bluuebunny/crossref_metadata_2025 huggingface dataset:
Residual osteomyelitis at the resection margin after conservative surgery is not associated with the recurrence of diabetic foot infection and may successfully be treated without postoperative antibiotic therapy
Authors: Aragón‐Sánchez Javier , Víquez‐Molina Gerardo , López‐Valverde María Eugenia , Rojas‐Bonilla José María , Segura‐Retana Elvira
Published: June 2023

Aims

We hypothesize that microbiology‐ and pathology‐confirmed positive bone margins after the resection of diabetes‐related foot osteomyelitis are associated with worse outcomes.

Methods

We conducted a prospective study consisting of a cohort of 93 patients with diabetes‐related foot osteomyelitis (histopathology confirmed) who underwent bone resection and where an additional bone biopsy was taken at the resection margin. The primary outcome was the recurrence of the infection.

Results

Pathology‐confirmed positive margins were detected in 62 cases (66.7%), microbiology‐confirmed positive margins were detected in 75 cases (80.6%) and recurrence was detected in 19 patients (20.4%). Chi‐squared test failed to show the presence of an association between the recurrence of the infection with pathology‐confirmed positive margins (p = 0.82), with microbiology‐confirmed positive margins, (p = 0.34) and with the use of postoperative antibiotics (p = 0.70). Healing in patients with pathology‐confirmed positive margins was achieved in a median of 12 weeks (95% CI 9.2‐18) and those with pathology‐confirmed negative margins in 14.9 weeks (95% CI 10.2‐21.9), Log‐rank test, p = 0.74. Thirty‐four patients out of 61 available for follow‐up (55.7%) with pathology‐confirmed positive margins were treated without postoperative antibiotics. In that group, Chi‐squared test failed to show the presence of an association between the recurrence of the infection with the use of postoperative antibiotics (p = 0.47).

Conclusions

A positive margin was neither associated with the recurrence of the infection nor with the time to healing. More than half of patients with pathology‐confirmed positive margins were treated without postoperative antibiotics and this approach was not associated with the recurrence of the infection.
Reported neurological symptoms after severe acute respiratory syndrome coronavirus type 2 infection: A systematic diagnostic approach
Authors: Ludwig Birgit , Deckert Matthias , Krajnc Nik , Keritam Omar , Macher Stefan , Bsteh Gabriel , Zulehner Gudrun , Thurnher Majda , Berger Thomas , Seidel Stefan , Willinger Ulrike , Rommer Paulus
Published: June 2023

Background and purpose

Following increasing demands of patients with suspected neurological symptoms after infection with severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2), the Department of Neurology at the Medical University of Vienna established a new outpatient clinic to systematically assess, diagnose, and document neurological complaints potentially associated with a prior SARS‐CoV‐2 infection.

Methods

The data presented here include prospectively collected 156 outpatients from May 2021 to April 2022. Patients underwent semistandardized interviewing about symptoms with reported onset after SARS‐CoV‐2 infection, neurological examination, and comprehensive diagnostic workup.

Results

Reported new onset symptoms after infection included fatigue (77.6%), subjective cognitive impairment (72.4%), headache (47.7%), loss of smell and/or taste (43.2%), and sleep disturbances (42.2%). Most patients had a mild coronavirus disease (COVID‐19) disease course (84%) and reported comorbidities (71%), of which the most frequent were psychiatric disorders (34%). Frequency of symptoms was not associated with age, sex, or severity of COVID‐19 course. A comprehensive diagnostic workup revealed no neurological abnormalities in the clinical examination, or electrophysiological or imaging assessments in the majority of patients (n = 143, 91.7%). Neuropsychological assessment of a subgroup of patients (n = 28, 17.9%) showed that cognitive impairments in executive functions and attention, anxiety, depression, and somatization symptoms were highly common.

Conclusions

In this systematic registry, we identified fatigue, cognitive impairment, and headache as the most frequently reported persisting complaints after SARS‐CoV‐2 infection. Structural neurological findings were rare. We also suspect a link between the growing burden of the COVID‐19 pandemic on personal lives and the increase in reported neurological and psychiatric complaints.
Wherever I may roam—Human activity alters movements of red deer (Cervus elaphus) and elk (Cervus canadensis) across two continents
Authors: Mumme Steffen , Middleton Arthur D. , Ciucci Paolo , De Groeve Johannes , Corradini Andrea , Aikens Ellen O. , Ossi Federico , Atwood Paul , Balkenhol Niko , Cole Eric K. , Debeffe Lucie , Dewey Sarah R. , Fischer Claude , Gude Justin , Heurich Marco , Hurley Mark A. , Jarnemo Anders , Kauffman Matthew J. , Licoppe Alain , van Loon Emiel , McWhirter Doug , Mong Tony W. , Pedrotti Luca , Morellet Nicolas , Mysterud Atle , Peters Wibke , Proffitt Kelly , Saïd Sonia , Signer Johannes , Sunde Peter , Starý Martin , Cagnacci Francesca
Published: June 2023

