bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Surgical Interest and Performance on a Virtual Reality Surgical Simulator in a Cohort of Untrained First Year Medical Students
Authors: Pigliacampi Marlena , West Justin , Soucier Claire , Cobbs Jovon , Phelps Alec , Ramalingam Archana , McCann Alec , Bullock Matthew
Published: April 2024

Background:
The intersection of technological advancements and medical education has led to integration of virtual reality (VR) surgical simulators, offering a risk-free environment for trainees to hone clinical decision-making and technical skills. Despite the allure of VR in surgical training, the utility of VR exposure in novice medical trainees remains unclear. Numerous studies aim to decipher the relationship between students’ career preferences and proficiency on VR surgical simulators, but results have been inconclusive, necessitating further exploration. We sought to investigate the correlation between students’ interest in a surgical specialty and performance on a VR surgical simulator, aiming to inform the development of tailored pipeline programs for aspiring surgical students and aid in residency program selection processes.
Methods:
Participants included 134 incoming medical students recruited from a local United States medical school. After an informative session on VR’s impact in surgical medicine, participants completed a pre-interventional questionnaire, engaged in a VR simulation of a slipped capital femoral epiphysis (SCFE) operative procedure, then completed a post-interventional questionnaire. Statistical analysis included Mann-Whitney-Wilcoxon test, Chi-squared test, and Fischer’s exact tests on survey responses and VR simulation markers.
Results:
Descriptive statistics revealed students predominately under 25 years old, nearly equitable gender distribution, and varying levels of interest in surgical specialties. Chi-square tests identified a significant association between sports participation and surgical interest. Nonparametric tests showed no statistically significant differences in VR performance metrics across categories of surgical interest, including the distributions of "number of retries" and "hints" against medical students’ surgical interest.
Discussion:
The findings underscore the potential value of sports participation in shaping students’ inclination towards surgical fields. However, no significant relationship was identified between students' performance in VR surgical simulations and their interest in surgery, challenging assumptions about career interests and practical skills performance. Sample limitations and mitigation strategies were discussed, emphasizing the need for further research to explore additional factors influencing performance in surgical simulations.
Conclusions:
Despite constraints, this study provides valuable insights into factors influencing medical students' career interests and performance in VR surgical simulations. Future investigations should delve into specific aspects of sports engagement and other factors that may shape career aspirations, informing targeted educational strategies and residency selection processes.
Evaluation of Mycocorrosion by Amorphotheca resinae in Aluminum Alloys 2024, 7075, 5083 and 3105: A Comprehensive Study
Authors: Shariat Amir Hosein , Moghimi Hamid , Giyahchi Minoo , Ebrahim-Habibi Mohammad-Bagher , Tirandaz Hassan
Published: April 2024

Amorphotheca resinae is a fungus that particularly corrodes aeronautical aluminum alloys, leading to economic issues in various industries. This study aims to investigate the effects of this fungus on the corrosion of four different aluminum alloys, namely 2024, 7075, 5083, and 3105, after 25, 50, and 75 days through scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), 3D profilometry, weight loss (%) measurement, energy dispersive spectrometry (EDS), electrochemical impedance (EIS), and pH changes. After 25 days, the 2024 alloy had the highest mycocorrosion rate (1.3417 mpy), while alloy 3105 had an undetectable value on this day. According to the EIS test, the 3105 alloy had the highest level of resistance (1.12×105 Ω.cm²) to corrosion, while the 2024 alloy was the most susceptible (7138 Ω.cm²). The qualitative data from SEM, CLSM, and 3D profilometry also confirmed the quantitative findings where the surface pits on the 2024 alloy were deeper than those of other alloys. Overall, the results showed that the lowest and highest corrosion rates mediated by A. resinae belonged to 3105 and 2024 alloys, respectively. These findings could have significant implications for industries that use aluminum alloys and might help in developing strategies to prevent or control biocorrosion.
Trends and patterns of ICU referrals in the Kingdom of Saudi Arabia during the COVID- 19 pandemic: Results from the National Saudi Medical Appointments and Referrals Centre
Authors: Alharbi Abdullah A. , Aljerian Nawfal A. , Alghamdi Hani A. , Binhotan Meshary S. , AlOmar Reem S. , Alsultan Ali K. , Arafat Mohammed S. , Aldhabib Abdulrahman , Aloqayli Ahmed I. , Alwahbi Eid B. , Alabdulaali Mohammed K.
Published: April 2024

