bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward an intelligent computing system for the early diagnosis of Alzheimer’s disease based on the modular hybrid growing neural gas
Authors: Cabrera-León Ylermi , Fernández-López Pablo , García Báez Patricio , Kluwak Konrad , Navarro-Mesa Juan Luis , Suárez-Araujo Carmen Paz ,   for the Alzheimer’s Disease Neuroimaging Initiative *
Published: October 2024

Objective

The proportion of older people will soon include nearly a quarter of the world population. This leads to an increased prevalence of non-communicable diseases such as Alzheimer’s disease (AD), a progressive neurodegenerative disorder and the most common dementia. mild cognitive impairment (MCI) can be considered its prodromal stage. The early diagnosis of AD is a huge issue. We face it by solving these classification tasks: MCI-AD and cognitively normal (CN)-MCI-AD.

Methods

An intelligent computing system has been developed and implemented to face both challenges. A non-neural preprocessing module was followed by a processing one based on a hybrid and ontogenetic neural architecture, the modular hybrid growing neural gas (MyGNG). The MyGNG is hierarchically organized, with a growing neural gas (GNG) for clustering followed by a perceptron for labeling. For each task, 495 and 819 patients from the Alzheimer’s disease neuroimaging initiative (ADNI) database were used, respectively, each with 211 characteristics.

Results

Encouraging results have been obtained in the MCI-AD classification task, reaching values of area under the curve (AUC) of 0.96 and sensitivity of 0.91, whereas 0.86 and 0.9 in CN-MCI-AD. Furthermore, a comparative study with popular machine learning (ML) models was also performed for each of these tasks.

Conclusions

The MyGNG proved to be a better computational solution than the other ML methods analyzed. Also, it had a similar performance to other deep learning schemes with neuroimaging. Our findings suggest that our proposal may be an interesting computing solution for the early diagnosis of AD.
Brain tumor classification using fine-tuned transfer learning models on magnetic resonance imaging (MRI) images
Authors: Rasa Sadia Maduri , Islam Md. Manowarul , Talukder Md. Alamin , Uddin Md. Ashraf , Khalid Majdi , Kazi Mohsin , Kazi Md. Zobayer
Published: October 2024

Objective

Brain tumors are a leading global cause of mortality, often leading to reduced life expectancy and challenging recovery. Early detection significantly improves survival rates. This paper introduces an efficient deep learning model to expedite brain tumor detection through timely and accurate identification using magnetic resonance imaging images.

Methods

Our approach leverages deep transfer learning with six transfer learning algorithms: VGG16, ResNet50, MobileNetV2, DenseNet201, EfficientNetB3, and InceptionV3. We optimize data preprocessing, upsample data through augmentation, and train the models using two optimizers: Adam and AdaMax. We perform three experiments with binary and multi-class datasets, fine-tuning parameters to reduce overfitting. Model effectiveness is analyzed using various performance scores with and without cross-validation.

Results

With smaller datasets, the models achieve 100% accuracy in both training and testing without cross-validation. After applying cross-validation, the framework records an outstanding accuracy of 99.96% with a receiver operating characteristic of 100% on average across five tests. For larger datasets, accuracy ranges from 96.34% to 98.20% across different models. The methodology also demonstrates a small computation time, contributing to its reliability and speed.

Conclusion

The study establishes a new standard for brain tumor classification, surpassing existing methods in accuracy and efficiency. Our deep learning approach, incorporating advanced transfer learning algorithms and optimized data processing, provides a robust and rapid solution for brain tumor detection.
From research to routine care: A historical review of internet-based cognitive behavioral therapy for adult mental health problems in Sweden
Authors: Vernmark Kristofer , Buhrman Moncia , Carlbring Per , Hedman-Lagerlöf Erik , Kaldo Viktor , Andersson Gerhard
Published: October 2024

This narrative historical review examines the development of internet-based cognitive behavioral therapy (ICBT) in Sweden, describing its progression within both academic and routine care settings. The review encompasses key publications, significant scientific findings, and contextual factors in real-world settings. Over 25 years ago, Sweden emerged as a pioneering force in internet-delivered treatment research for mental health. Since then, Swedish universities, in collaboration with research partners, have produced substantial research demonstrating the efficacy of ICBT across various psychological problems, including social anxiety disorder, panic disorder, generalized anxiety disorder, and depression. Although research conducted in clinical settings has been less frequent than in academic contexts, it has confirmed the effectiveness of therapist-supported ICBT programs for mild-to-moderate mental health problems in routine care. Early on, ICBT was provided as an option for patients at both the primary care level and in specialized clinics, using treatment programs developed by both public and private providers. The development of a national platform for delivering internet-based treatment and the use of procurement in selecting ICBT programs and providers are factors that have shaped the current routine care landscape. However, gaps persist in understanding how to optimize the integration of digital treatment in routine care, warranting further research and the use of specific implementation frameworks and outcomes. This historical perspective on the research and delivery of ICBT in Sweden over two decades offers insights for the international community into the development and broad dissemination of a specific digital mental health intervention within a national context.
A sustainable artificial-intelligence-augmented digital care pathway for epilepsy: Automating seizure tracking based on electroencephalogram data using artificial intelligence
Authors: Keikhosrokiani Pantea , Isomursu Minna , Uusimaa Johanna , Kortelainen Jukka
Published: October 2024