Human activity and associated landscape modifications alter the movements of animals with consequences for populations and ecosystems worldwide. Species performing long‐distance movements are thought to be particularly sensitive to human impact. Despite the increasing anthropogenic pressure, it remains challenging to understand and predict animals' responses to human activity. Here we address this knowledge gap using 1206 Global Positioning System movement trajectories of 815 individuals from 14 red deer (Cervus elaphus) and 14 elk (Cervus canadensis) populations spanning wide environmental gradients, namely the latitudinal range from the Alps to Scandinavia in Europe, and the Greater Yellowstone Ecosystem in North America. We measured individual‐level movements relative to the environmental context, or movement expression, using the standardized metric Intensity of Use, reflecting both the directionality and extent of movements. We expected movement expression to be affected by resource (Normalized Difference Vegetation Index, NDVI) predictability and topography, but those factors to be superseded by human impact. Red deer and elk movement expression varied along a continuum, from highly segmented trajectories over relatively small areas (high intensity of use), to directed transitions through restricted corridors (low intensity of use). Human activity (Human Footprint Index, HFI) was the strongest driver of movement expression, with a steep increase in Intensity of Use as HFI increased, but only until a threshold was reached. After exceeding this level of impact, the Intensity of Use remained unchanged. These results indicate the overall sensitivity of Cervus movement expression to human activity and suggest a limitation of plastic responses under high human pressure, despite the species also occurring in human‐dominated landscapes. Our work represents the first comparison of metric‐based movement expression across widely distributed populations of a deer genus, contributing to the understanding and prediction of animals' responses to human activity.
Policy experimentation within flood risk management: Transition pathways in Austria
Authors: Thaler Thomas , Penning‐Rowsell Edmund C.
Published: June 2023

Flood risk management (FRM) is facing various challenges, such as climate change and biodiversity losses. Traditional structural FRM measures are now not always feasible as responses to these challenges. One answer might be the use of policy experiments to promote innovation. This paper aims to assess and to explain why innovations in FRM are rarely implemented. We analysed seven innovative strategies across Austria that combine several different approaches. Each is concerned with risk reduction systems designed to save space, time and possible rising costs. The research used 76 qualitative standardised semi‐structured interviews with key FRM experts conducted between 2012 and 2021 in order to examine transition pathways through time. The results show that there exist numerous drivers and barriers to debating, designing and implementing FRM innovations. The capture of transition pathways nevertheless shows the system shift from a more traditional understanding towards a transformative path, which created new understandings of the role of the different actors in FRM as well as new institutional settings. However, these policy experiments were still led by the relevant public administrations as they are the main funders, the principal actors in the planning and implementation phases in the realisation of many of these innovations.
Divine Providence through Predictable Chance Events: A Problem for Non‐Competitive Accounts of Divine Action
Authors: Reeves Josh
Published: June 2023

This article addresses the question, ‘How can divine providence be reconciled with statistically random events?’ To limit the scope of the article, I focus on one popular version of meticulous providence that relies upon the primary/secondary causation distinction, influentially defended by Kathryn Tanner and her book God and Creation in Christian Theology. I argue that modern conceptions of chance and probability have made it more difficult to interpret chance events as part of God's meticulous providence since divine intentions in nature are expressed in ways that remove evidence of their purpose. The difficulty for meticulous providence is not that some events seem too random to be reconciled to God's providence, but rather the opposite: chance events do not have specific purpose behind them because they are predictable. I conclude that any satisfactory theological response to the problem of randomness necessitates a robust account of general providence that cannot be reduced to special providence.
Yesterday is history, tomorrow is a mystery: Directors’ and CEOs’ prior bankruptcy experiences and the financial risk of their current firms
Authors: Ivanova Mariya N. , Nilsson Henrik , Tylaite Milda
Published: June 2023

Using a large sample of Swedish private firms, we investigate the link between the prior corporate bankruptcy experiences (BEs) of directors and CEOs and the financial risk of their current firms. We find that firms with directors and CEOs previously involved in bankruptcies exhibit more aggressive corporate financial policies, have a higher corporate bankruptcy risk and are subject to a higher cost of debt. Our findings align with an innate characteristics explanation: corporate BEs and current corporate risk‐taking reflect personal risk preferences. Furthermore, while we find evidence of income losses for CEOs and directors involved in bankruptcies, such losses are transient, potentially explaining the risk‐taking behavior after experiencing bankruptcy. Overall, our results suggest that the presence of individuals with prior BE can be considered a signal of higher financial risk for their firms. This insight is relevant to regulators, lenders and corporate decision‐makers.
Reference gene recommendations and PACAP receptor expression in murine sympathetic ganglia of the autonomic nervous system that innervate adipose tissues after chronic cold exposure
Authors: Pandher Parleen K. , Rahim Yamna , Timms Katherine P. , Filatov Ekaterina , Short Landon I. , Gray Sarah L.
Published: June 2023

