bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study
Authors: Kartika Lisa , Subadi Imam , Pawana I Putu Alit , Andriana Meisy , Sugianto Paulus
Published: January 2024

Introduction:

Myasthenia gravis (MG) is a neuromuscular junction autoimmune disease characterised of intermittent muscle weakness that increases with activity and recovers with rest.

Objective:

Analysing the correlation of fatigue on walking ability in MG patients.

Methods:

This study used a cross-sectional design with consecutive sampling. Participants MG patients took in this trial. Data collection encompasses fatigue and walking ability, with fatigue being assessed using the fatigue severity scale (FSS) and walking ability being assessed using the 10-metre walking test. The 10-metre walking test assessment contains three components: comfortable walking speed (CWS), maximum walking speed (MWS), and natural cadence. The statistical analysis used in this study includes the Pearson correlation and Spearman rank tests withP<0.05.

Results:

The number of participants was 23 MG patients, and most of the participant was female (69.6%). The participant’s fatigue value was 5.46±1.13, including MGFA 1=5.32±1.15, MGFA 2A=5.5±1.11, and MGFA 2B=5.61±1.30. Meanwhile, the participant’s walking abilities included CWS of 1.10±0.11 m/s, MWS of 1.31±0.15 m/s, and natural cadence of 110.91±7.74 steps/min. No significant correlation of fatigue on walking ability including FSS vs. CWS (r=−0.141;P=0.520), FSS vs MWS (r=−0.169;P=0.442), and FSS vs. natural cadence (r=−0.050;P=0.822).

Conclusion:

There was no significant correlation between fatigue and walking ability in MG patients who had MGFA 1, MGFA 2A, and MGFA 2B.
Adult-to-adult right lobe graft living donor liver transplantation for acute-on-chronic liver failure: a single-centre retrospective study in Vietnam
Authors: Vu Quang V. , Le Thanh V. , Le Hieu T. , Nguyen Anh H N. , Nguyen Duy T.
Published: January 2024

Introduction:

Acute-on-chronic liver failure (ACLF) has a high mortality rate, and liver transplantation is considered a definite treatment for patients with this condition. This study aims to evaluate the outcomes of living donor liver transplantation (LDLT) in ACLF patients in a single centre in a lower middle-income country, Vietnam.

Materials and methods:

This was a retrospective study at the 108 Military Central Hospital (Hanoi, Vietnam), enroling 51 patients diagnosed with ACLF based on Asian Pacific Association for the Study of the Liver (APASL) criteria who underwent LDLT with a right lobe graft from December 2019 to December 2022. The authors utilize the model for end-stage liver disease (MELD) and APASL ACLF Research Consortium (AARC) scores to evaluate and stratify the severity of ACLF.

Results:

The average age of all patients was 47.27±13.61, with 88.24% being male. The average BMI was 22.78±2.61. The most common underlying liver disease was chronic viral hepatitis B (88.2%). The average MELD score of the patients was 34.90±5.61, with 33.3% having MELD score greater than or equal to 40. In terms of ACLF severity, five patients (9.8%) had grade I ACLF, 35 patients (68.6%) had grade II ACLF, and 11 patients (21.6%) had grade III ACLF. The average AARC score was 9.43±1.68. The duration of treatment in the ICU was 8.59±7.27 days, and the length of hospital stay was 28.02±13.45 days. The most common post-transplant complication was biliary complication (19.61%). Death occurred in 7 patients (13.7%). The survival rates at 6 months, 1 year, and 3 years were 84%, 81.7%, and 81.7%, respectively.

Conclusion:

Living donor liver transplantation for ACLF patients is safe and has a high post-transplant survival rate. Multidisciplinary care before, during, and after surgery, and the decision to do a liver transplant early, is essential in saving the lives of ACLF patients.
Differential Characteristics of Fatigue–Pain–Sleep Disturbance–Depression Symptom Cluster and Influencing Factors of Patients With Advanced Cancer During Treatment
Authors: Ye Yanxin , Zeng Kai , Qin Lan , Luo Jiahui , Liu Suting , Miao Jingxia , Liang Jingwen , Yu Ya , Zhao Ming , Zhang Lili
Published: January 2024

Background

Patients with advanced cancer may experience symptom clusters during treatment (eg, fatigue, pain, sleep disturbance, depression). Understanding the characteristics and factors associated with symptom cluster classes among this patient population is essential for effective symptom management.

Objective

The aims of this study were to identify symptom cluster (fatigue–pain–sleep disturbance–depression) classes and explore influencing factors in patients with advanced cancer during the treatment.

Methods

A cross-sectional survey was conducted in an oncology department of a tertiary hospital in China from September 2020 to March 2021. Cancer patients (stage III/IV) 18 years or older completed the questionnaires on pain, fatigue, sleep disturbance, depression, physical activity, and exercise self-efficacy. Latent class analysis and multinomial logistic regression were used.

