Original articles in the medical literature should have informative titles, also referred to as declarative titles. A nondeclarative title expresses the study\'s theme (topic) or, at most, the materials and methods used, whereas an informative title highlights the significance of the study findings (study\'s significance) and, at the very least, its results. A manuscript is typically organized to cover (i) the theme, (ii) materials and methods, (iii) results, and (iv) conclusion (study\'s significance). Consequently, a nondeclarative title typically encompasses only the (ii) stage, whereas an informative title extends to the (iii) or (iv) stages. This study underscores the importance of informative titles in medical papers and offers guidance for crafting titles that align with established paper writing fundamentals.

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BACKGROUND: No reports exist regarding the prevalence of different Na levels and their relationship with 90-day prognosis in hospitalized patients with acute-on-chronic liver disease (AoCLD) in China. Therefore, the benefit of hyponatremia correction in AoCLD patients remains unclear.
METHODS: We prospectively collected the data of 3970 patients with AoCLD from the CATCH-LIFE cohort in China. The prevalence of different Na levels (≤ 120; 120-135; 135-145; > 145) and their relationship with 90-day prognosis were analyzed. For hyponatremic patients, we measured Na levels on days 4 and 7 and compared their characteristics, based on whether hyponatremia was corrected.
RESULTS: A total of 3880 patients were involved; 712 of those developed adverse outcomes within 90 days. There were 80 (2.06%) hypernatremic, 28 (0.72%) severe hyponatremic, and 813 (20.95%) mild hyponatremic patients at admission. After adjusting for all confounding factors, the risk of 90-day adverse outcomes decreased by 5% (odds ratio [OR] 0.95; 95% confidence interval [CI] 0.93-0.97; p < 0.001), 24% (OR 0.76; 95% CI 0.70-0.84; p < 0.001), and 42% (OR 0.58; 95% CI 0.49-0.70; p < 0.001) as Na level increased by 1, 5, and 10 mmol/L, respectively. Noncorrection of hyponatremia on days 4 and 7 was associated with 2.05-fold (hazard ratio [HR], 2.05; 95% CI, 1.50-2.79; p < 0.001) and 1.46-fold (HR 1.46; 95% CI 1.05-2.02; p = 0.028) higher risk of adverse outcomes.
CONCLUSIONS: Hyponatremia was an independent risk factor for a poor 90-day prognosis in patients with AoCLD. Failure to correct hyponatremia in a week after admission was often associated with increased mortality. (ClinicalTrials.gov number: NCT02457637, NCT03641872).
BACKGROUND: This study is registered at Shanghai www.clinicaltrials.org (NCT02457637 and NCT03641872).

Environmental assessment is the process that decision-makers rely on to predict, evaluate, and prevent biophysical, social, and economic impacts of potential project developments. The determination of significance in environmental assessment is central to environmental management in many nations. We reviewed ten recent environmental impact assessments from British Columbia, Canada and systematically reviewed and scored significance determination and the approaches used by assessors, the use of thresholds in significance determination, threshold exceedances, and the outcomes. Findings of significant impacts were exceedingly rare and practitioners used a combination of significance determination approaches, most commonly relying upon reasoned argumentation. Quantitative thresholds were rarely employed, with less than 10% of the valued components evaluated using thresholds. Even where quantitative thresholds for significance were exceeded, in every case practitioners used a variety of rationales to demote negative impacts to non-significance. These reasons include combinations of scale (temporal and spatial) of impacts, an already exceeded baseline, model uncertainty and/or substituting less stringent thresholds. Governments and agencies can better protect resources by requiring clear and defensible significance determinations, by making government-defined thresholds legally enforceable and accountable, and by requiring or encouraging significance determination through inclusive and collaborative approaches.

The phasic orienting reflex (OR) was investigated in two counterbalanced blocks of an auditory dishabituation paradigm differing in stimulus Significance (operationalised as tone counting). Twelve tones were presented at very long, randomly-varying interstimulus intervals (ISIs). Novelty and Significance were varied within subjects. Stimulus-response patterns were assessed to find ERP matches for autonomic measures. The phasic OR index was represented by the skin conductance response (SCR). SCR decremented over 10 standard trials, showed recovery on trial 11 (change trial), enhancement to re-presentation of the standard tone (trial 12: dishabituation), and a main effect of Significance over the first 10 trials - demonstrating the formal criteria for an OR index. The evoked cardiac response (HR) subcomponents ECR1 (deceleration) and ECR2 (acceleration) showed no trial effects, but ECR2 showed a Significance effect. Respiratory pause (RP) decreased linearly over trials, and showed recovery, but no dishabituation or Significance effect. Temporal PCA was applied to single-trial EOG-corrected data. Ten ERP components were extracted: P1, N1-3, N1-1, PN, P2, P3a, P3b, HabP3, a Frontal Slow Wave (FSW), and the Classic SW. The dependent measures showed 4 distinct patterns. Pattern 1: No trial or Significance effects (ECR1, P1, N1-3, P3a, FSW); Pattern 2: No trial effect but a Significance effect (ECR2, N1-1, P2); Pattern 3: Trial but not Significance effects (RP, PN, P3b, HabP3); Pattern 4: Both trial and Significance effects (SCR and Classic SW). The evidenced fractionation of autonomic and central measures is compatible with Preliminary Process Theory (PPT), contrary to the notion of a unitary OR.