Pituitary adenylate cyclase‐activating polypeptide (PACAP) is an important regulator of the stress response in mammals, influencing both the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS). PACAP has been reported to influence energy homeostasis, including adaptive thermogenesis, an energy burning process in adipose tissue regulated by the SNS in response to cold stress and overfeeding. While research suggests PACAP acts centrally at the level of the hypothalamus, knowledge of PACAP's role within the sympathetic nerves innervating adipose tissues in response to metabolic stressors is limited. This work shows, for the first time, gene expression of PACAP receptors in stellate ganglia and highlights some differential expression with housing temperature. Additionally, we present our dissection protocol, analysis of tyrosine hydroxylase gene expression as a molecular biomarker for catecholamine producing tissue and recommend three stable reference genes for the normalization of quantitative real time‐polymerase chain reaction (qRT‐PCR) data when working with this tissue. This study adds to information about neuropeptide receptor expression in peripheral ganglia of the sympathetic nervous system innervating adipose tissue and provides insight into PACAP's role in the regulation of energy metabolism.
Social support and oral health among working‐age and older adults in the United States
Authors: Laniado Nadia , Cloidt Megan , Shah Parth
Published: June 2023

Objectives

The purpose of this study was to examine the association of social support with untreated dental caries and severe tooth loss in adults in the United States.

Methods

This cross‐sectional study was conducted by analyzing data obtained from 5,447 individuals, 40 years of age and older, in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 who had both a complete dental examination and social support index measures. Sample characteristics, overall and by social support level, were examined through descriptive statistical analyses. Logistic regression analyses were performed to estimate the association of social support with untreated dental caries and severe tooth loss.

Results

In this nationally representative sample (mean age 56.5 years) the prevalence of low social support was 27.5%. The prevalence of individuals with moderate‐to‐high social support increased with higher levels of educational attainment and income level. In fully adjusted models, relative to those who had moderate‐high social support levels, individuals with low social support had 1.49 higher odds of untreated dental caries (95% CI, 1.17‐1.90, p=0.002) and 1.23 higher odds of severe tooth loss (95% CI, 1.05‐1.44, p=0.011).

Conclusions

Higher odds of untreated dental caries and severe tooth loss were found among U.S. adults with low levels of social support compared to those with moderate‐to‐high levels of social support. Additional studies are warranted to provide a more current perspective on the impact of social support on oral health so that programs may be developed and tailored to reach these populations.
Philosophy as a thief?
Authors: Auxier Randall
Published: June 2023

This is a performative piece of writing in the presence of and inspired by Richard Shusterman'sPhilosophy and the Art of Writing. It tries to show that the relationship between the act of writing and the formation of our human consciousness (philosophical and, more deeply, poietic) is a developing and growing process through history, and before it. The dominance of an image consciousness was slowly challenged and then replaced by a linguistic consciousness with the advent of writing, and accelerated by the invention of printing and mass literacy. Shusterman teaches us an embodied kind of philosophizing that uses the word but isn't limited by it. This paper suggests that a return to image consciousness has already occurred and that the old book consciousness is disappearing. Lessons from the book consciousness are offered.
Arabidopsis Topless‐related 1 mitigates physiological damage and growth penalties of induced immunity
Authors: Griebel Thomas , Lapin Dmitry , Locci Federica , Kracher Barbara , Bautor Jaqueline , Concia Lorenzo , Benhamed Moussa , Parker Jane E.
Published: June 2023

Transcriptional corepressors of the Topless (TPL) family regulate plant hormone and immunity signaling. The lack of a genome‐wide profile of their chromatin associations limits understanding of the TPL family roles in transcriptional regulation.

Chromatin immunoprecipitation with sequencing (ChIP‐Seq) was performed on Arabidopsis thaliana lines expressing GFP‐tagged Topless‐related 1 (TPR1‐GFP) with and without constitutive immunity via Enhanced Disease Susceptibility 1 (EDS1). RNA‐Seq profiling of the TPR1‐GFP lines and pathogen‐infected tpl/tpr mutants, combined with measuring immunity, growth, and physiological parameters was employed to investigate TPL/TPR roles in immunity and defense homeostasis.

TPR1 was enriched at promoter regions of c. 1400 genes and c. 10% of the detected binding required EDS1 immunity signaling. In a tpr1 tpl tpr4 (t3) mutant, resistance to bacteria was slightly compromised, and defense‐related transcriptional reprogramming was weakly reduced or enhanced, respectively, at early (< 1 h) and late 24 h stages of bacterial infection. The t3 plants challenged with bacteria or pathogen‐associated molecular pattern nlp24 displayed photosystem II dysfunctions. Also, t3 plants were hypersensitive to phytocytokine pep1 at the level of root growth inhibition. Transgenic expression of TPR1 rescued these t3 physiological defects.

We propose that TPR1 and TPL family proteins function in Arabidopsis to reduce detrimental effects associated with activated transcriptional immunity.
Revisiting yield in terms of phloem transport to grains suggests phloem sap movement might be homeostatic
Authors: Tcherkez Guillaume , Holloway‐Phillips Meisha , Lothier Jérémy , Limami Anis , Ball Marilyn C.
Published: June 2023

