bluuebunny/crossref_metadata_2025 huggingface dataset:
Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings, Successes, and Preparedness for Disaster
Authors: Brijnath Bianca , Feldman Peter , Dow Briony , Muoio Rachel
Published: November 2023

This study examines how service providers in Victoria, Australia, undertook early intervention and response to elder abuse during the COVID-19 pandemic in 2020–2021. This study comprised two phases: (a) interviews with 29 staff members from 23 frontline service organizations about their experience responding to the needs of vulnerable older people during COVID-19; followed by (b) a co-design workshop with 15 service providers to discuss and endorse recommendations to improve sector preparedness for early intervention and responses to elder abuse during disasters. Participants reported that the severity and frequency of elder abuse increased during the pandemic, and that remoteness of services undermined comprehensive risk assessments, especially for older people who were not proficient in English and/or current digital platforms. Service providers endorsed a range of recommendations to improve sector preparedness for responses to elder abuse during disasters, primarily to upskill providers and improve the service system and direct support for individuals.
Preliminary Psychometric Assessment of STEM Attitude Measure for U.S. High School Students With Disabilities
Authors: Yamamoto Scott H.
Published: November 2023

This was the first study in which a psychometrically validated STEM measure, the “Student STEM” (S-STEM), was studied for HSSWD. This study also represented the first time a psychometrically validated STEM measure, the “Student STEM” (S-STEM), was studied for HSSWD. Data were collected from 229 HSSWD in a western state and analyzed using Cronbach’s Alpha, McDonald’s Omega, and exploratory factor analysis (EFA). The Alpha and Omega results showed less internal consistency in HSSWD attitudes toward mathematics than their attitudes toward the other three S-STEM subscales. The EFA results showed preliminary indications of construct validity for the engineering and technology subscale. Limitations of the study are its modest sample size and some measurement imprecision. Implications of the study are further psychometric analyses of the S-STEM for HSSWD and educators focusing on increasing STEM opportunities for HSSWD.
The Effects of Occupational Complexity on Late Life Cognition in ACTIVE: Examining the Mediating and Moderating Effects of Race
Authors: Owens Joshua , Jones Richard , Marsiske Michael
Published: November 2023

Objectives: This article sought to determine (1) whether occupational complexity (OC) explains individual differences in cognition at baseline, (2) whether this relationship is differentially related to cognition by Black/White race, and (3) whether OC mediates some or all of the Black/White race-related variance in late life cognition. Methods: 2371 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study reported longest held jobs and received OC ratings based on a factor analysis of 63 variables from the Dictionary of Occupational Titles. Results: We found that multiple dimensions of OC are related to cognition, but there were relatively few Black/White differences in these associations. Across all cognitive dimensions except for useful field of view, a history of having jobs lower in substantive complexity and fine motor skills and higher in physical demands may explain some of the Black/White race differences in elder’s cognition. Discussion: We conclude that occupations can be a target to reduce social disparities in late life cognition.
The ACTIVE Study: Association of Race and Social Determinants of Health (SDoH) with Long-Term Outcomes and Cognitive Training Effects
Authors: Rebok George W. , Clay Olivio J. , Thorpe Roland J. , Willis Sherry L.
Published: November 2023

Objective: The purpose of this article is to introduce a special issue on the ACTIVE project examining the association between race and social determinants of health (SDoH) and long-term participant outcomes and training effectiveness for older Black/African Americans and Whites in the ACTIVE (for Advanced Cognitive Training for Independent and Vital Elderly) Trial on cognitive abilities, everyday functioning, and incidence of dementia. The ACTIVE study is the largest randomized clinical trial ( N = 2802) of the efficacy of three types of cognitive training (memory, reasoning, speed of processing) in improving cognitive and everyday functioning in normal older adults, with follow-ups extending through 5 and 10 years post-intervention. Method: We provide background and context for studying the multiple domains of SDoH in understanding long-term participant outcomes in the ACTIVE trial and racial disparities in the efficacy of cognitive training and summarize the 11 articles in this special issue. Results: Articles in this special issue address several cross-cutting themes. These include 1) a focus on SDoH and race in relation to three cognitive abilities and driving; 2) cognitive training outcomes in older Black/African Americans (B/AA); 3) race differences in everyday function; and 4) associations of various risk factors (e.g., cardiovascular disease, obesity, depression) and protective factors (e.g., occupational complexity) for cognitive decline with health disparities in incident dementia and mortality. Conclusion: In cognitive training studies with cognitively healthy older adults, it is important to consider how factors such as race and SDoH relate to long-term participant outcomes and how they moderate intervention effects.
Rotordynamic characteristics of a novel labyrinth seal with partition walls and helical groove teeth
Authors: Xue Wensong , Fang Zhi , Wang Tianhao , Li Zhigang , Li Jun
Published: November 2023