Results

Three hundred sixty-five patients who were male (65.2%) and younger than 60 years (59.5%) completed questionnaires. Three symptom cluster classes were identified: class 1 (“low symptom burden” class), class 2 (“fatigue-insomnia” class), and class 3 (“high symptom burden” class), with a percentage of 54.5%, 38.6%, and 6.8%, respectively. The quality-of-life score, introversion/extroversion, economic burden, Karnofsky Performance Status, albumin level, and exercise self-efficacy were significantly different among the 3 classes (P < .05).

Conclusion

Patients with advanced cancer were classified into 3 distinct classes, with class 1 having the best function. Results from this study reveal that Karnofsky Performance Status, albumin level, and exercise self-efficacy were significant factors for the latent classes of symptom cluster.

Implications for Practice

Exercise self-efficacy is important for personalized interventions and improving symptom management efficiency.
Frostbite in the Pediatric Population
Authors: Ma Xiya , Pouoh Jamilah Temfack , Hogue Bénédicte Therrien , Bougie Emilie
Published: January 2024

Introduction

Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic.

Methods

A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management.

Results

A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases.

Conclusions

The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.
Factors Predisposing Patients to Non-Home Discharge After Surgery for Degenerative Cervical Myelopathy: A Retrospective Analysis
Authors: Callaghan-VanderWall Megan E. , Kuo Andy , Baumann Anthony N. , Furey Christopher G. , Cheng Christina W.
Published: January 2024

Objective

The objective of this study is to evaluate factors associated with discharge to subacute care after surgery for degenerative cervical myelopathy (DCM).

Design

This is a retrospective chart review of adults who underwent cervical spine surgery at a for DCM between 2014 and 2020 (n = 135).

Results

Patients discharged to a subacute setting were older (68.1 +/- 8.6 vs. 64.1 years +/- 8.8; p = 0.01); more likely to be unmarried (55.8% vs. 33.7% married; p = 0.01); and more likely to have Medicare or Medicaid (83.7% vs. 65.9% private insurance; p = 0.03). than patients discharged home. A posterior surgical approach was associated with discharge to a subacute setting (62.8% vs. 43.5% anterior approach; p = 0.04). 87.8% of patients discharged to a subacute setting required moderate or maximum assistance for bed mobility vs. 26.6% of patients discharged home (p < 0.0001).Compared to patients discharged home, patients discharged to a subacute setting ambulated a shorter distance in their first Physical Therapy Evaluation after surgery (8.9 meters +/- 35.8 vs. 53.7 meters +/- 61.78 in the home discharge group; p < 0.0001).

Conclusion

Analysis of these factors may guide discussions about patient expectations for postoperative discharge placement.
Clinical Applications of Tranexamic Acid in Plastic and Reconstructive Surgery
Authors: Brown Stav , Brown Tal , Rohrich Rod J.
Published: January 2024

Background:

Tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. This study reviews the scientific evidence regarding the use of TXA in the full range of plastic and reconstructive surgery to provide clinical recommendations for safe and effective use in various plastic surgical procedures.

Methods:

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. An established appraisal process was used to rate the quality of articles (Grading of Recommendations Assessment, Development, and Evaluation methodology).

Results:

Forty-five studies describing the use of TXA in plastic surgery were included. There is moderate-certainty evidence to support the use of intravenous administration of TXA in craniofacial surgery procedures to reduce blood loss and transfusion requirements. There is high-certainty evidence to support the use of TXA in cosmetic surgery and intravenous administration in rhinoplasty procedures to reduce blood loss. Further high-level studies are needed to determine TXA’s effects on hematoma rates in face-lift surgery and breast-related procedures. There is moderate-certainty evidence to support the use of TXA in burn care. Further studies are required to provide quantitative conclusions on the effects of TXA administration in microsurgery.

Conclusions:

This is the largest study to date on the use of TXA in plastic surgery and the first to provide clinical recommendations. The literature highlights TXA’s promising role in the fields of craniofacial surgery, cosmetic surgery, and burn care. Standardized, objective measurements are required to provide quantitative conclusions regarding TXA’s effects on ecchymoses and edema in cosmetic surgery procedures.
Use of MRI in patients with severe diffuse traumatic brain injury: a matched National Trauma Data Bank analysis
Authors: Chilakapati Sai , Dragun Anthony J. , Chiu Ryan G. , George Keith M. , Valadka Alex B.
Published: January 2024

Objective

MRI is increasingly used to evaluate patients with diffuse traumatic brain injury (dTBI). However, the utility of early MRI is understudied. We hypothesize that early MRI patients will have increased length of stay but no changes in ICP management or disposition.

Methods

The 2019 NTDB was queried for patients with dTBI and Glasgow Coma Scale score ≤ 8. Extra-axial and focal intra-axial hemorrhages were excluded. Clinical characteristics were controlled for. Patients with and without MRI were compared for ICP management, outcome, mortality, and disposition. A propensity score matching algorithm was used to create a 1:1 match cohort.