Phloem sap transport, velocity and allocation have been proposed to play a role in physiological limitations of crop yield, along with photosynthetic activity or water use efficiency. Although there is clear evidence that carbon allocation to grains effectively drives yield in cereals like wheat (as reflected by the harvest index), the influence of phloem transport rate and velocity is less clear. Here, we took advantage of previously published data on yield, respiration, carbon isotope composition, nitrogen content and water consumption in winter wheat cultivars grown across several sites with or without irrigation, to express grain production in terms of phloem sucrose transport and compare with xylem water transport. Our results suggest that phloem sucrose transport rate follows the same relationship with phloem N transport regardless of irrigation conditions and cultivars, and seems to depend mostly on grain weight (i.e., mg per grain). Depending on the assumption made for phloem sap sucrose concentration, either phloem sap velocity or its proportionality coefficient to xylem velocity change little with environmental conditions. Taken as a whole, phloem transport from leaves to grains seems to be homeostatic within a narrow range of values and following relationships with other plant physiological parameters across cultivars and conditions. This suggests that phloem transport per se is not a limitation for yield in wheat but rather, is controlled to sustain grain filling.
A retrospective multicentric cohort study of checkpoint inhibitors‐induced pruritus with focus on management
Authors: Papageorgiou Chryssoula , Lazaridou Elizabeth , Lallas Konstantinos , Papaioannou Kyparissos , Nikolaou Vasiliki , Mateeva Valeria , Efthymiadis Konstantinos , Koukoutzeli Chrysanthi , Loga Konstantia , Sogka Eleni , Karamitrousis Evangelos , Lazaridis George , Dionysopoulos Dimitrios , Lallas Aimilios , Kemanetzi Christina , Fotiadou Christina , Timotheadou Eleni , Apalla Zoe
Published: June 2023

Background

Limited data on immune checkpoint inhibitor (ICI)‐induced pruritus per se and efficacy of different therapeutic modalities in its management exist.

Objective

To study the quantitative and qualitative characteristics of ICI‐induced pruritus per se and to assess the efficacy of the therapeutic modalities usually applied.

Methods

We retrospectively reviewed the records of 91 patients who were under treatment with ICIs for any kind of neoplasia and developed pruritus during treatment.

Results

Twenty out of 91 individuals (22.0%) with ICI‐induced pruritus had pruritus as the only symptom, while 71/91 (78.0%) presented with pruritus coexisting with an additional cutaneous toxicity. Pruritus was treated with antihistamines (18/20, 90.0%) and/or topical regimens, as first‐line choice. In resistant cases, as a second therapeutic intervention, narrow‐band UVB (NBUVB), oral steroids and GABA analogs were added (70.0%). Statistical analysis revealed a significant difference in mean pruritus Numerical Rating Scale (NRS) scores between baseline and sequential visits. Moreover, subgroup analysis revealed a significant reduction in mean NRS scores in those treated with phototherapy.

Limitations

Retrospective design, low number of patients and survivorship bias.

Conclusion

Pruritus per se was present in a substantial portion of our cohort (22.0%). Our study confirms the efficacy of current treatment strategies and suggests NBUVB as a potential steroid‐sparing therapeutic alternative.
Fetal growth rather than prematurity determines lung function in children with asthma
Authors: Kim Hwan Soo , Lee Seung Won , Kim Jin Tack , Kim Jung Hoon , Lim Dae Hyun , Kim Woo Kyung , Song Dae Jin , Yoo Young , Suh Dong In , Baek Hey Sung , Shin Meeyong , Kwon Ji Won , Jang Gwang Cheon , Yang Hyeon‐Jong , Lee Eun , Seo Ju Hee , Woo Sung Il , Kim Hyung Young , Shin Youn Ho , Lee Ju Suk , Jung Sungsu , Lee Nang Kyeong , Yu Jinho
Published: June 2023

Background and Objective

Preterm birth or fetal growth has been associated with reduced lung function and asthma during childhood in the general population. We aimed to elucidate whether prematurity or fetal growth has a significant influence on lung function or symptoms in children with stable asthma.

Methods

We included children with stable asthma who participated in the Korean childhood Asthma Study cohort. Asthma symptoms were determined by asthma control test (ACT). Percent predicted values of pre‐ and post‐bronchodilator (BD) lung function including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and forced expiratory flow at 25%–75% of FVC (FEF25%–75%) were measured. Lung function and symptoms were compared according to the history of preterm birth and birth weight (BW) for gestational age (GA).

Results

The study population consisted of 566 children (age range: 5–18 years). There were no significant differences in lung function and ACT between preterm and term subjects. We observed no significant difference in ACT but significant differences were observed in pre‐ and post‐BD FEV1, pre‐ and post‐BD FVC, and post‐BD FEF25%–75% according to BW for GA in total subjects. Two‐way ANOVA revealed that BW for GA rather than prematurity was a significant determining factor for pre‐ and post‐BD lung function. After regression analysis, BW for GA was still a significant determining factor of pre‐ and post‐BD FEV1 and pre‐ and post‐BD FEF25%–75%.

