bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related?
Authors: Schröder Jonas , Saeys Wim , Embrechts Elissa , Hallemans Ann , Yperzeele Laetitia , Truijen Steven , Kwakkel Gert
Published: August 2023

Background

Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements.

Objective

To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke.

Methods

Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COPArea) and direction-dependent velocities (COPVel-ML and COPVel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry.

Results

Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COPArea, COPVel-ML, and COPVel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COPArea, COPVel-ML, and COPVel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COPArea, COPVel-ML, COPVel-AP, DCA, or WBA were generally non-significant.

Conclusions

Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke. Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.
Fatigue life optimization and lightweight design of wheel based on entropy weight grey relation analysis and modified NSGA-II
Authors: Zhang Shuai , Lu Dongzhen , Li Ruixu , Xu Liyou , Jiang Hang , Cao Yanling , Xu Wenchao
Published: August 2023

In order to study the fatigue performance of wheel and enhance its lightweight design level, this article proposes the structure, design and optimization method of magnesium-aluminum alloy assembled wheel. Taking a [Formula: see text] type wheel as the research object, the optimal topology of wheel spoke is solved by constructing a topology optimization model for wheel bending and radial fatigue test conditions. A finite element model for bending and radial fatigue testing of assembled wheels was established, which simulates and analyzes the fatigue performance and its influencing factors of the wheel under two working conditions. Combined with contribution analysis method, the modified NSGA-II and entropy weight grey relation analysis (EGRA), the multi-objective optimization of assembled wheel was performed. The result demonstrated that the weight reduction of the assembled wheel after optimized design is 4.49%, while the bending fatigue life and radial fatigue safety factor are decreased by 9.95% and 25%, respectively. In order to better balance the performance of assembled wheel and achieve lightweight design, this article combines the joint topology optimization of assembled wheels with multi-objective optimization method for multiple working conditions and screens the optimal compromise solution by EGRA, which provides an approach for wheel lightweight design and multi-objective optimization.
3D printing process for continuous fibre reinforced composites with variable deposition direction
Authors: Min Shuangfei , Tan Yuegang , Zhang Fan , Tu Yiwen
Published: August 2023

Continuous fibre reinforced polymer (CFRP) have a distinctive anisotropic character. In traditional 3D printing processes, deposition direction cannot be adjusted. As a result, the performance of CFRP parts is deficient in the fixed direction. To address the issue, this paper proposes a variable deposition direction (VDD) 3D printing process for CFRP. The process optimises the mechanical properties of the moulded part by adjusting the direction of deposition. The principles and processes of the VDD 3D printing are described in detail. Then, using the hollow cylinder as an example, a mathematical model of the variable deposition direction structure is developed, and subsequent simulations is conducted to evaluate its mechanical properties. In the experimental part, the composite material used has a fibre content of 20% and consists of PETG and carbon fibres. The VDD hollow cylindrical parts have been printed to verify the feasibility of the process. And performance testing experiments were carried out on a variety of test specimens of different structures with VDD. The results show that adjusting the deposition direction of the CFRP can greatly improve the tensile properties of hollow cylinder. The tensile properties of a suitable structure with VDD were improved by a factor of 69.4 compared to a single deposition direction structure. And the actual tensile situation is consistent with the simulation. To summarise, the proposed method can effectively solve the defects of the traditional process and optimise the mechanical properties of the moulded parts.
What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States
Authors: Patel Ishani , Dev Alka
Published: August 2023

Background:

Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood.

Objective:

To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration.

Eligibility Criteria:

We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG’s) social determinants of health screening tool.

Sources of Evidence:

We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022.

Charting Methods:

Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress.

Results:

An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress.

Conclusions:

Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
Repair failure and associated factors among women who underwent obstetric fistula surgery in Southwest Ethiopia: A retrospective study
Authors: Gezimu Wubishet , Sime Tadesse , Diriba Aboma , Gemechu Diriba
Published: August 2023

Background:

Surgical repair is one of the management strategies for obstetric fistulae, which are associated with tragic obstetric morbidities.

Objective:

This study assessed the proportion of repair failures and associated factors among women who underwent obstetric fistula surgery at the Mettu Hamlin Fistula Center.

Design:

This study is an institution-based, retrospective, cross-sectional design.

Methods:

This study included 385 patients who underwent obstetric fistula repair surgery at the Mettu Hamlin Fistula Center between 2015 and 2020. Participants were selected using a simple random sampling technique. EpiData version 3.1 and STATA version 14.2 were used for data entry and analysis, respectively. The association between obstetric fistula failure and independent variables was tested using binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used as a cut-off point to include variables in the multivariable logistic regression analysis. The statistical significance was finally set at a p-value of less than 0.05.

