bluuebunny/crossref_metadata_2025 huggingface dataset:
Infant mortality in Brazil from 2000 to 2020: a study of spatial and trend analysis
Authors: Ferreira Tainara Lorena dos Santos , Costa Ketyllem Tayanne da Silva , Silva Richardson Augusto Rosendo da , Oliveira Angelo Giuseppe Roncalli da Costa , de Andrade Fábia Barbosa
Published: November 2024

Background
The Infant Mortality Rate assesses the deaths occurring in children under one year of age and serves as an important health indicator in mapping the living conditions of a given society. The aim of the present study is to evaluate the epidemiological behavior of infant mortality in Brazil from 2000 to 2020, based on the most prevalent chapters of the International Classification of Diseases.
Methods
This is an ecological and retrospective study conducted using secondary data collection. The country of origin for the study is Brazil. The dependent variable of the study is infant mortality, specifically referring to children under one year of age. The independent variables include sex, color, and birth weight. The period analyzed spans from 2000 to 2020. The statistical processing was conducted using Joinpoint and GeoDa.
Results
The most prevalent chapters of infant mortality during the analyzed period were, respectively: (1) Chapter XVI - certain conditions originating in the perinatal period; (2) Chapter XVII - congenital malformations, deformities, and chromosomal anomalies; (3) Chapter I - certain infectious and parasitic diseases; (4) Chapter X - diseases of the respiratory system; (5) Chapter XX - external causes of morbidity and mortality.
Conclusions
Brazil has made progress over the years in public policies aimed at reducing infant mortality in the country, particularly through the consolidation and intensification of Primary Health Care coverage, which provides health promotion, protection, and recovery by identifying the main health risks and needs of each locality. However, addressing the health determinants that influence infant mortality requires actions that go beyond the health sector, necessitating a set of intersectoral strategies aimed at promoting health and well-being.
Exploring Machine Learning Algorithms for Predicting Early Antenatal Care Initiation at First Trimester among Reproductive Women in Nigeria
Authors: Sani Jamilu , Ahmed Mohamed Mustaf , Oluyomi Alabi Olatunji
Published: November 2024

Background
Early antenatal care (ANC) initiation during the first trimester is crucial for maternal and child health outcomes. However, in Nigeria, early ANC uptake remains low due to socioeconomic and cultural barriers. Traditional statistical models used to predict ANC initiation often fail to capture the complex nonlinear interactions between predictors. This study applies machine learning (ML) algorithms to predict early ANC initiation using data from Nigeria’s 2018 Demographic and Health Survey (NDHS).
Methods
This cross-sectional study utilized NDHS 2018 data and six ML algorithms: Logistic Regression (LR), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Decision Tree, Random Forest (RF), and XGBoost. The synthetic minority oversampling technique (SMOTE) was used to address data imbalance. The models were evaluated using metrics, such as accuracy, precision, recall, and AUROC values. Feature importance was assessed using the permutation importance and Gini impurity methods.
Results
The Random Forest model demonstrated the best performance, achieving the highest accuracy (77%), precision (75%), recall (80%), and AUROC value of 0.77. This model effectively identified key predictors of early ANC, including education level, wealth index, and place of delivery, with educated and wealthier women being more likely to seek early care. Feature importance analysis revealed significant sociodemographic and geographic disparities, highlighting the critical role of economic resources and healthcare accessibility in influencing ANC behavior.
Conclusion
ML models, particularly Random Forest, provide an effective approach for predicting early ANC initiation, offering comprehensive insights beyond traditional methods. These findings underscore the need for targeted interventions focusing on education, economic empowerment, and healthcare access to enhance early ANC uptake among Nigerian women.
Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: A retrospective study
Authors: Long Qing , Wen Yong , Li Jun
Published: November 2024

Background
Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan–Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative complications remain a major problem. This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids.
Methods
This was a single-center retrospective study. A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study. The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery. Secondary outcomes included intraoperative outcomes and postoperative outcomes.
Results
Follow-up was conducted by telephone or outpatient visit 12 months after surgery. The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group than in the MMH group (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). The median operation time in the two groups was similar (16 min (15–20 min) vs.16 min (15–18 min), p > 0.05). The median number of incisions in the the MMH + RBL + PFS group was 3 (2–3), while that in the MMH group was 3 (3–4) (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05). The wound healing time was shorter in the MMH + RBL + PFS group than in the MMH group (27.62 ± 3.74 vs. 28.73 ± 4.48 days, respectively, p < 0.05). The incidence of urinary retention was lower in the MMH + RBL + PFS group than in the MMH group (5.47% vs. 12.60, respectively, p < 0.05). Nine patients (one case in the MMH + RBL + PFS group and eight cases in the MMH group (p < 0.05)) had delayed bleeding and were successfully controlled with manual compression or surgical hemostasis. No cases had anal stenosis in the MMH + RBL + PFS group, and six cases had it in the MMH group, all with mild anal stenosis and successfully treated by dilatation alone (p < 0.01). No incision infection or anal incontinence occurred in either group.
Conclusions
Compared with the MMH, the MMH + RBL + PFS surgical procedure is safe and effective for grade III/IV hemorrhoids, which is associated with a lower recurrence rate, a higher patient satisfaction score, a lower postoperative pain score, fewer postoperative complications, and a shorter wound healing time.
Success of salivary gland fine-needle aspiration cytology is depending on various lesion- and sampling-related factors
Authors: Mayer Marcel , Alfarra Mohammad Marwan , Möllenhoff Kathrin , Engels Marianne , Arolt Christoph , Quaas Alexander , Wolber Philipp , Jansen Louis , Nachtsheim Lisa , Grosheva Maria , Klussmann Jens Peter , Shabli Sami
Published: November 2024

