Setting epidemiological cut-off values relevant to MIC and disc diffusion data for Aeromonas salmonicida generated by a standard method.

The Clinical and Laboratory Standards Institute has published epidemiological cut-off values for susceptibility data generated at 22°°C and read after 44-48 h for florfenicol, oxolinic acid and oxytetracycline against Aeromonas salmonicida. The cut-off values for the minimum inhibitory concentration (MIC) and disc diffusion were derived from data obtained by 1 laboratory and 2 laboratories respectively. The present work reports the generation of susceptibility data from additional laboratories and the calculation of provisional cut-off values from aggregations of these data with previously published data. With respect to MIC data, the provisional cut-off values, derived from aggregations of the data from 4 laboratories, were ≤4 µg ml-1 for florfenicol, ≤0.0625 µg ml-1 for oxolinic acid and ≤1 µg ml-1 for oxytetracycline. For disc diffusion data, the provisional cut-off values derived from aggregations of the data from 5 laboratories were ≥30 mm for florfenicol, ≥32 mm for oxolinic acid and ≥25 mm for oxytetracycline. In addition, a cut-off value of ≥29 mm for ampicillin was derived from the aggregation of data from 4 laboratories.

Life as a chief of medicine-Taking future hospital guidance to the front line.

The Future Hospital Commission developed a comprehensive and ambitious proposal of how hospitals should be run, with clinical leadership at its heart. A medical division led by the chief of medicine was integral to the vision and these senior physicians would be central to the running of hospitals alongside managers. The real-world experiences over 8 years of one chief of medicine are explored and compared to the guidance set out by the Future Hospital Commission, with an emphasis on interdisciplinary triumvirate working, values, behaviours, quality improvement and the impact of crises like the COVID pandemic. The chief of medicine role can play an important part in delivering the outcomes promoted by the Future Hospital Commission, but the role is likely to vary throughout the NHS dependent on local factors. Future guidance could focus on equipping the leaders of the future to design and improve services, and to develop the multiprofessional teams that meet the needs of their specific challenges that they face.

Public values to guide childhood vaccination mandates: A report on four Australian community juries.

OBJECTIVE: Governments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well-informed community members on the public acceptability of using childhood vaccination mandates in Australia. METHODS: Four community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions. RESULTS: All juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high. CONCLUSION: This paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co-operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates. PATIENT AND PUBLIC INVOLVEMENT: We sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.

Landing error scoring system: A scoping review about variants, reference values and differences according to sex and sport.

OBJECTIVE: The Landing Error Scoring System (LESS) is a movement analysis tool proposed to identify the risk of anterior cruciate ligament injuries, very useful for injury prevention. The aim of this study is to review the variants of the LESS, their normative scores and the differences according to sex and sport practiced. METHODS: PubMed, Scopus and ScienceDirect databases were searched from inception to October 19, 2023. Studies were eligible if the objective was finding normative or reference scores for the LESS, analyze the differences between sexes or sports, or used some variant of the test. Results were limited to available full-text articles published in English in peer-reviewed journals. RESULTS: Of the 360 articles identified, 20 were included for a full analysis (18,093 participants, age = 8-30 years, males = 70.6%). The military population was the most frequently analyzed (7 studies, n = 16,603). Results showed six variants of the LESS and average values ranged from 2.56 to 7.1. Males and females showed different pattern landing with errors in different planes. CONCLUSIONS: Our findings highlight the need for more field studies on LESS reference scores, particularly for females and basketball or hockey players. Further research is required before conducting a systematic review and meta-analysis.

Scalar Values in SNOMED CT: A Proposed Extension.

Representing numeric values such as scalars holds great importance for accurately depicting clinical data. While the result value itself will always be represented using an integer, decimal, or other scalar format, it needs to be linked to its corresponding data element. In SNOMED CT, as in most other terminology systems, this is done through an attribute relationship. While some scalar values are already included in this way, they only represent a small fraction of possibilities. Our intention is to expand the scope of scalar representation by validating new attributes using a previously established method. The result is a list of five attributes validated for local representation of scalar values, improving semantic representation and interoperability.

Comparison of Imputation Methods for Categorical Real-World Prostate Cancer Data with Natural Order.

