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Introduction The U.S. Military members experiencing combat-related injuries have a higher chance of developing infections by multidrug-resistant (MDR) bacteria at admission to military hospitals. MDR wound infections result in higher amputation rates and greater risks for subsequent or chronic infections that require readmission or extended stay in the hospital. Currently, there is no FDA-clear, deployable early diagnostic system for suitable field use. We are reporting our efforts to improve a previously developed Rapid Label-free Pathogen Identification (RAPID) system to detect viable MDR bacteria in wound infections and perform antibiotic susceptibility testing (AST). Specifically, we added multiplex and automation capability and significantly simplified the sample preparation process. A functional prototype of the improved system was built, and its performance was validated using a variety of lab-prepared spiked samples and real-world samples. Materials and Methods To access the baseline performance of the improved RAPID system in detecting bacteria presence, we selected 17 isolates, most of them from blood or wound infections, and prepared mono-strain spiked samples at 104 to 106 cfu/mL concentration. These samples were processed and analyzed by the RAPID system. To demonstrate the AST capability of the system, we selected 6 strains against 6 different antibiotics and compared the results from the system with the ones from the gold standard method. To validate the system's performance with real-world samples, we first investigated its performance on 3 swab samples from epicutaneous methicillin-resistant Staphylococcus aureus –exposed mouse model. The AST results from our system were compared with the ones from the gold standard method. All animal experiments were approved by the Johns Hopkins University Animal Care and Use Committee (Protocol No. MO21M378). Then, we obtained swab samples from 7 atopic dermatitis (AD) patients and compared our AST results with the ones from the gold standard method. The human subject protocol was approved by the Johns Hopkins Medicines Institutional Review Boards (Study No. CR00043438/IRB00307926) and by USAMRDC (Proposal Log Number/Study Number 20000251). Results High-quality data were obtained from the spiked samples of all 17 strains. A quantitative analysis model built using these data achieved 94% accuracy in predicting the species ID in 8 unknown samples. The AST results on the spiked samples had shown 100% matching with the gold standard method. Our system successfully detects the presence/absence of viable bacteria in all 3 mouse and 7 AD patient swab samples. Our system shows 100% and 85.7% (6 out of 7) accuracy when compared to the oxacillin susceptibility testing results for the mouse and the AD patient swabs, respectively. Conclusions Our system has achieved excellent performance in detecting viable bacteria presence and in performing AST in a multiplex, automated, and easy-to-operate manner, on both lab-prepared and real samples. Our results have shown a path forward to a rapid (sample-to-answer time ≤3 hours), accurate, sensitive, species-specific, and portable system to detect the presence of MDR combat-related wound infections in the field environment. Our future efforts involve ruggedizing the RAPID system and evaluating performance under relevant environmental conditions. [ABSTRACT FROM AUTHOR]

Background There are limited treatment options for prosthetic joint infections (PJI) due to multidrug-resistant Staphylococcus epidermidis (MDRSE). Fosfomycin (FOF) has gained attention as a potential therapy, but there is a paucity of information on the phenotypic and genotypic susceptibility amongst S. epidermidis , including MDRSE. Objectives To investigate phenotypical and genotypical susceptibility to FOF in S. epidermidis isolates prospectively collected from PJIs in Sweden. Methods MIC determination was performed using in-house agar dilution (AD) and a commercial AD panel. Genes and gene variants associated with FOF resistance were analysed. Results Multidrug resistance was common [74/89 (83%) isolates were MDRSE]. FOF inhibited all isolates except one, which had an MIC > 256 mg/L. The commercial AD panel demonstrated good overall performance but tended to overestimate the MIC, resulting in 84% essential agreement with the gold standard. Genomic analysis with publically available tools for whole-genome sequencing (WGS) data suggested genotypic FOF resistance in all isolates, but in-depth analysis revealed that fosB , associated with FOF resistance, was only present in the phenotypically resistant isolate. No other genes or gene variants associated with FOF resistance were detected. Conclusions Phenotypic resistance to FOF and presence of fosB were rare in this collection, indicating FOF's potential as a treatment option for S. epidermidis. The commercial AD panel demonstrated high reproducibility, but EA with the reference method was less than optimal. Findings of genotypic FOF resistance using common tools for WGS data should be critically evaluated and appropriately verified with relevant fosB references for S. epidermidis. [ABSTRACT FROM AUTHOR]

Background: Natural language processing (NLP) is increasingly being used to extract structured information from unstructured text to assist clinical decision-making and aid healthcare research. The availability of expert-annotated documents for the development and validation of NLP applications is limited. We created synthetic clinical documents to address this, and to validate the Extraction of Epilepsy Clinical Text version 2 (ExECTv2) NLP pipeline. Methods: We created 200 synthetic clinic letters based on hospital outpatient consultations with epilepsy specialists. The letters were double annotated by trained clinicians and researchers according to agreed guidelines. We used the annotation tool, Markup, with an epilepsy concept list based on the Unified Medical Language System ontology. All annotations were reviewed, and a gold standard set of annotations was agreed and used to validate the performance of ExECTv2. Results: The overall inter-annotator agreement (IAA) between the two sets of annotations produced a per item F1 score of 0.73. Validating ExECTv2 using the gold standard gave an overall F1 score of 0.87 per item, and 0.90 per letter. Conclusion: The synthetic letters, annotations, and annotation guidelines have been made freely available. To our knowledge, this is the first publicly available set of annotated epilepsy clinic letters and guidelines that can be used for NLP researchers with minimum epilepsy knowledge. The IAA results show that clinical text annotation tasks are difficult and require a gold standard to be arranged by researcher consensus. The results for ExECTv2, our automated epilepsy NLP pipeline, extracted detailed epilepsy information from unstructured epilepsy letters with more accuracy than human annotators, further confirming the utility of NLP for clinical and research applications. [ABSTRACT FROM AUTHOR]

