[Structured triage in the emergency department via intelligent assistant service OPTINOFA : Results of a multicenter, cluster-randomized and controlled interventional study in Germany].

In Germany, a substantial reform of emergency care is strictly recommended. Regulation of patient flows into the ambulatory and stationary sectors remains a major issue.In the OPTINOFA project funded by Innovationsfunds, a new triage system was developed for a structured primary evaluation of both urgency and care level of emergency cases.

Theta/Beta Ratio Neurofeedback Effects on Resting and Task-Related Theta Activity in Children with ADHD.

The EEG theta band displays distinct roles in resting and task states. Low resting theta and transient increases in frontal-midline (fm) theta power during tasks are associated with better cognitive control, such as error monitoring. ADHD can disrupt this balance, resulting in high resting theta linked to drowsiness and low fm-theta activity associated with reduced cognitive abilities.

Editorial Commentary: Acetabular Cartilage Delamination in Patients Having Femoroacetabular Impingement Syndrome Surgery Requires a Single-Stage Solution.

Acetabular cartilage delamination (ACD) can result in focal chondral defects, increasing contact stresses and contributing to osteoarthritis. This is commonly associated with femoroacetabular impingement, particularly with cam deformities due to shearing of the cam on the acetabulum. Additionally, ACD associated with labral tears or chondrolabral separation, when untreated, can compromise labral repair outcomes.

Empirical use of growth hormone in IVF is useless: the largest randomized controlled trial.

Study Question: Does adjuvant growth hormone (GH) therapy in GnRH antagonist cycles improve reproductive outcomes in the general IVF population?

Summary Answer: Empiric adjuvant GH therapy in GnRH antagonist cycles does not improve IVF stimulation results or reproductive outcomes, including implantation, miscarriage, and clinical pregnancy rates.

What Is Known Already: Previous evidence regarding the benefits of GH therapy in IVF cycles has been inconclusive due to the lack of well-designed, large-scale randomized controlled trials (RCTs) in the general IVF population.

Study Design, Size, Duration: This is a phase III open-label RCT involving 288 patients undergoing antagonist IVF cycles at the Ovo clinic in Montreal, Canada, between June 2014 and January 2020.

A Software Framework for the Functional Lumen Imaging Probe-Mechanics (MechView).

Background: The functional lumen imaging probe (FLIP) has proven to be a versatile device for diagnosing esophageal motility disorders and estimating esophageal wall compliance, but there is a lack of viable software for quantitative assessment of FLIP measurements.

Methods: A Python-based web framework was developed for a unified assessment of FLIP measurements including clinical metrics such as esophagogastric junction (EGJ) distensibility index (DI), maximum EGJ opening diameter, mechanics-based metrics for estimating strength, and effectiveness of contractions, such as contraction power and displaced volume, and machine learning-based clustering and predictive algorithms such as the virtual disease landscape (VDL) and EGJ obstruction probability. The clinical and VDL probability metrics were then validated using FLIP data from 121 subjects constituting different categories of EGJ opening which were diagnosed by expert clinicians.

Gene editing without ex vivo culture evades genotoxicity in human hematopoietic stem cells.

Gene editing the BCL11A erythroid enhancer is a validated approach to fetal hemoglobin (HbF) induction for β-hemoglobinopathy therapy, though heterogeneity in edit allele distribution and HbF response may impact its safety and efficacy. Here, we compare combined CRISPR-Cas9 editing of the BCL11A +58 and +55 enhancers with leading gene modification approaches under clinical investigation. Dual targeting of the BCL11A +58 and +55 enhancers with 3xNLS-SpCas9 and two single guide RNAs (sgRNAs) resulted in superior HbF induction, including in sickle cell disease (SCD) patient xenografts, attributable to simultaneous disruption of core half E-box/GATA motifs at both enhancers.

Chest Wall Injury Society recommendations for long-term follow-up after nonoperatively and operatively managed traumatic rib and sternal fractures.

Therapeutic/Care Management; Level IV.

Exploring non-Markovian dynamics: Stochastic analysis of a single-server retrial queue with recurrent clients and balking behavior under extended Bernoulli vacations.

The present study delves into the dynamics of a specific form of queueing system described as an retrial queue. Here, the queue comprises two distinct categories of clients: transit clients and recurrent clients. Transit clients are those who appear at the queue following a Poisson process, reflecting a random arrival pattern commonly seen in queueing scenarios.

Archetypal Analysis Reveals Consistent Visual Field Patterns for Stimulus Sizes III and V in Glaucoma and NAION.

Purpose: Disorders of the anterior optic nerve cause quantifiable patterns, or archetypes (AT), in visual fields (VFs) obtained using standardized automated perimetry using stimulus size III (size III). VFs with stimulus size V (size V) can reduce retest variability in eyes with moderate to severe loss. We postulated that VF testing using both stimuli would show similar ATs in eyes with glaucoma and nonarteritic anterior ischemic optic neuropathy (NAION).

Pathology-Driven Automation to Improve Updating Documented Follow-Up Recommendations in the Electronic Health Record After Colonoscopy.

Introduction: Failure to document colonoscopy follow-up needs postpolypectomy can lead to delayed detection of colorectal cancer (CRC). Automating the update of a unified follow-up date in the electronic health record (EHR) may increase the number of patients with guideline-concordant CRC follow-up screening.

