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El gusto por lo exótico: la depredación de la cotorra de Kramer invasora por el búho chico en una zona urbana La presión predatoria que ejercen las especies nativas puede limitar la propagación de especies invasoras exóticas y, en consecuencia, tener un papel decisivo en los efectos y la aplicación de estrategias de gestión. La cotorra de Kramer, Psittacula krameri, es una de las especies de aves exóticas más extendida de Europa, donde tiene cerca de 70 poblaciones establecidas. Entre los depredadores de esta especie se encuentran rapaces diurnas, córvidos sinantrópicos y roedores. En este estudio observamos por primera vez que el búho chico, Asio otus, puede cazar cotorras en sus dormideros. El análisis de 167 excrementos de búho chico mostró que las cotorras de Kramer constituyen el 10 % de volumen total de la dieta de estos búhos en invierno (32,93 % de frecuencia absoluta) y son la presa más importante después de los roedores múridos y las aves paseriformes. Es necesario seguir estudiando esta cuestión para analizar si el consumo de cotorras de Kramer por el búho chico es solo un fenómeno local o si se ha generalizado en las ciudades europeas. En ese caso, es posible que, la depredación por el búho chico termine suponiendo una forma de control de la cotorra y limite el impacto de esta especie introducida en la biodiversidad autóctona.

Understanding the environmental and microbial processes involved in DNA degradation from archaeological remains is a fundamental part of managing bone specimens. We investigated the state of DNA preservation in 33 archaeozoological caribou (Rangifer tarandus) ribs excavated from the same excavation trench at a former Inuit hunting camp in West Greenland, separated by 43 years: 1978 and 2021. Our findings show that DNA is better preserved in the most recently excavated samples, indicating a detrimental effect of museum storage on DNA integrity. Additionally, our data reveals a diverse microbiome in these bones, encoding genes relevant for bone degradation, such as enzymatic families relating to collagenases, peptidases and glycosidases. Microbes associated with bone degradation were present in both new and historical samples, with museum-stored bones showing significantly more DNA damage. Overall, our research sheds light on the nuanced dynamics governing the preservation of genomic material in archaeological contexts, underscoring the vital importance of careful considerations in museum curation practices for the sustainable conservation of invaluable skeletal records in museum repositories and in situ. DNA preservation in archaeozoological caribou ribs from West Greenland Inuit hunting camp shows better quality in newly excavated samples, revealing detrimental effects of museum storage and diverse microbial communities involved in bone degradation. [ABSTRACT FROM AUTHOR]

Peptide-based biomimetic treatments have gained increased attention in the dental field due to their biocompatibility and minimally invasive qualities. These biomimetic approaches can replicate the native architecture of dental tissues, thus contributing to higher success rates and improved longevity of restorations. The aim of this study was first to examine the biocompatibility and stability of an amelogenin peptide-based chitosan hydrogel (P26-CS) against salivary enzymes. Second, we aimed to evaluate its efficacy in biomimetically repairing human dental lesions in situ. White spot lesions (WSLs) in enamel and non-carious cervical lesions (NCCLs) in dentin were artificially created. Chitosan (CS) improved peptide stability, while remineralization of enamel sections with P26-CS was not impeded by salivary enzymes. The peptide was not cytotoxic, irritating, or sensitizing. Fluorescently labeled P26-CS penetrated ~300 μm into the enamel of WSLs and ~100 μm into the dentin of NCCLs. After peptide treatment, quantitative light-induced fluorescence (QLF) and microcomputed tomography (μCT) indicated a gain in mineral density of WSLs. In NCCLs, scanning electron microscopy showed that the dentin was covered by a mineral layer of needle-shaped crystals. Our results show that the repair of artificial WSLs and NCCLs was achieved by P26 peptide-guided remineralization and demonstrate its potential to repair dental lesions. [ABSTRACT FROM AUTHOR]

Introduction: While learning laparoscopic procedures, the physician must face the difficulties specific to this method. They include two-dimensional vision, disturbed eye-hand coordination, and lack of touch sense control. In this study, we examined the impact of different types of training on the performance of laparoscopic procedures on box trainers. We took into account the individual manual skills of the participants. Aim: This study aimed to assess the effectiveness of a self-built laparoscopic trainer and the influence of arcade smartphone games on improving laparoscopic psychomotor skills. Material and methods: Students with no experience in laparoscopy participated in the study. They took part in the Minnesota Manual Dexterity Test (MMDT). Then, they were divided randomly into three groups. The 1st group had a 3-hour laparoscopic training. The 2nd group was performing visual-manual tasks using a phone application. The 3rd group took part in the final test without prior preparation. The final test included transferring sponges using the laparoscopic trainer and cutting a latex glove. Results: There was a statistically significant difference between the groups in the results of the sponge-transferring test and the glove-cutting speed. There was no correlation between perforations during the cutting of latex gloves and the cutting length. Conclusions: The laparoscopic trainer – also self-built – is a valuable tool for laparoscopic training. The use of arcade smartphone games contributes to increased laparoscopic psychomotor skills. [ABSTRACT FROM AUTHOR]

