bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating catastrophic health expenditures among patients with long bone fractures in Ghana's major teaching hospitals: a hospital-based analysis
Authors: Buunaaim Alexis D. B. , Amenah Michel Adurayi , Konadu-Yeboah Dominic , Baidoo Richard , Asare Amgbo , Addo Wilfred Larbi , Martin Claude
Published: January 2025

Background

In low and middle-income countries like Ghana, out-of-pocket (OOP) payments remain a significant barrier to healthcare access, often leading to catastrophic health expenditures (CHE). This study evaluates the incidence of CHE among patients treated for long bone fractures at Ghana’s major teaching hospitals, providing insight into the economic burdens faced by these patients.

Methods

This cross-sectional study analyzed data from 2,980 patients with long bone fractures treated at four major teaching hospitals in Ghana from July 2017 to July 2020. We collected demographic, clinical, and economic data, including OOP payments and patient-reported income, to assess the incidence of CHE at varying income thresholds (10%, 20%, 30%, 40%). Logistic regression models were used to identify predictors of CHE, with variables including age, gender, education, region, fracture type, injury severity, and NHIS coverage.

Results

The incidence of CHE was highest at the 10% income threshold (53.21%) and decreased with higher thresholds. Male patients incurred higher average OOP payments ($343.68) than females ($271.63), and patients with tibia fractures faced the highest financial burden. Educational and regional disparities were evident, with lower CHE rates among patients with higher educational attainment and those from northern regions. NHIS coverage provided limited financial relief, particularly at lower income thresholds.

Conclusion

Long bone fractures impose a substantial financial burden on patients in Ghana, with significant gender, educational, and regional disparities in OOP payments and CHE. While NHIS provides some relief, it remains inadequate in protecting patients from financial distress. Policy interventions aimed at expanding NHIS coverage, reducing OOP payments for high-cost treatments, and addressing geographic inequities are urgently needed to improve financial protection for patients with long bone fractures in Ghana. Future research should focus on capturing long-term financial impacts and improving income data accuracy to better inform healthcare policies.
Developing an automatic treatment record review system for quality assurance of patient treatment delivery in radiation therapy
Authors: Huang Peng , Xu Yingjie , Huan Fukui , Zhang Yanxin , Ma Min , Men Kuo , Dai Jianrong
Published: January 2025

Background and purpose

Treatment record contains most of information related to treatment plan delivery in radiation therapy. Reviewing treatment record is an important quality assurance (QA) task for safety and quality of patient treatments. This task is usually performed by senior medical physicists. However, it is time-consuming, tedious, and error-prone. To assist this process, a treatment record review system (TRRS) is developed to automatically review items related to treatment delivery record.

Methods

The treatment record is firstly extracted from oncology information system (OIS). Based on the daily patient treatment information, the original plan from the treatment planning system is identified. Then the original plan and the delivered plan are correlated. Eight review categories (parameter consistency, treatment completeness, treatment progression, image guidance, override, treatment couch, documentation, and treatment mode) are created. Tailored rules are designed for various review items to automate the review process. As a result, for each daily treatment record, a reviewed flag (pass, failure, warning, and N/A) is assigned by the TRRS. Finally, this system is evaluated by 6 months patient treatment records collected in our institute and compared to the manual process on the same data.

Results

TRRS processed a total of 76,651 treatment fractions from 4230 patients with an average of 574 treatments per day. The percentage of the detected anomalies among the total records was 0.76%. The average processing time was 3.9 s and 282 s per treatment record for the automatic and manual processes, respectively. Comparing with the manual process, the time efficiency of TRRS is improved by a factor of 72. The average numbers of anomalies detected by the automatic and manual processes are 21 and 13 per day, respectively. TRRS detects 61.5% more anomalies than those of the manual process.

Conclusion

TRRS is not only efficient in processing a large amount of treatment records on a daily basis but also effective in finding more anomalies than those of physics weekly check. The application of the TRRS could significantly reduce the workload of the review physicists and let them focus on more important works related to patient safety.
Evaluating the feasibility of AI-predicted bpMRI image features for predicting prostate cancer aggressiveness: a multi-center study
Authors: Wang Kexin , Luo Ning , Sun Zhaonan , Zhao Xiangpeng , She Lilan , Xing Zhangli , Chen Yuntian , He Chunlei , Wu Pengsheng , Wang Xiangpeng , Kong ZiXuan
Published: January 2025

Objective

To evaluate the feasibility of utilizing artificial intelligence (AI)-predicted biparametric MRI (bpMRI) image features for predicting the aggressiveness of prostate cancer (PCa).

Materials and methods

A total of 878 PCa patients from 4 hospitals were retrospectively collected, all of whom had pathological results after radical prostatectomy (RP). A pre-trained AI algorithm was used to select suspected PCa lesions and extract lesion features for model development. The study evaluated five prediction methods, including (1) A clinical-imaging model of clinical features and image features of suspected PCa lesions selected by AI algorithm, (2) the PIRADS category, (3) a conventional radiomics model, (4) a deep-learning bases radiomics model, and (5) biopsy pathology.

