bluuebunny/crossref_metadata_2025 huggingface dataset:
STG-MTL: scalable task grouping for multi-task learning using data maps
Authors: Sherif Ammar , Abid Abubakar , Elattar Mustafa , ElHelw Mohamed
Published: May 2024

Multi-Task Learning (MTL) is a powerful technique that has gained popularity due to its performance improvement over traditional Single-Task Learning (STL). However, MTL is often challenging because there is an exponential number of possible task groupings, which can make it difficult to choose the best one because some groupings might produce performance degradation due to negative interference between tasks. That is why existing solutions are severely suffering from scalability issues, limiting any practical application. In our paper, we propose a new data-driven method that addresses these challenges and provides a scalable and modular solution for classification task grouping based on a re-proposed data-driven features, Data Maps, which capture the training dynamics for each classification task during the MTL training. Through a theoretical comparison with other techniques, we manage to show that our approach has the superior scalability. Our experiments show a better performance and verify the method’s effectiveness, even on an unprecedented number of tasks (up to 100 tasks on CIFAR100). Being the first to work on such number of tasks, our comparisons on the resulting grouping shows similar grouping to the mentioned in the dataset, CIFAR100. Finally, we provide a modular implementation
3

3

https://github.com/ammarSherif/STG-MTL.

for easier integration and testing, with examples from multiple datasets and tasks.
Global system errors to simultaneously improve the identification of subsystems with mixed data Gaussian process regression
Authors: LaMack Cameron J , Schearer Eric M
Published: May 2024

This paper explores the use of Gaussian process regression for system identification in control engineering. It introduces two novel approaches that utilize the data from a measured global system error. The paper demonstrates these approaches by identifying a simulated system with three subsystems, a one degree of freedom mass with two antagonist muscles. The first approach uses this whole-system error data alone, achieving accuracy on the same order of magnitude as subsystem-specific data (

9.28
±
0.87
N 
vs. 
6.96
±
0.32
N

of total model errors). This is significant, as it shows that the same data set can be used to identify unique subsystems, as opposed to requiring a set of data descriptive of only a single subsystem. The second approach demonstrated in this paper mixes traditional subsystem-specific data with the whole system error data, achieving up to 98.71% model improvement.
Journey over destination: dynamic sensor placement enhances generalization
Authors: Marcato Agnese , Guiltinan Eric , Viswanathan Hari , O’Malley Daniel , Lubbers Nicholas , Santos Javier E
Published: May 2024

Reconstructing complex, high-dimensional global fields from limited data points is a challenge across various scientific and industrial domains. This is particularly important for recovering spatio-temporal fields using sensor data from, for example, laboratory-based scientific experiments, weather forecasting, or drone surveys. Given the prohibitive costs of specialized sensors and the inaccessibility of certain regions of the domain, achieving full field coverage is typically not feasible. Therefore, the development of machine learning algorithms trained to reconstruct fields given a limited dataset is of critical importance. In this study, we introduce a general approach that employs moving sensors to enhance data exploitation during the training of an attention based neural network, thereby improving field reconstruction. The training of sensor locations is accomplished using an end-to-end workflow, ensuring differentiability in the interpolation of field values associated to the sensors, and is simple to implement using differentiable programming. Additionally, we have incorporated a correction mechanism to prevent sensors from entering invalid regions within the domain. We evaluated our method using two distinct datasets; the results show that our approach enhances learning, as evidenced by improved test scores.
Water adsorption kinetics on graphene controlled by surface modification of supporting substrates
Authors: Hirose Takumu , Ochi Naoto , Nouchi Ryo
Published: May 2024

Sensing layers with an increased affinity for water molecules are essential for the development of highly sensitive humidity sensors. Graphene possesses superior electrical properties that make it suitable for the fabrication of low-noise miniaturized sensors. However, the enhancement of water affinity by introducing surface defects such as covalently attached hydrophilic groups reduces the electrical conductivity of graphene. In this study, we exploit the wetting transparency of graphene to increase its water affinity without introducing defects. Kinetic measurements using a Kelvin probe with a large-diameter tip showed that the rate constant of water adsorption was higher for graphene deposited on a hydrophilic substrate. These findings suggest that the wetting transparency of graphene can be exploited to reduce defect introduction into the graphene sensing layer, and has potential applications in sensor technologies.
Doctrines in Motion
Authors: Feitoza Pedro
Published: May 2024

