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1. A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts

Author: Brasil, Sérgio, Godoy, Daniel Agustín, Videtta, Walter, Rubiano, Andrés Mariano, Solla, Davi, Taccone, Fabio Silvio, Robba, Chiara, Rasulo, Frank, Aries, Marcel, Smielewski, Peter, Meyfroidt, Geert, Battaglini, Denise, Hirzallah, Mohammad I., Amorim, Robson, Sampaio, Gisele, Moulin, Fabiano, Deana, Cristian, Picetti, Edoardo, Kolias, Angelos, Hutchinson, Peter, Hawryluk, Gregory W., Czosnyka, Marek, Panerai, Ronney B., Shutter, Lori A., Park, Soojin, Rynkowski, Carla, Paranhos, Jorge, Silva, Thiago H. S., Malbouisson, Luiz M. S., and Paiva, Wellingson S.
Published: 2024
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2. International web-based survey of patients with non-hydrocephalic symptomatic pineal cysts

Author: Harding, Jessica, Masina, Riccardo, Hill, Anna, Ansanipour, Ali, Steele, Amber, Kolias, Angelos, and Santarius, Thomas
Published: 2024
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3. A randomized controlled trial of social media promotion in neurosurgical publishing

Author: Vieli, Moira, Battilana, Bianca, Alamri, Alex, Rabiei, Katrin, Lippa, Laura, Karekezi, Claire, Kolias, Angelos, Serra, Carlo, Regli, Luca, Mathiesen, Tiit, and Staartjes, Victor E.
Published: 2024
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4. A guide to interpreting systematic reviews and meta-analyses in neurosurgery and surgery

Author: Esene, Ignatius, Tantengco, Ourlad Alzeus G., Robertson, Faith C., Still, Megan E. H., Ukachukwu, Alvan-Emeka K., Baticulon, Ronnie E., Barthélemy, Ernest J., Perez-Chadid, Daniela, Lippa, Laura, Silva, Ana Cristina Veiga, Jokonya, Luxwell, Hassani, Fahd D., Nicolosi, Federico, Takoutsing, Berjo D., Ntalaja, Jeff, Hoz, Samer S., Kalangu, Kazadi K. N., Dechambenoit, Gilbert, Servadei, Franco, El Abbadi, Najia, Park, Kee B., and Kolias, Angelos
Published: 2024
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5. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Author: Picetti, Edoardo, Demetriades, Andreas K., Catena, Fausto, Aarabi, Bizhan, Abu-Zidan, Fikri M., Alves, Oscar L., Ansaloni, Luca, Armonda, Rocco A., Badenes, Rafael, Bala, Miklosh, Balogh, Zsolt J., Barbanera, Andrea, Bertuccio, Alessandro, Biffl, Walter L., Bouzat, Pierre, Buki, Andras, Castano-Leon, Ana Maria, Cerasti, Davide, Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Costa, Francesco, De Iure, Federico, Depreitere, Bart, Fainardi, Enrico, Fehlings, Michael J., Gabrovsky, Nikolay, Godoy, Daniel Agustin, Gruen, Peter, Gupta, Deepak, Hawryluk, Gregory W. J., Helbok, Raimund, Hossain, Iftakher, Hutchinson, Peter J., Iaccarino, Corrado, Inaba, Kenji, Ivanov, Marcel, Kaprovoy, Stanislav, Kirkpatrick, Andrew W., Klein, Sam, Kolias, Angelos, Konovalov, Nikolay A., Lagares, Alfonso, Lippa, Laura, Loza-Gomez, Angelica, Luoto, Teemu M., Maas, Andrew I. R., Maciejczak, Andrzej, Maier, Ronald V., Marklund, Niklas, Martin, Matthew J., Melloni, Ilaria, Mendoza-Lattes, Sergio, Meyfroidt, Geert, Munari, Marina, Napolitano, Lena M., Okonkwo, David O., Otomo, Yasuhiro, Papadopoulos, Marios C., Petr, Ondra, Peul, Wilco C., Pudkrong, Aichholz K., Qasim, Zaffer, Rasulo, Frank, Reizinho, Carla, Ringel, Florian, Rizoli, Sandro, Rostami, Elham, Rubiano, Andres M., Russo, Emanuele, Sarwal, Aarti, Schwab, Jan M., Servadei, Franco, Sharma, Deepak, Sharif, Salman, Shiban, Ehab, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Terpolilli, Nicole A., Thomé, Claudius, Toth, Peter, Tsitsopoulos, Parmenion P., Udy, Andrew, Vaccaro, Alexander R., Varon, Albert J., Vavilala, Monica S., Younsi, Alexander, Zackova, Monika, Zoerle, Tommaso, and Robba, Chiara
Published: 2024
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6. Reduced temporal muscle thickness predicts shorter survival in patients undergoing chronic subdural haematoma drainage

Author: Tommi K. Korhonen, Otso Arponen, Moritz Steinruecke, Ilaria Pecorella, Harry Mee, Stefan Yordanov, Edoardo Viaroli, Mathew R. Guilfoyle, Angelos Kolias, Ivan Timofeev, Peter Hutchinson, and Adel Helmy
Subjects: Body composition, Chronic subdural haematoma, Computed tomography, Frailty, Sarcopenia, Diseases of the musculoskeletal system, RC925-935, Human anatomy, QM1-695
Abstract: Abstract Background Chronic subdural haematoma (CSDH) drainage is a common neurosurgical procedure. CSDHs cause excess mortality, which is exacerbated by frailty. Sarcopenia contributes to frailty – its key component, low muscle mass, can be assessed using cross‐sectional imaging. We aimed to examine the prognostic role of temporal muscle thickness (TMT) measured from preoperative computed tomography head scans among patients undergoing surgical CSDH drainage. Methods We retrospectively identified all patients who underwent CSDH drainage within 1 year of February 2019. We measured their mean TMT from preoperative computed tomography scans, tested the reliability of these measurements, and evaluated their prognostic value for postoperative survival. Results One hundred and eighty‐eight (122, 65% males) patients (median age 78 years, IQR 70–85 years) were included. Thirty‐four (18%) patients died within 2 years, and 51 (27%) died at a median follow‐up of 39 months (IQR 34–42 months). Intra‐ and inter‐observer reliability of TMT measurements was good‐to‐excellent (ICC 0.85–0.97, P
Published: 2024
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7. Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study.

Author: van Essen, Thomas, van Erp, Inge, Lingsma, Hester, Pisică, Dana, Singh, Ranjit, van Dijck, Jeroen, Volovici, Victor, Younsi, Alexander, Kolias, Angelos, Peppel, Lianne, Heijenbrok-Kal, Majanka, Ribbers, Gerard, Menon, David, Hutchinson, Peter, Manley, Geoffrey, Depreitere, Bart, Steyerberg, Ewout, Maas, Andrew, de Ruiter, Godard, Peul, Wilco, and Yue, John
Subjects: Acute subdural hematoma, Comparative effectiveness research, Craniotomy, Decompressive craniectomy, Instrumental variable analysis, Practice variation
Abstract: BACKGROUND: Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy. METHODS: We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014-2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the case-mix adjusted proportion DC per centre. The primary outcome was functional outcome rated by the 6-months Glasgow Outcome Scale Extended, estimated with ordinal regression as a common odds ratio (OR), adjusted for prespecified confounders. Variation in centre preference was quantified with the median odds ratio (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). FINDINGS: Between December 19, 2014 and December 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI of whom 336 (7%) underwent acute surgery for ASDH evacuation; 91 (27%) underwent DC and 245 (63%) craniotomy. The proportion primary DC within total acute surgery cases ranged from 6 to 67% with an interquartile range (IQR) of 12-26% among 46 centres; the odds of receiving a DC for prognostically similar patients in one centre versus another randomly selected centre were trebled (adjusted median odds ratio 2.7, p
Published: 2023

8. Towards Scalable EM-based Anomaly Detection For Embedded Devices Through Synthetic Fingerprinting

Author: Vedros, Kurt A., Makrakis, Georgios Michail, Kolias, Constantinos, Ivans, Robert C., and Rieger, Craig
Subjects: Computer Science - Cryptography and Security
Abstract: Embedded devices are omnipresent in modern networks including the ones operating inside critical environments. However, due to their constrained nature, novel mechanisms are required to provide external, and non-intrusive anomaly detection. Among such approaches, one that has gained traction is based on the analysis of the electromagnetic (EM) signals that get emanated during a device's operation. However, one of the most neglected challenges of this approach is the requirement for manually gathering and fingerprinting the signals that correspond to each execution path of the software/firmware. Indeed, even simple programs are comprised of hundreds if not thousands of branches thus, making the fingerprinting stage an extremely time-consuming process that involves the manual labor of a human specialist. To address this issue, we propose a framework for generating synthetic EM signals directly from the machine code. The synthetic signals can be used to train a Machine Learning based (ML) system for anomaly detection. The main advantage of the proposed approach is that it completely removes the need for an elaborate and error-prone fingerprinting stage, thus, dramatically increasing the scalability of the corresponding protection mechanisms. The experimental evaluations indicate that our method provides high detection accuracy (above 90% AUC score) when employed for the detection of injection attacks. Moreover, the proposed methodology inflicts only a small penalty (-1.3%) in accuracy for the detection of the injection of as little as four malicious instructions when compared to the same methods if real signals were to be used.
Published: 2023

9. Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study

Author: Kelly Jones, Antonio Belli, Suzanne Polinder, Emmanuel Stamatakis, Hester F Lingsma, Dick Tibboel, Ronny Beer, Raimund Helbok, Horia Ples, Ari Ercole, Peter Cameron, Marek Czosnyka, Catherine McMahon, Peter Vajkoczy, Paul Dark, Alexandra Brazinova, Marek Majdan, Rahul Raj, William Stewart, Ewout W Steyerberg, Giuseppe Citerio, Nino Stocchetti, Alessia Vargiolu, Hester Lingsma, Helen Dawes, Benoit Misset, Faye Johnson, David van Klaveren, Simon Stanworth, Fiona Lecky, Peter Smielewski, Alice Theadom, Peter Bragge, David Nelson, János Sándor, Paul M Vespa, Olli Tenovuo, Olav Røise, Wim Van Hecke, Vincent Degos, David Menon, Bart Depreitere, Audny Anke, Rolf Rossaint, Mark Coburn, Victor Volovici, Daan Nieboer, Jonathan Rosand, Nada Andelic, Hans Clusmann, Emma Donoghue, Jonathan Coles, stefan jankowski, Jonathan Rhodes, Guy Williams, Rolf Lefering, Mathieu van der Jagt, Daniel Kondziella, Noah D Silverberg, Arturo Chieregato, Sophie Richter, Endre Czeiter, Stefan Winzeck, Jan Verheyden, András Büki, Benjamin Gravesteijn, Evgenios Kornaropoulos, Virginia Newcombe, Lindsay Wilson, Lindsay Horton, Amra Covic, Dominique Van Praag, Cecilia Åkerlund, Krisztina Amrein, Lasse Andreassen, Anna Antoni, Gérard Audibert, Philippe Azouvi, Ronald Bartels, Pál Barzó, Romuald Beauvais, Bo-Michael Bellander, Habib Benali, Maurizio Berardino, Luigi Beretta, Morten Blaabjerg, Vibeke Brinck, Joanne Brooker, Camilla Brorsson, Monika Bullinger, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Guillermo Carbayo Lozano, Marco Carbonara, Simona Cavallo, Giorgio Chevallard, Marta Correia, Nicola Curry, Véronique De Keyser, Hugo den Boogert, Đula Đilvesi, Abhishek Dixit, Jens Dreier, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Kelly Foks, Shirin Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Dashiell Gantner, Guoyi Gao, Pradeep George, Alexandre Ghuysen, Lelde Giga, Jagoš Golubovic Ben Glocker, Johannes Gratz, Francesca Grossi, Deepak Gupta, Iain Haitsma, Eirik Helseth, Jilske Huijben, Bram Jacobs, Mike Jarrett, Mladen Karan, Erwin Kompanje, Noémi Kovács, Ana Kowark, Alfonso Lagares, Linda Lanyon, Steven Laureys, Didier Ledoux, Valerie Legrand, Aurelie Lejeune, Leon Levi, Roger Lightfoot, Marc Maegele, Alex Manara, Geoffrey Manley, Costanza Martino, Hugues Maréchal, Julia Mattern, Béla Melegh, Tomas Menovsky, Ana Mikolic, Visakh Muraleedharan, Lynnette Murray, Ancuta Negru, József Nyirádi, Otesile Olubukola, Matej Oresic, Fabrizio Ortolano, Aarno Palotie, Paul M Parizel, Natascha Perera, Vincent Perlbarg, Paolo Persona, Wilco Peul, Matti Pirinen, Inigo Pomposo, Louis Puybasset, Andreea Radoi, Arminas Ragauskas, Malinka Rambadagalla, Sylvia Richardson, Samuli Ripatti, Saulius Rocka, Cecilie Roe, Christina Rosenlund, Guy Rosenthal, Sandra Rossi, Juan Sahuquillo, Oliver Sakowitz, Nadine Schäfer, Silke Schmidt, Herbert Schoechl, Guus Schoonman, Elisabeth Schwendenwein, Charlie Sewalt, Toril Skandsen, Abayomi Sorinola, Robert Stevens, Nina Sundström, Riikka Takala, Viktória Tamás, Tomas Tamosuitis, Mark Steven Taylor, Matt Thomas, Marjolein Timmers, Christos Tolias, Tony Trapani, Shirley Vallance, Egils Valeinis, Zoltán Vámos, Emmanuel Vega, Kimberley Velt, Anne Vik, Rimantas Vilcinis, Daphne Voormolen, Petar Vulekovic, Kevin K W Wang, Eveline Wiegers, Stefan Wolf, Zhihui Yang, Peter Ylén, Alexander Younsi, Frederick A Zeiler, Veronika Zelinkova, Agate Ziverte, Tommaso Zoerle, Joukje van der Naalt, Braden Te Ao, Caroline van Heugten, Francesco Della Corte, Ernest Van Veen, Andrew IR Maas, Andreas Unterberg, Thomas A van Essen, Mathilde Jost, Shuyuan Shi, Maria Luisa Azzolini, Maria Rosa Calvi, Jamie D Cooper, Claire Dahyot Fizelier, Guy Loup Dulière, Valery L Feigin, Pedro A Gomez, Russell L Gruen, Juanita A Haagsma, Peter J Hutchinson, Ji yao Jiang, Angelos G Kolias, Lars Owe Koskinen, Andrew I Z Maas, Ana M Castaño León, Jean François Payen, Anna Piippo Karjalainen, Dana Pisica, Jussi PPosti, Isabel Retel Helmrich, Jeffrey VRosenfeld, Daniel Rueckert Martin Rusnák, Renan SanchezPorras, Rico Frederik Schou, Cristina Maria Tudora, Gregory Van der Steen, Jeroen T J M van Dijck, Thijs Vande Vyvere, Roel P J van Wijk, and Nicole von Steinbüchel
Subjects: Psychiatry, RC435-571
Abstract: Background Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI.Methods We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. We used linear regression to model the relationship between predictors and depression (Patient Health Questionnaire-9) and PTSD symptoms (PTSD Checklist for Diagnostic and Statistical Manual for Mental Health Disorders Fifth Edition). Predictors were selected based on Akaike’s Information Criterion. Additionally, we fitted logistic models for the endpoints ‘probable MDD’ and ‘probable PTSD’. We also examined the incremental prognostic value of 2–3 weeks of symptoms.Results We included 2163 adults (76% Glasgow Coma Scale=13–15). Depending on the scoring criteria, 7–18% screened positive for probable MDD and about 10% for probable PTSD. For both outcomes, the selected models included psychiatric history, employment status, sex, injury cause, alcohol intoxication and total injury severity; and for depression symptoms also preinjury health and education. The performance of the models was modest (proportion of explained variance=R2 8% and 7% for depression and PTSD, respectively). Symptoms assessed at 2–3 weeks had a large incremental prognostic value (delta R2=0.25, 95% CI 0.24 to 0.26 for depression symptoms; delta R2=0.30, 95% CI 0.29 to 0.31 for PTSD).Conclusion Preinjury characteristics, such as psychiatric history and unemployment, and injury characteristics, such as violent injury cause, can increase the risk of mental health problems after TBI. The identification of patients at risk should be guided by early screening of mental health.
Published: 2025
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10. Gender differences in the perception of the indoor environment: Findings from residential buildings in a nordic climate

