Democritus University of Thrace

Background Over the last decades the study of schizophrenia-spectrum disorders has been focused on early and comprehensive intervention during the first episode of psychosis (FEP), but studies in rural settings are only rare. In Greece mental healthcare in rural areas is mostly delivered by the locally-based Mobile Mental Health Units (MMHUs). Aims The aim of the present study was to address treatment of FEP patients by the MMHUs in rural areas in Greece, focusing on patients with a first episode of schizophrenia. Method This is a multicenter, retrospective observational study with the participation of nine MMHUs across several areas in rural mainland and some islands of Greece. Patients of the age range of 15 to 55 years with a diagnosis of non-affective psychosis were included in the study. Results The study sample consisted of 216 patients, while analysis was performed for patients with a diagnosis of schizophrenia ( n = 153, 70.8% of the sample). Most patients were males ( n = 93, 60.8%), with a mean age at first presentation 34.9 years ( Md = 34.5, SD = 11.94). The mean duration of untreated psychosis (DUP) was 7.85 months ( Md = 3, IQR = 10.00) and was shorter in younger (15–25 years) patients. More than 60% of patients had been successfully engaged to treatment with the MMHUs, with a mean follow-up duration of 5.17 years ( Md = 5.00, IQR = 5.00). Younger patients (26–35 years) tend to disengage from treatment, while those aged 36 to 45 years were more likely to continue follow-up. A reduction of 47.22% in hospital admissions among patients with schizophrenia was observed over follow-up of patients by the MMHUS. Conclusion The most noteworthy findings of the study are the low percentage of patients seeking help from the MMHUs, compared to the expected cases and the high attendance rate of those that are examined in this context. Further research on psychosis/schizophrenia in the rural context is warranted.

This research uses a self-report questionnaire to examine how humour styles based on Martin’s taxonomy (affiliative, self-enhancing, aggressive, and self-defeating) may moderate the relationship between Dark Triad personality traits (Machiavellianism, narcissism, and psychopathy) and bullying behaviors among 662 university students. Significant positive correlations between Dark Triad traits and bullying emerged, as well as gender, with males scoring higher in all variables. Moderation analyses showed that affiliative humour reduced the impact of narcissism on bullying, while aggressive enhanced it. Additionally, self-enhancing and aggressive humour increased the impact of psychopathy on bullying behaviors. These results suggest that humour styles play a crucial role in the dynamics of bullying in relation to Dark Triad personality traits, offering new insights for intervention strategies.

This paper aims to forecast deviations of the US output measured by the industrial production index (IPI), from its long-run potential output, known as output gaps. These gaps are important for policymakers when designing relevant economic policies, especially when a negative output gap may show economic slack or underperformance, often associated with higher unemployment and low inflation. We use a dataset that includes 32 explanatory economic and financial variables and 18 lags of the IPI, spanning the period from 2000:1 to 2022:12, resulting in 50 variables and 276 monthly observations. The dataset is fed to five well-established machine learning (ML) methods, namely decision trees, random forests, XGBoost, long short-term memory (LSTM) and support vector machines (SVMs), coupled with the linear, the RBF and the polynomial kernel. Moreover, we use the standard elastic net logit method from the area of econometrics as a benchmark. Our results indicate that the tree-based ML techniques perform better in-sample, and the best overall forecasting model is the XGBoost achieving an out-of-sample accuracy of 91.67%.

The tumor microenvironment has a significant input on prognosis and also for predicting clinical outcomes in various types of cancers. However, tumor tissue is not always available, thus, rendering peripheral blood a preferable alternative in the search for prognostic and predictive gene signatures. Head and neck squamous cell carcinoma (HNSCC) constitutes a quite heterogeneous disease characterized by poor prognosis. Therefore, the discovery of novel therapeutics based on prognostic gene signatures for effective disease governance is of paramount importance. In this study, we report for the first time an immune-gene signature identified in the peripheral blood of HNSCC patients comprising five genes (CLEC4C, IL23A, LCK, LY9, and CD19) which were more than threefold downregulated as compared to healthy individuals and were associated with poor prognosis. By performing analyses of HNSCC tumor samples from The Cancer Genome Atlas (TCGA) database, we discovered that decreased expression of these genes, both as single genes and as a 5-gene signature (5-GS), was significantly correlated with worse overall survival (OS). Our data show that the levels of expression of the 5-GS represent an immune profile predicting OS in patients with HNSCC.

