Predictors of academic delay post-pediatric kidney transplant in the USA.

BACKGROUND: Pediatric patients with kidney failure often experience cognitive delays. However, academic delay (being more than one grade level below age-appropriate grade, or in special education) after pediatric kidney transplantation (KTx) has not been explored. We sought to identify patient characteristics associated with a higher risk of academic delay 1 year post-KTx. METHODS: We used the United Network for Organ Sharing (UNOS) database to identify children aged 6-17 years who received a primary KTx between 2014 and 2021 and had a functioning graft 1 year after KTx. The primary outcome was the patient's academic progress at 1 year post-transplant. The secondary outcome was change in academic progress between transplant and 1-year follow-up: onset of new delay, resolution of pre-existing delay, persistence of delay, or no delay at either timepoint. Binomial and multinomial mixed effects logistic regression models were used to predict each outcome based on patient characteristics. RESULTS: The study included 2197 patients, of whom 14% demonstrated academic delay at 1 year post-KTx, 4% demonstrated a new onset of academic delay, 5% demonstrated a resolution of academic delay, and 10% demonstrated persistent academic delay. Patients undergoing transplantation at a younger age, receiving a deceased donor kidney, experiencing longer waitlist times, and undergoing KTx for vascular or other disease indications for KTx were more likely to experience academic delays, including new-onset academic delays. CONCLUSIONS: Academic delays are frequently reported among pediatric KTx recipients. Additional academic support may help resolving or preventing academic delay for at-risk subgroups of children undergoing KTx.

Factors affecting antenatal care attendance in Soweto, Johannesburg: The three-delay model.

BACKGROUND:  Antenatal care remains critical for identifying and managing complications contributing to maternal and infant mortality, yet attendance among women in South Africa persists as a challenge. AIM:  This study aimed to understand the challenges faced by women attending antenatal care in Soweto, Johannesburg, using the three-delay model. SETTING:  This study was conducted in Soweto, Johannesburg. METHODS:  An exploratory, descriptive and qualitative research design was used, and in-depth interviews were conducted with 10 pregnant women and four women who had recently given birth. RESULTS:  Findings indicate delays in seeking care due to factors such as pregnancy unawareness, waiting for visible signs, and fear of human immunodeficiency virus (HIV) testing. Challenges such as transportation difficulties, distance to clinics, and facility conditions further impeded the initiation of antenatal care. Late initiation often occurred to avoid long waits, inadequate facilities, language barriers and nurse mistreatment. CONCLUSION:  From this study, we learn that challenges such as unawareness of pregnancy, cultural notions of keeping pregnancy a secret, fear of HIV testing, long waiting lines, high cost of transportation fees, clinic demarcation, shortage of essential medicines, broken toilets and verbal abuse from nurses have delayed women from initiating antenatal care early in Soweto, Johannesburg.Contribution: Challenges of women with antenatal care attendance in South Africa must be addressed by implementing community-based health education interventions, institutionalising HIV psycho-social support services and improving quality of antenatal care services in public health facilities.

The de novo missense mutation F224S in GABRB2, identified in epileptic encephalopathy and developmental delay, impairs GABAAR function.

Genetic variants in genes encoding subunits of the γ-aminobutyric acid-A receptor (GABAAR) have been found to cause neurodevelopmental disorders and epileptic encephalopathy. In a patient with epilepsy and developmental delay, a de novo heterozygous missense mutation c.671 T > C (p.F224S) was discovered in the GABRB2 gene, which encodes the ß2 subunit of GABAAR. Based on previous studies on GABRB2 variants, this new GABRB2 variant (F224S) would be pathogenic. To confirm and investigate the effects of this GABRB2 mutation on GABAAR channel function, we conducted transient expression experiments using GABAAR subunits in HEK293T cells. The GABAARs containing mutant ß2 (F224S) subunit showed poor trafficking to the cell membrane, while the expression and distribution of the normal α1 and γ2 subunits were unaffected. Furthermore, the peak current amplitude of the GABAAR containing the ß2 (F224S) subunit was significantly smaller compared to the wild type GABAAR. We propose that GABRB2 variant F224S is pathogenic and GABAARs containing this ß2 mutant reduce response to GABA under physiological conditions, which could potentially disrupt the excitation/inhibition balance in the brain, leading to epilepsy.