Objective

Scalp electroencephalograms (EEGs) are critical for neurological evaluations, particularly in epilepsy, yet they demand specialized expertise that is often lacking in many regions. Artificial intelligence (AI) offers potential solutions to this gap. While existing AI models address certain aspects of EEG analysis, a fully automated system for routine EEG interpretation is required for effective epilepsy management and healthcare professionals' decision-making. This study aims to develop an AI-augmented model for automating EEG seizure tracking, thereby supporting a sustainable digital care pathway for epilepsy (DCPE). The goal is to improve patient monitoring, facilitate collaborative decision-making, ensure timely medication adherence, and promote patient compliance.

Method

The study proposes an AI-augmented framework using machine learning, focusing on quantitative analysis of EEG data to automate DCPE. A focus group discussion was conducted with healthcare professionals to find the problem of the current digital care pathway and assess the feasibility, usability, and sustainability of the AI-augmented system in the digital care pathway.

Results

The study found that a combination of random forest with principal component analysis and support vector machines with KBest feature selection achieved high accuracy rates of 96.52% and 95.28%, respectively. Additionally, the convolutional neural networks model outperformed other deep learning algorithms with an accuracy of 97.65%. The focus group discussion revealed that automating the diagnostic process in digital care pathway could reduce the time needed to diagnose epilepsy. However, the sustainability of the AI-integrated framework depends on factors such as technological infrastructure, skilled personnel, training programs, patient digital literacy, financial resources, and regulatory compliance.

Conclusion

The proposed AI-augmented system could enhance epilepsy management by optimizing seizure tracking accuracy, improving monitoring and timely interventions, facilitating collaborative decision-making, and promoting patient-centered care, thereby making the digital care pathway more sustainable.
Knowledge mapping of telemedicine in urology in the past 20 years: A bibliometric analysis (2004–2024)
Authors: Zeng Na , Liu Mei-Cheng , Zhong Xing-Yu , Wang Shao-Gang , Xia Qi-Dong
Published: October 2024

Telemedicine refers to the process of utilizing communication technologies to exchange disease information, perform surgery and educate care providers remotely, breaking through the distance limit and promoting the health of individuals and communities. The fifth-generation (5G) technology and the COVID-19 pandemic have greatly boosted studies on the application of telemedicine in urology. In this study, we conduct a comprehensive overview of the knowledge structure and research hotspots of telemedicine in urology through bibliometrics. We searched publications related to telemedicine in urology from 2004 to 2024 on the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace and R package “bibliometrix” were employed in this bibliometric analysis. A total of 1,357 articles from 97 countries and 2,628 institutions were included. The number of annual publications on telemedicine in urology witnessed a steady increase in the last two decades. Duke University was the top research institution. Urology was the most popular journal, and Journal of Medical Internet Research was the most co-cited journal. Clarissa Diamantidis and Chad Ellimoottil published the most papers, and Boyd Viers was co-cited most frequently. Effectiveness evaluation of telemonitoring, cost–benefit analysis of teleconsultation and exploration of telesurgery are three main research hotspots. As the first bibliometric analysis of research on telemedicine in urology, this study reviews research progress and highlights frontiers and trending topics, offering valuable insights for future studies.
To read or not to read – A cross-sectional study of Swedish primary care patients’ adoption of patient accessible electronic health records
Authors: Muli Irene , Cajander Åsa , Hvitfeldt Helena , Lagerros Ylva Trolle , Söderberg Daniel , Sjöblom Linnea , Dahlgren Anna , Bertilson Bo C. , Farrokhnia Nasim , Amer-Wåhlin Isis , Taloyan Marina , Hägglund Maria
Published: October 2024

Objective

Patient-accessible electronic health records (PAEHR) were implemented in the Stockholm region of Sweden seven years ago. This study examines socio-demographic and psychographic factors associated with reading/not reading these records, as well as the common reasons for such behaviours.

Methods

Patients or guardians of minors seeking face-to-face or digital primary healthcare in the Stockholm region responded to a questionnaire about whether they were aware that they could read their PAEHR, and if so, if they had read it and reasons for reading or not reading. We conducted a comparative analysis of readers and non-readers and a stepwise multiple logistic regression.