Missing values (NA) often occur in cancer research, which may be due to reasons such as data protection, data loss, or missing follow-up data. Such incomplete patient information can have an impact on prediction models and other data analyses. Imputation methods are a tool for dealing with NA. Cancer data is often presented in an ordered categorical form, such as tumour grading and staging, which requires special methods. This work compares mode imputation, k nearest neighbour (knn) imputation, and, in the context of Multiple Imputation by Chained Equations (MICE), logistic regression model with proportional odds (mice_polr) and random forest (mice_rf) on a real-world prostate cancer dataset provided by the Cancer Registry of Rhineland-Palatinate in Germany. Our dataset contains relevant information for the risk classification of patients and the time between date of diagnosis and date of death. For the imputation comparison, we use Rubin's (1974) Missing Completely At Random (MCAR) mechanism to remove 10%, 20%, 30%, and 50% observations. The results are evaluated and ranked based on the accuracy per patient. Mice_rf performs significantly best for each percentage of NA, followed by knn, and mice_polr performs significantly worst. Furthermore, our findings indicate that the accuracy of imputation methods increases with a lower number of categories, a relatively even proportion of patients in the categories, or a majority of patients in a particular category.

RNA extended interventional nucleic acid longitudinal study: Clinical performance of Aptima messenger RNA HPV testing in cervical cancer screening with a 9-year follow-up.

BACKGROUND: There is a need for additional longitudinal studies with the Aptima messenger RNA human papillomavirus test (AHPV) to support the safety of extended screening intervals. RNA-based extended interventional nucleic acid (REINA) provides relevant information on the clinical performance of AHPV. METHODS: This is a longitudinal prospective analysis of 1538 participants after AHPV and liquid-based cytology (LBC) co-test complemented with REINA interventional protocol with a second co-test 4 years after negative screening on 2000 women. Diagnostic accuracy and cumulative risks for CIN2+ up to 9 years were calculated for all test combinations. RESULTS: Sensitivity and specificity for CIN2+ were 96.9% and 88.0% for AHPV and 72.3% and 92.0% for LBC. Negative predictive value (NPV) and positive predictive value (PPV) of AHPV were 99.9% and 23.6%. The 5- and 9-year risks of AHPV-negative women were 0.4% and 1.0% (CIN2+) and 0.3% and 0.7% (CIN3+), a 73% and 64% lower risk than with negative LBC (p ≤ .002). REINA participants with an AHPV-positive result at second co-test after a negative AHPV in first round had a significantly lower 5-year risk of CIN2+ (11.1%) than AHPV-positive women with unknown HPV history (29.5%). CONCLUSIONS: Currently, this constitutes the longest European longitudinal study with AHPV testing in screening population. It reveals 99.9% NPV and a significant protective effect of a previous negative test 5 years after a new HPV infection. These findings support the safety of Aptima for screening intervals beyond 5 years. The risk of disease is lower 9 years after a negative AHPV test than 3 years after a negative LBC. High specificity and PPV of Aptima may benefit controlling overtreatment and colposcopy referrals.

[The social health of modern student youth: sociological analysis].

The article presents results of sociological analysis of social health of modern student youth. The empirical basis of study was composed with results of monitoring study of student youth carried out by sociological laboratory of the Department of Sociology and Social Technologies. Within a framework of sociological monitoring, were evaluated such components of social health of student youth as relationships with friends and relatives, relationships in student community, inter-ethnic relations in University and region, participation in public life, social well-being, active life position and family practices and values. It is established that modern possibilities of living conditions allow each person to organize one's life-style in such a way as to develop synergetic effect for social health, combining achieved standards of organization of everyday life and fashion for healthy lifestyle. It is namely such synergistic effect can be enhanced and induced in social environment. The main role at that is played by namely large multi-generational family.

Valuing quality of life for economic evaluations in cancer: navigating multiple methods.

INTRODUCTION: Utility values offer a quantitative means to evaluate the impact of novel cancer treatments on patients' quality of life (QoL). However, the multiple methods available for valuing QoL present challenges in selecting the most appropriate method across different contexts. AREAS COVERED: This review provides cancer clinicians and researchers with an overview of methods to value QoL for economic evaluations, including standalone and derived preference-based measures (PBMs) and direct preference elicitation methods. Recent developments are described, including the comparative performance of cancer-specific PBMs versus generic PBMs, measurement of outcomes beyond health-related QoL, and increased use of discrete choice experiments to elicit preferences. Recommendations and considerations are provided to guide the choice of method for cancer research. EXPERT OPINION: We foresee continued adoption of the QLU-C10D and FACT-8D in cancer clinical trials given the extensive use of the EORTC QLQ-C30 and FACT-G in cancer research. While these cancer-specific PBMs offer the convenience of eliciting utility values without needing a standalone PBM, researchers should consider potential limitations if they intend to substitute them for generic PBMs. As the field advances, there is a greater need for consensus on the approach to selection and integration of various methods in cancer clinical trials.