Results:

Of the 385 participants who underwent obstetric fistula surgical repair, about 18.2% (95% confidence interval = 14.6–22.3) failed to close. Larger fistula size (>3 cm) (adjusted odds ratio (AOR) = 4.6; 95% confidence interval = 2.34–8.91), urethral damage (adjusted odds ratio = 2.8; 95% confidence interval = 1.47–5.44), home delivery (adjusted odds ratio = 5; 95% confidence interval = 2.56–9.77), and malnutrition (body mass index <18.5 kg/m2) (adjusted odds ratio = 2.7; 95% confidence interval = 1.10–6.79) were variables significantly associated with obstetric fistula repair failure.

Conclusion:

Obstetric fistula repair failure was lower in the area compared to the majority, but not all, of previous findings. Home delivery, damaged urethra, larger fistula size, and lower body mass index increased the probability of repair failure. To prevent repair failure early, it is necessary to strengthen pre- and post-operative care, including the assessment of women’s nutritional status, fistula size, and urethral injury. Moreover, maternal care providers should educate mothers about the negative outcomes of home deliveries.
New scheduling strategies and production culture in public service television in the digital era: The case of DR and TV 2 in Denmark
Authors: Bruun Hanne , Lassen Julie Münter
Published: August 2023

This article addresses the development of new scheduling practices within public service media (PSM) in the Nordic, focusing on DR and TV 2 in Denmark. These practices relate to in-house broadcaster-video-on-demand-services (BVoDs). Our findings show, first, that television’s time-structured identity and liveness are re-configured for a mainstream audience as opposed to the segmented audiences approach of the earlier multi-channel era. Second, we find that the public service identity and the benefits of being PSM natives are harnessed to help the survivability of PSM companies in the digital era.
Exploring the variation in spoonbill chick diet and trophic niches between traditional and recently colonised sites in Portugal
Authors: Rodrigues Manuela S , Alves José A , Ramos Jaime A , Araújo Pedro M
Published: August 2023

The Eurasian Spoonbill Platalea leucorodia is currently experiencing an increasing population trend in Western Europe and colonising areas in its breeding range. In this study we assessed the diet and trophic ecology of spoonbill chicks in Portuguese colonies (Ria Formosa and Tagus Estuary) occupied at different years during the population expansion in the country. We accomplished this by combining diet analysis with blood and feather stable isotopic analysis. Spoonbills from the Portuguese colonies relied mainly (but not exclusively) on crustaceans (Ria Formosa = 75%, Tagus Estuary = 72.5%) and fish (Ria Formosa = 17.11%, Tagus Estuary = 37.50%) to feed their chicks. Crustaceans seems to be the most important prey group. Nevertheless, chicks from Ria Formosa were fed with prey from a higher trophic level than chicks from Tagus Estuary. In both colonies chicks were fed with available in habitats near the colony, although in Tagus Estuary most prey originated from freshwater habitats. Diet of chicks remained constant through the development period and the proportions of crustaceans and fish consumed differed from other colonies elsewhere in Western Europe (Spain and the Netherlands). We conclude that in Portugal, spoonbills feed their chicks with prey commonly found in the vicinity of colonies. Prey originating from artificial habitats, particularly the invasive Louisiana crayfish Procambarus clarkii in the more recently occupied colony, were the most important items in the diet of chicks.
Incidence of resting-state functional connectivity to secondary language areas and contralateral language areas in patients with brain tumors
Authors: Young Angela L , Kundu Suprateek , Tappa Karthik K , Hou Ping , Liu Ho-Ling , Kumar Vinodh A
Published: August 2023

Purpose

Secondary language areas, including the pre-supplementary motor area (pre-SMA), dorsolateral prefrontal cortex (DLPFC), and the visual word form area (VWFA) play important roles in speech, but have been under-evaluated in the realm of resting-state (rs)-fMRI. The purpose of this study is to determine the incidence that secondary language areas and contralateral language areas can be localized using seed-based correlation (SBC) rs-fMRI.

Methods

We retrospectively reviewed 40 rs-fMRIs for functional connectivity (FC) to secondary language areas in cases where FC to Broca’s or Wernicke’s area near tumor in the left hemisphere were successfully generated using SBC analysis. Logistical regression was used for statistical analysis.

Results

SBC rs-fMRI with a seed in the left Broca’s or Wernicke’s area ipsilateral to the tumor was performed in the 40 patients. 72.5% of cases showed FC to the left DLPFC, 67.5% to left pre-SMA, and 52.5% of cases had FC to right Broca’s area. In addition to other correlations, we found older patients have a lower incidence of FC to the right Wernicke’s area when seeded from both left Broca’s and left Wernicke’s area ( p-value = .016, odds ratio = 0.94).

