bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on mood monitoring and intervention for anxiety disorder patients based on deep learning wearable devices
Authors: Gu Xiao , Hu Xuedan
Published: December 2024

Background

Anxiety disorders are common mental health issues that have a significant effect on people's quality of life. Conventional techniques for tracking emotional states frequently lack the accuracy and sensitivity needed for successful intervention.

Objectives

This project aims to create a sophisticated monitoring system that uses deep learning methods to evaluate physiological data from wearables, emphasizing heart rate variability (HRV), to forecast patients’ emotional states who suffer from anxiety disorders.

Methods

Wearable equipment monitors physiological characteristics, which we used to obtain patient HRV data. We processed the data using a Bidirectional Long-Short-Term Memory (Bi-LSTM) network to evaluate time-dependent variables and enhance the precision of emotional state predictions. The physiological signals were used to teach the model to recognize different emotional states, such as neutral, happy, and sad.

Results

Outperforming conventional machine learning models, the Bi-LSTM model showed a high accuracy rate of up to 97% in predicting emotional states. The findings suggest that ongoing HRV monitoring can accurately track shifts in emotional states and enable prompt responses.

Conclusion

This work emphasizes the possibility of real-time emotional state monitoring in patients with anxiety disorders with wearable technology and deep learning. The results point to the potential benefits of this strategy for improving emotional regulation and improving anxiety sufferers’ quality of life, opening new avenues for investigation and advancement in the field of mental health therapies.
Accelerated initiation of antiretroviral therapy by virtual health in service members newly diagnosed with HIV infection
Authors: Openshaw Anatole , Okulicz Jason , Yabes Joseph
Published: December 2024

Objectives

Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis.

Methods

Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher’s exact or Chi squared tests.

Results

Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15 days vs 25 days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96 days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05).

Conclusions

The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.
Preventing the Onset of Depressive Disorders: State of the Art and Future Directions
Authors: Cuijpers Pim
Published: December 2024

The prevention of depressive disorders may be an important way to reduce the disease burden. All three types of prevention (universal, selective, and indicated) have potential but also have important limitations. Increasing evidence suggests that universal prevention, aimed at a population, may have no impact on the incidence of depression. Selective prevention, aimed at high-risk groups, is probably effective but may be mostly helpful for those who already have problems. Indicated prevention, aimed at people with depressive symptoms but no disorder, is also probably effective, but uptake is very low. Innovation in the field is very much needed, including well-powered and longitudinal trials aimed at important determinants, such as poor parenting, interparental conflict, and family instability, but also inequalities, social status, and migration.
Relationship Among Upper, Middle, and Lower Thoracic Vertebrae and Upper and Lower Lumbar Vertebrae in Dancers During Arabesque
Authors: Nagashima Moe , Takabayashi Tomoya , Kikumoto Takanori , Kubo Masayoshi
Published: December 2024

Background: Low back pain is a common disorder with high severity among dancers. Since Arabesque used in dance is more likely to cause lower back pain, it is important to prevent the onset of lower back pain during arabesque. Previous studies are investigating motion of the lumbar vertebrae during various tasks in targeting dancers. However, since the thoracic and lumbar vertebrae are connected, it is necessary to assess including motion of the thoracic spine. The purpose of this study was to clarify the relationship between the upper, middle, and lower thoracic vertebrae and the upper and lower lumbar vertebrae in dancers during arabesque. Methods: The participants were 13 university students with dance experience, and they performed double-standing and arabesque tasks. During the tasks, the positions of reflective markers attached to the spine (upper, middle, and lower thoracic vertebrae, and upper and lower lumbar vertebrae) were measured using a three-dimensional motion analysis system. The amount of change in the spinal angle of during standing and arabesque were calculated based on positions of spinal markers, and the relationship between the amount of change each spinal region (6 pairs) were analyzed by using Pearson’s correlation test. Results: A significant negative correlation was observed between the amount of change in the angle of the middle thoracic vertebrae and the amount of change in the upper lumbar vertebrae ( r = −.66, P = .013), which means that as the movement of the middle thoracic vertebrae increases, the movement of the upper lumbar vertebrae decreases. No significant correlation was observed between other spinal angles ( P > .05). Conclusion: The results of this study suggest that increasing mobility in the middle thoracic vertebrae may be able to prevent hyperextension of the upper lumbar vertebrae, leading to the prevention of upper back pain in dancers.
Mitigation of hydroelastic responses of a very large floating structure by flexible porous barriers
Authors: Singla Sofia , Martha Subash Chandra , Sahoo Trilochan
Published: December 2024