Triggered by the need for developing a comprehensive flood protection strategy (referred to as the Master Plan) for Western Thessaly in Central Greece, we demonstrate a strategic approach for large-scale hydrosystems, where the need for design accuracy is contrasted to extreme computational burden. The area of interest occupies approximately 6,400 km², thus constituting a mega-scale hydrological, hydraulic and water management system, which poses multiple conceptual and computational challenges. The overall question is to provide a synthesis of flood protection solutions and prioritize them under a multipurpose prism. The core methodological framework comprises two axes: (i) a semi-distributed representation of the rainfall-runoff transformations and flood routing processes across the entire study area, and (ii) a coupled 1D/2D hydrodynamic simulation, targeted only over the flood prone riverine system and the highly complex network of main artificial channels. Key results show reductions in flood extents by up to 15% in high-risk areas and significant attenuation of peak flows (averaging to 56% across all dam sites). The final planning prioritizes the strengthening of flood protection through the combined influence of a set of large-scale projects, i.e., dikes, multi-purpose dams and retention basins of controlled inundation. The cornerstone objective is to sketch a framework for facing similar studies in a holistic manner, while maintaining a high level of computational efficiency and explainability.

Objective To evaluate the effects of resistance training on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus (T2DM) and overweight/obesity. Design Systematic review and meta-analysis of randomised controlled trials (RCTs). Data sources PubMed, Web of Science, Scopus, Science Direct, Cochrane Library and Google Scholar databases were searched from inception up to May 2024. The search strategy included the following keywords: diabetes, resistance exercise and strength training. Eligibility criteria for selecting studies RCTs published in English comparing resistance training alone with non-exercising standard treatment. Participants were adults diagnosed with T2DM and concurrent overweight/obesity (body mass index (BMI) ≥25 kg/m ² ). Results A total of 18 RCTs qualified involving 1180 patients (48.6/51.4 female/male ratio; 63.3±7.0 years; 29.3±4.3 kg/m ² ). Waist circumference (standardised mean differences (SMD) −0.85 cm, 95% CI −1.66 to −0.04), waist-to-hip ratio (SMD −0.72, 95% CI −1.30 to −0.15), high-density lipoprotein cholesterol (SMD +0.40 mg/dL, 95% CI 0.07 to −0.72), triglycerides (SMD −0.54 mg/dL, 95% CI −1.06 to −0.02), fasting blood glucose (SMD −0.65 mmol/L, 95% CI −1.19 to −0.12), fasting insulin (SMD −0.74 uIU/mL, 95% CI −1.12 to −0.36) and glycated haemoglobin (SMD −0.32%, 95% CI −0.63 to −0.01) improved compared with standard treatment. The risk of bias was low to unclear, and the quality of evidence was very low to moderate. Conclusions Resistance training as a standalone exercise intervention in the management and treatment of T2DM with concurrent overweight/obesity is associated with many cardiometabolic benefits when compared with standard treatment without exercise. PROSPERO registration number CRD42022355612.

In recent years, machine learning (ML), supported by the surge in computational power, has been integrated into numerous research domains, providing vital solutions to a broad spectrum of challenges. However, the increasing volume and complexity of data utilized by ML systems have necessitated the exploration of new methods to quicken and refine the precision of existing ML algorithms. The utilization of satellite data in agriculture has grown extensively, providing numerous opportunities to improve different facets of agricultural management and productivity. Interestingly, the volume of data produced increases exponentially with time posing a challenge for classical ML computing methods. Quantum computers, capable of exploiting an exponentially vast quantum state space via quantum superposition and entanglement, are aptly suited to handle such data volumes. Therefore, the integration of classical ML algorithms with quantum computing, known as quantum machine learning (QML), holds significant promise in processing satellite data. In our research, we developed, trained, and evaluated novel hybrid classical-quantum multilayer neural networks, comparing their efficacy with conventional classical networks. We applied QML to two classification tasks, namely the classification of rice and cotton crops using satellite data obtained by Sentinel-1 and Sentinel-2 satellites. Our results show that integrating quantum neurons into classical multilayer neural networks substantially improves their performance.