BackgroundICU e-referrals are an important indicator for exploring potential deficiency in critical care resources. This study explores the epidemiology and patterns of ICU referrals across all regions of the Kingdom of Saudi Arabia (KSA) during the COVID-19 pandemic using routinely collected secondary data between April 2020 and December 2021.MethodsThis descriptive epidemiological study used data from the Saudi Medical Appointments and Referrals Centre (SMARC). The analysed variables included age, sex, month and year of referral, the reason and the speciality and region from which the referral had originated. Descriptive statistics were performed as well as mapping of administrative areas according to the rate of referral requests per 10,000 of the population.ResultsDuring the study period, 36,619 patients had an ICU e-referral request. The average age of these patients was 54.28 ± 20.46 years. Males constituted 64.81% of all requests. Referrals due to being out of scope made up 71.44% of requests. Referrals related to medical specialities were the most common followed by surgical ones (62.48% and 22.13%). The temporal pattern of ICU requests shows a peak in Jully and August of 2020 and a second peak during May of 2021. The graphical distribution of requests shows that these were highest for the Northern Border and Albaha administrative areas.ConclusionsThe temporal patten and geographic distribution of ICU referrals identified in this study have been found to mirror that of previously reported critical cases in the KSA. The implementation of preventive measures and the introduction of the vaccination programs have been found to positively affect ICU referral requests. Also, adjustment for population size should be taken into consideration in healthcare resource management and policy.
Evaluation of a Prototype Metal Artifact Reduction Algorithm for Cone Beam CT in Patients Undergoing Radioembolization
Authors: Can Elif , Böning Georg , Lüdemann Willie Magnus , Hosse Clarissa , Kolck Johannes , Paparoditis Sophia , Nguyen Thao , Piper Sophie K. , Geisel Dominik , Wieners Gero , Gebauer Bernhard , Elkilany Aboelyazid , Jonczyk Martin
Published: April 2024

Background
Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE).
Materials and Methods
We retrospectively included 40 consecutive patients (aged 65±13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination.
Results
MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0,25 points on average). Interrater agreement was good to perfect (Kendall’s W coefficient = 0.68 - 0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy.
Conclusion
A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility.
PDCL3 is a Novel Oncogenic Indicator in Hepatocellular Carcinoma using Comprehensive Bioinformatics Analysis and in vitro Validation
Authors: Liang Hang , Liu Junnan , Sheng Huajun , Tan Lihao , Xu Jin , Shen Zihao , Zhu Shujuan
Published: April 2024

Hepatocellular carcinoma (HCC) is the prevalent form of liver cancer and the third major cause of cancer-induced mortality globally. Phosducin-like protein 3 (PDCL3) is linked to the onset and evolution of malignancies, but its role and mechanism in HCC progression are still unclear. Here, to address this issue, we performed multiple bioinformatics mining and analysis through databases such as GEO and TCGA to screen for the HCC-specific targets. Differential and survival prognostic analyses revealed that PDCL3 was upregulated in HCC tissues, and was accompanied by poorer outcomes for HCC patients. PDCL3 mRNA and protein expression were significantly higher in HCC cell lines HepG2, Hep3B, and Huh7 than in normal human hepatocytes MIHA. The assays with siRNA interference showed that PDCL3 exhibited the proliferation, migration, and invasion capacity of these HCC cells. The PDCL3 high-expression group presented different immune infiltration analysis and mutation features, compared with PDCL3 low-expression group. Furthermore, enrichment analysis identified that PDCL3 expression was linked to the Hippo pathway and YAP expression. Hence, we emphasized the promotive role of PDCL3 in HCC, thus providing reliable evidence for PDCL3-targeted diagnosis and therapeutic strategies.
The Experience and Knowledge of Traumatic Dental Injuries among Pediatric Physicians
Authors: Schachter Andrea Dora , Kaplan Nata , Blumer Sigalit , Ajzman Gisela Berenstein , Tunis Tanya Sella , Laviv Amir , Ratson Tal
Published: April 2024

Objective:To assess the knowledge and attitude of pediatric physicians towards management of permanent and primary avulsed teeth.
Materials and Methods: Pediatric physicians filled out a questionnaire. A total of 133 physicians agreed to participate. The questionnaire surveyed the physician's background, knowledge, and approach to managing tooth avulsion.
Results: Only 27.1% of the physicians underwent dental trauma training. Most of the physicians (74%) prefer to refer avulsed tooth cases to a dentist immediately. Only 3% would put the tooth back into the socket. When the participants were asked about storing the avulsed tooth, 38.3% correctly said they would advise keeping the tooth in milk. Most of the physicians (67%) answered that primary teeth should not be replanted.
Conclusions: The pediatric physicians’ knowledge about tooth avulsion is fair
Clinical Relevance:Educational training programs should be developed and conducted in order to improve awareness of emergency management strategies in such cases.
Non-linear Association of Alkaline Phosphatase-to-Albumin Ratio with All-Cause and Cancer Mortality: Evidence from NHANES 2005-2016
Authors: Wang Jiang , Wang Bo , Yuan Shiwang , Cheng Guangyi , Deng Sijia , Wang Yuyan , Shen Yu , Li Liantao
Published: April 2024