Background: The translational domain is a complex subfield of the biomedical life sciences focused on bridging the gap between scientific research and clinical application, with the ultimate goal of improving patient care through healthcare innovations. Professionals in this field, ranging from researchers to clinicians and industry experts, require specific core competencies. These include communication, collaboration, boundary crossing, innovation, and the ability to integrate diverse scientific domains. Methods: We investigated the translational competencies acquired most by life science students who participated in a six-month challenge-based course at a Dutch graduate school. Seventeen students were part of the 2021 cohort, supervised by five biomedical experts serving as their clients. Quantitative and qualitative student survey data (n = 10), and semi-structured expert interview data (n = 4) were collected after completion of the course in 2021. Two existing translational competency frameworks were used to categorize and rank the acquired competencies, highlighting those most developed and relevant during the translational challenge-based course. Results: Communication was the most listed competency category by both students and experts, and a new competency category was identified named Self-Development Tools, which included competencies related to decision-making, reflection, feedback, and creative thinking. Student data also showed that the course influenced their choice in pursuing a translational career path. Conclusions: This study provides insight into key translational competencies acquired by students during a six-month challenge-based course and insight into competencies that may be part of their continued education after graduation from both student and expert perspectives. These findings are relevant for both educators and prospective employers in the translational domain as they apply a novel ranking to the existing literature on translational competencies and elaborate on how to prepare life sciences graduates towards a translational career. [ABSTRACT FROM AUTHOR]

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We prove that relational structures admitting specific polymorphisms (namely, canonical pseudo-WNU operations of all arities n \geq 3) have low relational width. This implies a collapse of the bounded width hierarchy for numerous classes of infinite-domain constraint satisfaction problems (CSPs) studied in the literature. Moreover, we obtain a characterization of bounded width for first-order reducts of unary structures and a characterization of Monotone Monadic SNP (MMSNP) sentences that are equivalent to a Datalog program, answering a question posed by Bienvenu et al. In particular, the bounded width hierarchy collapses in those cases as well. Our results extend the scope of theorems of Barto and Kozik characterizing bounded width for finite structures and show the applicability of infinite-domain CSPs to other fields. [ABSTRACT FROM AUTHOR]

Background: Toothbrushing is the most commonly used method to physically remove dental plaque. However, there are many areas of the mouth that are difficult to reach with a toothbrush. The type of toothbrush is a critical factor influencing the effectiveness of oral care. The purpose of the study was to evaluate a toothbrush with a thin head, slender-neck and super-tapered bristles to target hard-to-reach areas in the oral cavity for reducing dental plaque and gingivitis. Methods: This crossover study included 58 adults aged 20 years and older. All participants were randomly assigned to use test and control toothbrushes (the latter had a normal head and round bristles) for two 4-week phases. Participants brushed their teeth twice daily in their habitual manner. At the start and end of each phase the Silness-Lӧe plaque index (PI), Lӧe -Silness gingival index (GI) and bleeding-on-probing index (BOP) were assessed and performed plaque fluorescence tests using quantitative light-induced fluorescence technology. Results: After using the test toothbrush, PI, GI and BOP decreased by 25%, 30% and 48%, respectively (P < 0.05). For the rearmost molars, PI, GI and BOP decreased by 18%, 26% and 47%, respectively (P < 0.05). For the implants, GI and BOP decreased by 31% and 57%, respectively (P < 0.05). The plaque fluorescence tests indicated that after using the test toothbrush, the dental plaque area for the anterior teeth and the simple plaque score for the rearmost molars decreased by 25% (P < 0.05) and 14% (P = 0.527), respectively. Conclusions: The test toothbrush was markedly better than the control toothbrush at reducing dental plaque and gingivitis. In particular, the test toothbrush produced an excellent reduction in dental plaque and gingivitis for the rearmost molars and the implants. Trial registration: KCT0009669, retrospectively registered 02/08/2024. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore multivariately the relationship between subjective symptoms allegedly due to amalgam and mercury measurements before and after administration of a chelator. Of 120 participants, the mercury concentrations in urine (U-Hg) and plasma (P-Hg) before and after a chelating agent or placebo were determined as were the numbers of fillings and symptoms allegedly due to subjective symptoms. The dental status was charted. Blood was analysed on 13 parameters. The analysis revealed neither the parameters in blood nor the subjective symptoms to be associated with a dimension dominated by 'mercury indicators'. The final analysis was therefore performed with 'number of subjective symptoms' and enabled to distinguish two subsamples. One subsample was characterised by > 2 subjective "symptoms", highest scores for U-Hg, P-Hg and filled surfaces, and chewing gum for > 1 h a day. The other subsample comprised the subjects with few filled surfaces and low U-Hg and P-Hg, but was not characterised by "no subjective symptoms". The chelator was considered neither to invalidate nor to improve these findings and was concluded not to be helpful in diagnosing "symptoms". The chelator caused side effects in 42% of the subjects and the placebo in 27%. A relationship between amalgam fillings and subjective symptoms could not be shown. Therefore, the mere fact of knowing to have amalgam fillings was assumed to be the reason why subjective symptoms were attributed to amalgam and side effects were ascribed to the treatment.