Results

In 2568 patients, MRI was less common in severe dTBI patients with clear reasons for poor exam, including bilaterally unreactive pupils or midline shift. After matching, 501 patients who underwent MRI within one week were compared to 501 patients without MRI. MRI patients had longer ICU stays (11.6 ± 9.6 vs. 13.4 ± 9.5, p < 0.01 [-3.03, -0.66 95% CI]). There was no difference between groups in ICP monitor (23.6% vs. 27.3%, p = 0.17 [-0.09, 0.02 95% CI]) or ventriculostomy placement (13.6% vs. 13.2%, p = 0.85 [-0.04, 0.05 95% CI]) or in withdrawal of care (15.0% versus 18.6%, p = 0.12 [-0.08, 0.01 95% CI]). MRI patients were more likely to be discharged to inpatient rehabilitation (42.9% vs. 33.5%, p < 0.01 [0.03, 0.15 95% CI]) but not to home (9.4% versus 9.0 %, p = 0.83 [-0.03, 0.04 95% CI]).

Conclusions

The decision to pursue early brain MRI may be driven by lack of obvious reasons for a patient’s poor neurologic status. MRI patients had longer ICU stays but no difference in rates of placement of ICP monitors or ventriculostomies or withdrawal of care. Further study is required to define the role of early MRI in dTBI patients.

Level of evidence

Prognostic/epidemiological, IV
Infection and Prophylaxis During Normothermic Liver Perfusion: Audit of Incidence and Pharmacokinetics of Antimicrobial Therapy
Authors: Qureshi Saeed , Elliott Heather , Noel Alan , Swift Lisa , Fear Corrina , Webster Rachel , Brown Nicholas M. , Gaurav Rohit , Butler Andrew J. , Watson Christopher J. E.
Published: January 2024

Background.

Ex situ normothermic liver perfusion (NMP) in a blood-based perfusate is associated with a risk of microbe growth, resulting in life-threatening posttransplant sepsis. Antibiotics are widely used, but the pharmacokinetics of these agents are unknown as is their efficacy. We wished to assess the perfusate concentrations of the meropenem and fluconazole that we use and to audit the incidence of infection with this antimicrobial therapy.

Methods.

Fluconazole and meropenem (100 mg each) were added to the perfusate before NMP began, and serial samples were taken and assayed for drug concentrations. Perfusate cultures were available from 210 of the 242 perfusions performed between February 1, 2018, and April 6, 2023; these were reviewed.

Results.

Following administration of 100 mg fluconazole, levels fell slightly from a median of 24.9 mg/L at 1 h to 22.6 mg/L at 10 h. In contrast, meropenem concentrations fell over time, from a median of 21.8 mg/L at 1 h to 9.4 mg/L at 10 h. There were 4 significant microorganisms grown in the perfusions, including 3 Candida species and an Enterococcus faecium. All the Candida-infected livers were transplanted with no adverse consequences, the recipients being treated with anidulafungin upon identification of the infecting organism; the Enterococcus-infected liver was not transplanted.

Conclusions.

Serious infection is a risk with NMP but appears to be mitigated with a protocol combining fluconazole and meropenem. This combination may not be appropriate in areas where resistance is prevalent. Routine culture of NMP perfusate is essential to identify breakthrough organisms early and enable recipient treatment.
Shallow water foraminifera from Niue and Beveridge Reef (South Pacific): insights into ecological significance and ecosystem integrity
Authors: Oron Shai , Friedlander Alan M. , Sala Enric , Goodman-Tchernov Beverly N.
Published: January 2024

Niue represents one of many important steppingstones facilitating the dispersal of marine organisms across the tropical Pacific Ocean. This study is part of a collaborative expedition involving National Geographic Pristine Seas, the government of Niue, Oceans 5, and the Pacific Community. We present the first survey documenting the species richness of foraminiferal communities in Niue and nearby Beveridge Reef and explore their significance for ecosystem integrity. A substantial portion (59%) of Niue's foraminiferal assemblages is Large Benthic Foraminifera (LBF), a symbiont-bearing group known as ecosystem engineers and indicators of coral reef regime shifts. LBF species reported here reflect the gradual decrease of tropical diversity from the Coral Triangle towards the central Pacific Ocean. Calcarinidae, an LBF family represented in this study by two species, is the easternmost ever recorded in published literature, and the biogeographical dispersal of this temperature-controlled group is of great importance to future global warming related studies. Foraminifera are an important component of beach development in Niue, with a close relationship between source and depositional zones. These essential ecological–sedimentary linkages highlight the importance of habitat conservation not only as a means to safeguard biodiversity, but also for its role in the island's physical framework.
Species- and sex-specific chemical composition from an internal gland-like tissue of an African frog family
Authors: Schäfer Marvin , Sydow David , Schauer Maria , Doumbia Joseph , Schmitt Thomas , Rödel Mark-Oliver
Published: January 2024