Introduction Cervical spondylosis in the warfighter is a common musculoskeletal problem and can be career-ending especially if it requires fusion. Head-mounted equipment and increased biomechanical forces on the cervical spine have resulted in accelerated cervical spine degeneration. Current surgical gold standard is anterior cervical discectomy and fusion (ACDF). Posterior cervical foraminotomy (PCF) is a nonfusion surgical alternative, and this can be effective in alleviating radiculopathy from foraminal stenosis caused by disc-osteophyte complex. Biomechanical studies have not been done to analyze motion associated with military aircrew personnel following PCF. The aim of this study was to compare the biomechanical responses of the effects of ACDF and PCF with different grades of facet resection under simulated military aircrew conditions using range of motion, disc pressure, and facet loads at the index and adjacent levels. Materials and Methods A validated 3D finite element model of the human cervical spinal column was used to simulate various graded PCF and ACDF. All surgical simulations were performed at the most commonly operated level (C5-C6) in warfighters. Pure moment loading under flexion, extension, and lateral bending, and in vivo follower force of 75 N were applied to the intact spine. Hybrid loading protocol was used to achieve 134 degrees of combined flexion-extension and 83 degrees of lateral bending in intact and surgical models to reflect military loading conditions. Segmental motions, disc pressure, and facet load were obtained and normalized with respect to the intact model to quantify the biomechanical effect. Results Anterior cervical discectomy and fusion decreased range of motion at the index and increased motion at the adjacent levels, while all graded PCF responses had an opposite trend: increased motion at the index and decreased motion at adjacent levels. The magnitude of changes depended on the level of resection, spinal level, and loading mode. Disc pressure increased at the index level and decreased at the adjacent levels after PCF. These changes were exaggerated with increasing extent of facet resection. Facet load increased at the index level after PCF especially with extension and right (contralateral) lateral bending. Complete facetectomy led to facet load increases greater than ACDF at the adjacent levels in both flexion and extension. Conclusions Posterior cervical foraminotomy is a motion-preserving implant-free surgical alternative to ACDF for warfighters with cervical radiculopathy after failure of conservative management. The treating surgeon must pay close attention to the extent of facet resection to avoid potential spinal instability and future disc and facet degeneration after PCF. Posterior cervical foraminotomy can be more advantageous than ACDF in terms of adjacent segment degeneration, motion preservation, reoperation rate, surgical cost, and retention of warfighters. [ABSTRACT FROM AUTHOR]

This paper explores the effects of government debts and deficits on long-term interest rates under different international monetary systems from the perspective of monetary sovereignty. The findings of this paper confirm conventional accounts of financial crowding-out and the adverse impact of growing public debt on interest rates among countries under the classical Gold Standard period (1879–1913) and non-sovereign countries under the recent fiat system (1973–2016). By contrast, countries in the Bretton Woods era (1959–1970) and sovereign countries in the contemporary post-Bretton Woods era (1973–2016) do not exhibit such positive debt-interest rates relationships while still showing crowding-out but with much less magnitude. Overall, the results support the Modern Money Theory (MMT) view that the consequence of monetary sovereignty from 1879 to 2016 is to remove, or greatly attenuate, the impact of default risk, fiscal balance, and bond vigilantes on the interest rate. [ABSTRACT FROM AUTHOR]

The purpose of this study is to clarify the prospects for the creation of a new reserve currency by the (Shanghai Cooperation Organization (SCO) countries to reduce foreign exchange costs in trade transactions, to strengthen integration processes in the Eurasian space, to increase the investment potential of developing Asian countries and to stimulate sustainable economic growth. The paper presents the results of mathematical modeling of the optimal portfolio structure of collateral assets with the possible issuance of a new reserve currency by the SCO countries. The article concludes that currently the best reserve assets that have been analyzed are the Chinese yuan, Indian rupee and gold. The expected return of the new reserve currency does not depend on fluctuations in the global foreign exchange market, and its calculated risk (standard deviation of return) turned out to be lower than the risk of fluctuations in the value of the yuan and gold. The article concludes that gold is the best collateral asset, as it has a stable positive yield, constant purchasing power and a fair value that is 4 times higher than the market value. It is proposed to issue a new reserve currency in the form of stablecoins so that it incorporates all the best properties of cryptocurrencies and fiat money

Abstract Background Natural language processing (NLP) is increasingly being used to extract structured information from unstructured text to assist clinical decision-making and aid healthcare research. The availability of expert-annotated documents for the development and validation of NLP applications is limited. We created synthetic clinical documents to address this, and to validate the Extraction of Epilepsy Clinical Text version 2 (ExECTv2) NLP pipeline. Methods We created 200 synthetic clinic letters based on hospital outpatient consultations with epilepsy specialists. The letters were double annotated by trained clinicians and researchers according to agreed guidelines. We used the annotation tool, Markup, with an epilepsy concept list based on the Unified Medical Language System ontology. All annotations were reviewed, and a gold standard set of annotations was agreed and used to validate the performance of ExECTv2. Results The overall inter-annotator agreement (IAA) between the two sets of annotations produced a per item F1 score of 0.73. Validating ExECTv2 using the gold standard gave an overall F1 score of 0.87 per item, and 0.90 per letter. Conclusion The synthetic letters, annotations, and annotation guidelines have been made freely available. To our knowledge, this is the first publicly available set of annotated epilepsy clinic letters and guidelines that can be used for NLP researchers with minimum epilepsy knowledge. The IAA results show that clinical text annotation tasks are difficult and require a gold standard to be arranged by researcher consensus. The results for ExECTv2, our automated epilepsy NLP pipeline, extracted detailed epilepsy information from unstructured epilepsy letters with more accuracy than human annotators, further confirming the utility of NLP for clinical and research applications.

Background: Systematic reviews are potentially less biased and provide more precise estimates than primary studies of diagnostic test accuracy. Their use to inform evidence-based diagnosis is rapidly expanding. However, the extent, scope and methodologies of systematic reviews of studies of the accuracy of diagnostic tests relevant to physical therapy have not yet been described. Information about methods used in these systematic reviews could inform future reviews and subsequently improve evidence-based diagnosis in physical therapy. Objectives: To describe the systematic review methodology of diagnostic test accuracy studies relevant to physical therapy. Methods: All systematic reviews indexed on DiTA (Diagnostic Test Accuracy database) were included. Data on methodology, reporting characteristics, and review topics were extracted. A random sample was assessed for risk of bias using the Risk Of Bias In Systematic Reviews (ROBIS) tool. Results: The review included 241 reviews published between 1995 and 2022, covering all 10 major physical therapy subdisciplines, although 90% related to musculoskeletal physical therapy. In 72% of reviews, QUADAS and QUADAS-2 were used to assess the risk of bias. In a random sample of included reviews, 47% of reviews displayed a 'high' risk of bias. Conclusions: Systematic reviews of diagnostic test accuracy studies relevant to physical therapists are becoming more prevalent. There is a relatively large number of these reviews however a large proportion use methods that expose them to bias. This makes the interpretation of their results more difficult. Future research could focus on publishing methodology guidelines for physical therapy-relevant diagnostic test accuracy reviews. [ABSTRACT FROM AUTHOR]

