bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficient diagnosis of IDH-mutant gliomas: 1p/19qNET assesses 1p/19q codeletion status using weakly-supervised learning
Authors: Kim Gi Jeong , Lee Tonghyun , Ahn Sangjeong , Uh Youngjung , Kim Se Hoon
Published: September 2023

Accurate identification of molecular alterations in gliomas is crucial for their diagnosis and treatment. Although, fluorescence in situ hybridization (FISH) allows for the observation of diverse and heterogeneous alterations, it is inherently time-consuming and challenging due to the limitations of the molecular method. Here, we report the development of 1p/19qNET, an advanced deep-learning network designed to predict fold change values of 1p and 19q chromosomes and classify isocitrate dehydrogenase (IDH)-mutant gliomas from whole-slide images. We trained 1p/19qNET on next-generation sequencing data from a discovery set (DS) of 288 patients and utilized a weakly-supervised approach with slide-level labels to reduce bias and workload. We then performed validation on an independent validation set (IVS) comprising 385 samples from The Cancer Genome Atlas, a comprehensive cancer genomics resource. 1p/19qNET outperformed traditional FISH, achieving R2 values of 0.589 and 0.547 for the 1p and 19q arms, respectively. As an IDH-mutant glioma classifier, 1p/19qNET attained AUCs of 0.930 and 0.837 in the DS and IVS, respectively. The weakly-supervised nature of 1p/19qNET provides explainable heatmaps for the results. This study demonstrates the successful use of deep learning for precise determination of 1p/19q codeletion status and classification of IDH-mutant gliomas as astrocytoma or oligodendroglioma. 1p/19qNET offers comparable results to FISH and provides informative spatial information. This approach has broader applications in tumor classification.
Deep learning enabled topological design of exceptional points for multi-optical-parameter control
Authors: Fu Peng , Du Shuo , Lan Wenze , Hu Leyong , Wu Yiqing , Li Zhenfei , Huang Xin , Guo Yang , Zhu Weiren , Li Junjie , Liu Baoli , Gu Changzhi
Published: September 2023

Metasurfaces are 2D artificial nanostructures that exhibit fascinating optical phenomena and flexible capabilities. Multi-optical-parameter metasurfaces have advantages over single-function or single-dimensional metasurfaces, especially in practical applications like holography, sub-diffraction imaging, and vectorial fields. However, achieving multi-optical-parameter control is challenging due to a lack of design strategy, limited manipulation channels, and signal-to-noise ratio problems. Exceptional points (EPs) possess inherent polarization decoupling properties and allow for amplitude and wavelength modulation, opening up research prospects for multi-optical-parameter electromagnetic field modulation and developing compact integrated devices. Leveraging deep learning, we observe topological charge conservation and utilize the topologically protected optical parameter distribution around scattered EPs. Based on these, we introduce amplitude-phase multiplexing and wavelength division multiplexing devices. Our work allows rapid and precise discovery of EPs topology, offers a powerful tool for digging related physics, and provides a paradigm for multi-optical parametric manipulation with high performance and less crosstalk, which is critical for imaging, encryption, and information storage applications.
Dual-template imprinted polymer electrochemical sensor for simultaneous determination of malathion and carbendazim using graphene quantum dots
Authors: Beigmoradi Fariba , Rohani Moghadam Masoud , Garkani-Nejad Zahra , Bazmandegan-Shamili Alireza , Masoodi Hamid Reza
Published: September 2023

Malathion (MAL) and carbendazim (CBZ) are organophosphate pesticides and fungicides, respectively.
Enhanced Z-schematic water splitting using a (CuGa)0.5ZnS2 H2-evolving photocatalyst with treatment in aqueous solutions
Authors: Iwase Akihide , Yagishita Koki
Published: September 2023

Undesired hole consumption over metal sulfide such as photocorrosion was suppressed by a treatment in an aqueous Na2S solution, resulting in improved Z-schematic water splitting.
Discovery of novel tubulin CBSI (R)-9k from the indanone scaffold for the treatment of colorectal cancer
Authors: Huo Zhipeng , Min Delin , Zhang Shijie , Tang Mei-Lin , Sun Xun
Published: September 2023