Conclusion

SBC rs-fMRI can detect left hemispheric secondary language areas as well as right hemispheric primary and secondary language areas. The left DLPFC showed the highest incidence of FC, followed by the left pre-SMA when seeded from both left Broca’s and Wernicke’s area. Logistics regression also showed in some instances, differences in the incidence of FC to language areas was dependent on age, seed location, and gender.
Augmedix Bangladesh re-humanizing healthcare service
Authors: Huda SSM Sadrul , Nazmul Shahriar Bin , Mowla Syeda Madeha , Mowla Syeda Aida
Published: August 2023

In 2012, Stanford University graduates “Ian Shakil” and “Pelu Tan” founded Augmedix in Silicon Valley (Augmedix Remote Documentation Services, 2019). Augmedix serves patients in the United States and three other countries. One of them is Bangladesh. This case is developed to present the operational framework of Augmedix Bangladesh based on secondary sources of information. To free up doctors’ time, this app instantly documents doctor-patient talks in the patient’s medical file. Augmedix’s platform uses NLP Technology and skilled staff to ensure correct and consistent documentation. In Bangladesh, this highly skilled group goes by the name “Scribe.” Using audio and visual input, a doctor in the United States and a scribe in Bangladesh (Augmedix BD) build a patient’s medical record in real-time. Clinicians using the Augmedix Ambient Automation Platform carry out Augmedix processes. This innovation will reduce the amount of time spent by doctors manually documenting patient information. This innovative technology might save doctors two to 3 hours per day. In this service, they provide live communication, notes, data service, etc.
Dengue beyond fever-fatal dengue myocarditis and complete heart block: A case report and brief overview of cardiac manifestations of dengue fever
Authors: Khan Asad Ali , Khan Farhat Ullah , Akhtar Syed Ahsan , Ghaffar Rahmat
Published: August 2023

Dengue is an endemic viral fever transmitted by mosquitoes that may be asymptomatic or cause a nonspecific flu-like illness. The disease’s most severe manifestations are dengue hemorrhagic fever and dengue shock syndrome. Various atypical manifestations have been observed that constitute the expanded dengue syndrome. Although uncommon, it is now known to cause cardiac complications that can be life-threatening and difficult to diagnose. We illustrate a case of a 16-year-old boy infected with dengue who experienced syncope, dizziness, and lethargy. His electrocardiogram showed third degree atrioventricular block which did not resolve with atropine and fluid resuscitation. After excluding all possible causes of complete heart block, transvenous pacing was done. A detailed workup was carried out that favored a diagnosis of subclinical myocarditis leading to complete heart block. The patient did not regain a normal rhythm and was considered for permanent pacemaker implantation. Myocarditis, pericarditis, rhythm disturbances, first- and second-degree atrioventricular blocks, and rarely third-degree heart blocks have been seen in dengue patients. However, a case of dengue illness associated complete heart blocks that is irreversible and necessitates a permanent pacemaker has never been described in the literature, and this is the first such case being reported. This article intends to increase clinicians’ awareness, particularly those in dengue-endemic regions, about better recognition and comprehension of cardiac problems associated with dengue fever.
Feminism within parties: Implications for political elite evaluations and policy attitudes
Authors: Oceno Marzia , Chojnacki Lauren
Published: August 2023

Although gender-related attitudes have played an increasingly larger role in recent U.S. elections, the implications of feminist identity beyond electoral politics remain largely understudied. This paper examines how the interaction of feminist and party ID impacts political elite evaluations and policy attitudes that are not gender-based by relying on an original survey fielded as part of the 2020 CES and the 2016 ANES. Our analyses show that feminists of both parties give the highest feminist ratings to co-partisan elites. However, while Democratic feminists rate Democratic elites as more feminist than Republican elites, Republican feminists rate the two similarly. Furthermore, within both parties, feminist self-labeling is associated with increased support for policies that advance social equity and inclusion. This gap in policy preferences between feminists and non-feminists largely persists across ideologies—among liberal, moderate, and conservative members of both parties. These findings suggest that feminist identifiers constitute a distinct group within each party, and fostering feminism across political leanings may strengthen public support for more equitable and inclusive policy goals and outcomes.
Exploring the Effect of E-Business Operations on E-Business Performance: Moderating Effect of Responsiveness to the Supplier
Authors: Ukko Juhani , Saunila Minna , Sore Sariseelia , Rantala Tero , Nasiri Mina
Published: August 2023

Extant research on service operations has called for investigating the link between e-retailers’ e-business operations and e-business performance. In addition to investigating this link, this study examined whether such links are moderated by an e-retailer’s responsiveness to the supplier. Since, as previous studies have shown, web store suppliers play an essential role in e-retailers’ value creation, it is important to study how the cooperation between the parties works. The data were collected from Finnish e-retailers through a survey, and the results revealed that one component of e-business operations, namely customer orientation, significantly impacts both the e-retailer’s financial and operational performance, while service maintenance and customization do not affect e-business performance. Responsiveness to the supplier, it was also found, exerts a statistically significant positive moderating effect on the relationship between the e-retailer’s customer orientation and financial performance. Moreover, to boost e-business performance, web store suppliers could take a more active part in e-retailers’ business operations. By focusing on the link between web store suppliers and e-retailers, this study brings awareness to the less-studied role of web store suppliers in e-retailers’ performance and offers a new perspective.
Employer Attractiveness: Two Instruments to Measure Employer Branding and Reputation
Authors: Caputo Andrea , Molino Monica , Cerato Barbara , Cortese Claudio G.
Published: August 2023

