bluuebunny/crossref_metadata_2025 huggingface dataset:
Test–Retest Reliability and Reliable Change Estimates for Sensorimotor Concussion Assessments in Healthy Young Adults
Authors: Edwards Gregory C. , Bruggeman Alex E. , Fogt Nick , Onate James A. , Bliss Rebecca A. , Quatman-Yates Catherine C. , Caccese Jaclyn B.
Published: January 2025

Context: Sensorimotor impairments are common sequela following concussion, but recovery following a concussion is often determined through examiner scored clinical testing. There are emerging technologies that provide objective methods to determine physiological impairment after concussion, but the psychometrics of these tools are lacking and must be established for use in clinical practice. Objective: The purpose of this study was to examine the test–retest reliability and provide reliable change estimates in healthy young adults for outcomes from 3 emerging technologies providing objective assessments of sensorimotor function in healthy young adults. Design: Test–retest reliability design in a laboratory setting. Methods: Healthy, young adults completed testing at 2 time points 4 weeks apart on the Bertec Vision Trainer, the Concussion Balance Test (COBALT), and the Neurolign Dx-100 eye-tracking system. We determined test–retest reliability using intraclass correlation coefficients with a 2-way mixed-effects model absolute agreement. Reliable change estimates were calculated for 70%, 80%, 90%, and 95% CIs. Results: Participants included 30 healthy young adults (age = 25 [5] y, interquartile range = 20–29; range = 18–38; 17% [57%] women). Test–retest reliability for the Bertec Vision Trainer outcomes ranged from 0.56 to 0.88, with 45% of the outcomes being classified as clinically acceptable (>.70 intraclass correlation coefficients ); for COBALT conditions, sway velocity ranged from 0.50 to 0.95, 95% ellipse area ranged from −0.22 to 0.88, and Sway Score ranged from 0.07 to 0.85, with 50% of COBALT metrics being clinically acceptable; and for the Dx-100, outcomes ranged from −0.20 to 0.89, with 52% being clinically acceptable. Conclusions: Overall, test–retest reliability was moderate-to-good for the Bertec Vision Trainer assessment outcomes but were highly variable for outcomes of postural control using the COBALT and eye-tracking metrics using the Dx-100. This study adds clinically relevant test–retest reliability and reliable change estimates in healthy adults for 3 commercially available sensorimotor assessments.
On the Theoretical Interpretation of the Data on Collisions of Argon Nuclei with Various Nuclei at High Energies
Authors: Uzhinsky V. V. , Galoyan A. S. , Chalyi N. A.
Published: January 2025

Recently (2024), the NA61/SHINE collaboration has presented new experimental data on
$${{\pi }^{ \pm }}$$
,
$${{K}^{ \pm }}$$
, proton, and antiproton productions in central 40Ar + 45Sc collisions at the laboratory momenta P
lab = 13–150 A GeV/c and has compared these data with predictions of popular theoretical models. It turned out that the models poorly describe the data in the entire energy range. In this work, it has been suggested for the first time that nucleons participating in non-diffractive collisions cannot diffractively dissociate in subsequent nucleon–nucleon collisions. This idea has been implemented in the Geant4 FTF model. Good description of the data, including the first NICA BM@N data on
$${{\pi }^{ + }}$$
meson production in the collisions of 40Ar nuclei with various nuclei at an energy of 3.2 A GeV, has been achieved.
Manifestation of Layer-by-Layer Localization of van Hove Singularities in Tunneling between Bilayer Graphene Sheets
Authors: Vdovin E. E. , Khanin Yu. N. , Morozov S. V. , Kashchenko M. A. , Sokolik A. A. , Novoselov K. S.
Published: January 2025

Tunneling between two sheets of bilayer graphene, the crystal lattices of which are rotated relative to each other by a small angle, has been studied. An anomalous behavior of the tunneling conductivity caused by van Hove singularities at the edges of the conduction and valence bands spatially localized in different sheets of bilayer graphene has been found.
Outcomes of extremely preterm infants who participated in a randomised trial of dopamine for treatment of hypotension (the HIP trial) at 2 years corrected age
Authors: Marlow Neil , Barrington Keith J , ODonnell Colm Patrick Finbarr , Miletin Jan , Naulaers Gunnar , Cheung Po-Yin , Corcoran John David , Khuffash El , Boylan Geraldine B , Livingstone Vicki , Pons Gerard , Straňák Zbyněk , Van Laere David , Macko Jozef , Wiedermannova Hana , Dempsey Eugene M
Published: January 2025

Objective

To determine survival and neurodevelopmental outcomes in the Hypotension in Preterm (HIP) trial.

Design

Prospective follow-up of infants enrolled in randomised controlled trial.

Participants

58 infants born before 28 weeks of gestation with low mean arterial blood pressure.

Intervention

Random allocation to treatment of low blood pressure values with infusion of dopamine or placebo.

Primary outcome

Survival without neurodevelopmental impairment to 24 months corrected age (CA).

Results

The HIP trial stopped early due to logistic and recruitment difficulties. Outcomes were determined for 55 infants (27 in the dopamine group and 28 in the placebo group) at 24 months CA. Survival without impairment was present in 13 (48%) infants in the dopamine group and 7 (25%) infants in the placebo group (OR 2.79 (95% CI 0.89, 8.72); p=0.078). The components of the primary outcome were similarly distributed between the two arms. Mean Bayley composite scores and the frequency of somatic impairments did not differ significantly between groups but infants were shorter and lighter at 2 years of age after dopamine administration.