Compared with the first line therapy 5-fluorouracil, (R)-9k bound to the colchicine site and showed more potent inhibitory activities against colorectal cancer cells, lower cytotoxicity against normal cells and less cardiotoxicity.
Discovery of all-inorganic lead-free perovskites with high photovoltaic performance via ensemble machine learning
Authors: Cai Xia , Li Yan , Liu Jianfei , Zhang Hao , Pan Jianguo , Zhan Yiqiang
Published: September 2023

A multi-step and multi-stage high-throughput materials search via ensemble machine learning is developed to carefully and comprehensively screen nearly 12 million all-inorganic perovskites with potential high photovoltaic performance.
Resilience‐oriented expansion planning of multi‐carrier microgrid utilizing bi‐level technique
Authors: Dehshiri Badi Alireza , Amir Vahid , Shariatmadar Seyed Mohammad
Published: September 2023

This paper presents the generation and transmission expansion planning (GTEP) in electricity and gas networks by considering their resilience against floods and earthquakes. These networks supply electricity, heat, and gas consumption energies as a multi‐carrier microgrid. The scheme is expressed in the form of bi‐level optimization, the upper level of which is the minimization of generation and transmission planning cost (total investment cost and expected operating cost) in the mentioned networks constrained to the investment budget and the planning model of the mentioned elements. Lower‐level formulation minimizes the total expected annual operating cost of these networks and the expected outage cost of electricity, heat, and gas consumers in the event of floods and earthquakes. This formulation is bound by the power flow equations of electricity and gas networks, the operation and resilience constraints of the networks, and the limitation on generation capability. In this problem, the expected energy not‐supplied and the outage cost during natural disasters are considered resilience indicators. Next, a single‐level model for the proposed design is extracted from the Karush–Kuhn–Tucker (KKT) method. The basic requirement of this method is the convexity of the lower‐level constraints. For this purpose, first, a linear approximation model is obtained for the lower‐level constraints of the problem. Furthermore, stochastic optimization is adopted to model the uncertainty of load, renewable power, and network equipment availability during floods and earthquakes. Finally, the extracted numerical results confirm the capability of the proposed scheme in improving the operation and resilience of the mentioned networks using optimal generation and transmission planning.
A lightweight and anti‐collusion trust model combined with nodes dynamic relevance for the power internet of things
Authors: Zhao Shice , Zhao Hongshan , Sun Jingjie
Published: September 2023

A large number of monitoring sensors are introduced in the power grid. However, the traditional trust models commonly used for edge‐side security management are weak in detecting large‐scale malicious interactions and collusion attacks. For that, a lightweight and anti‐collusion trust model combined with nodes’ dynamic relevance for the power Internet of Things (IoT) is proposed. Firstly, a global trust management system is constructed according to the working mechanism of sensors in the power grid. After that, trust feedback and contact frequency of the devices are combined to build an adaptive dynamic weight vector based on relevance volatility. Fluctuations in trust values are reduced and the trust difference between normal and malicious nodes is widened. An anti‐collusion algorithm based on contact set awareness is also designed to effectively detect collusion attacks. The checksum local broadcast is established in the trust model to counteract the risk of intelligent terminal failure. The results show that the trust model achieves 100% accuracy of node discrimination when the maximum proportion of malicious nodes is 20% in a 50‐node network scale. In addition, the calculation time of the overall model is 211 ms and the memory consumption is 161 kb, which is suitable for power IoT sensor networks.
Partisanship predicts COVID-19 vaccine brand preference: the case of Argentina
Authors: Fumagalli Elena , Krick Candelaria Belén , Dolmatzian Marina Belén , Del Negro Julieta Edith , Navajas Joaquin
Published: September 2023