To improve the stability of the conventional labyrinth seal (LS), in this paper, four novel fully partitioned helically labyrinth seals (FPHGLS) were designed and they were in comparison with one FPPGLS. The influences of the preswirl ratio and the helical groove pitch on the leakage flow and rotordynamic characteristics were numerically investigated, using the transient computational fluid dynamics (CFD) method based on the multi-frequency elliptical whirling orbit model. The accuracy and availability of the present transient numerical method were demonstrated based on the experiment data. The results show that the partition walls design can significantly increase the direct damping and cross-coupling stiffness for labyrinth seals and the helical teeth design can significantly decrease the cross-coupling stiffness and tangential force. When the helical groove pitch is equal to the seal length, the leakage nearly remains unchanged. Compared to the baseline design (LS), the FPPGLS and the FPHGLS have similar and significantly larger direct stiffness and direct damping. The two designs possess positive direct stiffness throughout the frequency range. The FPPGLS and FPHGLS possess significantly higher direct damping (∼323.7% larger than LS). But the FPPGLS possesses the largest cross-coupling stiffness among three seals at two preswirl ratios. From preswirl ratio = 0.13–0.84, the cross-coupling stiffness of the FPHGLS decreases by 53.4-310.1% compared with the FPPGLS. Increasing the helical groove pitch increases both direct stiffness and direct damping and reduces cross-coupling stiffness, but it also leads to greater leakage losses. In general, the novel FPHGLS whose helical groove pitch is equal to seal length possesses superior rotordynamic characteristics and similar leakage characteristic. This work provides the reference of the seal design and safety operation for the turbomachinery.
Correlational analyses of biomarkers that are harmonized through a bridging study due to measurement errors
Authors: Xiong Chengjie , Schindler Suzanne E , Henson Rachel L , Wolk David A , Shaw Leslie M , Agboola Folasade , Morris John C , Lu Ruijin , Luo Jingqin
Published: November 2023

Evaluating correlations between disease biomarkers and clinical outcomes is crucial in biomedical research. During the early stages of many chronic diseases, changes in biomarkers and clinical outcomes are often subtle. A major challenge to detecting subtle correlations is that studies with large sample sizes are usually needed to achieve sufficient statistical power. This challenge is even greater when biofluid and imaging biomarker data are used because the required procedures are burdensome, perceived as invasive, and/or expensive, limiting sample sizes in individual studies. Combining data across multiple studies may increase statistical power, but biomarker data may be generated using different assay platforms, scanner types, or processing protocols, which may affect measured biomarker values. Therefore, harmonizing biomarker data is essential to combining data across studies. Bridging studies involve re-processing of a subset of samples or imaging scans to evaluate how biomarker values vary by studies. This presents an analytic challenge on how to best harmonize biomarker data across studies to allow unbiased and optimal estimates of their correlations with standardized clinical outcomes. We conceptualize that a latent biomarker underlies the observed biomarkers across studies, and propose a novel approach that integrates the data in the bridging study with the study-specific biomarker data for estimating the biological correlations between biomarkers and clinical outcomes. Through extensive simulations, we compare our method to several alternative methods/algorithms often used to estimate the correlations. Finally, we demonstrate the application of this methodology to a real-world multi-center Alzheimer’s disease biomarker study to correlate cerebrospinal fluid biomarker concentrations with cognitive outcomes.
Education Beyond Techno-global Rationality: Transnational Learning, Communicative Agency and the Neo-colonial Ethic
Authors: Palmer Nicholas , Chandir Harsha
Published: November 2023

The marriage of twenty-first-century horizons of technology and the global ideal constitutes techno-global rationality as it reflects contemporary impulses, frames and teleologies. Fast-paced automation, the importance of cosmopolitanism and the colonial legacy have come to dominate educational discourse and drive calls for streamlined educative practice. Although such efficiency models empower a transactional/linear mode of teaching and learning, they do little to privilege integrative voices, deliberation and intersubjective care found in global citizenship education (GCE) definitions. We argue such rationality has exacerbated a neo-colonial ethic that promulgates economic, political and cultural pressure to control and narrow otherwise diverse learning opportunities. Drawing from recent research into technology and GCE in two International Baccalaureate international schools, we note the importance of communicative outreach and agency in diversity. We also highlight the distorting effects of hyper-rationalised neo-colonial interpretations of global agency. This article will interest those seeking to develop global educational policy and practice along with revitalising interpretations of technology integration.
State roles in platform governance: AI’s regulatory geographies
Authors: Ferrari Fabian
Published: November 2023

Platform governance scholarship commonly derives the role of the state from its actions as a regulator of platforms: a rule-setter that sets limits and restricts their activities. This article argues that three additional state roles enable and constrain the agency of states to regulate platforms: facilitator, buyer, and producer. Using the EU’s Artificial Intelligence Act as a case study, the article asks: How do different state roles in platform governance shape AI’s regulatory geographies? It answers this research question by outlining two policy dilemmas between those four state roles. First, the EU’s ambition to act as a facilitator of digital markets constrains its scope of interventions as a regulator of platforms. Second, the EU’s deficits in acting as a producer of AI infrastructure exacerbate its dependency as a buyer of Big Tech offerings, especially cloud computing services. The article contends that dilemmas between state roles are not anomalies but defining features of state-platform relations. As generative AI systems gain sophistication, an understanding of how state roles relate to each other helps to navigate their complex governance regimes.
Beyond Experience: Uncovering the Travel Experience of Cancer Patients
Authors: Xiong Wei , Wang Ting , Okumus Bendegul , Huang Meijiao , Cai Xiaomei
Published: November 2023