Results

In the externally validated dataset, the deep learning-based radiomics model showed the highest area under the curve (AUC 0.700 to 0.791). It exceeded the clinical-imaging model (AUC 0.597 to 0.718), conventional radiomic model (AUC 0.566 to 0.632), PIRADS score (AUC 0.554 to 0.613), and biopsy pathology (AUC 0.537 to 0.578). The AUC predicted by the model did not show a statistically significant difference among the three externally verified hospitals (p > 0.05).

Conclusion

Deep-learning radiomics models utilizing AI-extracted image features from bpMRI images can potentially be used to predict PCa aggressiveness, demonstrating a generalized ability for external validation.

Critical relevance statement

Predicting the aggressiveness of prostate cancer (PCa) is important for formulating the best treatment plan for patients. The radiomic model based on deep learning is expected to provide an objective and non-invasive method for evaluating the aggressiveness of PCa.

Key Points

Predicting the aggressiveness of PCa is important for patients to obtain the best treatment options.

The deep learning-based radiomics model can predict the aggressiveness of PCa with high accuracy.

The model has good universality when tested on multiple external datasets.

Graphical Abstract
Tacit engagement in humanitarian action: making sense of silence and secrecy in humanitarian negotiations
Authors: Akal Ayse Bala , Roepstorff Kristina , Lidén Kristoffer
Published: January 2025

Secrecy and silence regarding the compromises and trade-offs made by frontline humanitarians in order to achieve access, protection, efficiency and legitimacy are a widely observable but underconceptualized phenomenon in humanitarian action. As a form of “tacit engagement”, it allows humanitarian practitioners to operate in difficult settings but also implies lacking accountability, coordination and learning. There is thus a need for disentangling the productive and restraining effects of secrecy in this field. In this paper, we do so by conceptualizing these practices as forms of “tacit engagement” and relating them to political theory on secrecy and silence. Drawing on insights from expert consultations and qualitative interviews on humanitarian negotiations, we relate it to existing literatures on remote management, risk management and a culture of silence in humanitarian organizations more generally and humanitarian negotiations more specifically. In the conclusion, we work out the potentially productive and destructive effects of tacit engagement as an invitation to ethical assessment.
Deep learning of noncontrast CT for fast prediction of hemorrhagic transformation of acute ischemic stroke: a multicenter study
Authors: Ren Huanhuan , Song Haojie , Cui Shaoguo , Xiong Hua , Long Bangyuan , Li Yongmei
Published: January 2025

Background

Hemorrhagic transformation (HT) is a complication of reperfusion therapy following acute ischemic stroke (AIS). We aimed to develop and validate a model for predicting HT and its subtypes with poor prognosis—parenchymal hemorrhage (PH), including PH-1 (hematoma within infarcted tissue, occupying < 30%) and PH-2 (hematoma occupying ≥ 30% of the infarcted tissue)—in AIS patients following intravenous thrombolysis (IVT) based on noncontrast computed tomography (NCCT) and clinical data.

Methods

In this six-center retrospective study, clinical and imaging data from 445 consecutive IVT-treated AIS patients were collected (01/2018–06/2023). The training cohort comprised 344 patients from five centers, and the test cohort included 101 patients from the sixth center. A clinical model was developed using eXtreme Gradient Boosting, an NCCT-based imaging model was created using deep learning, and an ensemble model integrated both models. Comparison with existing clinical scores (MSS, SEDAN, GRASPS) was performed using the DeLong test.

Results

Of the 445 individuals, 202 (45.4%) had HT, 79 (17.8%) had hemorrhagic infarction, and 123 (27.6%) had PH. In the test cohort, the area under the receiver operating characteristic curve (AUROC) of the clinical, imaging, and ensemble model for HT prediction was 0.877, 0.920, and 0.937, respectively. The ensemble model for HT prediction outperformed MSS, SEDAN, and GRASPS scores (p ≤ 0.023). The ensemble model predicted PH and PH-2 with AUROC of 0.858 and 0.806, respectively.

Conclusion

Developing and validating an integrated model that can predict HT and its subtypes in AIS patients following IVT based on NCCT and clinical data is feasible.

Relevance statement

The clinical, imaging, and ensemble models based on noncontrast CT and clinical data outperformed existing clinical scores in predicting hemorrhagic transformation of AIS and its subtypes with poor prognosis, facilitating personalized treatment decisions.

Key Points

The models demonstrated the capability to predict hemorrhagic transformation of acute ischemic stroke quickly, accurately, and reliably.

The proposed models outperformed existing clinical scores in predicting hemorrhagic transformation.

The ensemble model provided risk assessment of parenchymal hemorrhage and parenchymal hemorrhage-2 outperforming existing clinical scores.