Conclusion

In this placebo-controlled trial of the treatment of hypotension in extremely preterm infants, dopamine administration did not increase survival without impairment at 2 years CA. However, the study was not sufficiently powered and a clinically important effect cannot be excluded. The role of inotropic medication in facilitating good outcomes requires further study.
Therapeutic plasmapheresis as an effective treatment for refractory anti-3-hydroxy-3-methylglutaryl coenzyme A reductase-positive immune-mediated necrotising myopathy
Authors: Lyon Andrea , Portek Ian , Parker Matthew , Limaye Vidya
Published: January 2025

Immune-mediated necrotising myopathy (IMNM) can be associated with autoantibodies to 3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR). We present a case of a man in his 60s with a 13-year history of relapsing anti-HMGCR-positive IMNM, intermittently partially responsive to various treatments including corticosteroids, methotrexate, mycophenolate, intravenous immunoglobulin, abatacept and rituximab. After a repeat presentation with severe weakness, plasmapheresis was commenced, resulting in rapid and significant improvement in muscle strength and biochemical markers, which was sustained for several months. A subsequent disease relapse following discontinuation of regular plasmapheresis responded successfully to a second treatment course of plasmapheresis. The case highlights the potential of plasmapheresis in managing refractory IMNM.
Adaptive insights: dynamic assessment for speech sound intervention in a child with cleft lip and palate
Authors: Venkatraman Krupa , Prabhu Vandhana , Nallamuthu Aishwarya
Published: January 2025

Dynamic assessment (DA) is a new approach to evaluating speech and language disorders, focusing on the learning process over static abilities. It involves a test-teach-retest format and uses the mediated learning experience (MLE) to measure a child’s modifiability through intervention efforts. This method is especially relevant for children with cleft lip and palate (CLP). A study on DA in CLP aims to demonstrate its effectiveness in creating personalised intervention plans. The study involved a child with a history of repaired CLP presenting with misarticulation and hypernasality. Over five 45-min sessions of MLE teletherapy with a speech-language pathologist, the child’s modifiability across speech errors was observed. The results showed varying levels of modifiability, emphasising the importance of identifying and using a child’s learning potential in speech sound production.
Lupus psychosis: an unusual cause of acute confusion presenting to acute medicine
Authors: Samadder Abhimanyu , Wang Joe , Malaiya Ritu
Published: January 2025

A young lady was brought to the hospital by the police after they found her wandering in the streets far away from her home behaving oddly. At admission, she was confused and had various delusional thoughts accompanied by visual and auditory hallucinations. After she was identified and her old medical notes were retrieved, it was found that she had a diagnosis of systemic lupus erythematosus (SLE) previously for which she declined any treatment. MRI brain, CSF results and EEG were unremarkable. Laboratory results confirmed the diagnosis of SLE with low disease activity. Anti-RNP antibodies were positive alongside other common markers of SLE, which pointed towards a rare entity called lupus psychosis. She was started on immunosuppression with methylprednisolone and cyclophosphamide combined with antipsychotics. Following treatment, she improved significantly and is currently leading a normal life.
Wernicke’s encephalopathy presenting with confusion and hearing loss
Authors: Carson Lucy , Veremu Munashe , Jesuthasan Aaron , Ham Timothy
Published: January 2025

We present a case of a male in his early 50s assessed in the emergency department with a seemingly clear alcohol history but with classic symptoms of Wernicke’s encephalopathy (WE): disorientation, gait ataxia and vertical nystagmus. He also had significant bilateral hearing loss and profound anterograde amnesia. Neuroimaging revealed hallmark signs of WE, including symmetrical T2/fluid-attenuated inversion recovery hyperintensity in the medial thalami. Here, we consider important differentials beyond WE, discuss the importance of revisiting the patient’s history and explore the significance of his imaging findings. Although the patient’s cognitive function and ocular symptoms improved on standard treatment, his condition progressed to Korsakoff’s syndrome accompanied by residual anterograde amnesia and ongoing confabulation that required cognitive rehabilitation.
Petroclival meningioma regression after combined oestrogen and nomegestrol acetate interruption
Authors: Lebeau Julie , Deprez Louis , Pintiaux Axelle , Reuter Gilles
Published: January 2025

Meningioma regression after progestin treatment interruption is already established. Zoely is a combined oral contraceptive including oestradiol and progestin (nomegestrol acetate). The effect of combined oestrogen with nomegestrol acetate on meningioma is currently unknown. We report the case of a woman in her early 50s under Zoely for 5 years who was diagnosed with a large petroclival meningioma. After cessation of Zoely, the patient showed clinical improvement and shrinkage of the tumour volume from 27.22 cm3to 20.54 cm3in 6 months. This is probably the first report of spontaneous meningioma regression after Zoely interruption.
Diagnosing Huntington’s disease on the medical ward
Authors: Tuan Jessica
Published: January 2025