The COVID-19 pandemic underscored the significance of overcoming vaccine adoption resistance and addressing real and perceived barriers for efficient vaccination campaigns. One major problem faced by health systems around the world was that people’s preferences for a specific brand of vaccine often delayed vaccination efforts as people canceled or delayed appointments to receive their preferred brand. Therefore, in the event of another pandemic, it is important to know which factors influence preferences for specific vaccine brands. Previous literature showed that consumers choose products that are congruent with their self-concept, which includes their political affiliation. Given that the discourse around vaccine brands has been strongly politicized during the pandemic, in our work, we test whether partisanship influences preferences for COVID-19 vaccine brands. To test this, we collected survey data from Argentina (N = 432), a country with a clear bi-partisan structure and where a variety of vaccine brands were administered, both from Western and Eastern laboratories. We found that supporters of the ruling party, which had strong ties with Eastern countries such as Russia and China, perceived Eastern vaccine brands (e.g., Sputnik V) to be more effective and safer than Western ones (e.g., Pfizer) whereas the contrary was true for supporters of the opposition. Our results also showed that supporters of the opposing party were more likely to wish to hypothetically switch vaccines, to delay their appointment in case of not receiving their preferred brand, and to disapprove of their local vaccination campaign. Our results demonstrate that political party affiliation biases perceptions of both vaccine brands’ quality and vaccination campaign effectiveness. We anticipate that our results can inform public policy strategies when it comes to an efficient vaccine supply allocation, as political affiliation is a measurable and predictable consumer trait.
A current affair: worker perceptions of noise exposure and occupational hearing loss in Australian coal mines
Authors: Liebenberg Adelle , Oosthuizen Jacques , Reed Sue
Published: September 2023

Background

The objective of the online survey was to determine worker attitudes towards, perceptions on hearing loss, and management of workplace noise; and to identify barriers within current strategies that prevent effective management of hearing health in Australian mines.

Design

This cross-sectional study utilized a modified survey design, initially designed for use by Safe Work Australia for a broader study published in 2010.

Study Sample

The survey questionnaire was made available online to volunteer participants, recruited with the assistance of State and National Health and Safety, and mining organizations. Volunteer participants were required to be proficient in English, be employed by an Australian underground or open cut mine, including coal processing plants; or work as a contractor on one of the specified mine sites. All mining employees, regardless of occupation, job title, and occupational hearing loss classification or status, were invited to complete the questionnaire.

Results

Almost 60% of respondents indicated that they had high noise exposure for than 10 yr or more, and have some trouble hearing, mostly associated with infrequent tinnitus. Nearly 71% of these workers believe that the noise control strategies in their workplaces are effective, but this mostly refers to the use of hearing protection devices.

Conclusion

The results indicate that general knowledge on the cause and effect of noise exposure in the workplace is well understood. However, due to the long latency associated with the development of noise-induced hearing loss (NIHL), there is an issue urgency in terms of risk management. It is surprising that most of the respondents recommended more inspections and administrative controls, especially since most respondents were health, safety, and environment (HSE) professionals. HSE professionals should be advocating for higher order, more permanent solutions, and not purely administrative controls and personal protective equipment. These findings raise the question of whether there is a multifaceted working-culture issue that needs to be addressed, in combination with higher order control implementation.
Tele-Neuropsychology: From Science to Policy to Practice
Authors: Sperling Scott A , Acheson Shawn K , Fox-Fuller Joshua , Colvin Mary K , Harder Lana , Cullum C Munro , Randolph John J , Carter Kirstine R , Espe-Pfeifer Patricia , Lacritz Laura H , Arnett Peter A , Gillaspy Stephen R
Published: September 2023

Objective

The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t).

Method

We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States’ public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system’s telehealth lists, and existing disparities in healthcare access.

Results

The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology.

Conclusions

More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
Material deprivation and the Brexit referendum: a spatial multilevel analysis of the interplay between individual and regional deprivation
Authors: Haußmann Charlotte , Rüttenauer Tobias
Published: September 2023