AbstractObjective: To analyze the diagnostic value of HR-VWI in intracranial arterial stenosis and occlusion and compare it with DSA. Methods: A retrospective analysis of clinical data of 59 patients with intracranial arterial stenosis in our hospital was conducted to compare the diagnostic results of the two methods for different degrees of intracranial stenosis and various morphological plaques. Results: The diagnosis of stenosis and occlusion by both methods showed no significant difference (P > 0.05). Comparison of plaque morphology detected by HR-VWI with pathological examination results showed no significant difference (P > 0.05); however, there was a significant difference between plaque morphology detected by DSA and pathological examination results (P < 0.05). Additionally, there was a significant difference between plaque morphology detected by HR-VWI and DSA (P < 0.05). Conclusion: HR-VWI technique is comparable to DSA technique in diagnosing intracranial arterial stenosis and occlusion, but it is superior to DSA in plaque morphology diagnosis. [ABSTRACT FROM AUTHOR]

Background: No data exist at the population level on what tests are used to aid in the diagnosis of autism spectrum disorder in community practice. Objectives: To describe autism spectrum disorder testing practices to inform autism spectrum disorder identification efforts. Methods: Data are from the Autism and Developmental Disabilities Monitoring Network, a multi‐site surveillance system reporting prevalence estimates and characteristics of 8‐year‐old children with autism spectrum disorder. Percentages of children with autism spectrum disorder who received any autism spectrum disorder test or a 'gold standard' test were calculated by site, sex, race, median household income, and intellectual ability status. Risk ratios were calculated to compare group differences. Results: Of 5058 8‐year‐old children with autism spectrum disorder across 11 sites, 3236 (64.0%) had a record of any autism spectrum disorder test and 2136 (42.2%) had a 'gold standard' ADOS or ADI‐R test. Overall, 115 children (2.3%) had both the ADOS and ADI‐R in their records. Differences persisted across race, median household income, and intellectual ability status. Asian/Pacific Islander children had the highest percent receiving any ASD test (71.8%; other groups range: 57.4–66.0%) and White children had the highest percent receiving 'gold standard' tests (46.4%; other groups range: 35.6–43.2%). Children in low‐income neighbourhoods had a lower percent of any test (62.5%) and 'gold standard' tests (39.4%) compared to medium (70.2% and 47.5%, respectively) and high (69.6% and 46.8%, respectively) income neighbourhoods. Children with intellectual disability had a lower percent of any ASD test (81.7%) and 'gold standard' tests (52.6%) compared to children without intellectual disability (84.0% and 57.6%, respectively). Conclusions: Autism spectrum disorder testing practices vary widely by site and differ by race and presence of co‐occurring intellectual disability, suggesting opportunities to standardise and/or improve autism spectrum disorder identification practices. [ABSTRACT FROM AUTHOR]

Introduction To improve the feasibility of remote biochemical verification of smoking status, our team developed "COast," a mobile app integrated with REDCap that allows a research participant to complete self-report research assessments and provide a breath sample via the iCOQuit Smokerlyzer for the purposes of carbon monoxide (CO) testing. The aims of the present study were to examine (1) the validity of remote CO data capture using COast as compared to gold-standard approaches (salivary cotinine, stand-alone CO monitor) and (2) the feasibility of remote CO data capture using COast as applied to both daily and weekly CO collection schedules. Methods Participants (N  = 143, 59% Female), including recently quit (n  = 36) and current (n  = 107) smokers, completed a baseline video session to capture validity data, and then were randomized to daily or weekly CO monitoring for a period of 1 month. Results Balancing both sensitivity and specificity, optimal cut-points for defining abstinence using the COast system were <4 parts per million (ppm) with salivary cotinine as the referent (Sensitivity = 100%, Specificity = 92.8%) and <8 ppm with the stand-alone CO monitor as the referent (Sensitivity = 100%, Specificity = 88.9%). Compliance across groups with CO monitoring was high with average compliance of 74% for the daily group and 84% for the weekly group. Self-reported feasibility and acceptability of using the system were strong. Conclusions Pairing the iCOQuit with REDCap via the COast app was both valid and feasible among a sample of adults who smoke cigarettes enrolled remotely. This integration may help to improve the rigor of decentralized smoking cessation trials. Implications With increasing prevalence of decentralized trial designs, innovative methods are needed to remotely capture biomarkers. Methods that leverage existing widely available research data capture platforms may be particularly useful for promoting adoption. The COast app, which integrates a Bluetooth-enabled CO monitor with REDCap, is a fitting, valid, and feasible solution to remotely biochemically verify smoking status. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality worldwide. In India, PPH affects approximately 12% of women. The prevention and management of PPH are the significant challenges in obstetrics, with accurate assessment of blood loss and timely intervention being critical. Active Management of the Third Stage of Labor is a gold standard strategy for prevention. Recent advancements in PPH management include the use of recombinant activated factor VIIa, which has shown promise in decreasing the need for invasive procedures and second-line therapies. Additionally, surgical and radiological interventions have been effective in cases of refractory PPH. Overall, ongoing research and advancements in PPH management continue to enhance the quality of care and maternal outcomes experiencing this potentially life-threatening complication of childbirth. This editorial explores prevention and management of Atonic PPH with encompassing medical and surgical strategies, to enhance understanding and optimize clinical care for mothers at risk of this obstetric emergency. [ABSTRACT FROM AUTHOR]

This article considers the contributions of Ralph Hawtrey to monetary theory and macroeconomics, focusing on his monetary business cycle theory and his monetary explanation of the Great Depression. Unlike Milton Friedman's US‐centred explanation of the Great Depression, Hawtrey's was focused on the international gold standard that collapsed with the outset of World War I and the attempt to restore it. Hawtrey urged that, after restoration of the gold standard, increased monetary demand for gold be restrained to prevent gold appreciation and deflation. But deliberate French gold accumulation in 1928 and interest‐rate increases by the Federal Reserve, led to the ruinous deflation foreseen by Hawtrey. The article then critically evaluates recent discussions of Hawtrey's contributions in books by Hetzel (2023) and Mattei (2022). [ABSTRACT FROM AUTHOR]

