Background: There are few growth monitoring and promotion indexes, and currently none of them include any metrics that measure caregiver behaviours. No index to date combines the metrics of both community health worker activeness and caregiver barriers and facilitators towards growth monitoring and promotion (GMP). This study developed a new growth monitoring and promotion index and validated it using the Delphi Technique. Methods: The study began with phase 1, which was a scoping review of the literature on GMP indexes. Phase 2 involved a community health worker (CHW) survey which explored the process of GMP within the Umguza health system, and determined how knowledge of GMP by CHWs translated to frequency of activities. A barrier analysis was also conducted with caregivers of children under five to determine the barriers and facilitators towards GMP attendance by caregivers. Phase 3 was the construction of the index along with its validation, using the Delphi Technique where fifteen experts within the health and nutrition sector were consulted to analyse the constructs/variables of the index. Results: A growth monitoring and promotion index was developed and validated by several technical experts in the health and nutrition sector in Zimbabwe. Conclusions: A new index has been developed to improve the quality of growth monitoring and promotion activities within the communities. Growth monitoring and promotion (GMP) is both a preventive and promotive activity that is used by health workers to monitor the growth of children. It helps in the prevention of child malnutrition through early detection of any growth faltering  and reduIn Zimbabwe, GMP is an important part of the nutrition surveillance system which operates from the national level right down to the community level . At the The challenges of GMP are two-pronged, those affecting the CHWs and those affecting the caregivers of CU5, and result in a vicious cycle. On the part of the CHWs, they are meant to be volunteers working for 2–3 half days a week. However, findings by the Zimbabwe Parliamentary Portfolio Committee on Health in 2017 found that the CHWs were now working throughout the week including at night. This then led to the realisation that they were working 40 h weeks /186 = 2.52 .The level of CHW activeness for this study was therefore 2.5.A three-point Likert scale was developed to classify the magnitude of facilitators of GMP  identifiThis study identified one facilitator; hence, the overall score for variable Y is 1.A three-point Likert scale was developed to classify the magnitude of the barriers identified in this study  towards This study identified four barriers; hence, the overall score for variable Z is 3.CHW activeness (X) is classified as most active  and scorCaregiver facilitators of GMP (Y) are many  and scorCaregiver barriers to GMP (Z) are few  and scorFrom the equation developed from this study, GMPI = X + Y − Z, the maximum value of the GMPI is attained when the following conditions are met:The maximum GMPI score is 7 from the formula calculation [5 + 3 − 1].CHW Activeness (X) is classified as least active ;Caregiver facilitators of GMP (Y) are few ;Caregiver barriers to GMP (Z) are many .The minimum value of the GMPI is attained when the following conditions are met:For the classification of the GMPI, a three-point Likert scale was developed where each threshold was weighted equally to one decimal place , i.e., lX = 2.5 CHW activenessY = 1 caregiver facilitators of GMPZ = 3 caregiver barriers to GMPFrom the results of this study, the GMPI is based on the equation GMPI = X + Y − Z where the variables have been outlined above as follows:The GMPI = 0.5 [2.5 + 1 − 3].Few barriers (Z);Many facilitators (Y);Most active CHWs (X).According to this study, GMPI is a measure of the quality of GMP activities, and thus it follows that the highest quality of GMP activities exists within a district or community when there are the following:Based on the GMPI score above, the quality of GMP activities in the Umguza district was found to be low.An analysis of opinions from the technical experts is shown in Based on the GMPI validation exercise, it was agreed that no immediate changes were to be made to the new GMPI. Recommendations were that the GMPI be tried out by the MOHCC and other implementers of GMP programs to ascertain its usability.The GMPI can be used by all implementers of GMP at either the district or ward level.It is best to use the GMPI initially when the routine GMP data indicate a low number of CU5 being assessed during GMP by CHWs. Such data can be obtained from the DHIS2.To use the GMPI, the different variables that constitute it must be measured. Their measurement is outlined below.CHW activeness (X).This is measured through a survey of all CHWs in the ward or district. A questionnaire should be designed to include the number of hours volunteered by the CHWs per week, among other desired aspects. Once data are obtained, analysis can be conducted using SPSS or STATA refer to  below.In order to develop a single score for all the CHWs, a weighted average score should be used: (frequency × scores)/n.II.Caregiver facilitators of GMP (Y)A standard barrier analysis as developed by Kittle  is conduIII.Caregiver barriers to GMP (Z)A standard barrier analysis as developed by Kittle  is conduD.Classification using the GMPIFrom this study, GMPI is the sum of X + Y − Z. Hence, based on the total sum of the three variables, the GMPI will be found and classified as to whether it is low, medium, or high.High implies that GMP activities as shown by the variables are performing well.Medium implies that one or more of the variables are performing poorly and specific strategies to improve them need to be implemented.Low implies that two or more of the variables are performing poorly and specific strategies to improve them need to be implemented.Having defined the GMPI as a measure of the quality of GMP activities has enabled GMP implementers to move away from the usual classifications which were based on the currently existing child health indexes such as weight-for-height. The scoping literature review by Moyo et al.  identifiThis brings to light the importance of CHWs, who are central to GMP activities at the community level. They collect the data that filter into the DHIS2. In the DHIS2, one of the indicators reflective of GMP is the number of children weighed per month. Caregivers of CU5, being the ones who attend or do not attend GMP, also needed to play a part in determining the quality of GMP activities in their communities. There is evidence suggesting that implementing growth monitoring without linking it to the promotion aspect of GMP is a waste of resources and a loss of opportunities . That beThe construction of the GMPI was guided by the conceptual framework by Ashworth et al.  and adapThis index was developed and validated, as guided by the research protocol . The stuThe Delphi Technique outcome used to validate the index did not result in any changes to the new GMPI variables. Contextualisation and validation strengthened the initial acceptance of the GMPI and thus increased its chances of being implemented and resulting in the intended outcomes . The keyThe researchers, through their scoping literature review , showed The child health indexes that are currently existing are weight-for-height, height-for-age, weight-for-age, and so forth . The varTo have improved GMP, caregiver barriers need to be reduced, caregiver facilitators need to be increased, and CHWs need to remain active for the GMPI to remain high. Improved GMP will then result in improved nutrition and health status of CU5.The study recommendations are outlined as follows for each GMP constituent and are thus for GMP program implementers :Community Health Workers CHWs are volunteers and are not meant to be working full time, i.e., 40 h a week. Furthermore, this is their understanding when they are enrolled as CHWs. It is thus unclear what the correct position should be as on paper it is said they should work for 2–3 half days a week, while in reality, they are working longer than this. The correct position needs to be established and enforced to address the risk of volunteer burnout and the demise of the active CHW cadre.Caregivers of children under five years Strategies need to be put in place to reduce the number of barriers hindering caregivers from attending GMP. The objective of GMP for CU5 is a preventive measure along with providing a curative platform to prevent child morbidity and morbidity. When caregivers do not attend GMP, the children suffer ultimately. It is thus imperative for even policies to be put in place that not only ensure attendance but also address the barriers such as those that were identified by this study.New GMPI Based on the outcome of the validation exercise with the technical experts, the GMPI must be piloted in a selected district. That is the only way that GMP implementers can make practical improvements, if any, to improve the index.The variable of CHW activeness is prone to recall bias as it was based on a recollection of the number of hours per week spent on CHW activities. Only one level of validation could be held for the GMPI with technical experts, and there was nothing for the lower-level end users at the district level due to limitations in funding for the study.In this study, criterion validity was not considered.The development of this GMPI opens doors for further refinement. A new dawn has arrived where public health practitioners are being challenged to continue to identify practical ways in which all the data that are obtained daily from varying health programs become more meaningful to the end users such as the MOHCC. The GMPI will be used to classify the GMP performance of districts through the DHIS2, thus strengthening the quality of GMP activities.