Results

The majority of participants were aware that they could read the PAEHR (86%) and among those aware, 77% had read it. The odds of reading decreased with increased age, unfavourable opinion of PAEHR, low information literacy and being single. Access to a smartphone increased the probability of reading. Participants who had read their PAEHR had commonly read it to get an overview of their health and care (65%) and to follow up on a healthcare visit (55%). Participants who had not read their PAEHR stated generally that they did not need to (63%) and/or had received sufficient information from their providers (38%).

Conclusions

While most people were aware they could read the PAEHR and many had read it, a digital divide and several barriers to reading the PAEHR were identified. Efforts to increase PAEHR reading may be targeted at older people, people needing more informal support, those who may be excluded due to limited information literacy, and towards improving the patient portals’ usability.
Classification of coronary artery disease severity based on SPECT MPI polarmap images and deep learning: A study on multi-vessel disease prediction
Authors: Chen Jui-Jen , Su Ting-Yi , Huang Chien-Che , Yang Ta-Hsin , Chang Yen-Hsiang , Lu Henry Horng-Shing
Published: October 2024

Background

Coronary artery disease (CAD) is a global health concern. Conventional single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is a noninvasive method for assessing the severity of CAD. However, it relies on manual classification by clinicians, which can lead to visual fatigue and potential errors. Deep learning techniques have displayed promising results in CAD diagnosis and prediction, providing efficient and accurate analysis of medical images.

Methods

In this study, we explore the application of deep learning methods for assessing the severity of CAD and identifying cases of multivessel disease (MVD). We utilized the EfficientNet-V2 model in combination with DeepSMOTE to evaluate CAD severity using SPECT MPI images.

Results

Utilizing a dataset consisting of 254 patients (176 with MVD and 78 with single-vessel disease [SVD]), our model achieved an accuracy rate of 84.31% and area under the receiver operating characteristic curve (AUC) value of 0.8714 in predicting cases of MVD. These results underline the promising potential of our approach in MVD prediction, offering valuable diagnostic insights and the prospect of reducing medical costs.

Conclusion

This study emphasizes the feasibility of employing deep learning techniques for predicting MVD based on SPECT MPI images. The integration of Efficient-Net-V2 and DeepSMOTE methods effectively evaluates CAD severity and distinguishes MVD from SVD. Our research presents a practical approach to the early prediction and diagnosis of MVD, ultimately leading to enhanced patient outcomes and reduced healthcare costs.
Complications following total wrist replacement: A single-center retrospective review
Authors: Lau Cyrus Tsun-Kit , Wan Raymond Chung-Wai , Chau Wai-Wang , Mak Michael Chu-Kay , Tse Wing-Lim , Ho Pak-Cheong
Published: October 2024

Background/Purpose: Total wrist replacement (TWR) is an alternative to wrist fusion in advance wrist arthritis with the advantage of preserving the wrist motion. TWR is, however, infrequently performed in Asia-Pacific region. This study aimed to describe our institution's experience in managing complications following TWR. Methods: This study represents a single-center retrospective review of all patients who underwent TWR at the Department of Orthopedics and Traumatology, Prince of Wales Hospital in Hong Kong. The study period spans from 1 January 2004 to 1 March 2023. Recorded demographic parameters include gender, age upon surgery, pathology, types of implants, and follow-up period. Outcomes focused particularly on postoperative complications and need for revision surgery. Results: Twelve TWR from 10 Chinese-Asian patients were reviewed with a mean follow-up duration of 97.4 months. The incidence of complications in our study was as follows: loosening (16.67%), metallosis (8.3%), infection (8.3%), and stiffness (8.3%). One patient required conversion to total wrist arthrodesis due to metallosis and stiffness. Conclusion: TWR offers promising solutions for managing painful arthritic wrists. However, it's crucial to recognize that complications can arise, necessitating further surgical intervention. Surgeons must thoroughly comprehend these risks to provide informed counseling to patients and explore alternative treatment approaches.
Can Women Thrive in a Predominantly Male Environment? Examining the Perception of Women in I-deal Negotiation
Authors: R Maithily , Soumyaja Devi
Published: October 2024