Intraspecific chemical communication in frogs is understudied and the few published cases are limited to externally visible and male-specific breeding glands. Frogs of the family Odontobatrachidae, a West African endemic complex of five morphologically cryptic species, have large, fatty gland-like strands along their lower mandible. We investigated the general anatomy of this gland-like strand and analysed its chemical composition. We found the strand to be present in males and females of all species. The strand varies in markedness, with well-developed strands usually found in reproductively active individuals. The strands are situated under particularly thin skin sections, the vocal sac in male frogs and a respective area in females. Gas-chromatography/mass spectrometry and multivariate analysis revealed that the strands contain sex- and species-specific chemical profiles, which are consistent across geographically distant populations. The profiles varied between reproductive and non-reproductive individuals. These results indicate that the mandibular strands in the Odontobatrachidae comprise a so far overlooked structure (potentially a gland) that most likely plays a role in the mating and/or breeding behaviour of the five
Odontobatrachus
species. Our results highlight the relevance of multimodal signalling in anurans, and indicate that chemical communication in frogs may not be restricted to sexually dimorphic, apparent skin glands.
Hummingbirds use distinct control strategies for forward and hovering flight
Authors: Baliga Vikram B. , Dakin Roslyn , Wylie Douglas R. , Altshuler Douglas L.
Published: January 2024

The detection of optic flow is important for generating optomotor responses to mediate retinal image stabilization, and it can also be used during ongoing locomotion for centring and velocity control. Previous work in hummingbirds has separately examined the roles of optic flow during hovering and when centring through a narrow passage during forward flight. To develop a hypothesis for the visual control of forward flight velocity, we examined the behaviour of hummingbirds in a flight tunnel where optic flow could be systematically manipulated. In all treatments, the animals exhibited periods of forward flight interspersed with bouts of spontaneous hovering. Hummingbirds flew fastest when they had a reliable signal of optic flow. All optic flow manipulations caused slower flight, suggesting that hummingbirds had an expected optic flow magnitude that was disrupted. In addition, upward and downward optic flow drove optomotor responses for maintaining altitude during forward flight. When hummingbirds made voluntary transitions to hovering, optomotor responses were observed to all directions. Collectively, these results are consistent with hummingbirds controlling flight speed via mechanisms that use an internal forward model to predict expected optic flow whereas flight altitude and hovering position are controlled more directly by sensory feedback from the environment.
Susceptible and infectious states for both vector and host in a dynamic pathogen–vector–host system
Authors: Lamas Zachary S. , Krichton Maiya , Ryabov Eugene V. , Hawthorne David J. , Evans Jay D.
Published: January 2024

Deformed wing virus (DWV) is a resurgent insect pathogen of honeybees that is efficiently transmitted by vectors and through host social contact. Continual transmission of DWV between hosts and vectors is required to maintain the pathogen within the population, and this vector–host–pathogen system offers unique disease transmission dynamics for pathogen maintenance between vectors and a social host. In a series of experiments, we measured vector–vector, host–host and host–vector transmission routes and show how these maintain DWV in honeybee populations. We found co-infestations on shared hosts allowed for movement of DWV from mite to mite. Additionally, two social behaviours of the honeybee, trophallaxis and cannibalization of pupae, provide routes for horizontal transmission from bee to bee. Circulation of the virus solely among hosts through communicable modes provides a reservoir of DWV for naïve
Varroa
to acquire and subsequently vector the pathogen. Our findings illustrate the importance of community transmission between hosts and vector transmission. We use these results to highlight the key avenues used by DWV during maintenance and infection and point to similarities with a handful of other infectious diseases of zoonotic and medical importance.
Local adaptation in trait-mediated trophic cascades
Authors: Corbett James J. , Trussell Geoffrey C.
Published: January 2024

Predator-induced changes in prey foraging can influence community dynamics by increasing the abundance of basal resources via a trait-mediated trophic cascade. The strength of these cascades may be altered by eco-evolutionary relationships between predators and prey, but the role of basal resources has received limited attention. We hypothesized that trait-mediated trophic cascade strength may be shaped by selection from trophic levels above and below prey. Field and laboratory experiments used snails (
Nucella lapillus
) from two regions in the Gulf of Maine (GoM) that vary in basal resource availability (e.g. mussels), seawater temperature, and contact history with the invasive green crab,
Carcinus maenas
. In field and laboratory experiments,
Nucella
from both regions foraged on mussels in the presence or absence of green crab risk cues. In the field,
Nucella
from the northern GoM, where mussels are scarce, were less responsive to risk cues and more responsive to seawater temperature than southern
Nucella
. In the lab, however, northern
Nucella
foraged and grew more than southern snails in the presence of risk, but foraging and growth were similar in the absence of risk. We suggest that adaptation to basal resource availability may shape geographical variation in the strength of trait-mediated trophic cascades.
More is not always better: peat moss mixtures slightly enhance peatland stability
Authors: Robroek Bjorn J. M. , Devilee Giulia , Telgenkamp Yvet , Härlin Carina , Steele Magdalena N. , Barel Janna M. , Lamers Leon P. M.
Published: January 2024