A misunderstanding of the mechanism of action and bacterial targets of antibiotics by consumers may drive inappropriate antibiotic use and antimicrobial resistance (AMR). Tackling AMR requires an in-depth understanding of consumer beliefs and misconceptions. We explored consumer conversations on a number of social media platforms on antibiotic use and AMR in the context of sore throat and how coronavirus disease 2019 (COVID-19) affected online conversations between 1 January 2018 and 25 November 2021 across eight countries. Five distinct consumer groups were identified  with a wide spectrum of beliefs around antibiotics in sore throat. Many opinions were based upon misconceptions, the most prominent of which was that antibiotics are strong medications that can treat all types of sore throat. COVID-19 had a multifaceted effect on the sore throat and AMR conversation. Sore throat triggered anxiety as consumers feared it may be a COVID-19 symptom while engagement in conversations around antibiotics for COVID-19 increased. Finally, consumers sought multiple routes to access antibiotics, such as directly from the pharmacy or by attempting to persuade physicians to prescribe. Knowledge obtained from this study could be used to develop focused approaches to dispel consumer misconceptions and mitigate AMR. Antimicrobial resistance (AMR) is one of the most urgent global health challenges of the 21st century . In 2019Overuse and misuse of antimicrobials significantly contribute to AMR ,5. DespiInappropriate antibiotic use, whether obtained on prescription or over the counter (OTC), is likely to be influenced by consumer misunderstanding. Studies conducted prior to coronavirus disease 2019 (COVID-19) revealed that up to 71% of patients believed that viruses can be treated with antibiotics ,12,13,14It has also been shown that consumers have a poor understanding of AMR. A study using qualitative semi-structured interviews with patients or parents of children presenting with an acute respiratory infection to general practices in Australia, revealed a lack of understanding of what becomes resistant (the person or the bacteria), how patients contribute to AMR, and that resistance can spread between people in close proximity . FurtherAddressing the challenge of AMR as we move past the height of the COVID-19 pandemic requires an in-depth understanding of consumer perceptions and misconceptions around antibiotic use and AMR, so that targeted educational materials/messages and strategies  can be developed and delivered. Social media provides unprecedented communication opportunities between individuals, companies and organizations. In 2021, around one-half of the global population (approximately 4.26 billion people) used social media worldwide . In addiThe extensive use of social media provides an opportunity to further explore consumer beliefs and conversations regarding antibiotics and AMR and offers opportunities to share appropriate messages through such platforms. The aim of this study was to explore consumer conversations on social media on antibiotic use and AMR in the context of sore throat using Brandwatch, a social listening platform that allows one to monitor and analyze online conversations , to deteThere were ~760,000 social media posts related to AMR and ~3,500,000 social media posts related to sore throat across the eight countries between 1 January 2018 and 25 November 2021. The social media listening exercise revealed three critical findings: (1) distinct consumer groups were involved in conversations on antibiotic use in sore throat with a substantial number of opinions based upon misconceptions; (2) COVID-19 impacted conversations on sore throat and AMR; and (3) COVID-19 impacted how the patient responded to early sore throat symptoms.Five distinct consumer profiles were identified with diverse opinions and beliefs on antibiotic use in sore throat .The first two consumer profiles had the greatest understanding of antibiotics and AMR. Antibiotic-preserving peer educators shared knowledge of the difference between viral and bacterial infections manifesting in sore throat and had a strong opinion on if and when antibiotics should be taken. Consumers in this group tended to share advice only when asked, and while their posts were largely neutral and educational, they appeared to be strongly against antibiotic misuse. Antibiotic-cautious consumers were more hesitant to take antibiotics for a sore throat for different reasons. On one hand, reluctance was due to an awareness of AMR or the knowledge that antibiotics are not indicated for self-limiting sore throat of viral etiology. On the other hand, reluctance stemmed from the perception that antibiotics are ‘too strong’ a medication to take for something as trivial as sore throat; the tone of the conversation by these consumers made it seem that they had a moral reluctance to take antibiotics for sore throat . These consumers often preferred home remedies and symptom relief; however, this was not driven by a belief that ‘natural’ solutions are superior, but rather by the knowledge that sore throat is self-limiting and will resolve over time with symptomatic management.The third group were categorized as medication-resistant antibiotic opponents, who appeared to prefer home remedies and were reluctant to take antibiotics due to a misunderstanding of AMR. Consumers in this group believed that AMR could be ‘caught through antibiotics’ and believed that antibiotics make bacteria in their body stronger, which was partially reinforced by a concern about missing antibiotic doses and forgetting to finish the full course of treatment. This group also included pregnant women and parents who were hesitant to give/take antibiotics because of a perception that they could cause side effects or weaken the immune system of their child.The final two consumer profiles appeared to be supporters of antibiotics with a lesser understanding of the mechanism of action of antibiotics. Consumers that were believers in the strength of antibiotics were typically keen to use antibiotics as they believed they are ‘strong medications’ that provide quick relief of symptoms. Consumers in this group were unable to make the distinction between viral and bacterial infections and often felt frustrated when their sore throat did not clear up with antibiotic treatment. Determined pro-antibiotic consumers were part of a smaller group. They often shared their beliefs that antibiotics are ‘strong medications’ and proactively attempted to source antibiotics by trying to persuade their physician. Some consumers even went directly to a pharmacy to obtain antibiotics OTC.A number of consumer misconceptions were identified, with the most prevalent often being misinterpretations of the science behind AMR rather than outright fallacies. The most common consumer misconception was that antibiotics are strong medications that can treat all types of sore throat .COVID-19 had a multifaceted effect on sore throat and AMR conversations. Firstly, sore throat triggered anxiety in consumers as they feared it may be a symptom of COVID-19, which prompted consumers to test for COVID-19. Secondly, the pandemic led to consumers engaging in conversations around antibiotics and the distinction between viral and bacterial infections in the context of COVID-19, and antibiotics not being effective against viral infections. Furthermore, early in the pandemic, commentary by consumers and HCPs was directed towards people being prescribed antibiotics for COVID-19. A minority of consumers suggested that antibiotic prescriptions for COVID-19 may play a role in the prevention of opportunistic bacterial infections. Finally, public interest in natural remedies for sore throat remained prominent, and possibly even increased during the pandemic, driven by a reluctance to visit healthcare centers for fear of contracting COVID-19 or overburdening the health system, as