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Paroxysmal sympathetic hyperactivity risk modeling based on transients in time series describing the autonomic nervous system and cerebral hemodynamics
No full textPurposeOverstimulation of the autonomic nervous system (ANS) in the acute phase after traumatic brain injury (TBI) may lead to paroxysmal sympathetic hyperactivity (PSH) syndrome. This study aimed to investigate the impact of the relationship between ANS activity and cerebral hemodynamics on the development of PSH syndrome.Materials and methodsThis retrospective study included 41 TBI patients admitted to Wroclaw University Hospital (Poland). Among them, 14 were classified as at risk for PSH based on the probabilistic Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM), with 10 rated as 'possible' and 4 as 'probable'. High-resolution neuromonitoring data from the first 72 h post-injury included intracranial pressure (ICP), pressure reactivity index (PRx), baroreflex sensitivity (BRS), arterial blood pressure (ABP), and heart rate (HR). The correlation between ANS activity and cerebral hemodynamics was quantified using the mean, standard deviation, and zero-crossing rate (ZCR) across sliding windows of 3, 6, 12, and 24 h. Logistic regression was used to model PSH risk.ResultsThe PSH risk model, including ZCR-based variability of ANS-cerebral hemodynamic correlations within a 3-h sliding window and adjusted by clinical metadata, achieved the highest performance (AUC 0.72 +/- 0.27), outperforming the clinical metadata-only model (AUC 0.64 +/- 0.18). Aggregated feature importance values indicated that the most predictive relationships were observed between HR-ICP and HR-PRx.ConclusionsIncluding the early post-injury interactions between ANS and cerebral hemodynamics in the clinical characteristics-based PSH risk model may improve its performance. Further studies in larger cohorts are necessary to validate these findings
Optimizing Periodic Operations for Efficient Inland Waterway Lock Management
No full textIn inland waterways, the efficient management of water lock operations impacts the level of congestion and the resulting uncertainty in inland waterway transportation. To achieve reliable and efficient traffic, schedules should be easy to understand and implement, reducing the likelihood of errors. The simplest schedules follow periodic patterns, reducing complexity and facilitating predictable management. Since vessels do not arrive in perfectly regular intervals, periodic schedules may lead to more wait time. The aim of this research is to estimate this cost by evaluating how effective these periodic schedules manage vessel traffic at water locks. The first objective is to estimate a periodic arrival pattern that closely matches a dataset of irregular vessel arrivals at a specific lock. We develop an algorithm that, given a fixed number of vessel streams, solves the problem in polynomial time. The solution then serves as input for the subsequent part, where we consider algorithms that compute operational schedules by formulating an optimisation problem with periodic arrival patterns as input, and the goal is to determine a periodic schedule that minimises the long-run average waiting time of vessels. We present a polynomial-time algorithm for the two-stream case and a pseudo-polynomial-time algorithm for the general case, along with incremental polynomial-time approximation schemes. In our numerical experiments, use AIS data to construct a periodic arrival pattern closely matching the observed data. Our experiments demonstrate that when evaluated against actual data, intuitive and straightforward policies often outperform optimal policies specifically trained on the periodic arrival pattern
Implementing safe and effective treatment for Plasmodium vivax Malaria in pre-elimination endemic settings:A case study of Cambodia
No full textThe Utility of an Attention-Based Performance Validity Test in a Sample of Austrian Early Retirement Claimants
No full textMost performance validity tests (PVTs) are memory-based which might lead to an underestimation of performance validity issues in other cognitive domains. Accordingly, the Groningen Effort Test (GET) was developed as an attention-based PVT to detect noncredible attentional performance. This study aimed to examine the utility of the GET performance validity measures-the GET index score (GETI) and the number of errors (GETE)-in a civil forensic setting. Archival data were drawn from neuropsychological assessments of 132 individuals seeking early retirement in Austria. Performance on the Word Memory Test (WMT) and Reliable Digit Span (RDS) served as an external performance validity criterion. Additionally, correlations between all PVTs and two cognitive ability tests (i.e., the Cognitrone and Test of Attentional Performance) were calculated. GET performance was substantially