Graphical Abstract
Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study
Authors: Ifarraguerri Anna M. , Graham George D. , White Alexander B. , Berk Alexander N. , Gachigi Kennedy K. , Siparsky Patrick N. , Trofa David P. , Piasecki Dana P. , Fleischli James E. , Saltzman Bryan M.
Published: January 2025

Background

There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure.

Methods

All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected.

Results

The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR −11.7; 95% CI −22.35 to −1.04; P = 0.031), KOOS symptoms score (OR −17.11; 95% CI −28.85 to −5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR −11.15; 95% CI −21.71 to −0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR −9.99; 95% CI −15.77 to −4.22; P = 0.001).

Conclusions

The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.

Study design

Retrospective cohort study; level of evidence, 3
Investigating Student Noticing of Quantitative Reasoning in Introductory Biology Labs
Authors: Hsu Jeremy L. , Gartland Sara , Prate Joelle , Hohensee Charles
Published: January 2025

Quantitative reasoning (QR) is a key part of biology. Here, we apply the theoretical framework of student noticing to investigate into how students learn QR in an intro bio lab course. Using observations and interviews, we characterize what students notice when working with QR, their depth of noticing, and the factors that shape their noticing.
How do Early-career Biology Faculty Develop Pedagogical Content Knowledge? Exploring Variation and Longitudinal Development
Authors: Waugh Alex H. , Green Kathryn E. , Andrews Tessa C.
Published: January 2025

Effective teaching requires teachers to leverage their knowledge of how students think about and learn specific topics (i.e., pedagogical content knowledge). This longitudinal qualitative study of early-career biology instructors examines the development of this specialized teaching knowledge.
Self-harm in women in midlife: rates, precipitating problems and outcomes following hospital presentations in the multicentre study of self-harm in England
Authors: Clements Caroline , Bickley Harriet , Hawton Keith , Geulayov Galit , Waters Keith , Ness Jennifer , Kelly Samantha , Townsend Ellen , Appleby Louis , Kapur Nav
Published: January 2025

Background

Suicide in women in the UK is highest among those in midlife. Given the unique changes in biological, social and economic risk factors experienced by women in midlife, more information is needed to inform care.

Aim

To investigate rates, characteristics and outcomes of self-harm in women in midlife compared to younger women and identify differences within the midlife age-group.

Method

Data on women aged 40–59 years from the Multicentre Study of Self-harm in England from 2003 to 2016 were used, including mortality follow-up to 2019, collected via specialist assessments and/or emergency department records. Trends were assessed using negative binomial regression models. Comparative analysis used chi-square tests of association. Self-harm repetition and suicide mortality analyses used Cox proportional hazards models.

Results

The self-harm rate in midlife women was 435 per 100 000 population and relatively stable over time (incident rate ratio (IRR) 0.99, p < 0.01). Midlife women reported more problems with finances, alcohol and physical and mental health. Suicide was more common in the oldest midlife women (hazard ratio 2.20, p < 0.01), while psychosocial assessment and psychiatric inpatient admission also increased with age.

Conclusion

Addressing issues relating to finances, mental health and alcohol misuse, alongside known social and biological transitions, may help reduce self-harm in women in midlife. Alcohol use was important across midlife while physical health problems and bereavement increased with age. Despite receiving more intensive follow-up care, suicide risk in the oldest women was elevated. Awareness of these vulnerabilities may help inform clinicians’ risk formulation and safety planning.
Associations of mental disorders in children with parents' subsequent mental disorders: nationwide cohort study from Finland and Denmark
Authors: Hakulinen Christian , Gutvilig Mai , Niemi Ripsa , Momen Natalie C. , Pulkki-Råback Laura , Böckerman Petri , Plana-Ripoll Oleguer , Komulainen Kaisla , Elovainio Marko
Published: January 2025

Background

Intergenerational transmission of mental disorders has been well established, but it is unclear whether exposure to a child's mental disorder increases parents' subsequent risk of mental disorders.

Aims

We examined the association of mental disorders in children with their parents' subsequent mental disorders.

Method

In this population-based cohort study, we included all individuals with children born in Finland or Denmark in 1990–2010. Information about mental disorders was acquired from national registers. The follow-up period began when the parent's eldest child was 5 years old (for ICD-10 codes F10–F60) or 1 year old (for codes F70–F98) and ended on 31 December 2019 or when the parent received a mental disorder diagnosis, died, or emigrated from Finland or Denmark. The associations of mental disorders in children with their parents' subsequent mental disorders were examined using Cox proportional hazards models.

Results

The study cohort included 1 651 723 parents. In total, 248 328 women and 250 763 men had at least one child who had been diagnosed with a mental disorder. The risk of a parent receiving a mental disorder diagnosis was higher among those who had a child with a mental disorder compared with those who did not. For both parents, the hazard ratios were greatest in the first 6 months after the child's diagnosis (hazard ratio 2.04–2.54), followed by a subtle decline in the risk (after 2 years, the hazard ratio was 1.33–1.77).