In this study, we investigate the relationship between individual and neighbourhood deprivation and the decision to vote for Brexit in the 2016 referendum. Our analysis uses data from the UK Household Longitudinal Study and the English Index of Multiple Deprivation, and employs multilevel models to account for individual-level deprivation, neighbourhood deprivation, and larger-scale regional deprivation. We also examine the interaction between these scales. On average, we find that individual, neighbourhood, and wider area deprivation are associated with a higher likelihood of voting Leave. However, the effect of neighbourhood deprivation is heterogeneous and depends on the broader spatial context: living in deprived neighbourhoods (and to a lesser extent experiencing personal deprivation) has a stronger effect on voting behaviour in more affluent regions. Conversely, the effect of individual and neighbourhood deprivation is close to zero and statistically insignificant in more deprived areas of the country. These results suggest that social comparison processes of in-groups and out-groups operate within larger regional contexts. Our study thus highlights the role of individual and regional deprivation, but also their intersection, in shaping political attitudes and outcomes.
Optimal left ventricular ejection fraction in risk stratification of patients with cardiac sarcoidosis
Authors: Hutt Erika , Brizneda Maria Vega , Goldar Ghazaleh , Aguilera Jose , Wang Tom Kai Ming , Taimeh Ziad , Culver Daniel , Callahan Thomas , Tang W H Wilson , Cremer Paul C , Jaber Wael A , Ribeiro Neto Manuel L , Jellis Christine L
Published: September 2023

Aims

Identifying patients with cardiac sarcoidosis (CS) who are at an increased risk of sudden cardiac death (SCD) poses a clinical challenge. We sought to identify the optimal cutoff for left ventricular ejection fraction (LVEF) in predicting ventricular arrhythmia (VA) and all-cause mortality and to identify clinical and imaging risk factors in patients with known CS.

Methods and results

This retrospective cohort included 273 patients with well-established CS. The primary endpoint was a composite of VA and all-cause mortality. A modified receiver operating curve analysis was utilized to identify the optimal cutoff for LVEF in predicting the primary composite endpoint. Cox proportional hazard regression analysis was used to identify independent risk factors of the outcomes. At median follow-up of 7.9 years, the rate of the primary endpoint was 38% (83 VAs and 32 all-cause deaths). The 5-year overall survival rate was 97%. The optimal cutoff LVEF for the primary composite endpoint was 42% in the entire cohort and in subjects without a history of VA. Younger age, history of VA, lower LVEF, and any presence of scar by cardiac magnetic resonance (CMR) imaging and/or positron emission tomography (PET) were found to be independent risk factors for the primary endpoint and for VA, whereas lower LVEF, baseline NT-proBNP, and any presence of scar were independent risk factor of all-cause mortality.

Conclusion

Among patients with CS, a mild reduction in LVEF of 42% was identified as the optimal cutoff for predicting VA and all-cause mortality. Prior VA and scar by CMR or PET are strong risk factors for future VA and all-cause mortality.
Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older
Authors: Onwudebe Chinedu , Al Snih Soham , Raji Mukaila A , Milani Sadaf Arefi
Published: September 2023

Background and Objectives

Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older.

Research Design and Methods

We used data from Waves 7 to 9 (2010–2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics.

Results

At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications.

Discussion and Implications

The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.
Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States
Authors: Zhou Yuanjin , Choi Namkee G , Sadak Tatiana , Ghosh Nayanika , Phelan Elizabeth A
Published: September 2023

Background and Objectives

Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup.

Research Design and Methods

We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65–107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, “did you worry about falling down” and “did this worry ever limit your activities.” Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry.

Results

Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12–1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12–3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry.

Discussion and Implications

These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.
Self-Reported Pain Treatment Practices Among U.S. and Canadian Adults: Findings From a Population Survey
Authors: Zajacova Anna , Pereira Filho Alvaro , Limani Merita , Grol-Prokopczyk Hanna , Zimmer Zachary , Scherbakov Dmitry , Fillingim Roger B , Hayward Mark D , Gilron Ian , Macfarlane Gary J
Published: September 2023

Background and Objectives

Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fill this gap, we evaluated self-reported pain treatment types among community-dwelling adults in the United States and Canada. We also assessed how treatment types correlate with individuals’ pain levels, sociodemographic characteristics, and country of residence, and identified unique clusters of adults in terms of treatment combinations.

Research Design and Methods

We used the 2020 “Recovery and Resilience” United States–Canada general online survey with 2 041 U.S. and 2 072 Canadian community-dwelling adults. Respondents selected up to 10 pain treatment options including medication, physical therapy, exercise, etc., and an open-ended item was available for self-report of any additional treatments. Data were analyzed using descriptive, regression-based, and latent class analyses.

