bluuebunny/crossref_metadata_2025 huggingface dataset:
Child-adult speech diarization in naturalistic conditions of preschool classrooms using room-independent ResNet model and automatic speech recognition-based re-segmentation
Authors: Kothalkar Prasanna V. , Hansen John H. L. , Irvin Dwight , Buzhardt Jay
Published: February 2024

Speech and language development are early indicators of overall analytical and learning ability in children. The preschool classroom is a rich language environment for monitoring and ensuring growth in young children by measuring their vocal interactions with teachers and classmates. Early childhood researchers are naturally interested in analyzing naturalistic vs controlled lab recordings to measure both quality and quantity of such interactions. Unfortunately, present-day speech technologies are not capable of addressing the wide dynamic scenario of early childhood classroom settings. Due to the diversity of acoustic events/conditions in such daylong audio streams, automated speaker diarization technology would need to be advanced to address this challenging domain for segmenting audio as well as information extraction. This study investigates alternate deep learning-based lightweight, knowledge-distilled, diarization solutions for segmenting classroom interactions of 3–5 years old children with teachers. In this context, the focus on speech-type diarization which classifies speech segments as being either from adults or children partitioned across multiple classrooms. Our lightest CNN model achieves a best F1-score of ∼76.0% on data from two classrooms, based on dev and test sets of each classroom. It is utilized with automatic speech recognition-based re-segmentation modules to perform child-adult diarization. Additionally, F1-scores are obtained for individual segments with corresponding speaker tags (e.g., adult vs child), which provide knowledge for educators on child engagement through naturalistic communications. The study demonstrates the prospects of addressing educational assessment needs through communication audio stream analysis, while maintaining both security and privacy of all children and adults. The resulting child communication metrics have been used for broad-based feedback for teachers with the help of visualizations.
The formula for acoustical privacy
Authors: HOOVER K. ANTHONY
Published: February 2024

The Reflections series takes a look back on historical articles from The Journal of the Acoustical Society of America that have had a significant impact on the science and practice of acoustics.
Effects of viscous dissipation in propagation of sound in periodic layered structures
Authors: Shymkiv Dmitrii , Krokhin Arkadii
Published: February 2024

Propagation and attenuation of sound through a layered phononic crystal with viscous constituents is theoretically studied. The Navier–Stokes equation with appropriate boundary conditions is solved and the dispersion relation for sound is obtained for a periodic layered heterogeneous structure where at least one of the constituents is a viscous fluid. Simplified dispersion equations are obtained when the other component of the unit is either elastic solid, viscous fluid, or ideal fluid. The limit of low frequencies when periodic structure homogenizes and the frequencies close to the band edge when propagating Bloch wave becomes a standing wave are considered and enhanced viscous dissipation is calculated. Angular dependence of the attenuation coefficient is analyzed. It is shown that transition from dissipation in the bulk to dissipation in a narrow boundary layer occurs in the region of angles close to normal incidence. Enormously high dissipation is predicted for solid–fluid structure in the region of angles where transmission practically vanishes due to appearance of so-called “transmission zeros,” according to El Hassouani, El Boudouti, Djafari-Rouhani, and Aynaou [Phys. Rev. B 78, 174306 (2008)]. For the case when the unit cell contains a narrow layer of high viscosity fluid, the anomaly related to acoustic manifestation of Borrmann effect is explained.
Using learned priors to regularize the Helmholtz equation least-squares method
Authors: Lobato Thiago , Sottek Roland , Vorländer Michael
Published: February 2024

The Helmholtz equation least-squares (HELS) method is a valuable tool for estimating equivalent sound sources of a radiating object. It solves an inverse problem by mapping measured pressures to a set of basis functions satisfying the Helmholtz equation in spherical coordinates. However, this problem is often ill-posed, necessitating additional regularization methods, in which often variations of Ridge or Lasso are used. These conventional methods do not explicitly consider the distribution underlying the source radiations (besides sparsity) and are often used in the context of obtaining only a point estimate, even in the presence of ambiguity in the data. In this work, we propose the use of empirical priors through a normalizing flow model to enhance the inversion results obtained with the HELS method. We first validate our approach using numerical data and subsequently demonstrate its superior performance in interpolating a measured violin directivity compared to Lasso and Ridge methods, even when optimal regularization parameters are selected.
Theoretical and numerical simulation to control the wideband three-dimensional interfering noise by the broadband constant beam pattern method for a spherical array
Authors: Huang Dehua
Published: February 2024

The broadband constant beam pattern (CBP) spherical array synthesis theory is applied to suppress or to cancel wideband three-dimensional interfering noise sources by implanting zeros in the array's original synthesized shading function. This modified array angular shading function can be expanded by a series of spherical harmonics that will converge to the beam pattern in the far-field such that the created nulls are in the wideband interfering noise source directions per the CBP theory where the ratio of the spherical array radius to the operating frequency wavelength is large. The simulated numerical examples given for this wideband noise source suppression method demonstrate that a broadband CBP performance is maintained for the spherical array with a Legendre polynomial shading function, the classic Dolph–Chebyshev shading function, or a combination. With the CBP design, one set of the real shading functions works for all frequencies in the array's operating band to cancel or to suppress three-dimensional wideband interfering noise sources.
Model calculations and measurements of shooting sound in practical situations
Authors: Salomons E. M. , van der Eerden F. J. M. , van den Berg F. H. A.
Published: February 2024