False Discovery Rate Control for Lesion-Symptom Mapping With Heterogeneous Data via Weighted p-Values.

Lesion-symptom mapping studies provide insight into what areas of the brain are involved in different aspects of cognition. This is commonly done via behavioral testing in patients with a naturally occurring brain injury or lesions (e.g., strokes or brain tumors). This results in high-dimensional observational data where lesion status (present/absent) is nonuniformly distributed, with some voxels having lesions in very few (or no) subjects. In this situation, mass univariate hypothesis tests have severe power heterogeneity where many tests are known a priori to have little to no power. Recent advancements in multiple testing methodologies allow researchers to weigh hypotheses according to side information (e.g., information on power heterogeneity). In this paper, we propose the use of p-value weighting for voxel-based lesion-symptom mapping studies. The weights are created using the distribution of lesion status and spatial information to estimate different non-null prior probabilities for each hypothesis test through some common approaches. We provide a monotone minimum weight criterion, which requires minimum a priori power information. Our methods are demonstrated on dependent simulated data and an aphasia study investigating which regions of the brain are associated with the severity of language impairment among stroke survivors. The results demonstrate that the proposed methods have robust error control and can increase power. Further, we showcase how weights can be used to identify regions that are inconclusive due to lack of power.

Normal menstrual flow volume range and its characteristics measured from sanitary napkins in Japanese women: Discrepancy between measured and subjective menstrual flow volume.

AIM: The 2018 International Federation of Gynecology and Obstetrics abnormal uterine bleeding System-1 defines menstrual flow volume on a 3-point scale based on subjective assessment. However, the normal flow range has not been established, and it is unclear whether subjective assessment is accurate. We investigated the normal menstrual flow volume range in Japanese women and whether the actual measured menstrual flow volume agreed with the subjective evaluation. METHODS: We included female menstruating volunteers aged 18-49 years in this prospective observational study. Menstrual napkins were weighed before and after use for up to three cycles, and the values were recorded in an online diary. RESULTS: Overall, 211 participants were recruited. All items were completed by 167 participants, and 497 menstrual cycles were included in the analysis. The median total menstrual flow volume per cycle for 497 cycles was 56.7 g. The 5th-95th percentile values ranged from 15.7 to 166.4 g. The mean value was 77.6 ± 99.6 g, with no significant differences according to age group. In the 25 cycles corresponding to heavy flow, that is, above the 95th percentile of measured flow volume, 92% were underrated as "normal" by subjective evaluation, and only 8% were correctly rated as "heavy." CONCLUSIONS: Our results clarify the actual menstrual flow volume in the Japanese population; this will contribute toward making women aware of the normal range of menstrual flow volume, which may facilitate appropriate preconception care.

The development of nursing-sensitive indicators: A critical discussion.

Discussion arguments: In a science-based profession, nurses must continuously monitor and evaluate the effectiveness of their care. However, data on what constitutes nursing care in practice and the delivery process is lacking. Insufficient evidence on how nurses contribute to patient care hampers the evaluation of nursing practice.We discuss nursing-sensitive indicators, their origins, current applications, and challenges related to their use in evaluating the quality of nursing care. We analyse nursing-sensitive indicators in the context of criticisms levelled at the profession related to the lack of evidence to support their value in the larger healthcare environment. Conclusions: We have a disjointed approach to evaluating nursing care. Current systems designed to monitor nursing care, such as metrics and data sets, are not adequate or effective for comprehensively evaluating nursing care, considering the fundamentals and values of the nursing profession.

A value hierarchy for inclusive design of heart valve implants in regenerative medicine.

Aim: This paper investigates the conditions for inclusive design of regenerative medicine interventions from a bioethical perspective, taking regenerative valve implants as a showcase.Methods: A value hierarchy is construed to translate the value of justice into norms and design requirements for inclusive design of regenerative valve implants.Results: Three norms are proposed and translated into design requirements: regenerative valve implants should be designed to promote equal opportunity to good health for all potential users; equal respect for all potential users should be shown; and the implants should be designed to be accessible to everyone in need.Conclusion: The norms and design requirements help to design regenerative valve implants that are appropriate, respectful and available for everyone in need.