Purpose. Ultrasound-guided fine-needle aspiration cytology (FNAC) is a widely used diagnostic procedure which facilitates the differentiation of salivary gland lesions. Although the performance of salivary gland FNAC (SG-FNAC) has improved since the introduction of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the range of the reported performance is still wide. Therefore, the aim of this study was to determine lesion- and sampling-related factors that influence the success of SG-FNAC.
Methods. All SG-FNAC cases performed in a tertiary referral hospital between September 1st, 2011, and August 31st, 2022, were retrospectively identified. Demographic, histopathological, lesion-specific, and sampling-related data were retrieved from the clinical charts. Cytopathological reports were categorized according to the MSRSGC. The risk of malignancy (ROM), the performance measures, and factors influencing the success of SG‑FNAC were calculated.
Results. Overall, 1,289 cases with histopathological follow-up diagnosis (out of 1,952 SG-FNACs) were included. The ROM was: non-diagnostic = 23.9%, non-neoplastic = 4.4%, atypia of undetermined significance (AUS) = 34.5%, neoplasm-benign = 1.0%, neoplasm‑salivary gland neoplasm of uncertain malignant potential (SUMP) = 15.3%, suspicious for malignancy = 74.1%, malignant = 96.2%. The sensitivity, specificity, accuracy, positive, and negative predictive value for differentiating benign from malignant lesions (excluding lesions categorized as AUS and SUMP) were 87.5%, 97.7%, 96.3%, 85.0%, and 98.1%, respectively. A larger lesion size (OR (95% CI) =1.21 (1.06-1.39), p = 0.004), a higher number of obtained slides (OR (95% CI) = 1.31 (1.17-1.46), p < 0.001), and the physician performing the FNAC (p = 0.047) were independent predictors for a higher success, while localization of the lesion within the submandibular compared to the parotid gland (OR (95% CI) = 0.38 (0.19-0.77), p = 0.008) was an independent predictor for lower success of SG-FNAC.
Conclusion. This is the largest single-center study evaluating SG-FNAC performance to date. It identified independent lesion- and sampling-related factors influencing the success of SG‑FNAC. Knowledge of those can improve performance of the procedure.
Experimental study of extracorporeal shock wave therapy for periprosthetic osteolysis induced by wear particles
Authors: Zhao Fengnian , Chen Yufei , Dong Ao , Song Keguan
Published: November 2024

Extracorporeal shock wave therapy (ESWT) is a conservative orthopedic treatment that has been shown to be effective in a variety of orthopedic diseases; however, its effectiveness in addressing sterile prosthesis loosening remains uncertain. This study aimed to establish a model of periprosthetic osteolysis and to assess the impact of ESWT on osteolysis induced by wear particles. The findings indicated that the group receiving ESWT exhibited an increase in bone mineral density, alongside a reduction in the extent of osteolysis, the quantity of osteoclasts, and serum levels of IL-1β. Consequently, we conclude that ESWT significantly diminishes inflammatory factor levels, inhibits the development of periprosthetic osteoclasts, and effectively slows the progression of osteolysis, thereby presenting substantial clinical relevance.
Mangroves and their services are at risk from tropical cyclones and sea level rise under climate change
Authors: Hülsen Sarah , Dee Laura , Kropf Chahan , Meiler Simona , Bresch David
Published: November 2024

Climate change is expected to alter the frequency and intensity of extreme events, modifying the natural disturbance regimes to which ecosystems are currently adapted. Here, we present a spatially explicit risk index for mangroves and their associated biodiversity and ecosystem services based on projected frequency changes of tropical cyclone wind speeds and rates of relative sea level rise under SSPs 245, 370 and 585 by 2100. Globally, approximately half of the total mangrove area (40-56% depending on the SSP) will be at high to severe levels of risk due to climate-modified tropical cyclone disturbance regimes. Further, we find mangrove areas with high levels of biodiversity and ecosystem services provision, including coastal protection for people and assets, carbon sequestration, and fishery benefits, are at proportionally higher levels of risk than mangrove forests generally. Our findings emphasize the need to anticipate changes in natural disturbance regimes and to adapt ecosystem management to sustain ecosystem services in the future.
Analysis of clinical audiology characteristics in children with Williams syndrome in China
Authors: LI Fangfang , XU Bin , SHEN Jiyang , CHEN Weijun , GUO Junxia , YAO Dan , SHAO Jie , JI Chai
Published: November 2024