Terrestrial wetland ecosystems challenge biodiversity–ecosystem function theory, which generally links high species diversity to stable ecosystem functions. An open question in ecosystem ecology is whether assemblages of co-occurring peat mosses contribute to the stability of peatland ecosystem processes. We conducted a two-species (
Sphagnum cuspidatum
,
Sphagnum medium
) replacement series mesocosm experiment to evaluate the resistance, resilience, and recovery rates of net ecosystem CO
2
exchange (NEE) under mild and deep water table drawdown. Our results show a positive effect of mild water table drawdown on NEE with no apparent role for peat moss mixture. Our study indicates that the carbon uptake capacity by peat moss mixtures is rather resilient to mild water table drawdown, but seriously affected by deeper drought conditions. Co-occurring peat moss species seem to enhance the resilience of the carbon uptake function (i.e. ability of NEE to return to pre-perturbation levels) of peat moss mixtures only slightly. These findings suggest that assemblages of co-occurring
Sphagnum
mosses do only marginally contribute to the stability of ecosystem functions in peatlands under drought conditions. Above all, our results highlight that predicted severe droughts can gravely affect the sink capacity of peatlands, with only a small extenuating role for peat moss mixtures.
Effects of changes in calculating GFR using KDIGO standards: Discordance in the Staging and Timing of Diagnosis of Chronic Kidney Disease
Authors: Baker Charlotte , Gratzl Samuel , Rodriguez Patricia J , Simonov Michael , Cartwright Brianna M Goodwin , Brar Rajdeep , Stucky Nicholas L
Published: January 2024

Introduction

Chronic kidney disease (CKD) is a highly prevalent disease with disparities in diagnosis and treatment. Until recently, primary diagnosis for CKD was based on equations that incorporated race and have demonstrated racial bias. This study had two aims comparing outcomes for Black patients and their counterparts: 1) whether using the new 2021 CKD-EPI equation led to decreased disparity with time to diagnosis; and 2) whether there was discordance in the staging between the two equations at potential diagnosis point.

Methods

We evaluated patients aged 18 and over with non-hospitalization related serum creatinine laboratory results between January 1, 2016 and September 30, 2023. We estimated the GFR for each patient using the 2009 and 2021 CKD-EPI creatinine equations. We assessed stage discordance for stages 3a, 3b, 4, and 5 using chi-square tests and the Cochran-Mantel-Haenszel. We used multivariate logistic regression to assess a change in staging based on the equation used.

Results

15.5% of the 8,080,889 patients included in this study were Black. The median age was 57 years and 15.3% of patients met the criteria for stage 3a CKD or higher using either equation. Discordance in staging by equation and by race existed, especially for Black patients at stages 3a and 3b. 40% of Black patients identified as stage 4 using the 2021 equation were 3b or lower using the 2009 equation.

Discussion

Well established medical algorithms with race components are being re-examined. We found more disparity with the initial staging of the disease. The disconnect in the timing of staging by equation for Black patients means a number of these patients may not have received the appropriate treatment. Future work should elucidate the impact of the change in CKD staging with the 2021 CKD-EPI creatinine equation on treatment.

Conclusion

Significant disparity exists in the timing and staging of CKD by CKD-EPI equation and by race.
Robodoc: a conversational-AI based app for medical conversations
Authors: Guerra Pires Jorge
Published: January 2024

Artificial Intelligence (AI) evolved in trends. Currently, the trend is Conversational Artificial Intelligence (CAI). Those models of AI are focused on text-related tasks, and their commonest applications are chatbots. On this paper, we explore a smart chatbot using the Large Language Models (LLMs) from openAI. I have used a tool called Teachable Machine (TM) from Google to apply transfer learning and create image-based models. I have built two image-based model: for X-ray and for OCT. The model of X-ray is able to detect viral and bacterial pneumonia, whereas the Optical coherence tomography (OCT) model can detect Drusen, Choroidal Neovascularization (CNV) and (Diabetic Macular Edema DME) conditions on the patient’s eyes image. I have also used TensorFlow.js from Google to create a diabetes detection model. All those models are integrated into a chatbot, that according to the message entered by a user, is able to use the models intelligently. Our results show a good integration between the models and the chatbot, with slight deviations from the expected behaviors. For the OCT model, we have also tested a stub function for medical appointments done by the bot, based on how serious is the patient condition. The future of artificial intelligence are public APIs, as I have shown that a complex model can be built, without a complex research infrastructure, and with low costs. Bioinformatics may have gained a new supporter towards more friendly interfaces on bioinformatics.
Real-world smartphone data can trace the behavioural impact of epilepsy: A Case study
Authors: van Nieuw Amerongen Arthur R , Meppelink Anne Marthe , Ghosh Arko , Thijs Roland D
Published: January 2024