Scientists in the field of regenerative medicine are developing a new type of heart valve implant. After implantation, the synthetic implant slowly breaks down and is replaced by a new living heart valve. These so-called regenerative implants promise a complete cure. However, they also raise ethical questions. For example, questions related to justice and inclusion. In this paper, we explore how regenerative implants can be designed to be inclusive, meaning suitable, respectful and available for everyone. We argue that the design of regenerative implants should be adapted to relevant differences between users. The implants should be affordable in the short and long term. The implants should be suitable for use worldwide. The implants should be designed by teams of diverse age, gender and ethnicity. Users should be engaged in the design. And the communication about the implants to researchers and users should be inclusive. Overall, this paper provides ethical guidance to researchers and clinicians developing regenerative implants.

Effective toxicity of pH to embryonic development of the banded lampeye killifish Aplocheilichthys spilauchen (Duméril, 1861).

The banded lampeye killifish, Aplocheilichthys spilauchen, feeds on larvae of the anopheles mosquito, which makes the fish a good candidate for biological control of malaria. Aquatic organisms require optimal hydrogen ion concentration (pH) for healthy aquatic life, but the impact of pH alteration on A. spilauchen reproductive potential is not known. This study investigated the toxic effect of pH on the embryonic development of A. spilauchen using a static renewal exposure method. Newly fertilised embryos were exposed to a range of pH treatments (5-6 acidic; 7 neutral; 8-9 alkaline) until hatching. All pH media involved triplicates and pH 7 was used as a control. The pH media were checked every 24 h for change and adjusted if necessary. Dissolved oxygen (DO), electrical conductivity (EC), and temperature were monitored throughout the experiment. The endpoints investigated were hatching success, hatchling length, and hatching period. Results indicated a mean hatching success of 95.83 % for pH 7 (neutral) group, while embryos exposed to acidic and basic media recorded lower hatching successes of 60.42 % and 83.34 %, respectively. Hatchling length and hatching period were longer in the control group than in groups of acidic and basic media. Effective toxic pH values of 4.5, 6 and 6.5 were estimated for the hatching period, hatching success, and hatchling length, respectively. These results suggest that sharp changes in the pH of aquatic environments from neutral may adversely impact the reproductive potential of A. spilauchen via embryonic development. This is the first time effective toxic pH values have been estimated for A. spilauchen embryonic development.

Family obligation moderates longitudinal associations between parental psychological control and adjustment of urban adolescents.

This study investigated child-reported family obligation values (FOV) in early adolescence as a moderator for associations between mother-, father-, and child-reported parental psychological control (PC) in early adolescence and child-reported internalizing and externalizing symptoms in middle and late adolescents in the Philippines. Data were drawn from three waves of a larger longitudinal study, when the Filipino youth were in late elementary grades (age M=12.04, SD=.58; N=91), in junior high school (age M=15.03, SD=.59; N=80), and in senior high school (age M=17.00, SD=.59, N=75). Results revealed that high levels of FOV buffered the positive associations between mother-reported PC and internalizing symptoms in late adolescence, and between child-reported PC and internalizing symptoms in middle and late adolescence, as well as externalizing symptoms in late adolescence. Conversely, low levels of FOV exacerbated the associations between mother- and child-reported PC on externalizing symptoms in late adolescence. Findings suggest that FOV may shape the meaning and influence of PC for children and adolescents in contexts where familial obligations are normative and important.

Characterizing and decoding the key odor compounds of Spirulina platensis at different processing stages by sensomics.

Processing is an indispensable technology in the preparation of Spirulina platensis (S. platensis). The key odorants in liquids, muds, and powders from S. platensis (NM and GZ) were characterized. A total of 90 odorants were identified and 41 odorants were sniffed with the flavor dilution (FD) factors ranging from 1 to 729. Among them, nonanal, decanal, d-limonene, ß-cyclocitral, and ß-ionone with FD factors ≥1 were detected in S. platensis during the whole processing stages. In addition, heptanal, (E, E)-2,4-nonadienal, trans-4,5-epoxy-(E)-2-decenal, 1-hepten-3-one, isophorone, 3-ethyl-2,5-dimethylpyrazine, and α-ionone exhibited higher odor activity values in powders; ß-myrcene, methional, and S-methyl methanethiosulphonate were key odorants in muds; while trans-3-penten-2-ol was key odorant in liquids. Besides, the GZ-mud presented stronger earthy and fishy odor than NM-mud. S. platensis powders have the stronger grassy odor, roasted odor, and marine odor than S. platensis muds. Overall, drying process promotes the formation of aldehydes, heterocyclic compounds, and terpenoids.