well as a desire to lead a healthy lifestyle focused on wellness.In addition to consumers, the study found that other stakeholders played a larger part in conversations that included sore throat, AMR and COVID-19. For example, activities carried out during World Antibiotic Awareness Week (WAAW) by government agencies, health authorities, local branches of the WHO and regional healthcare bodies focused on raising awareness of AMR and the dangers it poses in general, and garnered significant coverage through online platforms. A small proportion of individual campaigners and consumers  joined the conversations. Supportive campaigns and conversations around AMR became less prominent during the height of the COVID-19 pandemic, as health authorities focused on tackling COVID-19. Furthermore, many stakeholders outside of government influenced the AMR conversation, including peer educators  and non-healthcare figures in the public domain .Consumers sought advice for sore throat relief through multiple routes. Consumers seeking advice from people in an individual’s social network was common in online sore throat conversation. Some consumers frequently visited the pharmacy for OTC symptom relief if they did not already have this at home. Meanwhile, other consumers visited their physician or pharmacist immediately, especially when they were unsure if their symptoms were COVID-19-related. In some markets , consumers with sore throat were more likely to demand specific antibiotics from their physician. In other markets , consumers attempted to persuade their physician to prescribe antibiotics by stating that they were necessary or exaggerating their symptoms. Antibiotics or antibiotic-containing products frequently mentioned by people experiencing sore throat included amoxicillin (Thailand), amoxicillin combined with clavulanic acid (Thailand), penicillin V (Germany), Benzetacil (benzyl penicillin) (Brazil), Grammidin (gramicidin) (Russian Federation), and Bioparox (fusafungine) spray (Romania). A trigger for visiting primary care/family physicians was when symptoms worsened or lingered for some time and depended on factors related to COVID-19, such as the desire to test and fear of infection, as well as factors related to the health systems . In addition, in countries where antibiotics were more commonly available without a prescription directly from the pharmacy , some consumers went directly to the pharmacy to access treatment.To our knowledge this is the first study to examine consumer beliefs and conversations on sore throat, antibiotics and AMR, and the impact that the COVID-19 pandemic has had on such conversations, using posts from multiple social platforms and forums. Our study assessed a large number of social media posts, which allowed us to unpack the diverse consumer beliefs related to antibiotic use. We found that consumer conservations were clustered, which allowed us to define five distinct groups, with many groups’ opinions based upon misconceptions. In addition, COVID-19 impacted conversations around sore throat and AMR and how patients respond to early sore throat symptoms.Beliefs and misconceptions observed among the five groups aligned with previous studies. At one end of the scale were antibiotic-preserving peer educators and antibiotic-cautious consumers who had the greatest understanding of antibiotics and AMR. Other survey-based studies also found that there were a proportion of patients (between 36.5% and ~50%) who clearly understand that antibiotics are only effective against bacterial infections ,13. PrevAsk questions to establish the understanding of AMR by the consumer and identify misconceptions; Customize messages according to the consumer profile; Empower consumers with the knowledge to understand the cause of their illness and why symptomatic relief can be effective.For HCPs to help address consumer misconceptions, we recommend a multifaceted approach. Firstly, we would suggest that HCPs become knowledgeable on the identified consumer profiles and the desired messages that should be conveyed to bring a shift in belief/behavior. Secondly, as it may be difficult to determine the beliefs of a consumer on first contact, we would suggest utilizing open-ended statements and questions to explore what consumers are looking for and identify any misconceptions. Once this information has been gathered, messages can be customized and relevant decision aids and knowledge bites on appropriate antibiotic use and symptomatic management can be provided, to address misconceptions and empower the consumer to make appropriate health decisions . A simplThe large number of social media posts analyzed in our study indicated that social media platforms are regularly used by various stakeholders to share opinions and perspectives and engage in discussions. Other studies have also found that social media is widely used by patients to source information and connect with their peers, healthcare organizations and HCPs ,24,25,26Along with the development of social media content to provide education and convey messages, consumers and HCPs that are less familiar with social media should not be overlooked. We recommend that targeted educational materials  remain available within the healthcare setting to ensure all consumers continue to receive relevant education. Notably, future HCPs (including community pharmacists and pharmacy counter assistants) are likely to be digitally native in their forms of communication and digital social engagement, meaning that they may not need as much training and education in this area. However, it is essential that future HCPs receive appropriate training on the different consumer profiles that have been identified in this study, along with AMR and antimicrobial stewardship , so thatSocial media can be a useful tool for health promotion, providing communication opportunities between several stakeholders and audiences . HoweverCOVID-19 had a multifaceted effect on sore throat and AMR conversations. For example, sore throat triggered anxiety in consumers as they feared it may be a symptom of COVID-19, which prompted them to carry out diagnostic testing. Interestingly, supportive campaigns and conversations around AMR became less prominent during the height of the COVID-19 pandemic, as health authorities focused on tackling COVID-19. Given that AMR remains a major health issue, we recommend that communications should be refocused on how inappropriate antibiotic use can contribute to AMR and the threat that it poses and should leverage our learnings from the COVID-19 pandemic.Streptococcus pyogenes (S. pyogenes) [S. pyogenes; therefore, it is considered the antibiotic of choice for the treatment of group A streptococcal pharyngitis [In addition to targeted materials, messages and approaches to address consumer misconceptions on sore throat and antibiotic use, additional strategies could be employed to further help in the fight against AMR. Most cases of sore throat (up to 80%) are of viral etiology, meaning that antibiotics will not work . Furtheryogenes) . Penicilryngitis . Howeverryngitis ,37,38. Bryngitis . It is iThis was a multinational, observational, consumer content analysis study initiated and commissioned by Reckitt, the maker of Strepsils. The study was conducted across eight countries: Germany, Italy, Spain, Mexico, Brazil, Thailand, Romania and the Russian Federation. Social media searches were conducted between 1 January 2018 and 25 November 2021 to explore conversations around AMR and sore throat and the effect of COVID-19 on online conversations by contrasting the conversation before and after 1 January 2020. The master search terms in English are provided in During Step 1, Brandwatch, a social listening platform that allows one to monitor and analyze what is being said online about brands, people and products , was utiStep 3 consisted of a preliminary analysis, which was conducted in local languages. During