The external purpose of Employer Branding is attraction, that is, the brand’s capability to be preferred to its competitors through attractiveness and reputation. This study aims to (1) propose the Italian adaptation of the Employer Attractiveness scale (EmpAt scale) in its “real” version; (2) propose a tool to evaluate employer reputation; and (3) measure the convergent and predictive validity of these two measures. An online survey was administered to a sample of convenience ( N = 407; 56% were women). The results of exploratory and confirmatory factor analyses are presented for both scales, including correlations and regression results to demonstrate reliability and validity. Organizations could use these two tools to perform preliminary analyses to improve their employer branding, being aware of their own image’s strengths and areas for improvement, and thus differentiating themselves from competitors.
How to Talk About Books on Social Media: The German-Language Social Media Reviewer Sphere on Instagram
Authors: Stollfuß Sven
Published: August 2023

This explorative study investigates how book readers engage on Instagram within the platform-based reviewer sphere as part of the Bookstagram community. The communicative patterns and practices of online book reviews align with the communicative infrastructure of social media. The aim is to define and describe the communicative patterns and practices of online book reviewing under the changing conditions in a social media environment. The article analyzes a sample of the German-language reviewer sphere on Instagram in order to investigate a local formation of a global community. Based on a content analysis of posts ( N = 514) from three thematic hashtags—#rezension (“review”), #buch (“book”), and #bookstagramgermany—, I will discuss the types of reviewers and analyze their content by the categories of platform affordances, imagery, textual forms, and review approach. The article contributes to the research of online book reviewing within communication and media studies by providing insight into the communication and review approaches of a niche-structured Instagram community.
Republication of “Assessment of Recovery From Geriatric Ankle Fracture Using the Life Space Mobility Assessment (LSA): A Pilot Study”
Authors: Ahearn Briggs , Mueller Claire , Boden Stephanie , Mignemi Danielle , Tenenbaum Shay , Bariteau Jason
Published: August 2023

Background:

The Life Space Assessment (LSA) is a validated outcomes measure that aims to assess the level of mobility and physical functioning within one’s own environment following a medical event. We sought to study the recovery of geriatric ankle fracture patients utilizing the LSA. We hypothesized that the LSA would provide improved assessment of these patients and help identify key differences in operative and nonoperatively treated patients.

Methods:

Prospective observational study of geriatric patients age 65 years and older with an ankle fracture with 1-year follow-up. Operative versus nonoperative intervention was determined by the attending physician on a patient-specific basis. The LSA, Short Form–36 (SF-36), and visual analog pain scale (VAPS) were administered at predetermined intervals postinjury and scores were analyzed for significance.

Results:

20 patients were enrolled in this study. 11 underwent surgery whereas 9 were treated nonoperatively. Regardless of treatment, the preinjury LSA score was 86.7. This significantly dropped to 20.6 at 6 weeks and recovered to 73.6 at 12 months. In the operative cohort, the LSA scores preinjury were 91.4 and improved to 87.6 after 1 year. The nonoperative group recorded 80.9 preinjury and only improved to 59.5 at 1 year ( P = 0.007). There was no statistically significant difference when comparing the results of the SF-36 and VAPS to the LSA.

Conclusion:

The LSA was effective in assessing recovery in geriatric ankle fracture patients. A severe deficit in mobility was seen for the first 6 months of recovery regardless of treatment. Operative patients ultimately returned to their baseline LSA at 1 year while nonoperative patients did not. Outcomes from the VAS and SF-36 mirrored the LSA but were not found to be statistically significant.

Level of Evidence:

Level II.
Syndromic Craniosynostosis in a Child With Fontaine Progeroid Syndrome: A Rare Genetic Disorder and the Surgical Management
Authors: Wolbert Thao , Teitler Nate , Weis Lauren , Podber Anna , Miller Jason
Published: August 2023

We present a case of cranial vault remodeling in a patient with Fontaine Progeroid Syndrome. At birth, the patient presented with midfacial retrusion, pansynostosis, and significant agenesis of the central vertex skull. Genetic testing revealed a de novo variant in the SLC25A24 gene, confirming the diagnosis of Fontaine Progeroid Syndrome. For craniosynostotis management of her pansynostosis and the large central vertex agenesis, surgical reconstruction was purposely delayed to allow ossification of the cranial vault. Subsequently, the cranial vault expansion was performed at the age of 4. Intraoperatively, significant dense adherence of bilateral temporal, parietal, and frontal bones to the underlying dural lakes was noted. This is the first case report known in the literature regarding suggested surgical management of the syndromic craniosynostosis with an enormous central skull agenesis.
Noncorticosteroid Topical Therapies for the Treatment of Plaque Psoriasis: A Narrative Review
Authors: Chandy Rithi J. , Dao Diem-Phuong D. , Rivis Cristian C. , Shan Divya M. , Feldman Steven R.
Published: August 2023