The role of a vertical flexible porous barrier of two different configurations, namely (i) surface-piercing barrier (SPB) and (ii) bottom-standing barrier (BSB) in the mitigation of hyroelastic responses of a very large floating structure (VLFS) is analysed. Both the flexible barrier and the floating plate are modelled using Euler-Bernoulli beam equation under the assumption of small amplitude structural response. The solution of the associated mathematical problem is obtained using the eigenfunction expansion method. Various results illustrating the effect of the barrier length, porous-effect parameter, and the barrier-VLFS spacing on various hydroelastic responses of the VLFS are presented. Moreover, results on barrier deflection and overturning moments of the flexible porous barrier for various structural parameters are presented. Energy identity is derived using Green’s identity and used to check the accuracy of the computational results. The study reveals that for suitable values of the structural flexibility, porosity and barrier configurations, wave-induced structural responses on the VLFS and barriers can be reduced significantly. Moreover, the study depicts that the presence of flexible porous barriers can significantly reduce the wave reflection and wave forces exerted on the floating elastic plate.
Non-holonomic constraints-based adaptive trajectory tracking controller for a multi-joint snake robot
Authors: Hao Shuang , Chen Jiyao , He Yupeng , Wang Zheng , Li Dongfang
Published: December 2024

The multi-joint snake robot is poised to become a crucial asset for investigation, surveillance, and attack in national defense and military applications. This paper addresses the trajectory tracking challenge of a multi-joint snake robot characterized by high redundancy and multiple degrees of freedom in the plane. We propose an adaptive trajectory tracking controller that accounts for non-holonomic constraints. This controller estimates unknown environmental parameters, effectively mitigating the negative impacts of uncertain and time-varying conditions during robot movement, thereby ensuring stability. A suitable Lyapunov function is identified to confirm the controller’s stability. The trajectory tracking performance of the robot is thoroughly analyzed through simulations and experiments, demonstrating the effectiveness of the proposed adaptive controller.
A non-inferiority, phase III trial of gemcitabine plus capecitabine versus gemcitabine plus carboplatin as first-line therapy and tumor-infiltrating lymphocytes as a prognostic biomarker in patients with advanced triple-negative breast cancer
Authors: Liu Xiaodong , Zhao Weipeng , Jia Yongsheng , Shi Yehui , Wang Xu , Li Shufen , Zhang Pin , Wang Chen , Hao Chunfang , Tong Zhongsheng
Published: December 2024

Background:

Gemcitabine plus capecitabine (GX) shows survival benefit and manageable safety in patients with advanced triple-negative breast cancer (TNBC) but there is a paucity of phase III trial evidence. We aimed to compare the efficacy and safety of GX with gemcitabine plus carboplatin (GC) as first-line treatment for patients with advanced TNBC and validate the prognostic value of tumor-infiltrating lymphocytes (TILs).

Methods:

Patients with advanced TNBC were randomly assigned 1:1 to receive gemcitabine (1000 mg/m2) on days 1 and 8 plus oral capecitabine (1000 mg/m2 twice a day) on days 1–14, or gemcitabine (1000 mg/m2) on days 1 and 8 plus carboplatin area under curve 2 on days 1 and 8. The primary endpoint was progression-free survival (PFS). TILs were analyzed by immunohistochemistry. The margin used to establish non-inferiority was 1.2.

Results:

In all, 187 patients were randomly assigned, with 93 in GX and 94 in GC. Median PFS was 6.1 months in the GX arm compared with 6.3 months in the GC arm. The hazard ratio for PFS was 1.148, and a 95% CI was 0.856–1.539, exceeding the non-inferiority margin of 1.2. The median overall survival (OS) was 21.0 months in the GX arm compared with 21.5 months in the GC arm. The safety profile for the GX regimen was superior to the GC regimen, especially regarding hematological toxicity. Patients with high CD8+ TILs had significantly longer PFS and OS compared with patients with low CD8+ TILs. In the high CD8+ TIL group, the GC arm had prolonged PFS and OS compared with the GX arm.

Conclusion:

The trial did not meet the prespecified criteria for the primary endpoint of PFS in patients with advanced TNBC. Moreover, the GC regimen showed better efficacy compared with the GX regimen in patients with high CD8+ TILs. However, the GX regimen should be considered in patients who cannot tolerate hematological toxicity.

Trial registration:

ClinicalTrials.gov identifier: NCT02207335.
The Way You Do It Like You Do: Moon Jae-in’s Mediation in the U.S.–DPRK Crisis (2017–2018)
Authors: Schiff Amira
Published: December 2024

This article examines South Korean President Moon Jae-in’s mediation during the 2017–2018 U.S.–DPRK (Democratic People’s Republic of Korea) crisis, emphasising the importance of a multidimensional approach to power in international crisis mediation. This study argues that both strategic strengths—such as resource-based powers—and tactical strengths, including personal skills, are critical for successful mediation. Moon skilfully utilised South Korea’s relational, expert and reward powers while employing innovative tactics like the ‘borrowing tactic’, where he drew on South Korea’s international alliances and connections to create a link between the DPRK’s flexibility and its capacity to secure political concessions. His mediation helped de-escalate tensions and facilitated dialogue, leading to the first U.S.–DPRK summit. This analysis highlights the intricate interplay between a mediator’s resource-based powers and their tactical behaviour in crisis scenarios, underscoring how both elements are crucial for shaping preventive diplomacy efforts and their outcomes in high-stakes situations. Ultimately, this study demonstrates that it is not only what a mediator has at their disposal that matters, but also—equally importantly—how they use it.
Dual-targeting CAR T cells for B-cell acute lymphoblastic leukemia and B-cell non-Hodgkin lymphoma
Authors: de Oliveira Canedo Gustavo , Roddie Claire , Amrolia Persis J.
Published: December 2024