Background
Williams Syndrome (WS) is a neurodevelopmental disorder caused by microdeletion on chromosome 7. Hearing loss (HL) is common in this population but is rarely taken seriously. Previous studies had small sample sizes and mixed conclusions, and few studies have investigated HL in children with WS.
Objectives
To investigate audiological characteristics of children with WS, analyze the influence factors, and to provide scientific basis for further improvement of ear and hearing care in children with WS.
Methods
WS followed up between June 2020 to June 2024 were underwent a series of audiological examinations such as tympanogram, distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR) and pure-tone audiometry (PTA), to analyze the audiological characteristics of WS at different ages, and their difference with control group.
Results
The passing rate of tympanogram and DPOAE in WS was significantly decreased when compared with control group (p < 0.05), and these differences were found in all age groups. The lower DPOAE passing rate still remain after the tympanogram abnormal data were excluded. The SNR of 2000-5000Hz were statistically lower in children with WS after tympanogram, DPOAE abnormal data were excluded. No significant difference was found in the passing rate of tympanogram and DPOAE of the 25 subjects after 1–2 years. Threshold of ABR in WS was higher than control group. The latency of wave Ⅰ, Ⅲ and the interpeak latency Ⅰ-Ⅲ in WS were significantly longer (p < 0.05), and the interpeak latency Ⅲ-Ⅴ was significantly shorter than that in control group (p < 0.05). 50% of WS was assessed as HL by PTA, with conductive HL in 60%, sensorineural HL in 20% and mixed HL in 20%, most were mildly. The threshold of 250-8000Hz in WS group were significantly higher than that in control group (p < 0.05), either in air or bone conduction.
Conclusions
This study found that children with WS generally had abnormal functions of the middle ear and inner ear, accompanied with HL, or subclinical cochlear active mechanism dysfunction, and it can occur as early as before 3 years. Prolonged ABR latency suggests delayed myelination of auditory nerve. The shortened Ⅲ-V interval may be an electrophysiological marker in this population. It is recommended to carry out long-term and regular hearing follow-up for this population in order to detect HL early and treat diseases that may contribute to HL in time.
GSS-YOLO: Vehicle detection method and embedded deployment in complex traffic road scenarios
Authors: Lu Shengning , Ren Zhihao , Zhi Yan , Wang Xinhua , Yu Xu , Liang Yong
Published: November 2024

In real-world vehicle detection scenarios, numerous complex and highly uncertain factors, including variations in lighting, motion blur, occlusion, and weather conditions, can significantly impact performance. Autonomous driving and intelligent traffic systems must be able to respond quickly to various traffic situations. In order to reduce the impact of these uncertainties in actual scenarios and improve the accuracy of vehicle detection in complex backgrounds, we propose a new YOLO detector GSS-YOLO based on YOLOv5s. First, in order to reduce the amount of calculation while improving the performance of model detection and maintaining detection accuracy, we replaced all Conv convolutions in the neck with GSConv convolutions. Secondly, in order to reduce the sequence length and reduce the computational complexity while increasing to improve the receptive field of the model and improve feature extraction capabilities, we embed the Swin-Transformer attention mechanism into the C3 module. Finally, in order to increase the model's ability to handle small objects that are difficult to detect or objects in complex backgrounds, we use the FocalModulation module to replace the original fast spatial pyramid pooling module. Compared with traditional YOLOv5s, our method reduces model parameters by 21.21% and GFLOPS by 20.88%. GSS-YOLO can increase mAP by 4.2% and accuracy by 5.5% on the challenging vehicle detection data set UA-DETRAC. We deployed the GSS-YOLO algorithm on the Atlas200DK A2 embedded system. After testing, it can achieve an FPS of 37.04 when the accuracy is only reduced by 0.3, meeting the requirements of real-time detection.
DT-GCNN: Dynamic Triplet Network with GRU-CNN for Enhanced Text Classification
Authors: Li Jiahui , Yang Yuan , Sun Jian , Wang Fen , Chen Shuailiang
Published: November 2024

Text classification is a crucial task in natural language processing, and deep learning models have demonstrated exceptional performance in this domain. However, many deep neural network models struggle to handle complex and imbalanced datasets, and their adaptability across multiple scenarios remains limited. To tackle these challenges, this paper proposes DT-GCNN, a model that integrates GRU for capturing sequence information and CNN for extracting local features. Furthermore, the model incorporates an adaptive soft-margin triplet loss function that dynamically adjusts triplet margins, thereby enhancing the learning quality of the embedding space. During the training process, intelligent algorithms are periodically employed to dynamically reconstruct triplets, thereby enhancing the model's generalization capability. This study conducts extensive experiments on eight datasets from various categories. The results demonstrate that DT-GCNN outperforms most existing baseline models, showing notable superiority in handling complex and imbalanced category tasks. The proposed method also significantly enhances generalization ability and stability, exhibiting excellent performance across diverse datasets.
Bridging the Gap with Convolutional networks: A Graph-based Vision Transformer with Sparsity for Training on Small Datasets from Scratch
Authors: Shan Dongjing , Li Jin , Zhong Lisha , Qu Biao , Han Qi
Published: November 2024