A soluble model for synchronized rhythmic activity in ant colonies.

Synchronization is one of the most striking instances of collective behavior, occurring in many natural phenomena. For example, in some ant species, ants are inactive within the nest most of the time, but their bursts of activity are highly synchronized and involve the entire nest population. Here we revisit a simulation model that generates this synchronized rhythmic activity through autocatalytic behavior, i.e., active ants can activate inactive ants, followed by a period of rest. We derive a set of delay differential equations that provide an accurate description of the simulations for large ant colonies. Analysis of the fixed-point solutions, complemented by numerical integration of the equations, indicates the existence of stable limit-cycle solutions when the rest period is greater than a threshold and the event of spontaneous activation of inactive ants is very unlikely, so that most of the arousal of ants is done by active ants. Furthermore, we argue that the persistent oscillations observed in the simulations for colonies of finite size are due to resonant amplification of demographic noise.

Inconsistent advice by ChatGPT influences decision making in various areas.

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people's moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

A wave delay neural network for solving label-constrained shortest route query on time-varying communication networks.

The focus of the research is on the label-constrained time-varying shortest route query problem on time-varying communication networks. To the best of our knowledge, research on this issue is still relatively limited, and similar studies have the drawbacks of low solution accuracy and slow computational speed. In this study, a wave delay neural network (WDNN) framework and corresponding algorithms is proposed to effectively solve the label-constrained time-varying shortest routing query problem. This framework accurately simulates the time-varying characteristics of the network without any training requirements. WDNN adopts a new type of wave neuron, which is independently designed and all neurons are parallelly computed on WDNN. This algorithm determines the shortest route based on the waves received by the destination neuron (node). Furthermore, the time complexity and correctness of the proposed algorithm were analyzed in detail in this study, and the performance of the algorithm was analyzed in depth by comparing it with existing algorithms on randomly generated and real networks. The research results indicate that the proposed algorithm outperforms current existing algorithms in terms of response speed and computational accuracy.

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

BACKGROUND: The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). METHODS: This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. RESULTS: Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. CONCLUSION: The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

The phenotypic and genotypic spectrum of individuals with mono- or biallelic ANK3 variants.

ANK3 encodes ankyrin-G, a protein involved in neuronal development and signaling. Alternative splicing gives rise to three ankyrin-G isoforms comprising different domains with distinct expression patterns. Mono- or biallelic ANK3 variants are associated with non-specific syndromic intellectual disability in 14 individuals (seven with monoallelic and seven with biallelic variants). In this study, we describe the clinical features of 13 additional individuals and review the data on a total of 27 individuals (16 individuals with monoallelic and 11 with biallelic ANK3 variants) and demonstrate that the phenotype for biallelic variants is more severe. The phenotypic features include language delay (92%), autism spectrum disorder (76%), intellectual disability (78%), hypotonia (65%), motor delay (68%), attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) (57%), sleep disturbances (50%), aggressivity/self-injury (37.5%), and epilepsy (35%). A notable phenotypic difference was presence of ataxia in three individuals with biallelic variants, but in none of the individuals with monoallelic variants. While the majority of the monoallelic variants are predicted to result in a truncated protein, biallelic variants are almost exclusively missense. Moreover, mono- and biallelic variants appear to be localized differently across the three different ankyrin-G isoforms, suggesting isoform-specific pathological mechanisms.

The Retrosplenial Cortical Role in Delayed Spatial Alternation.

The retrosplenial cortex (RSC) plays an important role in spatial cognition. RSC neurons exhibit a variety of spatial firing patterns and lesion studies have found that the RSC is necessary for spatial working memory tasks. However, little is known about how RSC neurons might encode spatial memory during a delay period. In the present study, we trained control rats and rats with excitotoxic lesions of the RSC on spatial alternation task with varying delay durations and in a separate group of rats, we recorded RSC neuronal activity as the rats performed the alternation task. We found that RSC lesions significantly impaired alternation performance, particularly at the longest delay duration. We also found that RSC neurons exhibited reliably different firing patterns throughout the delay periods preceding left and right trials, consistent with a working memory signal. These differential firing patterns were absent during the delay periods preceding errors. We also found that many RSC neurons exhibit a large spike in firing rate leading up to the start of the trial. Many of these trial start responses also differentiated left and right trials, suggesting that they could play a role in priming the 'go left' or 'go right' behavioral responses. Our results suggest that these firing patterns represent critical memory information that underlies the RSC role in spatial working memory.