Author: Theofanis Psomas, Paul O.’ Sullivan, Pavlos Kolias, Adam O.’ Donovan, and Pawel Wargocki
Subjects: Dwellings, Biological sexes, Overall satisfaction and comfort, Building and occupant characteristics, Individual attributes, Advanced statistical analysis, Public aspects of medicine, RA1-1270, Building construction, TH1-9745
Abstract: Current research suggests gender (“sex assigned at birth”) differences with respect to indoor environmental conditions, indicating females are more critical and demanding towards satisfaction and preferences. The present paper analyzes the results of a subsample of a national survey completed in 375 representative dwellings in Sweden. The survey collected information on twelve comfort factors and satisfaction aspects concerning thermal comfort, indoor air quality, acoustic comfort, satisfaction with daylight, size, standard, layout, appearance, well-being, cost, and neighborhood. Advanced statistical analyses were used to investigate whether the responses of occupants experiencing similar indoor conditions (cohabitation) were different with respect to gender. The analysis did not observe any significant gender differences with respect to the ratings of indoor environments in dwellings. Males reported slightly higher satisfaction, while thermal and acoustic comfort exhibited the highest gender variability. Satisfaction aspects were generally very high, with the costs and acoustic comfort registering the highest levels of dissatisfaction. Additional analyses across various building characteristics and individual attributes (variables levels) confirmed no differences. Several hypotheses were put up to explain these results, including the extreme climatic conditions and the collaborative use of dwellings. The findings suggest that Swedish dwelling designs can provide some best practice guidance for stakeholders and practitioners elsewhere in similar climatic conditions. Future studies should confirm the present observations and the social and cultural aspects of the findings.
Published: 2024
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11. Genetic vulnerability and adverse mental health outcomes following mild traumatic brain injury: a meta-analysis of CENTER-TBI and TRACK-TBI cohortsResearch in context

Author: Mart Kals, Lindsay Wilson, Daniel F. Levey, Livia Parodi, Ewout W. Steyerberg, Sylvia Richardson, Feng He, Xiaoying Sun, Sonia Jain, Aarno Palotie, Samuli Ripatti, Jonathan Rosand, Geoff T. Manley, Andrew I.R. Maas, Murray B. Stein, David K. Menon, Cecilia Ackerlund, Hadie Adams, Krisztina Amrein, Nada Andelic, Lasse Andreassen, Audny Anke, Anna Antoni, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Pál Barzó, Romuald Beauvais, Ronny Beer, Bo-Michael Bellander, Antonio Belli, Habib Benali, Maurizio Berardino, Luigi Beretta, Morten Blaabjerg, Peter Bragge, Alexandra Brazinova, Vibeke Brinck, Joanne Brooker, Camilla Brorsson, Andras Buki, Monika Bullinger, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Maria Rosa Calvi, Peter Cameron, Guillermo Carbayo Lozano, Marco Carbonara, Ana M. Castaño-León, Simona Cavallo, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Mark Steven Coburn, Jonathan Coles, Jamie D. Cooper, Marta Correia, Amra Čović, Nicola Curry, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, Paul Dark, Helen Dawes, Véronique De Keyser, Vincent Degos, Francesco Della Corte, Hugo den Boogert, Bart Depreitere, Đula Đilvesi, Abhishek Dixit, Emma Donoghue, Jens Dreier, Guy-Loup Dulière, Ari Ercole, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Valery L. Feigin, Kelly Foks, Shirin Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Dashiell Gantner, Guoyi Gao, Pradeep George, Alexandre Ghuysen, Lelde Giga, Ben Glocker, Jagoš Golubović, Pedro A. Gomez, Johannes Gratz, Benjamin Gravesteijn, Francesca Grossi, Russell L. Gruen, Deepak Gupta, Juanita A. Haagsma, Iain Haitsma, Raimund Helbok, Eirik Helseth, Lindsay Horton, Jilske Huijben, Peter J. Hutchinson, Bram Jacobs, Stefan Jankowski, Mike Jarrett, Ji-yao Jiang, Faye Johnson, Kelly Jones, Mladen Karan, Angelos G. Kolias, Erwin Kompanje, Daniel Kondziella, Lars-Owe Koskinen, Noémi Kovács, Ana Kowark, Alfonso Lagares, Linda Lanyon, Steven Laureys, Fiona Lecky, Didier Ledoux, Rolf Lefering, Valerie Legrand, Aurelie Lejeune, Leon Levi, Roger Lightfoot, Hester Lingsma, Marc Maegele, Marek Majdan, Alex Manara, Hugues Maréchal, Costanza Martino, Julia Mattern, Charles McFadyen, Catherine McMahon, Béla Melegh, Tomas Menovsky, Ana Mikolic, Benoit Misset, Visakh Muraleedharan, Lynnette Murray, Ancuta Negru, David Nelson, Virginia Newcombe, Daan Nieboer, József Nyirádi, Matej Oresic, Fabrizio Ortolano, Olubukola Otesile, Paul M. Parizel, Jean-François Payen, Natascha Perera, Vincent Perlbarg, Paolo Persona, Wilco Peul, Anna Piippo-Karjalainen, Matti Pirinen, Dana Pisica, Horia Ples, Suzanne Polinder, Inigo Pomposo, Jussi P. Posti, Louis Puybasset, Andreea Rădoi, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Veronika Rehorčíková, Isabel Retel Helmrich, Jonathan Rhodes, Sophie Richter, Saulius Rocka, Cecilie Roe, Olav Roise, Jeffrey Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Daniel Rueckert, Martin Rusnák, Juan Sahuquillo, Oliver Sakowitz, Renan Sanchez-Porras, Janos Sandor, Nadine Schäfer, Silke Schmidt, Herbert Schoechl, Guus Schoonman, Rico Frederik Schou, Elisabeth Schwendenwein, Charlie Sewalt, Ranjit D. Singh, Toril Skandsen, Peter Smielewski, Abayomi Sorinola, Emmanuel Stamatakis, Simon Stanworth, Robert Stevens, William Stewart, Nino Stocchetti, Nina Sundström, Riikka Takala, Viktória Tamás, Tomas Tamosuitis, Mark Steven Taylor, Braden Te Ao, Olli Tenovuo, Alice Theadom, Aurore Thibaut, Matt Thomas, Dick Tibboel, Marjolijn Timmers, Christos Tolias, Tony Trapani, Cristina Maria Tudora, Andreas Unterberg, Peter Vajkoczy, Egils Valeinis, Shirley Vallance, Zoltán Vámos, Mathieu van der Jagt, Joukje van der Naalt, Gregory Van der Steen, Jeroen T.J.M. van Dijck, Inge A. van Erp, Thomas A. van Essen, Wim Van Hecke, Caroline van Heugten, Dominique Van Praag, Ernest van Veen, Roel van Wijk, Thijs Vande Vyvere, Alessia Vargiolu, Emmanuel Vega, Kimberley Velt, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Victor Volovici, Nicole von Steinbüchel, Daphne Voormolen, Peter Vulekovic, Daniel Whitehouse, Eveline Wiegers, Guy Williams, Stefan Wolf, Zhihui Yang, Peter Ylén, Alexander Younsi, Frederick A. Zeiler, Agate Ziverte, Tommaso Zoerle, Opeolu Adeoye, Neeraj Badjatia, Jason Barber, Michael Bergin, Kim Boase, Yelena Bodien, Randall Chesnut, John Corrigan, Karen Crawford, Ramon Diaz-Arrastia, Sureyya Dikmen, Ann-Christine Duhaime, Richard Ellenbogen, Venkata Feeser, Adam R. Ferguson, Brandon Foreman, Etienne Gaudette, Joseph Giacino, Luis Gonzalez, Shankar Gopinath, Ramesh Grandhi, Rao Gullapalli, Claude Hemphill, Gillian Hotz, Russell Huie, Ruchira Jha, Dirk C. Keene, Ryan Kitagawa, Frederick Korley, Joel Kramer, Natalie Kreitzer, Harvey Levin, Chris Lindsell, Joan Machamer, Christopher Madden, Alastair Martin, Thomas McAllister, Michael McCrea, Randall Merchant, Pratik Mukherjee, Lindsay Nelson, Laura B. Ngwenya, Florence Noel, Amber Nolan, David Okonkwo, Eva Palacios, Daniel Perl, Ava Puccio, Miri Rabinowitz, Claudia Robertson, Richard Ben Rodgers, Eric Rosenthal, Angelle Sander, Danielle Sandsmark, Andrea Schneider, David Schnyer, Seth Seabury, Mark Sherer, Gabriella Sugar, Nancy Temkin, Arthur Toga, Abel Torres-Espin, Alex Valadka, Mary Vassar, Kevin Wang, Vincent Wang, John K. Yue, Esther Yuh, and Ross Zafonte
Subjects: Traumatic brain injury, Mental health, Post-traumatic stress disorder, Depression, Polygenic risk score, Medicine (General), R5-920
Abstract: Summary: Background: Post-traumatic stress disorder (PTSD) and depression are common after mild traumatic brain injury (mTBI), but their biological drivers are uncertain. We therefore explored whether polygenic risk scores (PRS) derived for PTSD and major depressive disorder (MDD) are associated with the development of cognate TBI-related phenotypes. Methods: Meta-analyses were conducted using data from two multicenter, prospective observational cohort studies of patients with mTBI: the CENTER-TBI study (ClinicalTrials.gov ID NCT02210221) in Europe (December 2014–December 2017) and the TRACK-TBI study in the US (March 2014–July 2018). In both cohorts, the most common causes of injury were road traffic accidents and falls. Primary outcomes, specifically probable PTSD and depression, were defined at 6 months post-injury using scores ≥33 on the PTSD Checklist-5 and ≥15 on the Patient Health Questionnaire-9, respectively. We calculated PTSD-PRS and MDD-PRS for patients aged ≥17 years who had a Glasgow Coma Scale score of 13–15 upon hospital arrival and assessed their association with PTSD and depression following TBI. We also evaluated the transferability of the findings in a cohort of African Americans. Findings: Overall, 11.8% (219/1869) and 6.7% (124/1869) patients were classified as having probable PTSD and depression, respectively. The PTSD-PRS was significantly associated with higher adjusted odds of PTSD in both cohorts, with a pooled odds ratio (OR) of 1.55 [95% confidence interval (CI) 1.30–1.84, p
Published: 2024
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12. Detecting Code Injections in Noisy Environments Through EM Signal Analysis and SVD Denoising

Author: Miller, Ekaterina, Makrakis, Georgios Michail, Vedros, Kurt A., Kolias, Constantinos, Rieger, Craig, and Barbara, Daniel
Subjects: Computer Science - Cryptography and Security
Abstract: The penetration of embedded devices in networks that support critical applications has rendered them a lucrative target for attackers and evildoers. However, traditional protection mechanisms may not be supported due to the memory and computational limitations of these systems. Recently, the analysis of electromagnetic (EM) emanations has gathered the interest of the research community. Thus, analogous protection systems have emerged as a viable solution e.g., for providing external, non-intrusive control-flow attestation for resource-constrained devices. Unfortunately, the majority of current work fails to account for the implications of real-life factors, predominantly the impact of environmental noise. In this work, we introduce a framework that integrates singular value decomposition (SVD) along with outlier detection for discovering malicious modifications of embedded software even under variable conditions of noise. Our proposed framework achieves high detection accuracy i.e., above 93\% AUC score for unknown attacks, even for extreme noise conditions i.e., -10 SNR. To the best of our knowledge, this is the first time this realistic limiting factor, i.e., environmental noise, is successfully addressed in the context of EM-based anomaly detection for embedded devices.
Published: 2022

13. Psychometric properties of the Oxford Happiness Questionnaire Short Form (OHQ-SF) in a Greek student sample

Author: Evangelia Grigoriadou, Pavlos Kolias, Melissa Theocharidou, and Mara Gkioka
Subjects: OHQ-SF, Positive psychology, Measures of happiness, Psychometric properties, Subjective happiness, Psychology, BF1-990
Abstract: Abstract Background The purpose of the current study was to adapt and explore the psychometric properties of the Oxford Happiness Questionnaire Short Form (OHQ-SF) in a Greek student sample. Aim This quantitative cross-sectional study was applied in order to translate and validate the Oxford Happiness Questionnaire Short Form (OHQ-SF) into Greek and to assess the psychometric properties. Method The English version of OHQ-SF was translated into Greek using the forward and backward translation. The sample was consisted of 88 adult students from the Public Educational Training Institution in Thessaloniki. Two self-report measures the Greek version of OHQ-SF and the Greek version of the Life Orientation Test Revised (LOT-R—to check the construct validity) were completed twice, for test and retest assessment, in full anonymity and confidentiality. Statistical analysis The psychometric properties of OHQ-SF/GR, namely the internal–external reliability and construct validity, were assessed, and the expected unidimensional structure was tested with Confirmatory Factor Analysis (CFA). Results and discussion The Greek version of OHQ-SF (OHQ-SF/GR), for both test and retest, has adequate internal reliability, satisfactory structural validity, and adequate construct validity. The CFA indicated the unidimensional structure of the OHQ-SF/GR, and the fit indexes displayed good fit with the data. One item was removed due to poor correlation with the latent factor of happiness. The current study reveals that the final seven-item OHQ-SF/GR has very satisfactory psychometric properties being useful instrument to measure happiness levels in Greek adult students and is a valid tool that can be utilised in research field.
Published: 2024
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14. From Code to EM Signals: A Generative Approach to Side Channel Analysis-based Anomaly Detection.