Forest carbon markets have demonstrated numerous benefits across economic, social, and environmental dimensions, while also advancing sustainable development goals. This study examines the primary policy mechanisms and conditions related to the development of high-integrity forest carbon markets in Dak Lak province, Vietnam. Utilizing a combination of SWOT analysis and the DPSIR framework, the study provides a comprehensive evaluation of the opportunities, challenges, driving forces, pressures, potential impacts, and responses associated with developing these markets. The Gold Standard method was also employed to estimate the potential contribution to carbon emission reductions through the new forest planting programs in the province. Data analysis from 202 households and in-depth interviews with fifteen experts revealed that local residents have limited information about the forest carbon market. While forest management officials at various levels are aware of the market, there is a lack of specific guidance, limited participation in training sessions and workshops, and insufficient instructional materials. Dak Lak holds significant potential for carbon emission reductions, with an estimated average forest carbon storage capacity of 7.5 tCO2/ha/year for an afforestation/reforestation (A/R) carbon project. This initiative is projected to contribute approximately $753,972 annually to the province's GRDP and generate 280 jobs for local communities. However, the technical and financial resources are challenging in the province. The study identifies critical issues and proposes appropriate solutions to support Dak Lak in developing high-integrity forest carbon markets in alignment with the national roadmap, ultimately contributing to the achievement of sustainable development goals.

Book Review: WHITE, Lawrence H. Better Money: Gold, Fiat, or Bitcoin? 1st edition, Cambridge University Press, 2023, 250 p.

OBJECTIVES: This study aimed to estimate the validity of self-reported information on ever-night shift work among women with and without breast cancer and illustrate the consequences for breast cancer risk estimates. METHODS: During 2015–2016, 225 women diagnosed with breast cancer and 1800 matched controls without breast cancer employed within the Danish hospital regions during 2007–2016 participated in a questionnaire-based survey. Their reported night shift work status was linked with objective payroll register day-by-day working hour data from the Danish Working Hour Database and the Danish Cancer Registry. For the breast cancer patients and their matched controls, we estimated sensitivity and specificity for ever-working night shifts using the payroll data as the gold standard. We also used quantitative bias analysis to estimate the impact on relative risk estimates for a hypothetical population. RESULTS: For breast cancer patients, we observed a sensitivity of ever-night shifts of 86.2% and a specificity of never-night shifts of 82.6%. For controls, the sensitivity was 80.6% and the specificity 83.7%. Odds ratio for breast cancer in a hypothetical population decreased from 1.12 [95% confidence interval (CI) 1.03–1.21] to 1.05 (95% CI 0.95–1.16) when corrected by the sensitivity and specificity estimates. CONCLUSION: This study shows that female breast cancer patients had slightly better recall of previous night shift work than controls. Additionally, both breast cancer patients and controls recalled previous never-night shift work with low specificity. The net effect of this misclassification is a small over-estimation of the relative breast cancer risk due to night shift work.

AbstractDespite the potential role of soil carbon offset schemes to reduce greenhouse gas emissions, there are concerns that the rules for assessment, monitoring, and operation are barriers to engagement. This may explain why there is low participation of Australian landholders in soil carbon projects. This study reviews the literature on three leading voluntary carbon standards and methods to assess their suitability for developing soil carbon projects in grazing systems in Australia. The soil carbon method of each standard was analysed based on several criteria: scope, eligibility/applicability, newness and additionality, permanency, baselines and quantification methodology, environmental sustainability, safeguard mechanism, and crediting period. A hypothetical grazing case study in Central Queensland, Australia’s premier beef cattle region, was used to model the cost-effectiveness and potential returns from establishing soil carbon projects under the three standards. Results show that credits created under the Emissions Reduction Fund in Australia generate higher returns for soil carbon projects compared to the Verified Carbon Standard and Gold Standard. This is largely due to a higher market price for soil carbon credits in the Emissions Reduction Fund, reflecting more robust standards of assessment and verification. While assessment costs for credits were higher in the international schemes, returns were lower because prices reflected less rigorous standards.

The article informs about the validity of self-reported night shift work among women with and without breast cancer, highlighting its impact on breast cancer risk estimates. Topic include study reveals that breast cancer patients had slightly better recall of previous night shift work compared to controls, with both groups showing low specificity in recalling never-night shift work, resulting in a small overestimation of the relative breast cancer risk associated with night shift work.

Wilkie's syndrome is an unusual cause of upper intestinal obstruction due to mechanical compression of the superior mesenteric artery (SMA) to the duodenum, with nonspecific symptoms, whose diagnosis is confirmed by angiotomography. Initially, the treatment is conservative to regain weight and restore mesenteric adipose tissue, associated with postural changes of the patient. If this fails, surgical treatment is indicated, being laparoscopic duodenojejunostomy described as the gold standard. Robotics' assistance is feasible and safe to carry out the procedure. We present the case of a 21-year-old male patient who comes with stabbing abdominal pain and persistent postprandial vomiting that has caused weight loss of 11 kilograms in the last 2 years without apparent cause, associated with gastroesophageal reflux. During the procedure, we evidenced open diaphragmatic pillars and duodenal compression due to SMA, and robotic-assisted laparoscopic hyatoplasty + Nissen fundoplication + duodenojejunostomy were performed without complications, with excellent post-surgical results. [ABSTRACT FROM AUTHOR]

Background/Aims: Traditional manual methods of extracting anesthetic and physiological data from the electronic health record rely upon visual transcription by a human analyst that can be labor‐intensive and prone to error. Technical complexity, relative inexperience in computer coding, and decreased access to data warehouses can deter investigators from obtaining valuable electronic health record data for research studies, especially in under‐resourced settings. We therefore aimed to develop, pilot, and demonstrate the effectiveness and utility of a pragmatic data extraction methodology. Methods: Expired sevoflurane concentration data from the electronic health record transcribed by eye was compared to an intermediate preprocessing method in which the entire anesthetic flowsheet narrative report was selected, copy‐pasted, and processed using only Microsoft Word and Excel software to generate a comma‐delimited (.csv) file. A step‐by‐step presentation of this method is presented. Concordance rates, Pearson correlation coefficients, and scatterplots with lines of best fit were used to compare the two methods of data extraction. Results: A total of 1132 datapoints across eight subjects were analyzed, accounting for 18.9 h of anesthesia time. There was a high concordance rate of data extracted using the two methods (median concordance rate 100% range [96%, 100%]). The median time required to complete manual data extraction was significantly longer compared to the time required using the intermediate method (240 IQR [199, 482.5] seconds vs 92.5 IQR [69, 99] seconds, p =.01) and was linearly associated with the number of datapoints (rmanual =.97, p <.0001), whereas time required to complete data extraction using the intermediate approach was independent of the number of datapoints (rintermediate = −.02, p =.99). Conclusions: We describe a pragmatic data extraction methodology that does not require additional software or coding skills intended to enhance the ease, speed, and accuracy of data collection that could assist in clinician investigator‐initiated research and quality/process improvement projects. [ABSTRACT FROM AUTHOR]