Objective: The objective was to compare the safety and efficacy of noncorticosteroid topical treatments for plaque psoriasis. Data Sources: A literature search of the PubMed database was performed (January 1978 to May 2023) using the keywords plaque psoriasis, tapinarof, benvitimod, Vtama, roflumilast, Zoryve, pimecrolimus, tacrolimus, tazarotene, tacalcitol, calcitriol, Vectical, calcipotriene, Dovonex, tacalcitol, vitamin D analogs, salicylic acid, non-corticosteroid topical, Investigator’s Global Assessment, and Physician’s Global Assessment. Study Selection and Data Extraction: Relevant English-language articles and clinical trial data were considered. Data Synthesis: Six noncorticosteroid topical classes for the treatment of plaque psoriasis were selected. The percentage of patients with plaque psoriasis who achieved Investigator’s Global Assessment (IGA) success after 8 weeks of treatment with tacalcitol, calcipotriene/betamethasone dipropionate compound, tazarotene/halobetasol propionate, and roflumilast was 17.9%, 39.9%, 40.7%, and 42.4%, respectively. For 12-week trials of tapinarof and coal tar, 37.4% and 58.2% of patients achieved IGA success, respectively. There were 48% and 71.4% reductions in IGA scores with salicylic acid (12 weeks) and pimecrolimus (4 weeks), respectively. Finally, 66.7% of patients achieved Physician’s Global Assessment success with 8 weeks of tacrolimus. There were no serious adverse events for the noncorticosteroid topicals. Conclusion: Noncorticosteroid topicals are suitable options for patients with plaque psoriasis who would like to avoid topical corticosteroids or have experienced adverse effects from chronic corticosteroid use. Due to treatment duration differences and varied outcome measures, it is unclear which noncorticosteroid topical is most efficacious; however, calcineurin inhibitors appear to exhibit the greatest efficacy. Each topical was efficacious in treating plaque psoriasis and had an adequate safety profile. Despite several treatment options for plaque psoriasis, medication adherence is a limiting factor.
Atracurium Versus Cisatracurium in the Treatment of Acute Respiratory Distress Syndrome
Authors: Carabetta Shannon M. , Allen Bryan , Cannon Chad , Hailu Kirubel , Johnson Totty
Published: August 2023

Background: Neuromuscular blocking agents are one of the few medication classes that have demonstrated a clinical benefit in patients with severe acute respiratory distress syndrome (ARDS). However, most literature utilized cisatracurium, and utilization of atracurium is limited to 1 small study. Objective: The purpose of this study was to provide further evidence comparing the safety and efficacy of atracurium versus cisatracurium for the treatment of ARDS. Methods: This multicenter, retrospective, observational cohort noninferiority study was conducted at 3 hospitals within a tertiary health care system. We included subjects diagnosed with ARDS who received either atracurium or cisatracurium for at least 12 hours. The primary outcome measured the change in PaO2/FiO2 (P/F) ratio from baseline to 48 hours after initiation. Results: Baseline characteristics were similar between groups except for a higher median age and a higher proportion of subjects who were COVID-positive in the atracurium group. There were also some noted differences in the baseline P/F ratios. In a multivariable model adjusting for baseline characteristics, the change in the P/F ratio for atracurium was noninferior to cisatracurium at 24, 48, and 72 hours. A significant cost reduction, measured as cost per patient per day, was seen with the use of atracurium ($14.81-$25.16 vs $33.86-$41.91). Conclusion: Atracurium appears to be a safe and cheaper alternative agent in the management of ARDS.
An adaptive multi-modal hybrid model for classifying thyroid nodules by combining ultrasound and infrared thermal images
Authors: Zhang Na , Liu Juan , Jin Yu , Duan Wensi , Wu Ziling , Cai Zhaohui , Wu Meng
Published: August 2023

Background

Two types of non-invasive, radiation-free, and inexpensive imaging technologies that are widely employed in medical applications are ultrasound (US) and infrared thermography (IRT). The ultrasound image obtained by ultrasound imaging primarily expresses the size, shape, contour boundary, echo, and other morphological information of the lesion, while the infrared thermal image obtained by infrared thermography imaging primarily describes its thermodynamic function information. Although distinguishing between benign and malignant thyroid nodules requires both morphological and functional information, present deep learning models are only based on US images, making it possible that some malignant nodules with insignificant morphological changes but significant functional changes will go undetected.