This chapter examines the thinking and ideologies of Brazilian evangelicals between 1860–1910. It recovers the ways Protestants responded to the First Vatican Council (1869–1870), the papacy of Pius IX, the Religious Question in Brazil (1872–1875), and the secular ideologies of the time. The chapter concentrates on some influential tracts by Émile de Laveleye and William Gladstone, translated into Portuguese, discussing issues of religion, modernity, and race, and the publications of the Brazilian Society of Evangelical Tracts (1883–1897). Evangelicals built upon these religious and social debates to familiarize their publics with Protestant doctrines and ideas. The chapter also analyzes the tracts produced by Plymouth Brethren independent missionaries in Brazil and Portugal and their critique of the Brazilian religious landscape.
The role of European chemical manufacturing companies in promoting effective communication of conditions of safe use by workers
Authors: Urbanus Jan , Tjoe Nij Evelyn , Tietz Cornelia
Published: May 2024

In 2006, the revised chemicals management legislation mandated that manufacturers of hazardous chemical substances conduct risk assessments for the entire substance life cycle. Additionally, they must communicate use-specific safe handling advice (exposure scenarios) to their customer, as annex to the Safety Data Sheet (SDS). Despite significant efforts to develop workable solutions for chemical mixtures, this goal has not yet been fully achieved. Therefore, a Cefic research project (LRI B23) was commissioned on how to ensure meaningful health risk communication for workers across supply chains. The research project determined that risk-based safe use advice generated by manufacturers, often does not reach the intended end-user and was seen as not tailored to specific user needs. Recipients of the advice are also not prepared to act based on information developed by suppliers. From an industry perspective, the complexity of supply chains and substance life cycles are considered major barriers for effective safe use communication. Exposure scenarios for substance use in industrial work environments are often perceived as adding little value compared to existing safe use arrangements required by other health, safety, and environmental legislation applicable to employers and duty-holders. To attain meaningful use-specific safe handling advice for workers, including those at non-industrial premises who may benefit most from such advice, knowledge transfer and close collaboration between manufacturers and formulators remain key elements, supported by enhanced regulatory appreciation.
Ecological correlates of population genetics in Linum suffruticosum, an heterostylous polyploid and taxonomic complex endemic to the Western Mediterranean Basin
Authors: Vanrell Maria Antònia , Novaes Letícia R , Afonso Ana , Arroyo Juan , Simón-Porcar Violeta
Published: May 2024

Linum suffruticosum s.l. is a taxonomic complex widespread in the Western Mediterranean basin. The complex is characterized by a high phenotypic and cytogenetic diversity, and by a unique three-dimensional heterostyly system that makes it an obligate outcrosser. We studied the patterns of genetic diversity and structure of populations throughout the entire distribution of L. suffruticosum s.l. with microsatellite markers. We analysed their relationships with various biological and ecological variables, including the morph ratio and sex organ reciprocity of populations measured with a novel multi-dimensional method. Populations consistently showed an approximate 1:1 morph ratio with high sex organ reciprocity and high genetic diversity. We found high genetic differentiation of populations, showing a pattern of isolation by distance. The Rif mountains in NW Africa were the most important genetic barrier. The taxonomic treatment within the group was not related to the genetic differentiation of populations, but to their environmental differentiation. Genetic diversity was unrelated to latitude, elevation, population size, niche suitability or breeding system. However, there was a clear influence of ploidy level on the genetic diversity of populations, and a seeming centre–periphery pattern in its distribution. Our results suggest that polyploidization events, high outcrossing rates, isolation by distance and important geographical barriers to gene flow have played major roles in the microevolutionary history of this species complex.
Assessing pressure wave components for aortic stiffness monitoring through spectral regression learning
Authors: Aghilinejad Arian , Gharib Morteza
Published: May 2024

Aims

The ageing process notably induces structural changes in the arterial system, primarily manifesting as increased aortic stiffness, a precursor to cardiovascular events. While wave separation analysis is a robust tool for decomposing the components of blood pressure waveform, its relationship with cardiovascular events, such as aortic stiffening, is incompletely understood. Furthermore, its applicability has been limited due to the need for concurrent measurements of pressure and flow. Our aim in this study addresses this gap by introducing a spectral regression learning method for pressure-only wave separation analysis.

Methods and results

Leveraging data from the Framingham Heart Study (2640 individuals, 55% women), we evaluate the accuracy of pressure-only estimates, their interchangeability with a reference method based on ultrasound-derived flow waves, and their association with carotid-femoral pulse wave velocity (PWV). Method-derived estimates are strongly correlated with the reference ones for forward wave amplitude (R2=0.91), backward wave amplitude (R2=0.88), and reflection index (R2=0.87) and moderately correlated with a time delay between forward and backward waves (R2=0.38). The proposed pressure-only method shows interchangeability with the reference method through covariate analysis. Adjusting for age, sex, body size, mean blood pressure, and heart rate, the results suggest that both pressure-only and pressure-flow evaluations of wave separation parameters yield similar model performances for predicting carotid-femoral PWV, with forward wave amplitude being the only significant factor (P < 0.001; 95% confidence interval, 0.056–0.097).