Author: Kurt A. Vedros, Constantinos Kolias, Daniel Barbará, and Robert C. Ivans
Published: 2024
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15. Parsimonious immune-response endotypes and global outcome in patients with traumatic brain injuryResearch in context

Author: Romit J. Samanta, Anne-Cécile Chiollaz, Edward Needham, John K. Yue, Adel Helmy, Elisa R. Zanier, Kevin K.W. Wang, Firas Kobeissy, Jussi P. Posti, Charlotte Summers, Geoffrey T. Manley, Andrew IR. Maas, Olli Tenovuo, Jean-Charles Sanchez, David K. Menon, Neeraj Badjatia, Ramon Diaz-Arrastia, Ann-Christine Duhaime, V Ramana Feeser, Shankar Gopinath, Ramesh Grandhi, Ruchira J. Ha, Dirk Keene, Christopher Madden, Michael McCrea, Randall Merchant, Laura B. Ngwenya, Richard B. Rodgers, David Schnyer, Sabrina R. Taylor, Ross Zafonte, Cecilia Ackerlund, Krisztina Amrein, Nada Andelic, Lasse Andreassen, Audny Anke, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Ronny Beer, Bo-Michael Bellander, Habib Benali, Maurizio Berardino, Luigi Beretta, Erta Beqiri, Morten Blaabjerg, Stine Borgen Lund, Camilla Brorsson, Andras Buki, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Maria Rosa Calvi, Peter Cameron, Guillermo Carbayo Lozano, Marco Carbonara, Ana M. Castaño-León, Simona Cavallo, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Mark Steven Coburn, Jonathan Coles, Jamie D. Cooper, Marta Correia, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, Paul Dark, Véronique De Keyser, Vincent Degos, Francesco Della Corte, Hugo den Boogert, Bart Depreitere, Đula Đilvesi, Abhishek Dixit, Jens Dreier, Guy-Loup Dulière, Ari Ercole, Erzsébet Ezer, Martin Fabricius, Kelly Foks, Shirin Frisvold, Alex Furmanov, Damien Galanaud, Dashiell Gantner, Alexandre Ghuysen, Lelde Giga, Jagoš Golubović, Pedro A. Gomez, Benjamin Gravesteijn, Francesca Grossi, Deepak Gupta, Iain Haitsma, Raimund Helbok, Eirik Helseth, Jilske Huijben, Peter J. Hutchinson, Stefan Jankowski, Faye Johnson, Mladen Karan, Angelos G. Kolias, Daniel Kondziella, Evgenios Kornaropoulos, Lars-Owe Koskinen, Noémi Kovács, Ana Kowark, Alfonso Lagares, Steven Laureys, Fiona Lecky, Didier Ledoux, Roger Lightfoot, Hester Lingsma, Andrew I.R. Maas, Alex Manara, Hugues Maréchal, Costanza Martino, Julia Mattern, Catherine McMahon, David Menon, Tomas Menovsky, Benoit Misset, Visakh Muraleedharan, Lynnette Murray, Ancuta Negru, David Nelson, Virginia Newcombe, József Nyirádi, Fabrizio Ortolano, Jean-François Payen, Vincent Perlbarg, Paolo Persona, Wilco Peul, Anna Piippo-Karjalainen, Horia Ples, Inigo Pomposo, Louis Puybasset, Andreea Rădoi, Arminas Ragauskas, Rahul Raj, Jonathan Rhodes, Sophie Richter, Saulius Rocka, Cecilie Roe, Olav Roise, Jeffrey Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Juan Sahuquillo, Oliver Sakowitz, Renan Sanchez-Porras, Oddrun Sandrød, Kari Schirmer-Mikalsen, Rico Frederik Schou, Charlie Sewalt, Peter Smielewski, Abayomi Sorinola, Emmanuel Stamatakis, Ewout W. Steyerberg, Nino Stocchetti, Nina Sundström, Riikka Takala, Viktória Tamás, Tomas Tamosuitis, Matt Thomas, Dick Tibboel, Christos Tolias, Tony Trapani, Cristina Maria Tudora, Andreas Unterberg, Peter Vajkoczy, Egils Valeinis, Shirley Vallance, Zoltán Vámos, Gregory Van der Steen, Jeroen T.J.M. van Dijck, Thomas A. van Essen, Roel van Wijk, Alessia Vargiolu, Emmanuel Vega, Anne Vik, Rimantas Vilcinis, Victor Volovici, Peter Vulekovic, Eveline Wiegers, Guy Williams, Stefan Winzeck, Stefan Wolf, Alexander Younsi, Frederick A. Zeiler, Agate Ziverte, and Tommaso Zoerle
Subjects: Traumatic brain injury, Stratified medicine, Inflammation, Clustering, Medicine, Medicine (General), R5-920
Abstract: Summary: Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phenotype had higher concentrations of interleukin-6 (IL-6), IL-15, and monocyte chemoattractant protein 1 (MCP1). Patients with the early-inflammatory phenotype were older and more likely to have an unfavourable GOS-E at 6 months. There were no differences in the baseline injury severity scores between patients in each phenotype. A combined IL-15 and MCP1 signature identified patients with the early-inflammatory phenotype in both cohorts. Inflammatory processes mediated outcomes in older patients with moderate-severe TBI. Interpretation: Our findings offer a precision medicine approach for future clinical trials of immunomodulation in patients with TBI, by using inflammatory signatures to stratify patients. Funding: CENTER-TBI study was supported by the European Union 7th Framework Programme. TRACK-TBI is supported by the National Institute of Neurological Disorders and Stroke.
Published: 2024
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16. Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injuryResearch in context

Author: Lindsay Wilson, Virginia F.J. Newcombe, Daniel P. Whitehouse, Stefania Mondello, Andrew I.R. Maas, David K. Menon, Cecilia Ackerlund, Krisztina Amrein, Nada Andelic, Lasse Andreassen, Audny Anke, Anna Antoni, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Pál Barzó, Romuald Beauvais, Ronny Beer, Bo-Michael Bellander, Antonio Belli, Habib Benali, Maurizio Berardino, Luigi Beretta, Morten Blaabjerg, Peter Bragge, Alexandra Brazinova, Vibeke Brinck, Joanne Brooker, Camilla Brorsson, Andras Buki, Monika Bullinger, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Maria Rosa Calvi, Peter Cameron, Guillermo Carbayo Lozano, Marco Carbonara, Ana M. Castaño-León, Simona Cavallo, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Hans Clusmann, Mark Steven Coburn, Jonathan Coles, Jamie D. Cooper, Marta Correia, Amra Čović, Nicola Curry, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, Paul Dark, Helen Dawes, Véronique De Keyser, Vincent Degos, Francesco Della Corte, Hugo den Boogert, Bart Depreitere, Đula Đilvesi, Abhishek Dixit, Emma Donoghue, Jens Dreier, Guy-Loup Dulière, Ari Ercole, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Valery L. Feigin, Kelly Foks, Shirin Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Dashiell Gantner, Guoyi Gao, Pradeep George, Alexandre Ghuysen, Lelde Giga, Ben Glocker, Jagoš Golubović, Pedro A. Gomez, Johannes Gratz, Benjamin Gravesteijn, Francesca Grossi, Russell L. Gruen, Deepak Gupta, Juanita A. Haagsma, Iain Haitsma, Raimund Helbok, Eirik Helseth, Lindsay Horton, Jilske Huijben, Peter J. Hutchinson, Bram Jacobs, Stefan Jankowski, Mike Jarrett, Ji-yao Jiang, Faye Johnson, Kelly Jones, Mladen Karan, Angelos G. Kolias, Erwin Kompanje, Daniel Kondziella, Evgenios Kornaropoulos, Lars-Owe Koskinen, Noémi Kovács, Ana Kowark, Alfonso Lagares, Linda Lanyon, Steven Laureys, Fiona Lecky, Didier Ledoux, Rolf Lefering, Valerie Legrand, Aurelie Lejeune, Leon Levi, Roger Lightfoot, Hester Lingsma, Marc Maegele, Marek Majdan, Alex Manara, Geoffrey Manley, Hugues Maréchal, Costanza Martino, Julia Mattern, Catherine McMahon, Béla Melegh, Tomas Menovsky, Ana Mikolic, Benoit Misset, Visakh Muraleedharan, Lynnette Murray, Nandesh Nair, Ancuta Negru, David Nelson, Daan Nieboer, József Nyirádi, Matej Oresic, Fabrizio Ortolano, Olubukola Otesile, Aarno Palotie, Paul M. Parizel, Jean-François Payen, Natascha Perera, Vincent Perlbarg, Paolo Persona, Wilco Peul, Anna Piippo-Karjalainen, Matti Pirinen, Dana Pisica, Horia Ples, Suzanne Polinder, Inigo Pomposo, Jussi P. Posti, Louis Puybasset, Andreea Rădoi, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Isabel Retel Helmrich, Jonathan Rhodes, Sylvia Richardson, Sophie Richter, Samuli Ripatti, Saulius Rocka, Cecilie Roe, Olav Roise, Jonathan Rosand, Jeffrey Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Daniel Rueckert, Martin Rusnák, Juan Sahuquillo, Oliver Sakowitz, Renan Sanchez-Porras, Janos Sandor, Nadine Schäfer, Silke Schmidt, Herbert Schoechl, Guus Schoonman, Rico Frederik Schou, Elisabeth Schwendenwein, Ranjit D. Singh, Charlie Sewalt, Toril Skandsen, Peter Smielewski, Abayomi Sorinola, Emmanuel Stamatakis, Simon Stanworth, Robert Stevens, William Stewart, Ewout W. Steyerberg, Nino Stocchetti, Nina Sundström, Riikka Takala, Viktória Tamás, Tomas Tamosuitis, Mark Steven Taylor, Braden Te Ao, Olli Tenovuo, Alice Theadom, Matt Thomas, Aurore Thibaut, Dick Tibboel, Marjolijn Timmers, Christos Tolias, Tony Trapani, Cristina Maria Tudora, Andreas Unterberg, Peter Vajkoczy, Egils Valeinis, Shirley Vallance, Zoltán Vámos, Mathieu van der Jagt, Joukje van der Naalt, Gregory Van der Steen, Jeroen T.J.M. van Dijck, Inge A. van Erp, Thomas A. van Essen, Wim Van Hecke, Caroline van Heugten, Dominique Van Praag, Ernest van Veen, Roel P.J. van Wijk, Thijs Vande Vyvere, Alessia Vargiolu, Emmanuel Vega, Kimberley Velt, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Victor Volovici, Nicole von Steinbüchel, Daphne Voormolen, Peter Vulekovic, Kevin K.W. Wang, Eveline Wiegers, Guy Williams, Stefan Winzeck, Stefan Wolf, Zhihui Yang, Peter Ylén, Alexander Younsi, Frederick A. Zeiler, Veronika Zelinkova, Agate Ziverte, and Tommaso Zoerle
Subjects: Traumatic brain injury, Blood biomarkers, GFAP, NFL, UCH-L1, Outcomes, Medicine, Medicine (General), R5-920
Abstract: Summary: Background: Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods: Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings: Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation: Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. Funding: European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.
Published: 2024
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17. Assessing the detection of lateral movement through unsupervised learning techniques.

Author: Christos Smiliotopoulos, Georgios Kambourakis, Constantinos Kolias, and Stefanos Gritzalis
Published: 2025
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18. Evaluation of SDN security measures in the context of IEC 62443-3-3

Author: Makrakis, Georgios Michail, Roberson, Dakota, Kolias, Constantinos, and Cook, Dallin
Published: 2024
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19. Traumatic brain injury: progress and challenges in prevention, clinical care, and research.

Author: Maas, Andrew, Menon, David, Manley, Geoffrey, Abrams, Mathew, Åkerlund, Cecilia, Andelic, Nada, Aries, Marcel, Bashford, Tom, Bell, Michael, Bodien, Yelena, Brett, Benjamin, Büki, András, Chesnut, Randall, Citerio, Giuseppe, Clark, David, Clasby, Betony, Cooper, D, Czeiter, Endre, Czosnyka, Marek, Dams-OConnor, Kristen, De Keyser, Véronique, Diaz-Arrastia, Ramon, Ercole, Ari, van Essen, Thomas, Falvey, Éanna, Nelson, David, Nelson, Lindsay, Newcombe, Virginia, Okonkwo, David, Orešič, Matej, Peul, Wilco, Pisică, Dana, Polinder, Suzanne, Ponsford, Jennie, Puybasset, Louis, Raj, Rahul, Robba, Chiara, Røe, Cecilie, Rosand, Jonathan, Schueler, Peter, Sharp, David, Smielewski, Peter, Stein, Murray, von Steinbüchel, Nicole, Stewart, William, Steyerberg, Ewout, Stocchetti, Nino, Temkin, Nancy, Tenovuo, Olli, Theadom, Alice, Thomas, Ilias, Espin, Abel, Turgeon, Alexis, Unterberg, Andreas, Van Praag, Dominique, van Veen, Ernest, Verheyden, Jan, Vyvere, Thijs, Wang, Kevin, Wiegers, Eveline, Williams, W, Wilson, Lindsay, Wisniewski, Stephen, Younsi, Alexander, Figaji, Anthony, Fitzgerald, Melinda, Foreman, Brandon, Gantner, Dashiell, Gao, Guoyi, Giacino, Joseph, Gravesteijn, Benjamin, Guiza, Fabian, Gupta, Deepak, Gurnell, Mark, Haagsma, Juanita, Hammond, Flora, Hawryluk, Gregory, Hutchinson, Peter, van der Jagt, Mathieu, Jain, Sonia, Jain, Swati, Jiang, Ji-Yao, Kent, Hope, Kolias, Angelos, Kompanje, Erwin, Lecky, Fiona, Lingsma, Hester, Maegele, Marc, Majdan, Marek, Markowitz, Amy, McCrea, Michael, Meyfroidt, Geert, Mikolić, Ana, Mondello, Stefania, Yuh, Esther, Zeiler, Frederick, Zeldovich, Marina, Zemek, Roger, Ferguson, Adam, and Mukherjee, Pratik
Subjects: Humans, Brain Injuries, Traumatic, Cost of Illness, Violence, Sports
Abstract: Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research. In LMICs, the occurrence of TBI is driven by road traffic incidents, often involving vulnerable road users such as motorcyclists and pedestrians. In HICs, most TBI is caused by falls, particularly in older people (aged ≥65 years), who often have comorbidities. Risk factors such as frailty and alcohol misuse provide opportunities for targeted prevention actions. Little evidence exists to inform treatment of older patients, who have been commonly excluded from past clinical trials—consequently, appropriate evidence is urgently required. Although increasing age is associated with worse outcomes from TBI, age should not dictate limitations in therapy. However, patients injured by low-energy falls (who are mostly older people) are about 50% less likely to receive critical care or emergency interventions, compared with those injured by high-energy mechanisms, such as road traffic incidents. Mild TBI, defined as a Glasgow Coma sum score of 13–15, comprises most of the TBI cases (over 90%) presenting to hospital. Around 50% of adult patients with mild TBI presenting to hospital do not recover to pre-TBI levels of health by 6 months after their injury. Fewer than 10% of patients discharged after presenting to an emergency department for TBI in Europe currently receive follow-up. Structured follow-up after mild TBI should be considered good practice, and urgent research is needed to identify which patients with mild TBI are at risk for incomplete recovery. The selection of patients for CT is an important triage decision in mild TBI since it allows early identification of lesions that can trigger hospital admission or life-saving surgery. Current decision making for deciding on CT is inefficient, with 90–95% of scanned patients showing no intracranial injury but being subjected to radiation risks. InTBIR studies have shown that measurement of blood-based biomarkers adds value to previously proposed clinical decision rules, holding the potential to improve efficiency while reducing radiation exposure. Increased concentrations of biomarkers in the blood of patients with a normal presentation CT scan suggest structural brain damage, which is seen on MR scanning in up to 30% of patients with mild TBI. Advanced MRI, including diffusion tensor imaging and volumetric analyses, can identify additional injuries not detectable by visual inspection of standard clinical MR images. Thus, the absence of CT abnormalities does not exclude structural damage—an observation relevant to litigation procedures, to management of mild TBI, and when CT scans are insufficient to explain the severity of the clinical condition. Although blood-based protein biomarkers have been shown to have important roles in the evaluation of TBI, most available assays are for research use only. To date, there is only one vendor of such assays with regulatory clearance in Europe and the USA with an indication to rule out the need for CT imaging for patients with suspected TBI. Regulatory clearance is provided for a combination of biomarkers, although evidence is accumulating that a single biomarker can perform as well as a combination. Additional biomarkers and more clinical-use platforms are on the horizon, but cross-platform harmonisation of results is needed. Health-care efficiency would benefit from diversity in providers. In the intensive care setting, automated analysis of blood pressure and intracranial pressure with calculation of derived parameters can help individualise management of TBI. Interest in the identification of subgroups of patients who might benefit more from some specific therapeutic approaches than others represents a welcome shift towards precision medicine. Comparative-effectiveness research to identify best practice has delivered on expectations for providing evidence in support of best practices, both in adult and paediatric patients with TBI. Progress has also been made in improving outcome assessment after TBI. Key instruments have been translated into up to 20 languages and linguistically validated, and are now internationally available for clinical and research use. TBI affects multiple domains of functioning, and outcomes are affected by personal characteristics and life-course events, consistent with a multifactorial bio-psycho-socio-ecological model of TBI, as presented in the US National Academies of Sciences, Engineering, and Medicine (NASEM) 2022 report. Multidimensional assessment is desirable and might be best based on measurement of global functional impairment. More work is required to develop and implement recommendations for multidimensional assessment. Prediction of outcome is relevant to patients and their families, and can facilitate the benchmarking of quality of care. InTBIR studies have identified new building blocks (eg, blood biomarkers and quantitative CT analysis) to refine existing prognostic models. Further improvement in prognostication could come from MRI, genetics, and the integration of dynamic changes in patient status after presentation. Neurotrauma researchers traditionally seek translation of their research findings through publications, clinical guidelines, and industry collaborations. However, to effectively impact clinical care and outcome, interactions are also needed with research funders, regulators, and policy makers, and partnership with patient organisations. Such interactions are increasingly taking place, with exemplars including interactions with the All Party Parliamentary Group on Acquired Brain Injury in the UK, the production of the NASEM report in the USA, and interactions with the US Food and Drug Administration. More interactions should be encouraged, and future discussions with regulators should include debates around consent from patients with acute mental incapacity and data sharing. Data sharing is strongly advocated by funding agencies. From January 2023, the US National Institutes of Health will require upload of research data into public repositories, but the EU requires data controllers to safeguard data security and privacy regulation. The tension between open data-sharing and adherence to privacy regulation could be resolved by cross-dataset analyses on federated platforms, with the data remaining at their original safe location. Tools already exist for conventional statistical analyses on federated platforms, however federated machine learning requires further development. Support for further development of federated platforms, and neuroinformatics more generally, should be a priority. This update to the 2017 Commission presents new insights and challenges across a range of topics around TBI: epidemiology and prevention (section 1); system of care (section 2); clinical management (section 3); characterisation of TBI (section 4); outcome assessment (section 5); prognosis (Section 6); and new directions for acquiring and implementing evidence (section 7). Table 1 summarises key messages from this Commission and proposes recommendations for the way forward to advance research and clinical management of TBI.
Published: 2022