An African American man in his early 40s with progressive gait impairment and chronic cognitive impairment initially presented to the emergency department after statements of self-harm and was hospitalised. Examination revealed notable neurological abnormalities including impaired memory recall, oral dyskinesia/choreiform movements, dystonia of the right upper extremity with drift, hyper-reflexia and spastic gait. On further evaluation, including neurology and genetics consultation and workup, a clinical diagnosis of the neurodegenerative disorder Huntington’s disease (HD) was made. Further history revealed a family history of cognitive issues and dystonia in his uncle at the age of mid-40s. The diagnosis of HD was confirmed via genetic testing of the blood, specifically looking for trinucleotide repeats. HD allele 1 had full penetrance with 44 cytosine-adenine-guanine (CAG) repeats and HD allele 2 had partial penetrance with 15 CAG repeats. A multidisciplinary team was critical in diagnosing and managing this patient’s underlying HD.
Syndromic fibrous dysplasia of the proximal femur
Authors: Philips Alphy Cherian , Thanigachalam Durai Anand , Umesh Abhishek Mysore , Venkateshaiah Parikshith
Published: January 2025

A woman in her 50s presented with a 1-year history of left hip pain that increased over the past 2 weeks. The pain began following a low-energy fall. During the 1-year period, she had multiple lesions in the thigh and gluteal region, which were surgically excised. She was evaluated and diagnosed with polyostotic fibrous dysplasia of the left femur with a pathological fracture and multiple intramuscular neurofibromas. She underwent closed reduction and proximal femoral nailing of the left femur. The relation of fibrous dysplasia to McCune-Albright syndrome and Mazabraud syndrome (rare) has been well documented. However, in this case, radiographically, the patient was erroneously diagnosed with Mazabraud syndrome when she had coexisting fibrous dysplasia and neurofibromatosis.
Outcome evaluation and cost-effectiveness analysis for an integrated multidisciplinary diabetic limb salvage program: a combined observational and simulation study
Authors: Ge Lixia , Sun Yan , Tan Elaine , Liew Huiling , Hoe Jeremy , Lin Jaime , Molina Joseph , Ang Gary , Zhu Xiaoli , Low Kai Qiang , Yap Theophilus , Azmi Nur Aberleen Syafirah Binte , Yong Enming , Chew Tiffany , Koo Hui Yan , Law Chelsea , Chan Dexter Yak Seng , Shi Claris , Choo Julia , Hoi Wai Han , Chandraskear Sadhana , Lim Jo Ann , Siow Jemes , Kaspon Sabariah Binte , Tavintharan Subramaniam , Chew Daniel , Abisheganaden John , Lo Zhiwen Joseph
Published: January 2025

Introduction

To compare the clinical outcomes and healthcare utilization of patients enrolled in the multidisciplinary Diabetic Foot in Primary and Tertiary (DEFINITE) Care program with a matched historical cohort and estimate the program’s long-term cost-effectiveness using simulation.

Research design and methods

This study consisted of two components: a 1-year observational outcome evaluation and a long-term simulation-based cost-effectiveness analysis (CEA). We conducted an observational study to analyze 2798 patients with diabetic foot ulcers (DFUs) enrolled in the program between June 2020 and June 2021 (DEFINITE Care group) and 5462 patients with DFUs from June 2016 to December 2017 as historical controls. One-to-one propensity score matching (PSM) with replacement was conducted to estimate the treatment effect of the program on clinical outcomes and healthcare utilization over 1 year. For the simulation component, a long-term CEA was performed using a Markov state transition model on a simulated cohort of 10 000 patients with DFUs over a 20-year period, assessing transitions between health states, including minor and major amputations and death. The incremental cost-effectiveness ratio (ICER) was calculated for the DEFINITE Care program relative to routine care.

Results

The estimation of average treatment effects based on propensity scores showed that the DEFINITE Care group exhibited a 9% lower mortality, 5% higher lower extremity amputation (LEA)-free survival, yet a 5% higher minor LEA rate compared with the matched historical controls. Additionally, they experienced fewer inpatient admissions (0.98 fewer episodes) and shorter hospital stays (5.5 fewer days) within 1 year (p-value <0.001). The ICER was US$22 707 (SE: 430) per quality-adjusted life year gained, indicating long-term cost-effectiveness. Probabilistic sensitivity analysis supported these findings.

Conclusions

The integrated multidisciplinary DEFINITE Care program improved LEA-free survival, reduced inpatient admissions and length of stay within 1 year and demonstrated long-term cost-effectiveness managing DFUs.
Acceptability and effectiveness of a study information video in improving the research consent process for youth: a non-inferiority trial
Authors: Mwaturura Tinashe Cynthia , Simms Victoria , Dauya Ethel , Shrestha Som Kumar , Ferrand Salmaan , Shavani Talent , Dziva Chikwari Chido , Mackworth-Young Constance R S , Bandason Tsitsi , Mavodza Constancia , Tembo Mandikudza , Kranzer Katharina , Bernays Sarah , Ferrand Rashida Abbas
Published: January 2025

Introduction

Obtaining informed consent for research includes the use of information sheets, which are often long and may be difficult for participants to understand. We conducted a trial to investigate whether consent procedures using a study information video coupled with electronic consent were non-inferior to standard consent procedures using participant information sheets (PIS) among youth aged 18–24 years in Zimbabwe.