Conclusion

We propose an interchangeable pressure-only wave separation analysis method and demonstrate its clinical applicability in capturing aortic stiffening. The proposed method provides a valuable non-invasive tool for assessing cardiovascular health.
Dementia-Friendly Transportation Services: A Scoping Review
Authors: Lanthier-Labonté Stéphanie , Chaudhury Habib , Wong Joey , Hung Lillian
Published: May 2024

Background and Objectives

Transportation is an important component of dementia-friendly communities. People living with dementia have the right to access transportation services to keep their mobility in their community, which is essential for independence, well-being, and quality of life. This scoping review maps the literature on dementia-friendly transportation services and explores their characteristics to inform future development and research.

Research Design and Methods

Empirical quantitative and qualitative studies in English or French that informed on transportation services for people living with dementia in the community were searched in 15 databases. Two authors independently screened records and charted relevant characteristics from selected publications. Important findings were summarized with a narrative synthesis approach.

Results

Thirty-five studies informed on important dimensions of transportation services in urban and/or rural context: availability, accessibility, acceptability, adaptability, and affordability. Important insights were identified: the importance of staff training and attitude, and the challenges of availability of affordable services in the rural context. Emerging policy and program intervention areas include the need for access to quiet areas in transit hubs, training to use mass public transit and mobility management.

Discussion and Implications

The literature on dementia-friendly transportation services is important in the expansion and maintenance of mobility for people living with dementia in the community. The scope of the existing scientific literature remains limited. Although several studies indicated a clear need for better access to dementia-friendly transportation services, the best practices still need to be demonstrated in the scientific literature.
Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers
Authors: Pereira-Osorio Carolina , Brickell Emily , Lee Bern , Arredondo Beth , Sawyer Robert John
Published: May 2024

Background and Objectives

This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia.

Research Design and Methods

Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups.

Results

Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = −0.54, Black: r = −0.55), with a p < .001 for all validity analysis.

Discussion and Implications

The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.
Multivariate processing of airborne natural source electromagnetic data—application to field data from Gobabis (Namibia)
Authors: Thiede A , Schiffler M , Junge A , Becken M
Published: May 2024

As deep-seated ore deposits become increasingly relevant for mineral exploration, the demand for time-efficient and powerful deep-sounding exploration methods rises. A suitable method for efficiently sensing ores at great depth is airborne electromagnetics (EM) using natural signal of atmospheric origin. The method relates airborne magnetic field recordings in the audio-frequency range to reference magnetic field recordings measured at a ground-based site and can achieve greater penetration depths when compared to controlled source airborne EM techniques. However, airborne natural source EM data are prone to noise caused by platform vibrations especially deteriorating data quality at low frequencies and thus narrowing the depth of investigation. Motional noise manifests as coherent noise on all airborne magnetic field components demanding for a powerful processing tool to remove such kind of noise. Unlike the bivariate approach, which is widely used in natural source EM, the multivariate approach is capable of detecting and reducing the effect of coherent noise. We introduce a robust multivariate processing for airborne natural source EM data and present the code implementation. The code was applied to a large-scale data set from the Kalahari–Copper–Belt in Namibia covering over 1000 km2. We obtained spatially consistent and smooth sounding curves in a frequency range of 10 to 1000 Hz including frequencies with prominent motional noise. Transfer functions are in good agreement with other geophysical and geological information.
An integrated method for gravity gradient inversion and gravity gradient depth imaging
Authors: Tian Yu , Liu Jinzhao , Ye Qing , Shi Lei , Wang Yong , Ebbing Jörg
Published: May 2024