Conclusion

Mental disorders in children are associated with a greater risk of subsequent mental disorders among their parents. Additional support is needed for parents whose children have been recently diagnosed with a mental disorder.
Prevalence and comorbidity rates of disruptive mood dysregulation disorder in epidemiological and clinical samples: systematic review and meta-analysis
Authors: Benarous Xavier , Lahaye Hélène , Consoli Angèle , Cohen David , Labelle Réal , Guilé Jean-Marc
Published: January 2025

Background

This systematic review and meta-analysis evaluates the prevalence of disruptive mood dysregulation disorders (DMDD) in community-based and clinical populations.

Methods

PubMed and PsychINFO databases were searched, using terms specific to DMDD, for studies of prevalence and comorbidity rates conducted in youths below 18.

Results

Fourteen studies reporting data from 2013 to 2023 were included. The prevalence of DMDD in the community-based samples was 3.3% (95% confidence interval [CI], 1.4–6.0) and 21.9% (95% CI, 15.5–29.0) in the clinical population. The differences in the identification strategy of DMDD were associated with significant heterogeneity between studies in the community-based samples, with a prevalence of 0.82% (95% CI, 0.11–2.13) when all diagnosis criteria were considered. Anxiety, depressive disorders, and ADHD were the most frequent comorbidity present with DMDD. The association with other neurodevelopmental disorders remained poorly investigated.

Conclusions

Caution is required when interpreting these findings, considering the quality of the reviewed data and the level of unexplained heterogeneity among studies. This review stresses the importance of considering a strict adhesion to DMDD criteria when exploring its clinical correlates.
Quantitative approaches for studying G protein-coupled receptor signalling and pharmacology
Authors: Pearce Abigail , Redfern-Nichols Theo , Wills Edward , Rosa Matthew , Manulak Iga , Sisk Claudia , Huang Xianglin , Atakpa-Adaji Peace , Prole David L. , Ladds Graham
Published: January 2025

G protein-coupled receptor (GPCR) signalling pathways underlie numerous physiological processes, are implicated in many diseases and are major targets for therapeutics. There are more than 800 GPCRs, which together transduce a vast array of extracellular stimuli into a variety of intracellular signals via heterotrimeric G protein activation and multiple downstream effectors. A key challenge in cell biology research and the pharmaceutical industry is developing tools that enable the quantitative investigation of GPCR signalling pathways to gain mechanistic insights into the varied cellular functions and pharmacology of GPCRs. Recent progress in this area has been rapid and extensive. In this Review, we provide a critical overview of these new, state-of-the-art approaches to investigate GPCR signalling pathways. These include novel sensors, Förster or bioluminescence resonance energy transfer assays, libraries of tagged G proteins and transcriptional reporters. These approaches enable improved quantitative studies of different stages of GPCR signalling, including GPCR activation, G protein activation, second messenger (cAMP and Ca2+) signalling, β-arrestin recruitment and the internalisation and intracellular trafficking of GPCRs.
Applications of Machine Learning (ML) in the context of marketing: a bibliometric approach
Authors: Cardona-Acevedo Sebastián , Agudelo-Ceballos Erica , Arango-Botero Diana , Valencia-Arias Alejandro , Ramírez Dávila Juana De La Cruz , Jimenez Garcia Jesus Alberto , Flores Goycochea Carlos , Martínez Rojas Ezequiel
Published: January 2025

Abstract* Currently, machine learning applications in marketing allow to optimize strategies, personalize experiences and improve decision making. However, there are still several research gaps, so the objective is to examine the research trends in the use of machine learning in marketing. A bibliometric analysis is proposed to assess the current scientific activity, following the parameters established by PRISMA-2020. Machine learning applications in marketing have experienced steady growth and increased attention in the academic community. Key references, such as Miklosik and Evans, and prominent journals, such as IEEE Access and Journal of Business Research, have been identified. A thematic evolution towards big data and digital marketing is observed, and thematic clusters such as “digital marketing”, “interpretation”, “prediction”, and “healthcare" stand out. These findings demonstrate the continued importance and research potential of this evolving field.
Application of Artificial Intelligence in Radiological Image Analysis for Pulmonary Disease Diagnosis: A Review of Current Methods and Challenges
Authors: Zalewa Karolina , Olszak Joanna , Kapłan Wojciech , Orłowska Dominika , Bartoszek Lidia , Kaus Marta , Klepacz Natalia
Published: January 2025