Relapse after CD19-directed chimeric antigen receptor (CAR) T-cell therapy remains a major challenge in B-cell acute lymphoblastic leukemia (ALL) and B-cell non-Hodgkin lymphoma (B-NHL). One of the main strategies to avoid CD19-negative relapse has been the development of dual CAR T cells targeting CD19 and an additional target, such as CD22 or CD20. Different methods have been used to achieve this, including coadministration of 2 products targeting 1 single antigen, cotransduction of autologous T cells, use of a bicistronic vector, or the development of bivalent CARs. Phase 1 and 2 trials across all manufacturing strategies have shown this to be a safe approach with equivalent remission rates and initial product expansion. CAR T-cell persistence remains a significant issue, with the majority of relapses being antigen-positive after CAR T-cell infusion. Further, despite adding a second antigen, antigen-negative relapses have not yet been eliminated. This review summarizes the state of the art with dual-targeting CAR T cells for B-cell ALL and B-NHL, the challenges encountered, and possible next steps to overcome them.
Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat?
Authors: Poddighe Diego , Van Hollebeke Marine , Rodrigues Antenor , Hermans Greet , Testelmans Dries , Kalkanis Alexandros , Clerckx Beatrix , Gayan-Ramirez Ghislaine , Gosselink Rik , Langer Daniel
Published: December 2024

Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing, phenotyping and assessing treatment efficacy in these patients. This review outlines established methods, such as measuring respiratory pressures, and explores novel techniques, including respiratory muscle neurophysiology assessments using electromyography and imaging with ultrasound.

Additionally, we review various treatment strategies designed to support and alleviate the burden on overworked respiratory muscles or to enhance their capacity through training interventions. These strategies range from invasive and noninvasive mechanical ventilation approaches to specialised respiratory muscle training programmes. By summarising both established techniques and recent methodological advancements, this review aims to provide a comprehensive overview of the tools available in clinical practice for evaluating and treating respiratory muscle dysfunction. Our goal is to present a clear understanding of the current capabilities and limitations of these diagnostic and therapeutic approaches. Integrating advanced diagnostic methods and innovative treatment strategies should help improve patient management and outcomes. This comprehensive review serves as a resource for clinicians, equipping them with the necessary knowledge to effectively diagnose and treat respiratory muscle dysfunction in both acute and chronic respiratory failure scenarios.
A Systematic Review Investigating the Impact of Dual Use of E-Cigarettes and Conventional Cigarettes on Smoking Cessation
Authors: Hamoud Josef , Hanewinkel Reiner , Andreas Stefan , Ammous Omar , Saalfrank Marc , Sussman Steve , Unger Jennifer B. , Pisinger Charlotta , Mathes Tim
Published: December 2024

Background

Dual use (DU) of conventional cigarettes (CC) and e-cigarettes (EC) has emerged as a common pattern among youth and adult populations. This review aims to investigate whether dual use can promote smoking cessation.

Methods

A systematic search was conducted in accordance with PRISMA guidelines, and all longitudinal studies reporting transitions between DU, exclusive e-cigarette use and exclusive conventional cigarette use were included. Two independent reviewers screened and read all records. Use status transitions among dual users were compared to transitions among exclusive e-cigarette users and exclusive CC smokers.

Results

Forty-six records (sixteen original studies) were identified. Of sixteen included studies, eight could be pooled for meta-analysis. The studies showed great heterogeneity, and many presented moderate to high risks of bias. Most dual users who changed state transitioned to cigarette smoking. Baseline dual users were less likely to report a transition into complete abstinence compared to exclusive CC smokers and exclusive EC users. About one-fifth of dual users remained in the same use status after >16–24 months, exposing them to DU for a prolonged time. After >24–48 months, 8% of DU maintained DU.

Conclusion

Current evidence suggests that DU is not a first step toward smoking cessation, with most DUs continuing cigarette consumption either through persistent DU or exclusive CC smoking. Relatively fewer dual users transitioned into complete nicotine abstinence compared to exclusive CC and exclusive EC users. The concerns raised about limitations of current evidence highlight the need for more research focussed on use status transitions among dual users.
Unmet needs in patients with COPD in Germany: a retrospective, cross-sectional study
Authors: Herth Felix J.F. , Vogelmeier Claus F. , Trudzinski Franziska C. , Watz Henrik , Skowasch Dirk , Beeh Kai-Michael , Compton Chris , Mohan Tharishini , Richter Hartmut , Claussen Jing , Bartel Sabine
Published: December 2024

Background

Earlier diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly preventing exacerbations, are key to slowing disease progression and reducing mortality. This study focused on the identification of patients in Germany with unstable COPD due to suboptimal treatments.