this step, social media conversations were reviewed by analysts to identify and summarize the most prevalent themes (‘conversation drivers’) of the conversations around antibiotics in the context of sore throat. Data were then distilled into an initial update by cross-referencing and validating the preliminary observations (Step 4).The first qualitative analysis was conducted (Step 5) by a team of social media analysts who were proficient in the local language of each country. The analysis explored how antibiotics were being perceived and used by consumers within the context of sore throat. Data collection via Brandwatch was supplemented with extensive human-led manual identification and exploration of additional forums and data-limited channels. These additional country-specific sources were identified by analysts with local country knowledge, and through internet searches using the terms that had featured most prominently within the conversations identified via Brandwatch. The full qualitative analysis included the review of ~2500 posts per country and focused on the following topics: sore throat diagnosis; sore throat tests; sore throat self-treatment; sore throat hospital treatment; sore throat treatment with antibiotics; health literacy; AMR in the context of sore throat; consumer perception of antibiotic policy (in the context of the country stance on antibiotic use) and campaigns; antibiotic availability; key influencers (celebrities and public figures) discussing AMR; and the biggest changes in AMR conversations before and after the advent of the COVID-19 pandemic.Following qualitative analysis, the first workshop was held to define the consumer profiles (Step 6). Workshop participants included analysis teams from all countries, Reckitt and Lumanity (the agency commissioned to carry out the study). Key beliefs and perceptions were summarized and organized along two axes: ‘in favor of antibiotics’ versus ‘opposed to antibiotics’ and ‘health literate’ versus ‘misinformed’. Where multiple individual beliefs were clustered together, these were grouped into different consumer profiles. An interim report was generated outlining the preliminary findings and identifying the additional key questions to explore (Step 7).Step 8 consisted of a subsequent qualitative analysis to further refine and add detail to the consumer profiles, including discussions centering on consumer perceptions of interactions with HCPs in the path of receiving antibiotics; biggest changes in the sore throat conversations before and after the advent of the COVID-19 pandemic; sore throat channel breakdown analysis to determine which social media channels were used by different stakeholder groups and which were the most prominent types of conversation on these channels; WAAW; and Strepsils. During the second workshop (Step 9), analysis teams from each country, Reckitt and Lumanity assessed the prevalence of consumer profiles and shifts due to COVID-19. Key findings from the qualitative analyses and the workshops were distilled into a final report (Step 10) detailing the main areas of implications and the key messages from the study.Key themes from the social media research were presented to a global group of pharmacists attending a Global Respiratory Infection Partnership workshop, which was held at an international pharmacy conference  World Congress of Pharmacy and Pharmaceutical Sciences 2022). The workshop assessed whether consumer profiles and perceptions were recognized by pharmacists in their country. In addition, the workshop aimed to define the questions consumers in each profile should be asked and potential responses that could be provided to address misconceptions (Step 11). The analysis formed the basis for our recommended strategies and resources that could be implemented to address consumer misconceptions and help tackle AMR (Step 12).Our social media listening study illustrated a number of misconceptions on sore throat, antibiotic use and AMR, and further showed that COVID-19 has impacted conversations and the patient response to early sore throat symptoms. The knowledge obtained from the study provides an opportunity to address the diverse consumer misconceptions through HCP interventions, both in person and in the social media space, and via other stakeholders, to effectively mitigate the challenge of AMR. One of the objectives of the WHO global action plan on AMR is to increase the awareness and understanding of AMR using strategies that focus on communication. Therefore, future efforts should focus on developing materials and messages that tackle identified misconceptions in a succinct and impactful way. In addition, finding the right people and channels to spread correct messaging to address misconceptions is of great importance.


Mechanistic modelling predictions were, on average, more frequently (3 of 4) unbiased than statistical modelling predictions (1 of 4). Additionally, power model predictions were, on average, more frequently (3 of 4) unbiased than exponential model predictions (1 of 4). The mechanistic power model, along with annual updating, had the highest R2 and the lowest mean squared error of predictions. It also exhibited the closest approximation to unbiased predictions. Notably, significantly biased predictions were all underestimates. Based on the mechanistic power model, the biological eradication of bTB from New Zealand is predicted to occur after 2055. Disease eradication planning will benefit from annual updating of future predictions.Bovine tuberculosis (bTB) is prevalent among livestock and wildlife in many countries including New Zealand (NZ), a country which aims to eradicate bTB by 2055. This study evaluates predictions related to the numbers of livestock herds with bTB in NZ from 2012 to 2021 inclusive using both statistical and mechanistic  modelling. Additionally, this study made predictions for the numbers of infected herds between 2022 and 2059. This study introduces a new graphical method representing the causal criteria of strength of association, such as R Trichosurus vulpecula). Brushtail possums are an important wildlife host of bTB [Bovine tuberculosis (bTB) is prevalent in New Zealand (NZ) and has been the focus of eradication efforts –4. Theset of bTB –7. Expert of bTB . In respt of bTB –4. The cMaking predictions and evaluating them is a fundamental part of science and can be highly useful in the management of wildlife and their diseases. Predictions generated by bTB models in possums have largely remained untested . PredictThe aim of this study is to evaluate the bias and precision of predictions of the number of livestock herds infected with bTB in New Zealand, as part of bTB eradication efforts. These predictions are generated by statistical modelling, which uses trends across years in bTB-infected herds, and mechanistic  modelling, which uses the costs associated with control efforts. These predictions are compared with observed numbers of bTB-infected herds to evaluate bias and precision. The implications for bTB eradication are then described through future predictions.3) combinations. The factors are statistical versus mechanistic inference, power versus exponential models, and no updating versus updating of predictions. Statistical modelling focuses on estimating relationships and parameters without specifying any mechanism(s). Trends refer to patterns in diseased herds over time, and since time is not a cause [The framework of analyses is analogous to a factorial design with three factors, each having two levels, resulting in a total of eight  with at least one positive reactor to a bTB test at 30 June each year. It also included the annual costs associated with disease control and vector control published in annual reports of the sequence of agencies responsible for coordinating bTB eradication, which include the Animal Health Board, TB Free NZ, and OSPRI . DiseaseaYb) and an exponential