bluuebunny/crossref_metadata_2025 huggingface dataset:
A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics
Authors: Hoover Leslie A. , Holstine Jessica B. , Williamson Jayme , Samora Julie B.
Published: August 2023

Background:

Bullying annually affects 20%–25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months.

Methods:

Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5–18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners.

Results:

The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health.

Conclusions:

Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.
Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease
Authors: Astles Rachel , Liu Zihao , Gillespie Scott E. , Lai Kristina W. , Maillis Alexander , Morris Claudia R. , Lane Peter A. , Krishnamurti Lakshmanan , Bakshi Nitya
Published: August 2023

Introduction/Objective:

Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED).

Methods:

Retrospective review of electronic health records from a large, multicampus, pediatric SCD program.

Results:

Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED.

Conclusion:

Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis
Authors: Lee Yu-Lin , Hsueh Po-Ren
Published: August 2023

Purpose of review

This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens,Stenotrophomonas maltophiliaandElizabethkingia anophelis.

Recent findings

Since 2020, numerous outbreaks ofS. maltophiliaandE. anophelishave been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused byE. anophelisin France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy againstS. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results inin vitrosusceptibility testing. ForE. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourablein vitrosusceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) againstE. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported.

Immunocompromised patients are particularly vulnerable to infections caused byS. maltophiliaandE. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
Surgical management of cystic echinococcosis of the liver
Authors: Berto Cesar G. , Liou Peter , Coyle Christina M. , Emond Jean C.
Published: August 2023

Purpose of review

Cystic echinococcosis is a zoonotic infection frequently involving the liver. Treatment options, including surgery, are decided based on the staging of the disease.

Recent findings

Ultrasound is the cornerstone for diagnosis, staging, and follow-up of cystic echinococcosis. MRI can help to evaluate for cystobiliary complications and planning of the surgery. The two main surgical approaches for cystic echinococcosis include a radical approach, which entails a partial hepatectomy and total pericystectomy, and a conservative approach or endocystectomy. Recent data suggest a conservative approach is well tolerated with acceptable morbidity and no mortality. Recurrences in centers with experience are rare. Data on laparoscopic surgery is emerging, but long-term follow-up still needs to be improved.

Surgical treatment options should be carefully evaluated according to the cystic echinococcosis disease staging. A multidisciplinary approach, including diagnostic and interventional radiology, abdominal and liver surgery, and infectious diseases, results in better outcomes.
Intra-aortic balloon pump reduces 30-day mortality in early stage cardiogenic shock complicating acute myocardial infarction according to SCAI classification
Authors: Luo Da , Huang Rihong , Wang Xiaoying , Zhang Jing , Cai Xinyong , Liu Fuyuan , Lei Yuhua , Li Dongsheng , Zhou Wenjie , Xu Changwu , Huang Bing , Jiang Hong , Chen Jing
Published: August 2023

Background

Cardiogenic shock complicating acute myocardial infarction (AMICS) remains a high 30-day mortality. Mechanical circulatory support devices are increasingly used in AMICS, but their effects on mortality vary partly due to shock severity.

Aims

This study aimed to evaluate the association between intra-aortic balloon pump (IABP) and 30-day mortality in patients with early stage AMICS.

Methods

We retrospectively analyzed patients with ST-segment elevation myocardial infarction (STEMI) based on a multicenter clinical trial (NCT04996901). Patients were stratified by IABP use and shock severity was classified according to the Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK stages. The primary outcome was 30-day all-cause mortality. The association between IABP and 30-day mortality was evaluated across shock stages using propensity score matching, weighting, and logistic regression.

Results

5343 patients were included and 299 received IABP. SCAI SHOCK stage was associated with 30-day mortality (OR 20.19, 95%CI 13.60-29.97, P < 0.001). In the 580 matched patients, a significant interaction between IABP and 30-day mortality at different shock stages was observed (P = 0.005). IABP was associated with lower 30-day mortality among patients with shock stage A/B (5.8% vs. 1.2%, OR 0.19, 95%CI 0.03-0.73, P = 0.034) but not stage C/D/E (29.3% vs. 38.1%, OR 1.49, 95%CI 0.84-2.65, P = 0.172). These results were confirmed by sensitivity analyses of the weighted cohort.