Background The relationship between the alkaline phosphatase-to-albumin ratio (APAR) and mortality remains unclear. This research looked into the association between APAR levels and cause-specific mortality in US adults.
Methods A cohort of 7561 participants from NHANES (2005-2016) was analyzed, with mortality outcomes collected from National Death Index (NDI) records. Cox proportional hazards models and restricted cubic spline (RCS) analysis were utilized to determine hazard ratio (HR) and reveal the non-linear relationship between APAR levels and mortality. Inflection points were calculated using a recursive algorithm.
Results Followed for an average 99.41 months, a total of 1048 deaths occurred, including 200 cancer deaths and 348 cardiovascular disease (CVD)-related deaths. Following multivariate adjustment, significant associations were observed between APAR levels and increased all-cause and CVD mortality. Furthermore, non-linear correlations between APAR levels and all-cause and cancer mortality were revealed, characterized by an L-shaped pattern, with mortality rates stabilizing at 1.289 and 2.167, respectively. Participants with APAR levels above the inflection point exhibited a 29.2% increase in all-cause mortality risk per unit increase in APAR levels (HR 1.292, 95% CI 1.217-1.372), and a 38.3% increase in cancer mortality risk (HR 1.383, 95% CI 1.199-1.596).
Conclusion This study demonstrated non-linear associations between APAR levels and all-cause and cancer mortality. Thresholds of 1.289 and 2.167 might serve as potential targets for APAR to reduce all-cause and cancer mortality, respectively. Nevertheless, these findings necessitate validation through large-scale clinical trials for further substantiation.
RETRACTED: A Wnt pathway-associated model and nomogram predict the outcome of GBM patients
Authors: Li Ganglei , Chai Zhaohui , Yan Min , Zhu Yu , Wang Feng , Zhou Lihui , Zhan Renya , Shen Jian
Published: April 2024

The authors have requested that this preprint be removed from Research Square.
Development of An Intelligent Mobile Application based on A Cloud Integrated Information System for Car Rental Services.
Authors: Tuyambaze Thacianne , Mkoba Elizabeth , Mgawe Bonny , Mbunda Beatus
Published: April 2024

Car rental companies have used technology to improve their operations, including mobile applications and information management systems. This project addresses the evolving needs of the automobile rental sector, focusing on Solidarity Car Rental company. The Solidarity Car Rental faces challenges such as multiple bookings, inefficient system integration, and managing customer feedback. To tackle these issues, an intelligent mobile application based on a cloud integrated information system was developed. Both Qualitative and quantitative research methods were employed, revealing that the system enables seamless browsing, reservations, and secure payments for customers. Internally, it streamlines operations, automates invoicing, facilitates real-time reporting, and enhances car management. Security measures ensure data protection, with Microsoft Azure used for scalability and integration. This solution reduces delays, boosts client satisfaction, and enhances operational efficiency, optimizing rental processes and ensuring adaptability to industry dynamics. It marks a significant evolution in Tanzania's car rental management systems, enhancing efficiency and competitiveness
Association of Urinary Nitrate with Blood Pressure, Prevalence of Cardiovascular Diseases and Cardiovascular Mortality in Hypertensive Population
Authors: Zhao Wei , Chen Yunlin , Wang Kai , Zhang Bo , Du Huaan , Wang Zihao , Yi Xin , Ling Zhiyu , Yin Yuehui
Published: April 2024

Background: Although the association of dietary nitrate intake and improved blood pressure and cardiovascular outcomes has been confirmed in healthy individuals and non-cardiovascular disease (CVD) population, it still remains uncertain whether the protective effect of inorganic nitrate remains significant in the hypertensive population.
Methods: This study analyzed health data of 5,989 hypertensive participants based on the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2014. The correlation between urinary nitrate and blood pressure, the prevalence of CVD subtypes and cardiovascular mortality were assessed respectively. Mediating effect analysis and subgroup analysis was performed.
Results: Within a range of 0-4.34 mg/dL, an inverse linear correlation between urinary nitrate and systolic blood pressure (SBP) was observed (β= -0.84; 95% CI -1.28, -0.41; P<0.001). The increase in urinary nitrate was associated with a decreased prevalence of heart failure (OR=0.914; 95% CI 0.859, 0.972; P=0.006). Urinary nitrate was inversely associated with cardiovascular mortality (HR=0.906; 95% CI 0.864, 0.951; P<0.001). Neither SBP nor coexisting heart failure at baseline mediated the association between urinary nitrate and cardiovascular mortality. Subgroup analysis showed that the inverse association between urinary nitrate and cardiovascular mortality was influenced by smoking, coexisting coronary heart disease and heart failure at baseline.
Conclusions: In hypertensive individuals, an appropriate increase in urinary nitrate was associated with a reduction in SBP, a diminished incidence of heart failure, and a mitigated risk of cardiovascular mortality. These findings suggested urinary nitrate as a plausible marker for monitoring cardiovascular health.
Protective effects of sitagliptin on cholemic nephropathy: the role of sesterin2, and Nrf2/SOD pathway
Authors: akhbari Mohammad , Khaksari Mohammah , Askaripour Majid , Jafari Elham , Saberi Shadan
Published: April 2024