equation (H = aebY), where H denotes the number of bTB herds and Y denotes year. Additionally, a linear regression which assumed a constant annual change in the number of positive herds, was evaluated, and preliminary analysis showed it was highly biased; hence, it was not examined further. Both the power and exponential models are based on the assumption of diminishing returns. The exponential model assumes a constant proportional change annually. In all analyses involving the power and exponential equations, logarithms with base e were used, either as loge-loge or loge–linear regression. Furthermore, for each model, the mean squared error (MSE = bias2 + variance) [Two models for analysing trends were evaluated: a power equation (H = ariance) , was alse-loge regression, corresponding to an inverse relationship (H = aCb when b < 0) on an arithmetic scale and a linear relationship on a loge-loge scale. This power relationship is expected to occur as disease cases, like pest abundance in general, tend to be inversely related to effort (cost) [aebC, was also assessed. In the case of exponential decline, b < 0. The costs of eradication were represented by the cumulative costs (NZ$ millions) of possum and livestock disease control, starting from and including 1995. The cumulative costs were used as they provided an overall representation of the combined effects of both current and past controls, without an attempt to separate the effects of each. These costs were not discounted over the years, reflecting a higher value placed on future costs than the case where discounting is applied. In reviews on climate change in the UK [The relationship between the annual number of bTB herds (H) and the cumulative costs of eradication (C) was examined, assuming a curved relationship, as reported previously , and wast (cost) , 19. Addt (cost) , an expon the UK  and Austn the UK , very lon the UK , and 5% n the UK  when disAnas platyrhynchos) abundance in parts of North America [In this study, validation refers to the process of comparing observed and predicted values of a parameter. The analysis involved the estimation of a regression relationship, hereafter referred to as the calibration regression, using data from 2005 to 2011 inclusive and then using the out-of-sample  data fro America . The tery axis and observed data were placed on the x axis [The bias and precision of predictions were evaluated using two measures: strength of association (which examines the relationship between predicted and observed data) and difference . In the association analysis, predicted data were placed on the e x axis .2) and consistency [2 is the horizontal (x) axis (2 of 1.0 (or 100%), and perfect predictions have no bias and a zero variance, resulting in an MSE of 0. This ideal scenario is a point located at the bottom right corner of the graph at   axis . A perfeat  . The wor and 1.0 , thus caeH vs logeY scale revealed a significant negative linear relationship  from 2005 to 2011 inclusive. The estimated slope was −328.259 (95%CI -400.350 to −256.168) and intercept was 2501.300 (95%CI of 1953.056 to 3049.544). After back-transformation, the relationship exhibited a curved, concave-up pattern , with a slope of −0.1635 (95%CI -0.1994 to −0.1276) and an intercept of 333.1882 (95%CI 261.1155 to 405.2608).The curved relationship between bTB herds (H) and years (Y) was strongly supported. The power model on a log pattern . The expt value of 3.0 , indicating that the power model was significantly biased as it underestimated the number of bTB herds (P < 0.025)  . The mea< 0.025) .Table 1.P > 0.2)  . The MSEP > 0.2) . HoweverP > 0.2) . In the P > 0.2) . The MSEP > 0.2) .1,15 = 138.10, P < 0.0001, R2 = 0.90) between number of bTB herds (H) and years (Y) on a logeH –logeY scale from 2005 to 2021 inclusive. The power model had a slope of −249.513 (95%CI -294.768 to −204.258) and an intercept of 1902.433 (95%CI 1558.161 to 2246.706). After back-transformation, the relationship displayed a clear curved, concave-up pattern , with an estimated slope of −0.124 (95%CI -0.147 to −0.101) and an intercept of 253.766 (95%CI 208.443 to 299.088). Both fitted regressions predicted that the number of positive bTB herds was 24 in 2022, which coincided with the observed number. They also projected a decrease to 3 in the year 2040 and ultimately the eradication of bTB by 2055  between bTB herds (H) and cumulative costs (C) on a logeH vs logeC scale. After back-transformation, the relationship with predictions was a clear curved, concave-up pattern  on a logeH vs C scale. After back-transformation, this relationship also displayed a clear curved, concave-up pattern (The curved relationship between bTB herds (H) and cumulative costs (C) was strongly supported. The power model showed a significant negative linear relationship  (y axis was 6.985 (95%CI -14.760 to 28.730), which was not different to 0 and was unbiased (P < 0.05), with predictions tending to be, on average, underestimates  . On the  > 0.20) . The estunbiased . Howeverstimates . The meastimates .P > 0.5) (P > 0.20)  . The meaP > 0.5) . SimilarP > 0.5) . HoweverP > 0.5) . In the  > 0.20) . The mea > 0.20) . The mec > 0.20) . This su > 0.20) .Figure 51,15 = 163.72, P < 0.0001, R2 = 0.92). The fitted equation is as follows:Predictions were also made for the future number of herds with bTB using data from 2005 to 2021 inclusive. The power model showed a high level of significance . The fitted is as follows:The exponential model was highly significant  would be 26 in 2022, 17 in 2026, and 1 in 2055 . The actThe power model estimates that reducing the number of bTB-infected herds to 1.0 would require a cumulative cost of NZ$10,437 million. On the other hand, the exponential model estimates that achieving the same goal would require a cumulative cost of NZ$3,382 million. In 2021, the cumulative cost was NZ$1,587 million.The present study has demonstrated that the number of bTB-infected herds in New Zealand (NZ) can be predicted with low bias. Mechanistic models that imply causal relationships received more support than statistical models, and these models described diminishing returns on investments. Specifically, the power model had less biased predictions than the exponential model. Both measures of association and difference yielded some similar findings, but there were also some differences in the results. Future predictions suggest that bTB eradication may take longer than 2055 if the predictions remain unbiased and current strategies and costs of control are maintained.The control and eradication efforts for bTB in NZ have shown impressive progress , 2, 4. PThe study does not formally evaluate the aim of achieving bTB-free possums in NZ by 2040 because it is challenging to distinguish the separate effects of concurrent livestock disease control and possum control. Other studies have evaluated various aspects of surveillance and control of possums as bTB hosts . It is nGiven the substantial costs associated with bTB eradication, it is important to demonstrate benefits . In thisA comparison between statistical and mechanistic modelling of climate change revealed that mechanistic modelling yielded less biased results than statistical modelling , 37. Simx variable in the mechanistic models. This variation could reduce the estimated slope of the linear regression between predicted and observed numbers [The study has several limitations. The use of cumulative costs for bTB control may introduce limitations. Firstly, how the same amount of money is spent may differ between years, thus generating extra variation in the  numbers  in the aIn summary, the present study concludes that mechanistic  models provide less biased predictions of the number of bTB-infected herds in New Zealand than statistical models. The results indicate that New Zealand is progressing towards bTB eradication, although it may take longer than the target year of 2055.