Idiosyncratic deals (i-deals) are nonstandardized work arrangements that help employees balance their work and nonwork demands. Previous literature has paid increased attention to the concept of i-deals, yet there is a lack of clarity regarding the perception of i-deals among Indian women employees. India’s social context is patrifocal, where women face multiple work challenges. Women are more drawn toward nontraditional forms of employment because they prioritize balancing work and personal life. Therefore, the study investigates how i-deals mitigate challenges faced by women in their workplace using an exploratory research design. Data were collected by interviewing 20 women employees in the IT sector in India who had successfully negotiated i-deals. A content-coding method was used to analyze the interview transcripts, and the study findings show that reduced turnover intention, hedonic well-being, and career advancement are the critical outcomes of negotiating i-deals. We also discuss the theoretical and managerial implications.
The Role of Biomarkers in Predicting Outcomes of Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Batty Lachlan M. , Mackenzie Christopher , Landwehr Chelsea , Webster Kate E. , Feller Julian A.
Published: October 2024

Background:

Anterior cruciate ligament (ACL) injury is frequently associated with injuries to other parts of the knee, including the menisci and articular cartilage. After ACL injury and reconstruction, there may be progressive chondral degradation. Biomarkers in blood, urine, and synovial fluid can be measured after ACL injury and reconstruction and have been proposed as a means of measuring the associated cellular changes occurring in the knee.

Purpose:

To systematically review the literature regarding biomarkers in urine, serum, or synovial fluid that have been associated with an outcome measure after ACL reconstruction.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE, Embase, CINAHL, and Web of Science databases were searched to identify studies published before September 2023 that reported on patients undergoing ACL reconstruction where a biomarker was measured and related to an outcome variable. Of 9360 results, 16 studies comprising 492 patients were included. Findings were reported as descriptive summaries synthesizing the available literature.

Results:

A total of 45 unique biomarkers or biomarker ratios were investigated (12 serum, 3 urine, and 38 synovial fluid; 8 biomarkers were measured from >1 source). Nineteen different outcome measures were identified, including the International Knee Documentation Committee Subjective Knee Form, Knee injury and Osteoarthritis Outcome Score, numeric pain scores, radiological outcomes (magnetic resonance imaging and radiography), rates of arthrofibrosis and cyclops lesions, and gait biomechanics. Across the included studies, 17 biomarkers were found to have a statistically significant association ( P < .05) with an outcome variable. Serum interleukin 6 (s-IL-6), serum and synovial fluid matrix metalloproteinase-3 (s-MMP-3 and sf-MMP-3), urinary and synovial fluid C-terminal telopeptide of type 2 collagen (u-CTX-II and sf-CTX-II), and serum collagen type 2 cleavage product (s-C2C) showed promise in predicting outcomes after ACL reconstruction, specifically regarding patient-reported outcome measures (s-IL-6 and u-CTX-II), gait biomechanical parameters (s-IL-6, sf-MMP-3, s-MMP-3, and s-C2C), pain (s-IL-6 and u-CTX-II), and radiological osteoarthritis (ratio of u-CTX-II to serum procollagen 2 C-propeptide).

Conclusion:

The results highlight several biomarkers that have been associated with clinically important postoperative outcome measures and may warrant further research to understand if they can provide meaningful information in the clinical environment.
Association Between Hip Translation and Hip Rotation and Anatomy: A Pilot Quasi-static MRI Study
Authors: Kiapour Ata M. , Mitchell Charles , Hosseinzadeh Shayan , Emami Alex , Lewis Cara L. , Warfield Simon K. , Bixby Sarah , Stracciolini Andrea , Novais Eduardo N. , Kim Young-Jo
Published: October 2024

Background:

There is little known about translation of the hip and the relationship with hip rotation and morphology in asymptomatic patients.

Hypotheses:

(1) Femoral head would exhibit significant translations in asymptomatic hips, (2) femoral head translations would correlate to femoral rotations, and (3) range of femoral head translations would correlate to hip morphology.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 11 individuals (age, 23-47 years; 64% female) with asymptomatic hips underwent hip magnetic resonance imaging (MRI) in the following postures: neutral (supine), midflexion, maximum-flexion, internal rotation, internal rotation + midflexion, internal rotation + maximum-flexion, adduction, flexion-abduction-external rotation (FABER), extension, and lateral abduction. All rotations were passive. MRI-generated 3-dimensional hip models were used to quantify femoral rotations and translations. Femoral head diameter, acetabular diameter, lateral center-edge angle, alpha angle, femoral anteversion, acetabular version and inclination, and neck-shaft angle were measured from MRI. A t test was used if measured translations were statistically significant. Linear regression was used to assess the associations between translation and rotation. Pearson correlation was used to assess the relationships between hip anatomy and range of femoral head translations.