Urinary bladder diverticula are formed by the herniation of the mucosa into the muscle layer of the bladder wall, often ending with a narrow neck that communicates with the bladder lumen. They may be congenital or acquired, and they most often affect males. Urinary bladder diverticula discovery during autopsy incidence described in the literature is approximately 5–10%. Various causative factors have been described, including urinary tract obstruction (e.g., benign prostate hyperplasia) and neurogenic and iatrogenic causes. The most described site of occurrence is adjacent to the ureteral orifice. Their clinical presentation does not often facilitate diagnosis, as most are small and asymptomatic. Complications of urinary bladder diverticulosis include infections, lithiasis, neoplasia, pressure on adjacent tissues, obstruction, and rupture. Indeed, urinary bladder diverticula may lead to spontaneous bladder rupture in extremely rare cases. This paper presents the case of an 87-year-old female suffering from atrial fibrillation and under anticoagulant therapy who was pronounced dead in a hospital and was subsequently referred to our department for medico-legal examination. Upon macroscopic examination of the body, intra-abdominal hemorrhage was observed in the vicinity of the urinary bladder, extraperitoneally. A meticulous examination excluded the possibility of injury as the cause of this finding, and tissue samples were collected for histopathological examination. A ruptured urinary diverticulum was discovered and confirmed histopathologically. Death was attributed to intra-abdominal hemorrhage after rupture of urinary bladder diverticulum. A forensic pathologist should be aware of this diagnosis, as although extremely rare, such pathology may lead to death, especially when the patient is under anticoagulant therapy. [ABSTRACT FROM AUTHOR]

The child welfare system's method of service delivery shifted abruptly during the pandemic to a telehealth modality. The perceived impact of this change upon service delivery is largely unknown, however. The purpose of this study was to describe how a large child welfare agency shifted to telehealth delivery, including investigating barriers and innovative strategies that were undertaken to resolve obstacles and enhance engagement and the provision of services. In September, 2020, direct service providers, supervisors and clinic directors at a large, Southeastern child welfare agency completed a survey that tapped into the perceived impact of telehealth on service delivery, and barriers and benefits of telehealth delivery. Twenty-six (n = 26) individuals completed the survey. Over half of participants reported an improvement in service delivery through the use of telehealth, and most saw it as being beneficial to both families and staff. Few participants believed that services were negatively impeded by telehealth.The main barrier to telehealth delivery was technology access and navigation (both on the part of families and staff). Telehealth was largely perceived as a facilitator to child welfare service delivery; implications and use of remote platforms are discussed. [ABSTRACT FROM AUTHOR]

We study the complexity of infinite-domain constraint satisfaction problems (CSPs): our basic setting is that a complexity classification for the CSPs of first-order expansions of a structure 21 can be transferred to a classification of the CSPs of first-order expansions of another structure 53. We exploit a product of structures (the algebraic product) that corresponds to the product of the respective polymorphism clones and present a complete complexity classification of the CSPs for first-order expansions of the n-fold algebraic power of (ℚ;<). This is proved by various algebraic and logical methods in combination with knowledge of the polymorphisms of the tractable first-order expansions of (ℚ;<) and explicit descriptions of the expressible relations in terms of syntactically restricted first-order formulas. By combining our classification result with general classification transfer techniques, we obtain surprisingly strong new classification results for highly relevant formalisms such as Allen's Interval Algebra, the n-dimensional Block Algebra, and the Cardinal Direction Calculus, even if higher-arity relations are allowed. Our results confirm the infinite-domain tractability conjecture for classes of structures that have been difficult to analyze with older methods. For the special case of structures with binary signatures, the results can be substantially strengthened and tightly connected to Ord-Horn formulas; this solves several longstanding open problems from the artificial intelligence (AI) literature. [ABSTRACT FROM AUTHOR]