Navigating Dravet syndrome in Spain: A cross-sectional study of diagnosis, management, and care coordination.

OBJECTIVES: Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage-gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment. METHODS: Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain. RESULTS: Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis. SIGNIFICANCE: To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio-sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease. PLAIN LANGUAGE SUMMARY: Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies.

The role of neurosurgeon in the multidisciplinary approach to ectopic or bifocal intracranial germinoma: A systematic review and report of two illustrative cases.

BACKGROUND: Pure germinoma typically originates from the midline and is usually found in the pineal and suprasellar regions in 76-90 % of cases. When it is in both regions, it is considered bifocal (10 % at diagnosis). If pure germinoma is located outside of the midline, it is considered ectopic, with a global incidence of about 0.7 %. The study aims to describe the clinical and surgical approach to patients with atypical intracranial ectopic germinoma (IEG) and bifocal germinoma (BG) through a literature review with the goal to delineate the correct diagnostic and therapeutic pathway, to reduce the diagnostic delay and improve the prognosis of these patients. METHODS: A systematic review of the literature in most common electronic database (PubMed, Ovid MEDLINE and Ovid EMBASE) on IEG and BG, in according with the "PRISMA statement" criteria, from January 1990 to September 2022 was done. In addition, two rare cases of IEG and BG were reported. RESULTS: This systematic review included 16 papers (20 patients) with a final diagnosis of IEG and 30 papers (121 patients) with a final diagnosis of BG. IEGs seems to involve primary basal ganglia (40 %) and corpus callosum (40 %). For IEGs, biopsy (70 %, 14 cases out of 20) was the most common surgical approach: open approach (35 %), stereotactic minimally invasive approach (30 %) or endoscopic trans-sphenoidal approach (5 %). Partial resection was performed in 10 % of cases, whereas a total resection was performed in 20 % of cases. Also for BGs, biopsy was the most common surgical approach in 80 % of patients, whereas surgical resection (partial or total) was performed in 5.3 % of patients. CONCLUSION: IEG and BG are rare type of primary intracranial germ cell tumor, whose unusual location often can cause delays in diagnosis, which can have a significant impact on the patient's prognosis and requiring a multidisciplinary and timely approach.

The perceived controllability of negatively-valenced episodic future thinking modulates delay discounting.

Intertemporal decision-making is important for both economy and physical health. Nevertheless, in daily life, individuals tend to prefer immediate and smaller rewards to delayed and larger rewards, which is known as delay discounting (DD). Episodic future thinking (EFT) has been proven to influence DD. However, there is still no inconsistent conclusion on the effect of negative EFT on DD. Considering the perceived controllability of negative EFT may address the issue (Controllability refers to the extent to which progress and result of an event could be controlled by ourselves). In the current study, we manipulated EFT conditions (baseline, neutral EFT, negative-controllable EFT and negative-uncontrollable EFT), delayed time (i.e. 1 week, 1 month, 3 months, 6 months, 1 year and 3 years) and reward magnitude (small, large). We mainly found that when experiencing negative-uncontrollable EFT compared to negative-controllable EFT in the delayed time of 6 months with large rewards, individuals chose more delayed rewards, suggesting that negative-uncontrollable EFT effectively reduced DD under conditions of both large-magnitude reward and longer delayed time. The current study provides new insight for healthy groups on optimising EFT. In that case, individuals are able to gain long-term benefits in financial management and healthcare.

Effect of a Tailored Physiotherapy Rehabilitation on Developmental Delay Primary to Non-communicating Hydrocephalus: A Case Study.