Methods

The trial was nested within an endline population-based survey for a cluster-randomised trial from October 2021 to June 2022. Randomisation of participants to video or paper-based consent was at household level. We assessed non-inferiority in comprehension of the study using a questionnaire. The video method was accepted as non-inferior to standard consent procedures if the 95% CIs of the mean difference did not fall below the prespecified margin of 1.98. Thematic analysis was conducted on brief qualitative discussions with randomly selected youth to explore the acceptability of video and PIS within consent methods.

Results

Overall, 921 participants were enrolled (54% female). The median age was 20 (IQR 18–24) years. The mean comprehension score was 25.4/30 in both arms. The mean difference in comprehension between arms was −0.02 (95% CI −0.51 to 0.47) showing non-inferiority of the intervention in comprehension of study information. Youth (N=90) described both consent methods as interactive and inclusive. Those in the video consent arm felt it was exciting and youth focused. The use of imagery to explain procedures strengthened the perceived trustworthiness of the research. However, the high volume of information in both arms reduced acceptability.

Conclusion

Comprehension of study information using an information video is non-inferior to a paper-based consent method. Using information videos for consent processes shows promise as a person-centred and context-sensitive approach to enhance the informed consent process and should be encouraged by ethics committees.
The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy
Authors: Begnel Emily R , Ojee Ednah , Adhiambo Judy , Mabele Eliza , Wandika Brenda , Ogweno Vincent , Lim Efrem S , Gantt Soren , Kinuthia John , Lehman Dara A , Slyker Jennifer , Wamalwa Dalton
Published: January 2025

Background

Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.

Methods

From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother–infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.

Results

Among 187 mother–infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).

Conclusions

CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.
Upscaling a regional telecardiology service to a nationwide coverage and beyond: the experience of the Telehealth Network of Minas Gerais
Authors: Oliveira Clara Rodrigues Alves , Paixão Gabriela Miana de Mattos , Tostes Vinicius Carvalho , Gomes Paulo Rodrigues , Mendes Mayara Santos , Paixão Maria Cristina , Marcolino Milena Soriano , Ribeiro Antonio Luiz Pinho
Published: January 2025

Cardiovascular diseases are the leading cause of death globally and in Brazil. The provision of quality healthcare faces challenges due to resource scarcity and unequal distribution, particularly affecting rural areas. Telehealth strategies have shown potential to address these challenges by improving access to specialised care. The Telehealth Network of Minas Gerais (TNMG) is a large-scale Brazilian public telehealth service, established in 2005 to provide telecardiology support to primary healthcare teams. Positive outcomes led to its expansion. Currently, the TNMG provides telecardiology support for 14 out of the 27 states and 1320 municipalities in Brazil, 72.1% of those with up to 20 000 inhabitants. Between 2006 and 2024, more than 9 million ECG reports were issued by the TNMG. Operational aspects include 24/7 availability, with elective ECG reports issued in a median of 41 min 30 s (Q1=6 min 44 s, Q3=1 h 32 min 24 s) and emergency reports in 47 s (Q1=22 s, Q3=1 min 55 s). Clinical alerts notify urgent conditions, facilitating timely interventions. Synchronous eConsults service support local primary care-based physicians, promoting collaborative care. TNMG’s telecardiology system has facilitated scientific and technological advancements, including machine learning applications for ECG interpretation and prognostic implications. International collaborations have expanded, with ongoing projects in Africa and partnerships with prestigious institutions worldwide. Future directions involve integrating artificial intelligence (AI) algorithms into the telecardiology service to improve efficiency and prioritise critical cases. AI offers promising opportunities for enhancing medical ECG reporting and sustaining the effectiveness of telehealth services.
Protease-activated receptor 1 in the pathogenesis of cystic fibrosis
Authors: Sarkar Sohinee , Han Jia-Xi , Azzopardi Kristy , Dhar Poshmaal , Saeed Muhammad A , Day Sophie , Ranganathan Sarath , Sutton Philip
Published: January 2025

Background

The most common cause of death in those with cystic fibrosis (CF) is respiratory failure due to bronchiectasis resulting from repeated cycles of respiratory infection and inflammation. Protease-activated receptor 1 (PAR1) is a cell surface receptor activated by serine proteases including neutrophil elastase, which is recognised as a potent modulator of inflammation. While PAR1 is known to play an important role in regulating inflammation, nothing is known about any potential role of this receptor in CF pathogenesis.

Methods

PAR1 (PAR1-/-) and intestinal-corrected CFTR (Cftr-/-) deficient mice were crossed to generate double knock-out (DKO) mutants lacking both PAR1 and CFTR, as well as matching sibling single mutant and wildtype (WT) littermate controls. Mice were weighed weekly to 15 weeks of age; then, the lungs and intestines were examined.

Results

Cftr-deficient mice gained body weight at a significantly slower rate than WT controls and presented with no lung inflammation, but had increased weights of their ilea and proximal colons. DKO mice (lacking both CFTR and PAR1) gained body weight at a similar rate toCftr-/-mice but only gained weight in their proximal colons. Weight gain in the ilea ofCftr-/-but not DKO mice was associated with increased ileal levels in the pro-inflammatory cytokine interleukin (IL)-6.