Background
Cholestasis or bile duct ligation (BDL) could develop cirrhosis and may lead to other organ dysfunction, including kidneys which, is called cholemic nephropathy (CN). Hyperbilirubinemia, bile acid accumulation, renal hypoperfusion, oxidative stress, and inflammation are implicated in the pathogenesis of CN. Sitagliptin is an oral antihyperglycemic drug with anti-inflammatory and anti-oxidative effects. The effects of sitagliptin on CN is unknown.
Methods
BDL was performed to induce CN model in 42 male Wistar rats (200–250 gr), which were divided equally into six groups: sham-operated received distilled water as the vehicle (sham + veh), sham received 50mg/kg sitagliptin (sham + sit 50), BDL group, BDL + sit 10, BDL + sit 50, BDL + sit 100 groups, received sitagliptin 10, 50, and 100mg/Kg respectively for 14 days by gavage. Aspartate transferase, alkaline phosphatase, total bilirubin (T-Bil), serum and urine biomarkers of renal function, redox system status, TNF-α, and renal histopathology were assessed.
Results
Induction of BDL increased serum liver enzymes, T-Bil, creatinine (Cr), urea, urine Cr, albumin to Cr ratio, and decreased Cr clearance. Renal sestrin2, malondialdehyde, TNF-α, renal index, and kidney tissue injury score were elevated, while superoxide dismutase activity, total antioxidant capacity, and nuclear factor erythroid 2–related factor 2 (Nrf2) were reduced. Treatment with sitagliptin especially in low dose reverse these effects.
Conclusions
Sitagliptin improves renal injury and function via ameliorating inflammation and oxidative stress by activating Nrf2/SOD pathway in BDL rats. Sitagliptin might be helpful in treating renal complications in cirrhosis and severe liver disease.
Psychometric Properties of the Arabic Translation of the Psy-Flex Scale in a sample of Lebanese Adolescents
Authors: Topalian Michael , Mir Rita El , Malaeb Diana , Sakr Fouad , Dabbous Mariam , Hallit Souheil , Fekih-Romdhane Feten , Obeid Sahar
Published: April 2024

Background:Psychologic flexibility, integral to mental wellbeing, has gained popularity for its role in fostering adaptive coping mechanisms. However, research on this subject in the Middle Eastern population, particularly among adolescents, is limited. This study aimed to examine the psychometric properties of an Arabic translation of the Psy-Flex Scale in a sample of Lebanese adolescents.
Methods: Using a cross-sectional design, 793 adolescents form all districts/governorates participated in the study conducted in November 2023 using a snowball sampling technique. The Psy-Flex Scale and the Depression Anxiety Stress Scale were used in this study.
Results: CFA indicated that the fit of the one-factor model of the Psy-Flex Scale was modest: RMSEA = .109 (90% CI .090, .130), SRMR = .039, CFI = .948, TLI = .914. The modification index between items 3 and 6 was high; after adding a correlation between those residuals, the fit indices improved: RMSEA = .089 (90% CI .069, .112), SRMR = .033, CFI = .969, TLI = .942. The composite reliability of scores was adequate in the total sample (ω = .84 / α = .84). We were able to show the invariance across sex at the configural, metric, and scalar levels. No significant difference was seen between males and females in terms of psychological flexibility scores (17.91 ± 4.90 vs 17.40 ± 4.34; t(791) = 1.50; p = .134). Concurrent validity was shown since higher psychological flexibility was significantly associated with lower depression (r = -.08; p = .024) and lower anxiety (r = -.10; p = .004), but not stress (r = .06; p = .090).
Conclusion: The validation of the Arabic Psy-Flex Scale represents a significant contribution to Arab mental health research, providing a culturally sensitive tool to assess psychological flexibility in adolescents and explore its associations with psychological distress.
Study on the Thermal Characteristics of a Turning and Milling Machine Using Taguchi-FEM with ANOVA-Driven Search
Authors: Wu Chen-Zhe , Hsieh Wen-Hsin , Kuo Tzu-Chien , Chang Yu-Hao , ZHUANG Jyun-Rong
Published: April 2024