Conclusion

Fetal growth rather than prematurity appears to have a significant effect on lung function in children with stable asthma.
Social externalities of women empowerment: Evidence from suffrage movements of late nineteenth and early twentieth century United States
Authors: Noghanibehambari Hamid , Noghani Farzaneh , Tavassoli Nahid
Published: June 2023

Previous literature suggests that empowering women is associated with children's improved outcomes. However, little is known about its effects on children's later‐life crime and incarceration. We argue that women empowerment through suffrage law changes during the late nineteenth and early twentieth centuries in the US generated incentives for women to invest in their children's human capital. The accumulated human capital then has the potential to reduce future incarceration of children. We use full‐count censuses 1920–1930, implement a difference‐in‐difference framework, and empirically show that childhood exposure to suffrage laws is associated with considerable reductions in incarceration. The effects appear to be primarily driven by decreases in male and Black incarceration. The balancing tests rule out the concern that the effects are driven by demographic compositional changes or endogenous changes in other state‐level characteristics. Furthermore, an event‐study analysis rejects the concern that the effects are driven by preexisting trends in incarceration among exposed cohorts. The findings of this research note offer informative implications for overlooked externalities of women empowerment in a historical setting.
An examination of the human presence in precalculus textbooks: What are we communicating to students about who uses mathematics and how?
Authors: Marzocchi Alison S. , Martinez Priscilla M. , Truong Anthony P.
Published: June 2023

Women and people of color continue to be underrepresented in science, technology, engineering, and mathematics (STEM), even while STEM fields are faced with recruitment issues and shortages of workers. Mathematics textbooks may be complicit in this issue, with past research indicating that textbooks are not fairly representing women and people of color. Even in instances when representation appears equal, further inspection indicates that men and white characters are given more meaningful and scientific roles in textbooks. Our study investigated the 15 precalculus honors textbooks used in public schools across a county to determine the message that is communicated to potential STEM majors about who uses mathematics and how. To do so, we identified the presence of context, human presence, genders, names, and hobbies/occupations within the textbook exercises. Our study reveals an overall low proportion of real‐life contexts, of humans in general, of women and of gender non‐binary characters, and of STEM careers. Examples of women in STEM careers are strikingly low. To improve recruitment of students to STEM careers, in general, as well as recruitment of marginalized populations, in particular, we must improve representation such that all students are able to see themselves in mathematics and their textbooks.
Topology Optimization Design for Heat Dissipation Performance of Semiconductor Ignition Device
Authors: Chen Jia , Zhang Xiaobing , Zhu Ruijie
Published: June 2023

The trend of miniaturization and intgration of the electronic device has put forward higher requirements on efficiency of heat radiating, which can hardly be satisfied by the traditional forced convection heat dissipation method. In this paper, the strategy of topology optimization technique is adopted to greatly improve the heat dissipation efficiency of a semiconductor ignition device. The penalization method is used to implement the topology optimization process. Three kinds of objective functions of thermal compliance, temperature variance and geometric average temperature were separately applied in the topological optimization of two typical uniform heat generation cases, and the resulted topologically optimization results were analyzed and compared. Based on the two benchmark cases, the appropriate objective function was selected to conduct structural optimization of semiconductor bridge ignition devices with the aim of making the highest temperature in the design domain the lowest possible. Additionally, a parametric study on the effect of thermal conductivity on topology optimization results was conducted, which leads to a design suggestion beneficial for heat dissipation and material selection.
DEPLOYING COMPUTER VISION DETECTION METHOD IN MEDICAL SIMULATION TRAINING USING MACHINE LEARNING
Authors: Wu Hang-Ling , Brown Dailen , Miller Scarlett , Moore Jason
Published: June 2023

A machine learning (ML) object detection algorithm was developed to replace the original color-based image detection algorithm for the Dynamic Haptic Robotic Trainer Plus (DHRT+). This image recognition system was used for medical training in Central Venous Catheterization (CVC). This image tracking allows for the training system to provide accurate performance feedback to the user during the training process. The ML object detection algorithm was developed and evaluated using training data. The results indicate that increasing the training data set improves the detection system’s accuracy. The system was found to have an overall precision rate of 90.9% and a recall rate of 81.69%. This new ML model will be implemented into the DHRT+ system and used to train medical residents.
DESIGN OF A CUSTOM SENSING AND ACTUATING CUSHION FOR USE IN PRESSURE RELIEF IN WHEELCHAIR USERS
Authors: Robinson Jason , Shewalkar Vishakh , Rigo Isaiah , Rock Asaiah , Cinnamon Lucy , Chapman-Rienstra Daniella , Hong Jooyoung , Kim Joohyung , Golecki Holly
Published: June 2023

Pressure sores impact a wide range of individuals including wheelchair users. Solutions to address pressure sore prevention are limited. This work is aimed at developing devices to prevent pressure sores in wheelchair users with limited mobility or sensation. Informed by stakeholder input, we present a dynamic cushion design to sense areas of high pressure and actuate to relieve that pressure. We experimented using resistive sensors in a grid formation to map pressure across the seat. To relieve pressure, we propose a grid of custom pneumatic bladders to inflate in response to sensor thresholds. Bladders will inflate to redistribute pressure. After experimenting with a variety of possible bladder geometries, we selected torus-shaped actuators to optimize durability, stability, and increase breathability in the final design. Given the ability to fabricate custom bladders and program controls, the proposed device can be tailored to users’ specific needs. While static cushion solutions exist on the market, our custom design allows users to dynamically alleviate pressure eliminated the need to constantly readjust position and ultimately reduce time spent treating sores.
DESIGN OF AN INSERTION FUNNEL FOR A TRAINING SYSTEM FOR CENTRAL VENOUS CATHETER GUIDEWIRE INSERTION
Authors: Krieger Margaret , Kaul Aayod , Brown Dailen , Tzamaras Haroula M. , Moore Jason Z. , Miller Scarlett R.
Published: June 2023

