bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of the effect of multimodal input on vocabulary acquisition: Evidence from online Chinese language learners
Authors: Xing Binyu , Zhang Haiwei
Published: January 2025

In response to the growing prevalence of online second language learning and the burgeoning field of international Chinese language education, this study examines the impact of multimodal inputs (MMI) on vocabulary acquisition within online environments among learners of Chinese as a second language (CSL). A teaching intervention was conducted with 90 Mongolian CSL learners, who were grouped into audiovisual, audio, and visual groups. The findings indicate that the audiovisual condition significantly improved vocabulary retention compared to the single-modality conditions in a delayed post-test. Nevertheless, the efficacy of the MMI treatment was observed to vary with learners’ proficiency levels, with beginner-level CSL learners deriving greater benefit from MMI than intermediate-level learners. Furthermore, participants expressed both favorable and critical perspectives regarding the application of MMI in vocabulary instruction. These results highlight the potential of MMI interventions to enhance vocabulary learning in online second-language education, while also underscoring the necessity of considering learners’ target language proficiency and their attitudes when developing MMI-based instructional approaches.
The effect of language proficiency, usage, and exposure on cognitive control: A study in early adulthood Chinese learners of English
Authors: Xia Lihua , Sorace Antonella , Vega-Mendoza Mariana , Deng Xiaohong , Bak Thomas H.
Published: January 2025

Aims and Objectives/Purpose/Research Questions:

This study investigated the effect of the specific L2 learning experience (i.e., usage, proficiency, and exposure) on cognitive performance in 121 Chinese learners of English.

Design/Methodology/Approach:

The participants were divided into three groups: beginning, intermediate, and advanced learners. They are homogeneous in background variables (e.g., cultural and educational environment) but heterogeneous in the L2 language experience. They performed three non-linguistic cognitive tasks, tapping into multiple dimensions of cognitive functions in visual and auditory domains.

Data and Analysis:

Linear mixed-effect models were applied to RT-based analysis (i.e., analysis based on Reaction Time), and linear regression models were used for accuracy-based analysis. In addition, further multiple stepwise regression analyses were conducted to explore the relationships between individuals’ demographics, language experience, and their performance on the attentional tasks.

Findings/Conclusions:

Three groups were comparable in background measures (e.g., socioeconomic status [SES]) and fundamental cognitive abilities (e.g., working memory and IQ), but differed in specific subcomponents of cognitive functions. Specifically, compared with beginning learners, advanced learners who had a longer length of L2 usage and higher proficiency showed better inhibitory control; intermediate learners who received intensive L2 exposure and had higher proficiency showed better-switching ability and attentional disengagement. Intermediate and advanced learners were comparable in cognitive performance. The results suggest that early adulthood L2 learners experience similar cognitive effects of bilingualism, which are modulated by specific language experience.

Originality:

This is one of the first bilingual studies to incorporate both visual and auditory cognitive functions, while providing additional analyses to investigate the other components of cognitive control.

Significance/Implications:

The results contribute to the understanding of the key aspects of the L2 learning experience that contribute to the emergence of the cognitive effects of young adult learners.
Foucault, Parrhesia and the politics of presence: on not speaking truth to power
Authors: Howell Philip
Published: January 2025

This paper considers the take-up by geographers and others of Foucault’s late work on parrhesia, the ancient Greek concept of frank or fearless speech. While there has been productive work on its genealogy and geographies, parrhesia has been commonly translated as ‘speaking truth to power’ and discussion has centred around resistance. This paper argues that ‘speaking truth to power’ selects and simplifies the range of practices considered in Foucault’s history of truth and subjectivity. But Foucault’s genealogy of parrhesia suffers from the same problem that besets the idea of ‘speaking truth to power’. This is the privileging of the immediate presence of the speaking subject. The phonocentric ideal distorts our understanding of the geographies of parrhesia, particularly in the modern period, where political speech is never unmediated. This leaves the normative significance of parrhesia vulnerable to liberal academic self-congratulation as well as hampering the exploration of frank speech in our own day.
Familiarity influences on proactive interference in verbal memory
Authors: Mercer Tom
Published: January 2025

Proactive interference occurs when older memories interfere with current information processing and retrieval. It is often explained with reference to familiarity, where the reappearance of highly familiar items from the recent past produces more disruption than older, less familiar items. However, there are other forms of familiarity beyond recency that may be important, and these were explored in a verbal recent-probes task. Participants viewed eight targets per trial and then determined whether a probe matched any of those targets. Probes matching a target from the previous trial, rather than an earlier trial, led to more errors, revealing proactive interference. However, this effect was influenced by experimental familiarity (whether stimuli were repeated or unique) and pre-experimental familiarity (whether stimuli were meaningful words or meaningless non-words). Specifically, proactive interference was strongest for repeated non-words, and smallest for unique non-words, but stimulus repetition had little impact for words. In addition, the time separating trials (temporal familiarity) was unrelated to proactive interference. The present findings revealed more complex effects of familiarity than have previously been assumed. To understand proactive interference in a working memory task, it is necessary to consider the role of long-term memory via experimental and pre-experimental stimulus familiarity.
Global measures of syntactic and lexical complexity are not strong predictors of eye-movement patterns in sentence and passage reading
Authors: Kuperman Victor , Buzato Dalmo , Rothe-Neves Rui
Published: January 2025