The 5th edition of the World Health Organization (WHO) classification of central nervous system tumors incorporated specific molecular alterations into the categorization of gliomas. The major revision of the classification scheme effectuates significant changes in the diagnosis and management of glioma. This study aimed to depict the clinical, molecular, and prognostic characteristics of glioma and its subtypes according to the current WHO classification.in situ hybridization methods and enrolled in the analysis.Patients who underwent surgery for glioma at Peking Union Medical College Hospital during 11 years were re-examined for tumor genetic alterations using next-generation sequencing, polymerase chain reaction-based assay, and fluorescence The enrolled 452 gliomas were reclassified into adult-type diffuse glioma , pediatric-type diffuse glioma , circumscribed astrocytic glioma (n=20), and glioneuronal and neuronal tumor (n=36). The composition, definition, and incidence of adult- and pediatric-type gliomas changed significantly between the 4th and the 5th editions of the classification. The clinical, radiological, molecular, and survival characteristics of each subtype of glioma were identified. Alterations in CDK4/6, CIC, FGFR2/3/4, FUBP1, KIT, MET, NF1, PEG3, RB1, and NTRK2 were additional factors correlated with the survival of different subtypes of gliomas.The updated WHO classification based on histology and molecular alterations has updated our understanding of the clinical, radiological, molecular, survival, and prognostic characteristics of varied subtypes of gliomas and provided accurate guidance for diagnosis and potential prognosis for patients. DespiteDeveloped from the WHO CNS4 classification, the current edition reorganized gliomas into adult-type diffuse gliomas, pediatric-type low-grade and high-grade diffuse gliomas, glioneuronal and neuronal tumors, circumscribed astrocytic gliomas, and ependymal tumors . Some ofA detailed understanding of the categorization changes of gliomas, clinical characteristics of different subtypes, survival implications, and predictive ability of molecular features based on the current classification are still controversial but valuable. The present study aimed to subgroup the gliomas in the real world according to the current WHO classification and depict the clinical presentations, radiological features, pathological characteristics, and molecular alterations of different subtypes, as well as assess patient survival and the predictive values of molecular alterations for prognosis. To achieve the above objectives, we analyzed the data of patients with gliomas at the Department of Neurosurgery of Peking Union Medical College Hospital (PUMCH) over 11 years in order to provide a solid basis for the clinical categorization and decision-making of malignant gliomas.22.1A total of 605 patients who underwent surgery for glioma at PUMCH Neurosurgery from January 2011–2022 were screened. Among them, 452 patients with available and integrated clinical data were included for analyses. All enrolled patients signed inform consent, and the study was approved by the institutional review board of Peking Union Medical College Hospital (Approved ID of ethic committee:S-424).2.2Clinical data were collected from the medical records of all patients regarding age at diagnosis, sex, body mass index, clinical symptoms, disease duration before admission, baseline Karnofsky Performance Scale (KPS) score, and the extent of surgical resection (ESR). The ESR included gross total resection , subtotal resection , and biopsy. The OS was defined as the time span from the date of operation to the date of death or the last follow-up (censored).The radiological characteristics of the patients with complete sets of preoperative and follow-up magnetic resonance imaging (MRI) sequences were collected. Data on variables, such as tumor location, maximal tumor diameter, number of tumors, tumor contact with functional areas, intensity on T1WI and T2WI, and presence of contrast enhancement and intratumoral necrosis, were extracted. Histological data on Ki-67 index and histological WHO grade were obtained from the pathological studies at our institute.in situ hybridization methods. These markers were selected based on recent studies, with the initial perspective to differentiate the subtypes of gliomas according to the updated WHO CNS5 classification or to predict patient prognosis.A total of 60 molecular markers of interest, including EGFR, TERT, CDKN2A/B, MYB, MYBL1, CDK4, CDK6, CIC, FGFR2/3/4, KIT, KMT5B, MET, MGMT, NF1, NTRK2, PEG, PTEN, RB1, and chromosome copy number variations, were analyzed in this study using the next-generation sequencing, the polymerase chain reaction-based assay, and fluorescence 2.3Glioblastomas were defined as grade-4 IDH1/2-wildtype diffuse gliomas with microvascular proliferation and/or intratumoral necrosis or grade 2-3 IDH1/2-wildtype astrocytic gliomas with at least one of the following molecular features: telomerase reverse transcriptase (TERT) promoter mutation, epidermal growth factor receptor (EGFR) amplification, or concomitant gain of chromosome 7 and loss of chromosome 10 (+7/-10 copy number changes). The term IDH-mutant glioblastoma was changed to WHO grade 4 astrocytoma, IDH-mutant according to the current classification. Astrocytoma consisted only of IDH-mutant diffuse glioma and was sub-divided into three grades (2–4) according to the histologic findings and the status of CDKN2A/B homozygous deletion. IDH-wildtype astrocytoma was reclassified as either molecular glioblastoma with specific molecular features or as other subtypes of gliomas. The pediatric-type diffuse gliomas were sub-grouped into low- and high-grade subtypes based on their genetic alterations .2.4®, USA) was used to generate graphs.For clinical, radiological, and pathological data, categorical variables were presented as numbers and percentages, and continuous variables were presented as the means ± standard deviations (SDs) or medians plus interquartile range according to the data distribution. The comparison of categorical variables was performed using the chi-squared test. Student’s t-test was used to assess the differences between normally distributed continuous variables, while Mann–Whitney U test was used with variables that failed the normality test. Most parameters were analyzed for all patients enrolled in this study. However, for several variables, only the patients who had complete data available were enrolled for analysis. Statistical significance was considered when P<0.05. Sankey’s diagram was used to visualize the changes in the subtypes of gliomas from WHO CNS4 to CNS5 classification. The waterfall heatmap was to illustrate the molecular alterations in different subtypes of gliomas. The Median OS (mOS) and the 95% confidence interval (95% CI) were calculated for patients with different subtypes of gliomas and for those with distinct molecular features. Kaplan–Meier curves were drawn to illustrate the OS, and a log-rank P<0.05 indicated a significant survival difference between groups. SPSS  was used for data analysis, and RStudio , consisting of diffuse astrocytoma, IDH-mutant , anaplastic astrocytoma, IDH-mutant , and glioblastoma, IDH-mutant (20 in grade 4) defined according to the previous classification. The nomenclature of anaplastic oligodendroglioma and diffuse midline glioma, H3 K27M-mutant was altered while the number of tumors remained unchanged.The classification of adult- and pediatric-type gliomas changed greatly, while glioneuronal and neuronal tumors and circumscribed astrocytic glioma remained unchanged , oligodendroglioma (n=104), and astrocytoma (n=78), were dominant subtypes among 452 gliomas, followed by glioneuronal and neuronal tumors (n=36), pediatric-type diffuse gliomas (n=23), and circumscribed astrocytic gliomas (n=20). The mean age of patients was 56 years for glioblastoma, 44 years for oligodendroglioma, 41 years for astrocytoma, and 25 years for circumscribed astrocytic glioma. Male patients accounted for the majority of pediatric-type diffuse gliomas and other subtypes except for circumscribed astrocytic gliomas. Epilepsy was most common in glioneuronal and neuronal tumors, intracranial hypertension was most common in glioblastomas, and neurologic impairments were most common in glioblastomas and circumscribed astrocytic gliomas. The disease duration was shortest in glioblastomas and longest in glioneuronal and neuronal tumors. Glioblastoma had the largest maximal tumor diameter of 4.3cm, while circumscribed astrocytic glioma had the smallest diameter of 2.3 cm. The contrast enhancement of tumors and necrosis was common in glioblastoma. Other clinical, radiological, and pathological features of different subtypes of gliomas were summarized in 3.3Glioblastoma, IDH-wildtype, WHO grade 4, had the shortest mOS of 12.6 months among all subtypes. Astrocytoma, IDH-mutant had different mOS according to the WHO grade: grade 4 (26.4 months), grade 3 (53.6 months), and grade 2 (55.4 months). The latter two were similar to oligodendroglioma, IDH-mutant and 1p/19q co-deleted, WHO grade 3 (45.8 months) and grade 2 (56.5 months). The pediatric-type high-grade diffuse gliomas had an mOS of 35.8 months, while the low-grade gliomas had an mOS of 55.1 months . Pediatric-type high-grade glioma had an mOS of 35.8 months, which was significantly longer than both the glioblastoma  and astrocytoma, WHO grade 4 . The above results and other survival comparisons among adult-type diffuse gliomas and between different subtypes of gliomas were illustrated in The mOS of astrocytoma, IDH-mutant, WHO grade 4 was shorter than that of astrocytoma with a lower WHO grade of 2-3 [hazard ratio (HR)=1.83, 3.4Each subtype of gliomas had distinct patterns of molecular alterations in chromosomes and genes . A detailed molecular landscape of each subtype was shown in 3.5IDH1/2 mutation, MGMT promotor methylation, EGFR amplification, TERT promotor mutation, and CDKN2A/B homozygous deletion, we sought to elucidate the alterations of other potential molecular biomarkers that might provide clues for clinical decision-making in gliomas. The current results showed that alterations in CDK4, CDK6, CDKN2A, EGFR, FGFR2, FGFR3, KIT, NF1, NTRK2, and RB1 were correlated with a short OS in gliomas  patients treated at our center were enrolled in the analysis, further increased the selection bias. Thirdly, we pre-designed a panel of 60 molecular markers of interest for analyzing the molecular alterations. Although these markers were sufficient for categorization of gliomas according to the current classification scheme, there might be molecules not involved but affect the prognosis. Whole-exome sequencing could be an alternative tool to address this issue.5In this real-world study of 452 glioma patients during a follow-up of 11 years, we illustrated the comprehensive classification of gliomas according to the WHO CNS5 classification and presented the clinical, radiological, molecular, and survival features of each subtype. Clinicians are encouraged to acknowledge these diagnostic and therapeutic advances in this lethal brain malignancy since many clinical characteristics of glioma and its subtypes have changed significantly from the previous to the current classification. Additional biomarkers that might have prognostic potential have been identified, highlighting the value of an integrated histological and molecular classification scheme. The present study provided clinical implications of the revision of the WHO classification of gliomas that would guide future healthcare practice and the investigations in the diagnosis, treatment, prognosis, and molecular classification of gliomas.The original contributions presented in the study are included in the article/Substantial contributions to conception and design of this study: all authors; Substantial contributions to acquisition of data: all authors; Substantial contributions to analysis and interpretation of data: XG, YS, DL, YL, and WC; Drafting the original article: XG, YS, DL, YL, and WC; Revising the article critically for important intellectual content: YNW, YKW, HX, YX, JL, JW, TL, HW, QL, SJ, TQ, SG, HL, TY, KZ, YW, and WM. All authors contributed to the article and approved the submitted version.