Results

Over-the-counter (OTC) medication was reported most frequently (by 55% of respondents, 95% CI 53%–56%), followed by “just living with pain” (41%, 95% CI 40%–43%) and exercise (40%, 95% CI 38%–41%). The modal response (29%) to the open-ended item was cannabis use. Pain was the most salient correlate, predicting a greater frequency of all pain treatments. Country differences were generally small; a notable exception was alcohol use, which was reported twice as often among U.S. versus Canadian adults. Individuals were grouped into 5 distinct clusters: 2 groups relied predominantly on medication (prescription or OTC), another favored exercise and other self-care approaches, one included adults “just living with” pain, and the cluster with the highest pain levels employed all modalities heavily.

Discussion and Implications

Our findings provide new insights into recent pain treatment strategies among North American adults and identify population subgroups with potentially unmet need for more adaptive and effective pain management.
Autonomous Expansion of Grasshopper Wings Reveals External Forces Contribute to Final Adult Wing Shape
Authors: Salcedo Mary K , Jung Sunghwan , Combes Stacey A
Published: September 2023

Synopsis

Ecdysis, transformation from juvenile to adult form in insects, is time-consuming and leaves insects vulnerable to predation. For winged insects, the process of wing expansion during ecdysis, unfurling and expanding the wings, is a critical bottleneck in achieving sexual maturity. Internal and external forces play a role in wing expansion. Vigorous abdominal pumping during wing expansion allows insects to pressurize and inflate their wings, filling them with hemolymph. In addition, many insects adopt expansion-specific postures and, if inhibited, do not expand their wings normally, suggesting that external forces such as gravity may play a role. However, two previous studies over 40 years ago, reported that the forewings of swarming locusts can expand autonomously when removed from the emerging insect and laid flat on a saline solution. Termed “autoexpansion,” we replicated previous experiments of autoexpansion on flat liquid media, documenting changes in both wing length and area over time while also focusing on the role of gravity in autoexpansion. Using the North American bird grasshopper Schistocerca americana, we tested four autoexpansion treatments of varying surface tension and hydrophobicity (gravity, deionized water, buffer, and mineral oil) while simultaneously observing and measuring intact, normal wing expansion. Finally, we constructed a simple model of a viscoelastic expanding wing subjected to gravity, to determine whether it could capture aspects of wing expansion. Our data confirmed that wing autoexpansion does occur in S. americana, but autoexpanding wings, especially hindwings, failed to increase to the same final length and area as intact wings. We found that gravity plays an important role in wing expansion, early in the expansion process. Combined with the significant mass increase we documented in intact wings, it suggests that hydraulic pumping of hemolymph into the wings plays an important role in increasing the area of expanding wings, especially in driving expansion of the large, pleated hindwings. Autoexpansion in a non-swarming orthopteran suggests that local cues driving wing autoexpansion may serve a broader purpose, reducing total expansion time and costs by shifting some processes from central to local control. Documenting wing autoexpansion in a widely studied model organism and demonstrating a mathematical model provides a tractable new system for exploring higher level questions about the mechanisms of wing expansion and the implications of autoexpansion, as well as potential bioinspiration for future technologies applicable to micro-air vehicles, space exploration, or medical and prosthetic devices.
Probiotics as an alternative to antibiotics in modulating the intestinal microbiota and performance of broiler chickens
Authors: Grozina Alena A , Ilina Larisa A , Laptev Georgiy Yu , Yildirim Elena A , Ponomareva Ekaterina S , Filippova Valentina A , Tyurina Darya G , Fisinin Vladimir I , Kochish Ivan I , Griffin Darren K , Surai Peter F , Romanov Michael N
Published: September 2023

Aims

Gut bacteria play an important role in poultry nutrition and the immune defense system. Changes in the intestinal microbiome affect the physiological state, metabolism, and innate immunity of poultry. The present study aimed to characterize age-related changes in the gastrointestinal tract microflora in broiler chickens, depending on supplementation of the diet with the in-feed antibiotic Stafac® 110 and a Bacillus subtilis strain-based probiotic.

Methods and results

In this regard, a comprehensive analysis of the taxonomic structure of the microbial community in the gastrointestinal tract (GIT) of broiler chickens was carried out using a molecular genetic technique of the terminal-restriction fragment length polymorphism analysis and taking into account age dynamics and feeding treatment. A beneficial effect on the microbiological composition and body weight of broilers was observed when using the antibiotic and probiotic in compound feeds. Different bacterial communities were revealed in the duodenum and cecum, and their positive impact on broiler growth was established. The results obtained shed light on the formation of GIT microflora of broiler chickens during the growing period and its changes in response to the use of the antibiotic and the probiotic.