Conclusions

This study provides the first evidence of PAR1 contributing to the pathological effects ofCftrdeficiency in the intestine and suggests a possible effect of PAR1 on the regulation of IL-6 in CF pathogenesis.
Long-term incidence of implantable cardioverter-defibrillator therapy in patients with hypertrophic cardiomyopathy: analysis of appropriate and inappropriate interventions
Authors: Christensen Emma Basse , Vissing Christoffer Rasmus , Silajdzija Elvira , Mills Helen Lamiokor , Thune Jens Jakob , Larroudé Charlotte , Bosselmann Helle Skovmand , Philbert Berit Thornvig , Raja Anna Axelsson , Christensen Alex Hørby , Bundgaard Henning
Published: January 2025

Background

Treatment with implantable cardioverter-defibrillators (ICDs) effectively prevents sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). Identifying patients most likely to benefit from a primary prevention ICD remains challenging. We aimed to investigate the long-term incidence of ICD therapy in patients with HCM according to SCD-risk at baseline.

Methods

The study retrospectively included all patients with HCM treated with an ICD for primary or secondary prevention between 1995 and 2022 in Eastern Denmark. Medical records for each patient were evaluated. Patients were stratified into risk groups according to the European Society of Cardiology HCM Risk-SCD score.

Results

We included 208 patients (66% male) with HCM and an ICD for primary (78%) or secondary prevention (22%). During a median 10-year follow-up, 66 patients (32%) received appropriate ICD therapy (antitachycardia pacing and/or shock), while 20 (10%) received inappropriate therapy. Patients with an ICD implanted for secondary prevention were almost twice as likely to receive appropriate therapy compared with patients with an ICD implanted for primary prevention (47% vs 28%, p=0.02). The 5-year cumulative incidences of appropriate shock therapy were 17% in patients with a high HCM Risk-SCD score, 16% in patients with an intermediate-risk score and 6% in patients with a low-risk score. A high-risk score was associated with higher cumulative incidence of appropriate shock therapy (p=0.012).

Conclusion

One-third of patients with HCM treated with an ICD experienced appropriate ICD therapy. The HCM-Risk SCD score adequately distinguished between low-risk and high-risk patients among those who underwent ICD implantation. Further improvements of risk-tools are needed to identify a larger proportion of the two-thirds of patients who did not benefit from ICD implantation after 10 years of observation.
Spatio-temporal clustering of drowning mortality in Iran, from 2005 to 2022
Authors: Ziyaee Samaneh , Shahbazi Fatemeh , Hajmanouchehri Reza , Hashemi Nazari Seyed Saeed
Published: January 2025

Background

Drowning is a serious and neglected public health threat, and prevention of drowning has a multisectoral nature and requires multidimensional research. Therefore, this study aimed to evaluate the spatio-temporal variation in fatal unintentional drowning rates among the Iranian population from 2005 to 2022.

Methods

In this repeated cross-sectional study, registry data were extracted from legal medicine organisations during 2005–2022. The mortality rate per 1 million population was calculated by gender and province. The joinpoint regression model was fitted to estimate average annual percentage changes and an annual percentage change in the drowning mortality rate. We used spatial scan statistics to detect high-risk clusters of drowning deaths at the provincial level.

Results

Over 17 years 19 547 people died due to unintentional drowning. The highest yearly drowning rate was 15.58 per 1 000 000, and men had the highest rates of death (25.91) compared with women (4.98) in 2019. The overall mortality rate has decreased from 18.69 in 2005 to 12.87 in 2022. In the spatio-temporal analysis, four statistically significant high-risk clusters were detected in the north, southeast and centre of Iran.

Conclusion

The overall mortality rate in 2022 decreased compared with the 17-year period. In the spatial analysis, several high-risk clusters were identified in different locations, which highlights the importance of targeted and more comprehensive interventions. It seems that the prevention of drowning requires the effective participation of all responsible organisations and risk reduction plans in the field of environmental and individual risk factors.
When the patient can't walk away
Authors: Jesudason Edwin
Published: January 2025

When the clinician and patient are unable to reconcile differences over treatment, does this mean the latter lacks capacity to decide in such matters? Wellesleyet alanalyse the legal judgements in the case of Ms Sudiksha Thirumalesh where, on the particulars, the Court of Protection answered yes, only for the Court of Appeal to disagree. The authors highlight concerns about using isolated false belief as an indicator of incapacity and advise that such matters may be better resolved by greater discussion of the benefits and burdens of treatment, alongside consideration of their costs. Here, I suggest that a disability perspective is also helpful to such cases, recognising that this was a disagreement from which the patient couldn't walk away. Disability means that particular care is required when considering the burdens and benefits of treatment as these may vary widely in the eye of the beholder. Second, the costs of litigation are particularly high when a disabled person, with life-limiting illness, is left feeling they are using precious time and energy arguing for their existence. Third, any such legal judgments ought to make clear what reasonable adjustments have been offered to include the disabled person in proceedings. Fourth, and relatedly, such disputes should be attentive to the significant risk of epistemic injustice, where disabled patients find themselves less believed, in part because the ‘able-bodied’ have not shared their experiences. Together, these considerations (i) add to the call made by Wellesleyet alfor better discussions and (ii) suggest that early involvement of Rehabilitation Medicine, with expertise in disability and related ethics, could offer an important means to reduce the need for such litigation in the future.
Real-world evaluation of the accuracy of the Viz.AI automated intracranial hemorrhage volume calculation tool
Authors: Odland Ian , Liu Kayla J , Wu Dylan , Yaeger Kurt A , Ascanio Luis C , Smith Colton , Schuldt Braxton Riley , Young Tirone , Rossitto Christina P , Downes Margaret , Vasan Vikram , Ali Muhammad , Hardigan Trevor , Shigematsu Tomoyoshi , Fifi Johanna T , Mocco J , Kellner Christopher Paul
Published: January 2025