Introduction and purposeArtificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), is revolutionizing radiology by improving diagnostic accuracy and efficiency. This paper examines AI applications, especially convolutional neural networks (CNNs), in diagnosing pulmonary diseases, such as pneumonia, tuberculosis, and lung cancer. The goal is to explore the impact of these technologies and assess challenges in their integration into clinical practice.
Material and methodsThis review is based on articles from the PubMed database, published between 2015 and 2024, using keywords such as artificial intelligence in radiology, AI in medicine, AI in chest X-ray, and AI in chest-CT.
ResultsAI, driven by ML and DL, has significantly enhanced medical imaging analysis, automating tasks that require expert interpretation. CNNs excel in processing raw image data and identifying hierarchical features, surpassing traditional methods in diagnosing lung diseases from radiographs and CT scans. AI systems demonstrate exceptional accuracy in detecting pneumonia, tuberculosis, and lung cancer, providing rapid, consistent results, particularly valuable in resource-limited settings. However, challenges persist, including the need for diverse training datasets, model interpretability, and integration into existing workflows.
ConclusionsAI, especially CNN-based DL models, is reshaping radiology by advancing diagnostic capabilities. While it often outperforms traditional methods, AI is best used to complement human expertise. Overcoming challenges in data quality, system integration, and training is essential for broader clinical adoption. Continued research will enhance AI’s reliability and utility, ultimately improving patient outcomes.
How COVID-19 pandemic impacted students’ and staff ’s physical activity at a Brazilian University?
Authors: Martins Rafaela Costa , Ricardo Luiza Isnardi Cardoso , Crochemore-Silva Inácio , Demarco Flávio Fernando , Munhoz Tiago Neuenfeld , Levandowski Mateus Luz , Cademartori Mariana Gonzalez , Schuch Helena Silveira , Hallal Pedro Curi
Published: January 2025

Introduction: Physical activity and its positive effects on coronavirus have been extensively discussed in the literature. However, there is still a lack of evidence on the effects of the coronavirus pandemic on the health-related behaviors of the Brazilian university community. Objective: To describe physical activity practice during the coronavirus pandemic among students and staff of a southern Brazilian university, as well as its association with sociodemographic characteristics. Methods: This self-administered web-based cross-sectional study was carried out among a southern Brazilian community. The main outcome of this study was leisure time physical activity before and during the coronavirus pandemic. Results: Considering only leisure time, 21% and 24% of the students and staff, respectively, reported achieving physical activity recommendations (≥150 minutes per week). There was a decline of more than 15 percentage points in physical activity practice comparing to pre and during the pandemic, and those following the protocols of staying at home presented lower levels of leisure-time physical activity. Physical activity practice was mainly performed at home and without any professional help. Conclusion: Leisure-time physical activity prevalence during the pandemic was relatively low (compared with Brazilian population) among students and staff, and participants who followed the staying at home protocols presented lower levels of physical activity.
Multicell Experiments for Marginal Treatment Effect Estimation of Digital Ads
Authors: Waisman Caio , Gordon Brett R.
Published: January 2025

Randomized experiments with treatment and control groups are an important tool to measure the impacts of interventions. However, in experimental settings with one-sided noncompliance extant empirical approaches may not produce the estimands a decision maker needs to solve the problem of interest. For example, these experimental designs are common in digital advertising settings but typical methods do not yield effects that inform the intensive margin: how many consumers should be reached or how much should be spent on a campaign. We propose a solution that combines a novel multicell experimental design with modern estimation techniques that enables decision makers to solve problems with an intensive margin. Our design is straightforward to implement and does not require additional budget. We illustrate our method through simulations calibrated using an advertising experiment at Facebook, demonstrating its superior performance in various scenarios and its advantage over direct optimization approaches.

This paper was accepted by Jean-Pierre Dubé, marketing.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.01185 .
The Application of Action Research in Kindergarten: Analysis of the Professional Development Model of Preschool Educators for the Reggo-Inspired Educational Practice
Authors: Camović Dženeta , Bećirović-Karabegović Jasmina
Published: January 2025

This paper presents the results of an action research conducted in a kindergarten in Sarajevo Canton. The participants were four female kindergarten educators who collaborated with two university professors who took the role of research leaders and moderators of reflective meetings. The action research was conceived as a model of professional development for preschool teachers in the Reggio pedagogy field, aiming to develop the skill of documenting pedagogical observation and the competence of implementing reflective practice (RP below the text) based on the Reggio principles. Data were collected on two levels: the educators documented their educational practice (photos, transcripts, videos, etc.), which was the basic material for analysis at collaborative reflective meetings, and all of it was documented by the research leaders. The data were analyzed simultaneously during the research (to decide on further action) and finally at the end of the research. The results of the research indicate that the action research raised awareness of the elements of traditional educational practice and developed the skills of pedagogical documentation management and the skill of implementing RP. Considering the limited time period for the realization of the research (14 months), significant but not optimal results were achieved, and there is still room for further progress in terms of improving the skills of keeping records and the capacity of RP implementation. It is necessary to systematically provide support for the professional development of educators through the development of reflective learning communities in kindergartens instead of the one-off and lecture-based forms that are offered.
Enabling real-time reconstruction for large field-of-view single-molecule localization microscopy using discrete field-dependent point-spread function
Authors: Lu Jun , Xu Lei , Liao Shuyao , Wang Wei , Dong Biqin
Published: January 2025