Methods

The IQVIA™ LRx database, capturing 80% of Statutory Health Insurance prescriptions was used to identify patients with COPD using a machine learning (ML) model. Patients with unstable COPD were identified through high prescriptions of oral corticosteroid (OCS) and/or rescue inhalers during the period from April 2022 to March 2023.

Results

The ML model identified around 2.6 million treated patients with COPD, with 77% precision. The mean age was 71 years, 48% were female and 86% were aged ≥60 years. About 14% patients (n=363k) exhibited unstable COPD due to high OCS prescriptions, while 10% patients (n=256k) had high rescue inhaler prescriptions. Among those with high OCS and high rescue inhaler prescriptions, respectively, 43% and 38% were on dual therapy, 17% and 21% were on single inhaler triple therapy, 14% and 16% were on multiple inhaler triple therapy, 11% and 9% were on monotherapy and 15% and 17% had no maintenance therapy.

Conclusions

A substantial portion of unstable COPD patients were either on suboptimal maintenance therapy (monotherapy or inhaled corticosteroid-based dual therapy) or not receiving any maintenance therapy. The study highlights a substantial need in Germany for improved maintenance therapy, which could reduce disease burden, improve disease stability and reduce reliance on OCS and rescue therapies, thereby minimising side effects.
Research on Force-Saving Mechanism of Cutting Tool with Variable Curvature Directrix Rake Face Configuration
Authors: Xie Feng , Wei Huawei , Chen Xiaofeng , Lei Chao
Published: December 2024

Optimizing the geometric configuration of the tool cutting surface, reducing the resistance in the cutting process and energy consumption, are always a concern. Through the method of bionic design, the directrix function of the longitudinal section of the beaver tooth rake face is extracted, and its variable curvature characteristics are analyzed. Based on this, a turning tool with variable curvature directrix configuration rake face is designed. The cutting force experiment and machining surface quality analysis experiment were carried out with the designed tool and the linear directrix configuration rake face tool respectively. The measured data of the variable curvature directrix configuration rake face tool is better than the linear directrix configuration rake face tool and its drag reduction performance of the tool is verified by experiments. Through the analysis of the working rake angle and shear angle of the tool with variable curvature directrix configuration rake face, the relationship between the parameters of the variable curvature directrix function and the working rake angle, and shear angle has been obtained. By the method of finite element simulation analysis, the stress field in the cutting zone of two different configuration tools has been analyzed. It has been found that the tool with variable curvature directrix rake face has a ‘bending moment’ effect on the tool-chip interface due to its curved surface configuration, and a ‘prying’ effect at the tool tip. These two effects promote the separation of chips from the workpiece and make the cutting process more force-saving. The research of this paper will have reference significance for the design and application of the curved surface configuration rake face tool.
Is testicular microlithiasis associated with decreased semen parameters? a systematic review
Authors: Wilson Hannah G. , Birch Brian R. , Rees Rowland W.
Published: December 2024

Background

Testicular microlithiasis (TM) is characterised by microcalcifications in the testes and has been associated with infertility. This has led to studies of semen analysis in men with the condition. This systematic review aimed to compare semen parameters in men with TM and those without. Men with classic TM (≥ 5 microcalcifications per sonographic image) were also compared to those with limited TM (< 5 microcalcifications per sonographic image). Additionally, testicular volume and hormone levels were analysed as secondary outcomes. This review was carried out according to PRISMA guidelines and registered on PROSPERO. The quality of included studies was assessed using the Newcastle–Ottawa Scale.

Results

Embase, MEDLINE, World of Science and Scopus were searched. Abstracts were screened against inclusion/exclusion criteria by two independent reviewers. Eligible studies included data on semen parameters in men with TM where semen analysis was done according to World Health Organisation recommendations. Studies with populations consisting of men with testicular cancer were excluded. After searching the databases, 137 papers were found and 10 studies involving 611 men with TM were included in the analysis. In the studies that compared sperm concentration in men with TM to controls, six (100%) found lower sperm concentration in the TM group. Six studies compared sperm motility, of which 4 (66.7%) showed lower motility in the TM group compared to controls. Five studies compared sperm morphology, with three (60%) finding a lower percentage of normal morphology in the TM group compared to controls. Six studies compared classic TM with limited TM. All six (100%) found a lower sperm concentration in the classic TM group compared to the limited TM group. Results also suggested that more extensive disease is associated with poorer sperm concentration.

Conclusions

This review suggests that TM is associated with decreased semen parameters, particularly sperm concentration. However, clinical outcomes should be investigated by studying pregnancy rates in males with TM. Future research that controls for confounding variables, involves larger sample sizes, and utilises advanced sperm function tests is also advised. Further research is important for establishing clinical guidance and suggestions for fertility follow-up in men with TM.
Retrograde aortic dissection encountered amidst nephrectomy for renal cell carcinoma with IVC thrombus – a case report
Authors: Gali Kasi Viswanath , Rai Guruprasad D. , Choudhary Anupam , Surag K. R. , Kamath Ganesh S. , Chawla Arun , Gunashekar Vijay
Published: December 2024

Background

Management of RCC with IVC thrombus can be surgically challenging, particularly when the tumour thrombus extends above the diaphragm. Cardiopulmonary bypass is often employed to aid surgical removal of the tumour in such cases.