Aims Atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), and clinical outcomes of patients with AF vary depending on its subtype. While AF progression characterized by the transition from paroxysmal AF to persistent AF is sometimes observed, the incidence and clinical impact of AF progression in patients with HFpEF remain to be explored. Methods and results We enrolled patients with HFpEF and paroxysmal AF from the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study. AF progression was defined as the transition from paroxysmal AF to persistent AF. A total of 718 patients (median age: 72 years, 36% were female) were enrolled. For a median follow-up of 6.0 years (interquartile range: 3.0–10.2 years), AF progression occurred in 105 patients (14.6%), with a cumulative incidence of 16.7% at 10 years. In the multivariable Cox proportional hazards model, previous hospitalization for heart failure [hazard ratio (HR) 1.74, 95% confidence interval (CI) 1.16–2.60; P = 0.007] and left atrial diameter (per 5-mm increase) (HR 1.37, 95% CI 1.20–1.55; P < 0.001) were significantly associated with AF progression. Furthermore, AF progression was significantly linked to worsening heart failure (adjusted HR 1.68, 95% CI 1.18–2.40; P = 0.004). Notably, 27 cases (26%) of worsening heart failure occurred within 1 year following AF progression. Conclusion In patients with HFpEF, AF progression is significantly associated with adverse outcomes, particularly worsening heart failure. An increased risk is observed in the early phases following progression to persistent AF. Registration Clinical Trials.gov Identifier: NCT00418041 [ABSTRACT FROM AUTHOR]

Periodontal diseases, ranging from gingivitis to periodontitis, are prevalent oral diseases affecting over 50% of the global population. These diseases arise from infections and inflammation of the gums and supporting bones, significantly impacting oral health. The established link between periodontal diseases and systemic diseases, such as cardiovascular diseases, underscores their importance as a public health concern. Consequently, the early detection and prevention of periodontal diseases have become critical objectives in healthcare, particularly through the integration of advanced artificial intelligence (AI) technologies. This paper aims to bridge the gap between clinical practices and cutting-edge technologies by providing a comprehensive review of current research. We examine the identification of causative factors, disease progression, and the role of AI in enhancing early detection and treatment. Our goal is to underscore the importance of early intervention in improving patient outcomes and to stimulate further interest among researchers, bioengineers, and AI specialists in the ongoing exploration of AI applications in periodontal disease diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have explored facilitators and barriers to research conducted by allied health professionals in general medical settings. Since the mental health system is acknowledged to be significantly under-funded and more poorly functioning than general medical services, it is unclear whether the published facilitators and barriers also apply to mental health settings. This study sought to explore the research-related knowledge, understanding and practices of allied mental health clinicians based in a large public mental health service. Methods: A mixed methods study recruited 59 occupational therapists and social workers working in a dedicated metropolitan public mental health service in Melbourne, Australia. Quantitative survey results are reported elsewhere. Semi-structured interviews were conducted with 16 survey responder volunteers. Thematic analysis was conducted on the qualitative survey and interview data. Results: Four main themes were identified: research must connect with clinical practice; fragments of knowledge; research in practice; and research is not part of my professional identity. The third theme, research in practice, comprised four subthemes: no time for research in clinical roles, missing communication, lack of ownership, and what I need to do research. Conclusions: This study found that research and research-related activities were not considered part of the mental health social workers and occupational therapists' professional identities. Dealing with this issue may be instrumental to the realization of these clinicians' professional peak-body associations' code of practice and to government mandated practice standards. We provided several strategies to encourage both clinicians and services to view research-related activities as an everyday part of clinical roles. This is especially important if we think of allied health evidence-based practice requiring a reasonable level of research-related skills and/or competencies to appraise, practice, evaluate and adapt their evidence-based practice. [ABSTRACT FROM AUTHOR]

Aim: To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses. Design: Integrative literature review. Data Sources: Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases. Review Methods: A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected. Results: Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence‐based nursing practice for high‐quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under‐researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice. Conclusion: Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence‐based research infrastructures. Impact: Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses. Reporting Method: The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community. Patient or Public Contribution: No patient or public contribution was included in this review. [ABSTRACT FROM AUTHOR]