Vulnerable groups, such as those with life-threatening diseases and cancer patients, have been overlooked in current tourism activities despite their capability and need to participate. Therefore, this study analyzes the tourist-generated content published by cancer patients or their caregivers in the popular online community, Xiaohongshu, in order to gain a better understanding of their travel experiences. The unique perspective on tourism experienced by cancer patients leads to three distinct benefits. It includes overcoming challenges to attain self-identity, normalizing the tourism experience to ensure a fair travel experience, and gaining a better understanding of life’s meaning and self-esteem. A more comprehensive understanding of the hidden tourists’ experience is provided through this study. This expands the existing literature by highlighting people’s right to enjoy tourism and promoting wellness in the tourism experience.
Kapori: researching local responses to sorcery accusation–related violence in Papua New Guinea through Indigenous storytelling
Authors: Witne Bomai Dick , Thomas Verena , Kauli Jackie , Spurgeon Christina
Published: November 2023

This article explores kapori, an Indigenous form of storytelling to investigate and report experiences, motivations, responses, and challenges of sorcery accusation–related violence (SARV) by the Yuri people, a tribal group from the Papua New Guinea highlands. SARV is attributed to the belief that some people use supernatural powers to cause illness, deaths, or misfortunes to a community and, therefore, become targets of violent accusations. We outline the rationale for incorporating kapori into SARV research and discuss the findings from a storytelling workshop with 14 participants representing 13 clans of Yuri. The findings suggest that key strategies for curbing SARV include building community capacity to respond to the challenges of SARV, addressing the physical and emotional scars of SARV, and valuing collective interventions to prevent SARV. The use of kapori in this research helped to diversify, expand, and circulate Yuri narratives about SARV to support prevention strategies.
Lowered social motivation is associated with adolescent attention deficit hyperactivity disorder and social anxiety symptoms
Authors: Martin Rachael , McKay Erin , Kirk Hannah
Published: November 2023

Background

Difficulties in social skills are highly prevalent in children and adolescents with attention deficit hyperactivity disorder (ADHD), however, the reasons for these social difficulties are poorly understood. This study aimed to understand social motivation in children (aged 5–8) and adolescents (aged 13–17) with and without ADHD, and the relationship between social anxiety and social motivation in youth with ADHD.

Method

204 parents of children and adolescents with and without ADHD completed online questionnaires on social motivation, social anxiety, and ADHD symptoms.

Results

Adolescents with ADHD had significantly lower social motivation than typically developing adolescents, and children with ADHD. Higher social anxiety significantly predicted lowered social motivation in participants with ADHD.

Conclusions

These findings indicate a unique pattern of social motivation in ADHD, specifically a reduction during adolescence, reflecting social intervention inefficacy. Additionally, these findings establish a link between social motivation and social anxiety, suggesting that they may act as barriers to social intervention.
Area reconnaissance modeling of modular reconnaissance robotic systems
Authors: Nohel Jan , Stodola Petr , Zezula Jan , Zahradníček Pavel , Flasar Zdeněk
Published: November 2023

In terms of deploying forces and assets in different domains, the conduct of contemporary military operations can be characterized as complex. Information obtained from a wide range of sources and sensors is thus a crucial factor influencing the course and outcome of an operation. It must be robust, variably deployable, sustainable long-term, modular, and flexible when performing reconnaissance tasks in the rear of enemy forces or in areas threatened by, for example, chemical, biological, radiological, and/or nuclear (CBRN) threats. This paper describes the requirements of commanders for the capabilities of autonomous modular robotic systems performing reconnaissance tasks to support their units. It characterizes the possibilities of using mathematical-algorithmic models in planning the operation of robotic systems. The computational capabilities of tactical decision support system models are demonstrated on two scenarios for the reconnaissance of an area of interest. The partial calculations of the different parts of the reconnaissance task are performed in a logical sequence. Field tests practically verified the variants of performing reconnaissance tasks by robotic systems. The use of digital terrain and relief models, mathematical-algorithmic models, and variant modeling has increased the efficiency of the planning and deployment of a group of robotic systems in the reconnaissance of an area of interest.
A Novel Surgical Technique for Gynecomastia: Air-Assisted Minimally Invasive Surgery With Single Axillary Incision
Authors: Tukenmez Mustafa , Mollavelioglu Baran , Kozanoglu Erol , Emiroglu Selman , Cabioglu Neslihan , Muslumanoglu Mahmut
Published: November 2023

Background

Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia.

Patient and Methods

10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month.

Results

The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period.

