bluuebunny/crossref_metadata_2025 huggingface dataset:
Ontological Security: A Critical Analysis of Israel's Normalization With the Gulf Cooperation Council in Exit 7
Authors: Ghabra Haneen , Al Nashmi Eisa
Published: June 2023

This study employs a postcolonial critique of Middle East Broadcasting Center's Saudi television show, Exit 7, around the issue of normalization. The authors argue that episode 3 of Exit 7 showcases a new shift in Middle Eastern relations with Israel. The show demonstrates a deep-rooted change in ontological security of the Arab region and the globe at large, disrupting the routines of Arab individuals and calling into question their national identity, which for the most part, was anti-Israel. The authors explore ontological security at both a state level and a structural level in terms of the audience's relation to popular culture and the media. Through state-controlled media, they argue that Saudi Arabia can incrementally introduce new narratives that challenge long-standing animosities toward Israel and cultivate a sense of ontological security, which may, over time, further mask the apartheid occurring in Israel.
Are Both Object and Alphanumeric Rapid Automatized Naming Measures Required to Predict Word Reading Fluency in German Prereaders?
Authors: Schoefl Martin , Seifert Susanne , Steinmair Gabriele , Weber Christoph
Published: June 2023

Rapid automatized naming (RAN) powerfully predicts word-level reading fluency in the first 2 years of school as well as further reading development. Here, we analyze various RAN stimuli (objects and digits) and oral/silent word reading (OWR/SWR) modalities to find feasible measures for predicting early reading development. The RAN performances of 127 children starting first grade were assessed. The children’s oral and silent word reading skills were then reassessed in the second grade. Linear regression models and relative weight analysis were used to compare reading and screening modalities and further precursors of reading such as phonological awareness and nonverbal IQ were controlled. Scores from the first grade RAN assessment did not differentially predict second grade OWR versus SWR levels. RAN digits predicted word reading development more strongly than RAN objects, which contributed uniquely when predictions used only RAN variables. However, when different precursors of reading were controlled, only RAN digits helped to predict early reading performance.
Sepsis and Adrenal Insufficiency
Authors: Fowler Cosmo , Raoof Nina , Pastores Stephen M.
Published: June 2023

In sepsis, dysregulation of the hypothalamic–pituitary–adrenal axis, alterations in cortisol metabolism, and tissue resistance to glucocorticoids can all result in relative adrenal insufficiency or critical illness-related corticosteroid insufficiency (CIRCI). The symptoms and signs of CIRCI during sepsis are nonspecific, generally including decreased mental status, unexplained fever, or hypotension refractory to fluids, and the requirement of vasopressor therapy to maintain adequate blood pressure. While we have been aware of this syndrome for over a decade, it remains a poorly understood condition, challenging to diagnose, and associated with significantly diverging practices among clinicians, particularly regarding the optimal dosing and duration of corticosteroid therapy. The existing literature on corticosteroid use in patients with sepsis and septic shock is vast with dozens of randomized controlled trials conducted across the past 4 decades. These studies have universally demonstrated reduced duration of shock, though the effects of corticosteroids on mortality have been inconsistent, and their use has been associated with adverse effects including hyperglycemia, neuromuscular weakness, and an increased risk of infection. In this article, we aim to provide a thorough, evidence-based, and practical review of the current recommendations for the diagnosis and management of patients with sepsis who develop CIRCI, explore the controversies surrounding this topic, and highlight what lies on the horizon as new evidence continues to shape our practice.
Reverse Pedicle U-Shaped Palatal Flap: An Innovative Technique for Repair of Severe Caudal Palatal Defects in Two Dogs
Authors: Bartocetti Francesca , Radice Mirko , Simoi Alessandro De
Published: June 2023

An acquired palatal defect in dogs is a pathologic condition in which there is communication between the oral cavity and nasal cavities, maxillary recesses, or orbits. Many different causes exist and must be considered. Two dogs were presented for severe palatal defects secondary to a foreign body trapped between maxillary dental arches. Numerous techniques have been previously described to repair palatal defects, and the most appropriate choice is based on the clinical features of the defect and information obtained from advanced diagnostic imaging. Acquired palatal defects are not predictable in shape, size, and location; therefore, although the literature contains many different surgical techniques, these are not always reliable. The aim of this article is to describe an innovative surgical approach to repair severe acquired caudal palatal defects in two different dogs.
Treatment of Worn Tusks Using Metal Crowns in Two Young Captive Walruses (Odobenus Rosmarus)
Authors: Legendre Loïc
Published: June 2023

Two young walruses, recently transferred to the Vancouver Aquarium, presented with severe abrasion to their tusks. The walruses were sedated, and clinical examination and radiographs of the tusks showed that the pulp chambers were not exposed. The tips of the tusks were then prepared to receive metal crowns. Vinyl polysiloxane impressions were obtained and sent to the laboratory for chrome-nickel crown fabrication. A week later, the crowns were cemented onto the tusks and remained in place on follow-up examinations.
Numerical investigation on conjugate heat transfer characteristics of film and vortex composite cooling under rotating conditions
Authors: Wang Jiefeng , Li Jianwu , Zhao Yujuan , Li Jianming , Li Rong , Li Liang
Published: June 2023