The link between the cognitive effort of word processing and the eye-movement patterns elicited by that word is well established in psycholinguistic research using eye-tracking. Yet less evidence or consensus exists regarding whether the same link exists between linguistic complexity measures of a sentence or passage and eye movements registered at the sentence or passage level. This article focuses on “global” measures of syntactic and lexical complexity, i.e., the measures that characterise the structure of the sentence or passage rather than aggregate lexical properties of individual words. We selected several commonly used global complexity measures and tested their predictive power against sentence- and passage-level eye movements in samples of text reading from 13 languages represented in the Multilingual Eye Movement Corpus (MECO). While some syntactic or lexical complexity measures elicited statistically significant effects, they were negligibly small and not of practical relevance for predicting the processing effort either in individual languages or across languages. These findings suggest that the “eye-mind” link known to be valid at the word level may not scale up to larger linguistic units.
Angular hypertrophied epiphysis of the thumb distal phalanx in radial polydactyly
Authors: Kim Jae Kwang , Shin Young Ho , Lee Wonsun
Published: January 2025

In a series of 271 consecutive duplicated thumbs, an angular, hypertrophied epiphysis was detected in 13 thumbs. We propose a revised version of the radial polydactyly classification that includes this pattern as a separate type from triphalangeal thumb.
Artificial intelligence and machine learning capabilities in the detection of acute scaphoid fracture: a critical review
Authors: Miller Robert , Jackson Laurence , Vilic Dijana , Boyce Louis , Shuaib Haris
Published: January 2025

This paper discusses the current literature surrounding the potential use of artificial intelligence and machine learning models in the diagnosis of acute obvious and occult scaphoid fractures. Current studies have notable methodological flaws and are at high risk of bias, precluding meaningful comparisons with clinician performance (the current reference standard). Specific areas should be addressed in future studies to help advance the meaningful and clinical use of artificial intelligence for radiograph interpretation.
A fuzzy logic approach for tie strength assessment in relationship management: Design and performance comparison of two implemented fuzzy-based models
Authors: Higashi Shunya , Ampririt Phudit , Ikeda Makoto , Matsuo Keita , Barolli Leonard , Xhafa Fatos
Published: January 2025

In an increasingly digitalised and interconnected world, assessing the strength of interpersonal ties in social networks is crucial for fields such as business, marketing and sociology. Traditional methods for evaluating Tie Strength (TS), which often classify relationships as either ”strong” or ”weak”, fail to capture the uncertainty and ambiguity of human interactions. This study proposes a Fuzzy-based System for Assessment of Tie Strength (FSATS). We develop and evaluate two models: FSATSM1, which utilises three input parameters Interaction Time (IT), Level of Intimacy (LoI) and Emotional Intensity (EI); and FSATSM2, where we introduce Reciprocity (Rc) as an additional parameter. Through simulations, we compare the performance of both models for the assessment of TS. The simulation results show that for FSATSM1, when IT is 0.9 and EI is 0.7 for all values of LoI, the TS values are more than 0.5. While, for FSATSM2, when IT is 0.9, for EI 0.1 (Rc more than 0.8), EI 0.5 (Rc more than 0.5) and EI 0.9 (Rc more than 0.2), all values of TS are more than 0.5, indicating a strong relationship. The results suggest that FSATSM2 provides a more accurate reflection of real-world relationships, which can be applied in contexts such as Social Customer Relationship Management (SCRM), enabling businesses to enhance customer engagement strategies.
Watermelon Flower Petal-derived Apigenin Exhibits Anti-inflammatory Effects by Suppressing M1 Macrophage Polarization in Lipopolysaccharide/Interferon-gamma-co-stimulated RAW264.7 Cells
Authors: Fujita Shingo , Yamaguchi Akiho , Ninomiya Masayuki , Koketsu Mamoru , Hashizume Toshiharu , Itoh Tomohiro
Published: January 2025

Background

Watermelon fruits contain various bioactive compounds. However, the bioactivity of watermelon flower petals, specifically in the context of the anti-inflammatory effects, remains unknown.

Objectives

In this study, we aimed to evaluate the effects of watermelon flower petal-derived components on nitric oxide (NO) production and elucidate the mechanisms underlying this process in murine macrophage RAW264.7 cells that were co-stimulated with lipopolysaccharide (LPS) and interferon-gamma (IFNγ).

Materials and methods

Phenolic compounds (specifically p-hydroxybenzoic acid, protocatechuic acid, apigenin, and rhoifolin) were first isolated from watermelon flower petals. NO production was assessed using a Griess reagent kit. The mRNA expression of Nos2, Cox2, Tnfα, Il6, and Cd80 was determined using quantitative real-time polymerase chain reaction. The protein expression levels of the following molecules were assessed using western blotting: inducible NO synthase (iNOS); cyclooxygenase-2; heme oxygenase-1; toll-like receptor 4; phosphorylated-extracellular signal-regulated kinase (p-ERK); ERK; p-p38; p38; p-Jun amino terminal kinase (p-JNK); JNK; p-nuclear factor-kappa B (p-NF-κB); NF-κB; p-signal transducer and activator of transcription 1 (p-STAT1); and STAT1. Furthermore, the nuclear translocation of NF-κB was observed using fluorescence microscopy.