Neurobehavioural comorbidities have a detrimental effect on the quality of life of people with epilepsy, yet tracking their impact is challenging as behaviour may vary with seizures and anti-seizure medication side effects. Smartphones have the potential to monitor day-to-day neurobehavioural patterns objectively. We present the case of a man in his late twenties with refractory focal epilepsy in whom we ascertained the effects of ASMs withdrawal and a focal-to-bilateral tonic-clonic convulsion on his touchscreen interactions. Using a dedicated app, we recorded over 185 days, the timestamps of 718,357 interactions. We divided the various smartphone behaviours according to the next-interval dynamics of the interactions by using a joint interval distribution (JID). We analysed JIDs during two ASM load transitions: before versus during tapering and restarting medication versus tapering. Cluster-based permutation testing revealed significant differences, with accelerated next-interval dynamics during tapering and a reversal upon medication restart. We also compared the JID of the fbTCS day to the average of the three days before, showing markedly slower next-interval dynamics on the day of the convulsion. This suggests that smartphone interactions’ temporal dynamics may help monitor neurobehavioural comorbidities in epilepsy.
HOW ARE RAPID RESPONSE SERVICES IMPLEMENTED OR CHANGED, AND HOW IS THEIR SUCCESS MEASURED?
Authors: Rowley R. , Poulter A. L. , Smith A. , Pollock E. , Bush D. , Patel P. , Lam M. , Webb L. , Jones D. , Delaney A.
Published: January 2024

Introduction

Rapid Response Teams (RRT) exist in many different formats. With escalating rapid response calls, RRT services need to adapt to meet demand. We will describe how RRT service changes are implemented, either as a novel service or service redesign, and how the success of the implementation is measured.

Methods and analysis

We will systematically review observational cohort studies that involve RRT implementation service change, and measure their implementation success. We will extract data relating to the study characteristics, team characteristics, methods of change implementation, and the outcome measures. The analysis will be primarily narrative, and we will present simple statistics regarding the range and frequency of the methods of implementation.

Ethics and dissemination

As this review is of published studies, it does not require ethical approval. We aim to present our results at scientific meetings and publish the manuscript to a peer reviewed journal.

Trial registration number

This protocol will be registered on the preprint server medRxiv.

Strengths and limitations of this study

The review addresses a relevant question, and will provide a comprehensive evaluation of the implementation of RRT services, and their measures of outcomes. It will serve to provide a basis for future study. We acknowledge that there will be limitations, including heterogeneity of eligible studies, such as variability in team name, composition, resource base, and differing outcome reporting. Additionally, it may be limited by the lack of studies relating to the implementation of services/change management.
Levels and predictors of knowledge, attitude and practice of contraception among female TV undergraduates in Nigeria: a cross-sectional study
Authors: Agbo Hadizah Abigail , Adeoye Philip Adewale , Yilzung Danjuma Ropzak , Mangut Jawa Samson , Ogbada Paul Friday
Published: January 2024

Introduction

Access to contraception is a preventive measure against unplanned pregnancy and sexually transmitted infections; especially in sub-Saharan Africa where unmet need is a huge public health concern. This study assessed the levels and predictors of knowledge, attitude and practice of contraception among female TV studies students in Nigeria.

Methods

This is a cross-sectional study was conducted among female students of NTA TV College, Nigeria. Predictors of good knowledge, attitude and practice of contraception were determined by multivariable binary logistic regression. A p-value of < 0.05 was determined to be statistically.

Result

There were 217 study participants; with an average age of 22 years. Levels of good knowledge, attitude and practice of contraception were 55.3%, 47.5%, and 50.7% respectively. About 74% has ever had sex; with their main sources of contraceptive information from friends and the internet; and commonly used contraceptives are condom and oral contraceptive pills. The commonest reason for the non-use of contraceptives is fear of side effects or health risks. Being a young adult is a significant predictor (aOR: 2.633 [95% CI: 1.031-6.723); p=0.043) of good knowledge; while being a diploma student (aOR: 2.369 [95%CI: 1.219-4.604]; p=0.011); living off-campus (aOR: 2.134 [95%CI: 1.043-4.368]; p=0.038) and good knowledge (aOR: 3.798 [95%CI: 2.079-6.937]; p=0.000) are significant predictors of good attitude. Being from the state’s indigenous population (aOR: 2.369 [95%CI: 1.222-4.595]; p=0.011) and ever engaging in sex (aOR: 24.482 [95%CI: 7.914-75.736]; p=0.000) are significant predictors of good contraceptive use.

Conclusion

Our study has shown relatively low levels of good knowledge, attitude and practice of contraception and their predictors. Therefore, there is an urgent need to improve advocacy and policies to improve knowledge, attitude and practice on contraception and sexual and reproductive health services among young people.
‘I was an accident’. Long-term effects of unintended pregnancy on children: Findings from the Dutch prospective birth-cohort Amsterdam Born Children and their Development study
Authors: Beumer Wieke Y. , Koot Marjette H. , Vrijkotte Tanja , Roseboom Tessa J. , van Ditzhuijzen Jenneke
Published: January 2024

Background

Several studies investigated short-term risks of children born from unintended pregnancies, however evidence about long-term risks is missing. This study aimed to examine whether children born from unintended pregnancies experience psychosocial problems up into adolescence.