Case presentation

We detail an instance of 67-year-old Male patient suffering from RCC with IVC thrombus, with the tumour thrombus extending into the right atrium, who developed on-table retrograde type A aortic dissection amidst the surgical procedure, thereby precluding cardiopulmonary bypass. Transfixation of the renal arterial stump resulted in disappearance of the dissection flap.

Conclusions

Operating surgeons should be mindful of the potential for retrograde aortic dissection during Radical Nephrectomy and its implications intraoperatively.
Hospital administrators as forgotten partners in rare disease care: a call to action by the international hospital federation’s global rare pediatric disease network
Authors: Stoesz Andrea , Joers Barbara , Gaviglio Amy
Published: December 2024

Background

The global public health burden of rare diseases has become an increasingly discussed topic, and its societal impact cannot be overstated. While it may seem counterintuitive to discuss broad healthcare and public health impact in the context of rarity, taken together, over 400 million people worldwide are estimated to live with a rare disease. Over half of people living with a rare disease are children.

Providing robust and comprehensive services to the rare disease community requires coordinated efforts of numerous experts and partners. Globally, there are many initiatives focused on improving the lives of people living with a rare disease. Most of these networks and organizations are region or country based and have historically centered on three focal areas: research; provision of education, support, and/or information; and direct clinical care.

While all these efforts recognize the importance of a coordinated system of partners across a spectrum of disciplines to improve care for the rare disease community, one group has been largely untapped: hospital administrators and leadership. To address this gap, the International Hospital Federation (IHF) convened the Global Rare Pediatric Disease Network (GRPDN), composed of hospital leaders from around the world. To assess how hospital leadership can assist in providing the infrastructure for improving care for patients and families living with a rare disease, the GRPDN created a survey to gather feedback on hospital administrators’ perspectives on needed efforts to improve global rare disease care.

Results

The survey identified five themes: increased public awareness of rare diseases and support for families, diagnostic management and treatment guidelines, lifelong, multidisciplinary care, data and research, and funding.

Conclusions

Until recently, hospital leadership has been an untapped partner in addressing challenges faced by rare disease patients, and they are uniquely positioned to bridge existing gaps. The GRPDN will continue to focus on identifying practical strategies that hospital leaders—regardless of resource level—can implement to improve care for children living with a rare disease.
Effects of deliberate practice and structured feedback in psychotherapy training (DeeP): a study protocol of a randomized-control-trial
Authors: Berning Anna , Sell Stefan , Andersen Wiebke , Strauß Bernhard , Taubner Svenja
Published: December 2024

Background

Psychotherapeutic competencies encompass a variety of skills that influence the work and therapeutic success of psychotherapists. In particular, interpersonal skills and the associated ability to react appropriately in complex therapy situations have already shown significant correlations with later therapeutic success. Strengthening interpersonal skills should therefore be a central aim of psychotherapy training. However, previous studies have shown that not only content learning is decisive for later learning success and skill development, but also the didactic method has a significant effect. Deliberate Practice and Structured Feedback have shown to be promising didactic tools. The primary objective of this study is to investigate the efficacy of Deliberate Practice and Structured Feedback as well as their combination in the context of psychotherapy training in comparison to classic didactic training. The trainees’ learning progress of interpersonal skills and its influence on subsequent outpatient therapies will be examined. Secondary, the study aims to identify further determinants of trainees’ therapeutic skills and to investigate the effects of ruptures on the course of therapy.

Methods

The underlying study, a randomized-control-trial with three intervention groups (Deliberate Practice, Structured Feedback, combination of both) and an active control group, will be conducted on a sample of N = 240 trainees and their patients (N = 1000). All trainees will each attend three consecutive workshops on “Strengthening therapeutic skills in challenging therapy situations”, which will be carried out using the corresponding didactic tool. Scientific assessments will take place online for the trainees (pre, in-between, post, follow-up) and for the patients (after each therapy session for 24 weeks, follow-up). Primary outcomes will be constituted by the trainees’ Facilitative Interpersonal Skills and the patients’ symptoms. Multilevel as well as structural equation modelling will be used to analyze the data.

Discussion

The study investigates the efficacy of different didactic tools regarding the strengthening of trainee’s interpersonal competencies as well as their effects on subsequent therapies. Results of this study address a research gap concerning the improvement of psychotherapy training as well as the quality assurance of future therapies.

Trial registration

German Clinical Trial Register (DRKS) – DRKS00034279; retrospectively registered.
Exploring physical, subjective and psychological wellbeing profile membership in adolescents: a latent profile analysis
Authors: Hennessey Alexandra , MacQuarrie Sarah , Petersen Kimberly J.
Published: December 2024

Background

Understanding wellbeing in adolescents and within education settings is crucial to supporting young people. However, research defining and exploring wellbeing has typically taken a focus on subjective, psychological, social and emotional domains and has failed to incorporate aspects of physical health and wellbeing. This study aimed to explore how both physical and subjective and psychological wellbeing can be combined to generate different profiles of wellbeing in adolescents, and to understand the characteristics associated with this profile membership.