Turning and milling machines (TMMs) have diverse and complex heat sources, which pose challenges to understanding and accurately predicting their thermal behavior. This study established a transient 3D thermal model of the TMM using the Finite Element Method (FEM) to predict the temporal evolution of temperature and deformation fields. The FEM predictions were then compared with the experimental results from five machining scenarios for model validation, demonstrating accurate prediction of temperature and deformation with average errors of 0.9% and 5.59 μm, respectively. A comprehensive procedure was proposed to explore the thermal characteristics of TMMs and identify thermally critical components. This study employed a Taguchi-FEM approach along with sensitivity analysis to evaluate the significant contributing boundary conditions of TMMs to tool center point (TCP) deformation in the X, Y, and Z directions. An ANOVA-driven search was further proposed to identify thermal key points significantly impacting TCP deformation across directions and time intervals. Integrating both methods facilitated the identification of the TMM thermal critical regions. The spindle TCP’s thermal critical regions were most significantly influenced by the spindle component, followed by the milling cutter shaft component and then the right side of the base bed. Similarly, for the sub-spindle TCP, the highest impact came from the sub-spindle components, followed by the right side of the base bed and the milling cutter shaft components. The proposed procedure identified the significant regions for assisting evaluation in TMMs and reduced the number of required temperature monitoring points while optimizing their placements to minimize measurement costs.
Understanding Post-Operative Refractive Outcome in Pediatrics After IOL Implementation: Factors and Predictors
Authors: AlObaisi Saif , Alnasser Bashair N. , Almuhawas Hana A. , Alhoshan Saja A. , Aldebasi Mohammed H. , Alshaye Rana , Aldakhil Suliman , Alrasheed Saif H.
Published: April 2024

BACKGROUND: In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation.
METHODS This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years’ post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated.
RESULTS: The mean age was 6.52± 4.61 years, with an age range of 1 to 15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of -0.29 (p = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of -1.05 (p = 0.009) and -1.81 (p = 0.009), respectively.
CONCLUSION: High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor.
Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach
Authors: Fierro Giulia , Milan Barbara , Buelli Elena , Bugada Dario , Casarotta Erika , Rizzo Francesco , Ongaro Laura , Gritti Paolo , Previdi Fabio , Lorini Ferdinando Luca
Published: April 2024

Background: Effective pain during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.
Methods: We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included thetotal and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a five-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups and a correlation analysis was performed.
Results: The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only eight patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.
Conclusions: Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.
Influence of high-frequency pulse on droplet transfer process and weld formation in double-wire median pulsed GMAW of aluminum alloy
Authors: Wu Kaiyuan , Lin Jing , Yang Haoran , Wang Yifei , Hong Xiaobin
Published: April 2024

A double-wire median pulsed gas metal arc welding (GMAW) with a high-frequency pulse waveform was developed to study the influence of a high-frequency pulse on the droplet transfer process and weld formation in aluminum (Al) alloy. The droplet transfer process was recorded using a high-speed photography system. At the same time, the influence of a high-frequency pulse at peak stage was investigated. The experimental results demonstrated that stable droplet transfer and continuous welds are obtained by incorporating high-frequency pulses. The high-frequency pulses increase electromagnetic force and facilitate premature detachment of droplets. Especially, at a high frequency of 20 kHz, one drop per pulse (ODPP) droplet transfer mode is achieved, which is the ideal mode. In addition, high-frequency pulses increase axial arc pressure, strengthen convergent flow, and reduce the effect of divergent flow, resulting in increased weld penetration while decreasing weld width and porosity.
Constructing Causal Pathways for Premature Cardiovascular Disease Mortality using Directed Acyclic Graphs: Integrating Evidence Synthesis and Expert Knowledge
Authors: Hasani Wan Shakira Rodzlan , Musa Kamarul Imran , Chen Xin Wee , Cheng Kueh Yee
Published: April 2024

Cardiovascular disease (CVD) is a major global cause of premature mortality. While multiple studies propose CVD mortality prediction models based on regression frameworks, incorporating causal understanding through causal inference approaches can enhance accuracy. This paper demonstrates a methodology combining evidence synthesis and expert knowledge to construct a causal model for premature CVD mortality using Directed Acyclic Graphs (DAGs). The process involves three phases: (1) initial DAG development based on the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAGs) framework, (2) validation and consensus-building with 12 experts using the Fuzzy Delphi method (FDM), and (3) application to data analysis using population-based survey data linked with death records. Expert input refined the initial DAG model, achieving consensus on 45 causal paths. The revised model guided selection of confounding variables for adjustment. For example, to estimate the total effect of diabetes on premature CVD mortality, the suggested adjustment set included age, dietary pattern, genetic/family history, sex hormones, and physical activity. Testing different DAG models showed agreement between expert ratings and data accuracy from regression models. This systematic approach contributes to DAG methodology, offering a transparent process for constructing causal pathways for premature CVD mortality.
Analyzing the Interest in Digital Wellbeing Services: Are People More Willing to Pay for Them on Social Network Sites or Messaging Platforms?
Authors: Alshakhsi Sameha , Babiker Areej , Al-Thani Dena , Sindermann Cornelia , Montag Christian , Ali Raian
Published: April 2024