Single-molecule localization microscopy (SMLM) is a powerful super-resolution imaging technique that offers resolution far beyond the optical diffraction limit. The commonly used high numerical-aperture (NA) objective lenses in SMLM can only provide a nearly ideal point-spread function (PSF) at the center of the field-of-view (FOV), whereas the off-axis PSF is often distorted due to optical aberrations. Since precision and accuracy of three-dimensional (3D) spatial localization of single molecules heavily depend on the system’s PSF, the FOV of 3D SMLM is often restricted to about 50 µm × 50 µm limiting its applications in visualizing intra-/intercellular interactions and high-throughput single-molecule analysis. Here we present a systematic study to show the influence of optical aberrations on large FOV 3D SMLM using unmodified, astigmatic, and double-helix PSFs. Our results show that optical aberrations introduce significant localization errors during image reconstruction and thereby produce unreliable imaging results at the corner of the FOV. To maximize SMLM’s FOV, we proposed and verified the potential of using discrete field-dependent PSFs to retain precise and accurate single-molecule localization and compare their reconstruction results using simulated resolution test patterns and biological structures. Moreover, GPU acceleration empowers a discrete PSF calibration model with high localization speed, which can provide real-time SMLM image reconstruction. We envision these results will further guide the development of strategies that can provide real-time and reliable image reconstruction in large FOV 3D SMLM.
The effect of conflict on damage to medical facilities in Mariupol, Ukraine: A quasi-experimental study
Authors: Poole Danielle N. , Andersen Daniel , Raymond Nathaniel A. , Parham Jack , Howarth Caitlin , Hathaway Oona A. , Khoshnood Kaveh ,   Yale Humanitarian Research Lab
Published: January 2025

Medical facilities are civilian objects specially protected by international humanitarian law. Despite the need for systematic documentation of the effects of war on medical facilities for judiciary accountability, current methods for surveilling damage to protected civilian objects during ongoing armed conflict are insufficient. Satellite imagery damage assessment confers significant possibilities for investigating patterns of war. We leveraged commercially and publicly available satellite imagery and cross-referenced geolocated facility data to conduct a pre-post quasi-experimental study of damage to medical facilities in Mariupol, Ukraine as a result of Russia’s invasion. We found that 77% of medical facilities in Mariupol sustained damage during Russia’s siege lasting from February 24—May 20, 2022. Facility size was not associated with damage, suggesting that attacks on medical facilities are not random but instead may have been the result of intentional targeting. This is the first cross-referenced pre-post census study of the effects of an ongoing conflict on specially protected medical infrastructure.
Using internet-assisted geocoding of 1940 census addresses to reconstruct enumeration districts for use with redlining and longitudinal health datasets
Authors: Huang Shuo Jim , Boudreaux Michel , White Whilby Kellee , McCoy Rozalina G. , Sehgal Neil Jay
Published: January 2025

Many historical administrative documents, such as the 1940 census, have been digitized and thus could be merged with geographic data. Merged data could reveal social determinants of health, health and social policy milieu, life course events, and selection effects otherwise masked in longitudinal datasets. However, most exact boundaries of 1940 census enumeration districts have not yet been georeferenced. These exact boundaries could aid in analysis of redlining and other geographic and social contextual factors important for health outcomes today. Our objective is to locate and map a large set of 1940 enumeration districts. We use online resources and algorithmic solutions to locate and georeference unknown 1940 enumeration districts. We geocode addresses using the OpenCage API and construct “virtual” enumeration districts by using a convex hull algorithm on those geocoded addresses. We also merge in Home Owners’ Loan Corporation (HOLC) redlining maps from the 1930s to demonstrate how 1940 enumeration districts could be used in future work to examine the association between historic redlining and current health. We geocode 7,228,656 1940 census addresses from the largest 191 US cities in 1940 that contained 84% of the 1940 US urban population from the Geographic Reference File and construct 34,472 virtual enumeration districts in areas that had HOLC redlining maps. 18,340 virtual enumeration districts were previously unmapped, covering cities containing an additional 40% of the 1940 US urban population. Where virtual enumeration districts match with previously mapped districts, 96.8% of paired districts share HOLC redlining categorization. Researchers can use algorithmic methods to quickly process, geocode, merge, and analyze large scale repositories of historical documents that provide important data on social determinants of health. These 1940 enumeration district maps could be used with studies such as the Health and Retirement Study, Panel Study for Income Dynamics, and Wisconsin Longitudinal Study.
A descriptive study of fatal drownings among children and adolescents in the United States, with a focus on retention pond deaths, 2004–2020
Authors: Bista Saroj , Michaels Nichole L.
Published: January 2025

