Advancements in Microelectromechanical systems (MEMS) have enabled the manufacture of affordable and efficient wearable devices. In sensor-based gait analysis, motion and biofeedback sensor devices are easily attached to different parts of the body. Instrumentation of gait using different sensor technologies enables researchers and clinicians to capture high-resolution quantitative motion data within and beyond the lab. Integration of advanced sensor technologies provides objective and rater-independent multimodal outcomes that complement established clinical examination. Multi-modal data capture in ecologically valid, patient-relevant habitual settings opens new possibilities to monitor fluctuating and rare incidents by informing different aspects of impaired gait. Interconnected device communication and the Internet of Things (IoT) provide the infrastructural platform to enable remote gait assessment. However, an extended period of motion data recorded by different sensor technologies results in a vast amount of unlabelled data. Computational methods and artificial intelligence techniques (e.g., data mining) provide opportunities to manage data collected in unsupervised environments. Although technological advancement and algorithms promote remote gait assessment, more work needs to be done in terms of analytical and clinical validation to achieve robust and reliable gait analysis tools that contribute to better rehabilitation and treatment.
Background Some studies suggest that patients with pulmonary hypertension (PH) may be at higher risk of complications and death after noncardiac surgery. However, the magnitude of these associations is unclear. Objectives To determine the associations between PH and adverse outcomes after noncardiac surgery. Methods We searched PUBMED and EMBASE for studies published from January 1970 to April 2022. We included studies that reported the association between PH and one or more outcomes of interest occurring after noncardiac surgery. Data were pooled using random-effects models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I²=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis (OR 4.02; 95% CI, 2.14-7.54; I²=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I²=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I²=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73–6.60; I²=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81–3.12; I²=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70–21.02; I²=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke (OR 0.93; 95% CI, 0.88–0.98; I²=0%; 3 studies). Conclusion PH is a predictor of morbidity and mortality after noncardiac surgery. High quality studies are needed to determine effective strategies for reducing postoperative complications in this population.
The potential of MRI to predict cartilage mechanical properties across an entire cartilage surface in an ex vivo model would enable novel perspectives in modeling cartilage tolerance and predicting disease progression. The purpose of this study was to integrate MR imaging with full-surface indentation mapping to determine the relationship between femoral cartilage thickness and T2 relaxation change following loading, and cartilage mechanical properties in an ex vivo porcine stifle model. Matched-pairs of stifle joints from the same pig were randomized into either 1) an imaging protocol where stifles were imaged at baseline and after 35 min of static axial loading; and 2) full surface mapping of the instantaneous modulus (IM) and an electromechanical property named quantitative parameter (QP). The femur and femoral cartilage were segmented from baseline and post-intervention scans, then meshes were generated. Coordinate locations of the indentation mapping points were rigidly registered to the femur. Multiple linear regressions were performed at each voxel testing the relationship between cartilage outcomes (thickness change, T2 change) and mechanical properties (IM, QP) after accounting for covariates. Statistical Parametric Mapping was used to determine significance of clusters. No significant clusters were identified; however, this integrative method shows promise for future work in ex vivo modeling by identifying spatial relationships among variables.
Converging evidence has suggested that disturbances in monetary reward processing may subserve the shared biosignature between major depressive disorder (MDD) and obesity. However, there remains a paucity of studies that have evaluated the deficits in specific subcomponents of reward functioning in populations with MDD and obesity comorbidity. We evaluated the association between effort-expenditure for monetary reward and neural activation in regions associated with reward-based decision making (i.e., the caudate nucleus, anterior cingulate cortex (ACC) and hippocampus) in people with MDD and obesity comorbidity. We acquired structural and functional magnetic resonance imaging (fMRI) in 12 participants and performed a spherical region-of-interest analysis (ROI) using previously defined peak MNI coordinates. A one-sample t-test was employed to compare ROI-specific blood-oxygen-level-dependent (BOLD) signal change during the task choice selection window (i.e., high-effort vs. low-effort task) of the effort-expenditure for reward task (EEfRT). We observed no change in activation of the caudate nucleus, ACC or hippocampus in participants with increased BMI when contrasting the high effort > low effort reward magnitude condition for the EEfRT. The findings from our exploratory study evaluated the disturbances in fundamental reward processes, including cost-benefit decision making, in people MDD and obesity. Future studies should further investigate this relationship with a larger sample size.
