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Context: The rice-wheat (RW) system, spanning 13.5 million hectares in South Asia, is crucial for food security and livelihoods. However, intensive conventional tillage-based practices have harmed soil and environmental health, decreased productivity trends and increased greenhouse gas emissions. Objective: This study aims to develop resilient, climate-smart cropping systems within the RW system, focusing on soil and crop productivity, economic viability, and reduced greenhouse gas (GHG) emissions. Methods: Over eight years, the study evaluated diverse parameters compared to farmer practices (FP) in seven scenarios (Sc), including one representing FP (Sc1) and six based on conservation agriculture (CA) principles. The study assessed system crop productivity, economic returns, soil quality (organic carbon; OC, nitrogen; N, phosphorus; P, potassium; K contents, bulk density; BD, soil aggregation, infiltration rates, microbial counts, and earthworm density), and GHG emissions. Results: CA-based scenarios (Sc2 to Sc7) showed improved soil quality, lower bulk density, enhanced soil aggregation, and increased infiltration rates compared to Sc1. In the 0–15 cm layer, surface soil organic carbon (OC) and C stock were 63.7 % and 49.6 % higher, respectively, in CA-based scenarios. Additionally, available N, P and K contents in the surface layer increased by 10.2 %, 28.6 %, and 21.8 % under CA-based scenarios. Adoption of CA in intensified maize-based scenarios (Sc4 and Sc5) led to the increased system and economic yields, higher soil quality index (SQI), reduced GHG emissions and increased C stock compared to Sc1. Implications: The study highlights that Conservation Agriculture (CA) practices and diversified crop rotations can address issues like falling crop productivity, reduced economic returns, soil degradation, and increasing environmental impacts in northwestern India's traditional rice-wheat system. However, widespread adoption requires government policies, including C credit payments and guaranteed markets with supportive pricing.

Abstract: The anisotropy of energetic particles provides essential information to help resolve the underlying fundamental physics of their spatial distributions, injection, acceleration, and transport processes. In this work, we report an energetic ion enhancement that is characterized by very large and long-lasting anisotropies observed by STEREO A and Solar Orbiter, which are nearly aligned along the same nominal Parker spiral. This ion enhancement appears at the rising phase of a widespread solar energetic particle event that was associated with the farside coronal mass ejection on 2022 February 15. According to our analysis, the long-lasting anisotropy resulted from the continuous injection of energetic ions from a well-connected particle source located beyond the STEREO A’s orbit. Solar Orbiter also observed an interval of very large anisotropy dominated exclusively by sunward streaming ions but with the additional implication that it detected the very early phase of ion injections onto magnetic field lines that newly connected to the particle source, which is likely the first reported event of this kind. These results further illustrate how energetic particle anisotropy information, in particular from multiple observer locations, can be used to disentangle the sources and transport processes of energetic ions, even when their heliospheric context is not simple.

Damien F Goldberg,1 Claudio Orlich,2 Brian E Flowers,3 Inder P Singh,4 Sydney Tyson,5 Leonard K Seibold,6 Mohammed K ElMallah,7 Elysia M Ison,8 Med Harbin,8 Heather Reynolds,8 Malik Y Kahook9 1Wolstan & Goldberg Eye Associates, Torrance, CA, USA; 2Clinica 20/20, San Jose, Costa Rica; 3Ophthalmology Associates, Fort Worth, TX, USA; 4The Eye Centers of Racine & Kenosha, Racine, WI, USA; 5Eye Associates & SurgiCenter of Vineland, Vineland, NJ, USA; 6Department of Ophthalmology, University of Colorado Eye Center, Aurora, Colorado, USA; 7Ocala Eye, Ocala, FL, USA; 8New World Medical, Rancho Cucamonga, CA, USA; 9Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USACorrespondence: Malik Y Kahook, Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA, Tel +1 720 848 2501, Email Malik.Kahook@cuanschutz.eduPurpose: To report interim results of the VENICE study, a multi-center, randomized, controlled trial (RCT) comparing STREAMLINE Surgical System (STREAMLINE) canaloplasty with iStent inject W (iStent W) implantation in patients with mild-to-moderate primary open-angle glaucoma (POAG) undergoing phacoemulsification.Patients and Methods: Safety and efficacy analyses involving the first 72 randomized eyes are included in this report. Following pre- (Screening) and post-medication washout (Eligibility) visits, one eye per subject was randomized 1:1 to STREAMLINE or iStent W after undergoing uncomplicated phacoemulsification. Subjects were evaluated postoperatively at Day 1, Week 1, Month 1, 3, and 6. Intraocular pressure (IOP) measurements, number of IOP-lowering medications, and adverse events (AEs) were assessed at each follow-up visit.Results: Seventy-two eyes were randomized; 35 underwent STREAMLINE canaloplasty and 37 were implanted with the iStent W. Seventy eyes completed their 6-month follow-up. Both the mean morning post-washout Baseline IOP between STREAMLINE 24.86± 3.05 mmHg and iStent W 25.16± 3.41 mmHg and the mean IOP at 6 months between STREAMLINE eyes 16.52± 3.63 mmHg and iStent W eyes 16.08± 3.19 mmHg were not statistically significantly different (p=0.691 and 0.596, respectively). At 6 months, more eyes were on zero glaucoma medications in the STREAMLINE group (81.8%) compared to the iStent W group (78.4%). In medication-free eyes, the mean IOP was reduced from 24.80± 2.79 mmHg to 16.00± 3.40 mmHg and 24.60± 3.18 mmHg to 15.80± 2.21 mmHg in the STREAMLINE and iStent W groups, respectively (p=0.752). Both groups showed reduction in IOP-lowering medications at every visit, compared to pre-washout (Screening), with STREAMLINE resulting in numerically fewer medications 0.20± 0.48 compared to iStent W 0.40± 0.79 at 6 months (P=0.384). AEs were mild and self-limited.Conclusion: To our knowledge, the VENICE trial is the first RCT involving canaloplasty. These interim findings demonstrated comparable IOP and medication reduction between STREAMLINE canaloplasty and iStent W implantation, when combined with phacoemulsification.Keywords: primary open-angle glaucoma, POAG, STREAMLINE, iStent inject W, canaloplasty, microinvasive glaucoma surgery, MIGS