This paper numerically investigates the vortex and film composite cooling performance under rotating conditions. The cooling performance of the adiabatic and conjugate models is compared under the range of 0–4000 r/min. The conjugate model contains the fluid region: the cascade, the film holes, and the internal vortex cooling chamber, as well as the solid region: the blade material between the internal flow and the mainstream flow. The adiabatic model is established by removing the blade material part in the conjugate model. The dimensionless temperature θ inversely proportional to the temperature is adopted. Results show that the blade leading edge temperature doesn’t vary linearly with the rotating speed. The stagnation line of the mainstream flow on the blade leading edge moves from the pressure surface to the suction surface. The maximum θ appears at 1500 r/min when the stagnation line stays certainly on the row of film holes located on the pressure surface and is 7.86% higher than the minimum θ. The minimum θ appears at 2500 r/min when the stagnation line stays on the position between the rows of film holes. The distribution of θ is much uniform, and the value of θ is much higher in the conjugate cases than the adiabatic cases due to the heat conduction through the blade material. The highest aerodynamic parameter appears at 2000 r/min due to its relatively low blade leading edge temperature and low coolant consumption and is 41% higher than the aerodynamic parameter at 0 r/min.
Thermal energy analysis of multi-walled carbon nanotubes-Fe3O4/H2O flow over non-uniformed surface with Darcy–Forchheimer model
Authors: Lotfi Chibani , Redouane Fares , Zineb Chikr Djaoutsi , Jamshed Wasim , Eid Mohamed R. , Ibrahim Rabha W. , Mohamed Isa Siti Suzilliana Putri , Alqahtani Haifa , Hussain Syed M.
Published: June 2023

In this study, a new cavity shape was filled with an extension multi-walled carbon nanotubes-Fe2O3/H2O nanofluid under a constant magnetic field. The Darcy–Forchheimer model is used to account for the inertial impact of advection in the porous layer while maintaining the laminar and incompressible nature of the nanofluid flow. The dimensionless version of the governing equations is used to describe the issue and the finite element approach is used to resolve it. Through this complex geometry, various thermophysical factors such as Rayleigh number [Formula: see text], Hartmann number [Formula: see text], and nanoparticle concentration are considered [Formula: see text]. The porous layer's numerous characteristics are also explored. For example, its porosity [Formula: see text] and Darcy number [Formula: see text], which indicates the permeability of the porous medium. The content of the hybrid nanofluid is considered to be Newtonian, stable, incompressible, and following a constant Prandtl number for the base fluid [Formula: see text]. Calculations are made according to the finite element method. The results of this work are presented in terms of rheology, isotherms, entropy generation, and mean Nusselt numbers. They have demonstrated that increasing the Rayleigh and Darcy numbers improve heat transfer in the enclosure.
Self-assessment of Public Healthcare Facility in Conformity with Accreditation Guidelines for Quality Services
Authors: Gupta S. D. , Sharma Sandesh Kumar , Kumar Santosh , Sharma Neeraj , Jain Ashok
Published: June 2023

There is a growing global concern for healthcare quality and patient safety and several countries have initiated accreditation and self assessment programmes for improved quality healthcare and patient safety. Both are based on the quality improvement framework and standards. Case studies have shown that: I) Accreditation certification of hospitals and healthcare facilities has been improved the quality of healthcare and related healthcare services. ii) Self-assessment by healthcare organisations has proved to be very useful tool for continuous and sustainable improvement in organization performance, quality of services, patient satisfaction over and above building the self-confidence of the care providers. In context of facility assessed it was carried out using a checklist specifically designed for this study with 318 items. The scoring pattern comprised total points and percent compliance for functional capacity of the hospital in comparison to prescribed norms. Assessment revealed maximum compliance in the categories of MIS and communication (100%). The facility lacked standard operating procedures, quality assurance system and fire safety system. Self-assessment as continuous feature will lay the basis for planning new interventions for impacting over all quality healthcare outcomes as well sustainability.
What drives the intra-party democracy of the “Alternative for Germany”: Populist ideology, low institutionalisation or lack of party unity?
Authors: Heinze Anna-Sophie , Höhne Benjamin , Wortmann Callejón Felix
Published: June 2023

The organisation of populist radical right parties significantly shapes their long-term electoral success. Within this party family, great organisational variation can be found, with the “Alternative for Germany” (AfD) representing a least-likely case: in terms of candidate selection (CS), it ranks much higher on democracy scales than the other Bundestag parties. This paper explores the reasons for this high level of intra-party democracy (IPD) by focusing on three explanatory dimensions: ideology, institutionalisation, and party unity. Methodologically, we apply multivariate analyses of representative quantitative data collected among AfD members in CS prior to the 2017 federal election. The results show that high political dissatisfaction and low levels of institutionalisation are important drivers of inclusive CS procedures. Overall, the article provides a deeper understanding of the underlying attitudes for the AfD’s inclusive IPD, and offers substantial theoretical and empirical implications for future research.
The effect of primaries on voter evaluations of candidate quality: Experimental evidence
Authors: Schwenk Jana
Published: June 2023