Vision Transformers (ViTs) have achieved impressive results in large-scale image classification. However, when training from scratch on small datasets, there is still a significant performance gap between ViTs and Convolutional Neural Networks (CNNs), which is attributed to the lack of inductive bias. To address this issue, we propose a Graph-based Vision Transformer (GvT) that utilizes graph convolutional projection and graphpooling. In each block, queries and keys are calculated through graph convolutional projection based on the spatial adjacency matrix, while dot-product attention is used in another graph convolution to generate values. When using more attention heads, the queries and keys become lower-dimensional, making their dot product an uninformative matching function. To overcome this low-rank bottleneck in attention heads, we employ talkingheads technology based on bilinear pooled features and sparse selection of attention tensors. This allows interaction among filtered attention scores and enables each attention mechanism to depend on all queries and keys. Additionally, we apply graphpooling between two intermediate blocks to reduce the number of tokens and aggregate semantic information more effectively. Our experimental results show that GvT produces comparable or superior outcomes to deep convolutional networks and surpasses vision transformers without pre-training on large datasets. The code for our proposed model is publicly available on the website: GitHub/GvT.
Effect of using safely managed drinking water services on child diarrhoea
Authors: Greenwood Esther E. , Freymond Mathilda , Scheidegger Andreas , Lauber Thomas , Tussupova Kamshat , Pickering Amy J. , Julian Timothy R.
Published: November 2024

Diarrhoeal disease remains a leading cause of mortality in children under five in low- and
middle-income countries (LMICs) (1). Universal access to safe drinking water, as called for
under Sustainable Development Goal 6, is often motivated by perceived health benefits with a
historical focus on achieving diarrhoeal disease reductions (2). Here, we show through
structural causal modelling that household use of safely managed drinking water services
(SMDWS) significantly reduces risks of diarrhoea in children under five compared to the use
of drinking water services not fulfilling all of the SMDWS criteria (Relative risk (RR)= 0.90,
95% CI= 0.83-0.98) and services classified as less than basic (RR=0.87, 95% CI=0.78-0.97)
across 24 LMICs. Secondary analyses point towards contributions of drinking water
availability and fecal contamination at the point of use to risks of child diarrhoea. Specifically, risk reductions of between 4-6% were observed with every 1-log10 decrease in E. coli
contamination in stored drinking water. Our findings reaffirm the importance of SMDWS in
protecting against diarrhoeal disease, while suggesting that achieving universal access will
provide only modest additional reductions in child diarrhoea in LMICs. Further reductions will require
Distribution of glutathione peroxidase-1 immunoreactive cells in pancreatic islets from type 1 diabetic donors and non-diabetic donors with and without islet cell autoantibodies is variable and independent of disease
Authors: Pala Kaaj , Sun Kevin Xueying , Krogvold Lars , Dahl-Jørgensen Knut , Reddy Shiva
Published: November 2024

During type 1 diabetes (T1D), oxidative stress in beta cells may cause early dysfunction and initiate autoimmunity. Mouse islets express lower levels of reactive oxygen species (ROS) clearing enzymes, glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase in comparison with several other tissues. It remains unclear if human beta cells show a similar deficiency, particularly during T1D or show a higher degree oxidative resistance. We compared islet cell distributions and determined graded intensities of glutathione peroxidase1 (GPX1), a key enzyme which detoxifies hydrogen peroxide, by applying combined immunohistochemistry for GPX1, insulin and glucagon, in pancreatic sections from new-onset T1D (group 1), non-diabetic autoantibody-negative (group 2), non-diabetic autoantibody-positive (group 3) and long-term diabetic (group 4) donors. Islets from all study groups demonstrated either uniform but graded staining intensities for GPX1 in almost all islet cells or strong staining in selective islet cells with weaker intensities in the remaining cells. GPX1 was present in selective glucagon and in insulin cells also and in cells negative for both hormones, with stronger intensities in a higher percentage of glucagon than insulin cells. The enzyme was absent in a higher percentage of beta cells than glucagon cells independent of disease or autoantibody positivity. We conclude that a proportion of human beta cells and glucagon cells express GPX1 but show heterogeneity in its distribution and intensities, independent of disease or autoantibody status. Pharmacologic attempts to boost GPX1 level in human beta cells during early T1D or in isolated islets for transplantation may offer clinical benefits.
Multi-foucs imaging under complex surface and structure
Authors: Zhang Liyan , Li Ang
Published: November 2024