Background

Appropriate management of spontaneous intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) requires rapid, accurate volume estimation. Viz.AI has developed an artificial intelligence (AI)-powered ICH calculation tool that may improve existing methods.

Methods

Adult patients presenting to a large healthcare system between December 2015 and December 2021 with spontaneous ICH greater than 10mL and within 72 hours since ictus were analyzed for hematoma volume. mABC/2 (modified ABC/2) was measured by a board-certified neurosurgeon. Semi-autonomous segmentation (SAS) was performed by a trained medical student on 3D Slicer, adjudicated by a board-certified neurosurgeon and used as a surrogate ground-truth volume.

Results

139 CTs met inclusion criteria. Mean ICH volume via ground-truth SAS was 47.69±27.19 mL. Mean ICH volume difference between SAS and AI and SAS and mABC/2 was 4.77±4.06 mL and 8.36±9.48 mL, respectively (p<0.01). Bland-Altman plots yielded AI and SAS limits of agreement between −4.45 and 13.18 mL, and mABC/2 and SAS limits of agreement between −21.35 and 27.02 mL. The average absolute difference between IVH volume yielded by SAS and AI was 3.26±3.55 mL. Bland-Altman plots yielded IVH volume limits of agreement between −7.48 mLand 10.47 mL. AI was 94.6% sensitive and 94.0% specific for detecting IVH in the presence of ICH. The average time-to-volume for SAS and AI was 424±208 and 151±49.7 s (P<0.01), respectively.

Conclusion

Viz.AI is more accurate than mABC/2, and more rapid than SAS. The combination of speed and accuracy makes Viz.AI viable for clinical decision-making and clinical trial use.
Introducing the Caliber-Flow Status Scale (CFSS): a novel tool for assessing covered cortical branch status after flow diverter treatment of middle cerebral artery aneurysms
Authors: Nawka Marie Teresa , Zainal Isa Azzaki , Manceau Pierre-François , Soize Sebastien , Pierot Laurent
Published: January 2025

Background

This study assessed caliber and flow changes of covered cortical middle cerebral artery (MCA) branches using the new Caliber-Flow Status Scale (CFSS), postoperative diffusion-weighted imaging (DWI) lesions, and clinical outcome following flow diverter (FD) treatment of MCA aneurysms.

Methods

This single-center retrospective study collected data from patients treated with FD between January 2016 and March 2024, including patient characteristics, aneurysm features, postoperative DWI lesions, and clinical outcomes. Vessel status was assessed using CFSS: 1a (normal caliber and flow), 1b (normal caliber, reduced flow), 2a (reduced caliber, normal flow), 2b (reduced caliber and flow), and 3 (occlusion).

Results

Thirty-nine patients with 41 aneurysms with 63 covered MCA branches were included. Immediately after FD deployment, 63.5% of covered branches retained normal caliber and flow (CFSS 1a) while the remaining branches with compromised caliber and flow (CFSS >1a) showed significant improvement following tirofiban administration. Intraoperative thromboembolic complications led to occlusion in three branches, all restored after tirofiban without clinical symptoms (P=0.003). At 6 months, 79% of covered branches showed normal flow with or without caliber reduction (CFSS 1a/2a). DWI lesions showed no significant correlation with caliber and flow changes and clinical symptoms.

Conclusions

FD treatment for MCA aneurysms leads to significant but primarily asymptomatic CFSS changes in covered cortical branches within the first 6 months. Intra-arterial tirofiban effectively improves vessel status in branches with higher CFSS (>1a). CFSS is valuable for tracking these changes and underscores the importance of long-term follow-up.
Autoimmune encephalitis: recovery, residual symptoms and predictors of long-term sequelae
Authors: Thakolwiboon Smathorn , Gilligan Michael , Orozco Emma , Britton Jeffrey W , Dubey Divyanshu , Flanagan Eoin P , Lopez-Chiriboga A Sebastian , Smith Kelsey , Valencia-Sanchez Cristina , Zalewski Nicholas L , Zekeridou Anastasia , Pittock Sean J , McKeon Andrew
Published: January 2025

Background

Data regarding long-term recovery from autoimmune encephalitis (AE) remain limited.

Methods

This retrospective observational study investigated outcomes in 182 patients who met the 2016 criteria for definite AE. Recovery data were available in 172 patients. Follow-up data at ≥24 months post-attack were available for 119. Recovery trajectory, residual symptoms, outcome predictors and causes of post-AE death were assessed.