In this article, I argue that voters not only rely on characteristics of candidates, such as age and gender, but also on procedural cues to evaluate candidates, particularly on how candidates were selected. I argue that selection via primaries, which has become popular in Western Europe, is an important cue to voters. Drawing on procedural fairness theory, I develop contradicting arguments about how primaries affect voters’ evaluations of candidate quality, such that either the logic of procedural fairness improves voters’ evaluations of candidates’ quality, or the violation thereof through clientelism and vote-buying leads to worse evaluations of candidates. I employ a conjoint experiment, implemented in Spain, and analyze responses to an open-ended question to investigate underlying mechanisms. The findings indicate that voters perceive candidates resulting out of primaries as outsiders, who are less corrupt but also less experienced and less competent.
Vibrational loss analysis of a new type of phononic crystal with a tungsten block embedded inside a rubber matrix
Authors: Tang Rongjiang , Lu Taoqi , Pan Chaoyuan , Zheng Weiguang
Published: June 2023

Vibration and noise pollution is one of the main pollution in modern society. In order to obtain good vibration damping effect, more effective phononic crystals should be designed. Based on the theory of elastic wave propagation in solids, three types of phononic crystals are designed in this paper using tungsten blocks embedded in a rubber matrix, which are cup-shaped phononic crystal, solid cylindrical phononic crystal, and hollow cylindrical phononic crystal. Firstly, the band gap characteristics and vibration losses of the three phononic crystals are analyzed by using the finite element method. Secondly, the physical mechanism of band gap formation is explored by vibration modes. Finally, the cup-shaped phononic crystal was introduced into the core layer of the sandwich plate to form the cup-shaped phononic crystal sandwich plate, and its vibration damping performance was analyzed. The results show that the three phononic crystals can form three band gaps in the range of 0–800 Hz, and the first low-frequency band gap starts at about 140 Hz and is all wider than 200 Hz. It is noteworthy that the average loss of vibration transmission of the three types of phononic crystals is more than 69 dB, which possesses stronger damping capability and wider low- and middle-frequency band gaps than the flat plate type phononic crystals. The vibration direction of the phononic crystal is at an angle of 90° to the wave vector, which prevents the propagation of elastic waves. The phononic crystal embedded in the sandwich panel plate is more in line with the actual demand of vibration damping and obtains good vibration damping effect. The research in this paper can provide more feasibility for phononic crystal damping.
Futility monitoring for randomized clinical trials with non-proportional hazards: An optimal conditional power approach
Authors: Wang Xiaofei , George Stephen L
Published: June 2023

Background

Standard futility analyses designed for a proportional hazards setting may have serious drawbacks when non-proportional hazards are present. One important type of non-proportional hazards occurs when the treatment effect is delayed. That is, there is little or no early treatment effect but a substantial later effect.

Methods

We define optimality criteria for futility analyses in this setting and propose simple search procedures for deriving such rules in practice.

Results

We demonstrate the advantages of the optimal rules over commonly used rules in reducing the average number of events, the average sample size, or the average study duration under the null hypothesis with minimal power loss under the alternative hypothesis.

Conclusion

Optimal futility rules can be derived for a non-proportional hazards setting that control the loss of power under the alternative hypothesis while maximizing the gain in early stopping under the null hypothesis.
Relationship Between Airborne Fungi Presence and the Position of the High Efficiency Particulate Air Filter in the Heating, Ventilation, and Air Conditioning System
Authors: Sabuco-Tébar Emiliana A. , Arense-Gonzalo Julián J. , Campayo-Rojas F. Javier
Published: June 2023

Aim:

Establish the influence of the terminal or nonterminal position of High Efficiency Particulate Air (HEPA) filters in the Heating, Ventilation, and Air Conditioning (HVAC) system on the presence of airborne fungi in controlled environment rooms.

Background:

Fungal infections are an important cause of morbidity and mortality in hospitalized patients.

Methods:

This study was realized from 2010 to 2017, in rooms with terminal and nonterminal HEPA filters, in eight Spanish hospitals. In rooms with terminal HEPA filters, 2,053 and 2,049 samples were recollected, and in rooms with nonterminal HEPA filters, 430 and 428 samples were recollected in the air discharge outlet (Point 1) and in the center of the room (Point 2), respectively. Temperature, relative humidity, air changes per hour, and differential pressure were recollected.

Results:

Multivariable analysis showed higher odds ratio ( OR) of airborne fungi presence when HEPA filters were in nonterminal position ( OR: 6.78; 95% CI [3.77, 12.20]) in Point 1 and ( OR: 4.43; 95% CI [2.65, 7.40]) in Point 2. Other parameters influenced airborne fungi presence, such as temperature ( OR: 1.23; 95% CI [1.06, 1.41]) in Point 2 differential pressure ( OR: 0.86; 95% CI [0.84, 0.90]) and ( OR: 0.88; 95% CI [0.86, 0.91]) in Points 1 and 2, respectively.