The prevalence of social network sites (SNS) and messaging platforms (MSG) has transformed the way people communicate, interact, and share information. However, concerns about digital wellbeing have arisen due to issues such as disclosure of personal information, excessive usage, fake news, extremism, and mental health challenges. This study aims to investigate the level of interest in digital wellbeing services on both SNS and MSG and explore potential differences in willingness to pay (WTP) for these services between the two types of online platforms. The analysis encompasses the demographic factors of age, gender, financial wellness, and education level. Data were collected from 262 participants through an online questionnaire, focusing on ten digital wellbeing services. The findings indicate that overall, the WTP for digital wellbeing services was higher on SNS compared to MSG across the entire sample and among different demographic factors. However, variations were observed at the individual service level. For instance, participants demonstrated greater WTP on MSG for services related to data protection and abstaining from data usage for marketing purposes. On the other hand, they showed a stronger inclination to pay on SNS for services aimed at addressing issues of fake news, radicalization, and excessive online usage. These preferences remained consistent across various demographic factors, with no significant interactions or between-subject effects observed, suggesting that the impact of the platform on WTP was consistent across the demographics studied. The research provides valuable insights into consumers’ valuation of digital wellbeing services, which can guide market players and policy makers in tailoring their offerings and strategies accordingly.
Two Factor Authentication by Using Decentralized File Storage System
Authors: Suresh R , Balachander K , Varman S Logesh , Faris KS Sai
Published: April 2024

In today's digital age, the apps we use for social and business things are getting more advanced, so we need better ways to check if you are really you. Two-Factor Authentication (2FA) is crucial for making the usual way we confirm identities better, but it does have some challenges. Usual 2FA methods have vulnerabilities such as SIM swapping, denial of service (DoS), and man-in-the-middle (MITM)[1] attacks.These issues continue to exist even when services say they have strong encryption. The central system in 2FA is also problematic because if it's breached, an attacker could impersonate an authorized user or mess up the whole service.To tackle these issues, we are proposing decentralized 2FA methods. This means spreading out the authentication process and using public key encryption. In this system, the user's secret keys are encrypted with their wallet's public key, giving users control over their authentication.Users can generate distinct passwords even without their main device. Therefore, as digital security needs grow, the limitations of traditional 2FA are clear. The solution is to shift to decentralized methods, offering better security and more control for users over how they authenticate.
Enhancing Flexural Performance of Self-Compacting Concrete Beams Using Fiber-Reinforced Polymer Composites
Authors: Rakam Abhinay , Sahu Sritam Swapnadarshi
Published: April 2024

This paper presents an extensive experimental investigation into the behavior of beams made of reinforced self-compacting concrete (RSCC). These beams were subjected to strengthening and re-strengthening using various externally bonded sheets made of Carbon Fiber Reinforced Polymer (CFRP) and Glass Fiber Reinforced Polymer (GFRP). The primary aim of this study is to identify an effective wrapping method suitable for RSCC beams that require strengthening and re-strengthening. The experimental program consisted of a control beam and twelve test beams. Among these, six beams (Group-A) were strengthened, and the other six beams (Group-B) were repaired after undergoing 50% preloading using CFRP and GFRP sheets. Three different wrapping configurations were employed: Type 1 involved a single-layer U wrap, Type 2 utilized one layer at the soffit in combination with a single-layer U wrap, and Type 3 entailed a double-layer U wrap with epoxy adhesive. The experimental results revealed that the beam in Group-A, which used the Type 2 wrapping method, demonstrated a remarkable 109% increase in its load-carrying capacity and significantly reduced deflections when compared to the performance of the control beam. Furthermore, the observations from the experiments indicated that wrapping techniques involving CFRP and GFRP sheets outperformed the control specimens. This research provides valuable insights into the effectiveness of different wrapping approaches using CFRP and GFRP sheets in improving the flexural performance of RSCC beams. These findings have the potential to enhance the optimization and practical application of such strengthening and repair methods in RSCC structures.
Effects of Lotrafilcon A and Senofilcon A Bandage Contact Lenses on Visual Outcome and Ocular Comfort after Photorefractive Keratectomy (Effects of Two Different Bandage Contact Lens Following PRK)
Authors: Yakar Konuralp
Published: April 2024