Shooting sound in practical situations with propagation distances up to 300 m is investigated by means of model calculations and measurements. The results illustrate uncertainties in the model calculations for practical situations. The measurements were performed with various small-caliber weapons. Microphones were placed at positions screened by a noise barrier, and also at unscreened positions. The measured signals contain muzzle sound and bullet sound. The model calculations for muzzle sound and bullet sound take into account emission spectra and various propagation attenuation terms, including ground attenuation and barrier attenuation. The bullet sound model is based on a nonlinear theory of N waves generated by supersonic projectiles. For the unscreened situation, model and measurement results show that the sound levels are considerably reduced by ground attenuation. Ground-level variations and ground roughness in the measurement area play an important role. At a 300 m distance, the A-weighted bullet sound level is higher than the A-weighted muzzle sound level, which underlines the importance of bullet sound. For the screened situation, model and measurement results are used to analyze diffraction of bullet sound by the horizontal and vertical edges of the barrier. The diffraction is explained by considering Fresnel zones on the bullet trajectory.
Source depth estimation with feature matching using convolutional neural networks in shallow water
Authors: Liu Mingda , Niu Haiqiang , Li Zhenglin , Guo Yonggang
Published: February 2024

A feature matching method based on the convolutional neural network (named FM-CNN), inspired from matched-field processing (MFP), is proposed to estimate source depth in shallow water. The FM-CNN, trained on the acoustic field replicas of a single source generated by an acoustic propagation model in a range-independent environment, is used to estimate single and multiple source depths in range-independent and mildly range-dependent environments. The performance of the FM-CNN is compared to the conventional MFP method. Sensitivity analysis for the two methods is performed to study the impact of different environmental mismatches (i.e., bottom parameters, water column sound speed profile, and topography) on depth estimation performance in the East China Sea environment. Simulation results demonstrate that the FM-CNN is more robust to the environmental mismatch in both single and multiple source depth estimation than the conventional MFP. The proposed FM-CNN is validated by real data collected from four tracks in the East China Sea experiment. Experimental results demonstrate that the FM-CNN is capable of reliably estimating single and multiple source depths in complex environments, while MFP has a large failure probability due to the presence of strong sidelobes and wide mainlobes.
Scattering measurements of rocky seafloors using a split-beam echosounder
Authors: Gruber Jen A. , Olson Derek R.
Published: February 2024

Scattering measurements were made off the coast of Pacific Grove, CA at 200 kHz, in an exposed fractured granite seafloor. Using inertial sensors and a split-beam transducer, data were processed to obtain a range of grazing angles corresponding to scattering strength, and signal processing techniques were used to extract the relevant portion of each ping. The ensonified angular width from a circular aperture is presented. Scattering strength measurements using different assumptions regarding the grazing angle were compared. The empirical Lommel–Seeliger model provided a good fit to measured data with a parameter of −18.4 dB.
Characterization of anthropogenic noise and oyster toadfish (Opsanus tau) calling behavior in urban and small-town coastal soundscapes
Authors: Hom Kelsey N. , Quigley Thomas D. , Rodriguez Rachel D. , Gdanski Sydney G. , Lazrinth Xylo I. , Jones Rebecca , Forlano Paul M.
Published: February 2024

The oyster toadfish (Opsanus tau) is an ideal model to examine the effects of anthropogenic noise on behavior because they rely on acoustic signals for mate attraction and social interactions. We predict that oyster toadfish have acclimated to living in noise-rich environments because they are common in waterways of urban areas, like New York City (NYC). We used passive acoustic monitoring at two locations to see if calling behavior patterns are altered in areas of typically high boat traffic versus low boat traffic (Pier 40, NYC, NY, and Eel Pond, Woods Hole, MA, respectively). We hypothesized that toadfish in NYC would adjust their circadian calling behavior in response to daily anthropogenic noise patterns. We quantified toadfish calls and ship noise over three 24-h periods in the summer reproductive period at both locations. We observed an inverse relationship between the duration of noise and the number of toadfish calls at Pier 40 in comparison to Eel Pond. Additionally, toadfish at Pier 40 showed significant differences in peak calling behavior compared to Eel Pond. Therefore, oyster toadfish may have acclimated to living in an urban environment by potentially altering their communication behavior in the presence of boat noise.
An iteratively reweighted steered response power approach to multisource localization using a distributed microphone network
Authors: Dang Xudong , Zhu Hongyan
Published: February 2024