Conclusions:

HEPA filter in terminal position of the HVAC system reduces the presence of airborne fungi. To decrease the presence of airborne fungi, adequate maintenance of the environmental and design parameters is necessary in addition to the terminal position of the HEPA filter.
Interview with Christophe Hodder, the United Nations Climate Security and Environmental Advisor to Somalia, United Nations Environment Programme
Authors: Busby Joshua W
Published: June 2023

This is an interview with Christophe Hodder, the United Nations Climate Security and Environmental Advisor to Somalia, United Nations Environment Programme. In the interview, Hodder explains why it is so important for conventional security practitioners to build environmental considerations into peacebuilding. He explains how natural resource conflicts between groups are key sites of contestation in Somalia, more salient as the country experiences climate change. He talks about how militant groups use resource and resource conflicts to their advantage. Resolving natural resource conflicts is also important entry points for action, for addressing sources of conflict and building a foundation for peace. In the current moment, even as Somalia is beset by a difficult drought, it is important to work on long-run peacebuilding efforts through environmental restoration. Hodder provides examples of river bank protection programs and water catchment as areas ripe for cooperation.
Acute Kidney Injury Incidence With Bayesian Dosing Software Versus 2-Level First-Order Area Under the Curve–Based Dosing of Vancomycin With Piperacillin-Tazobactam
Authors: Bellamy Ashton , Covington Elizabeth W.
Published: June 2023

Background: Two methods of area under the curve (AUC) dosing are recommended in vancomycin consensus guidelines: first-order calculations utilizing 2 vancomycin concentrations or a Bayesian approach. It is unknown if there is a difference in acute kidney injury (AKI) between the 2 dosing strategies for patients receiving concomitant piperacillin-tazobactam and vancomycin (VPT). Objective: The objective of this study was to compare incidence of AKI in patients being administered VPT with first-order calculations versus model-informed precision dosing (MIPD)/Bayesian dosing. Methods: This was a single-center, retrospective, observational study at a community hospital. Patients who received VPT therapy for at least 48 hours were included. The primary outcome was overall incidence of AKI. Secondary outcomes included percentage target attainment with initial regimen, average serum creatinine increase, time to AKI, usable vancomycin levels, and need for temporary dialysis or intensive care unit admission. Results: There were 100 patients included (50 in the first-order group and 50 in the MIPD/Bayesian group). The overall incidence of AKI was lower in the MIPD/Bayesian group (12% vs 28%, P = 0.046). There was no difference in average serum creatinine increase, time to AKI, need for temporary dialysis, or intensive care unit admission. Patients in the MIPD/Bayesian group had a higher percentage of target attainment (46% vs 18%, P = 0.003) and usable vancomycin levels (98% vs 60%, P < 0.001). Conclusion and Relevance: In patients receiving VPT, model-informed precision dosing with Bayesian modeling resulted in a lower rate of AKI, higher target attainment, and more usable vancomycin levels compared with first-order AUC dosing. The small sample and retrospective nature of this study reinforces the need for additional data.
Glass Recognition and Map Optimization Method for Mobile Robot Based on Boundary Guidance
Authors: Tao Yong , Gao He , Wen Yufang , Duan Lian , Lan Jiangbo
Published: June 2023

Current research on autonomous mobile robots focuses primarily on perceptual accuracy and autonomous performance. In commercial and domestic constructions, concrete, wood, and glass are typically used. Laser and visual mapping or planning algorithms are highly accurate in mapping wood panels and concrete walls. However, indoor and outdoor glass curtain walls may fail to perceive these transparent materials. In this study, a novel indoor glass recognition and map optimization method based on boundary guidance is proposed. First, the status of glass recognition techniques is analyzed comprehensively. Next, a glass image segmentation network based on boundary data guidance and the optimization of a planning map based on depth repair are proposed. Finally, map optimization and path-planning tests are conducted and compared using different algorithms. The results confirm the favorable adaptability of the proposed method to indoor transparent plates and glass curtain walls. Using the proposed method, the recognition accuracy of a public test set increases to 94.1%. After adding the planning map, incorrect coverage redundancies for two test scenes reduce by 59.84% and 55.7%. Herein, a glass recognition and map optimization method is proposed that offers sufficient capacity in perceiving indoor glass materials and recognizing indoor no-entry regions.
Complex implementation mechanisms in primary care: do physicians’ beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study
Authors: Söling Sara , Demirer Ibrahim , Köberlein-Neu Juliane , Hower Kira Isabel , Müller Beate Sigrid , Pfaff Holger , Karbach Ute ,   AdAM Study Group
Published: June 2023

Background

The adoption of digital health technologies can improve the quality of care for polypharmacy patients, if the underlying complex implementation mechanisms are better understood. Context effects play a critical role in relation to implementation mechanisms. In primary care research, evidence on the effects of context in the adoption of digital innovation for polypharmacy management is lacking.

Study aim

This study aims to identify contextual factors relevant to physician behavior and how they might mediate the adoption process.

Methods

The physicians who participated in this formative evaluation study (n = 218) were part of the intervention group in a cluster-randomized controlled trial (AdAM). The intervention group implemented a digital innovation for clinical decision making in polypharmacy. A three-step methodological approach was used: (1) a realist inquiry approach, which involves the description of a context-mechanism-outcome configuration for the primary care setting; (2) a belief elicitation approach, which involves qualitative content analysis and the development of a quantitative latent contextualized scale; and (3) a mediation analysis using structural equation modeling (SEM) based on quantitative survey data from physicians to assess the mediating role of the contextualized scale (n = 179).