Improving the imaging accuracy of geological formations under dual complex conditions (including complex surface and structure) is essential for precisely illustrating structural morphology and understanding reservoir characteristics. The multi-focus imaging is a real surface imaging method that takes into account signal-to-noise ratio and resolution. Drawing upon the principles of paraxial ray theory and Hubra's two wavefronts theory, this approach employs a global optimization inversion algorithm to determine the radii and exit angles of the two wavefronts. Furthermore, it incorporates a non-hyperbolic travel time formula for accurate correction. By combining receiving channels from different CMP channels within the same Fresnel band radius, this method effectively enhances both signal-to-noise ratio and resolution of seismic data. The multi-focus imaging technique is a surface imaging method that considers both signal-to-noise ratio and resolution. Drawing upon the principles of paraxial ray theory and Hubra's two wavefronts theory, this approach employs a global optimization inversion algorithm to determine the radii and exit angles of the two wavefronts. Furthermore, it incorporates a non-hyperbolic travel time formula for accurate correction. By combining receiving channels from different CMP channels within the same Fresnel band radius, this method effectively enhances both signal-to-noise ratio and resolution of seismic data.
Variants in NR6A1 cause a novel oculo-vertebral-renal (OVR) syndrome
Authors: Brooks Brian , NEELATHI Uma , Ullah Ehsan , George Aman George , Maftei Mara , Boobalan Elangovan , Sanchez-Mendoza Daniel , Adams Chloe , McGaughey David , Sergeev Yuri , Rawi Ranya AI , Naik Amelia , Bender Chelsea , Maumenee Irene , Michaelides Michel , Tan Tun , Lin Siying , Villasmil Rafael , Blain Delphine , Hufnagel Robert , Arno Gavin , Young Rodrigo , Guan Bin
Published: November 2024

Colobomatous microphthalmia is a potentially blinding congenital ocular malformation that can present either in isolation or together with other syndromic features. Despite a strong genetic component to disease, many cases lack a molecular diagnosis. We describe a novel autosomal dominant oculo-vertebral-renal (OVR) syndrome in six independent families characterized by colobomatous microphthalmia, missing vertebrae and congenital kidney abnormalities. Genome sequencing identified six rare variants in the orphan nuclear receptor gene NR6A1 in these families. We performed in silico, cellular and zebrafish experiments to demonstrate the NR6A1 variants were pathogenic or likely pathogenic for OVR syndrome. Knockdown of either or both zebrafish paralogs of NR6A1 results in abnormal eye and somite development, which was rescued by wild-type but not variant NR6A1 mRNA. Illustrating the power of genomic ascertainment in medicine, our study establishes NR6A1 as a critical factor in eye and vertebral development and a pleiotropic gene responsible for OVR syndrome.
Disagreements in Medical Ethics Question Answering Between Large Language Models and Physicians
Authors: Soffer Shelly , Nesselroth Dafna , Pragier Keren , Anteby Roi , Apakama Donald , Holmes Emma , Sawant Ashwin Shreekant , Abbott Ethan , Lepow Lauren Alyse , Vasudev Ishita , Lampert Joshua , Gendler Moran , Horesh Nir , Efros Orly , Glicksberg Benjamin S , Freeman Robert , Reich David L , Charney Alexander W , Nadkarni Girish N , Klang Eyal
Published: November 2024

Importance.
Medical ethics is inherently complex, shaped by a broad spectrum of opinions, experiences, and cultural perspectives. The integration of large language models (LLMs) in healthcare is new and requires an understanding of their consistent adherence to ethical standards.
Objective.
To compare the agreement rates in answering questions based on ethically ambiguous situations between three frontier LLMs (GPT-4, Gemini-pro-1.5, and Llama-3-70b) and a multi-disciplinary physician group.
Methods.
In this cross-sectional study, three LLMs generated 1,248 medical ethics questions. These questions were derived based on the principles outlined in the American College of Physicians Ethics Manual. The topics spanned traditional, inclusive, interdisciplinary, and contemporary themes. Each model was then tasked in answering all generated questions. Twelve practicing physicians evaluated and responded to a randomly selected 10% subset of these questions. We compared agreement rates in question answering among the physicians, between the physicians and LLMs, and among LLMs.
Results.
The models generated a total of 3,744 answers. Despite physicians perceiving the questions' complexity as moderate, with scores between 2 and 3 on a 5-point scale, their agreement rate was only 55.9%. The agreement between physicians and LLMs was also low at 57.9%. In contrast, the agreement rate among LLMs was notably higher at 76.8% (p < 0.001), emphasizing the consistency in LLM responses compared to both physician-physician and physician-LLM agreement.
Conclusions.
LLMs demonstrate higher agreement rates in ethically complex scenarios compared to physicians, suggesting their potential utility as consultants in ambiguous ethical situations. Future research should explore how LLMs can enhance consistency while adapting to the complexities of real-world ethical dilemmas.
Patient’s knowledge and perception of anesthesia and the anesthesiologist at a tertiary hospital in Mogadishu, Somalia
Authors: Hussein Abdalla Mohamed Hussein , Bacak Mine Bacak , Eraslan Aşır Eraslan , Cimen Sertac Cimen , Ali Irshad Ibrahim Ali , Mohamud Rahma Yusuf Haji Mohamud Haji
Published: November 2024