Gravity gradient data can show the structural features of geological bodies in the shallow lithosphere with higher sensitivity and resolution than conventional gravity data. Gravity gradient inversion can be applied to obtain the lithospheric density structures of geological bodies. However, as with gravity data, gravity gradient data have no inherent depth resolution. The methods of gravity gradient depth imaging and gravity gradient inversion are integrated in this study. The depth imaging method is effective for calculations without prior information and iterative computations. As the parameters in the depth weighting function should be chosen from a set of values used in inversion tests of synthetic data, which brings some uncertainties, the depth imaging results of gravity gradient are introduced into the depth weighting function. Several synthetic models are tested to demonstrate the advantages and features of the effective integrated method. Finally, the integrated method is applied to the interpretation of the GOCE satellite gravity gradient tensors over the northeastern margin of the Qinghai–Tibet Plateau. The results reveal that in the crust of the study area, the distribution of density anomalies is more in line with the mechanism of the crustal flow model, in the upper mantle of the study area, the density anomalies are mainly influenced by the high heat flow environment.
Into the red: an M-band study of the chemistry and rotation of β Pictoris b at high spectral resolution
Authors: Parker Luke T , Birkby Jayne L , Landman Rico , Wardenier Joost P , Young Mitchell E , Vaughan Sophia R , van Sluijs Lennart , Brogi Matteo , Parmentier Vivien , Line Michael R
Published: May 2024

High-resolution cross-correlation spectroscopy (HRCCS) combined with adaptive optics has been enormously successful in advancing our knowledge of exoplanet atmospheres, from chemistry to rotation and atmospheric dynamics. This powerful technique now drives major science cases for ELT instrumentation including METIS/ELT, GMTNIRS/GMT, and MICHI/TMT, targeting biosignatures on rocky planets at 3–5 μm, but remains untested beyond 3.5 μm where the sky thermal background begins to provide the dominant contribution to the noise. We present 3.51–5.21 μm M-band CRIRES+/VLT observations of the archetypal young directly imaged gas giant β Pictoris b, detecting CO absorption at S/N = 6.6 at 4.73 μm and H2O at S/N = 5.7, and thus extending the use of HRCCS into the thermal background noise dominated infrared. Using this novel spectral range to search for more diverse chemistry, we report marginal evidence of SiO at S/N = 4.3, potentially indicative that previously proposed magnesium–silicate clouds in the atmosphere are either patchy, transparent at M-band wavelengths, or possibly absent on the planetary hemisphere observed. The molecular detections are rotationally broadened by the spin of β Pic b, and we infer a planetary rotation velocity of vsin(i) = 22 ± 2 km s−1 from the cross-correlation with the H2O model template, consistent with previous K-band studies. We discuss the observational challenges posed by the thermal background and telluric contamination in the M-band, the custom analysis procedures required to mitigate these issues, and the opportunities to exploit this new infrared window for HRCCS using existing and next-generation instrumentation.
A general method to reconstruct strong gravitational lenses based on the singular perturbative approach
Authors: Alard C
Published: May 2024

The number of gravitational arcs systems detected is increasing quickly and should even increase at a faster rate in the near future. This wealth of new gravitational arcs requires the development of a purely automated method to reconstruct the lens and source. A general reconstruction method based on the singular perturbative approach is proposed in this paper. This method generates a lens and source reconstruction directly from the gravitational arc image. The method is fully automated and works in two steps. The first step is to generate a guess solution based on the circular solution in the singular perturbative approach. The second step is to break the sign degeneracy and to refine the solution by using a general source model. The refinement of the solution is conducted step-by-step to avoid the source-lens degeneracy issue. One important asset of this automated method is that the lens solution is written in universal terms which allows the computation of statistics. Considering the large number of lenses which should be available in the near future this ability to compute unbiased statistics is an important asset.
A Catalogue and analysis of ultra-diffuse galaxy spectroscopic properties
Authors: Gannon Jonah S , Ferré-Mateu Anna , Forbes Duncan A , Brodie Jean P , Buzzo Maria Luisa , Romanowsky Aaron J
Published: May 2024

In order to facilitate the future study of ultra-diffuse galaxies (UDGs), we compile a catalogue of their spectroscopic properties. Using it, we investigate some of the biases inherent in the current UDG sample that have been targeted for spectroscopy. In comparison to a larger sample of UDGs studied via their spectral energy distributions (SED), current spectroscopic targets are intrinsically brighter, have higher stellar mass, are larger, more globular cluster-rich, older, and have a wider spread in their metallicities. In particular, many spectroscopically studied UDGs have a significant fraction of their stellar mass contained within their globular cluster (GC) system. We also search for correlations between parameters in the catalogue. Of note is a correlation between alpha element abundance and metallicity, as may be expected for a ‘failed galaxy’ scenario. However, the expected correlations of metallicity with age are not found, and it is unclear if this is evidence against a ‘failed galaxy’ scenario or simply due to the low number of statistics and the presence of outliers. Finally, we attempt to segment our catalogue into different classes using a machine learning K-means method. We find that the clustering is very weak and that it is currently not warranted to split the catalogue into multiple, distinct subpopulations. Our catalogue is available online, and we aim to maintain it beyond the publication of this work.
Strategies for biofilm optimization of plastic-degrading microorganisms and isolating biofilm formers from plastic-contaminated environments
Authors: McFall Adam , Coughlin Scott A , Hardiman Gary , Megaw Julianne
Published: May 2024