Results

Of 172 patients, 138 (80%) achieved good recovery (modified Rankin Scale (mRS) ≤2) with a median recovery time of 4 months (95% CI: 2 to 6 months). Recovery varied by associated neural antibody, with the best recovery observed in leucine-rich glioma-inactivated 1 (97% good recovery, median recovery time 0 (0 to 2) months). Paraneoplastic AE (p=0.007), severe attacks (eg, mRS ≥4 at attack, p=0.007) and cerebrospinal fluid pleocytosis (p=0.005) were associated with a lower likelihood of good recovery, while seizure presentation (p=0.026) was associated with better recovery. Despite good recovery, several residual symptoms persisted ≥24 months post-AE, including cognitive deficits (53%), seizures (26%), depression (23%), sleep disorders (25%), brainstem/cerebellar symptoms (13%), other movement disorders (14%) and autonomic symptoms (12%). Predictors of long-term sequelae included disabling cognitive deficit at onset and delayed immunotherapy for post AE-dementia, and medial temporal atrophy as well as escalation to cyclophosphamide therapy for both drug-resistant epilepsy and chronic depression. Of 182 patients, 20 (11%) died; the most common cause of death was progression of AE (6/20 (30%)).

Conclusion

While the majority of patients achieved functional independence after AE, several residual symptoms persisted. Several clinical and paraclinical features were associated with long-term sequelae.
Impact of quality of life on overall work productivity impairment and activity impairment of patients with systemic lupus erythematosus: the PEONY study
Authors: Tanaka Yoshiya , Miyazaki Yusuke , Hirata Shintaro , Kusaka Katsuhide , Kosaka Shunpei , Nakatsuka Keisuke , Saito Kazuyoshi , Iwata Shigeru , Yamaguchi Yoshiyuki , Yabe-Wada Toshiki , Fujiwara Masakazu , Arita Yoshifumi , Hoshino Mitsuru , Ozaki Naoko , Yamaoka Kunihiro , Nakayamada Shingo
Published: January 2025

Objectives

Even in a lupus low disease activity state (LLDAS), many patients with SLE continue to face residual symptoms and disease burden. We aimed to evaluate the quality of life, activity impairment and overall work productivity impairment among patients in LLDAS. Residual disease burden was also evaluated for patients in LLDAS.

Methods

This prospective, cross-sectional study enrolled Japanese outpatients with SLE. Patients completed patient-reported outcome (PRO) questionnaires, including LupusPRO, Work Productivity and Activity Impairment-Lupus, EQ-5D-5L and Health Assessment Questionnaire-Disability Index. Disease activity and organ damage were investigator-assessed. The primary objective was to assess the residual burden in patients in LLDAS and to investigate the association of LupusPRO domains with activity impairment using multivariate regression analysis. Other objectives were to investigate the relationship between overall work productivity impairment or activity impairment and other PRO or disease activity measures.

Results

The analysis set included 205 patients; 93.2% were female, mean (SD) age at index date was 52.5 (14.7) years, mean (SD) duration of morbidity was 167.2 (125.2) months and 164 were in LLDAS. The mean per cent overall work productivity impairment was 22.8% and mean per cent activity impairment was 30.0% for the LLDAS group. Among patients in LLDAS, overall work productivity impairment was significantly associated with the LupusPRO domains Desires-Goals, Body Image and Pain Vitality, and activity impairment was significantly associated with the LupusPRO domains Pain Vitality, Physical Health and Lupus Symptoms.

Conclusions

Patients with SLE in LLDAS still experience symptoms associated with activity impairment. Work productivity also showed impairments. Improving their quality of life and achieving social remission will require ongoing monitoring of PROs and tailoring treatments to optimise these outcomes.

Trial registration number

jRCT1030210647.
Evaluating the utility of large language models in generating search strings for systematic reviews in anesthesiology: a comparative analysis of top-ranked journals
Authors: De Cassai Alessandro , Dost Burhan , Karapinar Yunus Emre , Beldagli Müzeyyen , Yalin Mirac Selcen Ozkal , Turunc Esra , Turan Engin Ihsan , Sella Nicolò
Published: January 2025

Background

This study evaluated the effectiveness of large language models (LLMs), specifically ChatGPT 4o and a custom-designed model, Meta-Analysis Librarian, in generating accurate search strings for systematic reviews (SRs) in the field of anesthesiology.

Methods

We selected 85 SRs from the top 10 anesthesiology journals, according to Web of Science rankings, and extracted reference lists as benchmarks. Using study titles as input, we generated four search strings per SR: three with ChatGPT 4o using general prompts and one with the Meta-Analysis Librarian model, which follows a structured, Population, Intervention, Comparator, Outcome-based approach aligned with Cochrane Handbook standards. Each search string was used to query PubMed, and the retrieved results were compared with the PubMed retrieved studies from the original search string in each SR to assess retrieval accuracy. Statistical analysis compared the performance of each model.

Results

Original search strings demonstrated superior performance with a 65% (IQR: 43%–81%) retrieval rate, which was statistically different from both LLM groups in PubMed retrieved studies (p=0.001). The Meta-Analysis Librarian achieved a superior median retrieval rate to ChatGPT 4o (median, (IQR); 24% (13%–38%) vs 6% (0%–14%), respectively).