Results

Given the US and IRT images present thyroid nodules through distinct modalities, we proposed an Adaptive multi-modal Hybrid (AmmH) classification model that can leverage the amalgamation of these two image types to achieve superior classification performance. The AmmH approach involves the construction of a hybrid single-modal encoder module for each modal data, which facilitates the extraction of both local and global features by integrating a CNN module and a Transformer module. The extracted features from the two modalities are then weighted adaptively using an adaptive modality-weight generation network and fused using an adaptive cross-modal encoder module. The fused features are subsequently utilized for the classification of thyroid nodules through the use of MLP. On the collected dataset, our AmmH model respectively achieved 97.17% and 97.38% of F1 and F2 scores, which significantly outperformed the single-modal models. The results of four ablation experiments further show the superiority of our proposed method.

Conclusions

The proposed multi-modal model extracts features from various modal images, thereby enhancing the comprehensiveness of thyroid nodules descriptions. The adaptive modality-weight generation network enables adaptive attention to different modalities, facilitating the fusion of features using adaptive weights through the adaptive cross-modal encoder. Consequently, the model has demonstrated promising classification performance, indicating its potential as a non-invasive, radiation-free, and cost-effective screening tool for distinguishing between benign and malignant thyroid nodules. The source code is available at https://github.com/wuliZN2020/AmmH.
Characteristics and potential clinical applications of the extracellular vesicles of human pathogenic Fungi
Authors: Ullah Amir , Huang Yiyi , Zhao Kening , Hua Yuneng , Ullah Shafi , Rahman Mujeeb ur , Wang Jingyu , Wang Qian , Hu Xiumei , Zheng Lei
Published: August 2023

Extracellular vesicles (EVs) are a heterogeneous group of lipid membrane-enclosed compartments that contain different biomolecules and are released by almost all living cells, including fungal genera. Fungal EVs contain multiple bioactive components that perform various biological functions, such as stimulation of the host immune system, transport of virulence factors, induction of biofilm formation, and mediation of host–pathogen interactions. In this review, we summarize the current knowledge on EVs of human pathogenic fungi, mainly focusing on their biogenesis, composition, and biological effects. We also discuss the potential markers and therapeutic applications of fungal EVs.
Assessing the transportability of clinical prediction models for cognitive impairment using causal models
Authors: Fehr Jana , Piccininni Marco , Kurth Tobias , Konigorski Stefan
Published: August 2023

Background

Machine learning models promise to support diagnostic predictions, but may not perform well in new settings. Selecting the best model for a new setting without available data is challenging. We aimed to investigate the transportability by calibration and discrimination of prediction models for cognitive impairment in simulated external settings with different distributions of demographic and clinical characteristics.

Methods

We mapped and quantified relationships between variables associated with cognitive impairment using causal graphs, structural equation models, and data from the ADNI study. These estimates were then used to generate datasets and evaluate prediction models with different sets of predictors. We measured transportability to external settings under guided interventions on age, APOE ε4, and tau-protein, using performance differences between internal and external settings measured by calibration metrics and area under the receiver operating curve (AUC).

Results

Calibration differences indicated that models predicting with causes of the outcome were more transportable than those predicting with consequences. AUC differences indicated inconsistent trends of transportability between the different external settings. Models predicting with consequences tended to show higher AUC in the external settings compared to internal settings, while models predicting with parents or all variables showed similar AUC.

Conclusions

We demonstrated with a practical prediction task example that predicting with causes of the outcome results in better transportability compared to anti-causal predictions when considering calibration differences. We conclude that calibration performance is crucial when assessing model transportability to external settings.
The global prevalence of gastric cancer in Helicobacter pylori-infected individuals: a systematic review and meta-analysis
Authors: Shirani Maryam , Pakzad Reza , Haddadi Mohammad Hossein , Akrami Sousan , Asadi Arezoo , Kazemian Hossein , Moradi Melika , Kaviar Vahab Hassan , Zomorodi Abolfazl Rafati , Khoshnood Saeed , Shafieian Mahnaz , Tavasolian Ronia , Heidary Mohsen , Saki Morteza
Published: August 2023

Background

Helicobacter pylori is a gastrointestinal pathogen that infects around half of the world's population. H. pylori infection is the most severe known risk factor for gastric cancer (GC), which is the second highest cause of cancer-related deaths globally. We conducted a systematic review and meta-analysis to assess the global prevalence of GC in H. pylori-infected individuals.

Methods

We performed a systematic search of the PubMed, Web of Science, and Embase databases for studies of the prevalence of GC in H. pylori-infected individuals published from 1 January 2011 to 20 April 2021. Metaprop package were used to calculate the pooled prevalence with 95% confidence interval. Random-effects model was applied to estimate the pooled prevalence. We also quantified it with the I2 index. Based on the Higgins classification approach, I2 values above 0.7 were determined as high heterogeneity.