Background Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer. Methods A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%). Conclusions Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer. Registration The protocol was registered on PROSPERO (registration number: CRD42022334025).
Background: Prostate Specific Membrane Antigen (PSMA) - positron emission tomography (PET) guides metastasis-directed radiotherapy (MDRT) in prostate cancer (PrCa). However, its value as a treatment response assessment tool after MDRT remains unclear. Importantly, there is limited understanding of the potential of radiotherapy (RT) to alter PSMA gene (folate hydrolase 1; FOLH1) expression. Methodology: We reviewed a series of 11 men with oligo-metastatic PrCa (25 metastasis sites) treated with MDRT before re-staging with 18F-DCFPyL (PSMA) PET upon secondary recurrence. Acute effects of RT on PSMA protein and mRNA levels were examined with qPCR and immunoblotting in human wild-type androgen-sensitive (LNCap), castrate-resistant (22RV1) and castrate-resistant neuroendocrine (PC3 and DU145) PrCa cell lines. Xenograft tumors were analyzed with immunohistochemistry. Further, we examined PSMA expression in untreated and irradiated radio-resistant (RR) 22RV1 (22RV1-RR) and DU145 (DU145-RR) cells and xenografts selected for survival after high-dose RT. Results: The majority of MDRT-treated lesions showed lack of PSMA-PET/CT avidity, suggesting treatment response even after low biological effective dose (BED) MDRT. We observed similar high degree of heterogeneity of PSMA expression in both human specimens and in xenograft tumors. PSMA was highly expressed in LNCap and 22RV1 cells and tumors but not in the neuroendocrine PC3 and DU145 models. Single fraction RT caused detectable reduction in PSMA protein but not in mRNA levels in LNCap cells and did not significantly alter PSMA protein or mRNA levels in tissue culture or xenografts of the other cell lines. However, radio-resistant 22RV1-RR cells and tumors demonstrated marked decrease of PSMA transcript and protein expression over their parental counterparts. Conclusions: PSMA-PET may be a promising tool to assess RT response in oligo-metastatic PrCa. However, future systematic investigation of this concept should recognize the high degree of heterogeneity of PSMA expression within prostate tumors and the risk for loss of PSMA expression in tumor surviving curative courses of RT.
Background: Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children. Methods: Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months. Results: Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged. Conclusions: Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.
Background: SLC13A5 related developmental and epileptic encephalopathy (DEE) is an autosomal recessive condition characterized by neonatal seizures, fever sensitivity, status epilepticus, developmental delay and tooth anomalies. The neuroimaging spectrum of SLC13A5 related DEE is not fully known. We present a case of SLC13A5 related DEE with distinct neuroimaging findings and review the neuroimaging findings of all published cases of SLC13A5 related DEE. Methods: A retrospective case review and focused review of the literature was completed. Results: A 16-month-old male with a clinical phenotype consistent with SLC13A5 related DEE and a previously reported pathogenic variant in SLC13A5, c.655G>A, p.Gly219Arg and a novel likely pathogenic variant in SLC13A5, c.202C>T, p.Pro68Ser was identified. MRI at day 5 of life revealed wide spread punctate white matter lesions (PWMLs) affecting the subcortical white matter, periventricular white matter, splenium of the corpus callosum, posterior limb of the internal capsule, corticospinal tracts, midbrain, pons and medulla, mimicking a metabolic/infectious etiology. MRI at one month showed atrophy and evolution of white matter necrosis. One hundred and five cases of SLC13A5 related DEE were identified. Initial MRI was completed in 62 cases (59%). MRI was normal in 41 cases (66%) and abnormal in 21 (34%). White matter abnormalities were most common (n=15, 71%); PWMLs occurred in 8 cases (38%). Conclusion: Neuroimaging abnormalities may exist in a third of SLC13A5 related DEE cases. White matter abnormalities such as PWMLs appear most common. It remains unknown why some are susceptible to these lesions and how they affect long-term neurodevelopmental outcomes in SLC13A5 related DEE.