A novel concept is proposed to effectively measure and train central venous catheter guidewire insertion. This system utilizes a 3D printed funnel to direct the insertion of a guidewire from multiple angles and positions. This directed guidewire can then be passed through previously developed sensors to provide the user with valuable training feedback. Experiments are performed to measure the effectiveness of the funnel system under varying insertion positions, angles, and funnel coatings. After experimentation, it was found that a funnel greased with white lithium grease allows the guidewire to successfully make it through the funnel compared to alternatives tested. This design will be applied to the Dynamic Haptic Robotic Trainer Plus (DHRT+) system to train medical residents to safely perform central venous catheterization.
ON THE DESIGN OF A NOVEL PHONOENTEROGRAM SENSING DEVICE USING AI ASSISTED COMPUTER-AIDED AUSCULTATION
Authors: Damani Shivam , Damani Devanshi N. , Redij Renisha , Sethi Arshia K. , Muddaloor Pratyusha , Kapoor Anoushka , Rajagopal Anjali , Gopalakrishnan Keerthy , Wang Xiao Jing , Chedid Victor G. , Ryu Alexander J. , Aakre Christopher A. , Arunachalam Shivaram P.
Published: June 2023

Bowel sounds have been previously used to study intestinal motility and overall digestive health in various clinical settings. However, the blurred definition of bowel sounds and their subtypes, limited resources for interpretation, poor sensitivity, and low positive predictive value led to their restricted utility. Recent advances in artificial intelligence and machine learning have steered interest in developing unique tools using the phonoenterogram to analyze diverse bowel sounds. In our study, bowel sounds were recorded from eight healthy volunteers using the Eko Duo stethoscope. A novel deep-learning algorithm was designed to classify the recordings into baseline or prominent bowel sounds. A total of 11,210 data points (5,605 balanced sounds) were used to train and test the model to yield an accuracy of 0.895, a precision of 0.890, and a recall of 0.854 reflecting successful segregation of these sounds into respective groups. More extensive studies enrolling healthy and diseased subjects with a device specifically tailored to record bowel sounds are needed to generalize these results and determine their application in the patient population.
AlGe wafer bonding in ultra-high vacuum environment
Authors: Stöttinger Thomas , Rebhan Bernhard , Hingerl Kurt
Published: June 2023

Despite it being known that native oxides impair diffusion processes during eutectic wafer bonding, the possibility of oxide removal combined with avoidance of oxide regrowth on the surfaces is not usually employed in AlGe eutectic wafer bonding. In the present work, the focus is on the impact of different process parameters like temperature, concentration, and oxide regrowth on the AlGe bonding layer, while processing inside ultra-high vacuum. Based on the results, it could be shown that the in situ AlGe eutectic bonding process enables acceptable bonding results already below the eutectic temperature Te = 423 °C, which would be required to liquefy the AlGe bonding layer at the eutectic concentration ce = 28.4 at. % Ge. Even if the AlGe system was not entering the liquid state, solid-state diffusion is sufficient to achieve a high bonding quality. The applied bonding force corresponds to a pressure of ∼0.16 MPa, which is much lower compared to the typical (ex situ) AlGe bonding process. In addition, it could be clarified that extreme variations of concentrations below and above ce were not as critical as expected. A good phase mixture as well as a low number of voids has been observed even if the resulting concentration did not fit ce. The main feature of the bonding system, which is oxide removal while suppressing the oxide re-growth, enhanced the quality of bonding result compared to the regular ex situ eutectic bonding approach.
Ru thin films prepared by RF magnetron sputtering with Ru targets of different microstructures
Authors: Shen Yue , Wen Ming , Xu Yanting , Li Sixie
Published: June 2023

Ruthenium (Ru) exhibits excellent electrical properties at the nanoscale, and it can be used to replace Al and Cu as interconnect metals for nodes of 20 nm and below in the next generation of integrated circuits. Ru interconnects mainly exist in the form of films, and Ru targets are used as the key raw materials to produce these films. Establishing whether there is an inheritance relationship in terms of microstructure and electrical properties between these targets and the resultant films will determine whether these are important factors for improving the electrical properties of Ru films and will provide directional guidance for the preparation of Ru targets. In this work, Ru targets were prepared by vacuum hot pressing with two different Ru powders with different morphologies and particle sizes. Ru films were then deposited on SiO2/Si(100) substrates by RF magnetron sputtering at substrate temperatures ranging from room temperature (RT, about 25 °C) to 400 °C. The microstructures and electrical properties of the Ru targets and Ru films were investigated by high-resolution field-emission scanning electron microscopy, x ray diffraction, atomic force microscopy, four-probe resistivity measurements, and digital conductivity tests. The results showed that Ru targets with a more uniform microstructure had lower resistivity; furthermore, Ru films deposited by Ru targets with a more uniform microstructure were preferentially crystallized, and they also had a faster average deposition rate, a smaller average grain size, and lower surface roughness. However, no correlation was found between the crystal orientations of the Ru films and Ru targets.
Pitch discrimination in electric hearing with inconsistent and
consistent amplitude-modulation and inter-pulse rate cues
Authors: Lindenbeck Martin J. , Majdak Piotr , Srinivasan Sridhar , Laback Bernhard
Published: June 2023