Inguinal hernia is the most common surgical disease in pediatric patients, and urgent intervention such as manual reduction is needed for incarcerated inguinal hernia. Torsion of undescended testes, inguinal herniated ovarian torsion, and purulent lymphadenitis are mimickers of this condition. If these mimicker lesions are misdiagnosed as incarcerated inguinal hernia, manual reduction usually fails, and edematous and erythematous changes may occur in these mimicker lesions due to manual reduction. For physicians in the emergency department, prompt decisions and familiarity with the sonographic appearance of different contents within an inguinal hernia are important to accurately diagnose these mimickers. In this case series, we present sonographic images of a typical case of incarcerated inguinal hernia  and three cases of mimicker lesions . The incidence of incarcerated inguinal hernia is reported to be higher in males (80%), on the right side (60%), and in infants and toddlers. This information is important for diagnosing mimicker lesions. In addition, to prevent manual reduction in mimicker diseases, point-of-care ultrasound before manual reduction in suspected cases of incarcerated inguinal hernia is important. Inguinal hernia is the most common surgical disease in pediatric patients, and urgent intervention is needed for incarcerated inguinal hernia , 2. The An 11-month-old male with a right incarcerated inguinal hernia. He presented with a right inguinal bulge, vomiting, and crying. He was diagnosed with an incarcerated inguinal hernia . Manual A 7-month-old female with herniated ovarian torsion. She presented with a left inguinal bulge and inconsolable crying. She was diagnosed with an incarcerated inguinal hernia. Manual reduction was attempted but failed. Subsequently, ultrasound was performed, which showed multiple low-echoic cystic lesions with surrounding edematous subcutaneous tissue and diminished vascular perfusion . TherefoA 7-year-old boy with undescended testicular torsion. He had cerebral palsy due to premature birth. He presented with a left inguinal bulge and inconsolable crying. He was diagnosed with an incarcerated inguinal hernia. Manual reduction was attempted but failed. Subsequently, ultrasound was performed, which revealed a low-echoic testis accompanied by surrounding subcutaneous tissue edema. Vascular perfusion within the testis was diminished, and parenchymal echogenicity of the affected testis was low . TherefoStaphylococcus aureus was confirmed.A 2-month-old male with purulent lymphadenitis. He had a right inguinal bulge and was crying inconsolably. He was diagnosed with an incarcerated inguinal hernia. Manual reduction was attempted but failed. Subsequently, ultrasound was performed, which revealed a low-echoic lymph node with surrounding effusion and high-echoic surrounding subcutaneous tissue . TherefoThe incidence of incarcerated inguinal hernia is reported to be higher in males 80%), on the right side 60%), and in infants and toddlers (age 0-1 years (one-seventh), 1-2 years (one-seventh), and 2–5 years (one-third)) 0%, and i. In case0%, on thProper medical history and physical examination are important for the diagnosis of mimicker lesions, and point-of-care ultrasound can provide additional clues to help diagnose these lesions. In cases of torsion of an ovarian hernia, the inguinal lesion generally presents with multiple small cysts due to ovarian follicles, and Doppler imaging shows the absence of blood flow within the lesion . Electiv


Coronary artery disease (CAD) screening is usually performed before transcatheter aortic valve implantation (TAVI) by invasive coronary angiography (ICA). Computed coronary tomography angiography (CCTA) has shown good diagnostic performance for CAD screening in patients with a low probability of CAD and is systematically performed before TAVI. CCTA could be an efficient alternative to ICA for CAD screening before TAVI. We sought to investigate the diagnostic performance of CCTA in a population of unselected patients without known CAD who were candidates for TAVI. All consecutive patients referred to our center for TAVI without known CAD were enrolled. All patients underwent CCTA and ICA, which were considered the gold standard. A statistical analysis of the diagnostic performance per patient and per artery was performed. 307 consecutive patients were enrolled. CCTA was non-analyzable in 25 patients (8.9%). In the per-patient analysis, CCTA had a sensitivity of 89.6%, a specificity of 90.2%, a positive predictive value of 65.15%, and a negative predictive value of 97.7%. Only five patients were classified as false negatives on the CCTA. Despite some limitations of the study, CCTA seems reliable for CAD screening in patients without known CAD who are candidates for TAVI. By using CCTA, ICA could be avoided in patients with a CAD-RADS score ≤ 2, which represents 74.8% of patients. Transcatheter aortic valve implantation (TAVI) is the standard treatment for symptomatic severe aortic stenosis in patients at high surgical risk . In thisThe wider indications for TAVI, the systematic need for a pre-procedural injected CT for aortic valve anatomy assessment, and the diagnostic performance of CCTA in CAD suggest that CCTA could reduce the need for ICA in pre-procedural patient management. This could lead to faster and more ambulatory pre-procedural screenings, lower doses of iodine contrast medium, and lower costs. Several studies have attempted to evaluate the ability of CCTA to detect significant CAD in the pre-TAVI work-up, with varying results ,9. Two rThe main objective of this study is to evaluate the diagnostic accuracy of CCTA for the detection of significant CAD in patients undergoing TAVI.This single-center  retrospective study was conducted from March 2020 to March 2022, complied with the Declaration of Helsinki, and was approved by the local ethics committee. All patients had signed and written informed consent. All consecutive adult patients referred to our center for TAVI for severe symptomatic aortic stenosis were enrolled, and data were collected in our database (which is part of the France TAVI registry) . Given o® 350, GE Healthcare) was performed in a brachial vein using a power injector followed by a saline chaser in a triphasic injection protocol [CCTA was performed using a 256-row detector CT  with prospective cardiac gating and the following acquisition parameters: Gantry rotation: 0.28 s; tube current: 200–500 mA; tube voltage: 100–120 kVp; slice thickness: 0.625 mm; pitch: 1.375; field-of-view: 18 cm. The tube current and voltage were adapted to the patient’s BMI. An intravenous injection of 70–100 mL of iohexol  who was blinded to patient characteristics and ICA results. The four main coronary arteries, left main stem (LMS), left anterior descending artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA), were evaluated according to the CAD-RADS classification score  . If multAll patients underwent an ICA prior to TAVI. All ICA were reviewed by an independent committee composed of two interventional cardiologists from APHM; in case of discordance between the