Discrepancies in phase two and three studies can result in significant patient and financial burden, as well as the nonapproval of potentially efficacious drugs. We aimed to determine whether this discrepancy exists for clinical trials in inflammatory bowel disease (IBD). Electronic databases (MEDLINE and Embase) and clinical trial repositories were searched from 1 January 1946 to 12 March 2021, for paired phase two and three studies of advanced therapies for Crohn’s disease and ulcerative colitis. The primary outcome was to compare clinical remission rates between paired phase two and three studies for Crohn’s disease and ulcerative colitis. Multivariable mixed-model meta-analysis was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). The Cochrane risk-of-bias tool was used to grade the risk of bias. Of 2642 studies, 29 were included. Fifteen were phase three, 11 were phase two, one was phase one/two, and two were phase two/three. There were no differences in clinical remission rates between phase two and three studies for Crohn’s disease (OR, 1.07; 95% CI, 0.86–1.34; P = 0.54) and ulcerative colitis (OR, 0.81; 95% CI, 0.48–1.36; P = 0.43). Furthermore, there was a lack of any appreciable differences in study characteristics, inclusion criteria and patient demographics among paired phase two and three studies. Most studies were considered low risk of bias. Overall, paired phase two and three studies demonstrate similar clinical remission rates for advanced therapies in IBD. Whether this applies to newer outcomes, such as endoscopic and mucosal healing remains to be determined.
Acoustic sensing has attracted significant attention recently, thanks to the pervasive availability of device support. However, adopting consumer-grade devices (e.g., smartphones) to deploy acoustic sensing applications faces the challenge of device/OS heterogeneity. Researchers have to pay tremendous efforts in tackling platform-dependent details even in simply accessing raw audio samples, thus losing focus on innovating sensing algorithms. To this end, this paper presents the first Acoustic Software Defined Platform (ASDP): a versatile sensing and general benchmarking platform. ASDP encompasses several customized acoustic modules running on a ubiquitous computing board, backed by a dedicated software framework. It is superior to commodity devices in controlling and reconfiguring physical layer settings, thus offering much better usability. The tailored software framework abstracts platform details and provides user-friendly interface for fast prototyping, while maintaining adequate programmability. To demonstrate the usefulness of ASDP, we showcase several relevant applications based on it. The promising outcomes make us believe that the release of our ASDP could greatly advance acoustic sensing research.
Individuals differ in the extent to which they believe that their emotions are controllable or not, and these beliefs have significant impacts on emotional functioning. A strong belief that your emotions are uncontrollable (fixed mindset) is a vulnerability for emotional dysfunction, such as internalizing symptoms; however, the proximal mechanisms that might explain how emotional beliefs manifest as symptoms remain unclear. Across two studies, we examined whether mindset was indirectly related to internalizing symptoms through use of avoidance-based strategies and whether perceptions of stress function to amplify this relationship. In Study 1, (N = 163; mean age = 17.9), a fixed mindset was associated with a greater presence of depression and anxiety symptoms in undergraduates indirectly through the use of avoidance for anxiety, but not depression. Perceived stress did not moderate the indirect effect. In Study 2 (N = 183; mean age = 18.74) we replicated this model and extended this finding by examining social-avoidance. There was an indirect effect of mindset on anxiety and on depression via the use of avoidance-based strategies; however, there was no moderating effect of perceived stress. These findings extend the previous literature by demonstrating for role of avoidance in understanding the relationship between fixed mindsets and internalizing symptoms.