Results

The key dimensions of a (1) context-mechanism-outcome model were mapped and refined. A (2) latent construct of the physicians’ innovation beliefs related to the effectiveness of polypharmacy management practices was identified. Innovation beliefs play a (3) mediating role between the organizational readiness to implement change (p < 0.01) and the desired behavioral intent of physicians to adopt digital innovation (p < 0.01;R2 = 0.645). Our contextualized model estimated significant mediation, with a relative size of 38% for the mediation effect. Overall, the model demonstrated good fit indices (CFI = 0.985, RMSEA = 0.034).

Conclusion

Physician adoption is directly affected by the readiness of primary care organizations for the implementation of change. In addition, the mediation analysis revealed that this relationship is indirectly influenced by primary care physicians’ beliefs regarding the effectiveness of digital innovation. Both individual physician beliefs and practice organizational capacity could be equally prioritized in developing implementation strategies. The methodological approach used is suitable for the evaluation of complex implementation mechanisms. It has been proven to be an advantageous approach for formative evaluation.

Trial registration

NCT03430336. First registration: 12/02/2018. ClinicalTrials.gov.
Safety, tolerability, pharmacokinetics, and immunogenicity of JMB2002–an antibody against COVID-19: a phase 1 clinical trial in healthy Chinese adults
Authors: Chen Guiling , Zhang Ying , Wu Kaiqi , Jin Tinghan , Peng Conggao , Jiang Qi , Tian Wenjuan , Chen Zhong , Shen Zhenwei , Sheng Guoping
Published: June 2023

Background

The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and subsequent Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant global public health burden, leading to an urgent need for effective therapeutic strategies. Monoclonal antibodies (mAbs) are a potentially effective therapeutic option. We identified a potent antibody JMB2002 against the SARS-CoV-2 receptor binding domain. JMB2002 has demonstrated therapeutic efficacy in a SARS-CoV-2 infected rhesus macaque model.

Methods

We conducted a randomized, double-blind, phase 1 trial to evaluate the JMB2002’s safety, tolerability, pharmacokinetics, and immunogenicity in healthy Chinese adults. Participants were randomly assigned to one of four cohorts with sequential dose, administrated intravenously with JMB2002 or placebo, and followed up for 85 ± 5 days.

Results

40 participants were recruited and completed in the study. Eight (25.0%) participants experienced 13 treatment emergent adverse events (TEAEs) that were drug-related. No serious adverse events (SAEs), dose limiting events (DLTs), or adverse events of special interest (AESIs), such as infusion related/allergic reactions, were observed, and no drop out due to adverse events (AEs) occurred. There was no significant safety difference observed between JMB2002 and the placebo, suggesting it was well tolerated. The AUC0−∞, AUC0 − t of JMB2002 infusion increased dose-dependently from 5 mg/kg to 50 mg/kg while there is also a linear trend between doses and Cmax.

Conclusion

Therefore, JMB2002 was well tolerated after administration of a single dose in the range of 5 mg/kg to 50 mg/kg in healthy Chinese adults.

Trial registration

ChiCTR2100042150 at https://www.chictr.org.cn/searchproj.aspx (14/01/2021).
Cryptococcal meningoencephalitis with Actinomyces odontolyticus sepsis: a case report and literature review
Authors: Huang Qingyu , Hong Zhuquan , Hong Quanlong
Published: June 2023

Background

The combined infection of actinomyces odontolyticus sepsis and cryptococcal encephalitis is rare in routine clinical practice. Thus, we presented this case report and literature review to provide clues to improve such patients' diagnoses and treatment processes.

Case presentation

The main clinical manifestations of the patient were high fever and intracranial hypertension. Then, we completed the routine cerebrospinal fluid examination, biochemical detection, cytological examination, bacterial culture, and India ink staining. Firstly, the blood culture suggested actinomyces odontolyticus infection, considering the possibility of actinomyces odontolyticus sepsis and intracranial actinomyces odontolyticus infection. Accordingly, the patient was administered penicillin for treatment. Although the fever was slightly relieved, the symptoms of intracranial hypertension did not relieve. After 7 days, the characteristics of brain magnetic resonance imaging and the results of pathogenic metagenomics sequencing and cryptococcal capsular polysaccharide antigen suggested that cryptococcal infection. Based on the above results, the patient was diagnosed with a combined infection of cryptococcal meningoencephalitis and actinomyces odontolyticus sepsis. Anti-infection therapy with ‘penicillin, amphotericin, and fluconazole’ was provided, improving the clinical manifestations and objective indexes.