cardiologists, a third operator was requested. Significant stenosis was defined by an artery diameter reduction ≥50%. At the vessel level, vessels with one or more coronary segments considered to have significant stenosis were defined as positive. If more than one lesion was present within the same vessel, the most severe lesion was selected as representative of the vessel.The main outcome was to evaluate the diagnostic accuracy of CCTA for pre-procedural screening of CAD in patients undergoing TAVI in comparison to the gold standard, ICA. The diagnostic performance evaluation was done at both the patient level and for each coronary artery.For secondary outcomes, we compared PCI incidence between CAD-RADS ≤ 2 and CAD-RADS ≥ 3. We also described non-analyzable patient characteristics.p values < 0.05 were considered statistically significant. Statistical analyses were performed using RStudio software Version 2022.07.1 .The diagnostic performance of CCTA was compared with that of ICA by calculating sensitivity (Se), specificity (Sp), positive predictive values (PPV), and negative predictive values (NPV). The same indicators were calculated for the comparison between the diagnostic performance of CCTA and ICA for each artery . Patient characteristics were first described and compared between the 2 groups of interest . Quantitative variables were presented as mean and standard deviation in cases of normal distribution , otherwise as median and interquartile ranges, and compared using the Student’s t-test if valid (and using the Mann-Whitney U test if otherwise). Categorical variables were presented as numbers (percentages) and compared using the chi-squared test if valid (and Fisher’s exact test if otherwise). All tests were two-tailed, and During the study period, 651 patients underwent TAVI. Overall, 286 patients (44%) were ineligible because of a known history of CAD, TAVI for aortic regurgitation, or bioprosthetic valve deterioration. Among the remaining 365 patients, 58 (17%) were excluded due to unavailable CCTA (81%), incomplete CCTA (7%), and PCI performed before realization of CCTA (12%). A total of 307 patients  were included for analysis. Among these, 25 (8.1%) were not analyzable and were classified as 0 for the global image quality score . 282 CCTA (91.9%) were analyzable . In the analyzable group, the global image quality score was 2.8. A flow chart is presented in n = 282), no patient had CAD-RADS 0, 69 had CAD-RADS 1, 147 had CAD-RADS 2, 48 had CAD-RADS 3, 17 had CAD-RADS 4, and 1 had CAD-RADS 5 .On a patient-level analysis, five patients were considered false negatives. All of them were classified as CAD-RADS 2 on the CCTA, with the highest CAD-RADS measured in the LAD. Two had a CCTA quality score of 2, and the three remaining had a quality score of 1 . Among these 5 patients, 4 had significant lesions in the LAD, and one had two lesions, according to the ICA, one in the LAD and one in the RCA. Two underwent PCI to treat lesions of the LAD artery. One had a 60% stenosis with a positive FFR, and the other had a 90% stenosis. The three remaining patients received only medical treatment. In patients with CAD-RADS 3, 4, and 5, there were 23 false positives (34.8%).According to the ICA, 48 patients had significant coronary lesions, and 17 (35.4%) were treated with PCI. The main site of PCI was the left anterior descending artery (58.8%), followed by the right coronary artery (35.2%) and the left main stem (6%). No PCI was performed in the circumflex artery. The mean CAD-RADS score was 3.3 in patients who underwent PCI.The diagnostic performance of CCTA for discriminating significant coronary artery lesions is presented in In this observational, monocentric, retrospective study, we showed that in most cases, CCTA is reliable to screen for CAD before TAVI in patients with indications for severe symptomatic aortic stenosis but without known CAD. CCTA appeared to have a high diagnostic performance, allowing the safe exclusion of CAD in this population.Our study showed that CCTA had a high sensitivity of 89.6% and a negative predictive value of 97.7%, discriminating between patients with CAD-RADS ≤ 2 and patients with CAD-RADS ≥ 3. These results are in line with other studies on the diagnostic performance of CCTA for detecting CAD in the general population ,6,7,15 aIt appears that CCTA is analyzable in more than nine out of ten cases. The percentage of CCTA that is analyzable is slightly higher than in other studies on CCTA performed pre-TAVI ,21; howeIn our study, 58 eligible patients (17%) were excluded because of unavailable or incomplete CCTA or PCI performed before CCTA. We think that this corresponds to real-world situations. However, other studies have had fewer excluded patients. Gohmann et al.  excludedWe analyzed the diagnostic performance of CCTA for each coronary artery. It appears that the negative predictive value was slightly lower for the left anterior descending artery. This result is compatible with other studies using similar computed tomography protocols ,21. ThisIn our study, a total of 211 patients had a CCTA showing a CAD-RADS score ≤ 2 and no lesion according to ICA. Hence, we can suppose that 74.8% of the ICAs were performed in patients without significant coronary lesions and could have been avoided, which could have a major impact in this elderly population. In a study  concerniIn summary, our single-center observational study suggests that CCTA seems reliable in patients before TAVI for symptomatic aortic stenosis and provides good diagnostic performance that safely excludes CAD. CCTA might be an effective non-invasive CAD screening tool in patients before TAVI without known CAD.The study has several limitations. First, because of the retrospective interpretation of CCTA, the findings of the present investigation are subject to confounding bias. Second, based on the observational design, the collection of some data could have been incomplete . Third, about 50% of patients were excluded, which can lead to a selection bias. Fourth, this study is monocentric, which could limit extrapolation of the results to other populations, and the rate of PCI could also be different with other teams. Fifth, the relatively low number of included arteries could result in a lack of power to study the diagnostic performance of each artery. Sixth, the reading of the CCTA by a single radiologist did not allow for a reproducible inter-observer evaluation.In a population of patients without known CAD who would benefit from TAVI for symptomatic severe aortic stenosis, CCTA is an easily feasible, non-invasive tool for CAD screening with good diagnostic performance, allowing for the exclusion of CAD with a high degree of confidence. The diagnostic performance for each coronary artery was good. Performing CCTA alone in cases where there is no significant CAD could lead to a reduction in procedural risks, procedural costs, and hospitalization time. However, despite its good diagnostic performance, CCTA alone before TAVI must be investigated in randomized, controlled prospective studies to evaluate its safety in terms of the occurrence of clinical events.