Introduction: The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA. Methods: Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991–1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI). Results: Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA2) activity (HR 1.33; CI 1.17–1.52) and mass (HR 1.20; CI 1.05–1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36–1.76), copeptin (HR 1.46; CI 1.19–1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11–1.48), and cystatin C (HR 1.19; 95% 1.10–1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20–2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13–1.73), cystatin C (HR 1.21; CI 1.02–1.43), and CRP (HR 1.53; CI 1.13–1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease. Conclusions: Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA. [ABSTRACT FROM AUTHOR]

A proportion of patients who undergo intraoperative cholangiogram (IOC) do not have bile duct stones at the time of endoscopic retrograde cholangiopancreatography (ERCP), either due to the spontaneous passage of stones or a false-positive IOC. Glucagon has been utilized as an inexpensive tool to allow the passage of micro-choledocholithiasis to the duodenum and resolve filling defects caused by stones or air bubbles. The purpose of our study is to understand the change in diagnostic accuracy of IOC to detect choledocholithiasis with intraoperative glucagon. We conducted a retrospective study at a tertiary care center on adult patients who underwent laparoscopic cholecystectomy with IOC. The diagnostic accuracy of IOC was assessed before and after the administration of intravenous glucagon. Of 1455 patients, 374 (25.7%) received intraoperative glucagon, and 103 of these 374 patients (27.5%) showed resolution of the filling defect with the passage of contrast to the duodenum. Pre- and post-glucagon administration comparison showed enhancement in specificity from 78% to 83%, an increase in positive predictive value from 67.3% to 72.4%, and an improvement in the diagnostic accuracy of IOC from 81.5% to 84.3%. Our findings suggest that intraoperative glucagon administration carries the potential to reduce the rate of false-positive IOCs, thereby reducing the performance of unnecessary ERCPs. [ABSTRACT FROM AUTHOR]

Deep learning models have achieved impressive performance in various tasks, but they are usually opaque with regards to their inner complex operation, obfuscating the reasons for which they make decisions. This opacity raises ethical and legal concerns regarding the real-life use of such models, especially in critical domains such as in medicine, and has led to the emergence of the eXplainable Artificial Intelligence (XAI) field of research, which aims to make the operation of opaque AI systems more comprehensible to humans. The problem of explaining a black-box classifier is often approached by feeding it data and observing its behaviour. In this work, we feed the classifier with data that are part of a knowledge graph, and describe the behaviour with rules that are expressed in the terminology of the knowledge graph, that is understandable by humans. We first theoretically investigate the problem to provide guarantees for the extracted rules and then we investigate the relation of "explanation rules for a specific class" with "semantic queries collecting from the knowledge graph the instances classified by the black-box classifier to this specific class". Thus we approach the problem of extracting explanation rules as a semantic query reverse engineering problem. We develop algorithms for solving this inverse problem as a heuristic search in the space of semantic queries and we evaluate the proposed algorithms on four simulated use-cases and discuss the results. [ABSTRACT FROM AUTHOR]

Given two datasets, i.e., two sets of tuples of constants, representing positive and negative examples, logical separability is the reasoning task of finding a formula in a certain target query language that separates them. As already pointed out in previous works, this task turns out to be relevant in several application scenarios such as concept learning and generating referring expressions. Besides, if we think of the input datasets of positive and negative examples as composed of tuples of constants classified, respectively, positively and negatively by a black-box model, then the separating formula can be used to provide global post-hoc explanations of such a model. In this paper, we study the separability task in the context of Ontology-based Data Management (OBDM), in which a domain ontology provides a high-level, logic-based specification of a domain of interest, semantically linked through suitable mapping assertions to the data source layer of an information system. Since a formula that properly separates (proper separation) two input datasets does not always exist, our first contribution is to propose (best) approximations of the proper separation, called (minimally) complete and (maximally) sound separations. We do this by presenting a general framework for separability in OBDM. Then, in a scenario that uses by far the most popular languages for the OBDM paradigm, our second contribution is a comprehensive study of three natural computational problems associated with the framework, namely Verification (check whether a given formula is a proper, complete, or sound separation of two given datasets), Existence (check whether a proper, or best approximated separation of two given datasets exists at all), and Computation (compute any proper, or any best approximated separation of two given datasets). [ABSTRACT FROM AUTHOR]