20. The Greek economic crisis and its impact on the national health system

Author: Karamanis Kostas, Kolias Georgios, Triarchi Eirini, and Malescou Christina
Subjects: national health system (nhs), healthcare expenditures (hce), economic crisis, government, greece., Business, HF5001-6182
Abstract: The Greek economic crisis produced severe economic and social outcomes. A massive rescue package was conditional on implementing a Memorandum of Economic and Financial Policies agreed upon between the Greek government and the EU, European Central Bank, and the International Monetary Fund. The extremely austere fiscal consolidation and the structural reforms accompanying the Greek Economic Adjustment Programmes reduced the country’s GDP. Implementing the austerity policies on the Greek National Health System, which was already facing structural problems, reduced the quality and availability of public health care services. This paper investigates the impact of the GDP change on public healthcare expenditures (HCE) from 2000 to 2018. The empirical analysis reveals a statistically significant positive correlation between the GDP per capita and public healthcare expenditure (HCE) from 2000 to 2014 while the effect of GDP on HCE after the 2015 remains unchanged. This paper contributes to the field’s literature since it determines the impact of GDP on public HCE, specifically matched with empirical results to derive conclusive answers.
Published: 2024
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21. Promotion of a neurosurgical academic journal on social media: a 1-year experience

Author: Sorba, Elena L., Staartjes, Victor E., Serra, Carlo, Regli, Luca, Alamri, Alex, Rabiei, Katrin, Lippa, Laura, Karekezi, Claire, Kolias, Angelos, and Mathiesen, Tiit
Published: 2023
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22. Reported baseline variables in transsphenoidal surgery for pituitary adenoma over a 30 year period: a systematic review

Author: Layard Horsfall, Hugo, Loh, Ryan T. S., Venkatesh, Ashwin, Khan, Danyal Z., Lawrence, Alistair, Jayapalan, Ronie, Koulouri, Olympia, Borsetto, Daniele, Santarius, Thomas, Gurnell, Mark, Dorward, Neil, Mannion, Richard, Marcus, Hani J., and Kolias, Angelos G.
Published: 2023
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23. Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study

Author: van Erp, Inge A. M., van Essen, Thomas A., Lingsma, Hester, Pisica, Dana, Singh, Ranjit D., van Dijck, Jeroen T. J. M., Volovici, Victor, Kolias, Angelos, Peppel, Lianne D., Heijenbrok-Kal, Majanka, Ribbers, Gerard M., Menon, David K., Hutchinson, Peter, Depreitere, Bart, Steyerberg, Ewout W., Maas, Andrew I. R., de Ruiter, Godard C. W., and Peul, Wilco C.
Published: 2023
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24. Race and Affect in Early Modern English Literature ed. by Carol Mejia LaPerle (review)

Author: Kolias, Christina
Published: 2023
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25. Machine Learning Models for the Classification of Histopathological Images of Colorectal Cancer

Author: Nektarios Georgiou, Pavlos Kolias, and Ioanna Chouvarda
Subjects: machine learning, image classification, colorectal cancer, histopathological images, Technology, Engineering (General). Civil engineering (General), TA1-2040, Biology (General), QH301-705.5, Physics, QC1-999, Chemistry, QD1-999
Abstract: The aim of this study was to explore the application of computational models for the analysis of histopathological images in the context of colon cancer. A comprehensive dataset of colon cancer images annotated into eight distinct categories based on their representation of cancerous cell portions was used. The primary objective was to employ various image classification algorithms to assess their efficacy in the context of cancer classification. Additionally, this study investigated the use of feature extraction techniques to derive meaningful data from the images, contributing to a more nuanced understanding of cancerous tissues, comparing the performance of different image classification algorithms in the context of colon cancer image analysis. The findings of this research suggested that XGboost provides the highest accuracy (89.79%) and could contribute to the growing body of knowledge in computational pathology. Other algorithms, such as the random forest, SVM, and CNN, also provided satisfactory results, offering insights into the effectiveness of image classification algorithms in distinguishing between different categories of cancerous cells. This work holds implications for the development of more accurate and efficient tools, underscoring the potential of computational models in enhancing the analysis of histopathological images and improving diagnostic capabilities in cancer research.
Published: 2024
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26. Long-term outcome of traumatic brain injury patients with initial GCS of 3–5

Author: Rubén David dos Reis Zuniga, Rita de Cássia Almeida Vieira, Davi Jorge Fontoura Solla, Daniel Agustín Godoy, Angelos Kolias, Robson Luis Oliveira de Amorim, Almir Ferreira de Andrade, Manoel Jacobsen Teixeira, and Wellingson Silva Paiva
Subjects: Craniocerebral trauma, Critical care, Prognosis, Outcome, Long-term care, Glasgow outcome scale, Surgery, RD1-811, Neurology. Diseases of the nervous system, RC346-429
Published: 2024
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27. False claims of equivalence in the neurosurgical trauma literature: prevalence and associated factors—a systematic review protocol

Author: Angelos G Kolias, Davi Jorge Fontoura Solla, Wellingson S Paiva, João Vitor Miranda Porto Oliveira, and André Luiz Freitas Oliveira Júnior
Subjects: Medicine
Abstract: Introduction Research quality within the neurosurgical field remains suboptimal. Therefore, many studies published in the neurosurgical literature lack enough statistical power to establish the presence or absence of clinically important differences between treatment arms. The field of neurotrauma deals with additional challenges, with fewer financial incentives and restricted resources in low-income and middle-income countries with the highest burden of neurotrauma diseases. In this systematic review, we aim to estimate the prevalence of false claims of equivalence in the neurosurgical trauma literature and identify its predictive factors.Methods and analysis The Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations were followed. Randomised clinical trials that enrolled only traumatic brain injury patients and investigated any type of intervention (surgical or non-surgical) will be eligible for inclusion. The MEDLINE/PubMed database will be searched for articles in English published from January 1960 to July 2020 in 15 top-ranked journals. A false claim of equivalence will be identified by insufficient power to detect a clinically meaningful effect: for categorical outcomes, a difference of at least 25% and 50%, and for continuous outcomes, a Cohen’s d of at least 0.5 and 0.8. Using the number of patients in each treatment arm and the minimum effect sizes to be detected, the power of each study will be calculated with the assumption of a two-tailed alpha that equals 0.05. Standardised differences between the groups with and without a false claim of equivalence will be calculated, and the variables with a standardised difference equal or above 0.2 and 0.5 will be considered weakly and strongly associated with false claims of equivalence, respectively. The data analysis will be blinded to the authors and institutions of the studies.Ethics and dissemination This study will not involve primary data collection. Therefore, formal ethical approval will not be required. The final systematic review will be published in a peer-reviewed journal and presented at appropriate conferences.
Published: 2024
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28. Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data

Author: Mulugeta Semework, Tsegazeab Laeke, Abenezer Tirsit Aklilu, Abraham Tadele, Yordanos Ashagre, Peter Teklewold, Angelos G. Kolias, Peter Hutchinson, Abel Balcha, Dagnachew Yohannes, and Getaw Worku Hassen
Subjects: traumatic brain injury, TBI assessment, brain injury assessment, TBI tests, LMIC brain injury, Neurology. Diseases of the nervous system, RC346-429
Abstract: IntroductionTraumatic brain injury (TBI) is one of the leading causes of all injury-related deaths and disabilities in the world, especially in low to middle-income countries (LMICs) which also suffer from lower levels of funding for all levels of the health care system for patients suffering from TBI. These patients do not generally get comprehensive diagnostic workup, monitoring, or treatment, and return to work too quickly, often with undiagnosed post-traumatic deficits which in turn can lead to subsequent incidents of physical harm.MethodsHere, we share methods and results from our research project to establish innovative, simple, and scientifically based practices that dramatically leverage technology and validated testing strategies to identify post-TBI deficits quickly and accurately, to circumvent economic realities on the ground in LMICs. We utilized paper tests such as the Montreal cognitive assessment (MoCA), line-bisection, and Bell’s test. Furthermore, we combined modifications of neuroscience computer tasks to aid in assessing peripheral vision, memory, and analytical accuracies. Data from seventy-one subjects (51 patients and 20 controls, 15 females and 56 males) from 4 hospitals in Ethiopia are presented. The traumatic brain injury group consists of 17 mild, 28 moderate, and 8 severe patients (based on the initial Glasgow Comma Score). Controls are age and education-matched subjects (no known history of TBI, brain lesions, or spatial neglect symptoms).ResultsWe found these neurophysiological methods can: 1) be implemented in LMICs and 2) test impairments caused by TBI, which generally affect brain processing speed, memory, and both executive and cognitive controls.DiscussionThe main findings indicate that these examinations can identify several deficits, especially the MoCA test. These tests show great promise to assist in the evaluation of TBI patients and support the establishment of dedicated rehabilitation centers. Our next steps will be expansion of the cohort size and application of the tests to other settings.
Published: 2024
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29. Decompressive craniectomy to cranioplasty: a retrospective observational study using Hospital Episode Statistics in England

Author: A Helmy, Angelos G Kolias, Peter J Hutchinson, Michael Martin, J M Harris, T Korhonen, Harry Mee, F Anwar, A J Wahba, G Whiting, E Viaroli, and I Timofeev
Subjects: Medical technology, R855-855.5, Surgery, RD1-811
Abstract: Objectives To investigate the longitudinal trends of decompressive craniectomy (DC) following traumatic brain injury (TBI) or stroke and explore whether the timing of cranial reconstruction affected revision or removal rates using Hospital Episode Statistics (HES) between 2014 and 2019.Design Retrospective observational cohort study using HES. The time frame definitions mirror those often used in clinical practice.Setting HES data from neurosurgical centres in England.Participants HES data related to decompressive craniectomy procedures and cranioplasty following TBI or stroke between 2014 and 2019.Main outcome measures The primary outcome was the timing and rate of revision/removal compared with cranioplasty within
Published: 2024
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30. Cost-effectiveness of craniotomy versus decompressive craniectomy for UK patients with traumatic acute subdural haematoma

Author: Emma Toman, David K Menon, Antonio Belli, Sridevi Nagarajan, Julie Woodfield, Ruichong Ma, Jason J Chang, Jonathan Cook, Mark Kotter, Vin Shen Ban, Martin Smith, John D Pickard, Diederik Bulters, Giles Critchley, Damian Holliman, Nicole Keong, Andrew King, Catherine McMahon, Carole Turner, Peter Whitfield, Mark Wilson, Melvin Stone, Paul Brennan, David Turner, Garry Barton, Rasheed Zakaria, Angelos G Kolias, Simon Shaw, Sean Christie, Dmitri Shastin, Allison Hirst, Soumya Mukherjee, Gareth Roberts, Simon Thomson, Peter J Hutchinson, Alexis Joannides, Emanuel Cirstea, Ashish Bindra, Vairavan Narayanan, David Menon, Francesca Hill, Ashwin Kumaria, Franco Servadei, Rhys Thomas, Midhun Mohan, Silvia Tarantino, Ioana Moldovan, Sara Venturini, Tariq Khan, Marianne Hare, Louise Young, Joan Grieve, Ardalan Zolnourian, Paula Carroll, Diederik Oliver Bulters, Mathew Guilfoyle, Lisa Julien, Barbara Gregson, Martin Hunn, Richard Nelson, Stuart Smith, Shahid Khan, András Büki, Deepak Gupta, Christos Tolias, David A Turner, Christopher Madden, Paul Johnston, Peter John Hutchinson, Patrick Holton, Panagiota Gkolia, Nicola Owen, Kesava Reddy, Hani Marcus, Ibrahim Jalloh, Shabin Joshi, Ian Anderson, Himanshu Shekhar, Daniel Holsgrove, Erin Lewis, Tracey Moore, Marios C Papadopoulos, Paula Kareclas, Peter Kirkpatrick, Laura Parker, Martina Stippler, Sarah Pyne, Peter J Kirkpatrick, James Piercy, Neil Davidson, Prasanna Epaliyanage, Barbara A Gregson, Christopher Uff, Malik Zaben, Charlotte Eglinton, Linetty Makawa, Jane Perez, Louise Harrison, Mutwakil Abdulla, Garry R Barton, Mathew Joseph, Anthony Bell, Sarah Trippier, Michael Canty, Jonathan Pollock, Manjul Tripathi, Harry Mee, Ivan Timofeev, Ellie Edlmann, Nadia Scantlebury, Joseph Frantzias, Yahia Al-Tamimi, Kismet Hossain-Ibrahim, Ciaran Hill, Elisa Visentin, Sonia Raj, Ioannis Fouyas, Siobhan Kearney, Karen Caldwell, Tamara Tajsic, Belinda Gunning, Emma Clarkson, Manjunath Prasad, Mary Kambafwile, Tim Lawrence, Emily Galea, Sebastian Ille, Hadie Adams, Shumaila Hasan, Matthew G Stovell, Edoardo Viaroli, Adel E Helmy, Ivan S Timofeev, Kirsty Grieve, Liz Corteen, Janet Corn, Mohammad Naushahi, Richard Mair, Kamila Walker, Selma Tülü, Chipo Chitsenega, Geetha Boyapati, Muhammad Bhatti, Natalia Ermalai, Joseph Merola Liudmila, Laurence Glanz, Lani Patterson, Colin Bergin, Maximina Ventura, Laura Ortiz-Ruiz de Gordoa, Husam Georges, Sam Jeffrey, Natasha Wilmhurst, Philip Kane, Geraint Sunderland, John Kitchen, Mathew JosephMathew JosephGallagher, Sonia Fernandez Lopez, Andrea D’Mello, Jo-Anna Conyngham, Miriam Taylor, Charlaine Reeve, Vasileios Arzoglou, Arif Zafar, Efosa Ukponmwan, Anastasios Giamouriadis, Adam Wahba, Patrick Easton, Rose Clegg, Grace Cole, Louise Finlay, Alex Leggate, Terrie-Louise Cromie, Javier Magan Ventura, Ruth Womer, Beverley Fulkner, Geraldine Ward, Kareen Damley, Emma Fleming, Roddy O’Kane, Indira Devi Bhagavatula, Dhananjaya Ishwar Bhat, Dhaval Prem Shukla, Kanti Konar, Nagesh Shanhag, Vaishali Nl Valluri, Manoj Kumar Tewari, Kaveri Sharma, Christine Lock, Chen Min Wei, Julian Han, Janell Kwok, Nicolas Kon, Kam King, Emmalin Nelton, Louis Anthony Whitworth, Sonja Stutzman, Caryn Harper, Alice Salazar, Rocco Armonda, George B Moses, Patricia Tanjucto, Jamie Ullman, Orseola Arapi, Betsy Moclair, Nrupen Baxi, John Adair Prall, Meghan Baldwin, Jamie Jones, Clare Gallagher, Ish Bains, Leodante Da Costa, Fahad Alkherayf, Rafael Ochoa Sanchez, Kostas Fountas, Thanasis Paschalis, Sandro Krieg, Maria Luisa, Gandia Gomez, Alfonso Legares, Ana Maria Castaño Leon, Gábor Lenzsér, Mukhtar Khan, Massimo Tomei, Ronie Romelean Jayapalan, Sarah C Pyne, A David Mendelow, Christopher Cowie, Carol Davis-Wilkie, Tapiwa Tungamirai, Kerstin Wolf, Natalia Igosheva, Alicia Gore, Michele Jillings, Christopher Bushell, and Peter McCabe
Subjects: Medicine
Abstract: Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH).Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial.Setting UK secondary care.Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists.Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE.Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant).Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076).Trial registration number ISRCTN87370545.
Published: 2024
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31. An international, prospective observational study on traumatic brain injury epidemiology study protocol: GEO-TBI: Incidence [version 2; peer review: 2 approved]