Lamia K Alshamlani,1 Dana S Alsulaim,1 Raghad S Alabbad,1 Ahad A Alhoshan,1 Joud F Alkhoder,1 Norah S Alsaleh,2 Mohammed Almannai,1– 3 Faroug Ababneh,2 Manal Algattan,4 Lojain Alsini,4 Abdulrahman Faiz Alswaid,2 Wafaa M Eyaid,1– 3 Fuad Al Mutairi,1– 3 Muhammad Umair,3 Majid Alfadhel1– 3 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia; 2Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children Hospital (KASCH), King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia; 3Medical Genomics Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs (MNGH), Riyadh, Saudi Arabia; 4Pathology and Laboratory Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaCorrespondence: Majid Alfadhel, Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, P.O Box 22490, Riyadh, 11426, Saudi Arabia, Tel +00 966 11 805 3560, Fax +00 966 11 805 5555, Email dralfadhelm@gmail.comBackground: Consanguinity, or the practice of marrying close relatives, is a common cultural tradition in Saudi Arabia, with rates among the highest in the world. This practice has significant implications for the prevalence and distribution of major single genetic defects and chromosomal abnormalities within the Saudi population.Methods: Herein, using the BESTCare electronic medical record system (designed to streamline hospital operations, enhance patient care, and improve the overall efficiency of healthcare services; bestcare.ezcaretech.com) in a single tertiary centre, King Abdullah Specialized Children Hospital (KASCH) in Riyadh, Saudi Arabia, we performed a cross-sectional study for all patients referred to the hospital from the 1st January 2020 until 1st January 2022.Results: The present study, which included 1100 individuals, found a high prevalence of consanguinity (64%) and a significant proportion of third-degree relatives (69%). The mean age of participants was 12.24 years, and the diagnostic rate using advanced molecular genetics techniques was 45%, with whole exome sequencing (WES) being the most common method (43%). The study also noted a significant delay in diagnosis for more than a year in 16% of cases, with a common neurodevelopmental phenotype (18%).Conclusion: In conclusion, we revealed the prevalence of consanguineous marriages in the KASCH hospital in Riyadh, Saudi Arabia. We also highlighted the most frequently referred phenotype. These findings are consistent with previous research on the prevalence and impact of consanguinity on rare genetic disorders.Keywords: consanguinity, genetic disorders, autosomal recessive disorders, Saudi Arabia, prevalence of single gene disorder, chromosomal abnormalities

ABSTRACT Aims/Introduction Two Hong Kong Chinese non‐laboratory‐based prediabetes/diabetes mellitus (pre‐DM/DM) risk models were developed using logistic regression (LR) and machine learning, respectively. We aimed to evaluate the models' validity in case finding of pre‐DM/DM in a Chinese primary care (PC) population. We also evaluated the validity of a risk‐scoring algorithm derived from the LR model. Materials and Methods This was a cross‐sectional external validation study on Chinese adults, without a prior DM diagnosis, who were recruited from public/private PC clinics in Hong Kong. A total of 1,237 participants completed a questionnaire on the models' predictors. Of that, 919 underwent blood glucose testing. The primary outcome was the models' and the algorithm's sensitivity in finding pre‐DM/DM cases. The secondary outcomes were the models' and the algorithm's specificity, positive/negative predictive values, discrimination and calibration. Results The models' sensitivity were 0.70 (machine learning) and 0.72 (LR). Both showed good external discrimination (area under the receiver operating characteristic curve: machine learning 0.744, LR 0.739). The risks estimated by the models were lower than the observed incidence, indicating poor calibration. Both models were more effective among participants with lower pretest probabilities; that is, age 18–44 years. The algorithm's sensitivity was 0.77 at the cut‐off score of ≥16 out of 41. Conclusion This study showed the validity of the models and the algorithm for finding pre‐DM/DM cases in a Chinese PC population in Hong Kong. They can facilitate more cost‐effective identification of high‐risk individuals for blood testing to diagnose pre‐DM/DM in PC. Further studies should recalibrate the models for more precise risk estimation in PC populations.

Abstract Background The discovery of new prognostic biomarkers following spinal cord injury (SCI) is a rapidly growing field that could help uncover the underlying pathological mechanisms of SCI and aid in the development of new therapies. To date, this search has largely focused on the initial days after the lesion. However, during the subacute stage of SCI (weeks to months after the injury), there remains potential for sensorimotor recovery, and numerous secondary events develop in various organs. Additionally, the confounding effects of early interventions after the injury are less likely to interfere with the results. Methods In this study, we conducted an untargeted proteomics analysis to identify biomarkers of recovery in blood serum samples during the subacute phase of SCI patients, comparing those with strong recovery to those with no recovery between 30 and 120 days. We analyzed the fraction of serum that is depleted of the most abundant proteins to unmask proteins that would otherwise go undetected. Linear models were used to identify peptides and proteins related to neurological recovery and we validated changes in some of these proteins using Enzyme-linked Immunosorbent Assay (ELISA). Results Our findings reveal that differences in subacute recovery after SCI (from 30 to 120 days) are associated with an enrichment in proteins involved in inflammation, coagulation, and lipid metabolism. Technical validation using commercial ELISAs further confirms that high levels of SERPINE1 and ARHGAP35 are associated with strong neurological recovery, while high levels of CD300a and DEFA1 are associated with a lack of recovery. Conclusions Our study identifies new candidates for biomarkers of neurological recovery and for novel therapeutic targets after SCI.