The steered response power (SRP) with phase transform algorithm has been demonstrated to be robust against reverberation and noise for single-source localization. However, when this algorithm is applied to multisource localization (MSL), the “peak missing problem” can occur, namely, that some sources dominate over others over short time intervals, resulting in fewer significant SRP peaks being found than the true number of sources. This problem makes it difficult to detect all the sources among the available SRP peaks. We propose an iteratively reweighted steered response power (IR-SRP) approach that effectively solves the “peak missing problem” and achieves robust MSL in reverberant noisy environments. The initial IR-SRP localization function is computed over the time-frequency (T-F) bins selected by a combination of two weighting schemes, one using coherence, and the other using signal-to-noise ratio. When iterating, our method finds the significant SRP peaks for the dominant sources and eliminates the T-F bins contributed by these sources using inter-channel phase difference information. As a result, the remaining sources can be found in subsequent iterations among the remaining T-F bins. The proposed IR-SRP method is demonstrated using both simulated and measured experiment data.
On the area-averaged effective sound absorption coefficient of porous materials excited by a monopole
Authors: Sgard Franck , Atalla Noureddine , Robin Olivier , Berry Alain
Published: February 2024

The area-averaged effective sound absorption coefficient (SAC) of a rigid-backed homogeneous porous material subjected to a monopole excitation is calculated as the absorbed-to-incident sound power ratio. Using Allard's model to describe the sound propagation above the porous material, an analytical model for this power-based SAC is proposed and proves to give a good approximation of the sound absorption performance under monopole excitation of sufficiently large areas of material. The impact of factors on the power-based SAC, such as monopole height, material radial dimension used to calculate the sound powers, and material properties is discussed. The power-based SAC frequency-dependent behavior is analyzed through sound intensity field assessments at the material surface and is compared to normal incident plane wave and diffuse field SACs. The sound absorption behavior of sound absorbers under monopole excitation exhibits notable distinctions and peculiar results compared to those observed under plane wave and diffuse fields, particularly at low frequencies and for sources close to the material.
High resolution imaging of acoustic orbital angular momentum wave based on orthogonal matching tracking
Authors: Jia Yanqing , Hu Qing , Li Zhuoming , Wang Haijun
Published: February 2024

The orbital angular momentum (OAM) wave has shown great potential for improving radar imaging and underwater communication performance due to its helical wavefront phase and infinite orthogonal modes. However, there are currently no known applications of this technology in underwater imaging. In this paper, we employed acoustic OAM wave for underwater imaging and established transceiver signal models using the uniform circular array. We concurrently achieved two-dimensional imaging of azimuth and elevation angles, which differs from radar imaging. We proposed a matching process for the echo signal in the modal domain, the OAM wave beam image's sidelobe decreased by 7.9 dB in the elevation direction and 6.1 dB in the azimuth direction compared to the plane wave, with the mainlobe decreased by 0.2° in the elevation direction and 0.4° in the azimuth direction. Furthermore, this paper introduced OAM wave high-resolution image reconstruction based on the orthogonal matching pursuit (OMP) algorithm. Finally, we implemented broadband acoustic OAM wave for underwater imaging and introduced an image reconstruction method based on the modal domain OMP algorithm. Simulation results demonstrate that the use of OAM wave in underwater imaging is feasible, and the proposed scheme can achieve high-resolution imaging.
Automatic recognition of second language speech-in-noise
Authors: Kim Seung-Eun , Chernyak Bronya R. , Seleznova Olga , Keshet Joseph , Goldrick Matthew , Bradlow Ann R.
Published: February 2024

Measuring how well human listeners recognize speech under varying environmental conditions (speech intelligibility) is a challenge for theoretical, technological, and clinical approaches to speech communication. The current gold standard—human transcription—is time- and resource-intensive. Recent advances in automatic speech recognition (ASR) systems raise the possibility of automating intelligibility measurement. This study tested 4 state-of-the-art ASR systems with second language speech-in-noise and found that one, whisper, performed at or above human listener accuracy. However, the content of whisper's responses diverged substantially from human responses, especially at lower signal-to-noise ratios, suggesting both opportunities and limitations for ASR--based speech intelligibility modeling.
Prior dengue virus serotype 3 infection modulates subsequent plasmablast responses to Zika virus infection in rhesus macaques
Authors: Singh Tulika , Miller Itzayana G. , Venkatayogi Sravani , Webster Helen , Heimsath Holly J. , Eudailey Josh A. , Dudley Dawn M. , Kumar Amit , Mangan Riley J. , Thein Amelia , Aliota Matthew T. , Newman Christina M. , Mohns Mariel S. , Breitbach Meghan E. , Berry Madison , Friedrich Thomas C. , Wiehe Kevin , O'Connor David H. , Permar Sallie R.
Published: February 2024

Immunodominant and highly conserved flavivirus envelope proteins can trigger cross-reactive IgG antibodies against related flaviviruses, which shapes subsequent protection or disease severity. This study examined how prior dengue serotype 3 (DENV-3) infection affects subsequent Zika virus (ZIKV) plasmablast responses in rhesus macaques (
n
= 4). We found that prior DENV-3 infection was not associated with diminished ZIKV-neutralizing antibodies or magnitude of plasmablast activation. Rather, characterization of 363 plasmablasts and their derivative 177 monoclonal antibody supernatants from acute ZIKV infection revealed that prior DENV-3 infection was associated with a differential isotype distribution toward IgG, lower somatic hypermutation, and lesser B cell receptor variable gene diversity as compared with repeat ZIKV challenge. We did not find long-lasting DENV-3 cross-reactive IgG after a ZIKV infection but did find persistent ZIKV-binding cross-reactive IgG after a DENV-3 infection, suggesting non-reciprocal cross-reactive immunity. Infection with ZIKV after DENV-3 boosted pre-existing DENV-3-neutralizing antibodies by two- to threefold, demonstrating immune imprinting. These findings suggest that the order of DENV and ZIKV infections has impact on the quality of early B cell immunity which has implications for optimal immunization strategies.