Conclusions

We suggest that the implementation of the tested in-feed antibiotic and probiotic can be beneficial in regulating the intestinal microflora microbiological processes in the GIT and improving the feeding efficiency and productivity of broiler chickens.
Early Enzymatic Burn Debridement: Results of the DETECT Multicenter Randomized Controlled Trial
Authors: Shoham Yaron , Rosenberg Lior , Hickerson William , Goverman Jeremy , Iyer Narayan , Barrera-Oro Julio , Lipovy Bretislav , Monstrey Stan , Blome-Eberwein Sigrid , Wibbenmeyer Lucy A , Scharpenberg Martin , Singer Adam J
Published: September 2023

Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3–30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
Identification and Evaluation of Mobile Applications for Self-Management of Diet and Lifestyle for Patients with Inflammatory Bowel Disease
Authors: Gold Stephanie L , Chiew Brandon A , Rajagopalan Vidya , Lavallee Celeste M
Published: September 2023

Background

Mobile health applications (apps) providing diet and lifestyle self-management programs to patients with inflammatory bowel disease (IBD) are emerging. The objective of this study was to evaluate current apps available in the US and Canada based on app quality, perceived impact on diet and mental health and comprehensiveness to support self-management.

Methods

The Apple iOS and Google Play app stores were searched for terms related to IBD. Apps were included if they targeted diet and lifestyle behaviours for patients living with IBD and were available to the general public. Apps were excluded if they were not specific to IBD, not available in English, did not target diet or lifestyle therapy, were not available in the US and Canada, or did not offer stand-alone self-management programs. The Mobile App Rating Scale was used to assess mobile app quality.

Results

A total of 1,512 apps were identified through the app stores. Six apps met inclusion criteria. My IBD Care: Crohn’s and Colitis received the highest quality rating and LyfeMD received the highest overall app rating. Only these two apps provided behaviour tracking over time, and three (50 percent) apps provided good-quality information.

Conclusions

While many IBD-related apps exist, few support self-management of diet and lifestyle behaviours. The My IBD Care and LyfeMD apps had the highest ratings and can be used to track lifestyle behaviours. The effectiveness of these apps to improve behaviours, and subsequently impact the disease course and quality of life, should be explored in future studies.
FBBVA Lecture 2023. The Importance of Modeling Income Taxes over Time: U.S. Reforms and Outcomes
Authors: Borella Margherita , De Nardi Mariacristina , Pak Michael , Russo Nicolo , Yang Fang
Published: September 2023

The structure of taxes and their burden have undergone large and frequent changes over time. We provide a brief history of U.S. federal income tax reform since the 1960s, calculate effective federal income tax rates for each wave of the Panel Study of Income Dynamics, and discuss how effective taxation changed from 1969 to 2016. We show that most tax regimes are short-lived and that the variation in taxes over time and across groups is large. We also use an estimated dynamic model of couples and singles to show that the various tax regimes that we estimate imply very different labor market and saving behavior. These findings stress the importance of studying and modeling tax changes over time and across groups.
Education, Ontological Security, and Preserving Hope in Liminality: Learning from the Daily Strategies Exercised by Syrian Refugee Youth in Jordan
Authors: Salem Hiba
Published: September 2023

This article draws on a study with Syrian refugee youth and their teachers to examine how young people, holding liminal social and legal statuses in Jordan, manage uncertainty. Through an analysis of students' experiences, this article describes the varying strategies that they developed to protect their sense of hope across time by maintaining ontological security, or an understanding of self. These findings suggested that refugee youth, unable to navigate uncertainty through their educational spaces, explored alternative ways to actively build hope and sustain a sense of control in their lives. They nurtured hope by constructing a continuous narrative of their experiences, exploring their skills and potential, and forming attachments to ideas of place and possibility. Buildings on these findings, this article argues for the importance of integrating practices within education which respond to refugee youths’ needs to maintain ontological security and hope in the face of uncertainty.
Empirical bias-reducing adjustments to estimating functions
Authors: Kosmidis Ioannis , Lunardon Nicola
Published: September 2023