Author: David Clark, Tommi Kalevi Korhonen, Sara Venturini, Sujit Gnanakumar, Thomas Bashford, Midhun Mohan, Indira Devi Bhagavatula, Ronnie Baticulon, Rocío Fernández-Méndez, Ignatius Esene, Deepak Gupta, Anthony Figaji, Tsegazeab Laeke, Tariq Khan, David Menon, Michael Martin, Kee B. Park, Wellingson Paiva, Andres M. Rubiano, Jogi V. Pattisapu, Hamisi Shabani, Vijaya Sekhar, Davi Solla, Kachinga Sichizya, Manjul Tripathi, Abenezer Tirsit, Bart Depreitere, Carole Turner, Laura Lippa, Corrado Iaccarino, Gail Rosseau, Andrew Reisner, Rikin Trivedi, Franco Servadei, Angelos Kolias, Vicknes Waran, Peter Hutchinson, and Alexis Joannides
Subjects: epidemiology, global, registry, traumatic brain injury, eng, Medicine
Abstract: Background The epidemiology of traumatic brain injury (TBI) is unclear – it is estimated to affect 27–69 million individuals yearly with the bulk of the TBI burden in low-to-middle income countries (LMICs). Research has highlighted significant between-hospital variability in TBI outcomes following emergency surgery, but the overall incidence and epidemiology of TBI remains unclear. To address this need, we established the Global Epidemiology and Outcomes following Traumatic Brain Injury (GEO-TBI) registry, enabling recording of all TBI cases requiring admission irrespective of surgical treatment. Objective The GEO-TBI: Incidence study aims to describe TBI epidemiology and outcomes according to development indices, and to highlight best practices to facilitate further comparative research. Design Multi-centre, international, registry-based, prospective cohort study. Subjects Any unit managing TBI and participating in the GEO-TBI registry will be eligible to join the study. Each unit will select a 90-day study period. All TBI patients meeting the registry inclusion criteria (neurosurgical/ICU admission or neurosurgical operation) during the selected study period will be included in the GEO-TBI: Incidence. Methods All units will form a study team, that will gain local approval, identify eligible patients and input data. Data will be collected via the secure registry platform and validated after collection. Identifiers may be collected if required for local utility in accordance with the GEO-TBI protocol. Data Data related to initial presentation, interventions and short-term outcomes will be collected in line with the GEO-TBI core dataset, developed following consensus from an iterative survey and feedback process. Patient demographics, injury details, timing and nature of interventions and post-injury care will be collected alongside associated complications. The primary outcome measures for the study will be the Glasgow Outcome at Discharge Scale (GODS) and 14-day mortality. Secondary outcome measures will be mortality and extended Glasgow Outcome Scale (GOSE) at the most recent follow-up timepoint.
Published: 2024
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32. Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study

Author: Alvaro Yanez Touzet, Tatiana Houhou, Zerina Rahic, Angelos Kolias, Stefan Yordanov, David B Anderson, Ilya Laufer, Maggie Li, Gordan Grahovac, Mark RN Kotter, and Benjamin M Davies
Subjects: Medicine
Abstract: BackgroundDeveloping new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. ObjectiveThe aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. MethodsA prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. ResultsIn total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. ConclusionsThe criteria from COSMIN provide “very good” quality evidence of the reliability of the MoveMed tests in an adult population living with DCM.
Published: 2024
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33. Research priorities for the management of major trauma: an international priority setting partnership with the James Lind Alliance

Author: Akshay Patel, Ceri Battle, Naomi Davis, Gordon Fuller, Michael Wilson, Angelos Kolias, Catherine Hilton, Fiona Lecky, Julia Williams, Caroline Leech, Steve Bell, Louise Johnson, Karim Brohi, Lauren Exell, Claire Jackson, Ross Davenport, Rachel Jenner, Elaine Cole, Robert Hirst, Philip Braude, Jonathan Gower, Daphne van Embden, Ian Greaves, Carl Smith, Justine Theaker, Christopher Patrick Bretherton, Shan Martin, Xavier Luke Griffin, Sarah Hendrickson, Edward Caruana, Sarah Norris, Hamez Gacaferi, Scott Johnston, Daniel Axelrod, Heather Vallier, David J Stockton, Maritz Laubscher, Melissa Webb, Sithombo Maqungo, Caroline James, Carrol Lamouline, Russell Neighbour, Yesmin Begum, Jacqueline Robson, Mary Breslin, Rayner Maayen, and Spencer Wade
Subjects: Medicine
Abstract: Objective The objective of this study is to determine research priorities for the management of major trauma, representing the shared priorities of patients, their families, carers and healthcare professionals.Design/setting An international research priority-setting partnership.Participants People who have experienced major trauma, their carers and relatives, and healthcare professionals involved in treating patients after major trauma. The scope included chest, abdominal and pelvic injuries as well as major bleeding, multiple injuries and those that threaten life or limb.Methods A multiphase priority-setting exercise was conducted in partnership with the James Lind Alliance over 24 months (November 2021–October 2023). An international survey asked respondents to submit their research uncertainties which were then combined into several indicative questions. The existing evidence was searched to ensure that the questions had not already been sufficiently answered. A second international survey asked respondents to prioritise the research questions. A final shortlist of 19 questions was taken to a stakeholder workshop, where consensus was reached on the top 10 priorities.Results A total of 1572 uncertainties, submitted by 417 respondents (including 132 patients and carers), were received during the initial survey. These were refined into 53 unique indicative questions, of which all 53 were judged to be true uncertainties after reviewing the existing evidence. 373 people (including 115 patients and carers) responded to the interim prioritisation survey and 19 questions were taken to a final consensus workshop between patients, carers and healthcare professionals. At the final workshop, a consensus was reached for the ranking of the top 10 questions.Conclusions The top 10 research priorities for major trauma include patient-centred questions regarding pain relief and prehospital management, multidisciplinary working, novel technologies, rehabilitation and holistic support. These shared priorities will now be used to guide funders and teams wishing to research major trauma around the globe.
Published: 2024
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34. The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Author: Adamina, Michel, Ademuyiwa, Adesoji, Adisa, Adewale, Bhangu, Aneel A, Bravo, Ana Minaya, Cunha, Miguel F, Emile, Sameh, Ghosh, Dhruva, Glasbey, James C, Harris, Benjamin, Keller, Debby, Lawday, Samuel, Lederhuber, Hans, Leventoglu, Sezai, Li, Elizabeth, Modolo, Maria Marta, Mittal, Rohin, Mohan, Helen M, Nepogodiev, Dmitri, Parreño‐Sacdalan, Marie Dione, Pata, Francesco, Pockney, Peter, Rutegård, Martin, Smart, Neil, Varghese, Chris, Siaw‐Acheampong, Kwabena, Benson, Ruth A, Bywater, Edward, Chaudhry, Daoud, Dawson, Brett E, Evans, Jonathan P, Gujjuri, Rohan R, Heritage, Emily, Jones, Conor S, Kamarajah, Sivesh K, Khatri, Chetan, Khaw, Rachel A, Keatley, James M, Knight, Andrew, Mann, Harvinder S, Marson, Ella J, McLean, Kenneth A, Mckay, Siobhan C, Mills, Emily C, Pellino, Gianluca, Picciochi, Maria, Taylor, Elliott H, Tiwari, Abhinav, Trout, Isobel M, Venn, Mary L, Wilkin, Richard JW, Bhangu, Aneel, Smart, Neil J, Minaya‐Bravo, Ana, Gallo, Gaetano, Moug, Susan, Di Saverio, Salomone, Vallance, Abigail, Vimalchandran, Dale, Griffiths, Ewen A, Evans, Richard PT, Townend, Philip, Roberts, Keith, McKay, Siobhan, Isaac, John, Satoi, Sohei, Edwards, John, Coonar, Aman S, Marchbank, Adrian, Caruana, Edward J, Layton, Georgia R, Patel, Akshay, Brunelli, Alessandro, Ford, Samuel, Desai, Anant, Gronchi, Alessandro, Fiore, Marco, Almond, Max, Tirotta, Fabio, Dumitra, Sinziana, Kolias, Angelos, Price, Stephen J, Fountain, Daniel M, Jenkinson, Michael D, Hutchinson, Peter, Marcus, Hani J, Piper, Rory J, and Lippa, Laura
Subjects: Digestive Diseases, Clinical Research, Clinical Trials and Supportive Activities, Colo-Rectal Cancer, Cancer, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, colorectal cancer, coronavirus, COVID-19, SARS-CoV-2, surgery, surgical delay, COVIDSurg Collaborative, Clinical Sciences, Surgery
Abstract: AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P
Published: 2022

35. Vulnerabilities and Attacks Against Industrial Control Systems and Critical Infrastructures

Author: Makrakis, Georgios Michail, Kolias, Constantinos, Kambourakis, Georgios, Rieger, Craig, and Benjamin, Jacob
Subjects: Computer Science - Cryptography and Security
Abstract: Critical infrastructures (CI) and industrial organizations aggressively move towards integrating elements of modern Information Technology (IT) into their monolithic Operational Technology (OT) architectures. Yet, as OT systems progressively become more and more interconnected, they silently have turned into alluring targets for diverse groups of adversaries. Meanwhile, the inherent complexity of these systems, along with their advanced-in-age nature, prevents defenders from fully applying contemporary security controls in a timely manner. Forsooth, the combination of these hindering factors has led to some of the most severe cybersecurity incidents of the past years. This work contributes a full-fledged and up-to-date survey of the most prominent threats against Industrial Control Systems (ICS) along with the communication protocols and devices adopted in these environments. Our study highlights that threats against CI follow an upward spiral due to the mushrooming of commodity tools and techniques that can facilitate either the early or late stages of attacks. Furthermore, our survey exposes that existing vulnerabilities in the design and implementation of several of the OT-specific network protocols may easily grant adversaries the ability to decisively impact physical processes. We provide a categorization of such threats and the corresponding vulnerabilities based on various criteria. As far as we are aware, this is the first time an exhaustive and detailed survey of this kind is attempted.
Published: 2021
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36. Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study

Author: Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Anke, Audny, Antoni, Anna, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Barzó, Pál, Beauvais, Romuald, Beer, Ronny, Bellander, Bo-Michael, Belli, Antonio, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Blaabjerg, Morten, Bragge, Peter, Brazinova, Alexandra, Brinck, Vibeke, Brooker, Joanne, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Carbonara, Marco, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Coburn, Mark Steven, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Čović, Amra, Curry, Nicola, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, Dawes, Helen, De Keyser, Véronique, Degos, Vincent, Della Corte, Francesco, Boogert, Hugo den, Depreitere, Bart, Đilvesi, Đula, Dixit, Abhishek, Donoghue, Emma, Dreier, Jens, Dulière, Guy-Loup, Ercole, Ari, Esser, Patrick, Ezer, Erzsébet, Fabricius, Martin, Feigin, Valery L., Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Gagliardo, Pablo, Galanaud, Damien, Gantner, Dashiell, Gao, Guoyi, George, Pradeep, Ghuysen, Alexandre, Giga, Lelde, Glocker, Ben, Golubović, Jagoš, Gomez, Pedro A., Gratz, Johannes, Gravesteijn, Benjamin, Grossi, Francesca, Gruen, Russell L., Gupta, Deepak, Haagsma, Juanita A., Haitsma, Iain, Helbok, Raimund, Helseth, Eirik, Horton, Lindsay, Huijben, Jilske, Hutchinson, Peter J., Jacobs, Bram, Jankowski, Stefan, Jarrett, Mike, Jiang, Ji-yao, Johnson, Faye, Jones, Kelly, Karan, Mladen, Kolias, Angelos G., Kompanje, Erwin, Kondziella, Daniel, Kornaropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Lagares, Alfonso, Lanyon, Linda, Laureys, Steven, Lecky, Fiona, Ledoux, Didier, Lefering, Rolf, Legrand, Valerie, Lejeune, Aurelie, Levi, Leon, Lightfoot, Roger, Lingsma, Hester, Maas, Andrew I.R., Maegele, Marc, Majdan, Marek, Manara, Alex, Manley, Geoffrey, Maréchal, Hugues, Martino, Costanza, Mattern, Julia, McMahon, Catherine, Melegh, Béla, Menon, David, Menovsky, Tomas, Mikolic, Ana, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Nair, Nandesh, Negru, Ancuta, Nelson, David, Newcombe, Virginia, Nieboer, Daan, Nyirádi, József, Oresic, Matej, Ortolano, Fabrizio, Otesile, Olubukola, Palotie, Aarno, Parizel, Paul M., Payen, Jean-François, Perera, Natascha, Perlbarg, Vincent, Persona, Paolo, Peul, Wilco, Piippo-Karjalainen, Anna, Pirinen, Matti, Pisica, Dana, Ples, Horia, Polinder, Suzanne, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Rădoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rambadagalla, Malinka, Rehorčíková, Veronika, Helmrich, Isabel Retel, Rhodes, Jonathan, Richardson, Sylvia, Richter, Sophie, Ripatti, Samuli, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosand, Jonathan, Rosenfeld, Jeffrey, Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Rueckert, Daniel, Rusnák, Martin, Sahuquillo, Juan, Sakowitz, Oliver, Sanchez-Porras, Renan, Sandor, Janos, Schäfer, Nadine, Schmidt, Silke, Schoechl, Herbert, Schoonman, Guus, Schou, Rico Frederik, Schwendenwein, Elisabeth, Sewalt, Charlie, Skandsen, Toril, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stanworth, Simon, Kowark, Ana, Stevens, Robert, Stewart, William, Steyerberg, Ewout W., Stocchetti, Nino, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Taylor, Mark Steven, Ao, Braden Te, Tenovuo, Olli, Theadom, Alice, Thomas, Matt, Tibboel, Dick, Timmers, Marjolijn, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Unterberg, Andreas, Vajkoczy, Peter, Valeinis, Egils, Vallance, Shirley, Vámos, Zoltán, Van der Jagt, Mathieu, van der Naalt, Joukje, Van der Steen, Gregory, van Dijck, Jeroen T.J.M., van Essen, Thomas A., Van Hecke, Wim, van Heugten, Caroline, Van Praag, Dominique, Van Veen, Ernest, van Wijk, Roel, Vyvere, Thijs Vande, Vargiolu, Alessia, Vega, Emmanuel, Velt, Kimberley, Verheyden, Jan, Vespa, Paul M., Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, von Steinbüchel, Nicole, Voormolen, Daphne, Vulekovic, Petar, Wang, Kevin K.W., Wiegers, Eveline, Williams, Guy, Wilson, Lindsay, Winzeck, Stefan, Wolf, Stefan, Yang, Zhihui, Ylén, Peter, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Zoerle, Tommaso, van Erp, Inge A.M., Lingsma, Hester F., Pisică, Dana, Yue, John K., Singh, Ranjit D., Kolias, Angelos, Peppel, Lianne D., Heijenbrok-Kal, Majanka, Ribbers, Gerard M., Menon, David K., Hutchinson, Peter J.A., Manley, Geoffrey T., de Ruiter, Godard C.W., and Peul, Wilco C.
Published: 2023
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37. Black-Box IoT: Authentication and Distributed Storage of IoT Data from Constrained Sensors