Methods

366 adolescents aged 11-16yrs (mean age 12.75) from three mainstream secondary schools across England completed an online survey capturing demographic characteristics, physical, subjective and psychological wellbeing, physical activity, emotional literacy, school belonging, and perceptions of learning ability. Latent profile analysis used a data driven approach to explore profiles of wellbeing using physical wellbeing and positive emotional state and positive outlook as predictors of profile membership. To understand profile characteristics demographics, physical activity and educational variables were added as co-variates.

Results

Three profiles were identified, (1) low wellbeing (n = 68, 19%) displaying low scores across physical wellbeing, positive emotional state and positive outlook, (2) moderate wellbeing (n = 168, 46%) characterised by average levels across physical wellbeing, positive emotional state and positive outlook, and (3) high wellbeing (n = 128, 35%) showing high score across physical wellbeing, positive emotional state and positive outlook. Compared to the high wellbeing profile, the moderate and low profiles membership was characterised by being older, being a girl, lower perceived socio-economic status, fewer hours of physical activity a week, and lower emotional literacy, school belonging and perceptions of learning.

Conclusions

The results evidence that physical, subjective and psychological wellbeing are closely inter-related, this finding coupled with increased physical activity in the higher wellbeing group signify physical health and activity are important components of overall wellbeing and should form part of a holistic approach to school wellbeing curriculums.
TRPM channels in human cancers: regulatory mechanism and therapeutic prospects
Authors: Liu Qinfeng , Hu Mengyu , Li Shi , Zhang Xin , Zhang Rui , Lyu Hao , Xiao Shuai , Guo Dong , Chen Xing-Zhen , Tang Jingfeng , Zhou Cefan
Published: December 2024

The transient receptor potential melastatin (TRPM) channel family has been previously implicated in various diseases, including those related to temperature sensing, cardiovascular health, and neurodegeneration. Nowadays, increasing evidence indicates that TRPM family members also play significant roles in various types of cancers, exhibiting both pro- and anti-tumorigenic functions. They are involved in tumor cell proliferation, survival, invasion, and metastasis, serving as potential diagnostic and prognostic biomarkers for cancer. This paper begins by describing the structure and physiological functions of the TRPM family members. It then outlines their roles in several common malignancies, including pancreatic, prostate, colorectal, breast, brain cancer, and melanoma. Subsequently, we focused on investigating the specific mechanisms by which TRPM family members are involved in tumorigenesis and development from both the tumor microenvironment (TME) and intracellular signaling. TRPM channels not only transmit signals from the TME to regulate tumor cell functions, but also mediate extracellular matrix remodeling, which is conducive to the malignant transformation of tumor cells. Importantly, TRPM channels depend on the regulation of the inflow of various ions in cells, and participate in key signaling pathways involved in tumor progression, such as Wnt/β-catenin, MAPK, PI3K/AKT, p53, and autophagy. Finally, we summarize the current strategies and challenges of targeting TRPM channels in tumor treatment, and discuss the feasibility of combining targeted TRPM channel drugs with cancer immunotherapy.
GAN-based heterogeneous network for ancient mural restoration
Authors: Zhao Fanhua , Ren Hui , Sun Ke , Zhu Xian
Published: December 2024

Ancient murals, invaluable cultural artifacts, frequently suffer damage from environmental and human factors, necessitating effective restoration techniques. Traditional methods, which rely on manual skills, are time-consuming and often inconsistent. This study introduces an innovative mural restoration approach using a generative adversarial network (GAN) within a UNet architecture. The generator integrates Transformer and convolutional neural network (CNN) components, effectively capturing and reconstructing complex mural features. This work's novelty lies in integrating the Group-wise Multi-scale Self-Attention (GMSA), an Encoder-Decoder Feature Interaction (EDFI) module, and a Local Feature Enhancement Block (LFEB). These components allow the model to better capture, reconstruct, and enhance mural features, leading to a significant improvement over traditional restoration methods. Tested on a dataset of Tang Dynasty murals, the method demonstrated superior performance in PSNR, SSIM, and LPIPS metrics compared to seven other techniques. Ablation studies confirmed the effectiveness of the heterogeneous network design and the critical contributions of the GMSA, EDFI, and LFEB modules. Practical restoration experiments showed the method's ability to handle various types of mural damage, providing seamless and visually authentic restorations. This novel approach offers a promising solution for the digital preservation and restoration of cultural heritage murals, with potential applications in practical restoration projects.
Adherence to diabetic retinopathy screening among children and young adults in Bangladesh
Authors: Curran Katie , Ahmed Munir , Sultana Mirza Manbira , Moutari Salissou , Hossain Mohammad Awlad , Cushley Laura , Peto Tunde , Husain Lutful , Zabeen Bedowra , Congdon Nathan
Published: December 2024

Background

Effective diabetic retinopathy screening (DRS) programmes are important in preventing vision impairment and blindness caused by diabetes. This study focuses on identifying the factors affecting attendance or non-adherence to DRS among children and young adults with diabetes mellitus (DM) in Bangladesh.