Results:

In all tested positions, the femoral head translated anteriorly by 2 ± 1 mm (maximum 5 mm, P < .001), posteriorly by 1 ± 1 mm (maximum 6 mm, P < .001), superiorly by 2 ± 2 mm (maximum 7 mm, P < .001), inferiorly by 2 ± 2 mm (maximum 6 mm, P < .001), laterally by 1 ± 1 mm (maximum 4 mm, P < .001), and medially by 2 ± 1 mm (maximum 5 mm, P < .001), relative to the rested supine position. Femoral flexion was associated with posterior translation of the femoral head ( P = .038). Femoral abduction was associated with medial translation of the femoral head ( P = .042). Higher femoral anteversion and smaller alpha angle were associated with a higher total magnitude of femoral head translation in the anterior-posterior direction ( P < .04). Smaller femoral anteversion, higher acetabular inclination, smaller lateral center-edge angle, and lower neck-shaft angle were associated with a higher total magnitude of femoral head translation in the superior-inferior direction ( P ≤ .03).

Conclusion:

Our study demonstrated that, during passive physiologic movement, asymptomatic hips on average translated up to 2 mm (with up to 7 mm maximum translation in some positions), which is potentially related to hip rotations and morphology. Further investigations are warranted to understand the normal and pathologic hip translations and their impact on hip function (ie, instability and impingement).
Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players
Authors: Mercurio Michele , Cerciello Simone , Corona Katia , Guerra Germano , Simonetta Roberto , Familiari Filippo , Galasso Olimpio , Gasparini Giorgio
Published: October 2024

Background:

Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR.

Purpose:

To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL–Return to Sport after Injury scale.

Results:

After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score ( P = .013), IKDC ( P = .003), total KOOS ( P < .001), KOOS Symptoms ( P = .004), KOOS Pain ( P = .029), KOOS Activities of Daily Living (ADL) ( P = .044), KOOS Sport and Recreation (Sport/Rec) ( P = .001), KOOS Quality of Life (QoL) ( P < .001), and Lysholm score ( P = .008). Playing only on natural grass was associated with lower SF-12 PCS scores ( P = .003), total KOOS ( P = .001), and KOOS Sport/Rec ( P = .011). Playing only on artificial turf was associated with lower Lysholm score ( P = .018) and total KOOS ( P = .014). The contact mechanism was associated with higher IKDC ( P = .044) and KOOS QoL ( P = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores ( P = .012). Playing at a nonprofessional level was associated with lower total KOOS ( P = .028), KOOS Symptoms ( P = .002), KOOS ADL ( P = .033), and KOOS Sport/Rec ( P = .016).

Conclusion:

Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.
Breastfeeding Practice in Tunisia: Combined Results of Multiple Indicator Cluster Surveys (2000-2018)
Authors: Nouira Mariem , Souayeh Nesrine , Maatouk Mohamed , Nouira Hajer , Hasnaoui Anis , Arfa Sondess
Published: October 2024

Introduction. Breastfeeding practices fall short of optimal levels globally, despite its known health benefits and World Health Organization endorsements. We aimed through this study to firstly estimate the global prevalence of principal indicators of breastfeeding practice in Tunisia. Secondly, we aimed to identify their associated factors and to assess the temporal trend of breastfeeding practice in Tunsia from 2000 to 2018. Methods. We extracted data from all available reports of Multiple Indicator Cluster Surveys (MICS) surveys conducted in Tunisia (MICS2000, 2006, 2012 and 2018) that were publicly available on the MICS UNICEF website prior to 2024. Results. Never breastfeeding prevalence was 4% (95% CI [3%-7%]) with a significant increase ( P < 10−3) from 2000 (2.4%) to 2018(7.8%). The prevalence of early breastfeeding initiation was 56% (95% CI [20%-87%]) with a significant decrease( P < 10−3) from 2006(87.4%) to 2018(31.5%). The prevalence of exclusive breastfeeding was 15% (95% CI [5%-35%]) with a significant decrease( P < 10−3) from 2000(46.4%) to 2018(13.4%). The prevalence of predominant breastfeeding was 41% (95% CI [31%-51%]) with a significant decrease( P < 10−3) from 2000(50.5%) to 2018(30.4%). The prevalence of continued breastfeeding up to the age of 2 years was 19% (95% CI [16%-22%]) with no significant decrease from 2000 to 2018( P = .09). The mother educational level was significantly associated with early breastfeeding initiation, exclusive and predominant breastfeeding. A higher prevalence of exclusive breastfeeding was found among mothers from rural areas. Conclusions. Tunisia has been experiencing low rates of breastfeeding practice, with a concerning decline observed over the years. Addressing this issue effectively necessitates a comprehensive, multi-faceted approach that encompasses various aspects of society, healthcare, and policymaking.
Attitudes and Behavior Feedback Loops for Young Women’s Premarital Sex
Authors: Eilers Michelle A.
Published: October 2024