Methods: Prospective pre-post design study of an automated rules engine-based tool using colonoscopy pathology results to automate updates to documented CRC screening due dates was performed as an operational initiative, deployed enterprise-wide May 2023.

Central control of dynamic gene circuits governs T cell rest and activation.

The ability of cells to maintain distinct identities and respond to transient environmental signals requires tightly controlled regulation of gene networks. These dynamic regulatory circuits that respond to extracellular cues in primary human cells remain poorly defined. The need for context-dependent regulation is prominent in T cells, where distinct lineages must respond to diverse signals to mount effective immune responses and maintain homeostasis.

Neutralizing GDF-15 can overcome anti-PD-1 and anti-PD-L1 resistance in solid tumours.

Cancer immunotherapies with antibodies blocking immune checkpoint molecules are clinically active across multiple cancer entities and have markedly improved cancer treatment. Yet, response rates are still limited, and tumour progression commonly occurs. Soluble and cell-bound factors in the tumour microenvironment negatively affect cancer immunity.

Predictors of household drinking water E. coli contamination: Population-based results from rural areas of Ghana, Malawi, Mozambique, Niger, Rwanda, Uganda, and Zambia.

Background: In sub-Saharan Africa, rural areas have lower rates of access to safe drinking water compared to urban areas. We investigated predictors of Escherichia coli contamination in drinking water of rural households in Ghana, Malawi, Mozambique, Niger, Rwanda, Uganda, and Zambia.

Methods: We used a population-based, cluster randomized sampling design to select rural households in each country.

Development of an indigestible dietary protein index to investigate the effects of dietary protein content in postweaned pigs.

Proteolytic fermentation induces negative effects on gut health and function, which may affect pig performance. The objective was to conduct a meta-analysis to develop an index of dietary indigestible dietary protein (IDP) to investigate growth performance outcomes of mixed-sex weanling pigs (average body weight of 7.59 kg).

A prognostic molecular signature of hepatic steatosis is spatially heterogeneous and dynamic in human liver.

Hepatic steatosis is a central phenotype in multi-system metabolic dysfunction and is increasing in parallel with the obesity pandemic. We use a translational approach integrating clinical phenotyping and outcomes, circulating proteomics, and tissue transcriptomics to identify dynamic, functional biomarkers of hepatic steatosis. Using multi-modality imaging and broad proteomic profiling, we identify proteins implicated in the progression of hepatic steatosis that are largely encoded by genes enriched at the transcriptional level in the human liver.

Understanding Behavior Change in Clinical Practice Guideline Implementation: A Qualitative Study.

Background And Purpose: Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG.

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage.

Background: The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear.

Methods: We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months.

Elevated Donor-Derived Cell-Free DNA Levels Are Associated With Reduced Myocardial Blood Flow but Not Angiographic Cardiac Allograft Vasculopathy: The EVIDENT Study.

Background: Cardiac allograft vasculopathy (CAV) leads to impaired myocardial blood flow (MBF), increasing the risk of cardiovascular death or retransplant among heart transplantation (HT) recipients. Data on elevation in donor-derived cell-free DNA (dd-cfDNA) and CAV in the absence of rejection are mixed. We sought to test the hypothesis that CAV with reduced MBF (RMBF) is associated with elevated dd-cfDNA.

The mechanism of action of neuromodulation in the treatment of overactive bladder.

Neuromodulation has been used in the treatment of various pelvic organ dysfunctions for almost 40 years and several placebo-controlled studies have confirmed its clinical effect. Many neuromodulation methods using different devices and stimulation parameters, targeting different neural structures have been introduced, but only a limited number have been adopted into routine clinical use. A substantial volume of basic research and clinical studies addressing specific effects of neuromodulation in the treatment of overactive bladder (OAB) have been published to date; however, their mechanistic implications have not been comprehensively summarized.

Development and Evaluation of a Comprehensive Prediction Model for Incident Coronary Heart Disease Using Genetic, Social, and Lifestyle-Psychological Factors: A Prospective Analysis of the UK Biobank.

Background: Clinical risk calculators for coronary heart disease (CHD) do not include genetic, social, and lifestyle-psychological risk factors.

Objective: To improve CHD risk prediction by developing and evaluating a prediction model that incorporated a polygenic risk score (PRS) and a polysocial score (PSS), the latter including social determinants of health and lifestyle-psychological factors.

Design: Cohort study.

Novel Systemic Anticancer Therapy and Healthcare Utilization at the End of Life: A Retrospective Cohort Study.

Background: Novel systemic anticancer therapies (SACT) in the form of targeted and immunotherapies are increasingly replacing traditional chemotherapy. Little is known about the impact of novel SACT on healthcare resource utilization (HCRU) at the end of life.

Methodology: A retrospective review of patients attending a tertiary cancer center in Toronto, Canada, with advanced solid or hematological malignancies who died in 2019.

Prediction of antigenic peptides of SARS- CoV-2 pathogen using machine learning.

Antigenic peptides (APs), also known as T-cell epitopes (TCEs), represent the immunogenic segment of pathogens capable of inducing an immune response, making them potential candidates for epitope-based vaccine (EBV) design. Traditional wet lab methods for identifying TCEs are expensive, challenging, and time-consuming. Alternatively, computational approaches employing machine learning (ML) techniques offer a faster and more cost-effective solution.