Results

NO production was suppressed in LPS/IFNγ-co-stimulated RAW264.7 cells treated with apigenin. Additionally, iNOS mRNA and protein expression were reduced in LPS/IFNγ-co-stimulated RAW264.7 cells. Apigenin resulted in a slight reduction in the levels of phosphorylated p38, JNK, and STAT1; on the other hand, phosphorylation and nuclear translocation of NF-κB remaining unchanged in the LPS/IFNγ-co-stimulated RAW264.7 cells. mRNA expression of Cd80, a notable cell surface M1 macrophage marker, was suppressed by apigenin in LPS/IFNγ-co-stimulated RAW264.7 cells.

Conclusion

Apigenin was found to suppress M1 macrophage polarization in LPS/IFNγ-co-stimulated RAW264.7 cells. The study findings suggest that watermelon flower petals represent a promising and valuable source of anti-inflammatory agents.
The Evolving Nature of Generalized Prejudice Toward Marginalized Groups in the United States 2004–2020
Authors: Hodson Gordon , Puffer Hanna
Published: January 2025

Prejudices intercorrelate positively and can be modeled as a generalized prejudice (GP) factor that is considered robust and central to postulating that some people are relatively more prejudiced than others (i.e., prejudice is not purely contextual). Although past research documents changes in specific prejudices over time, the field tacitly assumes GP stability/robustness, an untested notion. Using nationally representative American National Election Survey 2004–2020 data ( N = 21,998) assessing attitudes toward Black people, illegal immigrants, gay people, and feminists, we discovered that prejudices have become increasingly correlated over time. Initially invariant, from 2012 onward GP became variant and required correlated residuals between prejudices (outside of GP). GP vastly increased its association with political conservatism (≈.41 in 2004–2008, ≈.70 by 2016–2020) but less so with age, sex, and education. Indeed, best fit in 2020 involved a “GP 2.0” factor indicated by specific prejudices and conservatism. Implications regarding the nature of prejudice are discussed.
Infection prevention in the immunocompromised traveler due to conditions other than transplantation: a review
Authors: Sassine Joseph , Siegrist Emily A. , Wilson Dib Rita , Henao-Cordero José , Agudelo Higuita Nelson Iván
Published: January 2025

This narrative review explores the risks related to infection in immunocompromised travelers due to conditions other than transplantation, and evaluates the evidence behind current prophylactic strategies, including immunizations, antimicrobials, and non-pharmacological interventions, to prevent various infection and how the current evidence applies to this special patient population, from the perspective of a US-based traveler.
Overview of basic design recommendations for user-centered explanation interfaces for AI-based clinical decision support systems: A scoping review
Authors: Jung Ian-C. , Schuler Katharina , Zerlik Maria , Grummt Sophia , Sedlmayr Martin , Sedlmayr Brita
Published: January 2025

Objective

The application of artificial intelligence (AI)-based clinical decision support systems (CDSS) in the healthcare domain is still limited. End-users’ difficulty understanding how the outputs of opaque black AI models are generated contributes to this. It is still unknown which explanations are best presented to end users and how to design the interfaces they are presented in (explanation user interface, XUI). This article aims to provide an overview of recommendations for the user-centered design of XUIs from the scientific literature.

Methods

A scoping review was conducted to identify recommendations for the design of XUIs. Articles published between 2017 and 2022 in English or German, presenting original research or literature reviews, focusing on XUIs for end users or domain experts, which are intended for presentation in graphical user interfaces and from which recommendations could be extracted were included in the review. Articles were retrieved from Scopus, Web of Science, IEEE Explore, PubMed, ACM Digital Library, and PsychInfo. A mind map was created to organize and summarize the identified recommendations.

Results

From the 47 included articles, 240 recommendations for the user-centered design were extracted. The organization in a mind map resulted in 64 summarized recommendations.

Conclusion

This review provides a synopsis of basic recommendations for the user-centered design of XUIs, focusing on the healthcare domain. During the analysis of the articles, it became clear that no specific and directly implementable design recommendations for AI-based CDSS can be given, but only basic recommendations for raising awareness about the user-centered design of XUIs.
Evaluation of reporting trends in the MAUDE Database: 1991 to 2022
Authors: Mishali Meital , Sheffer Nadav , Mishali Oren , Negev Maya
Published: January 2025

Adverse event reporting for medical devices is critical for risk mitigation. The Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database serves as a key tool for post-market surveillance, receiving reports from various sources. Ensuring information integrity, especially across diverse reporting sources, is paramount. Periodic regulatory updates aim to enhance reporting.

Objective

Analyze reporting patterns, assess the potential contribution of 2015 and 2018 regulatory updates on reporting rates for varies reporters. Additionally, evaluating reporting schedule compliance by comparing average reporting times to regulatory requirements for these reporters.

Methods

Data from 1991–2022 was retrieved from the MAUDE database. Annual report counts were filtered by reporter and event type. Average reporting time was calculated as the difference between received and awareness dates.