Conclusions

IABP reduced 30-day mortality in patients with early stage AMICS. The SCAI SHOCK stage provides risk stratification for patients with STEMI and helps identify those who may respond well to IABP.
EXTRACELLULAR CIRP INHIBITS NEUTROPHIL APOPTOSIS TO PROMOTE ITS AGING BY UPREGULATING SERPINB2 IN SEPSIS
Authors: Shimizu Junji , Murao Atsushi , Aziz Monowar , Wang Ping
Published: August 2023

Background:Sepsis reduces neutrophil apoptosis. As the result, neutrophils may become aged, exacerbating inflammation and tissue injury. Extracellular cold-inducible RNA-binding protein (eCIRP) acts as a damage-associated molecular pattern to promote inflammation and tissue injury in sepsis. SerpinB2, a serine protease inhibitor, has been shown to inhibit apoptosis. We hypothesize that eCIRP upregulates SerpinB2 to promote aged neutrophil subset by inhibiting apoptosis in sepsis.Methods:We stimulated bone marrow–derived neutrophils (BMDNs) of wild-type (WT) mice with 1 μg/mL of recombinant mouse CIRP (i.e., eCIRP) and assessed cleaved caspase-3 and SerpinB2 by western blotting. Apoptotic neutrophils were assessed by Annexin V/PI. Bone marrow–derived neutrophils were stimulated with 1 μg/mL eCIRP and treated with or without PAC-1 (caspase-3 activator) and aged neutrophils (CXCR4hiCD62Llo) were assessed by flow cytometry. To induce sepsis, we performed cecal ligation and puncture in WT or CIRP−/−mice. We determined the percentage of aged neutrophils and SerpinB2+neutrophils in blood and spleen by flow cytometry.Results:We found that cleaved caspase-3 levels were increased at 4 h of PBS treatment compared with 0 h but decreased by eCIRP treatment. Extracellular cold-inducible RNA-binding protein reduced apoptotic cells after 20 h of treatment. Extracellular cold-inducible RNA-binding protein also increased the frequencies of aged neutrophils compared with PBS after 20 h, while PAC-1 treatment reduced aging in eCIRP-treated BMDNs. Extracellular cold-inducible RNA-binding protein significantly increased the expression of SerpinB2 at protein levels in BMDNs at 20 h. In WT mice, the frequencies of aged and SerpinB2+neutrophils in blood and spleen were increased after 20 h of cecal ligation and puncture, while in CIRP−/−mice, aged and SerpinB2+neutrophils were significantly decreased compared with WT mice. We also found that aged neutrophils expressed significantly higher levels of SerpinB2 compared with non-aged neutrophils.Conclusions:eCIRP inhibits neutrophil apoptosis to increase aged phenotype by increasing SerpinB2 expression in sepsis. Thus, targeting eCIRP could be a new therapeutic strategy to ameliorate inflammation caused by neutrophil aging in sepsis.
The Compensatory Reserve Index for Predicting Hemorrhagic Shock in Prehospital Trauma
Authors: Latimer Andrew J. , Counts Catherine R. , Van Dyke Molly , Bulger Natalie , Maynard Charles , Rea Thomas D. , Kudenchuk Peter J. , Utarnachitt Richard B. , Blackwood Jennifer , Arbabi Saman , Sayre Michael R.
Published: August 2023

Background

The compensatory reserve index (CRI) is a noninvasive, continuous measure designed to detect intravascular volume loss. CRI is derived from the pulse oximetry waveform and reflects the proportion of physiologic reserve remaining before clinical hemodynamic decompensation.

Methods

In this prospective, observational, prehospital cohort study, we measured CRI in injured patients transported by Emergency Medical Services (EMS) to a single Level I trauma center. We determined whether the rolling average of CRI values over 60 seconds (CRI trend [CRI-T]) predicts in-hospital diagnosis of hemorrhagic shock, defined as blood product administration in the prehospital setting or within four hours of hospital arrival. We hypothesized that lower CRI-T values would be associated with an increased likelihood of hemorrhagic shock and better predict hemorrhagic shock than prehospital vital signs.

Results

Prehospital CRI was collected on 696 adult trauma patients, 21% of whom met our definition of hemorrhagic shock. The minimum CRI-T was 0.14 (Interquartile range (IQR) 0.08-0.31) in those with hemorrhagic shock and 0.31 (IQR 0.15-0.50) in those without (p = <0.0001). The positive likelihood ratio of a CRI-T value <0.2 predicting hemorrhagic shock was 1.85 (95% CI 1.55-2.22). The area under the ROC curve (AUC) for the minimum CRI-T predicting hemorrhagic shock was 0.65 (95% confidence interval (CI) 0.60-0.70), which outperformed initial prehospital HR (0.56 [95% CI 0.50-0.62]) but underperformed EMS systolic blood pressure and shock index (0.74 [95% CI 0.70-0.79] and 0.72 [95% CI 0.67-0.77] respectively).