This case report presents the physiotherapy intervention of a one-year-old male child diagnosed with non-communicating hydrocephalus primary to developmental delay. Hydrocephalus is marked by an accumulation of cerebrospinal fluid and often leads to significant developmental delays and neurological impairments in affected infants. The physiotherapy intervention aimed to achieve head and trunk control, improve sensory awareness, and enhance overall body coordination and balance. Various techniques, including neurodevelopmental techniques, sensory stimulation, hippotherapy, and sensory integration therapy, were utilized to target specific developmental milestones and functional abilities. Outcome measures, including the Gross Motor Function Measure, Infant Neurological International Battery, Hammersmith Infant Neurological Examination, and New Ballard Score, were used to assess the patient's progress pre- and post-intervention. Significant improvements were observed across all outcome measures following four months of physiotherapy rehabilitation. The patient demonstrated substantial gains in gross motor function, neurological examination scores, and overall developmental milestones. These findings underscore the effectiveness of physiotherapy rehabilitation in addressing developmental delays associated with non-communicating hydrocephalus. This case underscores the significance of early physiotherapy intervention, which plays a vital role in enhancing outcomes and improving the quality of life for affected children.

First report of Coffin-Siris Syndrome with SMARCB1 variant, normal intelligence and mild selective neuropsychological deficits: A case report and literature review.

Background: The SMARCB1 gene encodes a subunit of the BRG1-Associated Factor (BAF) complex, and mutations in this gene have been linked to Coffin-Siris Syndrome (CSS) type 3. CSS is characterized by a range of developmental disabilities, facial dysmorphic features, and feeding difficulties. There's been noted genotype-phenotype correlation in CSS, with cases involving SMARCB1 mutations often exhibiting more severe language impairment and intellectual disability. Method: We conducted a review of reported CSS type 3 cases and presented the first instance of CSS associated with a SMARCB1 variant wherein the patient exhibited normal intelligence and only mild selective neuropsychological deficits. The patient underwent evaluation for feeding challenges, growth delay, and dysmorphic features during their second year of life. Subsequently, CSS diagnosis was confirmed due to a de novo heterozygous c.568C > T (p.Arg190Trp) variant in the SMARCB1 gene. Due to learning difficulties, the patient underwent a comprehensive neuropsychological assessment, which was related to the retrospective reconstruction of her medical and developmental history. Results: The patient demonstrated normal intelligence and adaptive functioning, with specific deficits in arithmetic and selective difficulties in verbal learning and long-term memory. Feeding difficulties and language delay observed in early childhood showed significant improvement over time. Discussion: We discuss this case in relation to previously reported CSS type 3 cases, emphasizing neuropsychological aspects. It's evident that neuropsychological features of CSS can vary among affected individuals, highlighting the importance of personalized support and interventions tailored to specific cognitive and emotional needs by healthcare professionals. Our case suggests avenues for future research to identify specific modifiers of phenotypic expression to explain variability in intellect among patients and pinpoint potential targets for gene therapy.

Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Introduction: Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. Methods: The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Results: Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Discussion: Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Return rates and pregnancy outcomes after oocyte preservation for planned fertility delay: a systematic review and meta-analysis.

OBJECTIVE: To characterize the literature on social oocyte preservation, specifically the return rates, thaw rates, clinical pregnancy rates, and live birth rates. IMPORTANCE: Oocyte preservation for planned fertility delay, also referred to as social oocyte preservation or colloquially as "egg freezing" has become increasingly popular in the last few decades. Previous literature has suggested that there are gaps in counseling and expectations regarding the expected thaw rates and outcomes of preserved oocytes. DATA SOURCES: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of seven databases (MEDLINE, EMBASE, Emcare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus) until January 1st, 2024. The Risk Of Bias In Non-randomized Studies of Interventions tool was used for critical appraisal. Study selection and synthesis: All original human research that reported data for individuals who underwent autologous oocyte preservation for planned fertility delay (i.e., not for medical indications such as chemotherapy) were included for analysis. Meta-analysis was done using descriptive statistics and pooled prevalence rates. Title, and abstract screening and data extraction was conducted in duplicate by two independent reviewers for all studies until full agreement on eligibility was achieved through consensus-based discussion. RESULTS: After screening 1540 references, a total of 27 studies encompassing 13,724 patients were included. Follow-up ranged from 4 to 19 years, with a median follow-up time of 7 years. A total of 16,153 oocyte retrieval cycles for planned fertility delay were reported, with most individuals undergoing a single cryopreservation cycle. Overall, 10.8% of individuals returned to thaw their eggs with an aggregate oocyte survival rate of 79.52%. Implantation rate was 39.25%, clinical pregnancy rate was 32.5%, and ongoing pregnancy rate was 24.4% across the studies that reported these outcomes. A live birth was reported for 23.2% of individuals across all age groups who returned to thaw eggs. CONCLUSIONS AND RELEVANCE: Individuals should be counseled regarding the low return rates following oocyte preservation for planned fertility delay.