Results

Among 17,438 reports screened, we assessed 1053 full-text articles for eligibility; 149 were included in the final analysis, comprising data from 32 countries. The highest and lowest prevalence was observed in America (pooled prevalence: 18.06%; 95% CI: 16.48 − 19.63; I2: 98.84%) and Africa (pooled prevalence: 9.52%; 95% CI: 5.92 − 13.12; I2: 88.39%). Among individual countries, Japan had the highest pooled prevalence of GC in H. pylori positive patients (Prevalence: 90.90%:95% CI: 83.61–95.14), whereas Sweden had the lowest prevalence (Prevalence: 0.07%; 95% CI: 0.06–0.09). The highest and lowest prevalence was observed in prospective case series (pooled prevalence: 23.13%; 95% CI: 20.41 − 25.85; I2: 97.70%) and retrospective cohort (pooled prevalence: 1.17%; 95% CI: 0.55 − 1.78; I 2: 0.10%).

Conclusions

H. pylori infection in GC patients varied between regions in this systematic review and meta-analysis. We observed that large amounts of GCs in developed countries are associated with H. pylori. Using these data, regional initiatives can be taken to prevent and eradicate H. pylori worldwide, thus reducing its complications.
Defining the scope of extended NIPS in Western China: evidence from a large cohort of fetuses with normal ultrasound scans
Authors: Chen Lin , Wang Li , Zeng Yang , Yin Daishu , Tang Feng , Xie Dan , Zhu Hongmei , Liu Hongqian , Wang Jing
Published: August 2023

Background

Standard noninvasive prenatal screening(NIPS) is an accurate and reliable method to screen for common chromosome aneuploidies, such as trisomy 21, 18 and 13. Extended NIPS has been used in clinic for not only aneuploidies but also copy number variants(CNVs). Here we aim to define the range of chromosomal abnormalities that should be able to identify by NIPS in order to be an efficient extended screening test for chromosomal abnormalities.

Methods

A prospective study was conducted, involving pregnant women without fetal sonographic structural abnormalities who underwent amniocentesis. Prenatal samples were analyzed using copy number variation sequencing(CNV-seq) to identify fetal chromosomal abnormalities.

Results

Of 28,469 pregnancies included 1,022 (3.59%) were identified with clinically significant fetal chromosome abnormalities, including 587 aneuploidies (2.06%) and 435 (1.53%) pathogenic (P) / likely pathogenic (LP) CNVs. P/LP CNVs were found in all chromosomes, but the distribution was not uniform. Among them, P/LP CNVs in chromosomes 16, 22, and X exhibited the highest frequencies. In addition, P/LP CNVs were most common on distal ends of the chromosomes and in low copy repeat regions. Recurrent microdeletion/microduplication syndromes (MMS) accounted for 40.69% of total P/LP CNVs. The size of most P/LP CNVs (77.47%) was < 3 Mb.

Conclusions

In addition to aneuploidies, the scope of extended NIPS should include the currently known P/LP CNVs, especially the regions with recurrent MMS loci, distal ends of the chromosomes, and low copy repeat regions. To be effective detection should include CNVs of < 3 Mb. Meanwhile, sufficient preclinical validation is still needed to ensure the clinical effect of extended NIPS.
Characteristics and risk factors for colorectal polyps among children in an urban area of Wenzhou, China: a retrospective case control study
Authors: Wang Yinghui , Fang Lingjuan , Huang Kaiyu , Pan Tongtong , Lu Huajun , Yan Xiumei
Published: August 2023

Background

Scarce evidence exists on pediatric colorectal polyp risk factors. This study explored the clinical manifestations, morphological and pathological characteristics of, and risk factors for pediatric colorectal polyps.

Methods

This retrospective case-control study included children who received colonoscopy, divided into a colorectal polyp group and a normal control group based on colonoscopy results. The risk factors for colorectal polyps in children were analyzed through logistic regression analysis.

Results

The mean age of children with polyps was 6.77 ± 3.44 years. Polyps were detected predominantly in males (72.9%); hematochezia was the primary clinical manifestation (80.25%). Most polyps were juvenile (88.9%) and solitary (87.7%); 50.6% were located in the rectosigmoid area. Univariate analysis showed that gender (P = 0.037), age (P < 0.001), family aggregation (P < 0.001), specific immunoglobulin E (sIgE) (P < 0.001), platelet count (P = 0.001), aspartate aminotransferase (AST) (P = 0.016), meat intake (P = 0.010), and vegetable intake (P < 0.001) were significantly associated with colorectal polyps. Age ≤ 6 years (3–6 years: OR: 26.601, 95% CI: 3.761–160.910; < 3 years: OR: 22.678, 95% CI: 1.873–274.535), positive family aggregation (OR: 3.540, 95% CI: 1.177–10.643), positive sIgE (OR:2.263, 95% CI: 1.076–4.761), and higher meat intake (OR:1.046, 95% CI: 1.029–1.063) were risk factors for pediatric colorectal polyps in logistic regression analysis. Higher vegetable intake (OR: 0.993, 95% CI: 0.986–1.000) was a protective factor against pediatric colorectal polyps. The area under the curve (AUC) of meat intake in the receiver operating characteristic (ROC) curve analysis for predicting colorectal polyps was 0.607; the best cut-off value was 92.14 g/d (P = 0.010, 95% CI: 0.527–0.687). The meat and vegetable intake combination AUC in predicting pediatric colorectal polyps was 0.781 (P < 0.001, 95% CI: 0.718–0.845).