Peer review plays a crucial role in accreditation and credentialing processes as it can identify outliers and foster a peer learning approach, facilitating error analysis and knowledge sharing. However, traditional peer review methods may fall short in effectively addressing the interpretive variability among reviewing and primary reading radiologists, hindering scalability and effectiveness. Reducing this variability is key to enhancing the reliability of results and instilling confidence in the review process. In this paper, we propose a novel statistical approach called "Bayesian Inter-Reviewer Agreement Rate" (BIRAR) that integrates radiologist variability. By doing so, BIRAR aims to enhance the accuracy and consistency of peer review assessments, providing physicians involved in quality improvement and peer learning programs with valuable and reliable insights. A computer simulation was designed to assign predefined interpretive error rates to hypothetical interpreting and peer-reviewing radiologists. The Monte Carlo simulation then sampled (100 samples per experiment) the data that would be generated by peer reviews. The performances of BIRAR and four other peer review methods for measuring interpretive error rates were then evaluated, including a method that uses a gold standard diagnosis. Application of the BIRAR method resulted in 93% and 79% higher relative accuracy and 43% and 66% lower relative variability, compared to "Single/Standard" and "Majority Panel" peer review methods, respectively. Accuracy was defined by the median difference of Monte Carlo simulations between measured and pre-defined "actual" interpretive error rates. Variability was defined by the 95% CI around the median difference of Monte Carlo simulations between measured and pre-defined "actual" interpretive error rates. BIRAR is a practical and scalable peer review method that produces more accurate and less variable assessments of interpretive quality by accounting for variability within the group's radiologists, implicitly applying a standard derived from the level of consensus within the group across various types of interpretive findings. [ABSTRACT FROM AUTHOR]

Neurological and neurodevelopmental conditions are a major public health concern for which new therapies are urgently needed. The development of effective therapies relies on the precise mapping of the neural substrates causally involved in behaviour generation. Direct electrical stimulation (DES) performed during cognitive and neurological monitoring in awake surgery is currently considered the gold standard for the causal mapping of brain functions. However, DES is limited by the focal nature of the stimulation sites, hampering a real holistic exploration of human brain functions at the network level. We used 4137 DES points derived from 612 glioma patients in combination with human connectome data—resting-state functional MRI, n = 1000 and diffusion weighted imaging, n = 284—to provide a multimodal description of the causal macroscale functional networks subtending 12 distinct behavioural domains. To probe the validity of our procedure, we (i) compared the network topographies of healthy and clinical populations; (ii) tested the predictive capacity of DES-derived networks; (iii) quantified the coupling between structural and functional connectivity; and (iv) built a multivariate model able to quantify single subject deviations from a normative population. Lastly, we probed the translational potential of DES-derived functional networks by testing their specificity and sensitivity in identifying critical neuromodulation targets and neural substrates associated with postoperative language deficits. The combination of DES and human connectome data resulted in an average 29.4-fold increase in whole brain coverage compared to DES alone. DES-derived functional networks are predictive of future stimulation points (97.8% accuracy) and strongly supported by the anatomical connectivity of subcortical stimulations. We did not observe any significant topographical differences between the patients and the healthy population at both group and single subject level. Showcasing concrete clinical applications, we found that DES-derived functional networks overlap with effective neuromodulation targets across several functional domains, show a high degree of specificity when tested with the intracranial stimulation points of a different stimulation technique and can be used effectively to characterize postoperative behavioural deficits. The integration of DES with the human connectome fundamentally advances the quality of the functional mapping provided by DES or functional imaging alone. DES-derived functional networks can reliably predict future stimulation points, have a strong correspondence with the underlying white matter and can be used for patient specific functional mapping. Possible applications range from psychiatry and neurology to neuropsychology, neurosurgery and neurorehabilitation. [ABSTRACT FROM AUTHOR]

Background Switching strategy with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) has become a gold standard for people living with HIV (PLWH), achieving high efficacy and safety rates. However, data regarding immune status in long-term real-life cohorts of pretreated patients are needed. Methods We performed a multicentre, non-controlled, retrospective study in virologically suppressed PLWH switching to B/F/TAF. We evaluated CD4+, CD8+ and CD4+/CD8+ ratio, efficacy and safety at weeks 48 and 96. Results The study comprised 1966 PLWH from 12 hospitals in Spain, of whom 80% were men, and the median age was 51.0 [42.0–57.0] years. The median time of HIV infection was 18.0 [10.0–27.0] years. No significant changes in CD4+, CD8+ T cells, or CD4+/CD8+ were observed after 96 weeks. Nevertheless, in women at weeks 48 and 96, we found a significant increase of CD4+ T cells and a significant decrease in CD8+ T cells. In patients ≥60 years at week 96, CD4 T cells significantly increased and CD8+ T cells significantly decreased at week 48. The on-treatment analysis revealed HIV-RNA <50 copies/mL in 95.6% (1700/1779) and 96.7% (1312/1356) of patients at weeks 48 and 96, respectively. The rates increased to 99.2% (1765/1779) and 99.7% (1352/1356) when considering HIV-RNA <200 copies/mL. No resistance mutations were detected in virologic failures. B/F/TAF discontinuations accounted for 10.2% (200). Simplification was the most common reason for discontinuation in 3.8% (74) of patients. Conclusion In long-term virologically controlled PLWH, B/F/TAF achieved high efficacy rates and slightly improved immune status in women and individuals aged 60 and over after 48 and 96 of switching. [ABSTRACT FROM AUTHOR]