Sociologists have long been puzzled by whether attitudes inform behaviors or vice versa. Accurately assessing both possibilities requires panel data collected at relatively short intervals. In this study, I leverage intensive panel data from the Relationship Dynamics and Social Life Study to assess the case of young women’s premarital sexual attitudes and behavior. Through a series of descriptive analyses and cross-lagged panel models, I show that opposition to premarital sex in young adulthood is only sometimes associated with subsequent sexual behavior and that premarital sex is negatively associated with later opposition to premarital sex. Young women are especially likely to reduce their opposition following first sex relative to sex reported at any time. Thus, initial behavioral experiences may result in outsized shocks to attitudes, following an active updating model. That subsequent sex is associated with less attitudinal change suggests that young women initially update their attitudes before settling into them. This study nuances long-standing debates on the malleability of attitudes within a person over time and with respect to behavior and has implications for how people approach behavior according to their attitudes across a wide spectrum of social phenomena.
Exploring the Factors That Impact Recruitment and Retention of Pediatricians in Irish Community Hospitals Through the Attitudes of Trainees and Physicians-in-Practice
Authors: Healy Lydia , O'Grady Michael J , Fancourt Nigel , Mema Briseida
Published: October 2024

BACKGROUND

Difficulty attracting physicians to work in rural and remote areas is a worldwide problem. Specific to pediatrics, barriers to recruitment include burdensome on-call rosters, a lack of career opportunities for partners and professional isolation.

METHODS

To examine attitudes to working in a community hospital in Ireland, a mixed-methods sequential analysis approach was undertaken. Pediatricians-in training (70) and attending community pediatricians (25) completed surveys. Six semistructured interviews were used to triangulate survey results.

RESULTS

Most trainees planned to stay in Ireland (66/70), with five (eight%) stating that a career in a community hospital was their first preference. Personal factors such as a partner's career prospects and closeness to family and friends were the most important deterrents to working in a community hospital for trainees. Both trainees and attendings were concerned regarding professional isolation. Trainees were concerned about the poor reputation of community units. This converged with attendings feeling their role was not adequately respected, even though their job had more variability and exposure to emergencies, with less support, than working in a large center. Both groups agreed that targeted postgraduate training pathways and better training opportunities within Ireland were the best way to improve recruitment. Financial bonuses were not highly ranked as potential incentives. Motivators for considering a career in community units included the desire to make an impact and to build something new. Concerns about job satisfaction, professional recognition, and limited support for service development were prevalent.

CONCLUSION

This study reveals critical challenges and motivators influencing the shortage of pediatricians in Irish community units. Addressing these issues requires a multifaceted approach, incorporating targeted training, support structures, and recognition to enhance recruitment and retention in these underserved areas. Insights from the Irish context could be applied to improve recruitment and retention of pediatricians in regions with similar contexts.
Recent Updates on COVID-19 Associated Strokes
Authors: Betts Colton , Ahlfinger Zane , Udeh Mercy C , Kirmani Batool F
Published: October 2024

The SARS-CoV-2 virus is primarily a respiratory virus, but, as it spread worldwide, it became apparent that there are multiple extrapulmonary manifestations. Reports arose of young and otherwise healthy patients presenting to emergency departments with large-vessel occlusions. Because of a rapidly evolving pandemic, conflicting data sometimes arose regarding the impact of the pandemic on strokes. COVID-19 can induce a hypercoagulable and a proinflammatory state through the interactions with the ACE-2 receptor. These mechanisms may lead to the strokes, both ischemic and hemorrhagic, that are seen in this infection. Strokes, in conjunction with COVID-19 infection, tended to be more disabling and portended a higher mortality. Treatment of these strokes was challenging, as emergency departments were strained with the high burden of COVID-19 admissions. Finally, vaccines against COVID-19 were widely administered, and their potential to cause stroke as an adverse event are discussed. This article will provide an in depth review of the recent updates about the incidence, epidemiology, pathophysiology, clinical presentation and treatment of strokes that are associated with COVID-19.
Cerebral Proteomic Changes in the rTg-D Rat Model of Cerebral Amyloid Angiopathy Type-2 With Cortical Microhemorrhages and Cognitive Impairments
Authors: Schrader Joseph M , Majchrzak Mark , Xu Feng , Lee Hedok , Agostinucci Kevin , Davis Judianne , Benveniste Helene , Van Nostrand William E
Published: October 2024