The most serious long-term effects of diabetes is peripheral artery disease (PAD) which increases the chance of developing diabetic foot ulcers, gangrene and even lower limb amputation. The clinical manifestations of PAD which are typically not revealed until symptoms like intermittent claudication, rest pain and ischemic gangrene develop, are not present in majority of diabetes mellitus patients with PAD due to diabetic peripheral neuropathy. Therefore, current study is aimed to evaluate the inflammatory and endothelial dysfunction markers with their correlation to biomarkers that can help for in-time diagnosis and efficient prognosis of developing diabetes-associated PAD. Enzyme-linked immunosorbent assay was used to evaluate the interlukin-6, interlukin-8, intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) in PAD with diabetes group, diabetic group and healthy individual group while biomarkers were measured by kit method. It was observed that serum IL-6, IL-8, ICAM and VCAM levels in type II diabetes mellitus (T2DM) with PAD patients were increased significantly (85.93, 597.08, 94.80 and 80.66) as compared to T2DM patients (59.52, 231.34, 56.88 and 50.19) and healthy individuals (4.81, 16.93, 5.55 and 5.16). The overall means for the parameters, IL-6, IL-8, ICAM, VCAM, urea, S/creatinine, CK-MB, AST, ALT, cholesterol, triglyceride, HDL, LDL, PT, aPTT, INR, HbA1C, and CRP within all groups were significantly (P < 0.05) different from each other. Therefore, it was concluded that the change in IL-6, IL-8, ICAM and VCAM can serve as an accurate diagnostic indicator and successful treatment. [ABSTRACT FROM AUTHOR]

Dental caries is a multifactorial chronic disease resulting from the intricate interplay among acid‐generating bacteria, fermentable carbohydrates, and several host factors such as saliva. Saliva comprises several proteins which could be utilized as biomarkers for caries prevention, diagnosis, and prognosis. Mass spectrometry‐based salivary proteomics approaches, owing to their sensitivity, provide the opportunity to investigate and unveil crucial cariogenic pathogen activity and host indicators and may demonstrate clinically relevant biomarkers to improve caries diagnosis and management. The present review outlines the published literature of human clinical proteomics investigations on caries and extensively elucidates frequently reported salivary proteins as biomarkers. This review also discusses important aspects while designing an experimental proteomics workflow. The protein–protein interactions and the clinical relevance of salivary proteins as biomarkers for caries, together with uninvestigated domains of the discipline are also discussed critically. [ABSTRACT FROM AUTHOR]

Purpose: Inflammatory biomarkers associated with peripheral artery disease (PAD) have been examined separately; however, an algorithm that includes a panel of inflammatory proteins to inform prognosis of PAD could improve predictive accuracy. We developed predictive models for 2-year PAD-related major adverse limb events (MALE) using clinical/inflammatory biomarker data. Methods: We conducted a prognostic study using 2 phases (discovery/validation models). The discovery cohort included 100 PAD patients that were propensity-score matched to 100 non-PAD patients. The validation cohort included 365 patients with PAD and 144 patients without PAD (non-matched). Plasma concentrations of 29 inflammatory proteins were determined at recruitment and the cohorts were followed for 2 years. The outcome of interest was 2-year MALE (composite of major amputation, vascular intervention, or acute limb ischemia). A random forest model was trained with 10-fold cross-validation to predict 2-year MALE using the following input features: 1) clinical characteristics, 2) inflammatory biomarkers that were expressed differentially in PAD vs non-PAD patients, and 3) clinical characteristics and inflammatory biomarkers. Results: The model discovery cohort was well-matched on age, sex, and comorbidities. Of the 29 proteins tested, 5 were elevated in PAD vs non-PAD patients (MMP-7, MMP-10, IL-6, CCL2/MCP-1, and TFPI). For prognosis of 2-year MALE on the validation cohort, our model achieved AUROC 0.63 using clinical features alone and adding inflammatory biomarker levels improved performance to AUROC 0.84. Conclusion: Using clinical characteristics and inflammatory biomarker data, we developed an accurate predictive model for PAD prognosis. Plain Language Summary: Inflammatory biomarkers associated with peripheral artery disease (PAD) have been examined separately; however, an algorithm that includes an inflammatory protein panel to inform prognosis of PAD may improve predictive accuracy. We developed predictive models for 2-year major adverse limb events (MALE) using clinical characteristics (demographics, comorbidities, and medications) and a panel of 5 PAD-specific inflammatory biomarkers (MMP-7, MMP-10, IL-6, CCL2/MCP-1, and TFPI) that achieved excellent performance on an independent validation cohort (AUROC 0.84). The models developed through this study may support PAD risk-stratification and targeted management strategies. [ABSTRACT FROM AUTHOR]