Author: Chatzigiannis, Panagiotis, Baldimtsi, Foteini, Kolias, Constantinos, and Stavrou, Angelos
Subjects: Computer Science - Cryptography and Security
Abstract: We propose Black-Box IoT (BBox-IoT), a new ultra-lightweight black-box system for authenticating and storing IoT data. BBox-IoT is tailored for deployment on IoT devices (including low-Size Weight and Power sensors) which are extremely constrained in terms of computation, storage, and power. By utilizing core Blockchain principles, we ensure that the collected data is immutable and tamper-proof while preserving data provenance and non-repudiation. To realize BBox-IoT, we designed and implemented a novel chain-based hash signature scheme which only requires hashing operations and removes all synchronicity dependencies between signer and verifier. Our approach enables low-SWaP devices to authenticate removing reliance on clock synchronization. Our evaluation results show that BBox-IoT is practical in Industrial Internet of Things (IIoT) environments: even devices equipped with 16MHz micro-controllers and 2KB memory can broadcast their collected data without requiring heavy cryptographic operations or synchronicity assumptions. Finally, when compared to industry standard ECDSA, our approach is two and three orders of magnitude faster for signing and verification operations respectively. Thus, we are able to increase the total number of signing operations by more than 5000% for the same amount of power., Comment: To appear in IoTDI2021
Published: 2021

38. Detecting lateral movement: A systematic survey

Author: Smiliotopoulos, Christos, Kambourakis, Georgios, and Kolias, Constantinos
Published: 2024
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39. Reducing the Gap in Neurosurgical Education in LMICs: A Report of a Non-Profit Educational Program

Author: Menna, Grazia, Kolias, Angelos, Esene, Ignatius N., Barthélemy, Ernest J., Hoz, Samer, Laeke, Tsegazeab, Veiga Silva, Ana Cristina, Longo-Calderón, Gabriel Mauricio, Baticulon, Ronnie E., Zabala, Joaquín Pérez, Hassani, Fahd Derkaoui, El Abbadi, Naija, Khan, Muhammad Mukhtar, Robertson, Faith C., Thango, Nqobile, Cheresem, Beverly, Ogando-Rivas, Elizabeth, Roumy, Louis-Georges, Karekezi, Claire, Alamri, Alexander, Spena, Giannantonio, Cenzato, Marco, Servadei, Franco, Giussani, Carlo Giorgio, and Nicolosi, Federico
Published: 2024
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40. Is dementia more likely following traumatic brain injury? A systematic review

Author: Hanrahan, John Gerrard, Burford, Charlotte, Nagappan, Palani, Adegboyega, Gideon, Rajkumar, Shivani, Kolias, Angelos, Helmy, Adel, and Hutchinson, Peter John
Published: 2023
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41. Novel imaging techniques in refractory pituitary adenomas

Author: MacFarlane, J, Huynh, KA, Powlson, AS, Kolias, AG, Mannion, RJ, Scoffings, DJ, Mendichovszky, IA, Cheow, HK, Bashari, WA, Jones, J, Gillett, D, Koulouri, O, and Gurnell, Mark
Published: 2023
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42. Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery

Author: Lei Jiang, Alexandru Budu, Muhammad Shuaib Khan, Edward Goacher, Angelos Kolias, Rikin Trivedi, and Jibin Francis
Subjects: intradural spinal tumors, dural repair, cerebrospinal fluid leak, Neurology. Diseases of the nervous system, RC346-429
Abstract: Objective We aim to compare the effectiveness of dural closure techniques in preventing cerebrospinal fluid (CSF) leaks following surgery for intradural lesions and seek to identify additional factors associated with CSF leaks. Surgical management of spinal intradural lesions involves durotomy which requires a robust repair to prevent postoperative CSF leakage. The ideal method of dural closure and the efficacy of sealants has not been established in literature. Methods We performed a retrospective analysis of all intradural spinal cases performed at a tertiary spine centre from 1 April 2015 to 29 January 2020 and collected data on patient bio-profile, dural repair technique, and CSF leak rates. Multivariate analysis was performed to identify predictors for postoperative CSF leak. Results A total of 169 cases were reported during the study period. There were 15 cases in which postoperative CSF leak was reported (8.87%). Multivariate analysis demonstrated that patient age (odds ratio [OR], 0.942; 95% confidence interval [CI], 0.891–0.996), surgical indication listed in the “others” category (OR, 44.608; 95% CI, 1.706–166.290) and dural closure with suture, sealant and patch (OR, 22.235; 95% CI, 2.578–191.798) were factors associated with CSF leak. Postoperative CSF leak was associated with the risk of surgical site infection with a likelihood ratio of 8.704 (χ² (1) =14.633, p < 0.001). Conclusion Identifying predictors for CSF leaks can assist in the counselling of patients with regard to surgical risk and expected postoperative recovery.
Published: 2023
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43. A randomised, double blind, placebo-controlled trial of a two-week course of dexamethasone for adult patients with a symptomatic Chronic Subdural Haematoma (Dex-CSDH trial)

Author: Peter J Hutchinson, Ellie Edlmann, John G Hanrahan, Diederik Bulters, Ardalan Zolnourian, Patrick Holton, Nigel Suttner, Kevin Agyemang, Simon Thomson, Ian A Anderson, Yahia Al-Tamimi, Duncan Henderson, Peter Whitfield, Monica Gherle, Paul M Brennan, Annabel Allison, Eric P Thelin, Silvia Tarantino, Beatrice Pantaleo, Karen Caldwell, Carol Davis-Wilkie, Harry Mee, Elizabeth A Warburton, Garry Barton, Aswin Chari, Hani J Marcus, Sarah Pyne, Andrew T King, Antonio Belli, Phyo K Myint, Ian Wilkinson, Thomas Santarius, Carole Turner, Simon Bond, and Angelos G Kolias
Subjects: Medical technology, R855-855.5
Abstract: Background Chronic subdural haematoma is a collection of ‘old blood’ and its breakdown products in the subdural space and predominantly affects older people. Surgical evacuation remains the mainstay in the management of symptomatic cases. Objective The Dex-CSDH (DEXamethasone in Chronic SubDural Haematoma) randomised trial investigated the clinical effectiveness and cost-effectiveness of dexamethasone in patients with a symptomatic chronic subdural haematoma. Design This was a parallel, superiority, multicentre, pragmatic, randomised controlled trial. Assigned treatment was administered in a double-blind fashion. Outcome assessors were also blinded to treatment allocation. Setting Neurosurgical units in the UK. Participants Eligible participants included adults (aged ≥ 18 years) admitted to a neurosurgical unit with a symptomatic chronic subdural haematoma confirmed on cranial imaging. Interventions Participants were randomly assigned in a 1 : 1 allocation to a 2-week tapering course of dexamethasone or placebo alongside standard care. Main outcome measures The primary outcome was the Modified Rankin Scale score at 6 months dichotomised to a favourable (score of 0–3) or an unfavourable (score of 4–6) outcome. Secondary outcomes included the Modified Rankin Scale score at discharge and 3 months; number of chronic subdural haematoma-related surgical interventions undertaken during the index and subsequent admissions; Barthel Index and EuroQol 5-Dimension 5-Level utility index score reported at discharge, 3 months and 6 months; Glasgow Coma Scale score reported at discharge and 6 months; mortality at 30 days and 6 months; length of stay; discharge destination; and adverse events. An economic evaluation was also undertaken, during which the net monetary benefit was estimated at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. Results A total of 748 patients were included after randomisation: 375 were assigned to dexamethasone and 373 were assigned to placebo. The mean age of the patients was 74 years and 94% underwent evacuation of their chronic subdural haematoma during the trial period. A total of 680 patients (91%) had 6-month primary outcome data available for analysis: 339 in the placebo arm and 341 in the dexamethasone arm. On a modified intention-to-treat analysis of the full study population, there was an absolute reduction in the proportion of favourable outcomes of 6.4% (95% confidence interval 11.4% to 1.4%; p = 0.01) in the dexamethasone arm compared with the control arm at 6 months. At 3 months, the between-group difference was also in favour of placebo (−8.2%, 95% confidence interval −13.3% to −3.1%). Serious adverse events occurred in 60 out of 375 (16.0%) in the dexamethasone arm and 24 out of 373 (6.4%) in the placebo arm. The net monetary benefit of dexamethasone compared with placebo was estimated to be –£97.19. Conclusions This trial reports a higher rate of unfavourable outcomes at 6 months, and a higher rate of serious adverse events, in the dexamethasone arm than in the placebo arm. Dexamethasone was also not estimated to be cost-effective. Therefore, dexamethasone cannot be recommended for the treatment of chronic subdural haematoma in this population group. Future work and limitations A total of 94% of individuals underwent surgery, meaning that this trial does not fully define the role of dexamethasone in conservatively managed haematomas, which is a potential area for future study. Trial registration This trial is registered as ISRCTN80782810. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/15/02) and is published in full in Health Technology Assessment; Vol. 28, No. 12. See the NIHR Funding and Awards website for further award information. Plain language summary Chronic subdural haematoma is one of the most common conditions managed in adult neurosurgery and mainly affects older people. It is an ‘old’ collection of blood and blood breakdown products found on the surface of the brain. Surgery to drain the liquid collection is effective, with most patients improving. Given that inflammation is involved in the disease process, a commonly used steroid, dexamethasone, has been used alongside surgery or instead of surgery since the 1970s. However, there is no consensus or high-quality studies confirming the effectiveness of dexamethasone for the treatment of chronic subdural haematoma. This study was designed to determine the effectiveness of adding dexamethasone to the normal treatment for patients with a symptomatic chronic subdural haematoma. The benefit of adding dexamethasone was measured using a disability score called the Modified Rankin Scale, which can be divided into favourable and unfavourable outcomes. This was assessed at 6 months after entry into the study. In total, 748 adults with a symptomatic chronic subdural haematoma treated in neurosurgical units in the UK participated. Each participant had an equal chance of receiving either dexamethasone or a placebo because they were assigned randomly. Neither the patients nor the investigators knew who received dexamethasone and who received placebo. Most patients in both groups had an operation to drain the haematoma and experienced significant functional improvement at 6 months compared with their initial admission to hospital. However, patients who received dexamethasone had a lower chance than patients who received placebo of favourable recovery at 6 months. Specifically, 84% of patients who received dexamethasone had recovered well at 6 months, compared with 90% of patients who received placebo. There were more complications in the group that received dexamethasone. This trial demonstrates that adding dexamethasone to standard treatment reduced the chance of a favourable outcome compared with standard treatment alone. Therefore, this study does not support the use of dexamethasone in treating patients with a symptomatic chronic subdural haematoma. Scientific summary Background Chronic subdural haematoma (CSDH) is a common neurological disorder predominantly affecting older people, affecting approximately 5000 people aged over 65 years in the UK each year. Its incidence is increasing owing to an ageing population, alongside the growing use of antithrombotic agents. The majority of CSDHs do not cause symptoms and are managed conservatively. In those that do cause symptoms, surgical evacuation remains the mainstay of management, which achieves a good recovery in approximately 80% of patients. The remaining 10–20% of patients may suffer a recurrence, requiring further surgery. Additional and alternative measures to surgery are sought to improve outcomes in this patient group. Inflammation has been implicated in the pathogenesis of CSDHs, which suggests a role for anti-inflammatory medications, such as steroids. Therefore, steroids may serve as a useful adjunct or even alternative to surgery. However, to date, there is a lack of high-quality evidence in the form of a randomised clinical trial or meta-analysis. This trial investigates the clinical effectiveness of a steroid, dexamethasone, in patients with symptomatic CSDH. Objectives Primary objective The primary objective of the trial was to determine the clinical effectiveness of a 2-week course of dexamethasone for adult patients with a symptomatic CSDH, assessed by comparing the rate of favourable outcomes [defined as a Modified Rankin Scale (mRS) score of 0–3] at 6 months after randomisation between the treatment and the control arm. This outcome was reviewed centrally by a clinically trained investigator blinded to treatment allocation. Secondary objectives The secondary objectives were to compare the following outcomes between the treatment and the control arm of the trial: number of CSDH-related surgical interventions undertaken during the index admission number of CSDH-related surgical interventions undertaken during subsequent admissions in the follow-up period Glasgow Coma Scale (GCS) score at discharge from the neurosurgical unit (NSU) and at 6 months Modified Rankin Scale score at discharge from the NSU and at 3 months Barthel Index score at discharge from the NSU and at 3 and 6 months mortality (30 days and 6 months) EuroQol-5 Dimensions, five-level version (EQ-5D-5L), utility index at discharge from the NSU and at 3 and 6 months length of stay in the NSU discharge destination from the NSU length of stay in secondary care rates of adverse events (AEs). An economic evaluation was also undertaken to estimate the cost-effectiveness of dexamethasone compared with placebo. Tertiary objectives Postoperative recurrence is a tertiary outcome measure and is defined as a symptomatic recurrence requiring reoperation of a previously evacuated ipsilateral CSDH. Methods Trial design The Dex-CSDH (DEXamethasone in Chronic SubDural Haematoma) trial is a multicentre, pragmatic, clinical phase III, randomised, double-blind, placebo-controlled trial of a tapering 2-week course of dexamethasone in patients with a symptomatic CSDH. The pragmatic design meant that the trial ran in parallel with standard clinical care, with the only difference being the addition of the trial drug (dexamethasone) or placebo. Intervention Two-week tapering course of dexamethasone (with matching placebo as the control). Participants Participants were screened for eligibility from 23 NSUs across the UK, with the admitting neurosurgical team determining eligibility for participation. Participants were adult patients aged ≥ 18 years with a symptomatic CSDH confirmed on cranial imaging (computerised tomography or magnetic resonance imaging of the brain). The patient or their legal representative had to provide informed consent. In the absence of a legal representative, an independent healthcare professional provided authorisation for enrolment. Patients were excluded in the presence of any of the following criteria: presence of a condition for which steroids are clearly contraindicated patients who are (or within 1 month of) receiving regular oral or intravenous glucocorticoid steroids (this did not include inhaled or topical steroids, nor did it include those receiving a single intraoperative dose of dexamethasone for anti-emesis) previous enrolment in this trial for a prior episode time interval from time of admission to the NSU to first dose of trial medication exceeded 72 hours chronic subdural haematoma in the presence of a cerebrospinal fluid shunt severe lactose intolerance or a known hypersensitivity to dexamethasone or other excipients a history of psychotic disorders unwillingness to take products containing gelatine. Patients who were screened but not included in the study were recorded on a screening log and reported centrally, with both the number of failures and the reasons for failure to recruit to the trial documented. Trial procedures Patients were managed in NSUs in accordance with standard practice. In the UK, this typically includes burr hole evacuation with the use of a subdural drain for most symptomatic patients. The decision for surgery or active monitoring was made on an individual patient basis by the blinded admitting clinical team in conjunction with the patient, in keeping with the pragmatic nature of the trial. Enrolment in the trial took place irrespective of the decision to operate and the timing of surgical intervention. Patients were randomised in 1 : 1 allocation using a computer-generated randomisation schedule, stratified by site using permuted blocks of random sizes (two or four). An interactive web-based response system was used to allocate treatment packs of 62 overencapsulated 2-mg dexamethasone tablets or 62 identical placebo capsules. The enrolled participants, clinical and research team and outcome assessors were blinded to the treatment allocation. The assigned treatment was administered as part of the routine drug round by the ward nurses. Oral administration was the preferred option, but administration via a nasogastric tube was offered to those unable to swallow. The latter method required opening of the capsules for crushing of the contents, allowing potential unblinding of the ward nurse. Therefore, the content of any opened capsules was not documented in the patient notes to maintain the blinding of the neurosurgeons and research staff. Trial drug compliance was recorded through inpatient drug charts during admission or by completion of a medication diary. Data were collected at baseline (on admission to the neurosurgical department) as part of routine standard of care, on discharge from the acute NSU, at 30 days, at 3 months and at 6 months. Patients were monitored in line with routine clinical practice until discharge, and at 3 and 6 months, to score clinical outcomes. Sample size This sample size was calculated with the following assumptions: a favourable outcome rate of 80–85% in the control arm and allowing for up to 15% loss to follow-up. A target sample size of 750 patients was needed to detect an increase in favourable outcome rate from 80–85% to 88–93%, with a power of 81–92% at the 5% significance level (two sided). An 8% increase in the rate of favourable outcome (mRS score of 0–3) at 6 months represents a clinically important treatment effect. Statistical analysis Data were analysed in accordance with the prespecified statistical analysis plan that was agreed prior to unblinding of data. Outcome data were analysed using a modified intention-to-treat analysis (all patients were included as randomised, except for those who withdrew consent for participation in the trial and those lost to follow-up). The primary outcome (mRS score at 6 months) was dichotomised into favourable (0–3) or unfavourable (4–6) outcomes. Primary analysis estimated the absolute difference between the intervention arm and the control arm in the proportions achieving a favourable outcome. A normal approximation was used to produce 95% confidence intervals (CIs) and a two-sided p-value testing the null hypothesis of no difference. Secondary analysis included a logistic regression and proportional odds logistic regression of the original mRS score adjusting for baseline covariates of age and Glasgow Coma Scale (GCS) score. Economic evaluation In the base-case analysis, costs were estimated over the 6-month trial period from an NHS and a Personal Social Services perspective. Outcomes were quality-adjusted life-years (QALYs) derived from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), at NSU discharge and at the 3- and 6-month follow-ups. Analyses were undertaken to estimate the mean incremental cost and effect, and enable the net monetary benefit (NMB) (a negative score indicates that the intervention is not estimated to be cost-effective) to be calculated, along with the cost-effectiveness acceptability curve (CEAC) (probability that dexamethasone was cost-effective). NMB and CEAC values at a willingness-to-pay threshold of £20,000 per QALY are reported. Results Primary outcome An outcome of mRS score of 0–3 occurred in 286 out of 341 patients (83.9%) in the dexamethasone arm and 306 out of 339 patients (90.3%) in the placebo arm at 6 months (difference −6.4%, 95% CI −11.4% to −1.4%; p = 0.01). After adjustment for prespecified covariates (age > 70 years and GCS score on admission), the odds ratio (OR) of a favourable outcome with dexamethasone was 0.55 (95% CI 0.33 to 0.91; p = 0.022), favouring placebo. Secondary outcomes Modified Rankin Scale at discharge and 3 months At 3 months, 268 out of 322 patients (83.2%) in the dexamethasone arm and 298 out of 326 patients (91.4%) in the placebo arm had a favourable outcome, for a between-group difference of −8.2% (95% CI −13.3% to −3.1%) in favour of the placebo arm. There was no significant difference in mRS score between the two arms at discharge [255/318 (80.2%) in the dexamethasone arm and 263/316 (83.2%) in the placebo arm for a difference of −3.0% (95% CI −9.1% to 3.0%)]. Mortality At discharge, 8 out of 375 patients (2.1%) in the dexamethasone arm and 2 out of 373 patients (0.5%) in the placebo arm had died (OR 4.08, 95% CI 1.01 to 27.2). At 6 months, 30 out of 341 patients (8.8%) in the dexamethasone arm and 17 out of 339 patients (5.0%) in the placebo arm had died (OR 1.83, 95% CI 0.99 to 3.45). Number of chronic subdural haematoma-related surgical interventions undertaken The number of surgical interventions undertaken during the index admission or during subsequent admissions during the follow-up period was similar in both arms. However, in the subset of patients who received surgery, repeat surgery for recurrence of the CSDH was performed in 6 out of 349 patients (1.7%) in the dexamethasone arm and in 25 out of 350 patients (7.1%) in the placebo arm. EuroQol-5 Dimensions, five-level version, utility index (at discharge and at 3 and 6 months) The mean EQ-5D-5L, utility index scores were compared. At discharge, the difference was −0.03 (95% CI −0.07 to 0.01), favouring placebo. At 3 months, the difference was −0.07 (95% CI −0.12 to −0.02), favouring placebo. At 6 months, the difference was −0.03 (95% CI −0.09 to 0.02), favouring placebo. Glasgow Coma Scale (at discharge and at 6 months) Glasgow Coma Scale was grouped into scores of 9–12 and 13–15. The percentage of patients with a score of 13–15 was similar at discharge (99.7% in the placebo arm vs. 99.2% in the dexamethasone arm). Insufficient data at 6 months prevented analysis. Barthel Index (at discharge and at 3 and 6 months) No significant difference was seen between the placebo arm and the dexamethasone arm at discharge, 3 months or 6 months. Length of stay in the neurosurgical unit The mean length of stay was 9.03 days in the placebo arm and 9.32 days in the dexamethasone arm. Length of stay in secondary care The mean length of stay was 13.0 days in the dexamethasone arm and 13.7 days in the placebo arm, with no significant difference between the two arms (0.95, 95% CI 0.835 to 1.09; p = 0.467). Discharge destination from the neurosurgical unit No significant difference was observed between the placebo arm and the dexamethasone arm when comparing discharge destinations. Rates of adverse events The odds of an adverse event of special interest were greater in the dexamethasone arm than in the placebo arm (OR 3.40, 95% CI 1.81 to 6.85). Similarly, the odds of a serious adverse event occurring were greater in the dexamethasone arm than in the placebo arm (OR 2.49, 95% CI 1.54 to 4.15). Economic evaluation The mean incremental cost for dexamethasone was estimated to be −£143.73 (95% CI −£1793 to £1505), with a QALY of −0.012 (95% CI −0.027 to 0.003), compared with placebo. The associated NMB of dexamethasone compared with placebo was −£97.19, with an estimated 46% probability of being cost-effective. Conclusions Implications for healthcare Dexamethasone for the treatment of symptomatic CSDH resulted in a lower proportion of favourable outcomes, as measured with the mRS, and a larger number of AEs than placebo. This treatment regime was also not estimated to be cost-effective (based on the NMB). Therefore, dexamethasone is not recommended in the treatment of CSDH. Implications for research The results of our literature review indicate that this study is the first multicentre randomised controlled trial to investigate the clinical effectiveness and cost-effectiveness of dexamethasone in the management of symptomatic CSDH. It provides evidence to inform the role of dexamethasone in this condition. Trial registration This trial is registered as ISRCTN80782810. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/15/02) and is published in full in Health Technology Assessment; Vol. 28, No. 12. See the NIHR Funding and Awards website for further award information.
Published: 2024
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44. Correction: Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