Is an accurate self-perceived health risk beneficial for patients to minimize prehospital delay time at onset of a ST-segment elevated myocardial infarction (STEMI)?

High risk perception (HRP) is fundamental for adequate health behavior. However, its impact on rapid access to cardiac care after the onset of acute myocardial infarction (AMI) is not known. Conflicting evidence exists about sources that promote HRP. Data on sociodemographic and clinical characteristics of 588 AMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study were collected at the bedside. Adjusted multivariate logistic regression models identified factors associated with HRP. Only 13.4% (n = 79) of patients had a favorable HRP level. The HRP patients did not differ from those with low risk perception (LRP) in terms of sex, age, other sociodemographic features, and somatic risk factors. Among the univariate contributors to HRP were prodromal chest pain (p = 0.0004), symptom mismatch during AMI (p < 0.0001), depression (p = 0.01), and anxiety (p = 0.005). However, family history of AMI, a previous AMI, and knowledge of AMI remained significant in the multivariate regression model. Median delay time to reach a hospital-based emergency facility after the onset of AMI was 127 min (interquartile range [IQR]: 83-43, p = 0.02) in HRP patients and 216 min (IQR: 106-721) in LRP patients. An increasing risk perception score was associated with a corresponding stepwise decline in median delay time (p > 0.004). Self-perceived AMI risk is associated in a dose-response relationship with the time needed to reach coronary care emergency facilities. Recurrent AMI, family history of AMI, and sufficient knowledge of MI contribute to risk perception, whereas somatic risk factors do not.

Enhancement noise margin and delay time performance of novel punch-through nMOS for single-carrier CMOS.

In this paper, we propose the use of punch-through nMOS (PTnMOS) as an alternative to pMOS in complementary metal oxide semiconductor (CMOS) circuits. According to the TCAD simulation results, PTnMOS exhibit sub-threshold characteristics similar to those of pMOS and can be formed by simply changing the doping concentration of the source and drain. Without the need for sizing, which solves the area occupation problem caused by the need to increase the width of pMOS due to insufficient hole mobility. In addition, we compose a PTnMOS and nMOS without sizing to form a single-carrier CMOS in which only electrons are transmitted, and We extract its performance for comparison with conventional CMOS (Wp/Wn = 1). The results indicate that single-carrier CMOS has symmetric noise margin and 29% faster delay time compared to conventional CMOS (Wp/Wn = 1). If III-V or II-VI group materials could be applied to single-carrier CMOS, not only could costs be reduced and wafer area occupancy minimized, but also significant improvements in the performance and bandwidth application of microwave circuits could be achieved.

Dedicated anticoagulation management protocols in fragility femoral fracture care - a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study.

INTRODUCTION: Approximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. METHODS: Data was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. RESULTS: Dedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54-0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75-3.57, p=0.219). CONCLUSIONS: Around half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

Do Behavioral Characteristics Influence the Breast Cancer Diagnosis Delay? Evidence from French Retrospective Data.

OBJECTIVES: To analyze the behavioral determinants of breast cancer diagnosis delays in France. To do so, we investigated whether time discounting, risk tolerance, and personality traits influenced the breast cancer diagnosis delay of patients. METHODS: We used original retrospective data collected on two large online patient networks from 402 women diagnosed with breast cancer. The breast cancer diagnosis delay was measured by the difference between the date of diagnosis and the date of first symptoms. Time discounting and risk tolerance are measured with both self-reported questions and hypothetical lotteries. Personality traits are measured with the 10-items Big-Five indicator. Ordinary Least Square and Probit models were used to analyze whether these behavioral characteristics influenced the breast cancer diagnosis delay. RESULTS: Results showed that risk tolerance and time discounting were not significantly associated with the breast cancer diagnosis delay. We found, however, a longer diagnosis delay for women with a Neuroticism personality trait (standardized coefficients ranged from 0.104 (p-value = 0.036) to 0.090 (p-value = 0.065)). CONCLUSIONS: Overall, our findings underline the need for an increased consideration of cancer screening public health policy for women with mental vulnerabilities since such vulnerabilities were found to be highly correlated with a Neuroticism personality trait.