Results

The 2018 Voluntary Malfunction Summary Reporting (VMSR) program correlated with an increase in manufacturers’ event reporting, peaking at 3,135,501 events in 2022. Distributors’ reports surged post-2018, while voluntary reports steadily increased since 1997, spiking notably in 2015 with the Electronic Medical Device Reporting (eMDR) submission update. Reporting times for deaths averaged 80 days for manufacturers, far exceeding regulatory requirements, compared to 40 days for distributors and 46 days for user facilities. Malfunction events had longer average reporting times for manufacturers (89 days) compared to distributors (44 days).

Conclusions

Changes in reporting trends around 2015 and 2018 may be linked to regulatory updates. Tailoring regulatory changes for each reporter type, like user-friendly electronic forms, new reporting programs, and exemptions cancelations, can improve reporting. Balancing the volume of reports among different reporters is crucial for enhancing database integrity, transparency, and overall health outcomes.
Legacy and Leadership: Celebrating the Contributions of Six Visionary Presidents of the World Society for Pediatric and Congenital Heart Surgery
Authors: Kirklin James
Published: January 2025

Leadership in pediatric and congenital heart surgery requires a distinctive blend of clinical mastery, scientific innovation, and an unwavering commitment to education and mentorship. The individuals who rise to the top of this demanding field exhibit not only surgical prowess but also the ability to foster progress through impactful research, publications, and training the next generation of surgeons. These qualities are exemplified by the six past presidents of the World Society for Pediatric and Congenital Heart Surgery (WSPCHS), whose leadership has been instrumental in advancing both the Society and the broader field of pediatric cardiac care. This article pays tribute to these visionary leaders, highlighting their contributions to the Society and their global impact on congenital heart surgery. Their leadership has profoundly influenced the direction of the WSPCHS, contributing to its success and shaping the future of the specialty
Report on the 6th Ottawa International Conference on Neuromuscular Disease & Biology – September 7–9, 2023, Ottawa, Canada
Authors: Warman-Chardon Jodi , Jasmin Bernard J , Kothary Rashmi , Parks Robin J
Published: January 2025

The 6th Ottawa International Conference in Neuromuscular Disease and Biology was held on September 7–9, 2023 in Ottawa, Canada. The goal of the conference was to assemble international experts in fundamental science, translational medicine and clinical neuromuscular disease research. Speakers provided attendees with updates on a wide range of topics related to neuromuscular disease and biology, including methods to identify novel diseases, recent developments in muscle, motor neuron and stem cell biology, expanded disease pathogenesis of known diseases, and exciting advances in therapy development. A summary of the major topics and results presented by these speakers is provided.
Forgotten Children: The Crisis of Child Welfare and Alternative Care in Afghanistan
Authors: Murtaza Amir , Rogers Justin
Published: January 2025

This article explores the complex landscape of alternative care for orphaned and vulnerable children in Afghanistan against the backdrop of prolonged conflict, political turmoil and socio-economic challenges. With an estimated 2 million orphans and countless more children living in challenging circumstances, the country faces a daunting task in ensuring the well-being and protection of its most vulnerable population. This analysis explores the various forms of alternative care available in Afghanistan, including traditional family care, orphanages, foster care and community-based initiatives. It highlights the historical evolution of child protection policies and programmes, tracing the impact of significant events such as the Taliban regime’s rule, periods of conflict and the subsequent transition periods, including the Taliban’s resurgence in 2021. The compounded challenges faced by children and families are examined, including disruptions in funding, aid delivery and access to essential services. Key stakeholders involved in alternative care, including government authorities, non-governmental organisations, religious leaders and extended families, are identified, emphasising the importance of collaborative efforts in addressing these challenges. The article concludes with a set of recommendations aimed at enhancing child protection policies, strengthening family support systems, and fostering stable environments where children’s rights and well-being are prioritised. Ultimately, the article underscores the urgency of concerted action to ensure Afghanistan’s orphaned and vulnerable children are not forgotten amidst the context of ongoing turmoil and uncertainty in the nation’s governance.
A Study of Tenecteplase in Acute Ischaemic Stroke: A Descriptive Real World Single Centre Experience from a Public Tertiary Care Hospital in Western India
Authors: Nagendra Shashank , Chaudhary Gaurav , Ojha Pawan , Jagiasi Kamlesh , Singh Rakesh , Singh Rakesh K. , Chheda Akash , Shah Arjun , Mahto Anuradha , Aipu Bilia K , Goud Survi Karthik , Bagadia Harshil , Gutte Avinash Angad , Radhakrishnan Rahul , Deshmukh Narayan
Published: January 2025

Background

This study evaluates the efficacy and safety of tenecteplase, a newer thrombolytic agent, in acute ischaemic stroke (AIS) at a tertiary public care centre in Western India.

