The Importance of Risk Factors, Methods of Their Calculation and Evaluation, Prognosis in Medicine (Literature Review; Examples of Their Use in Own Clinical Practice) – Second Notice

Introduction. Despite the latest advances in modern medicine, the direct etiological factors of many diseases remain unknown or it is impossible to determine the significance of each of them in their occurrence, so the theory of risk factors is extremely relevant for both theoretical and practical medicine. There are also often situations in which it is necessary to determine the optimal tactics of patient care, because preventive, curative and rehabilitation activities of the doctor require timely prediction of the occurrence probability, further course of the pathological process, its complications, recurrences under the influence of certain environmental factors, threatening and terminal stages, side effects of drugs. Therefore, the need for a practical solution to these problems has become the basis for the theory of risk factors and prognosis methods. The aim of the study. Describe the importance of risk factors and methods of their calculation and evaluation, prognosis in medicine, using literature sources, provide specific examples of their use in own clinical practice. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of studying the current scientific researches concerning studying of the importance of risk factors and a technique of their calculation and estimation, prognosis in medicine were used. Sources were searched in scientometric databases: PubMed, Medline, Springer, Google Scholar, Research Gate by keywords: risk factors, one-way analysis, multi-factor analysis. 54 literary sources in English and Ukrainian, which highlight the importance of risk factors and methods of their calculation and evaluation, prognosis in medicine were selected and analyzed, we describe the results of their use in our own clinical practice. Results. The concept of risk, as the probability of an adverse event or outcome, is most often used in analytical studies, which are planned to identify the causes and their prevalence of certain conditions. "Risk" cannot be measured directly by the results of information evaluation in one person, but is calculated on the basis of selective observation of a group of persons who are under the influence (exposed group) of a certain factor. Risk factors are potentially pathogenic factors, in contact with which a person may develop a disease. A full analysis of pathological processes, assessment of risk factors and actual risks are impossible without prognosis, as well as multivariate analysis, which is often based on the probabilistic method of A. Wald or the survival curves construction. In practical health care, cases of medical and social research and in clinical studies, it is often necessary to identify the trends (predict) in changes of a certain condition. Conclusions. Determining the risk factors, calculating the actual risks and prognosis play an important role in medicine, because in the doctor's practice there are daily situations that need to determine the optimal tactics taking into account trends, course, severity and results of treatment, therefore, their definition/calculation must be clear and understandable. Depending on the case, the doctor can use the analysis of the score for certain factors, create risk groups, develop a monitoring plan etc. As a result, it becomes possible to create a plan of preventive measures and timely correction of treatment. Keywords: risk, relative risk, absolute risk, chance, forecast.

Evaluation and Influencing Factors of Agricultural Green Efficiency in Jianghuai Ecological Economic Zone

Traditionally, in the pursuit of economic development, ecological health was sacrificed, but this is no longer tenable considering the vast environmental damage that is difficult to control and expensive to repair. This is especially true for China’s Jianghuai River Basin (JRB). As a result, this paper uses the slacks-based measure (SBM) directional distance function and the tobit model on panel data from various cities and counties in the Jiangsu section of the HRB to empirically analyze regional green agricultural production efficiency and influencing factors from 2005 to 2019. The results illustrate that agricultural and environmental efficiency fluctuate upward in provincial areas. Still, a downward trend is observed in both redundancy and insufficiency rates of undesirable and desirable output. While this indicates improving regional agricultural and environmental efficiency, there is no readily detectable positive effect of technological progress and technical efficiency on green agricultural production efficiency improvements. Following a full analysis, policy implications are presented and discussed.

Isaac Newton and the Study of Chronology

Isaac Newton (1642-1727) devoted ample time to the study of ancient chronology, resulting in the posthumously published <i>The Chronology of Ancient Kingdoms Amended</i> (1728). Here, Newton attempted to show how the antiquity of Greece, Egypt, Assyria, Persia, and other Mediterranean nations could be reinterpreted to fit the timespan allowed for by Scripture. Yet, as the hundreds of books from his library and the thousands of manuscript pages devoted to the topic show, the <i>Chronology</i> was long in the making. This volume provides the first full analysis of the genesis and evolution of Newton's studies of ancient history and demonstrates how these emerged from that other major project of his, the interpretation of the apocalyptic prophecies in Scripture. A careful study of Newton's reading, note-taking, writing, and ordering practices provides the key to unravelling and reconstructing the chronology of Newton's chronological studies, bringing to light writings hitherto hidden in the archives.