IMPORTANCE

The Zika virus epidemic of 2015–2016 in the Americas revealed that this mosquito-transmitted virus could be congenitally transmitted during pregnancy and cause birth defects in newborns. Currently, there are no interventions to mitigate this disease and Zika virus is likely to re-emerge. Understanding how protective antibody responses are generated against Zika virus can help in the development of a safe and effective vaccine. One main challenge is that Zika virus co-circulates with related viruses like dengue, such that prior exposure to one can generate cross-reactive antibodies against the other which may enhance infection and disease from the second virus. In this study, we sought to understand how prior dengue virus infection impacts subsequent immunity to Zika virus by single-cell sequencing of antibody producing cells in a second Zika virus infection. Identifying specific qualities of Zika virus immunity that are modulated by prior dengue virus immunity will enable optimal immunization strategies.
The complete coding sequence of a rabies lyssavirus (RABV) detected in an American black bear (
Ursus americanus
) in Connecticut, USA.
Authors: Helal Zeinab H. , Francesca Soriano Nina , Hyeon Ji-Yeon , Chun Hyunjung , Sims Maureen , Wheeler Amelia , Risatti Guillermo R.
Published: February 2024

The complete coding sequence of a rabies lyssavirus (RABV) detected in a black bear (
Ursus americanus
) was generated. RNA extracted from brain tissues was amplified using reverse transcription followed by tiling PCR sequencing to obtain RABV whole viral genome. Sequencing was performed using an Illumina ISeq 100 instrument.
High-quality genome assembly and genetic transformation system of
Lasiodiplodia theobromae
strain LTTK16-3, a fungal pathogen of Chinese hickory
Authors: Ma Tianling , Yan Chenyi , Zhang Shuya , Liang Dong , Mao Chengxin , Zhang Chuanqing
Published: February 2024

Lasiodiplodia theobromae,
as one of the causative agents associated with Chinese hickory trunk cankers, has caused huge economic losses to the Chinese hickory industry. Although the biological characteristics of this pathogen and the occurrence pattern of this disease have been well studied, few studies have addressed the related mechanisms due to the poor molecular and genetic study basis of this fungus. In this study, we sequenced and assembled
L. theobromae
strain LTTK16-3, isolated from a Chinese hickory tree (cultivar of Linan) in Linan, Zhejiang province, China. Phylogenetic analysis and comparative genomics analysis presented crucial cues in the prediction of LTTK16-3, which shared similar regulatory mechanisms of transcription, DNA replication, and DNA damage response with the other four Chinese hickory trunk canker-associated
Botryosphaeria
strains including,
Botryosphaeria dothidea
,
Botryosphaeria fabicerciana
,
Botryosphaeria qingyuanensis,
and
Botryosphaeria corticis
. Moreover, it contained 18 strain-specific protein clusters (not conserved in the other
L. theobromae
strains, AM2As and CITRA15), with potential roles in specific host-pathogen interactions during the Chinese hickory infection. Additionally, an efficient system for
L. theobromae
protoplast preparation and polyethylene glycol (PEG) -mediated genetic transformation was firstly established as the foundation for its future mechanisms study. Collectively, the high-quality genome data and the efficient transformation system of
L. theobromae
here set up the possibility of targeted molecular improvements for Chinese hickory canker control.

IMPORTANCE

Fungi with disparate genomic features are physiologically diverse, possessing species-specific survival strategies and environmental adaptation mechanisms. The high-quality genome data and related molecular genetic studies are the basis for revealing the mechanisms behind the physiological traits that are responsible for their environmental fitness. In this study, we sequenced and assembled the LTTK16-3 strain, the genome of
Lasiodiplodia theobromae
first obtained from a diseased Chinese hickory tree (cultivar of Linan) in Linan, Zhejiang province, China. Further phylogenetic analysis and comparative genomics analysis provide crucial cues in the prediction of the proteins with potential roles in specific host-pathogen interactions during the Chinese hickory infection. An efficient PEG-mediated genetic transformation system of
L. theobromae
was established as the foundation for the future mechanisms exploration. The above genetic information and tools set up valuable clues to study
L. theobromae
pathogenesis and assist in Chinese hickory canker control.
Tunnelised superiorly based preauricular flap and conchal cartilage graft for antihelix reconstruction
Authors: Caretto Anna Amelia , Colavincenzo Chiara , Gentileschi Stefano
Published: February 2024

Reconstruction of a full-thickness defect of the auricle’s anterior surface represents a challenge for plastic surgeons. This report describes the case of a man in his 70s, who underwent radical excision of a squamous cell carcinoma involving his right antihelix. We adopted an innovative approach for the reconstruction of the antihelix, using a tunnelled preauricular flap reinforced with an ipsilateral concha cartilage graft. The flap’s base was de-epithelialised, allowing a single-stage procedure. Three months postoperation, no complications arose, and the scars at the donor site were effectively concealed. The aesthetic result was excellent, thanks to the perfect colour match, symmetry, shape of the auricle and the long-lasting integrity of the antihelical structure.