Methods

This retrospective study analysed 30 patients with AIS treated with tenecteplase, presenting within 4.5 hours from onset and receiving 0.25 mg/kg of tenecteplase. Primary outcomes were patients achieving a modified Rankin Scale (mRS) score of 0-1 at 90 days and those showing an improvement of the National Institutes of Health Stroke Scale (NIHSS) by 4 after 24 hours of thrombolysis. The secondary outcome was patients showing an improvement of NIHSS by 2 after 24 hours of thrombolysis and the number of patients showing an mRS score of 0-2 at 90 days. Safety outcomes were symptomatic intracerebral haemorrhage (ICH), all intracranial bleeding occurring within 24 hours, and in-hospital mortality. The impact of age and sex on outcomes was assessed.

Results

The mean age was 55.86 years. The mean symptom onset-to-hospital arrival time was 111.4 minutes and the mean door-to-needle time was 64.66 minutes. Out of all patients, 22 were male, and 8 were female. The mean NIHSS was 11.86 at presentation and 7.97 at 24 hours. The primary outcome of mRS 0-1 at 3 months was achieved in 19 patients; change in NIHSS ≥4 at 24 hours was in 7 patients. For secondary outcome, NIHSS change of 2 at 24 hours occurred in 13 patients, while 25 patients achieved mRS 0-2 at 3 months. Symptomatic ICH occurred in 1 patient, any ICH occurred in 7, while 2 patients had in-hospital mortality.

Conclusion

Tenecteplase is a safe and effective option for patients with AIS presenting within 4.5 hours.
In focus: Capturing female rock photojournalists trailblazing attitudes on gender and stereotypes (1970s–1980s)
Authors: Bronsoms Angels
Published: January 2025

Women music photojournalists in the 1980s escaped gender discrimination in the workforce because their work took place outside the newsroom. This finding merits an in-depth examination of women’s perspectives as photojournalists during this time. Based on the testimonies of five self-identified women born between 1953 and 1963 who worked as music photographers in the 1970s and 1980s, this paper analyzes the participants’ gender perceptions regarding their professional experiences in the photojournalism field. An analysis of the sample reveals that the public spaces where male and female photographers worked had no significant impact on gender discrimination, as editors operated with an economy of means compared to the work environments where men and women are forced to interact and socialize, such as newsrooms. The findings of this study contribute to ethnographic research on subcultures, increasing public interest in gender studies, particularly about education, professional performance, and perceptions of gender roles.
Shake table testing of a full-scale three-story seismically resilient steel-framed building with reconfigurable lateral force-resisting systems
Authors: Morano Michael , Liu Junwei , Williamson Emily , Hutchinson Tara , Pantelides Chris , Saxey Brandt , Richards Paul
Published: January 2025

Shake table testing is a costly endeavor, often requiring construction of large-scale 3D specimens to allow system stability, though the focus may be solely on understanding the behavior of select components, subsystems, or contents. To minimize this burden on future researchers using the six-degree-of-freedom (DOF) Large High-Performance Outdoor Shake Table (LHPOST6) at UC San Diego, a unique Modular Testbed Building (MTB2) is designed and tested in a variety of configurations atop the LHPOST6 facility. The MTB2 is a reconfigurable, 3-story steel-framed building designed with replaceable structural fuses. The first use of the MTB2 involved testing two primary lateral force-resisting system (LFRS) configurations, namely Special Moment Frames (SMFs) and Buckling-Restrained Braced Frames (BRBF). As part of the SMF configuration, a rotationally compliant, column baseplate (CB) connection was integrated as an additional form of energy dissipation. The MTB2 in each of its LFRS configurations was subjected to a suite of one-, two- and three-DOF earthquake motions of increasing intensity. This unique building and its primary components are designed and detailed to be reused with easily replaceable fuses allowing the building to be reconfigured and retested. A shake-down program was undertaken to elicit a range of building responses from elastic to nonlinear with a dense sensor array provided to monitor global and local component responses. A reduced-order numerical model is developed, which offers a robust comparison with the specimen’s measured response.
The blood transcriptional response in patients developing intensive care unit-acquired pneumonia
Authors: de Brabander Justin , Michels Erik H.A. , Butler Joe M. , Reijnders Tom D.Y. , van Engelen Tjitske S.R. , Leite Giuseppe G.F. , Paling Fleur P. , Klarenbeek Augustijn M. , Sie Daoud L.S. , Boyer Roxane E. , Sweeney Timothy E. , Bonten Marc J.M. , Timbermont Leen , Malhotra-Kumar Surbhi , Kluytmans Jan A.J.W. , Peters-Sengers Hessel , van der Poll Tom
Published: January 2025

Introduction

Immune response dysregulation has been implicated in the development of intensive care unit (ICU)-acquired pneumonia. We aimed to determine differences in the longitudinal blood transcriptional response between patients who develop ICU-acquired pneumonia (cases) and those who do not (controls).

Methods

We performed a case-cohort study in mechanically ventilated trauma and surgery patients with ICU stays >2 days, enrolled in 30 hospitals across Europe. We collected blood for RNA sequencing at baseline, day 7 and (in cases) the day of pneumonia diagnosis. We performed gene set enrichment analysis and analysed longitudinal gene expression changes using linear mixed models. External validation was performed using an independent trauma cohort.