Kaustav Banerjee,1 Subhasish Pramanik,2 Lakshmi Kanta Mondal3 1Decision Sciences Area, Indian Institute of Management Lucknow, Uttar Pradesh, 226013, India; 2Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, 700020, India; 3Department of Ophthalmology, Regional Institute of Ophthalmology, Medical College Campus, Kolkata, West Bengal, 700073, IndiaCorrespondence: Lakshmi Kanta Mondal, Department of Ophthalmology, Regional Institute of Ophthalmology, Medical College Campus, Kolkata, West Bengal, 700073, India, Tel +9830830216, Email Lakshmi.mondal62@gmail.comIntroduction: The focus is often on the best and worst eyes to detect early predictive and non-invasive biomarkers of diabetic retinopathy. Typically, such data have been dealt with in a case-control setting, which applies two-sample tests and ignores the correlation between the fellow eyes. Practitioners are mostly unaware that such measurements hide the labels of the fellow eyes, which rules out standard tools, such as paired t or signed-rank tests.Methods: This report discusses the problems with such data on best and worst eye measurements, and illustrates alternative paired tests for equality of means or locations using a case-control dataset.Results: This report illustrates that methods which ignore the correlation between fellow eyes result in grossly conservative tests. A battery of Z-tests which consider this correlation can resolve this issue.Discussion: This finding emphasizes the importance of selecting an appropriate control group for the detection of possible markers. Further, it cites an example to show that using data from fellow eyes and adjusting for their correlation may not always be the best option, contrary to common perception.Keywords: best eye, worst eye, unordered pairs

Lena-Karin Gustafsson,1 Els-Marie Anbacken,2 Gunnel Östlund,2 Anna Bondesson,1 Tina Pettersson,1 Viktoria Zander3 1Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 2Division of Social Work, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden; 3Division of Health and Welfare Technology, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, SwedenCorrespondence: Lena-Karin Gustafsson, Division of Caring Science, School of Health, Care and Social Welfare, Mälardalens University, Eskilstuna, Sweden, Tel +46 70 7874420, Email lena-karin.gustafsson@mdu.seAim: This study aims to describe experiences of the implementation of a new integrated healthcare model for older adults with complex care needs due to multimorbidity, living at home, from a health and welfare personnel perspective. The goal was to diminish hospitalization and still carry out high quality care at home for older adults living with multimorbidity. The model was implemented by two organizations working in cooperation, the municipality, and the region that handles interprofessional social care and healthcare in people’s homes.Materials and Method: Open-ended group interviews with personnel were carried out, three of the group interviews pre-implementations of the model, and three of the group interviews post-implementation. The interviews were audiotaped and analysed according to the procedure of thematic analysis.Results: The quality of the integrated care model was based on care-chain cooperation, shared professionalism, and creating relations with the patient including closeness to next of kin, which was underlined by the participants. Unencumbered time gave the professionals the possibility to develop quality in integrated healthcare as part of integrated and person-centred care. The coproduction of education, research interviews and the follow-up meeting identified successes in diminishing hospitalization rates according to the participants’ experiences of the post-implementation interviews. An identified failure was, however, that shared professionalism was not developed over time, rather the different responsibilities were accentuated according to the information retrieved at the follow-up meeting.Conclusion: Quality aspects of the model were identified in the present study. However, when implementation of a new model is completed, the organizations always have their own interpretation of how to further understand the model in question.Plain language summary: The intention of the present study was to follow the process of working with a new model of providing care at home, thus preventing increased numbers of hospital readmissions, based on the professionals´ point of view of what quality care is for older adults with complex care needs due to multimorbidity, living in their own home. The professionals were interviewed in group settings on several occasions during the implementation.The result showed hopeful expectations expressed by the professionals before the new model was implemented, such as a hope for getting more time for high-quality care for the older adults with multimorbidity. During the teamwork, the conversation within the team members was praised as a key factor that included shared professionalism from professionals with different levels of education and focus on their work. According to the staff, unnecessary hospital stays were reduced, while the interprofessional care-chain cooperation was improved through the work of the integrated care team. For many team members, the positive difference in both work and care satisfaction was highlighted in comparison to regular home care as they were able to use their multi-disciplinary skills and support.Keywords: integrated-care model, multi-morbidity, interprofessional care, home-based care, person-centred integrated care

Aim: We present a case of Ecthyma gangrenosum (EG) affecting left thigh in a child with acute lymphoblastic leukaemia (ALL) with an aim to raise awareness about this condition. Case presentation: A 7-year-old female child who presented with lethargy, pallor and lumps to inner lip was diagnosed with B-cell precursor ALL. She was started on treatment as per UKALL 2011 guidelines Regime B. On day 28, she developed neutropenic sepsis along with a new lesion in her left thigh. She was started on intravenous Meropenum, Gentamicin and Caspofungin. The clinical diagnosis of EG was made based on lesion progression, positive blood and wound swab & tissue cultures for Pseudomonas aeruginosa and patient's immunocompromised status. The wound healed with secondary intention following debridement. We present a series of photographs to demonstrate her remarkable improvement. Discussion: EG occurs in 1–30% of cases of Pseudomonas sepsis; other bacteria and fungi can be associated with this condition. It is identified more in oncology patients as seen in our patient. A multidisciplinary team approach should be provided in 3 stages with empirical antibiotics, followed by targeted antibiotics or antifungals & surgical debridement. Our patient was treated in similar fashion and made a good recovery. Conclusion: It is a rare skin condition associated with a high mortality. We suggest all clinicians to be vigilant about this condition to be able to provide accurate diagnosis and prompt treatment to improve the overall prognosis.