An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists

ABSTRACT Introduction Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout. Methods A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board–approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables. Results Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to &gt;5 years) had higher rates of wellness. There were no differences in burnout among groups. Conclusions Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.

Technology and Social Isolation, Loneliness, and Health Inequities Among Older Adults

Because of the COVID-19 pandemic, older adults have been advised to stay-at-home to reduce the risk of infection. Social distancing and quarantine measures increase their vulnerability to adverse health outcomes like depression and cardiovascular disease. Technology is an effective tool to promote social connectedness among older adults affected by the pandemic; however, its role in reducing loneliness and health inequities is not well understood. The goal of this project was to construct a model for how technologies may be deployed to mitigate the impact of a pandemic on social isolation, loneliness, and health inequities for older adults. PubMed, SCOPUS, and PsychINFO were searched for the following keywords: “social isolation,” “loneliness,” “social support,” “resilience,” “technology,” “pandemic,” and “health inequities.” Articles selected for full analysis attempted to understand or observe how technology alleviates social isolation and/or loneliness among older adults. Research evidence indicates that using technology reduces loneliness directly and indirectly (by reducing social isolation) and can strengthen social support, which in turn promotes resilience among older adults. Video-based technologies encourage care-seeking behaviors in this population. There is insufficient evidence to determine technology’s relationship to health inequities experienced by older adults. The model we have proposed should help advance research on the relationship between technology and health inequities among older adults that may be aggravated by pandemic-like situations. We hypothesize that technology interventions for social support and functional competence should be sequenced in order to have the best effects on reducing health disparities.

Dryer design parameters and parts specifications for an industrial scale bagasse drying system

The sugar industry is an ideal sector for electricity cogeneration due to a large amount of burnable bagasse produce as a by-product. Bagasse produced in the sugar industry always consists of moisture affecting the efficiency of a boiler in the cogeneration plant. In our case study, a cogeneration plant run by bagasse burning found with bagasse moisture problem and suffocating with low power generation for the last few years. The boiler efficiency per tonne of bagasse is currently lower than optimal due to the substantial percentage of water present in the bagasse. A bagasse dryer design for this industry can improve the efficiency of a boiler as well as the cogeneration plant. In this paper, a pneumatic bagasse drying system is proposed to reduce the moisture content of bagasse from 48% to 30%. This work provides a full analysis of bagasse dryer design parameters, including specifications for dryer system components, such as feeders, fan, drying tube, and cyclone. The total bagasse drying system proposed is expected to be fitted within a 6 × 6 × 25 m space to dry 60 tph of bagasse, reducing the moisture content from 48% to 30%, in full compliance with all relevant Australian and company standards.

Insight Into Disorder, Stress and Strain of Radiation Damaged Pyrochlores: A Possible Mechanism for the Appearance of Defect Fluorite

We have examined the irradiation response of a titanate and zirconate pyrochlore—both of which are well studied in the literature individually—in an attempt to define the appearance of defect fluorite in zirconate pyrochlores. To our knowledge this study is unique in that it attempts to discover the mechanism of formation by a comparison of the different systems exposed to the same conditions and then examined via a range of techniques that cover a wide length scale. The conditions of approximately 1 displacement per atom via He2+ ions were used to simulate long term waste storage conditions as outlined by previous results from Ewing in a large enough sample volume to allow for neutron diffraction, as not attempted previously. The titanate sample, used as a baseline comparison since it readily becomes amorphous under these conditions behaved as expected. In contrast, the zirconate sample accumulates tensile stress in the absence of detectable strain. We propose this is analogous to the lanthanide zirconate pyrochlores examined by Simeone et al. where they reported the appearance of defect fluorite diffraction patterns due to a reduction in grain size. Radiation damage and stress results in the grains breaking into even smaller crystallites, thus creating even smaller coherent diffraction domains. An (ErNd)2(ZrTi)2O7 pyrochlore was synthesized to examine which mechanism might dominate, amorphization or stress/strain build up. Although strain was detected in the pristine sample via Synchrotron X-ray diffraction it was not of sufficient quality to perform a full analysis on.