Conclusion

Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.
Data-Driven Precision Nutrition Improves Clinical Outcomes and Risk Scores for IBS, Depression, Anxiety, and T2D
Authors: Connell Janelle , Toma Ryan , Ho Cleo Han-Chen , Shen Nan , Moura Pedro , Le Tiep , Patridge Eric , Antoine Grant , Keiser Hilary , Julian Cristina , Naidoo Uma , Tanton Damon , Banavar Guruduth , Vuyisich Momchilo
Published: November 2023

Many studies have shown that foods and nutritional ingredients play an important role in healthy human homeostasis, either directly or via the microbiome. We have developed an objective, integrated, and automated approach to personalized food and supplement recommendations that is powered by artificial intelligence and individualized molecular data from the gut microbiome, the human host, and their interactions. The process starts with a clinically validated transcriptomic analysis of a person’s stool (and some cases also blood) sample. These molecular data are converted into personalized nutritional recommendations (foods and supplements) using algorithms derived from clinical research studies and domain knowledge. We describe an application of our precision nutrition technology platform to human populations with irritable bowel syndrome (IBS), depression, anxiety, and type 2 diabetes (T2D). In these pilot interventional studies, our precision nutrition program achieved significant improvements in clinical outcomes of IBS (39% for severe IBS), depression (31% for severe depression), anxiety (31% for severe anxiety), and the risk score for T2D (>30% reduction relative to the control arm). These data support the integration of data-driven precision nutrition into the standard of care.
Associations between menopause and body image: A systematic review
Authors: Vincent Coralie , Bodnaruc Alexandra M , Prud’homme Denis , Olson Viviane , Giroux Isabelle
Published: November 2023

Background:

The menopausal transition involves multiple biological and psychosocial challenges that may render middle-aged women vulnerable to body image concerns.

Objective:

The aim of this study was to summarize evidence on the associations between menopause and body image perception in healthy middle-aged women.

Design:

This study is a systematic review of observational studies.

Data sources and methods:

Menopause-related exposure measures included menopausal stages, menopausal symptoms, and reproductive hormone levels during the menopausal transition. Studies investigating body image as an outcome, including through a positive (e.g. body self-esteem) or negative (e.g. body dissatisfaction) lens, were considered eligible. Articles published before March 2023 were identified through MEDLINE, PsycINFO, and Embase and underwent double screening, extraction, and quality assessment by two independent investigators. Characteristics and results were summarized using narrative synthesis.

Results:

A total of 820 non-duplicate records were identified, with 18 observational studies deemed eligible for inclusion after full-text screening. All studies investigating menopausal symptoms and body image ( n = 6) found some significant association between them, with a higher frequency, intensity, or number of symptoms being associated with greater body image concern. Differences in body image perception between menopausal stages were inconsistent across studies ( n = 12), while evidence of potential associations between reproductive hormones and body image was minimal ( n = 2). Findings should be interpreted with caution as 17 of the included studies used a cross-sectional design, and not all studies adjusted their analyses for relevant confounders.

Conclusion:

Overall, menopausal symptoms showed relatively consistent associations with a more negative body image perception. Additional research is required to understand the potential role of menopausal stages and reproductive hormone levels in the body image perception of middle-aged women and to confirm the direction of reported associations.

Registration:

PROSPERO—CRD42021241637
Treatment of unstable pelvic fractures in children with an external fixator: Retrospective study of 56 patients
Authors: Wen Yuwei , Zhu Danjiang , Wang Qiang , Song Baojian , Feng Wei
Published: November 2023

Purpose:

We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this treatment and factors influencing pelvic function recovery.

Methods:

The data of patients with unstable pelvic fractures treated with an external fixator between January 2006 and December 2018 were retrospectively analyzed. The analyzed parameters included demographic data, fracture healing, pelvic asymmetry, deformity index, and complications. Fractures were categorized using the Tiles classification. Pelvic function was evaluated using the Cole score. Pelvic risk factors were identified using univariate and multivariate logistic regression analyses.

Results:

Fifty-six patients (29 and 27 with type B and C fractures, respectively) were included. All fractures were healed at the time of the final follow-up. Nine and three patients had pin tract infections and loosened external fixators postoperatively, respectively. Pelvic asymmetry was reduced from 1.34 ± 0.15 cm to 0.70 ± 0.19 cm (p < 0.01), and the deformity index decreased from 0.13 ± 0.03 to 0.07 ± 0.02 (p < 0.01). The Cole score was excellent and good in 41 and 15 patients, respectively. Risk factors for pelvic function recovery included injury severity score > 25.5, age > 11.3 years, and lower-extremity fractures.

Conclusions:

External fixation is an effective method for treating unstable pelvic fractures in children, with the advantages of a simple operation, short surgical time, no interference with treatments for associated injuries, and avoidance of re-trauma caused by open reduction. An ISS > 25.5, patient age > 11.3 years, and associated lower-extremity fractures are predictors of pelvic function recovery.