This technique allows for accurate reconstruction of the convoluted surface of the auricle in cases of full-thickness defects of the antihelix, without the need to harvest cartilage from other donor sites and in a single surgical procedure.
Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial
Authors: LeBlanc Erin S , Pittas Anastassios G , Nelson Jason , Chatterjee Ranee , Rasouli Neda , Rhee Mary K , Pratley Richard E , Desouza Cyrus V , Neff Lisa M , Peters Anne M , Dagogo-Jack Samuel , Hsia Daniel S
Published: February 2024

Introduction

Understanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral glucose tolerance test (OGTT) differed by race.

Research design and methods

From data collected at 22 US clinical sites, we conducted a cross-sectional study of concurrently measured A1c and OGTT and observational longitudinal follow-up of the subset with high-risk pre-diabetes. Numerical integration methods were used to calculate area under the glycemic curve (AUCglu) during OGTT and least squares regression model to estimate A1c for a given AUCgluby race, controlling for potential confounders.

Results

1016 black, 2658 white, and 193 Asian persons at risk of diabetes were included in cross-sectional analysis. Of these, 2154 with high-risk pre-diabetes were followed for 2.5 years. For a given A1c level, AUCgluwas lower in black versus white participants. After adjustment for potential confounders, A1c levels for a given AUCgluquintile were 0.15–0.20 and 0.02–0.19 percentage points higher in black and Asian compared with white participants, respectively (p<0.05). In longitudinal analyses, black participants were more likely to be diagnosed with diabetes by A1c than white participants (28% vs 10%, respectively; p<0.01). Black and Asian participants were less likely to be diagnosed by fasting glucose than white participants (16% vs 15% vs 37%, respectively; p<0.05). Black participants with A1c levels in the lower-level quintiles had greater increase in A1c over time compared with white participants.

Conclusions

Use of additional testing beyond A1c to screen for diabetes may better stratify diabetes risk in the diverse US population.
Can earlier BCG-Japan and OPV vaccination reduce early infant mortality? A cluster-randomised trial in Guinea-Bissau
Authors: Thysen Sanne Marie , da Silva Borges Igualdino , Martins Jailson , Stjernholm Alexander Dahl , Hansen Jesper Sloth , da Silva Leontino Manuel Vieira , Martins Justiniano Sebastião Durga , Jensen Aksel , Rodrigues Amabelia , Aaby Peter , Stabell Benn Christine , Fisker Ane Baerent
Published: February 2024

Objective

To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery.

Design

Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms.

Setting

Bandim Health Project Health and Demographic Surveillance System, Guinea-Bissau.

Participants

2226 newborns enrolled between July 2016 and August 2019.

Interventions

In both arms, newborns received a home visit within 72 hours after birth. In intervention clusters (n=46), BCG and OPV were provided at the home visit.

Main outcome measure

Rates of non-accidental mortality were compared in Cox proportional hazards models from (last of) day 1 or enrolment, until (first of) day 60 or registration of non-trial vaccines.

Results

A total of 35 deaths (intervention: 7, control: 28) were registered during the trial. Providing BCG and OPV reduced non-accidental early infant mortality by 59% (8–82%). The intervention also reduced non-accidental hospital admissions. The intervention had little impact on growth and BCG scarring and tended to increase the risk of consultations.

Conclusions

The trial was stopped early due to lower-than-expected enrolment and event rates when 33% of the planned number of newborns had been enrolled. Despite the small size of the trial, the results support that early BCG and OPV vaccinations are beneficial and reduce early child mortality and morbidity.

Trial registration number

ClinicalTrials.gov Registry (NCT02504203).
Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials
Authors: Cohen Sem E , Zantvoord Jasper Brian , Storosum Bram W C , Mattila Taina Kristiina , Daams Joost , Wezenberg Babet , de Boer Anthonius , Denys Damiaan A J P
Published: February 2024

Question

We examined the effect of study characteristics, risk of bias and publication bias on the efficacy of pharmacotherapy in randomised controlled trials (RCTs) for obsessive-compulsive disorder (OCD).

Study selection and analysis

We conducted a systematic search of double-blinded, placebo-controlled, short-term RCTs with selective serotonergic reuptake inhibitors (SSRIs) or clomipramine. We performed a random-effect meta-analysis using change in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as the primary outcome. We performed meta-regression for risk of bias, intervention, sponsor status, number of trial arms, use of placebo run-in, dosing, publication year, age, severity, illness duration and gender distribution. Furthermore, we analysed publication bias using a Bayesian selection model.

Findings

We screened 3729 articles and included 21 studies, with 4102 participants. Meta-analysis showed an effect size of −0.59 (Hedges’ G, 95% CI −0.73 to −0.46), equalling a 4.2-point reduction in the YBOCS compared with placebo. The most recent trial was performed in 2007 and most trials were at risk of bias. We found an indication for publication bias, and subsequent correction for this bias resulted in a depleted effect size. In our meta-regression, we found that high risk of bias was associated with a larger effect size. Clomipramine was more effective than SSRIs, even after correcting for risk of bias. After correction for multiple testing, other selected predictors were non-significant.