Purpose
To compare the efficacy of two different silicone hydrogel bandage contact lenses (BCLs) in terms of visual rehabilitation and ocular discomfort following photorefractive keratectomy (PRK).
Methods
This prospective study included 60 eyes of 30 patients who underwent bilateral PRK surgery to correct myopia and/or astigmatism refractive errors. Following surgery, Lotrafilcon A contact lenses were applied to the right eye and Senofilcon A material contact lenses were applied to the left eye. On postoperative day 5, when the BCLs were removed, subjective ocular symptoms of discomfort were evaluated on a scale of 0 to 10, where 0 indicated no discomfort and 10 indicated maximum discomfort. The postoperative spherical equivalents (SE) of both eyes were compared on 15th day and 1st month. Postoperative SE ≤ ± 0.50 diopters were accepted as emmetropia. The number of patients who achieved emmetropia was also compared on the 15th day and the 1st month postoperatively.
Results
The ocular discomfort scores did not differ significantly between the BCLs on postoperative 5-day time period (p > 0.05). However, a statistically significant difference was observed between the two lenses in terms of their SE values on the postoperative 15th day and 1st month (p < 0.05). The eyes fitted with Senofilcon A material lenses demonstrated better postoperative visual rehabilitation.
Conclusion
Although the ocular discomfort scores following PRK between the two BCLs did not differ significantly, the Senofilcon A lenses performed better performance on the goal of SE postoperatively.
Enhanced Biosynthesis of Coated Silver Nanoparticles using Isolated Bacteria from Heavy Metal Soils and their Photothermal- based antibacterial activity: Integrating Response Surface Methodology (RSM) Hybrid Artificial Neural Network (ANN)- Genetic Algorithm (GA) Strategies
Authors: Mechouche Meroua Safa , Merouane Fateh , Addad Ahmed , Karmazin Lydia , Boukherroub Rabah , Lakhdari Nadjem
Published: April 2024

This study explores the biosynthesis of silver nanoparticles (AgNPs) using the Streptomyces tuirus S16 strain, presenting an eco-friendly alternative to mitigate the environmental and health risks of chemical synthesis methods. It focuses on optimizing medium culture conditions, understanding their physicochemical properties, and investigating their potential photothermal-based antibacterial application. The S16 strain was selected from soil heavy metals to exploit its ability to produce diverse bioactive compounds. By employing the combination of Response Surface Methodology (RSM) and Artificial Neural Network (ANN)-Genetic Algorithm (GA) strategies, we optimized AgNPs synthesis, achieving a significant 59.2% improvement in yield under specific conditions (Bennet's medium supplemented with glycerol [5g/L] and casamino-acid [3g/L] at 30°C for 72h). A detailed physicochemical characterization was conducted. Notably, the AgNPs were well dispersed, and a carbonaceous coating layer on their surface was confirmed using Energy-Dispersive X-ray Spectroscopy. Furthermore, functional groups were identified using Fourier-transform infrared spectroscopy, which helped enhance the AgNPs' stability and biocompatibility. AgNPs also demonstrated efficient photothermal conversion under light irradiation (0,2w/cm2), with temperatures increasing to 41.7°C, after 30minutes. In addition, treatment with light irradiations against E.coli K-12 model effectively reduced the concentration of AgNPs from 105 to 52.5µg/mL, thereby to enhancing the efficacy of silver nanoparticles in contact with the E. coli K-12 model
Evaluation of clinical and radiographic warning signs for prediction of oroantral communication following tooth extractions
Authors: Jurasek Alexandra , Farkas Nelli , Frank Dorottya , Kolarovszki Bela , Sandor Balazs , Radacsi Andrea , Szanto Ildiko , Katona Krisztian
Published: April 2024

Objectives
Oroantral communication (OAC) is a relatively common and mild complication of maxillary tooth extractions. Preoperative prediction of OAC can reduce treatment duration and prepare both operators and patients for the procedure. This study aims to identify alarming radiographic and clinical indicators that can predict OAC.
Methods
In this retrospective case-control study, a control group twice the size of the OAC group was established. Clinical data were collected, and measurements were conducted separately by two blinded observers on digital panoramic radiographs. Inter-rater reliability was assessed. The correlation between OAC and demographic data (age, sex), as well as various factors assessed on panoramic radiographs (including, but not limited to, the length of the root, root projection into the sinus, bone width, presence of mesial and distal adjacent teeth), was statistically evaluated.
Results
Inter-rater reliability was found to be excellent. Several factors were identified as potential predictors of OAC. According to our model, the strongest predictors were the distance between the cemento-enamel junction and marginal bone, extent of root projection into the sinus, presence of sinus recess around the roots, angulation, and absence of the mesial adjacent tooth.
Conclusions
Well-defined measurements on panoramic radiographs may aid in predicting OAC. Further prospective investigations are necessary to confirm these indicators and address factors related to clinical examination and operation.
Research on Nonlinear Robust Control Strategy of Active Voltage Support for Grid-forming Photovoltaics
Authors: KANG Zhongjian , Dongjian LU
Published: April 2024