Level of evidence:

Level IV.
Equitable access to COVID-19 vaccine distribution – the case of the Andean Community
Authors: Cadillo Chandler Dhanay , Nuottila Jouko , Ballardini Rosa Maria
Published: November 2023

The COVID-19 pandemic has shown how equitable vaccine distribution still remains unaccomplished. While access to COVID-19 vaccines has been efficient in the EU, the Latin American situation is very different. For example, the Andean Community reports that, as of December 2022, 83% of the population had received at least the first dose of the vaccine while only 43% had received the third dose ( http://www.orasconhu.org ). Motivated by the challenges and successes endured by countries in the Andean Community vis-à-vis the EU during COVID-19 vaccine roll-outs, we analyse key legal, policy and management factors affecting vaccine equity. We are especially critical of the strategy followed in the Andean Community, namely, of increasing dependency on imports and donations instead of harnessing other more effective policies. We highlight the specific role of the factors identified in achieving coherent policy strategies and propose recommendations to promote equitable vaccine distribution in the Andean Community, and beyond.
Examining Appropriacy of CFI and TLI Cutoff Value in Multiple-Group CFA Test of Measurement Invariance to Enhance Accuracy of Test Score Interpretation
Authors: Khademi Abdolvahab , Wells Craig S. , Oliveri Maria Elena , Villalonga-Olives Ester
Published: November 2023

The most common effect size when using a multiple-group confirmatory factor analysis approach to measurement invariance is ΔCFI and ΔTLI with a cutoff value of 0.01. However, this recommended cutoff value may not be ubiquitously appropriate and may be of limited application for some tests (e.g., measures using dichotomous items or different estimation methods, sample sizes, or model complexity). Moreover, prior cutoff value estimations often have ignored consequences resulting in using measures that more accurately estimate countries’ or learners’ proficiency for some countries or groups versus others. In this study, we investigate whether the cutoff value proposed by Cheung and Rensvold (ΔCFI or ΔTLI > 0.01) is appropriate across educational measurement contexts. Specifically, we investigated the performance of ΔCFI and ΔTLI in capturing LOI at the scalar level in dichotomous items within item response theory on groups whose test characteristic curves differed by 0.5. Simulation results showed that the proposed cutoff value of 0.01 in ΔCFI and ΔTLI was not appropriate to capture LOI under the study conditions, which may result in the misinterpretation of test results or inaccurate inferences.
“Being Sick Does Not Define You”: Communicated Narrative Sense-Making of Autoimmune Disease in Emerging Adult Women in the U.S.
Authors: Gunning Jacqueline N. , Koenig Kellas Jody
Published: November 2023

The onset of autoimmune disease (AD) in emerging adulthood is a disruptive illness experience that is difficult to make sense of. Compounded by hegemonic ideologies, including the master illness narrative of restitution and stereotype of the hysterical female patient, women with AD struggle with narrative coherency. Guided by the retrospective storytelling heuristic of communicated narrative sense-making theory (CNSM), the present study investigates the meanings, values, and beliefs found in emerging adult women’s narratives of AD onset and diagnosis. Using qualitative in-depth interviews, findings identify how young women experiencing disruptive chronic illness at a formative age make sense and meaning of their experience, highlighting the role of identity (re)construction and resistance to dominant narratives. Framed as lessons learned, themes include rediscovering trust in self, separating self from illness, creating and committing to new normals, challenging assumptions about illness, and recognizing privilege and disparities in care. Theoretical and practical implications are discussed.
Evaluating the Quality and Usability of Artificial Intelligence–Generated Responses to Common Patient Questions in Foot and Ankle Surgery
Authors: Anastasio Albert Thomas , Mills Frederic Baker , Karavan Mark P. , Adams Samuel B.
Published: November 2023

Background:

Artificial intelligence (AI) platforms, such as ChatGPT, have become increasingly popular outlets for the consumption and distribution of health care–related advice. Because of a lack of regulation and oversight, the reliability of health care–related responses has become a topic of controversy in the medical community. To date, no study has explored the quality of AI-derived information as it relates to common foot and ankle pathologies. This study aims to assess the quality and educational benefit of ChatGPT responses to common foot and ankle–related questions.

Methods:

ChatGPT was asked a series of 5 questions, including “What is the optimal treatment for ankle arthritis?” “How should I decide on ankle arthroplasty versus ankle arthrodesis?” “Do I need surgery for Jones fracture?” “How can I prevent Charcot arthropathy?” and “Do I need to see a doctor for my ankle sprain?” Five responses (1 per each question) were included after applying the exclusion criteria. The content was graded using DISCERN (a well-validated informational analysis tool) and AIRM (a self-designed tool for exercise evaluation).

Results:

Health care professionals graded the ChatGPT-generated responses as bottom tier 4.5% of the time, middle tier 27.3% of the time, and top tier 68.2% of the time.

Conclusion:

Although ChatGPT and other related AI platforms have become a popular means for medical information distribution, the educational value of the AI-generated responses related to foot and ankle pathologies was variable. With 4.5% of responses receiving a bottom-tier rating, 27.3% of responses receiving a middle-tier rating, and 68.2% of responses receiving a top-tier rating, health care professionals should be aware of the high viewership of variable-quality content easily accessible on ChatGPT.

Level of Evidence:

Level III, cross sectional study.
The Role of Elastography in Diagnosing Endometrial Pathology
Authors: Marshall Kathleen , Clem Douglas
Published: November 2023

Objective:

The aim of this review was to provide a summary of literature and research on the use of elastography and its effectiveness in diagnosing endometrial pathology.