Conclusions

Our findings reveal superiority of clomipramine over SSRIs, even after adjusting for risk of bias. Effect sizes may be attenuated when considering publication bias and methodological rigour, emphasising the importance of robust studies to guide clinical utility of OCD pharmacotherapy.

PROSPERO registration number

CRD42023394924.
Association between asymptomatic hyperuricemia and risk of arthritis, findings from a US National Survey 2007–2018
Authors: Liang Zhenguo , WU Dongze , Zhang Hua , Gu Jieruo
Published: February 2024

Background

Arthritis is thought to be closely related to serum uric acid. The study aims to assess the association between asymptomatic hyperuricemia (AH) and arthritis.

Methods

A multistage, stratified cluster was used to conduct a cross-sectional study of adult US civilians aged≥20 years from the 2007–2018 National Health and Nutrition Examination Survey. Participants with hyperuricemia and without hyperuricemia prior to gout were included. A questionnaire was used to determine whether participants had arthritis and the type of arthritis. Logistic regression was used to investigate the association between hyperuricemia and arthritis.

Result

During the past 12 years, the percentage of participants with arthritis changed from 25.95% (22.53%–29.36%) to 25.53% (21.62%–29.44%). The prevalence of osteoarthritis (OA) increased from 8.70% (95% CI: 6.56% to 10.85%) to 12.44% (95% CI: 9.32% to 15.55%), the prevalence of AH changed from 16.35% (95% CI: 14.01% to 18.40%) to 16.39% (95% CI: 13.47% to 19.30%). Participants with AH were associated with onset of arthritis (OR=1.34, 95% CI: 1.07 to 1.69), but the association was muted after adjusting demographic and socioeconomic factors. For participants aged 40–49 years, AH is associated with incident arthritis (OR=1.96, 95% CI: 1.23 to 2.99) and the relationship remained after adjusting for education level, income to poverty ratio, body mass index, diabetes, hypertension and smoking (OR=2.00, 95% CI: 1.94 to 3.36). Compared with male, female participants with AH are more likely to develop arthritis, especially in OA (OR=1.35, 95% CI: 1.14 to 1.60).

Conclusion

Our data identified AH as the risk factor for incident arthritis, especially for OA, which might be exaggerated in aged population and female population.
Trends of mean systolic and diastolic blood pressure among adults in Shenzhen, China, 1997–2018: findings from three rounds of the population-based survey
Authors: Peng Ke , Cai Weicong , Liu Xiaoying , Liu Yishu , Ouyang Menglu , Gong Jessica , Wang Zhihui , Wang Yunfeng , Hao Jing , Wang Wei , Zhao Honglei , Lin Kaihao , Han Guiyuan , Shi Yu , Xie Yinghao , Xie Yuxin , Lei Lin , Si Lei
Published: February 2024

Objective

To quantify the trends in systolic and diastolic blood pressure (BP) among adults in Shenzhen from 1997 to 2018.

Design

Cross-sectional study.

Settings

The data were collected from all districts in Shenzhen, China in the years of 1997, 2009 and 2018 by multistage cluster sampling procedure.

Participants

Participants were residents aged 18–69 years in Shenzhen, China. A total of 26 621 people were included: 8266 people in 1997, 8599 people in 2009 and 9756 people in 2018.

Primary and secondary outcome measures

All participants were surveyed about their sociodemographic and lifestyle information. BP was measured by trained physicians using a mercury sphygmomanometer. Hypertension was defined as systolic BP of at least 140 mm Hg and diastolic BP of at least 90 mm Hg, self-reported use of antihypertensive medications or both. Hypertension control was defined as systolic BP values of less than 140 mm Hg and diastolic BP values of less than 90 mm Hg.

Result

Age-adjusted mean systolic BP increased from 117±16 mm Hg to 123±15 mm Hg (p<0.001) in males, and from 113±18 mm Hg to 115±16 mm Hg (p<0.001) in females from 1997 to 2018. Diastolic BP among males increased from 75 mm Hg (SD=11) to 79 mm Hg (SD=11) and increased from 71 mm Hg (SD=10) to 73 mm Hg (SD=10) among females between 1997 and 2018 (p<0.001). Rate of hypertension rose rapidly from 17.71% (95% CI: 16.60% to 18.90%) in 2009 to 24.01% (95% CI: 22.84% to 25.22%) in 2018 among males (p<0.001), whereas the prevalence among females remained stable at around 13.5% (p=0.98). Both awareness and treatment rates of hypertension among males and females showed a decreased trend between 2009 and 2018, while no significant changes were observed for control rates.