Introdução: A maioria das instituições que realizam coleta de Células Progenitoras Hematopoiéticas de Sangue Periférico (CPH-SP) por aférese tem a competência de coletar linfócitos para a terapia, considerando que do ponto de vista técnico não são muito diferentes. Entretanto, atingir a quantidade celular alvo pode ser um desafio, considerando que para a coleta de Concentrado de Linfócitos, além de não possibilitar mobilização para o sangue periférico, devemos considerar a linfopenia do paciente, que em grande parte são submetidos a várias linhas de tratamento quimioterápico. Após a quimioterapia recente, a primeira subpopulação linfocitária a incrementar no sangue periférico é de células NK e não de CD3+, podendo aumentar a dificuldade. Objetivos: Compartilhar a experiência das coletas de Concentrado de Linfócitos por aférese, realizadas para manufatura da terapia Car-T Cell adulto e pediátrico. Materiais e métodos: Análise descritiva retrospectiva, dos dados das coletas de Linfócitos por aférese para Terapia Car-T Cell na instituição, no período de 10/2022 até 05/2024. Os dados analisados foram: dosagem de CD3+ no sangue periférico, volemia de sangue total processada, produto coletado e a análise de eficiência da aférese. A dosagem celular ideal considerada é de no mínimo 1 × 109 células CD3+ para pacientes com diagnóstico de Leucemia Linfoide Aguda (LLA) e 2 × 109 para pacientes com diagnóstico de Linfoma Difuso de Grandes Células B (LDGCB). Resultados: No total foram analisadas 27 coletas em 21 pacientes, sendo 19 coletas em 16 pacientes adultos com diagnóstico de LDGCB e 8 coletas em 5 pacientes pediátricos com diagnóstico LLA. A dosagem celular ideal foi atingida em coleta única em 14 pacientes adultos e em 3 pacientes pediátricos, volume processado médio 3,5 volemias e eficiência média de 65,5% nas aféreses. Discussão: Se mostrou um desafio para alcançar a dosagem celular ideal em única coleta, nos pacientes adultos com dosagem de CD3+ periférico inferior a 300 × 10³/ml e os pediátricos com dosagem inferior a 600 × 10³/ml. Se fez necessário em adulto, três coletas por aférese quando dosagem de CD3+ periférico < a 100 × 10³/ml (atingido 2,59 × 109) e duas coletas por aférese com dosagem < 340 × 10³/ml (atingido 3,19 × 109). Quando pediátrico, três coletas com dosagem < 90 × 103/ml (0,75 × 109) e duas coletas com dosagem < 300 × 10³/ml na primeira e < 600 × 10³na segunda (1,94 × 109). O total de leucócitos parece não ter tanta significância para o produto coletado, relatando um paciente adulto com 49 kg, Leucócito Total 0.896 × 10³, Linfócito Total 396 × 10³, CD3+ periférico 395 × 10³/ml, volume processado 12.250 ml (3,9 volemias) e produto final satisfatório de 3,32 × 109. Conclusão: A dosagem de CD3+ periférico associado a volemia de sangue total do paciente, evidenciam maior relevância como parâmetro para programação da aférese, assim não definindo o volume total que será processado com base somente na dosagem de CD3+ periférica. Buscamos um número total de células no produto final, contrapondo a experiência adquirida na avaliação da dosagem das células periféricas para coletas de CPH-SP, que desejamos quantidade de células conforme o peso do paciente.

Multiple types and classes of medications are administered in the acute management of traumatic spinal cord injury. Prior clinical studies and evidence from animal models suggest that several of these medications could modify (i.e., enhance or impede) neurological recovery. We aimed to systematically determine the types of medications commonly administered, alone or in combination, in the transition from acute to subacute spinal cord injury. For that purpose, type, class, dosage, timing, and reason for administration were extracted from two large spinal cord injury datasets. Descriptive statistics were used to describe the medications administered within the first 60 days after spinal cord injury. Across 2040 individuals with spinal cord injury, 775 unique medications were administered within the two months after injury. On average, patients enrolled in a clinical trial were administered 9.9 ± 4.9 (range 0-34), 14.3 ± 6.3 (range 1-40), 18.6 ± 8.2 (range 0-58), and 21.5 ± 9.7 (range 0-59) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Those enrolled in an observational study were administered on average 1.7 ± 1.7 (range 0-11), 3.7 ± 3.7 (range 0-24), 8.5 ± 6.3 (range 0-42), and 13.5 ± 8.3 (range 0-52) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Polypharmacy was commonplace (up to 43 medications per day per patient). Approximately 10% of medications were administered acutely as prophylaxis (e.g., against the development of pain or infections). To our knowledge, this was the first time acute pharmacological practices have been comprehensively examined after spinal cord injury. Our study revealed a high degree of polypharmacy in the acute stages of spinal cord injury, raising the potential to impact neurological recovery. All results can be interactively explored on the RXSCI web site ( https://jutzelec.shinyapps.io/RxSCI/ ) and GitHub repository ( https://github.com/jutzca/Acute-Pharmacological-Treatment-in-SCI/ ).

Abstract Background Ex-ante identification of the last year in life facilitates a proactive palliative approach. Machine learning models trained on electronic health records (EHR) demonstrate promising performance in cancer prognostication. However, gaps in literature include incomplete reporting of model performance, inadequate alignment of model formulation with implementation use-case, and insufficient explainability hindering trust and adoption in clinical settings. Hence, we aim to develop an explainable machine learning EHR-based model that prompts palliative care processes by predicting for 365-day mortality risk among patients with advanced cancer within an outpatient setting. Methods Our cohort consisted of 5,926 adults diagnosed with Stage 3 or 4 solid organ cancer between July 1, 2017, and June 30, 2020 and receiving ambulatory cancer care within a tertiary center. The classification problem was modelled using Extreme Gradient Boosting (XGBoost) and aligned to our envisioned use-case: “Given a prediction point that corresponds to an outpatient cancer encounter, predict for mortality within 365-days from prediction point, using EHR data up to 365-days prior.” The model was trained with 75% of the dataset (n = 39,416 outpatient encounters) and validated on a 25% hold-out dataset (n = 13,122 outpatient encounters). To explain model outputs, we used Shapley Additive Explanations (SHAP) values. Clinical characteristics, laboratory tests and treatment data were used to train the model. Performance was evaluated using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC), while model calibration was assessed using the Brier score. Results In total, 17,149 of the 52,538 prediction points (32.6%) had a mortality event within the 365-day prediction window. The model demonstrated an AUROC of 0.861 (95% CI 0.856–0.867) and AUPRC of 0.771. The Brier score was 0.147, indicating slight overestimations of mortality risk. Explanatory diagrams utilizing SHAP values allowed visualization of feature impacts on predictions at both the global and individual levels. Conclusion Our machine learning model demonstrated good discrimination and precision-recall in predicting 365-day mortality risk among individuals with advanced cancer. It has the potential to provide personalized mortality predictions and facilitate earlier integration of palliative care.