Users of cochlear implants (CIs) struggle in situations that require selective hearing to focus on a target source while ignoring other sources. One major reason for that is the limited access to timing cues such as temporal pitch or interaural time differences (ITDs). Various approaches to improve timing-cue sensitivity while maintaining speech understanding have been proposed, among them inserting extra pulses with short inter-pulse intervals (SIPIs) into amplitude-modulated (AM) high-rate pulse trains. Indeed, SIPI rates matching the naturally occurring AM rates improve pitch discrimination. For ITD, however, low SIPI rates are required, potentially mismatching the naturally occurring AM rates and thus creating unknown pitch effects. In this study, we investigated the perceptual contribution of AM and SIPI rate to pitch discrimination in five CI listeners and with two AM depths (0.1 and 0.5). Our results show that the SIPI-rate cue generally dominated the percept for both consistent and inconsistent cues. When tested with inconsistent cues, also the AM rate contributed, however, at the large AM depth only. These findings have implications when aiming at jointly improving temporal-pitch and ITD sensitivity in a future mixed-rate stimulation approach.
Impact of a 6-Day Official Tournament on Physical Demands, Perceptual–Physiological Responses, Well-Being, and Game Performance of Under-18 Basketball Players
Authors: García Franc , Castellano Julen , Vicens-Bordas Jordi , Vázquez-Guerrero Jairo , Ferioli Davide
Published: June 2023

Purpose: This study aimed to examine the effect of a 6-day basketball tournament on the physical demands, perceptual–physiological responses, well-being, and game statistics of elite under-18 (years of age) players. Methods: Physical demands (player load [PL], steps, impacts, and jumps, all normalized by playing time), perceptual–physiological responses (heart rate and rating of perceived exertion), well-being (Hooper index), and game statistics of 12 basketball players were monitored during 6 consecutive games. Linear mixed models and Cohen d effect sizes were used to assess differences among games. Results: Significant changes were found for PL per minute, steps per minute, impacts per minute, peak heart rate, and Hooper index over the tournament. Pairwise comparisons showed that PL per minute was higher in game #1 than in games #4 (P = .011, large), #5 (P < .001, very large), and #6 (P < .001, very large). PL per minute recorded during game #5 was also lower than in games #2 (P = .041, large) and #3 (P = .035, large). The number of steps per minute was higher in game #1 than in all other games (all P < .05, large to very large). Impacts per minute were significantly higher in game #3 than in games #1 (P = .035, large) and #2 (P = .004, large). The only physiological variable that varied significantly was peak heart rate (higher in game #3 than in game #6; P = .025, large). The Hooper index gradually increased throughout the tournament, indicating poorer player well-being as the tournament advanced. Game statistics did not significantly change among games. Conclusions: The average intensities of each game and the players’ well-being gradually decreased throughout the tournament. Conversely, physiological responses were mostly unaffected, and game statistics were unaffected.
The Influence of Coaches and Support Staff on the Sleep Habits of Esports Athletes Competing at Professional and Semiprofessional Level
Authors: Bonnar Daniel , Hwu Matthew , Lee Sangha , Gradisar Michael , Suh Sooyeon , Kahn Michal
Published: June 2023

The present study investigated the influence and perspective of esports coaches and support staff on the sleep habits of esports athletes competing at professional and semiprofessional levels. Eighty-four esports coaches and support staff from 19 countries completed an online questionnaire. The first section obtained demographic information. The second section evaluated sleep hygiene knowledge using the Sleep Beliefs Scale. The third section assessed sleep monitoring and sleep hygiene practices used by coaches and support staff with esports athletes, barriers to the use of these practices, and conditions that impact the sleep of esports athletes. Overall, sleep hygiene knowledge was inadequate (<75%, based on the study of Miles et al.). Sleep monitoring frequency was low (48.8%), while sleep hygiene practices were implemented more often (66.7%). The most common barrier to sleep monitoring and sleep hygiene practices was players not liking it (50% and 46.3%, respectively). Night competitions (64.6%), congested competition times (51.2%), and night training schedules (47.6%) all rated highly as having an impact on esports athletes’ sleep. Sleep education and training for coaches and support staff in the optimal use of sleep monitoring and sleep hygiene practices may increase the frequency and quality of sleep health support provided to esports athletes.
Draft Genome Sequences of 17 Campylobacter coli Strains Isolated from Animal and Food Sources in Brazil
Authors: Gomes Carolina Nogueira , Duque Sheila da Silva , Balkey Maria , Allard Marc Willian , Falcão Juliana Pfrimer
Published: June 2023

Campylobacter
spp. have been reported as one of the most frequent causes of acute gastroenteritis in humans worldwide. Here, we report 17 draft genome sequences of
C. coli
strains isolated from animal and food sources in Brazil. These data will improve our understanding of this species in Brazil.
Digital PCR Discriminates between SARS-CoV-2 Omicron Variants and Immune Escape Mutations
Authors: Holland Steven C. , Holland LaRinda A. , Smith Matthew F. , Lee Mihyun B. , Hu James C. , Lim Efrem S.
Published: June 2023

Spike mutations in the SARS-CoV-2 genome confer resistance to therapeutic monoclonal antibodies. Authorization for treatment options is typically guided by general trends of variant prevalence.
Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study
Authors: Camden Andi , To Teresa , Gomes Tara , Ray Joel , Bai Li , Guttmann Astrid
Published: June 2023

Objectives

To quantify well-child visits by age 2 years and developmental screening at the 18-month enhanced well-child visit among children with prenatal opioid exposure (POE) and to identify factors associated with study outcomes.