Methods

A mixed-methods approach was used, which included patients diagnosed with DM aged 12–26 years from Bangladesh who were registered at BIRDEM Women and Children hospital in Dhaka. Data collection occurred between July 2019 and July 2020, mainly through telephone and email due to restrictions imposed by the COVID-19 pandemic. Statistical analyses, including chi-squared tests, t-tests, and logistic regression, were used to assess the demographic and clinical factors influencing attendance at DRS.

Results

The study reported a high 88% attendance rate for DRS among children and young adults in Bangladesh. However, some barriers to attendance were identified. Children under 15 years of age showed a higher tendency to attend their last DRS appointment when compared to older age participants (16–26 years), P < 0.05. Male participants demonstrated a lower likelihood of attending their DRS appointments than females (OR 0.29, CI: 0.17 to 0.50), P < 0.001. Additionally, participants with higher HbA1c levels (mean 9.1%, IQR 2.5) attended their last DRS appointment compared to those with lower levels (mean 8.0%) (p < 0.05). The primary barriers leading to missed DRS appointments were distance to the hospital (15, 31.9%), financial limitations (19, 40.4%), and busy schedules (14, 29.8%).

Conclusions

Compliance with DRS was high in this setting especially among younger patients, females, and those with higher HbA1c levels, highlighting the effectiveness of current DRS initiatives in Bangladesh. Addressing barriers such as cost, service accessibility and transportation could improve attendance rates further, and strategies such as flexible scheduling, transport subsidies, telemedicine, and use of artificial intelligence may help overcome these challenges.
Renyi entropy-driven network traffic anomaly detection with dynamic threshold
Authors: Yu Haoran , Yang Wenchuan , Cui Baojiang , Sui Runqi , Wu Xuedong
Published: December 2024

Network traffic anomaly detection is a critical issue in network security. Existing Abnormal traffic detection methods rely on statistical-based or anomaly-based approaches, and these detection methods all require a full understanding of traffic characteristics and attack patterns. Information entropy has been widely studied in abnormal traffic detection because it can describe the distribution characteristics of network traffic. However, this method makes it difficult to cope with the timing and variability of network traffic. To address these challenges, this paper proposes a network traffic anomaly detection method based on Renyi entropy. Simultaneously, we introduce a fixed time window and utilize an improved EWMA model within this window to dynamically set thresholds for anomaly detection. Experimental results show that the method proposed in this paper is superior to popular abnormal traffic detection methods in terms of effectiveness and efficiency, it is better adapted to the dynamic changes of network traffic and provides a more reliable solution for anomaly detection.
The distribution of Coronal Plane Alignment of the Knee (CPAK) phenotypes in the Malaysian population and their correlation with demographic variables
Authors: Wong Wai Kit , Abu Bakar Sajak Azliana , Chua Hwa Sen
Published: December 2024

Background

Only 80% of patients are satisfied with their outcomes post-TKA. Mounting attention has been paid to constitutional limb alignment and individualized alignment strategies in recent years. MacDessi et al. proposed the CPAK classification, which takes into account the patients’ arithmetic hip-knee-ankle axis (aHKA) and joint line obliquity (JLO). In this study, we aimed to establish local demographic data, compare them with published data, and assess their correlations with modifiable variables.

Methods

A total of 500 end-stage osteoarthritic knees subjected to TKA were radiologically analyzed. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were calculated from long limb radiographs before the aHKA and JLO were derived and a CPAK phenotype was assigned. Demographic data were harvested and analyzed for possible correlations.

Results

There were 160 males (32%) and 340 females (68%), with a mean age of 66.42 years (range, 47–88). The mean MPTA was 85.8° (± 3.0)°, and the mean LDFA was 87.6° (± 2.4)°. The average aHKA was a varus of 1.8° (± 4.2)°, and the average JLO was 173.4° (± 3.45)°. The most common CPAK phenotype was Type 1 (43.4%). The Intraclass Correlation Coefficient demonstrated excellent reliability (> 0.9). No correlation existed between CPAK phenotypes and age, height, weight, or body mass index (BMI), but CPAK phenotype was significantly correlated with gender.

Conclusion

An urban Malaysian population with osteoarthritic knees was found to be constitutionally varus, with the most common phenotype being varus aHKA with an apex-distal JLO. Constitutional alignment is not influenced by factors such as age, height, weight, or BMI.

Level of Evidence

Retrospective Observational Study-III.
How we perform ductulography in a tertiary referral centre for ductulography in Indonesia: case-series approach and a review
Authors: Supit Nina I. S. H. , Kusumaningtyas Nungky , Gultom Fajar Lamhot , Mudzakir Muhammad Adam , Sulay Callistus Bruce Henfry , Octavius Gilbert Sterling
Published: December 2024

Background

Ductulography is a key imaging technique for assessing nipple discharge. Despite modern advancements such as mammography and MRI, the relevance of ductulography in diagnosing pathologic nipple discharge (PND) remains significant, particularly in low-resource settings. This review examines our single-center experience with ductulography in Indonesia, highlighting patient characteristics and procedural outcomes.