The perpetual disposal of plastic waste, combined with ineffective waste management strategies, has resulted in widespread environmental plastic pollution. Microbial plastic biodegradation represents an emerging solution to this problem. However, biodegradation studies tend to overlook the fundamental prerequisite of initial surface colonization via biofilm formation. This study had two independent but connected aims relating to plastic surface colonization by microorganisms: to enhance biofilm formation by known plastic degraders, with translational potential for improved plastic degradation, and to isolate microorganisms from microplastic contaminated environments with the ability to colonize plastic surfaces. Planktonic and biofilm responses to diverse carbon and energy sources were investigated over 7 days, using Bacillus subtilis 168, Fusarium solani (Martius) Saccardo, Ideonella sakaiensis 201-F6, Pseudomonas putida KT2440, and Rhodococcus ruber C208. This enabled optimal conditions for biofilm formation by each strain to be determined. In parallel, environmental samples containing synthetic or natural polymeric substances (anaerobic digestate, landfill leachate, and microplastic contaminated compost) were incubated with polyethylene and polyethylene terephthalate films, to isolate microorganisms capable of colonizing their surfaces. This yielded eight bacterial isolates from three genera: Bacillus, Lysinibacillus, and Proteus. These genera contain species that have been shown to degrade plastics and other recalcitrant synthetic polymers, demonstrating the success of our approach. This study also suggests that discrete plastic types may create different ecological niches which can be exploited by unique bacterial colonizers. Our findings underscore the importance of considering plastic colonization by microbial biofilms in the context of their biodegradation.
Merging Photorefractive Keratectomy and Collagen Crosslinking: An Analysis of Literature and a Guide to Prevalent Protocols
Authors: Moshirfar Majid , Rognon Gregory T. , Olson Nate , Kay Walker , Sperry R. Alek , Ha Seungyeon , Hoopes Phillip C.
Published: May 2024

Purpose:

The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events.

Methods:

A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL.

Results:

Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen's D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively.

Conclusions:

Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.
Prophylactic Therapy for Long-Term Ocular Discomfort After Cataract Surgery
Authors: Di Zazzo Antonio , Spelta Sara , Micera Alessandra , De Gregorio Chiara , Affatato Marzia , Esposito Graziana , Balzamino Bijorn Omar , Sgrulletta Roberto , Coassin Marco , Bonini Stefano
Published: May 2024

Purpose:

The cataract surgery dissatisfaction rate is 20% to 35% due to ocular surface discomfort. We investigate the ocular surface discomfort after surgical failure as a consequence of age-related parainflammation. We also aim to prevent it by immune-modulating prophylactic management.

Methods:

Monocentric clinical trial realized in a teaching hospital. Prospective, randomized, open-label, unmasked clinical trial. One hundred patients diagnosed with cataracts underwent phacoemulsification surgery. Groups A (<65 years; n = 25) and B (>75 years; n = 25) received surgery only. Groups C and D (both >75 years and both n = 25) used cyclosporine A 0.1% cationic emulsion (CE) eye drops or CE lubricating eye drops (both twice daily), respectively, for 30 days before surgery. Patients were followed up 90 days after surgery. The primary outcome was postoperative ocular surface failure; secondary outcomes examined the influence of prophylactic cyclosporine A 0.1% CE therapy on ocular surface outcomes.

Results:

Group B demonstrated greater severity regarding ocular surface signs and symptoms throughout the study period, versus all other groups. Signs/symptoms were typically lower in Group A. Group C achieved significant reductions in conjunctival Symptom Assessment in Dry Eye values (P < 0.05), conjunctival hyperemia severity (P < 0.01), and meibomian gland dysfunction (P < 0.001) at Day 45, versus Group B, and tear break-up time was increased (P < 0.001). Ocular surface inflammatory marker transcription (HLADR, intercellular adhesion molecule 1 [ICAM-1], and interleukin 6 [IL-6]) was significantly downregulated in Group C, versus Group B, at 90 days (P < 0.05).