Conclusion

The combined infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis is first reported in this case report, and combined antibiotics with ‘penicillin, amphotericin, and fluconazole’ are effective.
Monkeypox detection using deep neural networks
Authors: Sorayaie Azar Amir , Naemi Amin , Babaei Rikan Samin , Bagherzadeh Mohasefi Jamshid , Pirnejad Habibollah , Wiil Uffe Kock
Published: June 2023

Background

In May 2022, the World Health Organization (WHO) European Region announced an atypical Monkeypox epidemic in response to reports of numerous cases in some member countries unrelated to those where the illness is endemic. This issue has raised concerns about the widespread nature of this disease around the world. The experience with Coronavirus Disease 2019 (COVID-19) has increased awareness about pandemics among researchers and health authorities.

Methods

Deep Neural Networks (DNNs) have shown promising performance in detecting COVID-19 and predicting its outcomes. As a result, researchers have begun applying similar methods to detect Monkeypox disease. In this study, we utilize a dataset comprising skin images of three diseases: Monkeypox, Chickenpox, Measles, and Normal cases. We develop seven DNN models to identify Monkeypox from these images. Two scenarios of including two classes and four classes are implemented.

Results

The results show that our proposed DenseNet201-based architecture has the best performance, with Accuracy = 97.63%, F1-Score = 90.51%, and Area Under Curve (AUC) = 94.27% in two-class scenario; and Accuracy = 95.18%, F1-Score = 89.61%, AUC = 92.06% for four-class scenario. Comparing our study with previous studies with similar scenarios, shows that our proposed model demonstrates superior performance, particularly in terms of the F1-Score metric. For the sake of transparency and explainability, Local Interpretable Model-Agnostic Explanations (LIME) and Gradient-weighted Class Activation Mapping (Grad-Cam) were developed to interpret the results. These techniques aim to provide insights into the decision-making process, thereby increasing the trust of clinicians.

Conclusion

The DenseNet201 model outperforms the other models in terms of the confusion metrics, regardless of the scenario. One significant accomplishment of this study is the utilization of LIME and Grad-Cam to identify the affected areas and assess their significance in diagnosing diseases based on skin images. By incorporating these techniques, we enhance our understanding of the infected regions and their relevance in distinguishing Monkeypox from other similar diseases. Our proposed model can serve as a valuable auxiliary tool for diagnosing Monkeypox and distinguishing it from other related conditions.
Determinants of urgent start dialysis in a chronic kidney disease cohort followed by nephrologists
Authors: Tachikart Amin , Vachey Clément , Vauchy Charline , Savet Caroline , Ducloux Didier , Courivaud Cécile
Published: June 2023

Background

The French Renal Epidemiology and Information Network (REIN) registry collect dialysis initiation context for each patient starting dialysis with a flawed definition of urgent start dialysis (USD). The main objective of this study was to identify factors associated with USD in patients regularly followed-up by a nephrologist using a classification of USD considering the preparation to renal replacement therapy.

Methods

This retrospective cohort study included adult patients who started dialysis between 2012 and 2018 in the Franche-Comté region of France after a minimum of two nephrology consultations. We classified dialysis initiation context as follows: USD for patients with no dialysis access (DA) created or planned, unplanned non urgent start dialysis (UNUSD) for patients starting with a recent or non-functional DA and planned start dialysis (PSD) for those starting with a functional and mature DA.

Results

Four hundred and sixty-five patients met inclusion criteria. According to REIN registry, 94 (20.3%) patients were urgent starters (US) whereas with our classification 80 (17.2%) and 73 (15.7%) where respectively US and unplanned non urgent starters (UNUS). The factors independently associated with USD in our classification were: stroke (odds ratio(OR) = 2.76, 95% confidence interval (95%CI)=[1.41–5.43]), cardiac failure (OR = 1.78, 95%CI=[1.07–2.96]) and the number of nephrology consultations prior dialysis onset (OR = 0.73, 95%CI=[0.64–0.83]). Thirty-one patients died during the first year after dialysis start. According to our classification, we observed significantly different survival probabilities: 95.7%, 89.5% and 83.4% respectively for planned starters, UNUS and US (p = 0.001).

Conclusion

The two factors independently associated with USD were cardiac failure and stroke.
A feasibility study for objective evaluation of visual acuity based on pattern-reversal visual evoked potentials and other related visual parameters with machine learning algorithm
Authors: Chen Jian Zheng , Li Cong Cong , Li Shao Heng , Su Yu Ting , Zhang Tao , Wang Yu Sheng , Dou Guo Rui , Chen Tao , Wang Xiao Cheng , Zhang Zuo Ming
Published: June 2023

Background

To develop machine learning models for objectively evaluating visual acuity (VA) based on pattern-reversal visual evoked potentials (PRVEPs) and other related visual parameters.

Methods

Twenty-four volunteers were recruited and forty-eight eyes were divided into four groups of 1.0, 0.8, 0.6, and 0.4 (decimal vision). The relationship between VA, peak time, or amplitude of P100 recorded at 5.7°, 2.6°, 1°, 34′, 15′, and 7′ check sizes were analyzed using repeated-measures analysis of variance. Correlations between VA and P100, contrast sensitivity (CS), refractive error, wavefront aberrations, and visual field were analyzed by rank correlation. Based on meaningful P100 peak time, P100 amplitude, and other related visual parameters, four machine learning algorithms and an ensemble classification algorithm were used to construct objective assessment models for VA. Receiver operating characteristic (ROC) curves were used to compare the efficacy of different models by repeated sampling comparisons and ten-fold cross-validation.