We develop a novel, general framework for reduced-bias M-estimation from asymptotically unbiased estimating functions. The framework relies on an empirical approximation of the bias by a function of derivatives of estimating function contributions. Reduced-bias M-estimation operates either implicitly, solving empirically adjusted estimating equations, or explicitly, subtracting the estimated bias from the original M-estimates, and applies to partially or fully specified models with likelihoods or surrogate objectives. Automatic differentiation can abstract away the algebra required to implement reduced-bias M-estimation. As a result, the bias-reduction methods, we introduce have broader applicability, straightforward implementation, and less algebraic or computational effort than other established bias-reduction methods that require resampling or expectations of products of log-likelihood derivatives. If M-estimation is by maximising an objective, then there always exists a bias-reducing penalised objective. That penalised objective relates to information criteria for model selection and can be enhanced with plug-in penalties to deliver reduced-bias M-estimates with extra properties, like finiteness for categorical data models. Inferential procedures and model selection procedures for M-estimators apply unaltered with the reduced-bias M-estimates. We demonstrate and assess the properties of reduced-bias M-estimation in well-used, prominent modelling settings of varying complexity.
COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers
Authors: Quartana Phillip J , Beymer Matthew R , Gomez Stephanie A Q , Adler Amy B , Santo Theresa Jackson , Thomas Jeffrey L , Bell Amy Millikan
Published: September 2023

Introduction

The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers.

Materials and Methods

Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible.

Results

Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points.

Conclusions

COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.
Outcome of Laparoscopic Versus Open Appendectomy for Acute Appendicitis—Results of a Propensity Score Matching Analysis of 542 Patients and Consequences for the Military Surgeon
Authors: Beltzer Christian , Haas Frank , Jahn Lena-Sofia , Bellmann Valerie , Strohäker Jens , Willms Arnulf , Schmidt Roland
Published: September 2023

Introduction

Appendectomy is the treatment of choice for acute appendicitis. The procedure can be performed open or laparoscopically. However, laparoscopy is not available on military missions abroad. It is unclear whether treatment outcomes differ between the two surgical approaches.

Materials and Methods

Treatment data of all patients undergoing open and laparoscopic appendectomies in the German Armed Forces Hospital of Ulm from 2013 to 2017 were collected retrospectively. A propensity score matching analysis was performed to minimize the influence of potential confounders and to assess the influence of surgical approach on outcome (reoperations, superficial and deep surgical infections, length of postoperative ileus, need for intravenous analgesics, and operative time).

Results

A total of 542 patients with complete datasets were included in the propensity score matching analysis, among these 64 with open and 478 laparoscopic procedures. There were no statistically significant differences between open and laparoscopic surgeries with respect to all outcome variables, with the exception of a 25-minute prolonged operative time for the open approach.

Conclusions

Open appendectomy can be considered equivalent in outcome to the laparoscopic procedure and thus can be performed on military missions abroad without compromising outcome. Military surgeons must continue to be trained and confident in open appendectomy.
Prevalence and Correlates of Cannabis Use among U.S. Veterans during the Second Wave of the COVID-19 Pandemic
Authors: Manzo Laura L , Sarkar Sayantani , Nicholson Nicholas R , Sanft Tara , Poghosyan Hermine
Published: September 2023

Introduction

Military veterans are at increased risk of substance use disorders. Limited research is available about veterans’ cannabis use (CU) during the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the prevalence of past 30-day CU, investigated individual-level correlates of past 30-day CU, and evaluated the reasons (medical, recreational, or both) of past 30-day CU among U.S. Veterans during the second wave of the COVID-19 pandemic.

Materials and Methods

We used population-based, cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System Survey Marijuana Use model. The sample included nationally representative military veterans aged 18+ years (n = 11,167). The outcome was past 30-day CU. Individual-level demographic, socioeconomic, behavioral, and clinical correlates were examined. Analyses were weighted to account for the survey’s complex design with results generalizable to nearly 2.9 million veterans. We conducted weighted descriptive statistics, prevalence estimates, and multivariable logistic regression analyses.