Conclusions:

Cataract surgery induced ocular surface system failure with a clinically significant persistent inflammatory status (InflammAging) in patients older than 75 years. Prophylactic cyclosporine A 0.1% CE eye drops were associated with improved ocular surface homeostasis and reductions in inflammatory markers.
Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes
Authors: Garcia Marcos , Al-Jaghbeer Mohammed , Morrison James , Boustany Antoine , Ghimire Bindesh , Tapryal Neel , Mushtaq Komal , Orlosky Kelly , Flowers-Surovi Amy , Murphy Christopher , Rath Palak , Rahman Muhaimen , Kickel Corrine , Lee Yu-Che , Chang Ko-Yun , Abi Fadel Francois
Published: May 2024

Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.
Prognostic stratification of patients with pT4bN0M0 colorectal cancer following multivisceral resection: a multi-institutional case series analysis
Authors: Quan Jichuan , Zuo Kai , Li Guoli , Liu Junguang , Mei Shiwen , Hu Gang , Qiu Wenlong , Zhuang Meng , Meng Ling , Wang Xishan , Chang Hu , Tang Jianqiang
Published: May 2024

Background:

Colorectal cancer (CRC) patients with stage pT4b are a complex group as they show differences in tumor-infiltrated organs. Patients with the same stage often exhibit differences in prognosis after multivisceral resection (MVR). Thus far, some important prognostic factors have not been thoroughly investigated. Here, we identified the prognostic factors influencing CRC patients at the pT4bN0M0 stage to stratify the prognostic differences among patients.

Materials and methods:

A retrospective analysis was conducted on patients diagnosed with locally advanced CRC and who underwent MVR at three medical institutions from January 2010 to December 2021. The prognostic factors affecting the survival of CRC patients at pT4bN0M0 stage were identified by multivariate Cox proportional hazard models. We then classified the prognosis into different grades on the basis of these independent prognostic factors.

Results:

We enrolled 690 patients with locally advanced CRC who underwent MVR; of these, 172 patients with pT4bN0M0 were finally included. Patients with digestive system [overall survival (OS): hazard ratio (HR)=0.441; 95% confidence interval (CI)=0.217–0.900; P=0.024; disease-free survival (DFS): HR=0.416; 95% CI=0.218–0.796; P=0.008) or genitourinary system invasion (OS: HR=0.405; 95% CI=0.193–0.851; P=0.017; DFS: HR=0.505; 95% CI=0.267–0.954; P=0.035) exhibited significantly better OS and DFS as compared to those with gynecological system invasion, while the OS and DFS were similar between the digestive system and genitourinary system invasion groups (OS: HR=0.941; 95% CI=0.434–2.042; P=0.878; DFS: HR=1.211; 95% CI=0.611–2.403; P=0.583). Multivariate analysis showed that age (OS: HR=2.121; 95% CI=1.157–3.886; P=0.015; DFS: HR=1.869; 95% CI=1.116–3.131; P=0.017) and type of organs invaded by CRC (OS: HR=3.107; 95% CI=1.121–8.609; P=0.029; DFS: HR=2.827; 95% CI=1.142–6.997; P=0.025) were the independent prognostic factors that influenced the OS and DFS of CRC patients with pT4bN0M0 disease. The OS and DFS of patients showing invasion of the gynecological system group were significantly worse (P=0.004 and P=0.003, respectively) than those of patients with invasion of the nongynecological system group. On the basis of the above-mentioned two independent prognostic factors, patients were assigned to high-risk, medium-risk, and low-risk groups. Subgroup analysis showed that the OS and DFS of the medium-risk and high-risk groups were significantly worse (P=0.001 and P=0.001, respectively) than those of the low-risk group.

Conclusion:

Patients with pT4bN0M0 CRC show significant differences in their prognosis. The type of organs invaded by CRC is a valuable indicator for prognostic stratification of CRC patients with pT4bN0M0.
Efficacy of different strategies for reducing labor pain: A Bayesian analysis
Authors: Feng Yuanyan , Zhu Fengjuan , Zhang Junfeng , Zeng Zishan , Li Qiumei
Published: May 2024

Background:

The effectiveness of different medical interventions in managing labor pain has yielded mixed results. Therefore, this systematic review and network meta-analysis aimed to provide a comprehensive summary of the available evidence on the impact of different strategies for reducing labor pain.

Methods:

We systematically searched 3 English databases (Pubmed, Embase and the Cochrane Library) from inception to January 2023. Randomized controlled trials (RCTs) or controlled clinical trials that investigating the effects of different strategies for reducing labor pain were included in this network meta-analysis. Risk of bias (ROB) was assessed using the Cochrane ROB tools. Network meta-analysis was performed using the R software (version 4.2.1) with gemtc package.

Results:

A total of 9 studies involving 823 patients, including 9 treatments (acupressure, birth ball exercise, Bonapace method, distraction techniques, ice pressure, LI4 acupressure, lidocaine spray, smartphone-based music intervention and placebo). The surface under the cumulative ranking (SUCRA) shows that Bonapace method ranked first (SUCRA, 79.5%), LI4 acupressure ranked second (SUCRA, 65.6%), distraction technique ranked third (SUCRA, 57.6%), birth ball exercise ranked fourth (SUCRA, 51.8%).