Methods

This study is based on the birth cohort study ‘Amsterdam Born Children and their Development’ (n= 7784). Unintended pregnancy was measured as a multidimensional construct. Children’s psychosocial problems were measured with the Strengths and Difficulties Questionnaire, at 5-6, 11-12 and 15-16 years old. Multiple Structural Equation Models were analyzed, examining associations between unintended pregnancy and children’s psychosocial problems, while controlling for co-occurring risks. Mediating effects via maternal mental health and bonding were assessed.

Results

Pregnancy mistiming was a significant predictor of internalizing (β = .10,p< .001) and externalizing problems (β = .07,p =.006) and unwanted pregnancy of internalizing problems (β = .13,p< .001) at 5-6 years. These associations were mostly mediated by maternal mental health and poorer maternal bonding. Associations were no longer present at 11-12 and 15-16 years.

Conclusion

Children born from unintended pregnancies experience more psychosocial problems at 5-6 years, but no longer in adolescence. Unintended pregnancies often coincide with maternal mental health problems, and the associations between unintended pregnancy and children’s psychosocial problems are influenced by maternal mental health and poorer bonding. Therefore it is important to improve maternal mental health and bonding for the benefit of both mother and child, rather than on the isolated effect of unintended pregnancy per se.

Key messages

What is already known on this topic

Of the few studies that have been done, most showed that unintended pregnancy is associated with more psychosocial problems of children later in life, but others found no evidence. Especially evidence about long-term effects on children is missing.

What this study adds

People who carry a more unintended pregnancy to term experience more mental health issues and poor bonding to their child, which in turn negatively affects their young child. However, when children are older (in adolescence), they no longer face a higher risk of psychosocial problems. This was studied in a context with relative liberal abortion laws and context (i.e., the Netherlands).

How this study might affect research, practice or policy

It is important to build on maternal mental health and bonding when wanting to reduce children’s psychosocial problems, instead of focusing on the unintended pregnancy per se.

Competing Interest Statement

The authors have declared no competing interest.
IL-32 producing CD8+memory T cells and Tregs define the IDO1 / PD-L1 niche in human cutaneous leishmaniasis skin lesions
Authors: Dey Nidhi S. , Dey Shoumit , Brown Naj , Senarathne Sujai , Reis Luiza Campos , Sengupta Ritika , Lindoso Jose Angelo L. , James Sally , Gilbert Lesley , Chatterjee Mitali , Goto Hiro , Ranasinghe Shalindra , Kaye Paul M.
Published: January 2024

Human cutaneous leishmaniasis (CL) is characterised by chronic skin pathology. Experimental and clinical data suggest that immune checkpoints (ICs) play a crucial role in disease outcome but the cellular and molecular niches that facilitate IC expression during leishmaniasis are ill-defined. We previously showed that in Sri Lankan patients with CL, indoleamine 2,3-dioxygenase 1 (IDO1) and programmed death-ligand 1 (PD-L1) are enriched in lesion skin and that reduced PD-L1 expression early after treatment onset predicted cure rate following antimonial therapy. Here, we use spatial cell interaction mapping to identify IL-32-expressing CD8+memory cells and regulatory T cells as key components of the IDO1 / PD-L1 niche in Sri Lankan CL patients and in patients with distinct forms of dermal leishmaniasis in Brazil and India. Furthermore, the abundance of IL-32+cells and IL-32+CD8+T cells at treatment onset was prognostic for rate of cure in Sri Lankan patients. This study provides a unique spatial perspective on the mechanisms underpinning IC expression during CL and a novel route to identify additional biomarkers of treatment response.

Graphical Abstract
Optical Genome Mapping improves detection and streamlines analysis of structural variants in myeloid neoplasms
Authors: Raca Gordana , Sahoo Trilochan , Anwar Iqbal M. , Smolarek Teresa A. , Levy Brynn , DuPont Barbara R. , Ryall Scott , Dubuc Adrian M. , Sahajpal Nikhil Shri , Liu Jie , Liao Jun , Wang Zi-Xuan , Stence Aaron A. , Guseva Natalya V. , Broach James R. , Miller Cecelia , Ma Deqin , Blachly James , Michaels Phillip , Kolhe Ravindra , Kanagal-Shamanna Rashmi
Published: January 2024