Rahaf K Sharif,1 Faisal F Aljahdali,1 Hind M Aljabri,1 Lugean K Alomari,1 Renad A Sagim,1 Duaa M Alamri,1 Merai A Alshehri,2 Rayan Abdullah Alshigari3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2Department of Surgery, College of Medicine, University of Bisha, Bisha, Saudi Arabia; 3Department of Glaucoma Section, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Faisal F Aljahdali, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, Email faisalfahadaljahdali@gmail.comBackground: Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification and laser peripheral iridotomy (LPI) effectively control IOP elevation and widen the angle. This systematic review and meta-analysis compared Phacoemulsification and LPI Effectiveness for PACG.Methods: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared Phacoemulsification and LPI for individuals with PACG. We sought to evaluate the following outcomes: mean IOP, number of glaucoma medications, visual acuity (VA), visual field (VF) progression, peripheral anterior synechiae (PAS), Shaffer gonioscopy grading, central corneal thickness (CCT), central endothelial cell density (CECD), and poor response to surgery. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.Results: 5 RCTs that enrolled 917 participants were deemed eligible. The phacoemulsification group showed statistically significance lower mean CCT and CECD and lower risk of poor response to surgery compared to LPI (SMD = − 1.10; 95% − 1.50, − 0.70; P< 0.001, SMD − 366.12; 95% − 652.59, − 79.65; P=0.01, and RR 0.35; 95% 0.23, 0.54; P< 0.001 respectively). There were no significant improvement in IOP and number of medications between both groups (SMD = − 0.74; 95% CI = − 2.26, 0.78; P=0.34, and SMD − 17.58; 95% CI = − 50.28, 15.12; P=0.29 respectively). Finally, there were also no significant differences in VA, VF progression, PAS, and mean Shaffer gonioscopy grading between both groups.Conclusion: Phacoemulsification showed statistically significant lower mean corneal thickness, central endothelial cell density, and lower risk of poor response to surgery compared to LPI. However, there were no significant differences in mean IOP, number of medications, VA, VF progression, PAS, and mean Shaffer gonioscopy grading between Phacoemulsification and LPI.Keywords: phacoemulsification, laser, iridotomy, glaucoma

J A Mansurova, Andrey Orekhov, A S Zhunuspekova, A A Kassymova, L K Karazhanova Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of KazakhstanCorrespondence: Andrey Orekhov, Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Molodogvardeyskaya 34-1 Street, Semey, F18E9T9, The Republic of Kazakhstan, Tel +87774141476, Email orekhov-andrei@list.ruBackground: The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods: This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated.Results: The study findings indicated an inverse relationship between stent thrombosis development (Rho=− 0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=− 0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p< 0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040).Conclusion: Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.Keywords: acute coronary syndrome, percutaneous coronary intervention, adherence, education, dual antiplatelet therapy

BackgroundDiagnosis of invasive candidiasis (IC) relies on insensitive cultures; the relative utility of fungal biomarkers in children is unclear.MethodsThis multinational observational cohort study enrolled patients aged >120 days and

Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy.Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO.Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study.Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design.Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH.Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK.Trial registration number CTRI/2022/01/039473.

Iron-sulfur cluster proteins are involved in critical functions for gene expression regulation and mitochondrial bioenergetics including the oxidative phosphorylation system. The c.215G>A p.(Arg72Gln) variant in NFS1 has been previously reported to cause infantile mitochondrial complex II and III deficiency. We describe three additional unrelated patients with the same missense variant. Two infants with the same homozygous variant presented with hypotonia, weakness and lactic acidosis, and one patient with compound heterozygous p.(Arg72Gln) and p.(Arg412His) variants presented as a young adult with gastrointestinal symptoms and fatigue. Skeletal muscle biopsy from patients 1 and 3 showed abnormal mitochondrial morphology, and functional analyses demonstrated decreased activity in respiratory chain complex II and variably in complexes I and III. We found decreased mitochondrial and cytosolic aconitase activities but only mildly affected lipoylation of pyruvate dehydrogenase and 2-oxoglutarate dehydrogenase enzymes. Our studies expand the phenotypic spectrum and provide further evidence for the pathogenicity and functional sequelae of NFS1-related disorders with disturbances in both mitochondrial and cytosolic iron-sulfur cluster containing enzymes.

The HERAPDF2.0 ensemble of parton distribution functions (PDFs) was introduced in 2015. The final stage is presented, a next-to-next-to-leading-order (NNLO) analysis of the HERA data on inclusive deep inelastic ep scattering together with jet data as published by the H1 and ZEUS collaborations. A perturbative QCD fit, simultaneously of αs(MZ2) and the PDFs, was performed with the result αs(MZ2)=0.1156±0.0011(exp)-0.0002+0.0001(model+parameterisation)±0.0029(scale). The PDF sets of HERAPDF2.0Jets NNLO were determined with separate fits using two fixed values of αs(MZ2), αs(MZ2)=0.1155 and 0.118, since the latter value was already chosen for the published HERAPDF2.0 NNLO analysis based on HERA inclusive DIS data only. The different sets of PDFs are presented, evaluated and compared. The consistency of the PDFs determined with and without the jet data demonstrates the consistency of HERA inclusive and jet-production cross-section data. The inclusion of the jet data reduced the uncertainty on the gluon PDF. Predictions based on the PDFs of HERAPDF2.0Jets NNLO give an excellent description of the jet-production data used as input.

This article is composed of three independent commentaries about the state of Integrated, Coordinated, Open, Networked (ICON) principles in the American Geophysical Union Biogeosciences section, and discussion on the opportunities and challenges of adopting them. Each commentary focuses on a different topic: (a) Global collaboration, technology transfer, and application (Section 2), (b) Community engagement, community science, education, and stakeholder involvement (Section 3), and (c) Field, experimental, remote sensing, and real-time data research and application (Section 4). We discuss needs and strategies for implementing ICON and outline short- and long-term goals. The inclusion of global data and international community engagement are key to tackling grand challenges in biogeosciences. Although recent technological advances and growing open-access information across the world have enabled global collaborations to some extent, several barriers, ranging from technical to organizational to cultural, have remained in advancing interoperability and tangible scientific progress in biogeosciences. Overcoming these hurdles is necessary to address pressing large-scale research questions and applications in the biogeosciences, where ICON principles are essential. Here, we list several opportunities for ICON, including coordinated experimentation and field observations across global sites, that are ripe for implementation in biogeosciences as a means to scientific advancements and social progress.

Abstract Objective This study aimed to evaluate the understanding and adherence to child car safety seat (CSS) guidelines among the general population in the Makkah region of Saudi Arabia following the implementation of new traffic regulations. Method A four-section questionnaire addressing knowledge and attitudes regarding CSSs was distributed among the general population of Makkah city in light of new traffic regulations. Data were collected from 487 respondents, and the chi-square test was utilized for statistical analysis. Results A total of 144 (29.6%) respondents reported using seat belts before the implementation of new regulations, while 101 (20.7%) started using them afterward. Only 31 (6.4%) stated that they would not use them. A total of 318 (65.3%) reported that their behavior towards using child car safety seats abroad will not change. Additionally, 452 (92.8%) believed that government financial support for car seat costs would increase usage and compliance. The knowledge level among those using CSSs (40.3%) was significantly higher than among those who do not (11.3%) (p = .001). Conclusions Most of the respondents believed that governmental financial support for CSS costs will lead to increased compliance. Furthermore, there is a direct correlation between knowledge levels and compliance. Therefore, further investment should be focused on raising awareness and enforcing strict regulations.