In a recent systematic review, Bastos et al. (Ann Intern Med. 2021;174(4):501–510) compared the sensitivities of saliva sampling and nasopharyngeal swabs in the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by assuming a composite reference standard defined as positive if either test is positive and negative if both tests are negative (double negative). Even under a perfect specificity assumption, this approach ignores the double-negative results and risks overestimating the sensitivities due to residual misclassification. In this article, we first illustrate the impact of double-negative results in the estimation of the sensitivities in a single study, and then propose a 2-step latent class meta-analysis method for reevaluating both sensitivities using the same published data set as that used in Bastos et al. by properly including the observed double-negative results. We also conduct extensive simulation studies to compare the performance of the proposed method with Bastos et al.'s method for varied levels of prevalence and between-study heterogeneity. The results demonstrate that the sensitivities are overestimated noticeably using Bastos et al.'s method, and the proposed method provides a more accurate evaluation with nearly no bias and close-to-nominal coverage probability. In conclusion, double-negative results can significantly impact the estimated sensitivities when a gold standard is absent, and thus they should be properly incorporated. [ABSTRACT FROM AUTHOR]

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Abstract Background Diagnosis of tuberculous meningitis (TBM) is hampered by the lack of a gold standard. Current microbiological tests lack sensitivity and clinical diagnostic approaches are subjective. We therefore built a diagnostic model that can be used before microbiological test results are known. Methods We included 659 individuals aged $$\ge 16$$ ≥ 16 years with suspected brain infections from a prospective observational study conducted in Vietnam. We fitted a logistic regression diagnostic model for TBM status, with unknown values estimated via a latent class model on three mycobacterial tests: Ziehl–Neelsen smear, Mycobacterial culture, and GeneXpert. We additionally re-evaluated mycobacterial test performance, estimated individual mycobacillary burden, and quantified the reduction in TBM risk after confirmatory tests were negative. We also fitted a simplified model and developed a scoring table for early screening. All models were compared and validated internally. Results Participants with HIV, miliary TB, long symptom duration, and high cerebrospinal fluid (CSF) lymphocyte count were more likely to have TBM. HIV and higher CSF protein were associated with higher mycobacillary burden. In the simplified model, HIV infection, clinical symptoms with long duration, and clinical or radiological evidence of extra-neural TB were associated with TBM At the cutpoints based on Youden’s Index, the sensitivity and specificity in diagnosing TBM for our full and simplified models were 86.0% and 79.0%, and 88.0% and 75.0% respectively. Conclusion Our diagnostic model shows reliable performance and can be developed as a decision assistant for clinicians to detect patients at high risk of TBM. Summary Diagnosis of tuberculous meningitis is hampered by the lack of gold standard. We developed a diagnostic model using latent class analysis, combining confirmatory test results and risk factors. Models were accurate, well-calibrated, and can support both clinical practice and research.

The prevalence of urinary disorders, especially urinary retention in canine patients, imposes the need for a protocol and optimal therapeutic management in order to detect the disease at an early stage, where complications are minimal or even nonexistent. Thus, ultrasound examination represents the gold standard in the detection of both mechanical and paralytic urinary retention, due to its accuracy, ease and noninvasive nature of the procedure, offering the possibility of prompt use of an optimal therapeutic management for each type of urinary retention. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of tuberculous meningitis (TBM) is hampered by the lack of a gold standard. Current microbiological tests lack sensitivity and clinical diagnostic approaches are subjective. We therefore built a diagnostic model that can be used before microbiological test results are known. Methods: We included 659 individuals aged ≥ 16 years with suspected brain infections from a prospective observational study conducted in Vietnam. We fitted a logistic regression diagnostic model for TBM status, with unknown values estimated via a latent class model on three mycobacterial tests: Ziehl–Neelsen smear, Mycobacterial culture, and GeneXpert. We additionally re-evaluated mycobacterial test performance, estimated individual mycobacillary burden, and quantified the reduction in TBM risk after confirmatory tests were negative. We also fitted a simplified model and developed a scoring table for early screening. All models were compared and validated internally. Results: Participants with HIV, miliary TB, long symptom duration, and high cerebrospinal fluid (CSF) lymphocyte count were more likely to have TBM. HIV and higher CSF protein were associated with higher mycobacillary burden. In the simplified model, HIV infection, clinical symptoms with long duration, and clinical or radiological evidence of extra-neural TB were associated with TBM At the cutpoints based on Youden's Index, the sensitivity and specificity in diagnosing TBM for our full and simplified models were 86.0% and 79.0%, and 88.0% and 75.0% respectively. Conclusion: Our diagnostic model shows reliable performance and can be developed as a decision assistant for clinicians to detect patients at high risk of TBM. Summary: Diagnosis of tuberculous meningitis is hampered by the lack of gold standard. We developed a diagnostic model using latent class analysis, combining confirmatory test results and risk factors. Models were accurate, well-calibrated, and can support both clinical practice and research. [ABSTRACT FROM AUTHOR]

Objectives Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening condition that requires rapid diagnosis for proper management. Laboratory testing should only be performed on patients with intermediate- or high-risk pretest probability. The platelet factor 4 (PF4) enzyme-linked immunosorbent assay (ELISA) is the screening test that should be confirmed by higher specificity testing such as the heparin-induced platelet aggregation (HIPA) or the serotonin release assay (SRA). This study aims to evaluate the performance of the HIPA in comparison to the SRA, establish cutoffs of the PF4 ELISA to predict positivity for HIPA/SRA, and study the mortality rate between patients with suspected HIT confirmed as HIT positive vs negative. Methods All positive PF4 ELISA cases with confirmatory HIPA and SRA testing were included. As the SRA was considered the gold standard, the HIPA performance was evaluated in comparison to SRA before and after the implementation of a new standardized interpretation guide in 2022. The mortality of these cases was also documented by chart reviews. Results In total, 232 cases with positive or indeterminate anti-PF4 IgG ELISA had confirmatory testing with HIPA and SRA. The sensitivity of the HIPA improved from 55.4% in 2018 to 2021 to 73.8% in 2022. The specificity remained similarly high in 2018 to 2021 vs 2022 (94.9% vs 87.5%). The negative predictive value (NPV) improved in 2022. The PF4 optical density cutoff to predict the positivity of SRA was 0.85 vs 1.47 to predict the positivity of HIPA but decreased to 0.83 when combining HIPA and/or SRA. There was no significant difference in mortality between patients with suspected HIT confirmed positive vs negative. Conclusions Although the HIPA has a lower sensitivity than the SRA, the new standardized interpretation guide improved its sensitivity and NPV in 2022. Future improvements are needed to use the HIPA as a stand-alone confirmatory test with the goal to shorten hospital length of stay and expedite proper anticoagulation management. [ABSTRACT FROM AUTHOR]

Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs. [ABSTRACT FROM AUTHOR]

Background Efficient infection control during carbapenem-resistant Enterobacterales outbreaks demands rapid and simple techniques for outbreak investigations. WGS, the current gold standard for outbreak identification, is expensive, time-consuming and requires a high level of expertise. Fourier-transform infrared (FTIR) spectroscopy (IR Biotyper) is a rapid typing method based on infrared radiation applied to samples, which provides a highly specific absorption spectrum. Objectives To investigate an outbreak of OXA-48-producing Escherichia coli in real-time using FTIR and subsequently compare the results with WGS. Methods Twenty-one isolates were collected during a nosocomial outbreak, and identification and antibiotic susceptibilities were confirmed by VITEK®2. FTIR was conducted for all isolates, and nine representative isolates were sequenced. Results FTIR was able to correctly determine the clonal relatedness of the isolates and to identify the outbreak cluster, as confirmed by WGS. By WGS, isolates in the main FTIR cluster belonged to the same MLST type and core-genome MLST type, and they harboured similar plasmids and resistance genes, whereas the singletons external to the FTIR cluster had different genetic content. Conclusions FTIR can operate as a rapid, efficient and reliable first-line tool for outbreak investigations during a real-time ongoing E. coli outbreak, which can contribute to limiting the spread of pathogens. [ABSTRACT FROM AUTHOR]

Science as a whole is organized into broad fields, and as a consequence, research, resources, students, etc., are also classified, assigned, or invited following a similar structure. Some fields have been established for centuries, and some others are just flourishing. Funding, staff, etc., to support fields are offered if there is some activity on it, commonly measured in terms of the number of published scientific papers. How to find them? There exist well-respected listings where scientific journals are ascribed to one or more knowledge fields. Such lists are human-made, but the complexity begins when a field covers more than one area of knowledge. How to discern if a particular paper is devoted to a field not considered in such lists? In this work, we propose a methodology able to classify the universe of papers into two classes; those belonging to the field of interest, and those that do not. This proposed procedure learns from the title and abstract of papers published in monothematic or "pure" journals. Provided that such journals exist, the procedure could be applied to any field of knowledge. We tested the process with Geographic Information Science. The field has contacts with Computer Science, Mathematics, Cartography, and others, a fact which makes the task very difficult. We also tested our procedure and analyzed its results with three different criteria, illustrating its power and capabilities. Interesting findings were found, where our proposed solution reached similar results as human taggers also similar results compared with state-of-the-art related work. [ABSTRACT FROM AUTHOR]

The Great Depression was characterized by widespread fiscal policy mistakes in the form of a contractionary or insufficiently expansionary fiscal stance. Despite this general conclusion, there were large differences in the conduct of fiscal policy between countries. I find that a higher degree of fiscal capacity helped countries run less procyclical fiscal policies by allowing them to borrow more extensively. Lower borrowing costs only partially explain this finding. Taken together, the results indicate that interwar governments were constrained in their policies by past investments in fiscal capacity, and not just by Gold Standard membership, ideology, and inadequate knowledge, as commonly held in the literature. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine an optimal cutoff value for the newly available HemosIL-AcuStar-HIT-IgG assay (AcuStar) for the diagnosis of heparin-induced thrombocytopenia (HIT). Method We evaluated the performance of AcuStar using serotonin release assay (SRA) as the gold standard and incorporated 4T score calculation in a cohort of suspected HIT cases. Statistical analysis was performed to determine optimal cutoff value for the diagnosis of HIT. Result A diagnosis of HIT can be excluded with a platelet factor 4 (PF4) value of <0.4 U/mL by AcuStar and 4T score in the low-risk category (≤3). All other cases will require confirmation with a functional test. Conclusion Our study resulted in the implementation of a diagnostic algorithm for laboratory diagnosis of HIT, which incorporates pretest calculation of 4T score and AcuStar as a screening test, with reflex confirmation by SRA. This new algorithm resulted in extended hours of test availability and a more rapid turnaround time in reporting PF4 results. [ABSTRACT FROM AUTHOR]

This paper explains the creation and purpose of the Chartered Management Consultant (ChMC) award in the UK, outlines the preparation and initial launch of the accreditation, describes the growth to mid-2023 and discusses how continued growth is needed not just in volume of chartered practitioners, but in the diversity of the accredited community. The paper describes the purpose and creation of the award, reviews growth and suggests where to focus next. The first part describes the two UK organisations who have been responsible for setting up and promoting the ChMC award – Chartered Management Institute (CMI) and the Management Consultancies Association (MCA) – and how the ChMC award supports their respective organisational raison d'etre. The second part provides a timeline between 2017 and 2020, in the run-up to the global pandemic. The third part describes the promotion of ChMC and the setting of pace coming out of the pandemic. The fourth part reviews the channels and levers used to accelerate growth in the take-up of ChMC during late 2022 and early 2023; and reflects on how to balance growth in volume of uptake whilst maintaining an appropriately reflective blend of community diversity. The fifth part discusses the practical challenge of promoting an industry-wide standard in a hitherto-unregulated environment. The sixth part covers the case for a strengthened approach; and The seventh and final part covers closing comments and a possible approach to build on the success achieved by CMI/MCA to date, drawing on the CMI's IC arm. [ABSTRACT FROM AUTHOR]

Introduction: The use of chemical agents has dramatically increased and holds a great promise for the prevention of dental plaque, of which chlorhexidine is considered the gold standard. New novel probiotic mouthrinses are being developed to combat the adverse effects of chlorhexidine mouthrinse. Objective: The objective of this study was to compare the effectiveness of probiotic mouthrinse with chlorhexidine mouthrinse for the treatment of chronic periodontitis as an adjunct to scaling and root planing. Materials and Methods: The patients were randomly divided into two groups of 7 subjects each. Group A (Control) and Group B (Test) had scaling and root planing along with chlorhexidine mouthrinse and probiotic mouthrinse, respectively. Clinical parameters measured at baseline and 45 days were gingival index, plaque index, probing pocket depth, and clinical attachment loss. Microbial analysis was done by collecting plaque samples at baseline and 45 days. Paired t-test was used for intragroup and intergroup comparisons, whereas independent t-test was used for intergroup comparisons. Keeping the level of significance at 5%, the significant difference was adjusted at P ≤ 0.05. Results: The mean clinical parameters were significantly reduced for both treatment groups posttherapy. The microbiological data analysis (colony-forming units/ml) showed that after the therapy, there was a significant reduction in both the groups with Group B > Group A. Conclusion: Probiotics can in the near future and with more research serve to be as natural candidates to substitute antibiotics and their derivatives. [ABSTRACT FROM AUTHOR]