Design

Population-based cohort study.

Setting

Ontario, Canada.

Participants

22 276 children with POE born 2014–2018 were classified as (1) 1–29 days of prescribed opioid analgesia, (2) 30+ days of prescribed opioid analgesia, (3) medication for opioid use disorder (MOUD), (4) MOUD and opioid analgesia, or (5) unregulated opioids.

Main outcome measures

Attending ≥5 well-child visits by age 2 years and the 18-month enhanced well-child visit. Modified Poisson regression was used to examine factors associated with outcomes.

Results

Children with POE to 1–29 days of analgesics were most likely to attend ≥5 well-child visits (61.2%). Compared with these children, adjusted relative risks (aRRs) for ≥5 well-child visits were lower among those exposed to 30+ days of opioid analgesics (0.95, 95% CI 0.91 to 0.99), MOUD (0.83, 95% CI 0.79 to 0.88), MOUD and opioid analgesics (0.78 95% CI 0.68 to 0.90) and unregulated opioids (0.89, 95% CI 0.83 to 0.95). Relative to children with POE to 1–29 days of analgesics (58.5%), respective aRRs for the 18-month enhanced well-child visit were 0.92 (95% CI 0.88 to 0.96), 0.76 (95% CI 0.72 to 0.81), 0.76 (95% CI 0.66 to 0.87) and 0.82 (95% CI 0.76 to 0.88). Having a regular primary care provider was positively associated with study outcomes; socioeconomic disadvantage, rurality and maternal mental health were negatively associated.

Conclusion

Well-child visits are low in children following POE, especially among offspring of mothers receiving MOUD or unregulated opioids. Strategies to improve attendance will be important for child outcomes.
SP2 Drug information for parents/carers taking babies home – Survey of healthcare professionals and parents/carers
Authors: Caldwell Neil
Published: June 2023

Aim

The aim of this multicentre study was to find out what parents/carers and healthcare professionals (HCPs) think about the current provision of information for parents/carers about medicines following discharge from neonatal units in UK and Ireland.

Method

HCPs in the UK and Ireland were identified using a stakeholder map. An electronic survey was developed and circulated to HCPs involved in the care of neonates at the five study sites and shared on social media. Parents were recruited via social media, parent support groups, in-patient and clinic settings.

Results

HCPs155 HCPs responded: 41% nurses, 34% pharmacists, 11% doctors; the remainder were a mixture of professions. The majority had over 5 years’ experience. 58% were aware of medicines resources or information being used at their hospital, the most popular method being face to face information given individually, followed by written information.

When asked which HCPs were best placed to provide information about medicines, ‘nurses’ were the most common response. When asked about the best time to provide information, ‘throughout the stay’ was felt to be the most appropriate time, however, in practice they reported that information was typically given immediately prior to discharge. The move to Family Integrated Care has led to improvements with many units now involving parents in the medicine administration process at a much earlier stage.

ParentsA total of 87 parents/carers completed the e-survey. 72% parents/carers had ‘none’, or ‘very little experience’ of giving medicines to children prior to their baby’s hospital stay. Only 53% received information about medicines prior to discharge. However, 48% of respondents were administering 4 or more medicines on discharge. 24% of parents/carers reported feeling stressed about giving medicines. Challenges with medicines following discharge were reported by 47%. Printed information was the preferred format for medicines resources (57%).

Conclusion

The findings from HCPs highlighted the importance of the ‘timing of information’ and involving parents at an earlier stage could be helpful in preparation for discharge. The results from parents show there are significant shortfalls in the existing provision of information about giving medicines to their babies at home. These findings will inform the co-design of new information resources about medicines for parents and carers taking babies home.
Conservative approach of a paediatric tracheal rupture
Authors: Duarte Catarina Marques , Vieira Elizabete , Almeida Sofia , Abecasis Francisco
Published: June 2023

A girl was brought into the emergency room after a non-penetrating cervical trauma. On physical examination, a rapidly progressing chest subcutaneous emphysema was denoted. The child was immediately intubated and mechanical ventilation was initiated. The CT-scan revealed a rupture to the posterior wall of the trachea and a pneumomediastinum. The child was transferred to the paediatric intensive care unit. A conservative approach was chosen, including tracheal intubation as a bypass through the tracheal injury, sedation to reduce the risk of further tracheal trauma and prophylactic antibiotic therapy. Twelve days after the incident, a bronchoscopy demonstrated the integrity of tracheal mucous and the child was successfully extubated. Three months after hospital discharge she was asymptomatic. In this clinical case, the conservative approach presented a successful outcome, avoiding the risks associated with surgery.