The objective of this study was to characterize fatal drownings among children and adolescents, with a focus on retention pond drownings, and identify risk factors for these fatalities using child death review data. We acquired 2004–2020 National Fatality Review-Case Reporting System data for drowning deaths among youth 0–19 years. Retention pond drownings were identified through case narratives. We analyzed demographics, primary caregiver, supervisor, death investigation, and drowning-related variables across age groups (<1, 1–4, 5–9, 10–14, and 15–19 years) using either the Chi-square test or Fisher’s Exact test, as appropriate, with a p-value of <0.05 indicating statistical significance. Of 7,539 drowning deaths reported during the study duration, 265 deaths occurred in retention ponds. Children 1–4 years comprised a greater proportion of retention pond drowning deaths (59.3%) compared to overall drowning deaths (50.9%) in this age group. In 51.3% of retention pond drowning deaths among children <5 years, supervision was needed but not provided. Most (80.4%) retention pond-related deaths among children <5 years and 50.7% of deaths among children 5–19 years were attributed to child neglect, poor or absent supervision, or exposure to hazards. Among all decedents who drowned in retention ponds, 19.1% were found to have a disability or chronic illness. Most retention ponds lacked local ordinances regulating water access (83.5%) and did not have barriers or protection (66.1%) or warning signs (82.0%). Younger children with poor or absent supervision who cannot swim are at high risk of drowning. Retention pond drownings are not infrequent, and most locations lack ordinances regulating water access or requiring barriers, such as fences. Greater efforts are needed to address this common hazard and environmental and policy strategies should be implemented to prevent future deaths.
Estimating the burden of underdiagnosis within England: A modelling study of linked primary care data
Authors: Anosova Olga , Head Anna , Collins Brendan , Alexiou Alexandros , Darras Kostas , Sutton Matt , Cookson Richard , Anselmi Laura , O’Flaherty Martin , Barr Ben , Kypridemos Chris
Published: January 2025

Introduction

Undiagnosed chronic disease has serious health consequences, and variation in rates of underdiagnosis between populations can contribute to health inequalities. We aimed to estimate the level of undiagnosed disease of 11 common conditions and its variation across sociodemographic characteristics and regions in England.

Methods

We used linked primary care, hospital and mortality data on approximately 1.3 million patients registered at a GP practice for more than one year from 01/04/2008–31/03/2020 from Clinical Practice Research Datalink. We created a dynamic state model with six states based on the diagnosis and mortality of 11 conditions: coronary heart disease (CHD), stroke, hypertension, chronic obstructive pulmonary disease, type 2 diabetes, dementia, breast cancer, prostate cancer, lung cancer, colorectal cancer, and depression/anxiety. Undiagnosed disease was conceptualised as those who died with a condition but were not previously diagnosed. This was combined with observed data on the incidence of diagnosis, the case fatality rate in the diagnosed, and an assumption about how that rate varies with diagnosis to estimate the number of undiagnosed disease cases over the total number of disease cases (underdiagnosis) in each population group. We estimated underdiagnosis by year, sex, 10-year age group, relative deprivation, and administrative region. We then applied small-area estimation techniques to derive underdiagnosis estimates for health planning areas (CCGs).

Results

Levels of underdiagnosis varied between 16% for stroke and 69% for prostate cancer in 2018. For all diseases, the level of underdiagnosis declined over time. Underdiagnosis was not consistently concentrated in areas with high deprivation. For depression/anxiety and stroke, underdiagnosis was estimated to be higher in less deprived CCGs, whilst for CHD and T2DM, it was estimated to be higher in more deprived CCGs, with no apparent relationships for other conditions. We found no uniform spatial patterns of underdiagnosis across all diseases, and the relationship between age, deprivation and the probability of being undiagnosed varied greatly between diseases.

Discussion

Our findings suggest that underdiagnosis is not consistently concentrated in areas with high deprivation, nor is there a uniform spatial underdiagnosis pattern across diseases. This novel method for estimating the burden of underdiagnosis within England depends on the quality of routinely collected data, but it suggests that more research is needed to understand the key drivers of underdiagnosis.
Shell colour luminance of Cuban painted snails, Polymita picta and Polymita muscarum (Gastropoda: Cepolidae)
Authors: Gordillo-Pérez Mario Juan , Beenaerts Natalie , Sánchez Dunia L. , Smeets Karen , Arias-Sosa Yaumel Calixto , Reyes-Tur Bernardo
Published: January 2025