Cerebral amyloid angiopathy (CAA) is a common disorder of the elderly, a prominent comorbidity of Alzheimer’s disease, and causes vascular cognitive impairment and dementia. Previously, we generated a novel transgenic rat model (rTg-D) that produces human familial CAA Dutch E22Q mutant amyloid β-protein (Aβ) in brain and develops arteriolar CAA type-2. Here, we show that deposition of fibrillar Aβ promotes arteriolar smooth muscle cell loss and cerebral microhemorrhages that can be detected by magnetic resonance imaging and confirmed by histopathology. Aged rTg-D rats also present with cognitive deficits. Cerebral proteomic analyses revealed 241 proteins that were significantly elevated with an increase of >50% in rTg-D rats presenting with CAA compared to wild-type rats. Fewer proteins were significantly decreased in rTg-D rats. Of note, high temperature requirement peptidase A (HTRA1), a proteinase linked to transforming growth factor beta 1 (TGF-β1) signaling, was elevated and found to accumulate in cerebral vessels harboring amyloid deposits. Pathway analysis indicated elevation of the TGF-β1 pathway and increased TGF-β1 levels were detected in rTg-D rats. In conclusion, the present findings provide new molecular insights into the pathogenesis of CAA and suggest a role for interactions between HTRA1 and TGF-β1 in the disease process.
Automating Trace Detection and Chemical Purity Analysis of Carbon Nanotube Mixtures by Non-Negative Matrix Factorization of Spatial Raman Scattering Hyperspectra
Authors: Wong Justin X. , Ouyang Jianying , Lapointe François , Mirka Brendan , Finnie Paul
Published: October 2024

Carbon nanotubes come in different species having different properties. So, it is useful to develop automated ways to quantify species purities and trace impurity content. Spatially scanned Raman spectra make hyperspectral data sets that can be used to discriminate between species and determine purities, and their analysis can be automated. A promising analytical machine learning approach is non-negative matrix factorization, which is a multivariate algorithm well adapted to hyperspectral Raman scattering data sets, and, significantly, available in open source. We prepare samples from different concentrations of pure nanotubes and acquire spatially scanned Raman scattering hyperspectra. We compare the known concentrations of the source dispersions to those determined from hyperspectra acquired from deposited materials on substrates. Here, we demonstrate and deal with several metrological issues: We show that the stability of the focusing conditions is critical. We show that if there are strong peaks that are not significant, normalization is helpful. We show that this approach compares favorably to the “best case” situation where the spectra are factored into a priori known library spectra. Scans of around 100 data points provided good bounds on concentrations down to about the parts per thousand level. Using more than one laser wavelength, so that different species are brought into resonance with each laser should enable higher relative purity measurements. However, there is an important consideration if the difference in laser energies is less than or comparable to the phonon energy. Overall, this approach is promising for the determination of chemical purity of carbon nanotubes and could be generalized to other chemical mixtures.
Implementation of Computerized Prescriber Order Entry Systems: A Review of Impacts, Barriers, and Facilitators
Authors: Farrugia Ian , Vella Bonanno Patricia
Published: October 2024

Objective:

This review evaluated the impact of a digitized computerized prescriber order entry (CPOE) system and described barriers and facilitators for introducing a digitized system.

Data Sources:

A systematic literature search was conducted in PubMed, Medline, and CINAHL using keywords. Articles in English during the last 10 years were included.

Study Selection and Data Extraction:

Study selection was presented using a PRISMA flow diagram. Forty-eight studies were included. Data from the articles were presented to address each of the three objectives.

Data Synthesis:

CPOE systems improved the quality of care provided but also introduced new types of errors. Facilitating factors for implementation included leadership, stakeholder engagement, training, and user-centered design. Inadequate training, software design, changes in workload, and workflow disruptions were identified as barriers. Recommendations for implementation included dedicated training of users, user-centered design, a backup for system downtimes, and stakeholder engagement.

Conclusion:

Application of knowledge of the facilitators and barriers for the introduction of a CPOE system supports this change-management process within the specific context and augurs for more successful implementation.
Exploring Gendered Ethical Decision-making Among Sales Professionals in India
Authors: Deka Debleena , S Anupama
Published: October 2024

Humans’ abject failure to uphold moral behaviour within workplace relationship calls for ongoing investigation of the complicated challenges brought on by the imbalance between productivity and commitment among employees. This current article is based on studying the gender differences in ethical decision-making among sales professionals in India and understanding under what circumstances the decision-making among the genders differ. The major findings show that no such decision-making difference between males and females exists. The research was conducted with a sample size of 10, but the data saturated at eight participants, wherein four were males and four were females. It is a qualitative study, and still, factors like incentives (money) and the experience level tend to deflect the ethical decisions of the individuals.
Approach Based on Response-Surface Method to Optimize Lining of Dies Used in 3D Free-Bending Forming Technology
Authors: Cheng Cheng , Guo Jiaxin , El-Aty Ali Abd , Tao Jie , Guo Xunzhong
Published: October 2024