Abdullah Alghamdi,1 Abdulmalak Abdullah Alsaleh,2 Omar Abdulaziz Alfozan,2 Rayan Qutob,1 Abdullah Alaryni,1 Abdullah Bukhari,1 Osamah A Hakami,1 Bassam Abdulaziz Alhusaini,2 Saad Abdullah Alzmamy,2 Fadhah Saud Alhudayris,2 Lama Khalid Alshuaibi,2 Ahad Marei Alenazi,2 Lama Shaya Alhosaini,2 Najd Khalid Aljarba,2 Shahad Hameed AlShammari2 1Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaCorrespondence: Bassam Abdulaziz Alhusaini, Faculty of medicine, Imam Mohammad Ibn Saud Islamic University, 7544 Othman Bin Affan Road Al-Nada, Riyadh, 13317, Saudi Arabia, Tel +966557818206, Email Bam.h98s@gmail.comBackground: Organ donation is a lifesaving option to rescue many patients with end-stage organ failure from possible morbidities and mortalities. Unfortunately, due to a shortage of donors, many patients suffering from their illnesses are waiting for an organ. This study aimed to determine the awareness, attitude, and beliefs toward organ donation among the Saudi population.Patients and Methods: This is an online cross-sectional survey that was conducted in Saudi Arabia between July and September 2022. A self-administered questionnaire was distributed to the general public using an online platform. The questionnaire consists of two sections: the first is about demographic data, and the second is about questions to assess awareness, attitude, and beliefs regarding organ donation. The Chi-squared test was used to examine the differences in participants’ awareness, attitude, and beliefs towards organ donation. A binary logistic regression analysis was used to identify predictors of a positive attitude towards organ donation.Results: A total of 3507 individuals participated in this study. Around 68.1% were aged between 18 and 30 years. Twenty-four percent of them knew of the legislative body for organ donation; 58.5% believed that organ donation should be promoted; and 66.1% had a positive attitude toward donating body organs. Younger age (31– 50 years), male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation.Conclusion: Although there was a positive attitude and belief about organ donation, awareness was suboptimal. Younger age, male gender, being unemployed or working in a government job, and being married were factors that decreased the likelihood of having a positive attitude towards organ donation. It is necessary to address the gaps in knowledge, and social media as well as mass media may have an important role in bridging the gaps.Keywords: organ donation, attitude, knowledge, belief, public

Lindsay K Finkas,1 Navneet Ramesh,2 Lawrence S Block,3 Bing Q Yu,3 Mei-Tsung Lee,3 Meng Lu,3 Jacek Skarbinski,2,3 Carlos Iribarren3 1Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA; 2Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Kaiser Permanente Division of Research, Oakland, CA, USACorrespondence: Carlos Iribarren, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA, Email Carlos.Iribarren@kp.orgIntroduction: Previous studies on the outcomes of asthma and COVID-19 have shown inconsistent results. This study aimed to elucidate the association between asthma and COVID-19 outcomes.Methods: We conducted a prospective study with a large health plan to compare the incidence of COVID-19 infection, hospitalization and ICU admission in a cohort of 41,282 patients with asthma and a 1:1 age-, sex-, and race-ethnicity-matched cohort without asthma across the following pandemic periods: pre-Delta (03/01/2020 to 05/31/2021), Delta (06/01/2021 to 12/31/2021), and Omicron (01/01/2022 to 08/13/2022). Demographic factors, comorbidities, COVID-19 test results, inpatient utilization, and COVID-19 vaccination status were collected from electronic health records.Results: Subjects with asthma were more likely than controls to undergo COVID-19 testing during the three pandemic periods and were less likely to test positive in the Omicron period (fully adjusted odds ratio=0.92; 95% CI=0.86– 0.98; p=0.01). Relative to controls, patients with asthma had an increased risk of hospitalization for COVID-19 (fully adjusted hazard ratio=1.33; 95% CI=1.08– 1.64; p=0.01) and borderline significant (p=0.05) higher rates of ICU admissions in the pre-delta period but not during the delta or Omicron periods. The increased risk of COVID-19 hospitalization associated with asthma was more pronounced in patients with severe asthma and in women compared with men. None of the associations were significantly modified by vaccination status.Conclusion: Asthma was associated with a lower risk of COVID-19 infection but only during the Omicron period. Asthma was an independent risk factor for hospitalization for COVID-19 in the pre-delta period and this association was stronger for severe asthma and in women.Keywords: asthma, COVID-19, severe asthma, cohort study

Pakhi Sharma,1 Sanjeewa Kularatna,1 Bridget Abell,1 Karen Eagleson,2,3 Linh K Vo,1 Ureni Halahakone,1 Sameera Senanayake,1 Steven M McPhail1,4 1Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; 2Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, QLD, Australia; 3Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 4Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, AustraliaCorrespondence: Pakhi Sharma, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia, Tel +61 401829045, Email p33.sharma@hdr.qut.edu.auAbstract: Neurodevelopmental disorders are a significant cause of morbidity. Early detection of neurodevelopmental delay is essential for timely diagnosis and intervention, and it is therefore important to understand the preferences of parents and clinicians for engaging with neurodevelopmental surveillance and follow-up care. Discrete choice experiment (DCE) may be an appropriate method for quantifying these preferences. This review systematically examined how DCEs have been designed and delivered in studies examining neurodevelopmental care of children and identified the preferred attributes that have been reported. PubMed, Embase, CINAHL, and Scopus databases were systematically searched. Studies were included if they used DCE to elicit preferences for a neurodevelopmental follow-up program for children. Two independent reviewers conducted the title and abstract and full-text screening. Risk of bias was assessed using a DCE-specific checklist. Findings were presented using a narrative synthesis. A total of 6618 records were identified and 16 papers were included. Orthogonal (n=5) and efficient (n=5) experimental designs were common. There was inconsistent reporting of design-related features. Analysis was primarily completed using mixed logit (n=6) or multinomial logit (n=3) models. Several key attributes for neurodevelopmental follow-up care were identified including social, behavioral and emotional support, therapy, waiting time, and out-of-pocket costs. DCE has been successfully used as a preference elicitation method for neurodevelopmental-related care. There is scope for improvement in the design and analysis of DCE in this field. Nonetheless, attributes identified in these studies are likely to be important considerations in the design and implementation of programs for neurodevelopmental care.Keywords: preferences, discrete choice experiment, attributes, neurodevelopment, follow-up