Results

We enrolled 113 cases and 115 controls, with similar baseline characteristics. At baseline (median 2 days after ICU admission), cases showed upregulated gene pathways relating to innate immunity, hemostasis and metabolism, and downregulated adaptive immune pathways. These changes persisted at the day of pneumonia diagnosis (median 6 days, compared to day 7 in controls). In the longitudinal comparison, cases exhibited enhanced upregulation of innate immunity, adaptive immunity and hemostasis pathways, along with enhanced downregulation of metabolism pathways relative to controls (all p<0.00001, except hemostasis p<0.05). These findings were largely externally validated. Cases had higher quantitative sepsis response signature scores (p<0.001), reflective of immune dysregulation.

Conclusion

Patients developing ICU-acquired pneumonia exhibit distinct blood transcriptional responses shortly after ICU admission and in the subsequent path to pneumonia, suggestive of broad immune dysfunction with both immunosuppressive and inflammatory features.
Development and external validation of a model for lung transplantation-free survival prediction of primary Sjögren's syndrome-associated interstitial lung disease: a prospective cohort study
Authors: Meng Wenyan , Zhang Xinran , Zhang Shu , Xie Bingbing , Ren Yanhong , Wang Shiyao , Geng Jing , Guo Xiaojuan , Liu Min , Xie Sheng , Zhao Ling , Wang Chen , Dai Huaping
Published: January 2025

Background

The primary Sjögren's Syndrome-associated Interstitial Lung Disease (pSS-ILD) patients have a worse prognosis than pSS patients without pulmonary involvement. This study aims to establish a prediction nomogram for early prediction of lung transplantation (LTx)-free survival in pSS-ILD patients.

Methods

The training cohort comprised 260 patients from China-Japan Friendship Hospital between January 1, 2016, and June 30, 2022, while the external validation cohort consisted of 135 patients from Beijing Chaoyang Hospital between January 1, 2007, and December 31, 2012. Univariable Cox regression analysis and least absolute shrinkage and selection operator (LASSO) were employed for variable selection, and a nomogram model was developed to predict the 1 -, 3 -, 5-year LTx-free survival. Both discrimination and calibration of the nomogram were assessed using concordance index (C-index), area under the curve (AUC), calibration curve and decision curve analysis (DCA).

Results

Multivariable Cox regression demonstrated that elevated age, oxygenation index, CA125 and fibrosis score were independent risk factors for LTx-free survival in pSS-ILD patients. The C-index displayed of the training and validation cohorts were 0.812 and 0.809. The 1-, 3-, 5-year AUC values in training and validation cohorts were 0.781, 0.874, 0.909 and 0.793, 0.826, 0.863 respectively. Bias-corrected curve is close to the ideal curve and revealed a strong consistency between actual observation and prediction.
Social support and recovery in ARDS survivors: a prospective cohort study
Authors: Szymczak Hermann , Brandstetter Susanne , Blecha Sebastian , Dodoo-Schittko Frank , Rohr Magdalena , Bein Thomas , Apfelbacher Christian
Published: January 2025

Background

Social support (SS) may contribute to the long-term recovery of critical illness survivors. This study focuses on survivors of the acute respiratory distress syndrome (ARDS) to investigate the causal relationship between SS and health related quality of life (HRQoL) and healthcare utilization in critically ill patients.

Methods

A cohort study with N=877 ARDS survivors in 61 ICUs was conducted in Germany, between 2014 and 2019. SS (F-SozU K-14) and HRQoL (Physical and Mental Component Scale: PCS, MCS of the SF-12) were assessed at 3, 6, 12, and 24 months after ICU discharge. Healthcare utilization was assessed after 12 and 24 months. To identify confounders and allow for causal inferences, a directed acyclic graph (DAG) was developed.

Results

Adjusted regression models demonstrated significant positive impact of SS on mental HRQoL after three months onward (all ßs >0.15, allps <0.05). This influence increases over time. In contrast, the influence of SS on physical HRQoL and healthcare utilization remained inconclusive (only one significant association for physical HRQoL at 12 months: β=0.128, p<0.05, otherwise allps >0.05).

Conclusion

Results indicate SS plays an important and unique role in the long-term recovery of survivors of critical illness in the mental area. It appears that the more distal mechanism of SS unfolds progressively over time, perhaps as the immediate sequelae of critical illness after discharge subside. In contrast, SS does not appear to exert a substantial causal impact on physical HRQoL and healthcare utilization.
Strains of a virtuoso: pacemaker infection and ventricular tachycardia in a violinist
Authors: Chen Yuanguo , Zhang Haibo , Qiao Qi , Ma Lian
Published: January 2025

Purpose

Pacemaker-related infections are serious complications of cardiac implantable electronic devices (CIEDs). This case report aims to describe the occurrence of pacemaker pocket infection and recurrent ventricular tachycardia (VT) in a Chinese amateur violinist with sick sinus syndrome (SSS), and to explore the possible connection between occupational habits and the infection, as well as VT.

Methods

A 76-year-old male violinist with a Biotronik Evia DR dual-chamber pacemaker presented with syncope and signs of a pacemaker pocket infection three years after implantation. Despite initial antibiotic treatment, the infection persisted with slightly elevated C-reactive protein (CRP) and negative cultures. The VT originated from the right ventricular outflow tract (RVOT), as confirmed by echocardiography and ECG findings. The infection was treated with debridement and extraction of the pacemaker and leads.