Introduction: Meta-analyses of prevalence studies reporting rare anatomic variants are prone to selective reporting of non-null, confirmatory results, thus resulting in publication bias. Aim: We aim to numerically approach this bias and evaluate the most widely used methods for its assessment. Materials and methods: We used probability theory over three sets of real-world and a single set of simulation data to assess the maximum publication bias due to selective reporting in meta-analysis of rare anatomic variants. For each individual study, we approximated the theoretical maximum of the neglected, “not published”, part of the truth, as revealed by the corresponding null, non-confirmatory result. Furthermore, we computed the relevant pooled estimate using the Freeman-Tuckey double arcsine transformation under the random effects model and the restricted maximum likelihood (REML) estimation in STATA 18. Finally, we comparatively applied Egger’s and Begg’s test, trim-and-fill analysis, and Doi plot / LFK index to assess publication bias before and after correction for maximum selective reporting. Results: Meta-analyses of prevalence studies reporting rare anatomic variants may exhibit significant publication bias due to selective reporting. This bias grows larger as the included studies report less confirmatory cases and may theoretically reach 50%. From all tools assessing publication bias, the LFK index was suggested to be the most informative. Conclusions: Selective reporting might result in inflated publication bias in meta-analyses of prevalence studies reporting rare anatomic variants. Although the accurate assessment of this kind of bias is highly challenging in both theory and practice, the use of the LFK index is proposed as the most appropriate tool for that purpose.

Introduction: Hepatitis B reactivation and administration of prophylactic antiviral treatment are considered in patients with autoimmune inflammatory rheumatic diseases (AIIRD) undergoing immunosuppressive/immunomodulatory treatment. Data are more robust for rheumatoid arthritis patients receiving bDMARDs but are limited for other AIIRD and drug categories. Methods: Adult patients with AIIRD (inflammatory arthritis [IA] or connective tissue diseases [CTD]) and documented chronic or resolved HBV infection (defined as serum HBsAg positivity or anti-HBcAb positivity in the case of HBsAg non-detection respectively), followed-up in six rheumatology centers in Greece and Italy, were included. Data collected included demographic characteristics, AIIRD medications prior and after HBV screening [cs-DMARDs, (b-ts)- DMARDs, other immunosuppressants initiated and mean glucocorticoid dose], HBV prophylactic treatment, and possible HBV-reactivation (defined as increase in HBV-DNA or HBsAg seroconversion) within one year of HBV screening. Frequency of HBV reactivation and possible association with recorded parameters were examined. Results: During one year of follow-up, HBV reactivation occurred in 5.6% and 7.9% of IA and CTD patients, respectively. In patients with chronic hepatitis B, reactivation rates were 14.8% for IA and 22.2% for CTD, while in patients with resolved hepatitis B were 3.7% and 6%, respectively. In patients with resolved hepatitis B no association was found between HBV reactivation and antiviral prophylactic treatment, or the use of csDMARDs, bDMARDS, or other immunosuppressants. Conclusion: The risk of HBV reactivation was similar between IA and CTD patients and was significantly higher in chronic compared to resolved hepatitis B infection. For the latter, prophylactic treatment was not associated with lower reactivation risk.

The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patient is referred to as overlap syndrome (OS). Patients with OS suffer more frequently from cardiovascular disease (CVD) and carry a higher risk of COPD-related exacerbations than patients with COPD alone, especially when OSA is left untreated. Based on recent evidence, triple therapy, namely inhaled corticosteroid/long-acting muscarinic antagonist/long-acting beta-agonist (ICS-LABA-LAMA), is a treatment strategy in COPD patients with a history of exacerbations and/or CVD comorbidity. While several studies have previously focused on the role of triple therapy in patients with COPD, none of these has examined the potential benefits of this treatment in patients with COPD and concomitant OSA. Moreover, it is unknown whether patients with OS should be treated with triple therapy starting from their initial assessment, since they represent a population at risk for future exacerbations, in comparison to patients with COPD alone. In this commentary, we discuss these issues and highlight the need for further studies regarding the role of triple therapy in outcomes for patients with OS.