This paper uses a broad geographical sample of economies to study stock market integration during the classical Gold Standard. It is novel in estimating a common or "global" component of stock market returns across all countries in the sample and studying how individual markets co-move with this. Variations in the integration of individual exchanges often appear related to large domestic financial and political crises as idiosyncratic shocks were more common than they are today. The results suggest that although overall integration rose during this period, it was low compared to more recent data. The results are robust to alternative formulations of the global component and alternative measures of returns. [ABSTRACT FROM AUTHOR]

For a number of years, the authors have been working in the sphere of asset tokenization, especially in connection with precious metals. An approach (including algorithms, mathematical models, and software implementation) to the gold reserve management problem has been developed. This approach allows to effectively manage the gold reserve, taking into account the fact that the faster the money is turned over, the less gold is required to ensure the functioning of the financial system. Moreover, the transfer of payments to the online mode dramatically reduces the need for working capital and, hence, the amount of gold required for it. The authors consider the provided algorithms as a very important part of a possible gold-backed settlement system that allows to solve the problem of organizing international payment transactions between countries in their national currencies to avoid the dominance of a single fiat currency. [ABSTRACT FROM AUTHOR]

Standard transthoracic echocardiography is considered the non-invasive gold standard for the diagnosis of most cardiac diseases. Defining reproducibility, repeatability, and reliability of this exam is imperative to reduce errors in clinical evaluations. The present study aimed at: (1) evaluating the reproducibility and repeatability of 15 echocardiographic parameters in dogs by analyzing measurements obtained from several operators with different levels of experience and comparing them to the ones obtained from two board-certified operators (gold standards - GSs); (2) assessing whether different formative paths have an influence on the variability of the echocardiographic measurements. Fifty-one operators have been included in this study, along with two diplomates of the European College of Veterinary Internal Medicine - Cardiology. Ten dogs were enrolled, 5 Golden Retrievers and 5 Cavalier King Charles Spaniels. Echocardiographic examination was performed on each dog by one GS and several operators on the same day. Results show the highest deviation from the GS and a poor inter-operator reproducibility for the M-mode measurements of the interventricular septum and the left ventricular free wall. Differently, M-mode-obtained internal diameters of the left ventricle in systole and diastole, and measurements of the aortic annulus and root show moderate to excellent intra- and inter-operator reliability and a good concordance with the GSs, demonstrating that all the operators correctly assess left ventricular systolic function and dilation, and evaluate the aortic valve. Furthermore, a specialist clinical activity, more than the acquired theoretical knowledge, affects the reliability of the echocardiographic examination by reducing the difference from the GS' measurements. [ABSTRACT FROM AUTHOR]

Inaccuracy in current diagnostic procedures for mental disorders can lead to misdiagnosis and increase the burden on the healthcare system. Therefore, Klenico, a diagnostic software designed to support comprehensive and efficient clinical diagnostic procedures that is easy to apply in everyday clinical practice, was developed. This study aimed to take the first step toward validating the Klenico self-report module. Data of 115 patients from a German psychotherapeutic outpatient clinic were included in this study. Criterion validity was tested by comparing Klenico with the diagnoses based on the structured clinical interview for DSM-IV (SCID). Construct validity was investigated by comparing Klenico with commonly used self-reporting questionnaires. The results showed that most of the Klenico disorder domains were able to differentiate between corresponding diagnoses and other diagnoses, confirming criterion validity. Construct validity was demonstrated by high correlations with the compared convergent questionnaire scales and non-significant or low correlations with most of the divergent scales. These preliminary results demonstrate the psychometric properties of the Klenico self-report module and imply that the Klenico system has high potential to improve the accuracy of diagnostic procedures in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Background Randomized clinical trials of novel treatments for solid tumors normally measure disease progression using the Response Evaluation Criteria in Solid Tumors. However, novel, scalable approaches to estimate disease progression using real-world data are needed to advance cancer outcomes research. The purpose of this narrative review is to summarize examples from the existing literature on approaches to estimate real-world disease progression and their relative strengths and limitations, using lung cancer as a case study. Methods A narrative literature review was conducted in PubMed to identify articles that used approaches to estimate real-world disease progression in lung cancer patients. Data abstracted included data source, approach used to estimate real-world progression, and comparison to a selected gold standard (if applicable). Results A total of 40 articles were identified from 2008 to 2022. Five approaches to estimate real-world disease progression were identified including manual abstraction of medical records, natural language processing of clinical notes and/or radiology reports, treatment-based algorithms, changes in tumor volume, and delta radiomics–based approaches. The accuracy of these progression approaches were assessed using different methods, including correlations between real-world endpoints and overall survival for manual abstraction (Spearman rank ρ = 0.61-0.84) and area under the curve for natural language processing approaches (area under the curve = 0.86-0.96). Conclusions Real-world disease progression has been measured in several observational studies of lung cancer. However, comparing the accuracy of methods across studies is challenging, in part, because of the lack of a gold standard and the different methods used to evaluate accuracy. Concerted efforts are needed to define a gold standard and quality metrics for real-world data. [ABSTRACT FROM AUTHOR]

Renal arteriovenous malformations (AVMs) are abnormal connections between the renal arteries and venous system. Arteriovenous fistulas account for 70%–80% of renal arteriovenous abnormalities, often resulting from iatrogenic injuries. While most renal AVMs are asymptomatic, hematuria is a common symptom caused by AVM rupture into the renal calyces. Angiography is the gold standard for diagnosis, but noninvasive imaging techniques like ultrasound, computed tomography, or magnetic resonance imaging are commonly used for initial evaluation. Most renal AVMs are managed conservatively. Symptomatic patients typically undergo endovascular embolization, the preferred treatment, while surgery is reserved for unstable patients or those with complex vascular anatomy. We present a case of a 32-year-old man with renal AVMs following a motor vehicle accident. The patient initially received unsuccessful endovascular embolization but achieved successful treatment through open fistula ligation. This case highlights the challenges in managing renal AVMs and the importance of considering alternative interventions when initial treatments prove ineffective. [ABSTRACT FROM AUTHOR]