Results

Debridement and extraction of the pacemaker and leads successfully resolved both the VT and the infection. The VT was likely linked to the infected lead, while the pacemaker infection was attributed to the patient’s violin playing, which caused mechanical stress and skin damage at the pacemaker site. Postoperative recovery was uneventful, with no recurrence of infection or arrhythmias at follow-up.

Conclusion

This case highlights the importance of considering a patient’s occupational habits when selecting pacemaker pocket sites to prevent infections and complications. In this case, the patient’s violin playing likely contributed to mechanical stress at the pacemaker site, leading to infection. Early identification and appropriate management, including device removal, are crucial to prevent further complications.
Role of regular medical visits in mitigating increased suicide risk during the early COVID-19 pandemic in Kobe, Japan
Authors: Miyamori Daisuke , Nagasaki Yasushi , Yoshida Shuhei , Kashima Saori , Omori Wataru , Itagaki Kei , Ito Masanori
Published: January 2025

Background

Japan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan.

Method

This quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012–2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020–2022) versus the control period (2012–2019). Regular visits to primary care and psychiatry stratified analysis.

Results

2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups.

Conclusion

This study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic.
Enhanced detection of mild cognitive impairment in Alzheimer’s disease: a hybrid model integrating dual biomarkers and advanced machine learning
Authors: Alex John Sahaya Rani , Roshini R. , Maneesha G. , Aparajeeta Jeetashree , Priyadarshini B. , Lin Chih-Yang , Lung Chi-Wen
Published: January 2025

Alzheimer's disease (AD) is a complex, progressive, and irreversible neurodegenerative disorder marked by cognitive decline and memory loss. Early diagnosis is the most effective strategy to slow the disease's progression. Mild Cognitive Impairment (MCI) is frequently viewed as a crucial stage before the onset of AD, making it the ideal period for therapeutic intervention. AD is marked by the buildup of amyloid-beta (Aβ) plaques and tau neurofibrillary tangles (NFTs), which are believed to cause neuronal loss and cognitive decline. Both Aβ plaques and NFTs accumulate for many years before the clinical symptoms become apparent in AD. As a result, in this study, CerebroSpinal Fluid (CSF) biomarker information is combined with hippocampal volumes to differentiate between MCI and AD. For this, a novel two-stage hybrid learning model that leverages 3D CNN and the notion of a Fuzzy and Machine learning model is proposed. A 3D-CNN architecture is employed to segment the hippocampus from the structural brain 3D-MR images and quantify the hippocampus volume. In stage 1, the hippocampus volume is passed through thirteen machine learning models and fuzzy clustering for classifying symptomatic AD and healthy brain (Normal Control - NC). The CSF data is fuzzified to capture the inherent uncertainty and overlap in clinical data. The identified symptomatic AD data in the stage1 are further classified into MCI and AD with the aid of a fuzzified CSF biomarker in stage 2. The experimental work presented in this study utilized the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. The proposed hybrid model achieved an average accuracy of 93.6% for distinguishing between NC and symptomatic AD and 93.7% for discriminating between MCI and AD. This approach enhances diagnostic accuracy and provides a more comprehensive assessment, allowing for earlier and more targeted therapeutic interventions.
Prevalence of obsessive-compulsive symptoms in patients with schizophrenia treated with clozapine: a scoping review
Authors: Moreno Tarazona Evelyn , Orozco Gonzalez Mauricio , La Rosa Giron Andrea , Ruiz-Grosso Paulo , Lazo-Porras Maria
Published: January 2025

Background

Schizophrenia is a complex psychiatric disorder, and in patients treated with clozapine, it may induce or exacerbate obsessive-compulsive symptoms (OCS), which negatively affect patients’ quality of life, functionality and treatment adherence. Despite its clinical relevance, the reported prevalence and characteristics of clozapine associated OCS vary widely, limiting effective management.

Objective

This scoping review synthesizes evidence on the prevalence of OCS in patients with schizophrenia treated with clozapine and explores treatment characteristics (types, severity, dose, and time to onset/exacerbation).

Methods

The PRISMA-ScR methodology guided the search in PubMed, LILACS, Embase, and Scielo. Observational studies in Spanish, English, Portuguese, and French reporting prevalence, incidence, or frequency of OCS in patients over 18 years with schizophrenia treated with clozapine were included. Clinical, qualitative studies, and those with access restrictions were excluded. Risk of bias was assessed using JBI tools.

Results

Fourteen studies were included, reporting OCS prevalence between 20% and 76%, and de novo OCS between 4.8% and 46.4%. Clozapine dose ranged from 196 to 525 mg/day, and treatment duration from 5 to 210 months. The most common obsessions were aggression and checking, with severity ranging from mild to moderate.