Results

The main effects of P100 peak time and amplitude between different VA and check sizes were statistically significant (all P < 0.05). Except amplitude at 2.6° and 5.7°, VA was negatively correlated with peak time and positively correlated with amplitude. The peak time initially shortened with increasing check size and gradually lengthened after the minimum value was reached at 1°. At the 1° check size, there were statistically significant differences when comparing the peak times between the vision groups with each other (all P < 0.05), and the amplitudes of the vision reduction groups were significantly lower than that of the 1.0 vision group (all P < 0.01). The correlations between peak time, amplitude, and visual acuity were all highest at 1° (rs = − 0.740, 0.438). VA positively correlated with CS and spherical equivalent (all P < 0.001). There was a negative correlation between VA and coma aberrations (P < 0.05). For different binarization classifications of VA, the classifier models with the best assessment efficacy all had the mean area under the ROC curves (AUC) above 0.95 for 500 replicate samples and above 0.84 for ten-fold cross-validation.

Conclusions

Machine learning models established by meaning visual parameters related to visual acuity can assist in the objective evaluation of VA.
Macrophage PTEN controls STING-induced inflammation and necroptosis through NICD/NRF2 signaling in APAP-induced liver injury
Authors: Yang Tao , Qu Xiaoye , Zhao Jiaying , Wang Xiao , Wang Qian , Dai Jingjing , Zhu Chuanlong , Li Jun , Jiang Longfeng
Published: June 2023

Background

Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) signaling has been known to play a critical role in maintaining cellular and tissue homeostasis, which also has an essential role in the inflammatory response. However, it remains unidentified whether and how the macrophage PTEN may govern the innate immune signaling stimulator of interferon genes (STING) mediated inflammation and hepatocyte necroptosis in APAP-induced liver injury (AILI).

Methods

Myeloid-specific PTEN knockout (PTENM−KO) and floxed PTEN (PTENFL/FL) mice were treated with APAP (400 mg/kg) or PBS. In a parallel in vitro study, bone marrow-derived macrophages (BMMs) were isolated from these conditional knockout mice and transfected with CRISPR/Cas9-mediated Notch1 knockout (KO) or CRISPR/Cas9-mediated STING activation vector followed by LPS (100 ng/ml) stimulation.

Results

Here, we report that myeloid-specific PTEN knockout (PTENM−KO) mice were resistant to oxidative stress-induced hepatocellular injury with reduced macrophage/neutrophil accumulation and proinflammatory mediators in AILI. PTENM−KO increased the interaction of nuclear Notch intracellular domain (NICD) and nuclear factor (erythroid-derived 2)-like 2 (NRF2) in the macrophage nucleus, reducing reactive oxygen species (ROS) generation. Mechanistically, it is worth noting that macrophage NICD and NRF2 co-localize within the nucleus under inflammatory conditions. Additionally, Notch1 promotes the interaction of immunoglobulin kappa J region (RBPjκ) with NRF2. Disruption of the Notch1 signal in PTEN deletion macrophages, reduced RBPjκ and NRF2 binding, and activated STING signaling. Moreover, PTENM−KO macrophages with STING activated led to ROS generation and TNF-α release, resulting in hepatocyte necroptosis upon co-culture with primary hepatocytes.

Conclusions

Our findings demonstrate that the macrophage PTEN-NICD/NRF2-STING axis is critical to regulating oxidative stress-induced liver inflammation and necroptosis in AILI and implies the therapeutic potential for managing sterile liver inflammation.

Graphical Abstract
Enpp1 deficiency caused chondrocyte apoptosis by inhibiting AMPK signaling pathway
Authors: Gao Zhiqiang , Wang Qiang , Guo Kai , Li Xinhua , Huang Yufeng
Published: June 2023

Objective and background

The deficiency of ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1) causes the phenotype similar to knee osteoarthritis (OA). However, the molecular mechanism is poorly understood.

Method

The global deletion of Enpp1 (Enpp1−/−) mice was created to analyze the role of Enpp1 in the progress of knee OA. The apoptosis, proliferation and chondrogenic differentiation ability of chondrocytes from wild-type (WT) and Enpp1−/− joints were compared. According to the results of high-throughput quantitative molecular measurements, the proteins of chondrocytes from WT and Enpp1−/− mice were used to explore the mechanism of Enpp1 deficiency-associated knee OA.

Result

In Enpp1−/− knee joints, we found significant chondrocyte apoptosis and proteomic results showed that abnormal expression of AMP-activated protein kinase (AMPK) signaling pathway may contribute to this phenotype. In primary chondrocyte cultures in vitro, Enpp1 deletion dramatically enhancing chondrocyte apoptosis. Meanwhile, we found Enpp1 deletion inhibits the phosphorylation of AMPK (P-AMPK). We also found that decreased level of P-AMPK and chondrocyte apoptosis, which are caused by Enpp1 deficiency, can be reversed by Acadesine (AICAR), the activator of AMPK.