Background: Remission of asthma can occur as part of the natural history of the disease; however, the use of biologics can result in disease remission in some patients. Objective: In this post hoc analysis of the RELIght study, we aimed to evaluate clinical remission in real life among patients treated with mepolizumab, to detect possible differences between “remitters” and “nonremitters,” and to evaluate possible predictors of remission. Methods: Clinical remission was defined as the absence of asthma exacerbations, discontinuation of oral corticosteroids (OCS), achievement of asthma control (Asthma Control Test [ACT] ≥ 20), and stable or improved lung function. Results: A total of 146 patients were evaluated; remission was achieved in 40 (27.4%) and 29 (22%) after 12 and 24 months, respectively. At 12 months, the patients in remission had a better baseline ACT score (17.0 [14.0‐19.0] versus 15.0 [12.0‐17.0]; p = 0.027), were more rarely using OCS (35% versus 62.2%; p = 0.004), and required a lower baseline dose of OCS (5.0 mg/day [5.0‐10.0 mg/day] versus 10.0 mg/day [5.0‐15.0 mg/day]; p = 0.042) at baseline, whereas, at 24 months, they less frequently carried a baseline diagnosis of gastroesophageal reflux disease (GERD) (10.3% versus 32%; p = 0.031) and used lower doses of OCS at baseline (5.0 [1.0‐5.0] versus 10.0 [5.0‐15.0]; p = ≤0.001) versus nonremitters; 52.5% of patients had sustained remission, whereas 42.5% experienced relapse. These patients more frequently had GERD versus patients with sustained remission (52.9% versus 4.8%; p = 0.002). Finally, regression analysis has shown that GERD was the only predictor of relapse. Conclusion: Remitters had better asthma control and needed lower doses or no maintenance OCS at baseline, whereas GERD seems to be an important factor that affects remission and relapse.Clinical trial NCT04084613, www.clinical trials.gov</ext-link

Background/objectives: Despite being widely promoted, protein supplementation's overall effectiveness during demanding basketball schedules remains unclear. This study investigated whether increased protein intake can accelerate recovery of muscle function during a 6-day congested basketball microcycle consisting of three consecutive games while accounting for the impact of playing time. Methods: In a randomized, two-trial, cross-over, double-blind repeated measures design, eighteen male basketball players were assigned to a high (High PT) or a moderate (Mod PT) playing time group and participated in two trials, receiving daily either milk protein (PRO trial) or an isoenergetic amount of carbohydrates. Each trial included three consecutive games (days 1-3) and a 72 h recovery period following Game 3 (days 4-6), during which players participated in low-load practice sessions. Isometric and isokinetic peak torque of knee extensors and flexors in the dominant limb, serum creatine kinase (CK) concentration, and erythrocyte glutathione (GSH) levels were assessed prior to each game and practice session. Results: CK increased (p < 0.01) on game days in both groups but recovered earlier in Mod PT compared to High PT. Both eccentric and concentric peak torque was impaired (p < 0.01) up to 24-48 h post-G3 in a velocity-dependent manner. Eccentric peak torque of knee flexors at 60°/s declined to a greater extent in High PT compared to Mod PT (p < 0.01). Protein supplementation resulted in higher erythrocyte GSH concentration at pre-G2 (p < 0.05) and pre-G3 (p < 0.05) compared to placebo in both groups but did not affect any of the study outcomes. Conclusions: Increased protein intake during a congested basketball schedule increases erythrocyte GSH concentration but does not accelerate recovery of muscle function.

The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for “reshuffling” clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

This paper aims to translate the strategy of a Greek manufacturing company into objectives and measures that can be clearly communicated to all units and employees. For this purpose two basic strategic tools are implemented, the Balanced Scorecard (BSC) and the strategy map. Based on the statements about mission, vision, and values of the company, and the strategic analysis, we formulate the strategy on four axes. The company’s strategy map is constructed using the four axes as strategic themes, and the four traditional perspectives of the BSC. Twenty eight objectives and thirty six measures are used, and nine departments are engaged to monitor the performance of objectives in order the company to achieve the determined targets. Finally, ten strategic initiatives are proposed that company must curry out to achieve the targeted performance of strategic objectives and measures.