Latent profile analysis of nurses' moral courage: a professional values perspective.

INTRODUCTION: Nurses' moral courage (NMC) enhances care quality and patient safety. Nurses' professional values promote ethical adherence, moral obligation fulfillment, and compliance to prevent ethical violations. It is necessary to explore the current status and influencing factors of moral courage from the perspective of professional values. AIM: To investigate the current situation of nurses' moral courage, analyze the latent profiles of nurses' moral courage, and explore the influencing factors from the perspective of professional values. RESEARCH DESIGN: A cross-sectional design was employed. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through convenient sampling at a tertiary hospital during May 2023 in Wuhan, Hubei province, China. A self-designed web-based questionnaire consisting of demographic characteristics, the Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV) and the Nurses' Moral Courage Scale (NMCS) were used for the cross-sectional survey. Latent profile analysis was conducted using the results of 3 explicit indexes of NMCS, and multivariate logistic regression was used to analyze the influencing factors of NMC. ETHICAL CONSIDERATIONS: Research ethics approval (with the code of TJ- IRB 20220543) was obtained from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. FINDINGS: This study included 966 nurses, predominantly female and under 30 years old, with 91.10% holding a bachelor's degree. Latent profile analysis identified three moral courage profiles: low-level (31.5%), medium-level (47.2%), and high-level (21.3%). Multivariate logistic regression analysis showed significant positive correlations between professional values and moral courage, with head nurses being significantly more likely to exhibit high moral courage (OR = 3.586, p = 0.013). CONCLUSIONS: The moral courage of nurses can be classified into 3 subgroups. Nurses' professional values positively correlate with moral courage, with head nurses showing significantly higher levels of moral courage. Strengthening professional values through training can enhance ethical behavior in nursing, potentially improving patient care and safety.

Adaptive Multiple Comparisons With the Best.

Subset selection methods aim to choose a nonempty subset of populations including a best population with some prespecified probability. An example application involves location parameters that quantify yields in agriculture to select the best wheat variety. This is quite different from variable selection problems, for instance, in regression. Unfortunately, subset selection methods can become very conservative when the parameter configuration is not least favorable. This will lead to a selection of many non-best populations, making the set of selected populations less informative. To solve this issue, we propose less conservative adaptive approaches based on estimating the number of best populations. We also discuss variants of our adaptive approaches that are applicable when the sample sizes and/or variances differ between populations. Using simulations, we show that our methods yield a desirable performance. As an illustration of potential gains, we apply them to two real datasets, one on the yield of wheat varieties and the other obtained via genome sequencing of repeated samples.

Direct and Indirect Mapping of AQoL-6D onto EQ-5D-5L Utilities Using Data from a Multi-centre, Cross-Sectional Study of Malaysians with Chronic Heart Failure.

OBJECTIVE: The AQoL-6D, a generic preference-based measure, is an appealing alternative to EQ-5D-5L for assessing health status in patients with chronic heart failure (HF), given its expanded scope. However, without a Malaysian value set, the AQoL-6D cannot generate health state utility values (HSUVs) to support local economic evaluations. This study intended to develop algorithms for predicting EQ-5D-5L HSUVs from AQoL-6D in an HF population. METHODS: Cross-sectional data from a multi-centre cohort of 419 HF outpatients were used. Both direct and indirect mapping approaches were attempted using five sets of explanatory variables and 8 models (ordinary least squares, Tobit, censored least absolute deviations, generalised linear model, two-part model [TPM], beta regression-based model, adjusted limited dependent variable mixture model, and multinomial ordinal regression [MLOGIT]). The models' predictive performance was assessed through ten-fold cross-validated mean absolute error [MAE] and root mean squared error [RMSE]). Potential prediction bias was also examined graphically. The best-performing models, with the lowest RMSE and no bias, were then identified. RESULTS: Among the models evaluated, TPM, which included age, sex, and five AQoL-6D dimension scores as predictors, appears to be the best-performing model for directly predicting EQ-5D-5L HSUVs from AQoL-6D. TPM yielded the lowest MAE (0.0802) and RMSE (0.1116), and demonstrated predictive accuracy for HSUVs >0.2 without significant bias. A MLOGIT model developed for response mapping had suboptimal predictive accuracy. CONCLUSION: This study developed potentially useful mapping algorithms for generating Malaysian EQ-5D-5L HSUVs from AQoL-6D responses among patients with HF when direct EQ-5D-5L data is unavailable.