Results

Out of 2.9 million veterans, 11.1% self-reported as non-Hispanic Black, 3.7% Hispanic, and 79.1% non-Hispanic White; 88.5% were men, and 72.8% were aged 50+ years. About 14.6% were current tobacco smokers, 4.7% were current e-cigarette users, 12.5% were binge alcohol drinkers, and 43.4% had three or more comorbid conditions. Overall, 8.5% reported CU in the past 30 days, of which 30.4% used it for medical reasons and 25.8% used it for nonmedical reasons. The prevalence of past 30-day CU decreased with age, education, and income level. Compared to their counterparts, the odds of past 30-day CU were greater among men, those living in urban areas, those with frequent mental distress, infrequent physical distress, and those who had at least one comorbid condition. Non-Hispanic Black veterans had 89% increased odds of past 30-day CU (adjusted odds ratio [AOR] =1.89, 95% confidence interval [CI], 1.19-3.0) compared with non-Hispanic White veterans. Current tobacco smokers had 3.54 (95% CI, 2.40-5.24) and former smokers had 1.78 (95% CI, 1.28-2.47) times higher odds of reporting past 30-day CU than never smokers. Current e-cigarette use (AOR = 3.37, 95% CI, 2.20-5.16) and binge drinking (AOR = 3.18, 95% CI, 2.29-4.41) were also statistically significantly associated with increased odds of past 30-day CU compared to no e-cigarette use and no binge drinking.

Conclusions

CU is prevalent among veterans, and certain subgroups are at higher risk of CU. Thus, identifying high-risk subgroups of veterans and adequately educating them about CU’s benefits, risks, and safety is crucial.
Limiting Exposure to Scattered Radiation From a CT System Installed in a Two-Sided Deployable ISO-Shelter
Authors: Tucker Jonathan E , Wirt Michael D
Published: September 2023

Introduction

Diagnostic radiology in the deployed military environment (in-theater diagnostic radiology) was greatly improved in the early 1990s with the addition of CT systems installed in military-grade one-sided expandable ISO-shelters. These shelters were provided with limited radiation shielding by several flexible lead curtains covering only a small portion of the shelter walls, necessitating placement of deployed CT systems at substantial distances from the field medical facility to limit exposures to personnel from secondary radiation. The newest generation deployable CT system is housed in a two-sided ISO-shelter with radiation shielding applied to the shelter walls. To ensure compliance with military and national standards for protection against ionizing radiation, we developed a simple method to calculate safe distances based on workload, frequencies of the various CT exams performed, and occupancy of controlled and uncontrolled areas.

Materials and Methods

Calculation of radiation air kerma rates outside a two-sided CT ISO-shelter was developed using guidance from the National Council on Radiation Protection and Measurements Report No. 147. The simplified formula included measured radiation transmission factors for the ISO-shelter wall and installed shielding, occupancy factors, fraction of all CT exams that covered the chest, abdomen, and/or pelvis, total number of CT exams per week, and shielding design goals for controlled and uncontrolled areas. The formula was modified subsequently to account for whole-body CT exams expected during armed conflict.

Results

Calculated safe distances revealed that the shielded two-sided CT ISO-shelter can be positioned much closer to the surgical shelters of the field medical unit than the previously unshielded one-sided CT ISO-shelter. Tables of safe distances for controlled and uncontrolled areas for the two medical support environments of disaster relief/peacekeeping and combat are provided. For example, for a controlled area at 100% occupancy when 300 CT exams per week are performed and 50% of those exams are of the chest, abdomen, and/or pelvis, the safe distance between the nearest surgical shelter and the shielded CT ISO-shelter is 2.1 m. By comparison, the safe distance for an unshielded CT ISO-shelter is 8.5 m under the same conditions. For lower occupancy factors and lower weekly workload, safe distances from the nearest surgical shelter are often negligible.

Conclusions

The shielding in the new deployable CT ISO-shelter substantially reduces the distance between it and the surgical shelters of the field medical unit necessary to ensure radiation safety. Safe distances depend on several factors including workload, types and frequencies of CT exams, occupancy factors, and classification of the area around the ISO-shelter, i.e., controlled and uncontrolled.