The purpose of this study is to improve the quality of the multi-track laser cladding coating. The Taguchi-Grey relation method was selected to realize process parameter optimization. The Taguchi method is used to design an L16 orthogonal experiment. The influence of three important laser cladding parameters (laser power, powder feeding rate, and scanning speed) on the micro-hardness, maximum load value, yield strength, UTS, and elongation had been analyzed based on the analysis of variance (ANOVA) and signal to noise ratio (SNR) methods. The results showed that the yield strength, UTS, and elongation were significantly affected by the laser power; the powder feeding rate denoted a highly significant influence on the microhardness and yield strength; and the scanning speed was a highly significant factor that had an influence on the maximum load value. Then, grey relational analysis (GRA) was used to convert five response targets into a single grey relational grade (GRG) that could be quantified in order to optimize the parameters for maximum micro-hardness, maximum load value, yield strength, UTS, and elongation. Finally, the optimum cladding process parameters were obtained. Through analysis of microstructure, the reduction of the Laves phase might be the main reason for the improvement of coating performance after optimization.
Background Collecting duct carcinoma (CDC) is biologically more aggressive than clear cell renal cell carcinoma (ccRCC). We tested for differences in cancer specific mortality (CSM) rates according to CDC vs. ISUP (International Society of Urological Pathology) 4 ccRCC histological subtype. We hypothesized that the survival disadvantage still applies, even after most detailed adjustments. Methods Within Surveillance, Epidemiology, and End Results database (2004–2018), we identified 380 CDC vs. 6273 ISUP 4 ccRCC patients of all stages. Propensity score matching (age, sex, race/ethnicity, T, N, and M stages, nephrectomy, and systemic therapy status), Kaplan-Meier plots and multivariable Cox regression models were used. Results All 380 CDC were matched (1:2) with 760 ISUP4 ccRCC patients. Prior to matching CDC patients exhibited higher rates of lymph node invasion (37.6 % vs. 14.7 %, p < 0.001), and of distant metastases (40.8 % vs. 30.4 %, p < 0.001). Systemic therapy rates were higher in CDC (29.5 % vs. 20.5 %, p < 0.001). However, nephrectomy rates were higher in ISUP4 ccRCC patients (97.5 % vs. 84.7 %, p < 0.001). After matching, in multivariable Cox regression models addressing CSM, CDC was associated with a HR of 1.5 (p < 0.001) in the overall population vs. 1.9 (p = 0.014) in stage I-II vs. 1.4 (p = 0.022) in stage III vs. 1.6 in stage IV (p < 0.001), relative to ISUP4 ccRCC. Conclusion CDC patients exhibited 40–90 % higher CSM than their ISUP4 ccRCC counterparts in the overall analysis, as well as in stage specific analyses. The CSM disadvantage applies despite higher rates of systemic therapy in CDC patients.
Much research suggests democracies invest more in human capital formation than dictatorships. In particular, scholars have suggested that democracies outspend autocracies on education, due to electoral and interest group pressures. However, some democracies spend no more on education - and some spend much less - than autocracies. What explains this variation within democracies? The answer is the influence of landed agricultural elites. Urban industrial elites support human capital investment because it leads to higher rates of return even if wages increase. Yet greater education spending encourages out-migration from the countryside, reducing the supply and increasing the price of agricultural labor. Given the differential impact of education spending across economic sectors, the effect of democracy on education spending may be conditional on the power of landed elites. We test this argument in two ways. First, we run a series of time series cross-sectional regressions on data from 107 countries for the period 1970 to 2000. Second, we conduct a difference-in-difference analysis, comparing countries that democratize at high versus low levels of land inequality, for 73 countries for the same time period. Results confirm a negative relationship between the power of landed elites and investment in public education under democracy, adding important and novel insight into the sources of differences in public-goods spending and human capital investment both within across political regimes.