Health professions education (HPE) has matured into field of study that employs and produces specialized educational scholars. Many academic institutions employ such scholars to support development and innovation in education. Simultaneously, the possibilities to obtain a PhD degree in HPE are expanding. Clarity in the expectations that such a degree brings along can be useful for scholars, employers and institutions. Anticipating that the views of what a PhD in HPE is or should be can vary between institutions, cultures and countries, we conducted an international Delphi study to identify EPAs for HPE PhDs. We used a framework of 24 EPAs resulted from a national consensus study in Iran as input to seek more generalized validity and a wider consensus of reasonably suitable activities. A three-round modified Delphi study was conducted with participation of 15 international experts. Final framework consisted of 17 relevant EPAs with a justification, specifications and limitations, and risks in case of failure per EPA (all had overall CVI > 0.8 for adequacy of description). Eleven EPAs were considered by the majority to be core to PhD training, 16 to be desirable for HPE PhDs as a capability to carry out without supervision, but the majority would trust current HPE PhDs to carry out only 5 of the 17 without supervision. The EPAs identified in this study arguably reflect the expectations of educators with a PhD degree in HPE. The framework has the potential to advance HPE training across countries and to inform personal development and employment decisions., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD)., Methods: A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs). The methodological quality of the included studies was assessed utilizing the validated Quality of Health Economics Studies (QHES) checklist. Subsequently, a qualitative analysis was performed to synthesize the collected data. We converted the incremental cost-effectiveness ratios (ICERs) into the equivalent amount in US dollars for the year 2024., Results: Out of 315 identified articles, 11 met inclusion criteria and were included in the review. RIV + ASA was generally found to be cost-effective, with ICERs falling within acceptable willingness-to-pay (WTP) thresholds. However, substantial variation in ICERs was observed across studies due to differences in healthcare systems, drug pricing, and WTP thresholds. In these studies, ICERs per quality-adjusted life-year (QALY) were (in 2024 US dollars) US$4939 to $29,162 for all patients, $10,385 to $85,394 for CAD, and $1013 to $40,244 for PAD in different studies. RIV + ASA was more cost-effective in high-risk subgroups, such as patients with PAD. Key drivers of cost-effectiveness included mortality rates, the cost of rivaroxaban, and utility scores., Conclusions: RIV + ASA appears to be a cost-effective treatment option for patients with CAD or PAD or both. Future research should address geographical biases, consider societal perspectives, and explore alternative treatment options to optimize resource allocation and improve patient outcomes in the management of CVDs. Future research should also consider evaluating the cost-effectiveness of alternative new oral anticoagulants (NOACs) to provide a broader perspective on treatment options for CVD., Competing Interests: Declarations. Ethics approval: This study was approved by the Research Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1402.1051). Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This scoping review focuses on the evolution of pre-analytical errors (PAEs) in medical laboratories, a critical area with significant implications for patient care, healthcare costs, hospital length of stay, and operational efficiency. The Covidence Review tool was used to formulate the keywords, and then a comprehensive literature search was performed using several databases, importing the search results directly into Covidence (n=379). Title, abstract screening, duplicate removal, and full-text screening were done. The retrieved studies (n=232) were scanned for eligibility (n=228) and included in the review (n=83), and the results were summarised in a PRISMA flow chart. The review highlights the role of healthcare professionals in preventing PAEs in specimen collection and processing, as well as analyses. The review also discusses the use and advancements of artificial intelligence (AI) and machine learning in reducing PAEs and identifies inadequacies in standard definitions, measurement units, and education strategies. It demonstrates the need for further research to ensure model validation, address the regulatory validation of Risk Probability Indexation (RPI) models and consider regulatory, safety, and privacy concerns. The review suggests that comprehensive studies on the effectiveness of AI and software platforms in real-world settings and their implementation in healthcare are lacking, presenting opportunities for further research to advance patient care and improve the management of PAEs., (© 2025 the author(s), published by De Gruyter, Berlin/Boston.)

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Vulnerable plaque is closely related to the occurrence of ischemic stroke. Therefore, early accurate identification of plaque vulnerability is crucial in risk stratification. In the development of vulnerable plaques, the change of the adventitia is earlier than that of the intima. Currently, researchers focused on the ultrasound detection of intraplaque and intima, but adventitia was often ignored in the examination. Real-time elastography technology (RTE) provides an estimation of adventitia stiffness, and contrast-enhanced ultrasound (CEUS) provides the quantification of adventitial VV. Therefore, we aimed to evaluate the value of adventitia in the early diagnosis of plaque vulnerability by combining CEUS and RTE based on histopathology. Rabbit carotid atherosclerosis models were established, and CEUS and RTE were performed. Normalized maximal video-intensity enhancement (MVE) was calculated to quantify adventitial VV density, and strain values were acquired to evaluate the adventitial elasticity. After removal of the lesion lumen, histological analysis of each excised plaque and adventitia was performed, and vulnerable plaques (n = 32) and stable group (n = 13) were distinguished. Normalized MVE of the adventitial VV and adventitial strain values in the vulnerable group was significantly higher than those in the stable group. Normalized MVE and strain values had a positive linear correlation with histological findings. Normalized MVE of the adventitial VV combined with adventitial strain values could identify plaque vulnerability with the area under the curve of 0.913 (sensitivity 90% and specificity 97%). Accordingly, the multimodal ultrasound detection strategy of adventitia has a high diagnostic value for early plaque vulnerability. [ABSTRACT FROM AUTHOR]