Methods

This review is based on case-based experiences from a private tertiary hospital in Indonesia, a main referral center for ductulography. We describe 28 women who underwent ductulography between January 2019 and June 2024. This review is supplemented by the theories of ductulography and how we do it in our institution.

Results

The median age of the patients was 46.5 years (IQR: 42–53.5 years). Among the 28 women, 2 experienced non-spontaneous discharge, 12 had colorless discharge, 12 had bloody discharge, and the remaining had yellowish to brownish discharge. Laterality was almost evenly distributed with 14 right-sided, 13 left-sided, and 1 bilateral discharge. The Galactogram Imaging Classification System (GICS) outcomes were 2 patients with GICS 0, 7 with GICS 1, 17 with GICS 2, and 2 with GICS 4a. Histopathologic analyses were performed on three patients, revealing fibrocystic changes in two and intraductal papilloma with fibrocystic changes in one.

Conclusions

While ductulography may be considered an older technique, it remains a valuable diagnostic tool in the modern imaging era, especially in settings with limited access to advanced imaging modalities. Our single-center experience supports the continued use of ductulography, providing crucial preoperative mapping and aiding in the accurate diagnosis of PND.
Respiratory health problems among ferroalloys factory workers
Authors: Elghazally Shimaa A. , Zayet Hussein H. , Alkarn Ayah A. , Bazeed Alaa , ElKhayat Mariam Roshdy
Published: December 2024

Background

Ferrosilicon alloys are a mixture of iron and silicon. It offers better iron characteristics such as hardness, strength, and resistance to corrosion and heat by adding alloys of ferrosilicon to steel and cast iron. The ferrosilicon alloy industry workers are exposed to many hazards that can affect their respiratory function due to exposure to silica dust which is present in all steps in this industry mainly from furnaces, in addition to exposure to irritant gases in refining and casting operations. Thus, the current study was conducted to estimate the respiratory problems prevalence especially silicosis among workers of ferroalloy factories.

Results

All studied workers (100%) were males with a mean (± SD) age of 50.15 ± 5.77 years. Seventy percent of workers had been working for ≥ 20 years and 76.4% were working in places with high levels of exposure. About one-third of the studied workers were diagnosed with silicosis. There was a statistically significant higher occurrence of silicosis among workers aged ≥ 50 years old. Work duration and level of exposure were significant predictors of silicosis occurrence among studied workers.

Conclusion

Ferroalloy factory work environment affects the respiratory health of the workers and impairs their pulmonary function. It may increase the risk of developing silicosis which impacts the effectiveness of their work and quality of life. Workers in ferroalloys factories must receive regular medical care, and safety precautions are recommended.

Trial registration

ClinicalTrials.gov. NCT05374148. Registered May 13, 2022.
Phosphoenolpyruvate carboxylase (PEPC) is essential for the glycolytic pathway and parasite proliferation in Babesia gibsoni
Authors: Li Dong-Fang , Wang Ling-Na , Bai Yi-Dan , Yu Yu-Xin , Lu Xing , Guan Xing-Ai , Li Fang-Jie , Wang Sen , He Lan , Zhao Jun-Long
Published: December 2024

Apicomplexan parasites predominantly generate ATP and lactic acid through glycolysis and anaerobic glucose metabolism, incorporating CO2 into glycolysis via a stage-dependent phosphoenolpyruvate carboxylase (PEPC) mechanism. Although the role of PEPC in plant and bacterial carbon fixation is well documented, its function within Babesia remains largely unexplored. This study employs reverse genetics to probe the biological role of PEPC in Babesia gibsoni, noting its conservation across similar protozoa, suggesting a pivotal and conserved biological function. Western blotting and immunofluorescence (IFA) experiments using the BgPEPC-3 × Flag strain revealed that the BgPEPC protein has a molecular weight of 105 kDa and localizes predominantly to the cytoplasm. Attempts to knock out the PEPC gene in BgPEPC-3 × Flag strains failed under standard media conditions, succeeded only with the addition of 5 mM malate, an upstream metabolite of oxaloacetic acid (OAA). In addition to malate, the downstream metabolite of OAA can also partially compensate for the phenotypic defects caused by PEPC deficiency. This intervention alleviated severe growth deficits, underscoring the critical role of aspartate in the parasite lifecycle. Moreover, metabolic inhibitors such as L-cycloserine and triazamidine, which target aspartate aminotransferase and mitochondrial functions, respectively, demonstrated increased efficacy against BgPEPC knockout strains. The lack of a compensatory response to malic acid supplementation underscores the integral role of BgPEPC in intermediary carbon metabolism and its necessity in providing aspartate as a precursor to pyrimidine synthesis. Collectively, these findings suggest that PEPC could be a potential target for future drug development against B. gibsoni infections.

Graphical Abstract