Accurate diagnosis and risk stratification of hematological malignancies require disease-specific laboratory testing procedures involving the use of hematopathology, flow cytometry, molecular, and cytogenetic testing. While individual laboratories develop unique workflows to accommodate volume, clinical needs, and staffing, cytogenetic laboratories generally require a multitude of targeted and genome-wide tests that detect clinically relevant aberrations in hematologic malignancies. Specifically, the frequent use of multiple FISH panels coupled with concurrent chromosome analysis, can be both labor, and resource intensive. Optical Genome Mapping (OGM) is a comprehensive cytogenetic solution for detecting structural variants with high resolution and increased accuracy for hematological malignancy subtypes at the DNA level without need of any cell culture regimens. A new software tool for analysis of OGM data called VIA (Variant Intelligence Applications), provides an integrative analysis, interpretation, and reporting solution for OGM and other datatypes. In this study, we performed retrospective review of 56 datasets, representing 10 unique myeloid cases to assess multi-user (technologist and laboratory director) analyses and classification. Interpretation and reporting of OGM results were 100% concordant between reviewers for four cases with negative results by standard of care (SOC) testing. For the other six cases, five pathognomonic gene fusions identified by SOC assays were unanimously reported as Tier 1A classification was unanimous for five sentinel gene fusion rearrangements identified by SOC. OGM also found additional structural variants of clinical relevance in five of the six cases that were not found by SOC methods. Leveraging automatic pre-classification of variants and a custom decision tree, the VIA software enabled complete analysis with a mean technologist review time (variant analysis and initial tier determination) of 30.7 minutes. The analysis, interpretation, and reporting workflow described in this pilot study provides a framework for standardized and streamlined reporting of clinically significant variant in myeloid malignancies using VIA.
Prevalence of metabolic dysfunction-associated fatty liver disease and its association with glycemic control in persons with type 2 diabetes in Africa: a systematic review and meta-analysis
Authors: Ekpor Emmanuel , Akyirem Samuel , Adade Duodu Precious
Published: January 2024

Metabolic dysfunction-associated fatty liver (MAFLD) and type 2 diabetes (T2D) are interconnected metabolic disorders that pose serious repercussions on health, yet a comprehensive understanding of the extent of their co-occurrence in Africa is lacking. This study aimed to determine the prevalence of MAFLD and its association with glycemic control (HbA1c) in persons with T2D in Africa. A systematic search was conducted on PubMed, Medline, Embase, Scopus, Global Health, and Web of Science from their inception to December 6, 2023. Data on MAFLD prevalence and correlation coefficients for the association with glycemic control were pooled in random effect meta-analyses. Potential sources of heterogeneity were investigated using subgroup analysis and meta-regression. A total of 10 studies were included in the meta-analysis of MAFLD prevalence, while 2 incorporated in the analysis of the association between MAFLD and glycemic control. The pooled prevalence of MAFLD in persons with T2D was 48.1% (95% CI: 36.1–60.3). By region, the prevalence recorded were 44.7% (95% CI: 28.7–62.0) in sub-Saharan Africa and 55.3% (95% CI: 36.2–73.0) in Northern Africa. We observe an increasing trend in MAFLD prevalence, recording 55.1% (95% CI: 43.6– 66.1) in the recent five years. There was a weak positive correlation between MAFLD and HbA1c (r = 0.33, 95% CI: 0.18 – 0.47). There is a high prevalence of MAFLD in persons with T2D in Africa, with a suggested link between MAFLD and suboptimal glycemic control.
Identifying alterations in hand movement coordination from chronic stroke survivors using a wearable high-density EMG sleeve
Authors: Tacca Nicholas , Baumgart Ian , Schlink Bryan , Kamath Ashwini , Dunlap Collin , Darrow Michael , Colachis Samuel , Putnam Philip , Branch Joshua , Wengerd Lauren , Friedenberg David A , Meyers Eric C
Published: January 2024

Non-invasive, high-density electromyography (HD-EMG) has emerged as a useful tool to collect a range of neurophysiological motor information. Recent studies have demonstrated changes in EMG features that occur after stroke, which correlate with functional ability, highlighting their potential use as biomarkers. However, previous studies have largely explored these EMG features in isolation with individual electrodes to assess gross movements, limiting their potential clinical utility. Here, able-bodied (N=7) and chronic stroke subjects (N=7) performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. We demonstrate that a variety of HD-EMG features, or views, can be decomposed from the wearable sleeve. Stroke subjects, on average, had higher co-contraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. In an expanded dataset consisting of 37 movements, we characterized muscle synergies in the forearm of able-bodied individuals. We found that the high-density array provides additional resolution over manually placed electrodes, which may help dissociate finer nuances in motor control. Additionally, muscle synergies decomposed in the stroke population were relatively preserved, with a large spatial overlap in composition of matched synergies. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. When combining co-contraction and muscle synergy features, the first principal component was correlated with upper-extremity Fugl Meyer hand sub-score of stroke participants (R2=0.86). Principal component embeddings of individual features revealed interpretable measures of motor coordination and muscle coupling alterations. These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stroke research and clinical care.
The Mortality Burden from COVID in Low-Income Settings: Evidence from Verbal Autopsies in India
Authors: Malani Anup , Zhao Wanran
Published: January 2024

Measuring the mortality burden of SARS-CoV-2 in lower-income countries is difficult because death registries are incomplete and lack cause of death. We address this problem in India, which had the second-highest number of officially reported cases. We completed WHO-compliant verbal autopsy (VA) surveys on roughly 20,000 deaths drawn from a population-representative sample. SARS-CoV-2 deaths spike in June 2020, just after India’s lockdown, and in May 2021, after its second wave. During those spikes the virus is responsible for 23.3% and 35.8% of all deaths, respectively. Cardiovascular deaths also spike during the start of the pandemic. We find that the death rate rises by 81% during the pandemic, SARS-CoV-2 is responsible for 33% of these excess deaths, and cardiovascular disease for 23% of these deaths.