Aim Some studies have reported that children with poor motor functioning tend to improve over time. However, much existing research does not account for regression towards the mean (RTM). Here, we examine measurement stability among 589 children aged 4–5 years. Method We administered the Movement Assessment Battery for Children 2nd Edition annually to 269 children initially scoring above and 252 at or below the 16th percentile. We measured agreement between year 1 and year 2 standard scores using Pearson correlation and derived expected regression towards the mean (RTM). We then regressed follow-up on baseline scores, controlling for relative age, sex, and exact interval between assessments. Finally, we performed a small illustrative simulation. Outcomes and results The mean score in the poor-coordination group rose from 5.6 (SD = 1.5) to 7.2 (SD = 2.8). Year 1 and year 2 scores were correlated at r = 0.66, corresponding to predicted RTM in the MI group of 1.56, close to the observed change of 1.57. Degree of change was not associated with time between assessments. Interpretation Observed improvements in motor functioning were consistent with measurement error. The stability of motor functioning may be greater than it appears from past research, and reported functional improvements in some studies may be illusory. What this paper adds? -Impaired motor coordination is common and can meaningfully affect functioning. -Our analysis suggests that coordination is generally stable. -Apparent improvement in research may often be produced by measurement error.
The inclusion of microencapsulated phase change materials (MPCM) in construction materials is a promising solution for increasing the energy efficiency of buildings and reducing their carbon emissions. Although MPCMs provide thermal energy storage capability in concrete, they typically decrease its compressive strength. A unified framework for the mixture design of concrete incorporating MPCM is yet to be developed to facilitate practical applications. This study proposes a mix design procedure using a novel ternary machine learning (ML) paradigm. For this purpose, the tabular generative adversarial network (TGAN) was utilized to generate large synthetic mixture design data based on the limited available experimental observations. The synthetic data is then employed to construct robust predictive ML models. The gradient boosting regressor (GBR) model trained with synthetic data outperformed the model trained with real data, achieving a testing coefficient of determination (R 2) of 0.963 and mean absolute error (MAE) of 2.085 MPa. The TGAN-GBR model was ultimately integrated with the particle swarm optimization (PSO) algorithm to construct a powerful recommendation system for optimizing the mixture design of concrete and mortar incorporating different types of MPCMs. Extensive parametric analyses along with the employed optimization procedure accomplished the mixture design of latent heat thermal energy storage concrete with maximum MPCM inclusion and minimum cement content for various compressive strength classes. The proposed framework enables energy conservation technology in the design of eco-friendly building materials with acceptable mechanical performance.
In patients with non–ST-elevation myocardial infarction (NSTEMI), total occlusion of the culprit coronary artery (OCA) is not uncommon. We sought to determine the frequency and clinical impact of OCA at presentation in a large population of patients presenting with NSTEMI and who underwent systematic early invasive management. We performed a post hoc analysis of the TAO (Treatment of Acute Coronary Syndrome with Otamixaban) randomized trial, which included patients with NSTEMI with systematic coronary angiography within 72 hours. We compared the baseline characteristics and outcomes of patients according to whether the culprit vessel was occluded (thrombolysis in myocardial infarction flow grade [TFG] 0 to 1) or patent (TFG 2 to 3) at presentation. A total of 7,473 patients with NSTEMI with only 1 culprit lesion identified were enrolled, of whom 1,702 patients had OCA (22.8%). In the OCA group, coronary angiography was performed earlier (18 ± 15 vs 20 ± 16 hours, p <0.01), the culprit lesion was less likely to be the left anterior descending artery (26.5% vs 41.4%, p <0.001) but with more frequent angiographic thrombus (49.9% vs 22.7%, p <0.01). Culprit artery percutaneous coronary intervention during the index procedure was also more frequent (88.5% vs 78.1%, p <0.001) but with a lower rate of TFG grade 3 after the procedure and higher subsequent peak troponin I levels (8.3 ± 13.6 µg/L vs 5.6 ± 11.9 µg/L, p <0.001). At day 7, patients with OCA had higher mortality, and this persisted after adjustment on gender, Grace risk score, cardiovascular risk factors, and culprit vessel location (0.9% vs 0.4%, p = 0.02; adjusted odds ratio [OR] = 2.55, 95% confidence interval [CI] 1.23 to 5.29, p = 0.01). The absolute difference of mortality was maintained through 30 days: 1.2% versus 0.8%, p = 0.13; OR: 1.72, 95% CI 0.97 to 3.05, but mortality rates were similar by 180 days: 1.5% versus 1.6%, p = 0.8, adjusted OR = 1.11, 95% CI 0.69 to 1.80, p = 0.66. In conclusion, a significant proportion of patients with NSTEMI have a totally occluded culprit vessel at presentation. These patients are at higher risk of early mortality but not at 6 months.