Conclusions:

According to the results of the network meta-analysis, among the different strategies examined, the Bonapace Method stands out as the most effective nonpharmacological intervention for reducing labor pain. The results of this meta-analysis can aid both patients and healthcare professionals in choosing the most effective techniques to reduce labor pain.
Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus
Authors: Ayrout Ramah Abdo , Kookash Majd Hatem , Kalalib Al Ashabi Khaled , Safiah Mhd Homam , Latifeh Youssef
Published: May 2024

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.
Prediction of severe preeclampsia and intrauterine growth restriction based on serum placental exosome miR-520a-5p levels during the first-trimester
Authors: Xu Xin-Ran , Cheng Lan , Wang Yan-Ping
Published: May 2024

Background:

To assess the predictive capabilities of serum exosomal levels of micro-RNA-520a-5p (miR-520a-5p) concerning the occurrence of severe preeclampsia (sPE) and fetal growth restriction (FGR) during the first trimester of pregnancy.

Methods:

During the period spanning from October 2020 to October 2021, serum samples were procured from the first trimester and subsequently preserved by freezing at −80 ℃. These samples were obtained from 105 pregnant women in a nested case–control study. This cohort consisted of individuals who later developed sPE (sPE group, n = 35) and FGR (FGR group, n = 35) during the third trimester. Additionally, 35 women with normal blood pressure were denoted as normal pregnancy group. Serum samples from the first trimester were retrieved from all groups for further analysis after thawing. Exosomes were extracted from the serum samples collected during the first trimester and examined using transmission electron microscopy, western blot, and nanoparticle tracking analysis. Additionally, the determination of their placental origin was also established during the course of the study. Exosome miR-520a-5p levels were measured using real-time quantitative polymerase chain reaction assays, primarily involving quantitative reverse transcription polymerase chain reactions. Fetal placental tissues from the 3 groups were collected shortly after birth, and miR-520a-5p expression was measured using real-time quantitative polymerase chain reaction. Serum placental exosomes and fetal placental tissues were compared for miR-520a-5p levels. Placental trophoblasts were identified as the source of serum exosomes in all 3 groups.

Results:

It was found that serum placental exosomes exhibited lower levels of miR-520a-5p in both the sPE and FGR groups when compared to the normal pregnancy group. This finding was consistent with observations made in postpartum placental tissues. The predictive accuracy for sPE using miR-520a-5p levels in serum placental exosomes during the first trimester was notably higher (area under the receiver operating characteristic curve = 0.806, P <.05) compared to the prediction of FGR (area under the receiver operating characteristic curve = 0.628, P <.05).

Conclusion:

Placenta-derived exosomes can be extracted from maternal serum during the first trimester of pregnancy and miR-520a-5p detected from the exosomes. The downregulation of miR-520a-5p serves as a more predictive indicator for the subsequent development of sPE compared to predicting FGR.
Association of serum 25-hydroxyvitamin D levels, vitamin D-binding protein levels, and diabetes mellitus: Two-sample Mendelian randomization
Authors: Zhao Xu , Li Bo , Li Xiao , Ding Yan , Zhang Yi
Published: May 2024

Studies have suggested that Vitamin D deficiency is associated with the occurrence of both type 1 and type 2 diabetes, and that vitamin D-binding proteins (VDBP) are necessary for metabolic stress in pancreatic α-cells. However, the causal relationship between serum 25-hydroxyvitamin D [25(OH)D] levels, VDBP, and the risk of diabetes mellitus (DM) remains unclear. Mendelian randomization (MR) was used to investigate the causal relationship between 25(OH)D, VDBP, and DM. Relevant recent data were downloaded from the NHGRI-EBI Catalog of published genome-wide association studies (GWAS) and filtered for single nucleotide polymorphisms (SNPs). We used multiple MR methods, including inverse variance weighting (IVW), and performed sensitivity analyses to detect whether pleiotropy or heterogeneity biased the results. There was a causal relationship between genetically predicted VDBP levels and serum 25(OH)D levels, and serum 25(OH)D levels increased with increasing VDBP levels (IVW: β = 0.111, OR = 1.117, 95% CI:1.076–1.162, P = 1.41 × 10-8). There was no causal relationship between the genetically predicted VDBP levels, serum 25(OH)D levels, and DM (VDBP: IVW β:0.001, OR:1.001, 95% CI:0.998–1.003, P > .05; 25(OH)D: IVW β: −0.009, OR:0.991, 95% CI:0.982–1.001, P = .068). Sensitivity analysis indicated that horizontal pleiotropy was unlikely to bias causality in this study. MR analysis results demonstrated a positive causal relationship between VDBP levels and serum 25(OH)D levels in the European population. The 25(OH)D and VDBP levels were not causally related to an increased risk of diabetes.
A Prospective Study of the Diagnostic Performance of Photon-Counting CT Compared With MRI in the Characterization of Renal Masses
Authors: Homayounieh Fatemeh , Gopal Nikhil , Firouzabadi Fatemeh Dehghani , Sahbaee Pooyan , Yazdian Pouria , Nikpanah Moozhan , Do Michael , Wang Muyang , Gautam Rabindra , Ball Mark W. , Pritchard William F. , Jones Elizabeth C. , Wen Han , Linehan W. Marston , Turkbey Evrim B. , Malayeri Ashkan A.
Published: May 2024