BackgroundPatients receiving chemotherapy for acute myeloid leukemia (AML) are at high risk for invasive fungal disease (IFD). Diagnosis of IFD is challenging, leading to interest in fungal biomarkers. The objective was to define the utility of surveillance testing with Platelia Aspergillus galactomannan (GM) enzyme immunoassay (EIA) and Fungitell β-d-glucan (BDG) assay in children with AML receiving antifungal prophylaxis.MethodsTwice-weekly surveillance blood testing with GM EIA and BDG assay was performed during periods of neutropenia in the context of a randomized trial of children, adolescents, and young adults with AML allocated to fluconazole or caspofungin prophylaxis. Proven or probable IFD was adjudicated using blinded central reviewers. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for Platelia and Fungitell assays alone and in combination for the outcomes of proven and probable invasive aspergillosis (IA) or invasive candidiasis (IC).ResultsAmong 471 patients enrolled, 425 participants (209 fluconazole and 216 caspofungin) contributed ≥1 blood specimen. In total, 6103 specimens were evaluated, with a median of 15 specimens per patient (range 1-43). The NPV was >99% for GM EIA and BDG assay alone and in combination. However, there were no true positive results, resulting in sensitivity and PPV for each assay of 0%.ConclusionsThe GM EIA and the BDG assay alone or in combination were not successful at detecting IA or IC during periods of neutropenia in children, adolescents, and young adults with AML receiving antifungal prophylaxis. Utilization of these assays for surveillance in this clinical setting should be discouraged.

Introduction: Sciatic nerve block is used for anaesthesia and analgesia in lower limb surgeries. The anterior approach to the sciatic nerve is rarely performed due to unreliable anatomical surface markings. Aim: To compare the anterior and posterior approaches to sciatic nerve block in terms of patient comfort and technical difficulty. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. A total of 84 patients who underwent lower limb surgeries from November 2020 to August 2022 were included. Informed consent was obtained, and patients were randomised into two groups-Group-A and Group-P-using the card method. Ultrasound-guided sciatic nerve block was performed using the anterior approach in Group-A and the posterior approach in Group-P. Sensory and motor blockade, time to perform the block, number of attempts, duration of analgesia, and patient satisfaction were recorded. Statistical analysis was performed using the Chi-square test, Analysis of Variance (ANOVA), student t-test, and the results were represented in tables. Results: The median age in Group-A was 42.95±12.69 years, and in Group-P was 43.95±8.68 years. Males were higher in number with 26 (31%) in Group-A and 23 (27%) in Group-P, respectively. Patient satisfaction, duration of analgesia (10.3±3.5 years Group-P and 10.5±4.0 years Group-A), onset of sensory (11.85±7.35 years Group-P and 9.53±5.40 years Group-A), and motor blockade (18.67±7.05 years Group-P years and 17.82±5.70 years Group-A) were similar in both groups. The number of attempts (2.85±0.90 years Group-P and 3.05±0.91 years Group-A) and time taken for performing the sciatic nerve block (6.75±1.10 years Group-P and 7.44±1.00 years Group-A) was higher in the anterior approach compared to the posterior approach. Conclusion: Although both approaches to sciatic nerve block are equally effective, this study concludes that the posterior approach is simpler to perform, requires less time, and provides better patient comfort and satisfaction. Ultrasound-guided posterior sciatic nerve block offers effective anaesthesia and excellent post-operative analgesia.

The fact that they are unpredictable and unreliable, renewable energy sources (RES) are increasingly crucial to the electrical power grid's ability to maintain energy continuity. The challenge of energy sustainability can only be solved by energy storage technology. Regarding a Hybrid Energy Storage System (HESS) powered by a 4-wire, 3-phase grid connected solar Photovoltaic (PV) power system, a novel Smart Energy Control Technique (SECT) with a Whale optimization algorithm is presented in this work. The sustainability of energy via solar PV power generating systems is achieved by using HESS, which consists of batteries and ultra-capacitor storage devices for energy. The suggested SECT has been used for the analysis and experimental testing of several HESS operating scenarios. During experimental testing, the load status of a single sunny day and the PV power outline were constructed and dynamically assessed by utilizing SECT; some test findings in eight distinct operating modes are included in this paper. The system uses 1320W of electricity to charge the battery group, and in one of its modes of operation, the leftover energy is sent to the grid using 5% present harmonics. And because of the system's high power density, quick reaction, and great efficiency, the HESS is a highly efficient energy storage method. Simulation findings and laboratory testing have validated the suggested system.

Abstract Background The EQ-5D-5 L is a commonly used generic measure of health. This study aimed to evaluate the psychometric properties of the EQ-5D-5 L in patients with Graves’ disease (GD). Methods A prospective cohort of patients with GD recruited at three public hospitals in Hong Kong completed the EQ-5D-5 L and ThyPRO-39 questionnaires at baseline, 1-month, and 6-month follow-ups. Convergent validity was tested by examining the Spearman correlation between EQ-5D-5 L and ThyPRO-39 scores at baseline. 1-month test-retest reliability was assessed by Intraclass Correlation Coefficient (ICC), Gwet’s Agreement Coefficient 2 (AC2), and percentage agreement. Responsiveness of EQ-5D-5 L index and EQ-VAS scores was assessed using effect size statistics (standardized effect size [SES] and standardized response mean [SRM]). Results Of 125 recruited patients, 101 (80.8%) and 100 (80.0%) patients were followed up at 1- and 6-month, respectively. For convergent validity, there was a moderate negative correlation between EQ-5D-5 L index or EQ-VAS score and ThyPRO-39 overall QoL-impact score (-0.350, -0.451), between EQ-VAS score and composite score (-0.483), and strong negative correlation between EQ-5D-5 L index score and composite score (-0.567). The Gwet’s AC2 and percentage agreement were the highest in self-care (0.964 and 0.967), followed by mobility (0.952 and 0.962), usual activities (0.934 and 0.948), pain/discomfort (0.801 and 0.887), and anxiety/depression (0.788 and 0.882). The ICC for the EQ-5D-5 L index and the EQ-VAS was 0.707 and 0.700. For patients who reported having ‘worsened’ health at 6-month follow-up, the SES and SRM were − 0.66 and − 0.42 for EQ-5D-5 L index and − 1.15 and − 1.00 for EQ-VAS, respectively. Conclusions The EQ-5D-5 L demonstrated convergent validity, test-retest reliability, and responsiveness to worsened health status among patients with GD.