better for individuals exhibiting valid performance than for individuals exhibiting invalid performance, with moderate (GETId = 0.73) and large (GETEd = 2.20) effect sizes. The GETI showed sensitivity of 71.0% and specificity of 81.8%. The GETE showed sensitivity of 77.4% and specificity of 89.1%. Correlations between the PVTs and the cognitive ability tests were in the small-to-medium range among participants with valid performance. The GET proved valuable in assessing performance validity in early retirement claimants. Of the two GET measures, the GETE was slightly superior to the GETI and should be preferred for clinical use. While the findings indicate that the GET is relatively easy to pass for most individuals, further investigation into its cognitive demands is desirable
Prehabilitation before pancreatic surgery in the Netherlands:insights from a nationwide survey among pancreatic surgeons
No full textBackgroundPrehabilitation programs are increasingly used to optimize patients before pancreatic surgery. A prehabilitation program should include screening, assessment, intervention, and reassessment of multiple patient-related modifiable risk factors. Consensus on the content of a prehabilitation program and which patients should receive prehabilitation is missing. This study aims to assess current preoperative screening practices, surgeons' opinions, and knowledge of prehabilitation and identify existing prehabilitation programs for pancreatic surgery in the Netherlands.MethodsA nationwide descriptive cross-sectional study was conducted. All 15 hospitals providing pancreatic surgery in the Netherlands were included, and an online survey was sent to only one pancreatic surgeon per hospital. The survey was developed by the authors of this paper and based on a previously published survey for prehabilitation in colorectal surgery. Logical ordering and adaptive questioning were used.ResultsAll 15 surgeons responded, and they were all familiar with the term prehabilitation. Twelve hospitals (80%) offered prehabilitation, and in the majority of hospitals (7/12), prehabilitation was offered to all patients. Prehabilitation programs included multiple domains, whereby physical fitness and nutrition were most often included and mental resilience was the least often included domain. Each hospital implemented a different prehabilitation program in terms of included domains, screening methods, and interventions. For the majority of the domains, two or more different forms of screening and three or more different interventions were used across hospitals. A total of 53.3% of surgeons were willing to postpone the surgery of pancreatic malignancies up to a maximum of 4 weeks, 20% up to a maximum of 6 weeks, and 26.7% as long as necessary to optimize the patients' preoperative overall fitness.ConclusionsPancreatic surgeons in the Netherlands have knowledge of prehabilitation, but high variability exists in current practice regarding prehabilitation programs. There is a need for a uniform standardized prehabilitation program to be able to implement prehabilitation in the standard preoperative care pathway and enable comparison of results across hospitals
The indicator amino acid oxidation (IAAO) technique:a novel approach to assess protein intakes that maximize whole-body protein anabolism
No full textDietary protein requirement is defined as the daily intake at which whole-body protein net balance remains in equilibrium and body protein is maintained. Protein intakes to meet the dietary requirement (the Recommended Daily Allowance, RDA; 0.83 g protein<middle dot>kg BM-1<middle dot>d-1) were determined using nitrogen balance methodology. More recently, studies using indirect Indicator Amino Acid Oxidation (IAAO) breakpoint analysis suggest a RDA value of 1.20 g protein<middle dot>kg BM-1<middle dot>d-1. However, since breakpoint analysis determines the protein intake at which whole-body protein net balance is maximized, we suggest the value determined by IAAO analysis represents the maximal anabolic protein intake, not a protein requirement. Several aspects of the IAAO method should be considered prior to its application and/or interpretation, such as: (1) extrapolation of hourly to daily values; (2) extrapolation of free amino acid sip-feeding to whole-foods, and; (3) misidentification of the upper limit of the 95% confidence interval as the intake level that covers 98% of the population. We conclude that the current IAAO method represents a minimally invasive technique allowing elegant within-subject designs to assess the maximal anabolic protein intake. Therefore, data derived from such studies should not be misinterpreted as an estimate of protein requirements
Correction:The support of early-career researchers in health professions education-an expert position statement
No full text[This corrects the article DOI: 10.3389/fmed.2025.1621194.]