Conclusions

The mean systolic BP and diastolic BP among adults in Shenzhen increased from 1997 to 2018, and no improvements in hypertension awareness, treatment and control rates were found.
Fruquintinib plus oxaliplatin combined with S-1 (SOX) as neoadjuvant therapy for locally advanced gastric cancer (GC) or gastro-oesophageal junction adenocarcinoma (GEJ): a multicentre, phase II, single-arm, open-label clinical trial (FRUTINEOGA) protocol
Authors: Wu Liucheng , Yan Haiqing , Qin Yuzhou , Huang Mingwei , Wang Tingan , Jin Qinwen , Wei Weiyuan
Published: February 2024

Introduction

Curing locally advanced gastric cancer (GC) or gastro-oesophageal junction adenocarcinoma (GEJ) with surgery alone is challenging. Neoadjuvant chemotherapy (NCT) has become the standard treatment for patients with locally advanced GC/GEJ, and SOX is the most common neoadjuvant regimen in China. The generally good tolerability in patients and fruquintinib’s low potential for drug–drug interaction suggest that it may be highly suitable for combinations with other antineoplastic therapies. A combination of fruquintinib, S-1 and oxaliplatin can be a promising neoadjuvant treatment for locally advanced GC/GEJ. In this phase II study, we aim to investigate the efficacy and toxicity of fruquintinib plus SOX as neoadjuvant treatment for locally advanced GC/GEJ.

Methods and analysis

The FRUTINEOGA trial is a prospective, multicentre, phase II, single-arm, open-label clinical trial that will enrol 54 patients. Eligible patients will be registered, enrolled and receive 2–4 cycles of fruquintinib plus SOX, after which surgery will be performed and tumour regression will be evaluated. The primary endpoint is the pathological remission rate, and the secondary endpoints are disease-free survival, overall survival, objective response rate, major pathological response rate and R0 resection rate.

Ethics and dissemination

Written informed consent will be required from all patients enrolled, and it will be provided by them. The study protocol received approval from the independent ethical review committee of Guangxi Medical University Cancer Hospital, Wuming Hospital of Guangxi Medical University and Wuzhou Red Cross Hospital, Wuzhou Gongren Hospital (approval number: CS2021(96)). We will submit the finalised paper for publication on completing the analyses. This study will provide valuable insights to clinicians regarding the safety and efficacy of incorporating fruquintinib into SOX as neoadjuvant treatment for locally advanced GC/GEJ. The findings have the potential to inform future research proposals and may guide the use of fruquintinib in the neoadjuvant setting for locally advanced GC/GEJ.

Trial registration number

NCT05122091.
Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study
Authors: Wolf Florian , Folkerts Ann-Kristin , Zimmer Philipp , Nielsen Jörn
Published: February 2024

Objectives

(1) To explore experiences of fatigued persons with multiple sclerosis (pwMS) with a new multimodal agility-based exercise training (MAT) framework and (2) to investigate the demands of the Rehabilitation, Fatigue, and Exercise (ReFEx) study protocol, which compares high-frequency MAT and ‘traditional’ strength and endurance training (SET) to identify possible adaptations for a powered randomised controlled trial (RCT).

Design

A qualitative interview study nested within a feasibility RCT, comparing MAT and SET.

Setting

Neurological inpatient rehabilitation centre in Germany.

Participants

Twenty-two pwMS were recruited for the feasibility study. Six were selected from MAT and SET, respectively, for semistructured face-to-face interviews prior to discharge, following a purposive sampling strategy. Participants had low physical disability but were at least moderately fatigued.

Interventions

During inpatient rehabilitation (4–6 weeks) MAT participants attended group-based and manual-based MAT sessions in the gym (5×/week, 30 min) and the pool (3×/week, 30 min). SET participants exercised individually on a cycle ergometer (5×/week, 22 min) and on strength training machines (3×/week, 30 min).

Results

Three key categories emerged from the interviews: (1)facilitatorsregarding MAT were variety and playfulness, group setting and challenging exercises.Barriersregarding MAT were feeling overburdened, feeling pressured in the group setting and the wish to perform ‘traditional’ strength training (not part of MAT). (2) MATbenefitswere of physical and psychological nature, with improved balance stated the most. (3)Demandsdescribed the perceived exertion during MAT and SET, reflecting that there is no accumulation of fatigue during the intervention.

Conclusions

MAT is appreciated by pwMS and includes facilitators less attainable with ‘traditional’ SET. Evaluation of MAT in a powered RCT is indicated, if rest breaks postsession, and screening for negative self-evaluation and social comparison are considered. Future (qualitative) research should investigate the important factors of inpatient rehabilitation contributing to fatigue reduction in pwMS.

Trial registration number

DRKS00023943; German Clinical Trials Register.
Development of a Core Outcome Set for Dysphagia Interventions in Parkinson’s disease (COS-DIP): study protocol
Authors: Hirschwald Julia , Duncan Sallyanne , Warnecke Tobias , Boyle Gary , Regan Julie , Walshe Margaret
Published: February 2024

Introduction

Current clinical trials on swallowing disorders (dysphagia) in Parkinson’s disease (PD) apply a high variety of outcomes and different outcome measures making comparative effectiveness research challenging. Furthermore, views of patients and dysphagia clinicians when selecting trial outcomes have not been considered in the past, thus study results may have little importance to them. This study aims to develop an agreed standardised Core Outcome Set for Dysphagia Interventions in Parkinson’s disease (COS-DIP), systematically measured and reported as a minimum for all clinical trials. It will also comprise guidance on outcome definitions, outcome measures and time points of measurement.