Objectives

The aim of this study was to assess the interreader reliability and per-RCC sensitivity of high-resolution photon-counting computed tomography (PCCT) in the detection and characterization of renal masses in comparison to MRI.

Materials and Methods

This prospective study included 24 adult patients (mean age, 52 ± 14 years; 14 females) who underwent PCCT (using an investigational whole-body CT scanner) and abdominal MRI within a 3-month time interval and underwent surgical resection (partial or radical nephrectomy) with histopathology (n = 70 lesions). Of the 24 patients, 17 had a germline mutation and the remainder were sporadic cases. Two radiologists (R1 and R2) assessed the PCCT and corresponding MRI studies with a 3-week washout period between reviews. Readers recorded the number of lesions in each patient and graded each targeted lesion's characteristic features, dimensions, and location. Data were analyzed using a 2-sample t test, Fisher exact test, and weighted kappa.

Results

In patients with von Hippel–Lindau mutation, R1 identified a similar number of lesions suspicious for neoplasm on both modalities (51 vs 50, P = 0.94), whereas R2 identified more suspicious lesions on PCCT scans as compared with MRI studies (80 vs 56, P = 0.12). R1 and R2 characterized more lesions as predominantly solid in MRIs (R1: 58/70 in MRI vs 52/70 in PCCT, P < 0.001; R2: 60/70 in MRI vs 55/70 in PCCT, P < 0.001). R1 and R2 performed similarly in detecting neoplastic lesions on PCCT and MRI studies (R1: 94% vs 90%, P = 0.5; R2: 73% vs 79%, P = 0.13).

Conclusions

The interreader reliability and per-RCC sensitivity of PCCT scans acquired on an investigational whole-body PCCT were comparable to MRI scans in detecting and characterizing renal masses.

Clinical Relevance Statement

PCCT scans have comparable performance to MRI studies while allowing for improved characterization of the internal composition of lesions due to material decomposition analysis. Future generations of this imaging modality may reveal additional advantages of PCCT over MRI.
Bacterial Colonization on Endoscopic Materials and Surgical Field Without Infections After Transoral Endoscopic Thyroidectomy
Authors: Zhang Daqi , Sun Hui , Kim Hoon Yub , Chai Young Jun , Tufano Ralph P. , Wu Che-Wei , Pino Antonella , Anuwong Angoon , Dionigi Gianlorenzo
Published: May 2024

Introduction:

Our aim was to determine whether bacteria contamination occurred within the surgical field or on endoscopic equipment during surgery using the transoral endoscopic thyroidectomy vestibular approach (TOETVA).

Materials and Methods:

Participants were recruited from patients planned for TOETVA between May 2017 and December 2019. Bacterial samples were taken before and at the conclusion of the TOETVA procedure. The preoperative and postoperative samples were taken from the endoscopic materials and inferior oral vestibulum using a sterile flocked swab.

Results:

The study resulted in 480 samples (80 TOETVAs). No vestibular, port site, or neck infections occurred in any of the patients. Three (3.7%) out of 80 patients developed postoperative fever. Our results show different microbial communities during TOETVA. The most prevalent species detected were Streptococcus species. Multivariate logistic regression analyses revealed that the degree of contamination depended on the sampling site (inferior vestibulum > equipment) (P=0.03). In addition, the abundance of bacteria was affected by operative time (P=0.013). There were no significant differences observed in isolation frequencies of bacteria in malignancy (P=0.34).

Conclusions:

TOETVA surgery is categorized as a “clean-contaminated” operation. A swab identified the common colonizers of oral microbiota on the endoscopic equipment and within the surgical field.