Author: Picetti, Edoardo, Catena, Fausto, Abu-Zidan, Fikri, Ansaloni, Luca, Armonda, Rocco A., Bala, Miklosh, Balogh, Zsolt J., Bertuccio, Alessandro, Biffl, Walt L., Bouzat, Pierre, Buki, Andras, Cerasti, Davide, Chesnut, Randall M., Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Fainardi, Enrico, Gupta, Deepak, Gurney, Jennifer M., Hawryluk, Gregory W. J., Helbok, Raimund, Hutchinson, Peter J. A., Iaccarino, Corrado, Kolias, Angelos, Maier, Ronald W., Martin, Matthew J., Meyfroidt, Geert, Okonkwo, David O., Rasulo, Frank, Rizoli, Sandro, Rubiano, Andres, Sahuquillo, Juan, Sams, Valerie G., Servadei, Franco, Sharma, Deepak, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Udy, Andrew, Zoerle, Tommaso, Agnoletti, Vanni, Bravi, Francesca, De Simone, Belinda, Kluger, Yoram, Martino, Costanza, Moore, Ernest E., Sartelli, Massimo, Weber, Dieter, and Robba, Chiara
Published: 2023
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45. Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

Author: Picetti, Edoardo, Catena, Fausto, Abu-Zidan, Fikri, Ansaloni, Luca, Armonda, Rocco A., Bala, Miklosh, Balogh, Zsolt J., Bertuccio, Alessandro, Biffl, Walt L., Bouzat, Pierre, Buki, Andras, Cerasti, Davide, Chesnut, Randall M., Citerio, Giuseppe, Coccolini, Federico, Coimbra, Raul, Coniglio, Carlo, Fainardi, Enrico, Gupta, Deepak, Gurney, Jennifer M., Hawryluk, Gregory W. J., Helbok, Raimund, Hutchinson, Peter J. A., Iaccarino, Corrado, Kolias, Angelos, Maier, Ronald W., Martin, Matthew J., Meyfroidt, Geert, Okonkwo, David O., Rasulo, Frank, Rizoli, Sandro, Rubiano, Andres, Sahuquillo, Juan, Sams, Valerie G., Servadei, Franco, Sharma, Deepak, Shutter, Lori, Stahel, Philip F., Taccone, Fabio S., Udy, Andrew, Zoerle, Tommaso, Agnoletti, Vanni, Bravi, Francesca, De Simone, Belinda, Kluger, Yoram, Martino, Costanza, Moore, Ernest E., Sartelli, Massimo, Weber, Dieter, and Robba, Chiara
Published: 2023
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46. A Framework for Contextual Recommendations Using Instance Segmentation.

Author: Dimitris Tsiktsiris, Nikolaos Dimitriou, Zisis Kolias, Stavri Skourti, Paul Girssas, Antonios Lalas, Konstantinos Votis, and Dimitrios Tzovaras
Published: 2023
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47. Do Programs Dream of Electromagnetic Signals? Towards GAN-based Code-to-Signal Synthesis.

Author: Kurt A. Vedros, Constantinos Kolias, and Robert C. Ivans
Published: 2023
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48. We are different and yet the same: the role of CEOs’ regulatory focus and attention in SMEs’ innovation orientation preferences