BiTTM: A Core Biterms-Based Topic Model for Targeted Analysis

While most of the existing topic models perform a full analysis on a set of documents to discover all topics, it is noticed recently that in many situations users are interested in fine-grained topics related to some specific aspects only. As a result, targeted analysis (or focused analysis) has been proposed to address this problem. Given a corpus of documents from a broad area, targeted analysis discovers only topics related with user-interested aspects that are expressed by a set of user-provided query keywords. Existing approaches for targeted analysis suffer from problems such as topic loss and topic suppression because of their inherent assumptions and strategies. Moreover, existing approaches are not designed to address computation efficiency, while targeted analysis is supposed to provide responses to user queries as soon as possible. In this paper, we propose a coreBiTerms-basedTopicModel (BiTTM). By modelling topics from core biterms that are potentially relevant to the target query, on one hand, BiTTM captures the context information across documents to alleviate the problem of topic loss or suppression; on the other hand, our proposed model enables the efficient modelling of topics related to specific aspects. Our experiments on nine real-world datasets demonstrate BiTTM outperforms existing approaches in terms of both effectiveness and efficiency.

A double-blind, placebo-controlled, randomized trial of PXT3003 for the treatment of Charcot–Marie–Tooth type 1A

Background Charcot–Marie–Tooth disease type 1A (CMT1A) is a rare, orphan, hereditary neuromuscular disorder with no cure and for which only symptomatic treatment is currently available. A previous phase 2 trial has shown preliminary evidence of efficacy for PXT3003 in treating CMT1A. This phase 3, international, randomized, double-blind, placebo-controlled study further investigated the efficacy and safety of high- or low-dose PXT3003 (baclofen/naltrexone/D-sorbitol [mg]: 6/0.70/210 or 3/0.35/105) in treating subjects with mild to moderate CMT1A. Methods In this study, 323 subjects with mild-to-moderate CMT1A were randomly assigned in a 1:1:1 ratio to receive 5 mL of high- or low-dose PXT3003, or placebo, orally twice daily for up to 15 months. Efficacy was assessed using the change in Overall Neuropathy Limitations Scale total score from baseline to months 12 and 15 (primary endpoint). Secondary endpoints included the 10-m walk test and other assessments. The high-dose group was discontinued early due to unexpected crystal formation in the high-dose formulation, which resulted in an unanticipated high discontinuation rate, overall and especially in the high-dose group. The statistical analysis plan was adapted to account for the large amount of missing data before database lock, and a modified full analysis set was used in the main analyses. Two sensitivity analyses were performed to check the interpretation based on the use of the modified full analysis set. Results High-dose PXT3003 demonstrated significant improvement in the Overall Neuropathy Limitations Scale total score vs placebo (mean difference: − 0.37 points; 97.5% CI [− 0.68 to − 0.06]; p = 0.008), and consistent treatment effects were shown in the sensitivity analyses. Both PXT3003 doses were safe and well-tolerated. Conclusion The high-dose group demonstrated a statistically significant improvement in the primary endpoint and a good safety profile. Overall, high-dose PXT3003 is a promising treatment option for patients with Charcot–Marie–Tooth disease type 1A.

Biosimilar SB11 versus reference ranibizumab in neovascular age-related macular degeneration: 1-year phase III randomised clinical trial outcomes

Background/AimsTo provide longer-term data on efficacy, safety, immunogenicity and pharmacokinetics (PK) of ranibizumab biosimilar SB11 compared with the reference ranibizumab (RBZ) in patients with neovascular age-related macular degeneration (nAMD).MethodsSetting: Multicentre. Design: Randomised, double-masked, parallel-group, phase III equivalence study. Patient population: ≥50 years old participants with nAMD (n=705), one ‘study eye’. Intervention: 1:1 randomisation to monthly intravitreal injection of 0.5 mg SB11 or RBZ. Main outcome measures: Visual efficacy endpoints, safety, immunogenicity and PK up to 52 weeks.ResultsBaseline and disease characteristics were comparable between treatment groups. Of 705 randomised participants (SB11: n=351; RBZ: n=354), 634 participants (89.9%; SB11: n=307; RBZ: n=327) completed the study until week 52. Previously reported equivalence in primary efficacy remained stable up to week 52 and were comparable between SB11 and RBZ. The adjusted treatment difference between SB11 and RBZ in full analysis set at week 52 of change from baseline in best-corrected visual acuity was −0.6 letters (90% CI −2.1 to 0.9) and of change from baseline in central subfield thickness was −14.9 µm (95% CI –25.3 to –4.5). The incidence of ocular treatment-emergent adverse events (TEAEs) (SB11: 32.0% vs RBZ: 29.7%) and serious ocular TEAE (SB11: 2.9% vs RBZ: 2.3%) appeared comparable between treatment groups, and no new safety concerns were observed. The PK and immunogenicity profiles were comparable, with a 4.2% and 5.5% cumulative incidence of antidrug antibodies up to week 52 for SB11 and RBZ, respectively.ConclusionsLonger-term results of this study further support the biosimilarity established between SB11 and RBZ.