRACT FROM AUTHOR]

Published
2024
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45. A Holistic Approach to CT Protocol and Dose Management.

Author

Eastman, Emi, Pressman, Barry D., Roy, Lynne, and Zhou, Yifang

Abstract

Challenges from administrative support, scanners' heterogeneity, patient size variation, and protocol mapping hinder CT protocol and dose management. We present a holistic approach to overcome these challenges. A dose tracking software was selected with two key requirements: intelligent protocol mapping and customizable dose threshold settings according to the patient size. A multifaceted workflow was carefully implemented. It included patient size–dependent dose thresholds for e-mail alerts, a base protocol archive on a website with a unified format using an in-house developed reformat software upon protocol export, prompt dose alert follow-up, and well-controlled protocol changes. The thresholds were iteratively updated following protocol changes or review of dose statistics. The program outcome was evaluated using 11 protocols from January 2020 to May 2023 (N = 148,678) in comparison to ACR's achievable dose (AD) and dose reference levels (DRLs). The 75th percentile dose data were lower than the ACR's DRL on average, ranging from −4.9% to −36%. The median doses were in a range of −23% to 19% on average in comparison with the ACR's AD. The median value from pulmonary embolism scans initially showed 36% higher than the AD but was gradually reduced to nearly 3% lower than the AD. The percentage of unjustified alerted cases decreased from 80% in first half year of 2020 to 17% in the first 5 months of 2023. The results showed that our holistic approach to protocol and dose management has been effective. The impact to practice has been prompt and sustainable. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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46. AI-enabled cardiac chambers volumetry in coronary artery calcium scans (AI-CACTM) predicts heart failure and outperforms NT-proBNP: The multi-ethnic study of Atherosclerosis.

Author

Naghavi, Morteza, Reeves, Anthony, Budoff, Matthew, Li, Dong, Atlas, Kyle, Zhang, Chenyu, Atlas, Thomas, Roy, Sion K., Henschke, Claudia I., Wong, Nathan D., Defilippi, Christopher, Levy, Daniel, and Yankelevitz, David F.

Abstract

Coronary artery calcium (CAC) scans contain useful information beyond the Agatston CAC score that is not currently reported. We recently reported that artificial intelligence (AI)-enabled cardiac chambers volumetry in CAC scans (AI-CAC™) predicted incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we investigated the performance of AI-CAC cardiac chambers for prediction of incident heart failure (HF). We applied AI-CAC to 5750 CAC scans of asymptomatic individuals (52% female, White 40%, Black 26%, Hispanic 22% Chinese 12%) free of known cardiovascular disease at the MESA baseline examination (2000–2002). We used the 15-year outcomes data and compared the time-dependent area under the curve (AUC) of AI-CAC volumetry versus NT-proBNP, Agatston score, and 9 known clinical risk factors (age, gender, diabetes, current smoking, hypertension medication, systolic and diastolic blood pressure, LDL, HDL for predicting incident HF over 15 years. Over 15 years of follow-up, 256 HF events accrued. The time-dependent AUC [95% CI] at 15 years for predicting HF with AI-CAC all chambers volumetry (0.86 [0.82,0.91]) was significantly higher than NT-proBNP (0.74 [0.69, 0.77]) and Agatston score (0.71 [0.68, 0.78]) (p ​< ​0.0001), and comparable to clinical risk factors (0.85, p ​= ​0.4141). Category-free Net Reclassification Index (NRI) [95% CI] adding AI-CAC LV significantly improved on clinical risk factors (0.32 [0.16,0.41]), NT-proBNP (0.46 [0.33,0.58]), and Agatston score (0.71 [0.57,0.81]) for HF prediction at 15 years (p ​< ​0.0001). AI-CAC volumetry significantly outperformed NT-proBNP and the Agatston CAC score, and significantly improved the AUC and category-free NRI of clinical risk factors for incident HF prediction. [ABSTRACT FROM AUTHOR]

Published
2024
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47. AI-enabled left atrial volumetry in coronary artery calcium scans (AI-CACTM) predicts atrial fibrillation as early as one year, improves CHARGE-AF, and outperforms NT-proBNP: The multi-ethnic study of atherosclerosis.

Author

Naghavi, Morteza, Yankelevitz, David, Reeves, Anthony P., Budoff, Matthew J., Li, Dong, Atlas, Kyle, Zhang, Chenyu, Atlas, Thomas L., Lirette, Seth, Wasserthal, Jakob, Roy, Sion K., Henschke, Claudia, Wong, Nathan D., Defilippi, Christopher, Heckbert, Susan R., and Greenland, Philip

Abstract

Coronary artery calcium (CAC) scans contain actionable information beyond CAC scores that is not currently reported. We have applied artificial intelligence-enabled automated cardiac chambers volumetry to CAC scans (AI-CACTM) to 5535 asymptomatic individuals (52.2% women, ages 45–84) that were previously obtained for CAC scoring in the baseline examination (2000–2002) of the Multi-Ethnic Study of Atherosclerosis (MESA). AI-CAC took on average 21 ​s per CAC scan. We used the 5-year outcomes data for incident atrial fibrillation (AF) and assessed discrimination using the time-dependent area under the curve (AUC) of AI-CAC LA volume with known predictors of AF, the CHARGE-AF Risk Score and NT-proBNP. The mean follow-up time to an AF event was 2.9 ​± ​1.4 years. At 1,2,3,4, and 5 years follow-up 36, 77, 123, 182, and 236 cases of AF were identified, respectively. The AUC for AI-CAC LA volume was significantly higher than CHARGE-AF for Years 1, 2, and 3 (0.83 vs. 0.74, 0.84 vs. 0.80, and 0.81 vs. 0.78, respectively, all p ​< ​0.05), but similar for Years 4 and 5, and significantly higher than NT-proBNP at Years 1–5 (all p ​< ​0.01), but not for combined CHARGE-AF and NT-proBNP at any year. AI-CAC LA significantly improved the continuous Net Reclassification Index for prediction of AF over years 1–5 when added to CHARGE-AF Risk Score (0.60, 0.28, 0.32, 0.19, 0.24), and NT-proBNP (0.68, 0.44, 0.42, 0.30, 0.37) (all p ​< ​0.01). AI-CAC LA volume enabled prediction of AF as early as one year and significantly improved on risk classification of CHARGE-AF Risk Score and NT-proBNP. [ABSTRACT FROM AUTHOR]

Published
2024
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48. A 'giant' pterodactyloid pterosaur from the British Jurassic.

Author

Etienne, James L., Smith, Roy E., Unwin, David M., Smyth, Robert S.H., and Martill, David M.

Abstract

The fossil remains of a pterodactyloid pterosaur from the Kimmeridge Clay Formation (Jurassic: Tithonian) of Abingdon, Oxfordshire, central England are identified as a partial left first wing finger phalanx. The elongation of the phalanx and distinctive morphology of the proximal articular region, in particular the square outline of the extensor tendon process, permit the specimen to be assigned to Ctenochasmatoidea. Although fragmentary, it is sufficiently well preserved to determine accurately its dimensions when complete. Morphometric analysis reveals the specimen to represent one of the largest known examples of a Jurassic pterosaur, with an estimated wingspan of at least 3 m, and is one of the first pterodactyloids to be reported from the Jurassic of the United Kingdom. [ABSTRACT FROM AUTHOR]

Published
2024
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