Author: Glaveli, Niki, Galanou, Aikaterini, Kolias, Georgios, and Karamanis, Konstantinos
Published: 2023
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49. Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Author: Glasbey, James C, Abbott, Tom EF, Ademuyiwa, Adesoji, Adisa, Adewale, AlAmeer, Ehab, Alshryda, Sattar, Arnaud, Alexis P, Bankhead-Kendall, Brittany, Abou Chaar, M K, Chaudhry, Daoud, Costas-Chavarri, Ainhoa, Cunha, Miguel F, Davies, Justine I, Desai, Anant, Elhadi, Muhammed, Fiore, Marco, Fitzgerald, James Edward, Fourtounas, Maria, Fowler, Alex James, Futaba, Kay, Gallo, Gaetano, Ghosh, Dhruva, Gujjuri, Rohan R, Hamilton, Rebecca, Haque, Parvez, Harrison, Ewen M, Hutchinson, Peter, Hyman, Gabriella, Isik, Arda, Jayarajah, Umesh, Kaafarani, Haytham MA, Kadir, Bryar, Lawani, Ismail, Lederhuber, Hans, Li, Elizabeth, Löffler, Markus W, Lorena, Maria Aguilera, Mann, Harvinder, Martin, Janet, Mazingi, Dennis, McClain, Craig D, McLean, Kenneth A, Meara, John G, Ramos-De La Medina, Antonio, Mengesha, Mengistu, Minaya, Ana, Modolo, Maria Marta, Moore, Rachel, Morton, Dion, Nepogodiev, Dmitri, Ntirenganya, Faustin, Pata, Francesco, Pearse, Rupert, Picciochi, Maria, Pinkney, Thomas, Pockney, Peter, van Ramshorst, Gabrielle H, Richards, Toby, Roslani, April Camilla, Satoi, Sohei, Sayyed, Raza, Shaw, Richard, Simões, Joana FF, Smart, Neil, Sullivan, Richard, Sund, Malin, Sundar, Sudha, Tabiri, Stephen, Taylor, Elliott H, Venn, Mary L, Wickramasinghe, Dakshitha, Wright, Naomi, Yip, Sebastian Bernardo Shu, Bhangu, Aneel, Omar, Omar, Harrison, Ewen, Bhangu, Aneel A, Siaw-Acheampong, Kwabena, Benson, Ruth A, Bywater, Edward, Dawson, Brett E, Evans, Jonathan P, Heritage, Emily, Jones, Conor S, Kamarajah, Sivesh K, Khatri, Chetan, Khaw, Rachel A, Keatley, James M, Knight, Andrew, Lawday, Samuel, Mann, Harvinder S, Marson, Ella J, Mckay, Siobhan C, Mills, Emily C, Pellino, Gianluca, Tiwari, Abhinav, Trout, Isobel M, Wilkin, Richard JW, Abukhalaf, Sadi, Adamina, Michel, Ademuyiwa, Adesoji O, Agarwal, Arnav, Akkulak, Murat, Alameer, Ehab, Alderson, Derek, Alakaloko, Felix, Albertsmeier, Markus, Alser, Osaid, Alshaar, Muhammad, Augestad, Knut Magne, Ayasra, Faris, Azevedo, José, Bankhead-Kendall, Brittany K, Barlow, Emma, Beard, David, Blanco-Colino, Ruth, Brar, Amanpreet, Minaya-Bravo, Ana, Breen, Kerry A, Bretherton, Chris, Buarque, Igor Lima, Burke, Joshua, Caruana, Edward J, Chaar, Mohammad, Chakrabortee, Sohini, Christensen, Peter, Cox, Daniel, Cukier, Moises, Davidson, Giana H, Di Saverio, Salomone, Drake, Thomas M, Edwards, John G, Emile, Sameh, Farik, Shebani, Ford, Samuel, Garmanova, Tatiana, Gomes, Gustavo Mendonça Ataíde, Grecinos, Gustavo, Griffiths, Ewen A, Gruendl, Magdalena, Halkias, Constantine, Hisham, Intisar, Hutchinson, Peter J, Hwang, Shelley, Jenkinson, Michael D, Jonker, Pascal, Keller, Debby, Kolias, Angelos, Kruijff, Schelto, Leventoglu, Sezai, Litvin, Andrey, Loehrer, Andrew, Major, Piotr, Mashbari, Hassan N, Metallidis, Symeon, Mohan, Helen M, Moszkowicz, David, Moug, Susan, Ng-Kamstra, Joshua S, Maimbo, Mayaba, Negoi, Ionut, Niquen, Milagros, Olivos, Maricarmen, Oussama, Kacimi, Outani, Oumaima, Parreno-Sacdalanm, Marie Dione, 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Stephen, Laoye, Adeyinka, Hussain, Abdulzahra Abdulsamad, Zafar, Muneeb, Elsheikh, Mohammed H, Shaerf, Daniel A, Soggiu, Fiammetta, Massoumi, Abaris, Gareb, Fahed, Yao, Mark W, Qamar, Mubasher A, Fang, Clarissa E H, Greenhalgh, Michael S, Hunt, Alexander, Oladeji, Emmanuel O, Benjamin, Miles W, Beak, Philip, Rae, Fraser J, Aithie, Joanna M S, Clarke, Gareth W J, Veeramootoo, Darmarajah, Ashman, Alex J, Kahka, Ehab E, Rafe, Tanvir, PATEL, PANNA K, Albirnawi, Hatim, Katory, Mark, Fisher, Ann, Amonkar, Sunil J, Rao, Pawan Kumar Dhruva, Holroyd, David J, Gkikas, Andreas, Newton, Lydia S, Kirk, Alan J B, Khalid, Ayesha, Ferguson, David, Stanier, Paul B, Shah, Vinay, El-Boghdadly, Kariem, Schizas, Alexis M P, ilyas, Minahi, George, Mark L, Gawad, Mothana, Groom, William D, Al-Azzawi, Mohammed, Ahluwalia, Julian CJ, Punjabi, Prakash P, Cheung, Fang Yi, Wilson, Michael D, Mitrofan, Claudia Gabriela, Malam, Yogeshkumar, Townson, Adam, Loubani, Mahmoud, Yau, Jih Dar, Seebah, Kevin, Akowuah, Enoch F, Pushpoth, Sreekumari R, Viswanath, Yirupaiahgari KS, ElSanhoury, Kareem, Chew, Misha, Walker, Thomas E, Elhassan, Almutasim Billah Elbagir, Belcher, Elizabeth, Goricar, Matej, majd, Hooman Soleymani, Knight, Dominic, Ismail, Lamiese, McKinnon, Chris, Ganau, Mario, Prokopenko, Max, Doshi, Neel S, Gkorila, Aikaterina, Sheikh, Nomaan A, Helm, Jessica R, Low, Mei Ken, Ogunfusika, Oluseyi Harold, Bisheet, George, Alhammali, Tariq, Arnob, Ahmed Showki, Singh, Jatinder, Allde, Emma L, Sambhwani, Sharan H, Dube, Manas, Gemmill, Elizabeth H, John, Joby, Gerogiannis, Ioannis N, Abuelgasim, Mona A A, Crate, Georgina, Holme, Thomas J, Nguyen, Anh T V, Ho, Michael W, Wade, Ryckie G, Hussain, Azar, Andrzejowski, Paul, Omakobia, Eugene, Eltayeb, Momin, Galabov, Tsanko P, Lee, Chung Yan Vernon, Nazir, Anum, Siaw, Oliver L, Ashford, Robert U, Boddy, Alex P, Ashmore, Christopher D, Shah, Snehadhar M, Gowers, Benjamin T V, Thekkinkattil, Dinesh K, Worku, Dawit, Harky, Amer, Talwar, Rishi, Sagoo, Harkiran K, Jambulingam, Periyathambi S, Smart, Christopher J, Doherty, Daniel T, Mastoridis, Sotiris, Kumar, Sidharth, Mahmoud, Rana, Solari, Francesca, Egan, Richard J, Barry, Jonathan D, Morrison, Jo, Davoudi, Kaveh, Hollyman, Marianne, Kelly, Andrew, Badenoch, Thomas F, pandanaboyana, sanjay, Critchley, Rebecca J, Sarodaya, Varun R, Sinnerton, Robert J H, Manickavasagam, Jaiganesh, Lindsay, Elizabeth F, Arora, Ankita, Hasan, Raashad, Liew, Ignatius, Ozua, Joshua, Kouritas, Vasileios, Collins, Rachael V, Lafford, George H, Moret, Charlie, Chean, Chung Shen, Horgan, Liam F, Aujayeb, Avinash, Siddique, Muhammad Harris, Navaratne, Lalin, Kotecha, Sanjeev, Bellato, Vittoria, Lewis, Sophia E, Ali, Muhammad Usman, Marson, Ben A, Craxford, Simon, Gajjar, Ketankumar, Theophilidou, Elena, Aboelmagd, Tariq, Khatkar, Harman, Awadallah, Mahmoud A, Blanco, Jose A, Chituku, Tsitsi G, Dixon, Oliver GB, sarveswaran, Janahan, Jones, Imogen S, Hammouche, Salah, Vijay, Vardhini, Ooi, Rucira, Karmarkar, Rahi, Khaleeq, Tahir, Bhatia, Mohit, Al-Khazaali, Badr L, Daadipour, Audrina, Mattar, Ahmed, Singhal, Tarun, Mahmoud, Moustafa Ibrahim, Glasbey, James, Nankivell, Paul C, Kalkat, Maninder S, Nour, Shahd, Beggs, Andrew D, Yershov, Danylo Y, Chughtai, Shafiq Ahmad, Youssef, Hesham, Norrish, Alan R, Mohammed, Mohammed M, Gwozdz, Adam M, Charalambous, Michalis P, Knight, Stephen R, McCaul, James A, Bridgman, Elsie A, El Sheikh, Mustafa, Ogunbowale, Akinsola, Wright, Evan O, Ahmed, Usama, Younus, Hafsa, Tincknell, Laura G, Weixing-Ho, Ken, Demetriou, Charis, Hussei, Mohammed, Reilly, John-Joe, Hormis, Anil P, Moug, Susan J, Anazor, Fitzgerald C, Horwell, Edward A, Neal-Smith, Gregory, McNamara, John M, Baryeh, Kwaku W, Bhatti, Khalid M, McKay, Joseph E, Cannoletta, Maria G, Perkins, Clare J, Gopalswamy, Sivakumar, Sheldon, Anna F, John, Joseph B, Mantle, Mark, Toia, Bogdan, Phillips, Andrew J, Al-Khyatt, Waleed, Lund, Jonathan N, Ammar, Ahmed Y, Yim, Guang H, Huntley, Daniel A, Daniels, Ian R, Valverde, Joao, Lumley, Edward David John, Walton, Thomas J, Raptis, Dimitri A, Dimitrokallis, Nikolaos, Nathan, Arjun, Motallebzadeh, Reza, Chowdhury, Shihab, Ahmed, Rezwan F A, Mirnezami, Reza, Szakmany, Tamas, Knight, Dominic J, Al-Azzani, Waheeb, Davies, Huw R, Ooi, Setthasorn Zhi Yang, Oo, Khaing K, Cullis, Paul S, Peng, Ed, Demetriades, Andreas K, Tambyraja, Andrew L, Poon, Michael TC, Brennan, Paul M, Oikonomou, Dimitrios, Newman, Samuel E, Le Blevec, Louise, Otify, Mohamed, Szatmary, Peter, Devkaran, Bhavesh, Sochorova, Dana, Sohrabi, Catrin, Sivaprakasam, Rajesh, Goh, Mingzheng Aaron, Atkinson, Kate V, Soares, Delvene, Prce, Daniela, Cann, Johnathon P, Grobbelaar, Amy C, Bradley, Rebecca, Strauss, Helen J, Taha, Ahmed, Minicozzi, Annamaria, Thakur, Bhaskar, Hanoun, Abdullah, Goru, Poornanand, Baumber, Rachel M, Sobti, Anshul S, Cross, George WV, Havenhand, Tom, Antoniou, George A, Chauhan, Govind Singh, Vokshi, Ismail, Mahmud, Ayesha, Albanese, Erminia, Evans, Daisy, Madhuri, Thumuluru Kavitha, Horsnell, Jonathan D, Zalmay, Pardis, Davies, Angharad J, Aljanadi, Firas, Jeganathan, Reubendra, Jones, Mark, Kakos, Christos, vidya, Raghavan, El-Ghobashy, Alaa, Habib, Ahmed M, Reid, Jeremy P, Rajgor, Harshadkumar Dhirajlal, Ahmed, Omar, Branagan, Graham, Mohamedahmed, Ali Yasen Y, Al-Sabbagh, Ali, Chetty, Govind, Kelty, Clive J, EL-Wajeh, Yasin A M, Tomlinson, James E, Rominiyi, Ola, Sinha, Saurabh, Saad, Sanad, Sahu, Banchhita, Charalampakis, Vasileios, Enemosah, Ibrahim, Williams, Simon J, Yaqoob, Hassan N, Laurent, Edward P, Moreau, Joshua L, Frostick, Rhiannon, Parwaiz, Hammad, Aboelmagd, Karim, Pournaras, Dimitri J, Hristova, Kalina H, Iyengar, Karthikeyan P, Mohamed, Muyed, Artioukh, Dmitri Y, Anwar, Sibtain, Hussein, Mostafa K A, Omogbehin, Tomisin S, Herron, Jonathan B T, Labib, Amir, Patel, Preemal, Marsden, Samuel C, Mehdian, Roshana, Santhirakumaran, Gowthanan, Smelt, Jeremy, Agarwal, Ketan, Lancerotto, Luca, Sahnan, Kapil, Shalhoub, 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Kandaswamy, Anyaugo, Ngozi S, Wuraola, Obafemi K, Odejinmi, Funlayo, Craven, Joanna M, West, Charlotte L, Barter, Reece A, Navaratnam, Devaraj M, Malik, Shahbaz S, Mahendran, Vimaladhithan, Zilvetti, Miguel, Lovegrove, Richard E, Board, Tim N, Zeiton, Moez, Sarwar, Safdar A, Duff, Sarah E, Hsabo, Elmuiz A, Nugur, Ashwani Kumar, Morris, Richard M, Lala, Anil K, Kwan-Feinberg, Rita O, Ross, Samuel W, Dressler, Jeremy A, Evans, Faye M, Wason, Shaun E L, Vogel, Keianna R, Wang, Joanna C, Sulciner, Megan L, Hirji, Sameer, Raoof, Mustafa, Wolff, Christopher J, kent, Ilan, Turan, Alparslan, Teixeira, Pedro G, Olson, Kristofor A, Patel, Neil D, Krishnamoorthy, Vijay, Moris, Dimitrios, Rice, Henry E, Gabr, Hesham, Satoskar, Savni R, Castater, Christine A, Jmaileh, Manal, Payne, Rachel E, Kwon, David S, Aarabi, Shahram, Escobar, Pedro F, Kronenfeld, Joshua P, Dalton, Michael K, Etchill, Eric W, Haut, Elliott R, Vervoort, Dominique, Dehal, Ahmed, McKenney, Mark, Elkbuli, Adel, Gosain, Ankush, Abdelsattar, Zaid M, Naunheim, Matthew R, Burks, Ciersten A, Zhou, Allen S, Heng, Marilyn, Abohashem, Shady, Lozano-Calderón, Santiago A, Reisenauer, Janani S, Mouawad, Nicolas J, Diehl, Thomas M, Eriksson, Evert A, Marwaha, Jayson S, Schroeppel, Thomas J, LaRocca, Christopher J, Chang, Grace H, Hassan, Romana, Nosanov, Lauren B, Rickard, Jennifer L, Avraham, Jacob B, Petrone, Patrizio, Sferra, Joseph J, Hadaya, Joseph, Mead, Brittany S, Hauptman, Jason S, Ahmad, Maleeha, Meola, Antonio, Chang, Steven D, Ko, Ara, Specht, Katherine E, Choudhry, Asad, Encalada, Ronald Zerna, Poggio, Juan L, Xing, Hang, Glass, Nina E, Hooker, Robert, Martins, Paulo N, Scott, Erin M, Bankhead, Brittany K, Giorgakis, Emmanouil, Nigh, Joe, Osborn, Tamara, Tay Lasso, Erika L, Beswick, Daniel M, Berndtson, Allison E, Kaups, Krista L, Chen, Lee-lynn, Farrell, Michael S, Boeck, Marissa A, Vaysburg, Dennis M, Kassam, Al-Faraaz, Turner, Kevin M, Dyas, Adam R, Coleman, Julia R, Folsom, Megan, Lam, Christopher M, Kumer, Sean C, Larson, Kelsey, Turner, Scott, Guidry, Christopher, Reddy, Madhuri, Berbel, German, Findley, Austin, Beahm, David, Bur, Andres, Marlor, Derek, Houndschell, Corey, Carver, Shea, Ulrich, Alissa, Bhutiani, Neal, DiChiacchio, Laura, Abdou, Hossam, Napolitano, Lena M, Ghebre, Rahel, Bass, Gary Alan, Kaplan, Lewis J, Martin, Niels D, Duffy, Caoimhe C, Abdelhamid, Sultan S, Daley, Brian J, Roland, Christina L, Dumas, Ryan P, Ban, Vin Shen, Rajesh, Aashish, Davies, Mark G, Purudappa, Prabhudev P, Walters, Camila B, Lin, Nicole, Ruzgar, Nensi M, Ullrich, Sarah J, Trostchansky, Ivan, Bonilla-Cal, Fernando, Castedo, Fabiola, Sobrero, Helena, Acuña, Gastón, Álvarez, Sofía M, Tarigo, Josefina, Carbajal, Ana C, Carbajal, Ana, Reyes, Antonio R, Al-Eryani, Fatima A, Alqousi, Nardeen N, Alattas, Zainab, Al-Saban, Rafat A, Al-Shehari, Mohammed M, ALHammadi, Nawal T, Shream, Sarah A, Al-Naggar, Hamza M, Al-Qalisi, Lina M, Nadeesh, Areej E, Al-Samawi, Hytham H, Bajjah, Hadeel M, AL-Ameri, Saba A, Albably, Jamal F, Ghannam, Rana A, Shamsan, Amatallah H, Meead, Abdullah A, Al- Zubaidi, Riham Q, Zulait, Mohammed A, Najeeb, Halah, Alsayadi, Musaed M, Al-Mashreqi, Seham K, Al-Jomai, Najla A, Alsayadi, Ramzi A, Al-Naggar, Moath M, Almarashi, Hassan A, Musaeed, Hasna M, Al-Raimi, Ibrahim M, Ghanem, Hossam N, Al-Zazay, Karim A, AL-Mahdi, Shehab A, Almontaser, Amatalaleem S, Savopoulos, Vanessa A S, Munthali, James, Kabongo, Kizito M C, Mushiwokufa, Willard, Ngulube, Allan, Ntoto, Crispin, Magama, Praise T, Dzinotyiwei, Daniel, Chivanga, Shelton K, Dube, Ngqabutho S, Sanchez, Ernesto C, Moyo, Assel T, Chengahomwe, Antony, Chinyowa, Simbarashe, Siamuchembu, Maphios, Bondera, Tafadzwa, and Mushawarima, Trust
Published: 2022
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50. The application of medical ethics in the developing countries – A neurosurgical perspective

Author: Hossain, Iftakher, Hutchinson, Peter, Kawsar, Khandkar, Kolias, Angelos, Santos, Adriana Libório dos, Esene, Ignatius N., Thango, Nqobile, Baticulon, Ronnie, Laki, Beata, and Ammar, Ahmed
Published: 2024
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