Materials and Methods:

An online database search produced 16 research articles. Inclusion criteria consisted of ultrasound elastography of benign and malignant endometrial pathology. Priority was given to articles focused on endometrial hyperplasia, polyps, and endometrial carcinoma.

Results:

The difference in stiffness between endometrial carcinoma and benign endometrial pathology, including lesions and hyperplasia, is statistically significant. High rates of sensitivity and specificity are seen in using elastography to determine endometrial carcinoma from a benign endometrial pathology.

Conclusion:

Elastography can provide valuable information to aid in diagnosing endometrial carcinoma. Currently, the standard of care for diagnosing endometrial pathology is 2D ultrasound imaging with tissue sampling and histology. Elastography imaging of the endometrium offers the opportunity to diagnose endometrial pathology without invasive tissue sampling procedures. While this exciting development offers great potential, there must be universal, consistent approaches and studies of subgroups to be considered the standard of care.
The impact of outpatientversusinpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial
Authors: Sivakumar Parthipan , Fitzgerald Deirdre B. , Ip Hugh , Rao Deepak , West Alex , Noorzad Farinaz , Wallace Deirdre , Haris Mohamed , Prudon Benjamin , Hettiarachchi Gihan , Jayaram Deepak , Goldring James , Maskell Nick , Holme Jayne , Sharma Neel , Ismail Iyad , Kadwani Owais , Simpson Sanchez , Read Catherine A. , Sun Xiaohui , Douiri Abdel , Lee Y.C. Gary , Ahmed Liju
Published: November 2023

Background

The principal aim of malignant pleural effusion (MPE) management is to improve health-related quality of life (HRQoL) and symptoms.

Methods

In this open-label randomised controlled trial, patients with symptomatic MPE were randomly assigned to either indwelling pleural catheter (IPC) insertion with the option of talc pleurodesis or chest drain and talc pleurodesis. The primary end-point was global health status, measured with the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) at 30 days post-intervention. 142 participants were enrolled from July 2015 to December 2019.

Results

Of participants randomly assigned to the IPC (n=70) and chest drain (n=72) groups, primary outcome data were available in 58 and 56 patients, respectively. Global health status improved in both groups at day 30 compared with baseline: IPC (mean difference 13.11; p=0.001) and chest drain (mean difference 10.11; p=0.001). However, there was no significant between-group difference at day 30 (mean intergroup difference in baseline-adjusted global health status 2.06, 95% CI −5.86–9.99; p=0.61), day 60 or day 90. No significant differences were identified between groups in breathlessness and chest pain scores. All chest drain arm patients were admitted (median length of stay 4 days); seven patients in the IPC arm required intervention-related hospitalisation.

Conclusions

While HRQoL significantly improved in both groups, there were no differences in patient-reported global health status at 30 days. The outpatient pathway using an IPC was not superior to inpatient treatment with a chest drain.
Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability
Authors: Hov Brit , Andersen Tiina , Toussaint Michel , Mikalsen Ingvild B. , Vollsæter Maria , Brunborg Cathrine , Hovde Mathea , Hovland Vegard
Published: November 2023

Background

Mechanical insufflation–exsufflation (MI-E) is used to augment cough in children with neurodisability. We aimed to determine the user comfort and cough flows during three MI-E strategies, and to predict factors associated with improved comfort and cough flows.

Methods

This multicentre, crossover trial was done at four regional hospitals in Norway. Children with neurodisability using MI-E long termviamask were enrolled. In randomised order, they tested three MI-E setting strategies (in-/exsufflation pressure (cmH2O)/in (In)-versusexsufflation (Ex) time): 1) “A-symmetric” (±50/In=Ex); 2) “B-asymmetric” (+25– +30)/−40, In>Ex); and 3) “C-personalised”, as set by their therapist. The primary outcomes were user-reported comfort on a visual analogue scale (VAS) (0=maximum comfort) and peak cough flows (PCF) (L·min−1) measured by a pneumotachograph in the MI-E circuit.

Results

We recruited 74 children median (IQR) age 8.1 (4.4–13.8) years, range 0.6–17.9, and analysed 218 MI-E sequences. The mean±sdVAS comfort scores were 4.7±2.96, 2.9±2.44 and 3.2±2.46 for strategies A, B and C, respectively (AversusB and C, p<0.001). The mean±sdPCF registered during strategies A, B and C were 203±46.87, 166±46.05 and 171±49.74 L·min−1, respectively (AversusB and C, p<0.001). Using low inspiratory flow predicted improved comfort. Age and unassisted cough flows increased exsufflation flows.

Conclusions

An asymmetric or personalised MI-E strategy resulted in better comfort scores, but lower PCF than a symmetric approach utilising high pressures. All three strategies generated cough flows above therapeutic thresholds and were rated as slightly to moderately uncomfortable.
Feasibility and value of a domiciliary spirometry programme in the assessment of severe asthma: a real-world evaluation
Authors: Williams Zander , Hull James H. , Ge Yueqi , Ming Jo , Roberts Cara , Rhamie Serena , Patel Pujan H.
Published: November 2023

Background

Domiciliary spirometry (DS) is a novel tool that is widely employed in the assessment of respiratory disease. We assessed real-world feasibility, effectiveness and value of a physiologist-led home spirometry programme in patients with treatment-refractory severe asthma.