AI Opportunistic Coronary Calcium Screening at Veterans Affairs Hospitals
Get PDFBACKGROUND: Coronary artery calcium (CAC) is highly predictive of cardiovascular events. Although millions of chest computed tomography (CT) scans are performed annually in the United States, CAC is not routinely quantified from scans done for noncardiac purposes. METHODS: We developed a deep learning algorithm, AI-CAC, using 446 expert segmentations to automatically quantify CAC on noncontrast, nongated CT scans. Our study differs from prior works by utilizing imaging data from 98 medical centers across the Veterans Affairs national health care system, capturing extensive heterogeneity in imaging protocols, scanners, and patients. AI-CAC performance on nongated scans was compared against clinical standard electrocardiogram (ECG)-gated CAC scoring in 795 patients with paired gated scans within 1 year of their nongated scan. In addition, the model was tested on 8052 low-dose CTs (LDCTs) to simulate opportunistic CAC screening. RESULTS: Nongated AI-CAC differentiated zero versus nonzero and less than 100 versus 100 or greater Agatston scores with accuracies of 89.4% (F1 0.93) and 87.3% (F1 0.89), respectively. Nongated AI-CAC was predictive of 10-year all-cause mortality (CAC 0 vs. >400 group: 25.4% vs. 60.2%, Cox hazard ratio 3.49; P<0.005), and composite first-time stroke, myocardial infarction, or death (CAC 0 vs. >400 group: 33.5% vs. 63.8%, Cox hazard ratio 3.00; P<0.005). In the LDCT dataset, 3091 out of 8052 (38.4%) individuals had AI-CAC scores >400. Four cardiologists qualitatively reviewed a random sample of the >400 AI-CAC LDCT patients and verified that 527 of the 531 (99.2%) would benefit from lipid-lowering therapy. CONCLUSIONS: This nongated CT CAC algorithm was developed across a national health care system and shows strong performance in evaluation against paired gated CT scans. The model code and weights are available at https://github.com/Raffi-Hagopian/AI-CAC/. (Funded by the Veterans Affairs health care system.)
Cost-effectiveness analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands
No full textOBJECTIVE: To assess the cost-effectiveness of cenobamate in epileptic people with focal seizures in the Netherlands. METHODS: A Markov model was used to simulate lifetime costs and quality-adjusted life years (QALYs) for cenobamate compared to perampanel, brivaracetam, and lacosamide from the Dutch societal perspective. Data from a randomized controlled trial and open-label extension were used to determine the transition probability, efficacy and safety of treatment with cenobamate. Treatment, administration, routine monitoring, seizure event management, adverse events and productivity costs were included. Both one-way and probabilistic sensitivity analyses were conducted to explore the uncertainty. RESULTS: Cenobamate was associated with an average total cost of €466,560 and 9.922 QALY gained. Among the four drugs tested, treatment with cenobamate indicated lowest cost and highest QALY gained, suggesting cenobamate dominates all comparators. One-way sensitivity analysis confirms the robustness of our results. Probabilistic sensitivity analyses revealed that at the willingness to pay threshold of €50,000/QALY, the probability that cenobamate is cost-effective was 100%. CONCLUSION: With the acknowledgment of the limitations, we concluded that cenobamate is less costly and more effective, which can be considered a cost-effective treatment option for patients with drug-resistant focal seizures in the Netherlands. Future real-world data are needed to confirm our findings
Healthcare-Associated Infections In Neonatal Intensive Care Units In Public Hospitals, South Ethiopia:Incidence, Risk Factors And Outcomes During 2017-2022
No full textBackground The extent of hospital-associated infections (HAIs) in low-income settings remains largely unknown and underestimated. Our aim is to describe the burden of HAIs associated with hospitalization in neonatal intensive care units (NICUs) in Sidama Region, Ethiopia. Methods We performed a retrospective cohort study at the NICUs of 4 purposely selected public hospitals among 5,216 neonates admitted over a 5-year period (2017-2022). Neonatal surveillance registers were reviewed and patients’ characteristics, HAIs incidence, risk factors, and outcomes of infections were recorded. Bayesian logistic regression analyses were used to control potential confounders. Results Among 5,216 neonates (52,514 observed patient-days), 2,079 cases of HAI were observed (40%), equivalent to 39.59 per 1,000 patient-days. The neonatal mortality rate was 105 deaths per 1,000 live births. Over the 5-year period, the infection rate decreased overall. Risk factors for HAIs were hospital type, place of delivery, antibiotic treatment, and low-birth-weight babies 2,000 to &lt; 2,500 g. Conclusions We found a high incidence of HAIs in NICUs, and HAIs-related deaths were unexpectedly high. Hospital type, place of birth, birth weight, and inappropriate use of antibiotic treatment were risk factors for HAIs. Emphasis should be given to reduce inappropriate antibiotic use and focus on risk factors.</p