Evann E Hilt,1 Laura KS Parnell,2 Dakun Wang,3 Ann E Stapleton,4 Emily S Lukacz5 1Author affiliations Department of Laboratory Medicine and Pathology, M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA; 2Author affiliations Department of Scientific Writing, Precision Consulting, Missouri City, TX, USA; 3Author affiliations Department of Writing, Stat4Ward, Pittsburgh, PA, USA; 4Author Affiliations Department of Medicine, University of Washington, Seattle, WA, USA; 5Author affiliations Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA, USACorrespondence: Laura KS Parnell, Precision Consulting, 6522 Harbor Mist, Missouri City, TX, 77459, USA, Tel +1 281-208-3037, Email lksparnell@yahoo.comAbstract: Given the growing impact of antimicrobial resistance, improvements in diagnosis and treatment of the most common outpatient infection, urinary tract infection (UTI), are of great interest to stakeholders. Regulatory authorities have long accepted a microbial threshold of 105 CFU/mL as the standard for diagnosing UTI based on standard urine cultures. However, microbial thresholds considered clinically relevant remain in dispute. The aim of this systematic scoping review is to assess the evidence supporting a threshold of 105 CFU/mL, to review microbial threshold guidelines, and highlight knowledge gaps in the diagnosis of UTI. A total of 36 guidelines containing 144 recommendations were identified with 64% of guidelines (n = 23) and 58% of recommendations (n = 83) published in the last six years (2016– 2023). Recommendations have changed over time and across variables including the geographical location of the guideline, urine specimen collection method, patient sex, and category of UTI. Guidelines uniformly agreed with suprapubic needle specimen collection; however, there was no consensus for midstream collected urine samples. Guideline microbial thresholds for clinical UTI diagnosis were higher for women at average risk (105 CFU/mL) than for men (102 to 105 CFU/mL) and high-risk patients (102 to 104 CFU/mL). Guidelines relied heavily on 48 research articles from 20 author teams published between 1956 and 2019 and recommendations frequently cited 23 research articles by 15 author teams published between 1956 and 2013. Evidence supporting 105 CFU/mL threshold originated in the mid-1950s from 4 research articles, whereas 18 frequently cited peer-reviewed publications focused their research on the clinical relevance of lower thresholds (101 to < 105 CFU/mL). This review demonstrates a lack of consensus for urine culture microbial threshold recommendations for the clinical diagnosis of UTI. Guidelines are primarily based upon sparse and dated evidence. Additional research is needed to inform clinically meaningful diagnostic microbial thresholds in the diagnosis of UTI.Keywords: urinary tract infection, guideline, microbial, diagnostic threshold, uropathogen, scoping systematic review

Mirkka Söderman, Anna Bondesson, Tina Pettersson, Lena-Karin Gustafsson Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, SwedenCorrespondence: Mirkka Söderman, School of Health, Care and Social Welfare, Box 325, Eskilstuna, 631 05, Sweden, Tel +46 16153433, Email mirkka.soderman@mdu.seBackground: Reablement as a concept includes a health-promoting perspective with the goal of strengthening health and the ability to perform and participate in daily activities, a broader perspective than in general home care and rehabilitation. Reablement interventions have shown to be both more effective and to a greater extent improve the function and health-related quality of life of older persons when compared to traditional home-based care. Success factors for intensive-home-rehabilitation (IHR), an intervention based on the reablement concept, have been described earlier; however, there is a lack of knowledge about why some persons do not recover despite receiving IHR.Aim: The aim was to shed light on the older persons’ conditions during IHR from the perspective of the rehabilitation team members and to describe obstacles to recovery.Methods: Qualitative analysis of health and care records of persons (65+) who received IHR (n=19) performed by an interprofessional team.Results: The analysis revealed various problematic situations, dilemmas, that occurred in the older persons’ lives during IHR, as well as their consequences and the strategies employed by the older persons as a result. IHR aspects perceived as successful by the older persons also emerged, as well as differences in experiences of the physical and mental aspects of the IHR. Analysis also revealed reasons why the IHR might be experienced as broadly successful.Conclusion: The older persons seemed to be satisfied with IHR and achieved their goals; however, some seemed to need more time to reach their goals. Background factors such as having additional diagnoses and living alone might affect the rehabilitation process.Implication for Practice: The study provides knowledge regarding the importance of IHR for the recovery process for the increasing numbers of older persons, which might also be useful in other patient groups requiring otherwise long-term rehabilitation and recovery such as after covid-19 infection.Keywords: home-based care, intensive-home-rehabilitation, interprofessional team, older persons, reablement, recovery, rehabilitation process

This proposed model introduces novel deep learning methodologies. The objective here is to create a reliable intrusion detection mechanism to help identify malicious attacks. Deep learning based solution framework is developed consisting of three approaches. The first approach is Long-Short Term Memory Recurrent Neural Network (LSTM-RNN) with seven optimizer functions such as adamax, SGD, adagrad, adam, RMSprop, nadam and adadelta. The model is evaluated on NSL-KDD dataset and classified multi attack classification. The model has outperformed with adamax optimizer in terms of accuracy, detection rate and low false alarm rate. The results of LSTM-RNN with adamax optimizer is compared with existing shallow machine and deep learning models in terms of accuracy, detection rate and low false alarm rate. The multi model methodology consisting of Recurrent Neural Network (RNN), Long-Short Term Memory Recurrent Neural Network (LSTM-RNN), and Deep Neural Network (DNN). The multi models are evaluated on bench mark datasets such as KDD’99, NSL-KDD, and UNSWNB15 datasets. The models self-learnt the features and classifies the attack classes as multi-attack classification. The models RNN, and LSTM-RNN provide considerable performance compared to other existing methods on KDD’99 and NSL-KDD dataset.