With the integration of a large number of photovoltaic renewable energy into the power grid, on the one hand, it will lead to a decrease in the proportion of synchronous generators with large inertia in the power grid, and on the other hand, because photovoltaic needs to be connected to the grid through inverters and other devices containing a large number of power electronic components, the inertia of the power grid will be reduced, the robustness will become poor, and the system voltage will fluctuate. In order to solve the above problems, this paper proposes a voltage active support method based on the expansion state observer and the terminal sliding mode control strategy. Firstly, a grid-forming photovoltaic grid-connected microgrid model was built in Matelab/Smulink. Secondly, the voltage controller in the virtual synchronous generator control was redesigned according to the synchronous generator control and nonlinear robust control technology. By adding an extended state observer and terminal sliding mode control to the voltage controller, the purpose of active voltage support and improved control performance is realized. Through simulation analysis, the results show that when the photovoltaic output changes, the voltage controller based on the expansion state observer and terminal sliding mode control can not only realize the voltage regulation function, but also effectively reduce the overshoot of the system voltage, improve the voltage response speed, and enhance the system stability of the system when the photovoltaic output changes.
Policy innovation in the digital era: Computational text analysis of media narratives on smart metering in India
Authors: Goyal Nihit
Published: April 2024

Although novel policies will be especially important for addressing grand societal challenges, how the digital transition influences the ability of governments to adopt new policies remains unclear. In this study, I explore the relationship between digitization and policy innovation to understand how the two might be related. Specifically, I study media narratives in the case of the ongoing roll-out of smart metering in India to assess whether and how this instance of digital governance has been discussed in the news. To do so, I analyze 370 articles in the largest English language daily newspaper in India using topic modelling and sentiment analysis. The findings highlight the polysemic nature of smart metering, its ability to support highly (re-)configurable and targeted policy designs, as well as some resistance to this policy innovation thus far. I discuss the implications of the findings for theory and research on digital governance and policy innovation.
Feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing intervention among men in two Ugandan fishing communities
Authors: Matovu Joseph KB , Namwama Aisha Twahiri , Kemigisha Linda , Taasi Geoffrey , Nakabugo Jennipher , Wandabwa Julius , Bogart Laura M , Fakier Nuraan , Wanyenze Rhoda K. , Musinguzi Joshua , Serwadda David
Published: April 2024

Background
Social network-based interventions can improve uptake of health interventions. However, limited evidence exists on their feasibility and acceptability in fishing community settings. We assessed the feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing (HIVST) intervention among men in Uganda.
Methods
The PEer-led HIVST intervention for MEN (PEST4MEN) is a pilot intervention conducted among men (15 + years) in Kalangala and Buvuma island districts. Data were collected between July and September 2022. The intervention was implemented through 22 “peer-leaders” who were trained in HIVST use and distribution processes and requested to refer at least 20 members from their social networks. A total of 475 men were referred; of these, 400 met the study enrolment criteria. Enrolled men were administered a baseline questionnaire and requested to pick two kits from their peer-leaders. The intervention was deemed feasible if > 80% of the kits given to the peer-leaders were distributed to men within their social networks and acceptable if > 80% of those who received the kits used them to self-test for HIV. First-time HIV-positive testers were asked if they linked to HIV care. Data were analyzed using STATA version 16.0.
Results
Of 400 men, 272 (67.9%) were aged 18–34 years; 227 (56.7%) were engaged in fishing or fishing-related activities while 328 (82%) had ever tested for HIV. Of 361 men (90.2%) interviewed at follow-up, 355 (98.3%) reported that they received kits from their peer-leaders; 352 (99.1%) used them to self-test for HIV. Of those who self-tested, 339 (96.3%) returned used kits for re-reading. Fifty-one men (14.5%) had reactive self-test results; of these, 16 men (31.4%) were first-time HIV-positive testers. Of first-time HIV-positive testers, 14 men (87.5%) went for confirmatory HIV testing, seven men (50%) were confirmed as HIV-positive and five men (71.4%) were linked to HIV care.
Conclusion
Our peer-led HIVST intervention was feasible and acceptable and identified a sizeable proportion of previously undiagnosed HIV-positive men who were linked to HIV care. However, while these results are promising, we recommend additional research in a large study, preferably in other fishing community settings, prior to the roll-out of this intervention.
Trial registration
ClinicalTrials.Gov: NCT05685498 (retrospectively registered on January 17, 2023).