Background and Objectives: Inflammatory proteins and their prognostic value in patients with carotid artery stenosis (CAS) have not been adequately studied. Herein, we identified CAS-specific biomarkers from a large pool of inflammatory proteins and assessed the ability of these biomarkers to predict adverse events in individuals with CAS. Materials and Methods: Samples of blood were prospectively obtained from 336 individuals (290 with CAS and 46 without CAS). Plasma concentrations of 29 inflammatory proteins were determined at recruitment, and the patients were followed for 24 months. The outcome of interest was a major adverse cardiovascular event (MACE; composite of stroke, myocardial infarction, or death). The differences in plasma protein concentrations between patients with vs. without a 2-year MACE were determined using the independent t-test or Mann–Whitney U test to identify CAS-specific prognostic biomarkers. Kaplan–Meier and Cox proportional hazards analyses with adjustment for baseline demographic and clinical characteristics were performed to assess the prognostic value of differentially expressed inflammatory proteins in predicting a 2-year MACE in patients with CAS. Results: The mean age of the cohort was 68.8 (SD 10.2) years and 39% were female. The plasma concentrations of two inflammatory proteins were significantly higher in individuals with a 2-year MACE relative to those without a 2-year MACE: IL-6 (5.07 (SD 4.66) vs. 3.36 (SD 4.04) pg/mL, p = 0.03) and CD163 (233.825 (SD 230.306) vs. 159.673 (SD 175.669) pg/mL, p = 0.033). Over a follow-up period of 2 years, individuals with elevated levels of IL-6 were more likely to develop MACE (HR 1.269 (95% CI 1.122–1.639), p = 0.042). Similarly, over a 2-year period, patients with high levels of CD163 were more likely to develop MACE (HR 1.413 (95% CI 1.022–1.954), p = 0.036). Conclusions: The plasma levels of inflammatory proteins IL-6 and CD163 are independently associated with adverse outcomes in individuals with CAS. These CAS-specific prognostic biomarkers may assist in the risk stratification of patients at an elevated risk of a MACE and subsequently guide further vascular evaluation, specialist referrals, and aggressive medical/surgical management, thereby improving outcomes for patients with CAS. [ABSTRACT FROM AUTHOR]

Background: The concept of entrustable professional activities (EPAs) has recently been extended to operationalize professional tasks in teacher training and faculty development in health professions education. The aim of this study is to report on the process and results of defining a set of teaching EPAs (t-EPAs) tailored to the local characteristics of a particular undergraduate medical program. Methods: The undergraduate medical program at the Charité – Universitätsmedizin Berlin is competency-based, integrates thematic modules and spans 6 years. A writing team identified teaching EPAs based on the program's study regulations and drafted content descriptions with titles, specifications and knowledge, skills and attitudes. Content validation involved a modified Delphi procedure with a systematic, iterative interaction between a panel of content experts consisting of purposively selected educators and physicians from our faculty (n = 11) and the writing team. The threshold for a consensus was an agreement of 80% of the participants. Results: After two Delphi rounds, a consensus was reached regarding the teaching activities to be included and their content descriptions. The response rate was 100% in both Delphi rounds. The Delphi results include the content descriptions of a total of 13 teaching EPAs, organized into the two overarching EPA domains of classroom-based (n = 10) and workplace-based (n = 3) activities. Tailoring the classroom EPAs to small group teaching and the workplace EPAs to supervising medical students led to several distinct EPAs. Another feature was the development of 2 teaching EPAs for interdisciplinary teaching. Conclusions: In systematic, Delphi-based process, we defined a set of 13 distinct teaching EPAs tailored to a specific undergraduate medical program that cover the core teaching tasks for faculty in this program. Our report on the principles of the process and the results may guide other medical schools and educators in defining and tailoring teaching EPAs according to their contexts. [ABSTRACT FROM AUTHOR]