Background: The field of anesthesia, evolving since the nineteenth century, extends beyond surgery to include critical roles in pain management, critical care, and emergency response, reflecting its importance in diverse healthcare scenarios. It addresses a significant gap in understanding in a region where trained nurses rather than specialist doctors often administer anesthesia. The aim is to investigate patients' knowledge and perception of anesthesia and the anesthetist at a tertiary hospital.
Methods: A cross-sectional study was conducted at Erdogan Hospital, Mogadishu, from September to December 2023. Participants were elective patients aged 15 or older, interviewed using pre-tested questionnaires covering demographics, knowledge of anesthesia, and perceptions of anesthesiologists.
Results: Out of 495 participants, 65.5% were aware of anesthesia, predominantly informed by friends and relatives. While most understood the role of anesthesiologists in administering anesthesia during surgery, there was limited awareness of their broader responsibilities. Critical factors associated with more excellent anesthesiology knowledge included educational level, which increased anesthesiology knowledge by a factor of 0.232 units (β=0.232, P-value=0.002). Employed people had 0.369 times more understanding of anesthesiology than unemployed ones (β=0.369, P-value=0.034). Female participants had higher knowledge scores in anesthesiology than male participants (β=0.383, P-value=0.037).
Conclusion: The study highlights a crucial knowledge gap among patients in Somalia regarding anesthesia and the role of anesthesiologists, underscoring the need for enhanced public education and specialized training. The results are, however, limited by the study's singular hospital setting and sample size.
Future Atlantic Meridional Overturning Circulation weakening driven by Labrador Sea warming and salt transport feedback
Authors: Park Hyo-Seok , Lim Won-Il , Stewart Andrew
Published: November 2024

Climate models predict a wide range of AMOC weakening, complicating future projections. Using 30 models from the Climate Model Intercomparison Project Phase 6 (CMIP6), this study finds that AMOC weakening is strongly correlated with increased downward heat flux in the Labrador Sea. A rapid rise in heat uptake and upper-ocean temperatures initiates AMOC weakening, but this is partially offset by reduced ocean heat transport. By the mid-21st century, changes in seawater temperature have a mild effect on density, while the reduced northward salt flux associated with AMOC weakening further decreases Labrador Sea density. Further analysis indicates that the degree of future AMOC weakening aligns with a conceptual model representing AMOC as a thermal wind balance governed by the meridional density gradient. Idealized ocean model simulations confirm that increased downward heat flux in the Labrador Sea can weaken AMOC and trigger a salt transport feedback. These findings suggest that future warming of the Labrador Sea, along with the associated salt transport feedback, will be critical in determining the extent of AMOC weakening.
A Study on the Effect of Snake Plants on Indoor Air Quality and Human Well-being in a Private Hostel in Aizawl, Mizoram
Authors: Mualchin Lalropeki , Lalrinpuii Hilda
Published: November 2024

Snake plants, one of the air purifiers can significantly improve indoor air quality in the kitchen, non-ventilation, and ventilation area and improve indoor air pollutants such as HCHO and TVOC with a consistent temperature, while indoor air pollutants such as PM 2.5 and PM 10 have less effectiveness in reduction by snake plants. Ventilation also contributes to the reduction of indoor air pollutants. From the study, students’ mood and productivity are at a high level, whereas high in stress level during placing snake plants. There is a strong positive relationship between humidity and mold growth, which is one of the major issues in a hostel, and a study found that snake plants may influence in reducing mold growth by regulating humidity levels. This study can play an important role in enhancing indoor air pollutants in the hostel, making it environmentally friendly, cost-effective, and easily accessible for students living in the hostel.
Predicting Patient Survival After Heart Failure Using Ensemble Learning Models
Authors: Santos Dheiver Francisco
Published: November 2024

Heart failure (HF) is the leading cause of global death from chronic diseases. Data mining using machine learning (ML) converts massive volumes of raw data created by healthcare institutions into meaningful information that can aid in making
predictions and crucial decisions. After an HF, collecting and analyzing follow-up data from patients is critical to monitor their health recovery. The aim of this study is to use ML and predict the survival possibility of patients after HF based on the follow-up data. Three supervised classifiers i.e., Random Forest (RF), XGBoost (XGB), and Decision Tree (DT) have been used in our study. Moreover, we proposed to design a supervised stacked ensemble learning model that can achieve a prediction accuracy, precision, recall, and F1 score of 99.98
The Relationship Between Hiv Positive Clients’ Satisfaction With Health Services and Their Health Outcomes - A Cross-sectional Survey in the South Eastern Hospitals in Nigeria
Authors: Akunne Maureen Ogochukwu , Ukwe Chinwe Victoria , Isah AbdulMuminu , Ekwunife Obinna Ikechukwu
Published: November 2024

Background: There’s limited information on the interrelationships of HIV-positive individuals’ satisfaction with health services and other health outcomes in the management of HIV infection in the Nigerian literature.
OBJECTIVES: To predict the patients’ adherence to ART, CD4 count, viral load, and quality of life from their satisfaction with health services.
METHODS: A large cross-sectional survey was conducted among the HIV-infected individuals in five tertiary institutions in South Eastern Nigeria using a validated Patient Satisfaction with Health Service Questionnaire (PSHS-Q), a European Quality of Life questionnaire, EQ-5D-5L, and the Center for Adherence Support Evaluation (CASE) Adherence index. Data analysis was done with appropriate descriptive and inferential statistics using IBM SPSS Version 23. P< 0.05 was considered statistically significant.
RESULTS: Levels of general satisfaction with health services were: Not satisfied (385, 24.2%), Slightly satisfied (341, 21.4 %), Satisfied (183, 11.5 %), and Very satisfied (684, 42.9 %). Patient satisfaction with health services is predictive of quality of life (β = 0.013, 95 % CI [0.008 - 0.017], p = 0.0001), but not of adherence to ART (β = 1.308, 95 % CI [0.770 – 2.222], p = 0.321), viral load suppression (β = 0.783, 95 % CI [0.435 – 1.411], p = 0.416) and CD4 Count (β = 0.938, 95% CI [0.568 – 1.551], p = 0.804).
CONCLUSION
The HIV/AIDS patients’ quality of life was positively predicted by their satisfaction with health services. However, their general satisfaction with health services did not affect their adherence to therapy, viral load, and CD4 count.
Improving Explainability in Machine Learning: A Cluster-Driven Approach to Feature Importance
Authors: Parashar Gaurav , Chaudhary Alka , Pandey Dilkeshwar
Published: November 2024