Conclusions

Juvenile, solitary, and located in the rectosigmoid region polyps are most common in children. Hematochezia is the main clinical manifestation. Most polyps were, but multiple and proximally located polyps were also detected. Age ≤ 6 years, especially 3–6 years, positive family aggregation, positive sIgE, and higher meat intake are risk factors for pediatric colorectal polyps. A higher vegetable intake is a protective factor.
A developmental formative evaluation of a pilot participatory music program for veterans with housing insecurity
Authors: Wasmuth Sally , Rattray Nicholas A. , Cheng Phillip , Crow Shannon , Myers Jennifer , Burns Debra S. , Myers Laura J. , Hook Brittany , Lustig Anne , Perkins Anthony J. , Cheatham Ariel J. , Bravata Dawn M.
Published: August 2023

Background

Interventions are needed to improve well-being and promote community reintegration among Veterans with housing insecurity. The objective was to conduct a developmental formative evaluation of a participatory music program.

Methods

This single-site, pilot study implemented a participatory music program at a U.S. Department of Veterans Affairs (VA) Homeless Domiciliary that included one-hour sessions (group music instruction and ensemble playing), 3 times per week for 3 months. Intervention development was guided by the Model of Human Occupation (MOHO). Evaluation was guided by the MOHO and the Consolidated Framework for Implementation Evaluation (CFIR). Qualitative data were collected via semi-structured interviews from participants and non-participants, and were analyzed using an interdisciplinary, constant comparison qualitative analysis technique.

Results

Sixteen program participants and 8 non-participants were enrolled, age range 26–59 (mean 41; standard deviation, 11) years; 75% were White. The sample for this study (N = 12) included five participants and seven non-participants. Semi-structured interview responses produced three salient themes illuminating Veterans’ perspectives: (1) key characteristics of the intervention (the relative advantage of the participatory program over other problem-focused programs; the importance of a supportive, encouraging teaching; the group setting; the role of music); (2) the therapeutic power of the program (based on it being enjoyable; and serving as an escape from preoccupations); and (3) the context and culture (which included Veterans supporting each other and the Domiciliary setting).

Conclusions

Veterans described the benefits of a participatory music intervention compared to problem-based groups, which included enjoyment, skill acquisition facilitating pride, escape, reconnecting with their identity prior to current problems, and experiencing positive aspects of Veteran culture such as mutual support and discipline. These data support ongoing research about participatory music programs to support Veterans with housing insecurity.

Graphical Abstract
Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review
Authors: Teibo Titilade Kehinde Ayandeyi , Andrade Rubia Laine de Paula , Rosa Rander Junior , Tavares Reginaldo Bazon Vaz , Berra Thais Zamboni , Arcêncio Ricardo Alexandre
Published: August 2023

Introduction

The objective of this systematic review is to identify tuberculosis (TB) high-risk among the general population globally. The review was conducted using the following steps: elaboration of the research question, search for relevant publications, selection of studies found, data extraction, analysis, and evidence synthesis.

Methods

The studies included were those published in English, from original research, presented findings relevant to tuberculosis high-risk across the globe, published between 2017 and 2023, and were based on geospatial analysis of TB. Two reviewers independently selected the articles and were blinded to each other`s comments. The resultant disagreement was resolved by a third blinded reviewer. For bibliographic search, controlled and free vocabularies that address the question to be investigated were used. The searches were carried out on PubMed, LILACS, EMBASE, Scopus, and Web of Science. and Google Scholar.

Results

A total of 79 published articles with a 40-year study period between 1982 and 2022 were evaluated. Based on the 79 studies, more than 40% of all countries that have carried out geospatial analysis of TB were from Asia, followed by South America with 23%, Africa had about 15%, and others with 2% and 1%. Various maps were used in the various studies and the most used is the thematic map (32%), rate map (26%), map of temporal tendency (20%), and others like the kernel density map (6%). The characteristics of the high-risk and the factors that affect the hotspot’s location are evident through studies related to poor socioeconomic conditions constituting (39%), followed by high population density (17%), climate-related clustering (15%), high-risk spread to neighbouring cities (13%), unstable and non-random cluster (11%).

Conclusion

There exist specific high-risk for TB which are areas that are related to low socioeconomic conditions and spectacular weather conditions, these areas when well-known will be easy targets for intervention by policymakers. We recommend that more studies making use of spatial, temporal, and spatiotemporal analysis be carried out to point out territories and populations that are vulnerable to TB.