Methods and analysis

The COS-DIP development will comprise five stages following established methodology: (1) a recent scoping review on all applied outcomes, their definitions, methods and time points of measurement in clinical trials in dysphagia in PD, (2) online surveys and focus groups with clinicians, patients, caregivers and family members to identify outcomes that are important to them, (3) an identified list of outcomes based on results of stage 1 and 2, (4) three round online Delphi survey with up to 200 key stakeholders to determine core outcomes and (5) two online consensus meetings with up to 40 representative key stakeholders to agree on all outcomes, definitions, methods and time points of measurement in the final COS-DIP.

Ethics and dissemination

Full ethical approval was obtained from the Research Ethics Committee, School of Linguistic, Speech and Communication Sciences, Trinity College Dublin, on 15 May 2023 (HT27). Dissemination of the COS-DIP will be enhanced through presentations at (inter-) national conferences and through peer-reviewed, open access publications of related manuscripts. Lay and professional information sheets and infographics will be circulated through relevant patient and professional organisations and networks.

Trial registration number

The COS-DIP study was registered prospectively with the Core Outcome Measures in Effectiveness Trials (COMET) database on 24 September 2021 (www.comet-initiative.org/Studies/Details/1942).
Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis
Authors: Abera Eyob Girma , Yesho Dawit Hailemariam , Erega Fraol Tesfaye , Adulo Zeleke Alemu , Gebreselasse Mahlet Zerabiruk , Gebremichael Ermias Habte
Published: February 2024

Objectives

This systematic review and meta-analysis aimed to assess the magnitude and determinants of diabetic ketoacidosis (DKA) among patients with diabetes mellitus (DM) in Ethiopia.

Design

Systematic review and meta-analysis.

Participants

Age 15 and above all patients with diabetes with the diagnosis of DKA in Ethiopia

Data source

PubMed/MEDLINE, Cochrane Library, Science Direct, HINARI, Google Scholar and grey literatures were accessed to find relevant articles. Studies that have been conducted and reported in English language, articles with an available full-text, and observational studies were included. The task of searching sources was carried out from all stated electronic databases performed during 15 April–29 April 2023.

Primary and secondary outcome measures

Eligible studies were critically appraised by three independent reviewers for methodological quality in the review using standardised critical appraisal instruments from Joanna Briggs Institute (JBI) for observational studies. After the finally extracted studies were exported, systematic review and meta-analysis were conducted using Unified Management, Assessment and Review of Information (JBI SUMARI) (JBI, Adelaide, Australia) and STATA V.17 software. Sensitivity tests were done, and funnel plot inspections with Egger’s test were used to check for publication bias.

Result

From a total of 19 studies with 6498 study participants, the pooled prevalence of DKA among patients with DM in Ethiopia was 30.92% (95% CI 29.96 to 31.89) with a significant statistical heterogeneity (I2=99.2, p=<0.001). Sensitivity analysis suggested that three studies showed deviations from the estimated pooled prevalence. A funnel plot inspection and Egger’s test indicated the absence of a publication bias.

Conclusion

This systematic review and meta-analysis revealed that the prevalence of DKA among patients with DM in Ethiopia was 30.92%. Besides, different behavioural and clinical determinants of DKA among patients with DM were identified. However, further studies should be conducted, particularly on the possible determinants of DKA, and different stakeholders should be engaged to minimise its burden.
‘DANMM that’s good!’: evaluating the feasibility and acceptability of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Programme across rural, regional and metropolitan NSW–a collaborative study protocol
Authors: Biles Brett , Christian Bradley , Marshall Charmaine , McMillan Faye , Sara Grant , Anderson Judith , Davies Nicolle , Fealy Shanna , Biles Jessica
Published: February 2024

Introduction

This paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a cultural mentoring programme designed for Aboriginal and Torres Strait Islander nurses and midwives across five diverse local health districts in New South Wales, Australia. Government and health agencies highlight the importance of culturally appropriate and safe environments for Aboriginal people. Specifically, New South Wales Health prioritises workforce strategies that support Aboriginal people to enter and stay in the health workforce. However, retaining Aboriginal nurses and midwives remains challenging. The DANMM Project aligns with these local and state-wide health plans and strategies, addressing critical issues of workforce cultural safety and retention.

Methods and analysis

A mixed-methods study design will be employed to assess feasibility, acceptability and preliminary efficacy of the DANMM Programme across five publicly funded local health districts in New South Wales, Australia. Adhering to cultural safety, a project cultural governance group will be formed. Quantitative outcome measures include the use of questionnaires (Nursing Workplace Satisfaction Questionnaire, Ganngaleh nga Yagaleh Cultural Safety assessment tool). Resource implications will be measured using the Organisational Commitment and Health Professional Program Readiness Assessment Compass. These will be triangulated with individual and group yarning circles to provide a holistic evaluation of the programme.

Ethics and dissemination

The study has ethics approval: Aboriginal Health and Medical Research Council (#2054/23); New South Wales Health Human Research Committees (Greater Western Human Research Committee #2022/ETH01971, Murrumbidgee—site-specific approval, Sydney Local Health District—site-specific approval, Western Sydney Local Health District—site-specific approval and Mid North Coast—site-specific approval); and Charles Sturt University Human Research Committee (#2054/23). Findings will be disseminated through peer-reviewed articles, conferences and through roundtable discussions with key stakeholders.