Machine learning (ML) models are increasingly being deployed in critical domains such as healthcare, finance, marketing, autonomous vehicles, and energy. As these models become more accurate and capable, concerns about the trustworthiness of their decisions grow. Trust in ML models is essential, particularly in high-stakes applications, and depends on both the transparency and fairness of the models. Transparency is achieved when an ML model can clearly explain its decision-making process, especially by identifying the key features that influence its predictions. In this paper, we introduce a novel technique, cluster-based feature importance, which identifies feature importance by analyzing localized regions within the dataset. This approach provides deeper insights into the features the model relies on for its predictions. We also compare our method to established explainability techniques, such as LIME and SHAP, to assess its effectiveness.
Performance-Driven Encryption for Cloud Data Transmission and Storage Security
Authors: sagrika  , Kumar Raj , Brar Gursewak Singh
Published: November 2024

As cloud technology continues to grow at a rapid pace, it offers substantial advantages to the IT sector, including scalability, cost savings, and ease of access. However, protecting data stored in the cloud remains a critical challenge, with increasing vulnerabilities to unauthorized access and cyber threats. This paper presents a comprehensive method for enhancing cloud security by integrating encryption and compression techniques. The proposed approach begins by encrypting data through the Diffie-Hellman key exchange, followed by compression and encoding with Huffman coding to reduce data size while strengthening security. A second layer of encryption is then applied using the AES algorithm, resulting in a dual-encryption framework that enhances both protection and storage efficiency. The primary goal of this research is to deliver a secure, efficient solution for safeguarding cloud data in a resource-conscious manner.
Yield and Quality of Snap Bean (Phaseolus vulgaris L.) Cultivars from Successive Harvests in Spring and Fall Production Seasons in Oklahoma
Authors: Richmond Jess , Maness Niels , Goad Carla , Brandenberger Lynn , Mason Tyler , Kathi Shivani , Chrz Donna , Hu Bizhen
Published: November 2024

Numerous studies have evaluated snap bean pod yield and quality at different pod maturities, but only a few have evaluated yield and pod quality across different seasons within the same year or for pods harvested at the same relative maturity successively from the same plants. Hence, the aim of this study was to determine if snap bean yield or pod sugar accumulation differed for pods at the same relative stage of maturity from plants harvested multiple times in spring and fall planting seasons in north central Oklahoma. Nine snap bean cultivars (seven green-podded and two yellow-podded) were field-grown in Spring and Fall 2022 and 2023. Pods were harvested weekly for 3 weeks from the same plants and at the same relative pod development stage. Pod yield and sugar concentration were measured. The total pod yield pooled across seasons and years of ‘Sybaris’ was lower (approximately 4100 kg⋅ha−1) than that of six of the other cultivars, which yielded between 7000 to 8600 kg⋅ha−1. In spring, pod yield increased from 900 to 1300 kg⋅ha−1 in the first harvest to 3500 to 3700 kg⋅ha−1 by the last harvest. In Fall 2022, the yield decreased from 1900 kg⋅ha−1 in the first harvest to 690 kg⋅ha−1 by the last harvest, whereas in Fall 2023 the pod yield remained steady at 2600 to 3000 kg⋅ha−1 at each weekly harvest. The Fall 2022 decrease in yield was likely caused by low temperatures during pod development and a freeze that shortened the harvest season. From the first to the last harvest, the total pod sugar concentration decreased from 145.5 to 107.2 mg⋅g−1, glucose decreased from 48.4 to 33.0 mg⋅g−1, and fructose decreased from 90.7 to 52.0 mg⋅g−1. However, the sucrose concentration increased from 9.2 to 21.9 mg⋅g−1. This decrease in the total and monomeric sugar concentrations, coupled with a disproportionally smaller increase in sucrose, is typical for overly mature snap bean pods, which are considered less desirable because of lower sweetness. Snap bean pods harvested later in the growing season in a successive harvest system at the same relative stage of maturity as earlier harvested pods had sugar concentrations resembling those of overly mature pods, indicating that snap bean plant age may influence the pod sugar concentration.
Examining and Overcoming Barriers to Leadership for Black Women in HBCU Spaces
Authors: Williams Dr. Tameka , Clark Dr. Tyler S. , Mcgill-Youngblood Dr. Larrisha , Henderson Lauren
Published: November 2024