Climate change is a global environmental threat, directly affecting biodiversity. Terrestrial gastropods are particularly susceptible to alterations in temperature and humidity and have develop morph-physiological and behavioural adaptations in this regard. Shell colour polymorphism and its potential implication for thermoresistance constitute an unexplored field in Neotropical land snails. The variation in shell colour luminance is characterized in the threatened endemic Eastern Cuban tree snails Polymita picta and Polymita muscarum using digital tools; being able to discriminate shell luminance between colour morphs for both species, under different image-taking conditions. For P. muscarum, the albino morph presented the highest luminance values (152.7 ± 0.4); while the lowest values correspond to the brown morph with dark bands (112.9 ± 0.8). Otherwise, for P. picta, the morphs showing the highest luminance were yellow with a pink sutural band (112.8 ± 7.1) and pale yellow (112.6 ± 10.3) and the lowest luminance corresponded to the black morph (44.5 ± 1.2). The presence of dark bands decreased the luminance values regardless of their position in the shell, the morph and the species analysed. In general, the shells of P. muscarum have higher luminance than those of P. picta. Luminance variations demonstrate the ’indiscrete’ nature of this trait and highlight the complex interactions between evolutionary mechanisms and shell color polymorphism in Polymita. This supports the hypothesis that colour has adaptive value for thermoregulation, encompassing not only the background colour but also the coloration of the bands. The differences in the shell luminance in both species suggest a correlation with the geographical distribution and corresponding habitats. Based on our findings, yellowish morphs will be more resistant to future climatic conditions in their respective habitats on the island.
Are adverse childhood experiences scores associated with heroism or villainy? A quantitative observational study of Marvel and DC Cinematic Universe characters
Authors: Wigmore Julia , Ahmed Bilal , Joaquino Gabriel , Jaibeeh Barah Elke , Upal Zahra , Boring Teressa , Lee Marika , Muel Eron , Perry Samantha , Davidson Sandra , Ginn Carla , Ferreira Carla , Ens Twyla , Jackson Jennifer
Published: January 2025

Many superhero and villain stories include trauma, which could influence how the public perceives the impact of trauma in their own lives. Our aim was to assess whether total Adverse Childhood Experiences (ACEs) scores were associated with heroism or villainy among Marvel and DC Characters. We watched 33 films, with a total runtime of 77 hours and 5 minutes. We scored 28 characters (19 men, 8 women, and 1 gender fluid). ACEs scores were evenly distributed across heroes/villains (U = 88, z = -.465, p = .642), Marvel/DC universes (U = 95.5, z = -0116, p = .907), and gender (U = 61, z = -.979, p = .328). There was no statistically significant correlation between ACEs scores and status (r(26) = .090, p = .65), universe (r(26) = .022, p = .91), or gender (r(26) = -.188, p = .34). We found that there was no association between ACEs scores and heroism or villainy. Thus, no one is doomed to be a villain just because of early childhood experiences.
Comparison of greenhouse gas emissions associated with the construction of timber, concrete, and steel check dams in Akita, Japan: An input-output analysis
Authors: Huzita Tomohumi , Noda Ryu
Published: January 2025

To mitigate global warming, replacing concrete and steel with timber as the primary construction material for construction projects, such as check dams, is being promoted in Japan and other countries. Timber check dams have more limited installation sites than concrete or steel dams because of installation conditions such as locations less susceptible to debris flows and locations where there is constant running water. However, even when the installation conditions are met, engineers and contractors are reluctant to select timber as a construction material because of its high construction cost. In this study, an input-output table was used to compare the greenhouse gas (GHG) emissions associated with the construction of a timber check dam at the design stage with those associated with the construction of concrete and steel check dams to quantitatively evaluate the added value of timber utilization (in addition to its construction cost). The results revealed that replacing concrete and steel check dams with timber check dams could reduce GHG emissions by 61% and 34%, respectively. This study demonstrated the possibility of evaluating the GHG emissions associated with a construction project at the design stage. Moreover, it highlights the importance of considering the GHG emissions associated with construction materials when selecting the most appropriate materials for public works projects.
Engineering dimer mutants of human geranylgeranyl pyrophosphate synthase
Authors: Ezekiel Sean J. , Searle Mackenzie , Park Jaeok
Published: January 2025

Geranylgeranyl pyrophosphate synthase (GGPPS), a key enzyme in protein prenylation, plays a critical role in cellular signal transduction and is a promising target for cancer therapy. However, the enzyme’s native hexameric quaternary structure presents challenges for crystallographic studies. The primary objective of this study was to engineer dimeric forms of human GGPPS to facilitate high-resolution crystallographic analysis of its ligand binding interactions. Through site-directed mutagenesis, we disrupted the inter-dimer interactions required for hexamer assembly, generating three stable double-site mutants: Y246D/C247L, Y246D/C205A, and Y246K/C247L. Enzyme assays confirmed that all mutants retained wild-type catalytic activity under both saturating and subsaturating substrate conditions. Differential scanning fluorimetry showed that the mutant proteins had a ~10°C lower melting temperature than the wild-type enzyme but exhibited similar shifts in melting temperature in the presence of the known inhibitors risedronate and zoledronate. Crystallographic analysis of the Y246D/C247L mutant yielded a 2.1 Å resolution structure, providing detailed insights into the binding of isopentenyl pyrophosphate. Closer inspection also revealed the unexpected formation of intermolecular disulfide bonds connecting neighboring dimers, which may explain the enhanced crystallizability of the Y246D/C247L mutant compared to the wild-type and other mutants. These findings highlight the potential of the dimeric mutants as substitutes for wild-type GGPPS in future studies. Optimized dimeric mutants could serve as valuable molecular tools to further our understanding of the enzyme’s structural and functional properties and aid in the rational design of novel therapeutic agents targeting GGPPS.