Context Outcomes in renal cell carcinoma (RCC) are reported inconsistently, with variability in definitions and measurement. Hence, it is difficult to compare intervention effectiveness and synthesise outcomes for systematic reviews and to create clinical practice guidelines. This uncertainty in the evidence makes it difficult to guide patient-clinician decision-making. One solution is a core outcome set (COS): an agreed minimum set of outcomes. Objective To describe outcome reporting, definitions, and measurement heterogeneity as the first stage in co-creating a COS for localised renal cancer. Evidence acquisition We systematically reviewed outcome reporting heterogeneity in effectiveness trials and observational studies in localised RCC. In total, 2822 studies (randomised controlled trials, cohort studies, case-control studies, systematic reviews) up to June 2020 meeting our inclusion criteria were identified. Abstracts and full texts were screened independently by two reviewers; in cases of disagreement, a third reviewer arbitrated. Data extractions were double-checked. Evidence synthesis We included 149 studies and found that there was inconsistency in which outcomes were reported across studies and variability in the definitions used for outcomes that were conceptually the same. We structured our analysis using the outcome classification taxonomy proposed by Dodd et al. Outcomes linked to adverse events (eg, bleeding, outcomes linked to surgery) and renal injury outcomes (reduced renal function) were reported most commonly. Outcomes related to deaths from any cause and from cancer were reported in 44% and 25% of studies, respectively, although the time point for measurement and the analysis methods were inconsistent. Outcomes linked to life impact (eg, global quality of life) were reported least often. Clinician-reported outcomes are more frequently reported than patient-reported outcomes in the renal cancer literature. Conclusions This systematic review underscores the heterogeneity of outcome reporting, definitions, and measurement in research on localised renal cancer. It catalogues the variety of outcomes and serves as a first step towards the development of a COS for localised renal cancer. Patient summary We reviewed studies on localised kidney cancer and found that multiple terms and definitions have been used to describe outcomes. These are not defined consistently, and often not defined at all. Our review is the first phase in developing a core outcome set to allow better comparisons of studies to improve medical care.
Objectives: We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours). Methods: We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care. Results: A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy. Conclusion: The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
Mathematical optimization can be a useful strategy for minimizing energy usage while designing low-energy buildings. To handle building energy optimization challenges, this study provides an effective hybrid technique based on the pelican optimization algorithm (POA) and the single candidate optimizer (SCO). The suggested hybrid algorithm (POSCO) benefits from both the robust local search power of the single candidate method and the efficient global search capabilities of the pelican optimization. To conduct the building optimization task, the optimization method was developed and integrated with the EnergyPlus codes. The effectiveness of the proposed POSCO method was verified using mathematical test functions, and the outcomes were contrasted with those of conventional POA and other effective optimization techniques. Application of POSCO for global function optimization reveals that, among the thirteen considered functions, the proposed method was best at finding the global solution for seven functions, while providing superior results for the other functions when compared with competitive techniques. The suggested POSCO is applied for reducing an office buildings' annual energy use. Comparing POSCO to POA procedures, the building energy usage is reduced. Furthermore, POSCO is compared to simple POA and other algorithms, with the results showing that, at specific temperatures and lighting conditions, the POSCO approach outperforms selected state-of-the-art methods and reduces building energy usage. As a result, all data suggests that POSCO is a very promising, dependable, and feasible optimization strategy for dealing with building energy optimization models. Finally, the building energy optimization findings for various climatic conditions demonstrate that the changes to the weather dataset had limited effect on the efficiency of the optimization procedure.
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