Conclusions

The prevalence of OCS in patients treated with clozapine varies widely. Further research is needed to clarify the relationship between dose, treatment duration, and the onset/exacerbation of OCS.
Histopathology of the tongue in a hamster model of COVID-19
Authors: Coggins John , Saito Marina Hosotani , Cook Rebecca , Urata Shinji , Urata Megumi , Harsell Nantian Lin , Tan Wilhelmina Nanrui , Figueira Bibiana Toro , Bradley Megan , Quadri Nadia Z. , Saripada Janisah Amirah I. , Reyna Rachel A. , Maruyama Junki , Paessler Slobodan , Makishima Tomoko
Published: January 2025

Objective

With altered sense of taste being a common symptom of coronavirus disease 2019 (COVID-19), the main objective was to investigate the presence and distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) within the tongue over the course of infection.

Methods

Golden Syrian hamsters were inoculated intranasally with SARS-CoV-2 and tongues were collected at 2, 3, 5, 8, 17, 21, 35, and 42 days post-infection (dpi) for analysis. In order to test for gross changes in the tongue, the papillae of the tongue were counted. Paraffin-embedded thin sections of the tongues were labeled for the presence of SARS-CoV-2 antigen.

Results

There was no difference in fungiform or filiform papillae density throughout the course of infection. SARS-CoV-2 antigen was observed in the vallate papillae taste buds (3–35 dpi) and autonomic ganglia (5–35 dpi), as well as in the serous and mucous salivary glands of the posterior tongue (2–42 dpi).

Conclusion

The presence and distribution of SARS-CoV-2 suggest that the virus could cause taste disturbance by infecting the vallate papillae taste buds. This effect could be exacerbated by a diminished secretion of saliva caused by infection of the serous salivary glands and the autonomic ganglia which innervate them.
Improving the healthcare user experience: an optimization model grounded in patient-centredness
Authors: Peruzzo Elisa , Seghieri Chiara , Vainieri Milena , De Rosis Sabina
Published: January 2025

Background

Patient satisfaction and experience are key outcomes of healthcare and can be computed as powerful measures of service quality. Understand what affects them is essential for service quality improvement. Investigating whether the care setting (i.e., medical or surgical) can impact the patients’ perception of the quality can be also important for the actionability of this data. The aim is to explore which experiential factors should be prioritized to improve patient satisfaction with hospitalization service, using experience items as intermediate results and considering different settings.

Methods

Patient-reported experience measures are used in an Italian region. This study uses the optimization approach to identify factors of healthcare user experience affecting and enhancing satisfaction.

Results

The results confirm that, among the significant determinants of satisfaction, some specific experiential aspects emerged as the potential primary focus to be prioritized in improvement actions. These aspects vary according to the specific departmental area.

Conclusions

The study presents an optimization model directly informed by healthcare service users, utilizing their insights to drive healthcare delivery improvements. It emphasizes the necessity of not only collect patient perspectives but also applying different methodologies to understand what matters to patients and what interventions could be prioritized, and to strategically use diverse insights to enhance the delivery of healthcare services and patient experience and satisfaction.
Understanding malaria treatment patronage from informal healthcare providers in Nigerian urban settlements: insights from community members and providers
Authors: Bamgboye Eniola A , Ogunwale Akintayo Olamide , Al-Mukhtar Adamu , Musa Bello , Mhlanga Laurette , Olawuwo Morenikeji , Fagbamigbe Adeniyi , Akinyemi Joshua , Ajayi IkeOluwapo , Ozodiegwu Ifeoma D
Published: January 2025

Background

Informal Healthcare Providers (IHCPs), including Proprietary Patent Medicine Vendors (PPMVs), drug peddlers, traditional healers, and herbal drug sellers are often the first choice for malaria treatment, especially in urban slums. Unplanned urbanization significantly impacts malaria transmission by creating cities with inadequate safety nets and healthcare access, increasing reliance on IHCPs. While the World Health Organization recognizes IHCP’s crucial role and emphasizes integrating them into formal healthcare for improved malaria care, they lack requisite training in malaria management and operate outside official regulations, raising concerns about the quality of care they provide. Understanding IHCPs' perceptions and practices is essential for their proper integration. This study explored the perceived malaria burden, IHCPs’ competence in malaria treatment, and reasons for visiting IHCPs in various urban settlements from both community member and provider perspectives.

Methods

This qualitative cross-sectional study was carried out in Ibadan and Kano metropolises. Eighteen Focus Group Discussions among 157 adult community members and twelve Key-Informant Interviews among PPMVs, drug peddlers, traditional healers and herbal drug sellers were conducted in these cities. Participants were drawn purposively from settlements—designated as formal, informal, and slum based on local definitions—in selected wards within the cities. Data were collected using pre-tested guides and analysed thematically.

Results

This study reveals that malaria remains a significant health problem in these Nigerian cities. Patronage of IHCPs generally is driven by affordable treatment, perceived mildness of illness, and access to credit facilities. However, cultural belief was key to patronage of traditional healers and herbal drug sellers, largely among informal and slum residents. Furthermore, while IHCPs had a strong perceived competence in managing malaria cases, inadequate diagnosis and treatment were standard practices.

Conclusions

IHCPs remain consistently patronized across urban settlements. IHCPs are continuously patronized in all urban settlement. Educating and equipping IHCPs with diagnostic tools, enhancing access to affordable healthcare, and raising public awareness is crucial for proper malaria management and promoting collaborations with formal healthcare providers.