Methods

Patients were referred and provided with a hand-held DS device. Patients completed baseline measurements in a physiologist-led virtual clinic and were instructed to provide further values during any periods of respiratory symptoms. Outcome measures included prevalence of new obstructed events, DS adherence and uptake of this approach.

Results

112 patients were enrolled from November 2020 to January 2023. 102 individuals, mean±sdage 44±13 years (86% female) with median (IQR) forced expiratory volume in 1 s % predicted 88% (77–97%), successfully recorded baseline spirometry values. During follow-up (24 months), 11 (11%) were identified with new obstructive spirometry and were subsequently able to be commenced on biologic therapy. Patient engagement was poor with median (IQR) of 4 (2–6) attempts of contact made before baseline values were recorded, and 2 (1–3) attempts required to record technically acceptable values. Continued DS use was suboptimal; 34% failed to use their device after baseline and only 10% continued at the end of the study period. The cost of DS measurements was greater than a single hospital-based visit but enables multiple event capture.

Conclusion

Overall, DS measurement uptake was poor, with a minority of patients continuing to use the device at the end of the study period. However, for those that engage, DS provides an alternative approach to traditional hospital-based spirometry measurements that can alter clinical management.
Effect of pre-use of Dexmedetomidine on the effective inhibitory dose of remimazolam tosilate on positive cardiovascular response in double-lumen endobronchial intubation: a clinical study
Authors: Wei Shiyou , Liu Xiaojuan , Chang Rui , Chen Xue , Zheng Tao , Wang Jingyun , Liu Huqing , Zhang Faqiang , Song Jiong , Lv Xin
Published: November 2023

Background

Herein, the effect of pre-use of Dexmedetomidine(Dex) on the half-effective dose (ED50) and 95%-effective dose (ED95) of Remimazolam tosilate(RT) in inhibiting the positive cardiovascular response(CR) which means blood pressure or heart rate rises above a critical threshold induced by double-lumen bronchial intubation was evaluated.

Methods

Patients who underwent video-assisted thoracic surgery were divided into groups A (0), B (0.5 µg/kg), and C (1 µg/kg) based on different Dex doses. Group A included subgroups comprising young (A-Y) and elderly (A-O) patients. Neither groups B nor C included elderly patients due of the sedative effect of Dex. Based on the previous subject’s CR, the dose of RT was increased or decreased in the next patient using the sequential method. This trial would be terminated when the seventh crossover occurred, at which point the sample size met the stable estimate of the target dose. Heart rate (HR) and mean arterial pressure (MAP) were monitored throughout the trial, and sedation was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale. HR and MAP were recorded at baseline (T1), the end of Dex (T2), and the end of RT (T3), the maximum HR and MAP were recorded within 3 min of intubation from beginning to end (T4). There was a positive CR when the T4 levels rose above 15% of the baseline. The ED50/ED95 and corresponding confidence interval were calculated using probability regression.

Results

In total, 114 patients completed the trial. Without the use of Dex, the ED50/ED95 of TR inhibiting the positive CR caused by double-lumen bronchial intubation was 0.198/0.227 and 0.155/0.181 mg/kg in groups A-Y and A-O, respectively. The changes in vital signs from T1 to T3 were similar in the subgroups, indicating that the elderly patients were more sensitive to the dose of RT. The ED50/ED95 of RT inhibiting the positive CR caused by double-lumen endobronchial intubation was 0.122/0.150 and 0.068/0.084 mg/kg in groups B and C, respectively. And, the fluctuation of blood pressure from T3 to T4 was reduced by using Dex. RT was 100% effective in sedation with no significant inhibition of circulation. Apart from one case of hypotension occurred in group A-Y, two cases of low HR in group B, and one case of low HR in group C, no other adverse events were noted.

Conclusions

The optimal dose of RT to inhibit positive CR induced by double-lumen bronchial intubation in elderly patients was 0.18 mg/kg and 0.23 mg/kg in younger patients. When the pre-use dose of Dex was 0.5 µg/kg, the optimal dose to inhibit positive CR of RT was 0.15 mg/kg. And, when the pre-use dose of Dex was 1 µg/kg, the optimal dose of RT was 0.9 mg/kg.

Clinical trial registration

NCT05631028.
Efficacy of a modified FRAIL scale in predicting the peri-operative outcome of hepatectomy in older adults (aged ≥ 75 years): a model development study
Authors: Xu Lining , Wang Weiyu , Xu Yingying , Yang Bo
Published: November 2023

Background

The FRAIL scale for evaluating frailty consists of five items: fatigue, resistance, aerobic, illness, and loss of weight. However, it is difficult to obtain a specific weight loss value. Since the Timed Up and Go Test (TUGT) is simple, accurate, and easy to perform, we replaced weight loss with the TUGT in the FRAIL scale, with the remaining four items unchanged, and named it the FRAIT scale. The aim of this study was to determine the value of the FRAIT scale in predicting the peri-operative outcome of hepatectomy.