Conclusion

The findings of this study highlight the significant advantage of using original search strings over LLM-generated search strings in PubMed retrieval studies. The Meta-Analysis Librarian demonstrated notable superiority in retrieval performance compared with ChatGPT 4o. Further research is needed to assess the broader applicability of LLM-generated search strings, especially across multiple databases.
Effects of dietary fiber on fecal microbiota of grower–finisher pig offspring from parents with divergent estimated breeding value for feed conversion ratio
Authors: Azevedo P. , Jin S. , Wu Y. , Derakhshani H. , Xu H. , Lei H. , Verschuren L. , Yang C.
Published: January 2025

The study investigated how dietary fiber influences fecal microbiota in grower–finisher pigs, particularly in those genetically selected for feed efficiency based on estimated breeding value for feed conversion ratio (EBV_FCR). Pigs were fed either a high-fiber (HF, 5.62% crude fiber, dry matter basis, DM) or low-fiber (2.46% crude fiber, DM basis) diet throughout three feeding phases (25–50, 50–75, and 75–100 kg) over 70 days. Fresh fecal samples were manually collected at various stages of pig growth and analyzed using 16S rRNA gene sequencing. The results showed that Firmicutes and Bacteroidetes were the dominant phyla in pigs, irrespective of genetic background or diet. However, bacterial families and genera were differentially influenced by genetic factors (feed efficiency selection) and dietary fiber content. High-efficiency pigs had higher abundances of Desulfovibrionaceae, while low-efficiency pigs exhibited greater levels of Campylobacter. Overall, increased dietary fiber enhanced microbial richness and evenness, underscoring its role in shaping the pig gut microbiota. Butyrate-producing bacteria, including those from Ruminococcus, Lachnospira_1, and Fibrobacter_1, were significantly higher in pigs fed HF diets. The study highlighted the complex interactions between genetics, diet, and age in modulating microbiota composition.
Relaxation dynamics of a mixed ferrimagnetic Ising system with random anisotropy
Authors: Karaaslan Yenal , Gülpınar Gül
Published: January 2025

The relaxation dynamics of a mixed spin-1/2 and spin-1 ferrimagnetic Ising system with random anisotropy has been investigated using Onsager’s theory of irreversible thermodynamics. The magnetic Gibbs energy production, arising due to irreversible processes, is computed using the equilibrium mean-field Gibbs energy, based on the variational principle and the Gibbs–Bogoliubov inequality. In the framework of linear response theory, the time derivatives of the sublattice magnetizations are treated as fluxes conjugate to their corresponding generalized forces. Two relaxation times are computed, and their dependence on temperature and crystal field variances is examined near phase transition points for four distinct topologies, each corresponding to different phase diagrams. These phase diagrams emerge from random anisotropy drawn from a bimodal probability distribution:

$$ P(\Delta _{i}) = \frac{1}{2}\left[ \delta (\Delta _{i} - \Delta (1+\alpha )) + \delta (\Delta _{i} - \Delta (1-\alpha ))\right] . $$

P

(

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2

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Δ

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One of the relaxation times, denoted as

$$\tau _1$$

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, increases rapidly and diverges near the critical and tricritical points separating the ferrimagnetic and paramagnetic phases. For

$$\alpha \ge 0$$

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, critical slowing down, characterized by the divergence of

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at which re-entrant phenomena occur, due to the competing interactions in the random system.
Uncertainty Handling and Decision Optimization of Fuzzy Logic Algorithm in E-commerce Sales Forecasting
Authors: Liao Wenjing
Published: January 2025

The daily responsibilities of e-commerce enterprises, such as operational preparation and market assessment, are greatly impacted by sales forecasting. Since the market is constantly shifting, e-commerce enterprises must immediately solve the important difficulty of effectively forecasting sales. Traditional forecasting techniques also have limitations. This study offers a novel fuzzy logic-based method for improving sales forecasting’s handling of uncertainty. This study gathers a wide range of data from multiple sources, such as transaction logs, analytics of consumer behavior, and market trends. To guarantee its quality and dependability, the gathered data are pre-processed by using min–max normalization and glowworm swarm optimization (GSO) was employed for feature selection. This research develops a fuzzy logic multi-criteria (FLMC) algorithm that takes into account a number of influencing elements, such as customer behavior, customer demographics, market trends, website traffic and engagement, product availability, and seasonal fluctuations, by leveraging fuzzy logic’s ability to simulate imprecision and ambiguity. The suggested algorithm uses a multi-criteria decision-making process to assess and evaluate these variables, producing useful information that helps firms maximize their marketing, pricing, and inventory control initiatives. The efficacy of the FLMC algorithm in enhancing forecasting accuracy is demonstrated empirically. The findings demonstrate how the algorithm could be used to mitigate the unpredictability found in e-commerce settings, promoting better decision-making and increasing operational effectiveness.
The Feasibility and Future of Middle-state Hedging
Authors: KUIK Cheng-Chwee , JAMIL Nur Shahadah
Published: January 2025

Hedging, similar to all forms of state alignment behaviour and foreign policy choice, is dynamic and adaptive, rather than static. Hedging emerges and evolves under certain circumstances; and it will end when those conditions diminish. By examining Malaysia’s China policy, this article identifies the factors at the structural, bilateral and domestic levels that collectively determine the feasibility and future of middle-state hedging in contemporary time.