In three-dimensional free-bending forming (3D-FBF), the tube is not overly constrained, and the plastic deformation behavior and forming quality of the bent tube are significantly affected by the critical structure of the forming die lining. However, the effects of die-lining structural parameters on the tube quality, and a method to determine the combination of die-lining structural parameters is yet to be devised. This study aims to propose a new framework that allows one to understand the effects of various die-lining structural parameters on tube quality and to propose the best combination of die-lining structural parameters. First, finite-element modeling is performed to simulate 3D-FBF and examine the effects of individual die-lining structures on the quality of tube formation. The simulation results show that the deformation-zone length and die gap are positively correlated with the tube-section distortion and wall-thickness variation, whereas it shows an opposite trend with respect to the bending radius. Additionally, the lining chamfer radius of the bending die and the guide lining chamfer radius minimally affect the tube forming quality. Subsequently, the optimal die-lining structure is obtained using the response-surface method. The tube cross-sectional distortion rate reduced from 2.73 to 2.53% after the die lining is optimized. Additionally, the average inner-wall thickness reduced to 1.06 mm, whereas the average outer-wall thickness increased to 0.97 mm. This paper proposes a method for optimizing the forming-die-lining mechanism and for improving the tube forming quality in 3D-FBF.
Neuroprotective effects of psilocybin in a rat model of stroke
Authors: Yu Seong-Jin , Wu Kuo-Jen , Wang Yu-Syuan , Bae Eunkyung , Chianelli Fabio , Bambakidis Nicholas , Wang Yun
Published: October 2024

Background

Psilocybin is a psychedelic 5HT2A receptor agonist found in “magic mushrooms”. Recent studies have indicated that 5HT2A agonists, such as dimethyltryptamine, given before middle cerebral artery occlusion (MCAo), improve staircase behavior, increased BDNF expression, and reduce brain infarction in stroke rats. The objective of this study is to determine the protective effect of psilocybin in cellular and animal models of stroke.

Methods

Adult male and timed-pregnant Sprague-Dawley rats were used for this study. The neural protective effects of psilocybin were determined in primary rat cortical neurons and adult rats. Rats were subjected to a 60-min middle cerebral artery occlusion. Brain tissues were collected for histological and qRTPCR analysis.

Results

Psilocybin reduced glutamate-mediated neuronal loss in rat primary cortical neuronal cultures. Psilocybin-mediated protection in culture was antagonized by the BDNF inhibitor ANA12. Pretreatment with psilocybin reduced brain infarction and neurological deficits in stroke rats. Early post-treatment with psilocybin improved locomotor behavior, upregulated the expression of MAP2 and synaptophysin, and down-regulated the expression of IBA1 in the stroke brain. ANA12 significantly attenuated psilocybin-mediated reduction in brain infarction and improvements in locomotor behavior.

Conclusions

Psilocybin reduced brain infarction and improved locomotor behavior in stroke rats; the protective mechanisms involve regulating BDNF expression. Our data support a novel therapeutic approach of psilocybin in stroke.
Association between physical activity and costs in very mild to moderately frail community-dwelling older adults: a cross-sectional study
Authors: Gottschalk Sophie , König Hans-Helmut , Werner Christian , Fleiner Tim , Thiel Christian , Büchele Gisela , Schäufele Martina , Rapp Kilian , Dams Judith
Published: October 2024

Background

Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults.

Methods

This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as ‘insufficient’/’sufficient’ or ‘insufficient’/‘moderate’/‘high’ in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates.

Results

Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]).

Conclusion

Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.
Diagnosis of leukemic lung infiltration mimicking fungal infection by transbronchial lung cryobiopsy: the first case report
Authors: Kim Duk Ki , Chung Chaeuk , Park Dongil
Published: October 2024

Background

We here report the first case of leukemic lung infiltration diagnosed by transbronchial lung cryobiopsy (TBLC). TBLC is likely to be a superior method to transbronchial forceps biopsy because TBLC can get larger specimens, resulting in a higher chance of containing the leukemic cells infiltrated tissues. TBLC is generally considered a superior diagnostic method compared to transbronchial lung forceps biopsy (TBLB) because it utilizes cryotechnology to obtain larger specimens, increasing the likelihood of capturing tissues infiltrated with leukemic cells.

Case presentation

A 69-year-old male patient with acute myeloid leukemia presented with a fever. His initial chest CT scans revealed consolidative lesions, raising suspicion of fungal infection such as angioinvasive aspergillosis or mucormycosis. TBLC and TBLB were conducted to achieve a precise diagnosis, and eventually, leukemic lung infiltration was identified exclusively in the tissues obtained from TBLC. Two cycles of chemotherapy was administrated to patient, showing improvements in symptoms and chest CT findings.

Conclusions

TBLC has greater potential as a differential diagnostic method for pulmonary lesions than TBLB in leukemia patients facing therapeutic challenges due to its higher diagnostic yield.