Methods

This model development study was conducted between January 2017 and December 2021. The reliability, validity and area under the curve (AUC) of the FRAIL/FRAIT scales were calculated. The frailty status of patients aged ≥ 75 years who underwent hepatectomy was measured using the FRAIL/FRAIT scales. Logistic regression was used to compare the relationship between FRAIL/FRAIT scores/grades and perioperative outcomes.

Results

The AUCs for predicting operation duration, intraoperative bleeding, complications, and death based on the FRAIL score were 0.692, 0.740, 0.709, and 0.733, respectively, and those based on the FRAIT score were 0.700, 0.745, 0.708, and 0.724, respectively. The AUCs for predicting operation duration, intraoperative bleeding, complications, and death based on the FRAIL grade were 0.693, 0.735, 0.695, and 0.755, respectively, and those based on the FRAIT grades were 0.700, 0.758, 0.699, and 0.750, respectively. The FRAIL score has three effective predictors (intraoperative bleeding, complications, and death), while the FRAIT score has four effective predictors (operation duration, intraoperative bleeding, complications, and death). The FRAIL grade has two effective predictors (intraoperative bleeding and death), while the FRAIT grade has three effective predictors (operation duration, intraoperative bleeding, and death).

Conclusions

This study describes a new and more effective tool for the assessment of preoperative frailty in older adults undergoing hepatectomy. The items of the FRAIT scale are easier to obtain than those of the FRAIL scale, and the predictive effect of the FRAIT scale is stronger than that of the FRAIL scale.
The evaluation of a rapid microfluidic immunofluorescence antigen test in detecting the infectiousness of COVID-19 patients
Authors: Ota Kenji , Kodama Hina , Kawamoto Yasuhide , Sasaki Daisuke , Mitsumoto-Kaseida Fujiko , Sakamoto Kei , Kosai Kosuke , Hasegawa Hiroo , Takazono Takahiro , Izumikawa Koichi , Mukae Hiroshi , Tun Mya Myat Ngwe , Morita Kouichi , Yanagihara Katsunori
Published: November 2023

Background

A test-based strategy against coronavirus disease 2019 (COVID-19) is one of the measures to assess the need for isolation and prevention of infection. However, testing with high sensitivity methods, such as quantitative RT-PCR, leads to unnecessary isolation, whereas the lateral flow antigen test shows low sensitivity and false negative results. The purpose of this study was to evaluate the performance of the LumiraDx SARS-CoV-2 Ag test (Lumira Ag), a rapid microfluidic immunofluorescence method, in assessing infectivity.

Methods

This study was performed from March 2022 to July 2022. A pair of nasopharyngeal swab samples were obtained from each patient with mild COVID-19. One swab was used for Lumira Ag testing, and the other for quantitative RT-PCR testing and virus culture.

Results

A total of 84 patients were included in the study. Among them, PCR, Lumira Ag test, and virus culture indicated positivity for 82, 66, and 24 patients, respectively. When comparing the Lumira Ag test to virus culture, its sensitivity was 100.0% (24/24), specificity, 30.0% (18/60); positive predictive value, 36.3% (24/66); and negative predictive value (NPV), 100.0% (18/18). The positive sample for virus culture was observed until the ninth day from the onset of symptoms, while the Lumira Ag test was observed until day 11.

Conclusions

The Lumira Ag test showed high sensitivity and NPV (100% each) compared to virus culture. A test-based strategy using the Lumira Ag test can effectively exclude COVID-19 infectiousness.
A novel mutation of the RPGRIP1L gene in a Chinese boy with Joubert syndrome with oculorenal involvement
Authors: Li Qian , Liu Qianying , Liu Suwen , Yu Lichun , Yang Zhenle , Wang Cong , Wang Jing , Sun Shuzhen
Published: November 2023

Background

Joubert syndrome (JS) is a rare genetically heterogeneous primary ciliopathy characterized by a pathognomonic cerebellar and brainstem malformation, the “molar tooth sign”, and variable organ involvement (such as eye, kidney, liver, and skeleton). Here, we present a case of JS in a Chinese boy.

Case presentation

An 11-year-old Chinese boy presented with neonatal asphyxiation and hypoxia, strabismus, subsequent developmental delay, ataxia and end-stage kidney disease (ESKD). Routine blood tests showed severe anemia, increasing blood urea nitrogen and creatinine, elevated parathyroid hormone, hypocalcemia, hypokalemia and metabolic acidosis. Urine tests showed mild proteinuria. Ultrasound showed two small kidneys. Brain magnetic resonance imaging (MRI) showed dysplasia of the cerebellar vermis and extension of the upper cerebellar feet with the “molar tooth sign”. Genetic analysis showed novel compound heterozygous mutations in the RPGRIP1L gene [p.L447fs*7(p.Leu447fsTer7) and p.G908V (p.Gly908Val)].

Conclusion

In the present study, we identified novel compound heterozygous mutations in the RPGRIP1L gene in a Chinese boy. The clinical and genetic findings of this study will expand the understanding of JS.