The researchers in this study aimed to explore the barriers Black women face when ascending to leadership roles at Historically Black Colleges and Universities (HBCUs) and the coping strategies they employ to overcome them. Guided by two research questions, we gathered data from 93 Black women who currently work or have worked at HBCUs and aspire to leadership roles. Our findings, integrated with existing literature, reveal several significant barriers: microaggressions and gender oppression, limited access to professional networks and mentors, and work-life imbalances. Gender Oppression and Workplace Microaggressions emerged as prominent barriers, aligning with previous research on gender discrimination in academic settings. Most respondents reported not having access to formal mentorship programs, significantly impacting career progression. Additionally, balancing work and personal responsibilities, coupled with discrimination, adversely affects well-being and career advancement. The stereotypes and perceptions of Black women also emerged as a significant issue, placing undue emotional and psychological burdens on Black women. Respondents highlighted the importance of personal support networks, professional networks, and mentorship in coping strategies. Support from family and friends, professional networks, and seeking additional education were commonly cited strategies, with mentorship being particularly valued.
Keywords: Black, women, Historically Black College and University, HBCU, ascension, leadership, barriers
Epileptic encephalopathy, autism and cognitive deficit caused by the SYNGAP1 gene mutation
Authors: Gamirova R. G. , Zabirova K. R. , Gorobets E. A. , Safina A. R. , Samoilova L. R. , Volgina S. Ya.
Published: November 2024

The paper analyzes data from scientific publications and presents a clinical case study of a rare genetic epileptic encephalopathy caused by a mutation in the SYNGAP1 gene. The case study focuses on a 4-year-old girl who has been diagnosed with epileptic encephalopathy due to the mutation. The paper describes the anamnesis of the child’s illness, including family history, neurological, neuropsychological, and speech assessments, as well as the results of genetic testing, electroencephalography, and magnetic resonance imaging (MRI). The findings indicate that the main symptoms of the condition are typically epilepsy, autism spectrum disorder, difficulty with phrasal speech, and mental retardation. Common types of seizures include atypical absence seizures, myoclonic seizures, atonic seizures, and eyelid myoclonia with absences. On the electroencephalogram, there is a slowdown in occipital activity and diffuse, prolonged «peak-polypic-slow-wave» complexes. Pathognomonic neuroimaging changes in the brain are typically absent. Valproic acid, levetiracetam, and ethosuximide have been shown to be the most effective treatments for controlling epileptic seizures. Due to the rarity of this syndrome, the authors have provided a detailed clinical case report from their practice.

Conclusion. SYNGAP1-related epileptic encephalopathy has a specific clinical presentation, including characteristic EEG findings and a particular pattern of seizures. The diagnostic approach for children with this condition, autism spectrum disorder, and delayed language development should include video electroencephalography with sleep deprivation, as well as genetic testing if necessary, using next-generation sequencing, to ensure early detection and appropriate treatment planning.
Clinical and etiological characteristics and cytokine profile in school-age children with community-acquired pneumonia
Authors: Mizernitsky Yu. L. , Vakhitov Kh. M. , Sitdikova G. F. , Safiullin T. R. , Nurmieva A. R. , Loskutova E. V.
Published: November 2024

The urgent task of modern pediatrics is the study of the etiology and pathophysiology of community-acquired pneumonia in school-aged children due to difficulties in diagnosis and treatment, as well as the high risk of life-threatening complications and death.

Purpose. To investigate the activity of pro-inflammatory and anti-inflammatory responses as measured by cytokine levels in the peripheral blood of children with community-acquired pneumococcal and non-pneumococcal pneumonia.

Material and methods. The etiology of community-acquired pneumonia was confirmed by comparing the results of rapid testing of pneumococcus in urine and data from traditional bacteriological methods. The study included 118 children (57 boys and 61 girls) aged 7 to 16 years with various morphological variants of community-acquired pneumonia, which were divided into 2 groups. The first group included 28 children with pneumococcal etiology of community-acquired pneumonia, and the second group included 90 patients with non-pneumococcal community-acquired pneumonia. Levels of interleukins IL-1, IL-4, IL-8 and TNF-α were determined in all children by enzyme immunoassays.

Results. In the etiology of community-acquired pneumonia in school-age children, atypical pathogens are responsible for more than 50% of cases. The clinical effectiveness of rapid testing of pneumococcal antigens in urine has been shown, and their use in routine pediatric practice has made it possible to timely identify a group of severe community-acquired pneumonia and reasonably prescribe antibacterial medications. It has been demonstrated that pneumococcal-induced pneumonia is characterized by higher levels of proinflammatory cytokines. These levels, along with the clinical course of the disease, confirm the high level of systemic inflammation. Relatively lower levels of proinflammatory cytokines corresponded to a more mild clinical picture of community-acquired pneumonia of non-pneumococcal etiology, which on the one hand may reflect a relatively «balanced» inflammatory response, and on the other hand determine the protracted and polyclinic course of the infectious process.

Conclusion. The etiology of community-acquired pneumonia in school-age children is dominated by atypical pathogens. Community-acquired pneumonia of pneumococcal etiology has more severe clinical courses, and their early identification will allow for the appropriate prescription of initial antibacterial treatment.