Conclusion

Consequently, Enpp1 deficiency plays an essential role in knee OA by regulating AMPK signaling pathway.
Formononetin alleviates acute pancreatitis by reducing oxidative stress and modulating intestinal barrier
Authors: Yang Jun , Sha Xiaowei , Wu Di , Wu Bo , Pan Xiaohua , Pan Li-Long , Gu Yuanlong , Dong Xiaoliang
Published: June 2023

Background

Acute pancreatitis (AP) is a recurrent inflammatory disease. Studies have shown that intestinal homeostasis is essential for the treatment of AP. Formononetin is a plant-derived isoflavone with antioxidant properties that can effectively treat a variety of inflammatory diseases. This study aims to investigate the role of formononetin in protecting against AP and underlying mechanism.

Methods

Caerulein was used to induce AP. The inflammatory cytokines were detected using Quantitative real-time PCR and commercial kits. Histological examination was applied with hematoxylin and eosin staining. Western blot was conducted to detect expression of intestinal barrier protein and signaling molecular. Molecular docking was performed to assess protein-ligand interaction.

Results

In this study, we found formononetin administration significantly reduced pancreatic edema, the activities of serum amylase, lipase, myeloperoxidase, and serum endotoxin. The mRNA levels of inflammatory cytokines such as tumor necrosis factor α, monocyte chemoattractant protein-1, interleukin-6, and interleukin-1 beta (IL-1β) in pancreas were also significantly decreased by formononetin. The following data showed formononetin pretreatment up-regulated the expressions of tight junction proteins in the colon, and decreased Escherichia coli translocation in the pancreas. In addition, formononetin inhibited the activation of nucleotide-binding oligomerization domain leucine-rich repeat and pyrin domain-containing 3 in pancreatic and colonic tissues of AP mice. Moreover, formononetin activated Kelch Like ECH Associated Protein 1 (Keap1) / Nuclear factor erythroid2-related factor 2 (Nrf2) signaling pathway to reduce reactive oxygen species (ROS) levels. Docking results showed that formononetin interact with Keap1 through hydrogen bond.

Conclusions

These findings demonstrate that formononetin administration significantly mitigate AP through reducing oxidative stress and restoring intestinal homeostasis, and provide insights into the new treatment for AP.
Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation
Authors: Naito Hiromichi , Sakuraya Masaaki , Hongo Takashi , Takada Hiroaki , Yumoto Tetsuya , Yorifuji Takashi , Hifumi Toru , Inoue Akihiko , Sakamoto Tetsuya , Kuroda Yasuhiro , Nakao Atsunori ,   SAVE-J II Study Group
Published: June 2023

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR.

Methods

We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined.

Results

We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions.

Conclusion

For approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis.
The MTego trap: a potential tool for monitoring malaria and arbovirus vectors
Authors: Maasayi Masudi Suleiman , Machange Jane Johnson , Kamande Dismas S. , Kibondo Ummi Abdul , Odufuwa Olukayode G. , Moore Sarah Jane , Tambwe Mgeni Mohamed
Published: June 2023

Background

Odour-baited traps are useful for vector surveillance and control. However, most existing traps have shown inconsistent recapture rates across different mosquito species, necessitating the need for more effective and efficient traps. The MTego trap with integrated thermal stimuli has been developed as an alternative trap. This study was undertaken to determine and compare the efficacy of the MTego trap to that of the Biogents (BG) modular BG-Pro (BGP) trap for sampling different mosquito species in a semi-field system.

Methods

Fully balanced Latin square design experiments (no-choice and dual choice) were conducted in semi-field chambers using laboratory-reared female Anopheles gambiae sensu stricto, Anopheles funestus, Anopheles arabiensis, Culex quinquefasciatus and Aedes aegypti. There were 16 replicates, and 50 mosquitoes of each species were released in each chamber per replicate. The evaluated traps were as follows: the MTego trap baited with PM6 (MT-PM6), the MTego trap baited with BG-Lure (BGL) (MT-BGL), and the BGP trap baited with BG-Lure (BGP-BGL).

Results

In the no-choice test, the MT-BGL and BGP-BGL traps captured a similar proportion of An. gambiae (31% vs 29%, P-value = 0.519) and An. funestus (32% vs 33%, P = 0.520). The MT-PM6 and BGP-BGL traps showed no significant difference in capturing Ae. aegypti (33% vs 31%, P = 0.324). However, the BGP-BGL caught more An. arabiensis and Cx. quinquefasciatus mosquitoes than the other traps (P < 0.0001). In the dual-choice test of MT-PM6 vs BGP-BGL, similar proportions of An. funestus (25% vs 27%, P = 0.473) and Ae. aegypti (29% vs 25%, P = 0.264) were captured in the traps, while the BGP-BGL captured more An. gambiae, An. arabiensis and Cx. quinquefasciatus mosquitoes than the MT-PM6 (P < 0.0001).

Conclusions

This study demonstrated that the MTego trap has potential as a tool that can be used interchangeably with the BGP trap for sampling anthropophilic mosquitoes including African malaria vectors An. gambiae and An. funestus and the principal arbovirus vector Ae. aegypti.

Graphical abstract