Conclusions

Low prehospital CRI-T predicts blood product transfusion by EMS or within four hours of hospital arrival but is less prognostic than EMS blood pressure or shock index. The evaluated version of CRI may be useful in an austere setting at identifying injured patients that require the most significant medical resources. CRI may be improved with noise filtering to attenuate the effects of vibration and patient movement.
Efficacy of supplemental hemoadsorption therapy on severe and critical patients with COVID-19: an evidence-based analysis
Authors: He Junbing , Lin Yao , Cai Weiming , Lin Yingying , Qin Wanbing , Shao Yiming , Liu Qinghua
Published: August 2023

Background

The COVID-19 pandemic has posed a disproportionately high threat to the global health system and social stability. COVID-19 damage can lead to hyperinflammation and tissue damage due to a "cytokine storm", which in turn contributes to an increase in the mortality rate. Extracorporeal hemoadsorption therapy (HAT) in patients with severe COVID-19 may improve organ function and stabilize hemodynamic status; however, the effects of supplemental HAT remain controversial.

Methods

The Cochrane Library, Embase and PubMed databases were comprehensively searched from inception to August 20, 2022 for potential studies.

Results

A total of 648 patients with severe COVID-19 in 3 randomized controlled trials and 11 observational studies met the inclusion criteria. A meta-analysis indicated that supplemental HAT significantly improved the mortality rate of patients with severe COVID-19 compared with conventional therapy (CT) (RR = 0.74, 95% CI: [0.56, 0.96], P = 0.026). In subgroup analyses, supplemental HAT significantly decreased mortality rates in patients without extracorporeal membrane oxygenation (ECMO) support (RR = 0.59, 95% CI: [0.44, 0.79], P < 0.0001), while a significant difference was not observed in patients requiring ECMO support (RR = 1.61, 95% CI: [0.63, 4.09], P = 0.316). Standardized mean difference (SMD) meta-analysis showed that IL-6 removal was more significant in HAT group than CT group (SMD = 0.46, 95% CI: [0.01, 0.91], P = 0.043), followed by CRP (SMD = 0.70, 95% CI: [-0.04, 1.44], P = 0.065) and IL-8 (SMD = 0.36, 95% CI: [-0.34, 1.07], P = 0.311). No evidence of substantial publication bias concerning mortality was observed.

Conclusion

Given the better mortality outcomes, HAT confers clinical benefits to patients with severe COVID-19, which correlated with cytokine removal by HAT. Cytokine adsorption may not provide clinical benefits for patients with severe COVID-19 requiring ECMO and should be used with caution. However, due to the very low quality of evidence, multicenter randomized trials with large sample sizes are required to verify these findings.
Treatment with human umbilical cord-derived mesenchymal stem cells in a pig model of sepsis-induced acute kidney injury: effects on microvascular endothelial cells and tubular cells in the kidney
Authors: Ramos Maia Débora Rothstein , Otsuki Denise Aya , Rodrigues Camila Eleutério , Zboril Sabrina , Sanches Talita Rojas , Neto Amaro Nunes Duarte , Andrade Lúcia , Auler José Otávio Costa
Published: August 2023

Background

Approximately 50% of patients with sepsis develop acute kidney injury (AKI), which is predictive of poor outcomes, with mortality rates of up to 70%. The endothelium is a major target for treatments aimed at preventing the complications of sepsis. We hypothesized that human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) could attenuate tubular and endothelial injury in a porcine model of sepsis-induced AKI.

Methods

Anesthetized pigs were induced to fecal peritonitis, resulting in septic shock, and were randomized to treatment with fluids, vasopressors, and antibiotics (sepsis group; n = 11) or to that same treatment plus infusion of 1 × 106 cells/kg of hUC-MSCs (sepsis+MSC group; n = 11).

Results

At 24 h after sepsis induction, changes in serum creatinine and mean arterial pressure were comparable between the two groups, as was mortality. However, the sepsis+MSC group showed some significant differences in comparison with the sepsis group: lower fractional excretions of sodium and potassium; greater epithelial sodium channel protein expression; and lower protein expression of the Na-K-2Cl cotransporter and aquaporin 2 in the renal medulla. Expression of P-selectin, thrombomodulin, and vascular endothelial growth factor was significantly lower in the sepsis+MSC group than in the sepsis group, whereas that of Toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-κB) was lower in the former.

Conclusion

Treatment with hUC-MSCs seems to protect endothelial and tubular cells in sepsis-induced AKI, possibly via the TLR4/NF-κB signaling pathway. Therefore, it might be an effective treatment for sepsis-induced AKI.
Remote burn injury in aged mice induces colonic lymphoid aggregate expansion and dysbiosis of the fecal microbiome which correlates with neuroinflammation
Authors: Walrath Travis , Najarro Kevin M. , Giesy Lauren E. , Khair Shanawaj , Frank Daniel N. , Robertson Charles E. , Orlicky David J. , Quillinan Nidia , Idrovo Juan-Pablo , McMahan Rachel H. , Kovacs Elizabeth J.
Published: August 2023

The Earth’s population is aging and, by 2050, 1 out of 6 people will be 65 or older. Therefore, proper treatment of injuries that disproportionately impact people of advanced age will be more important. Clinical studies reveal people aged ≥65 account for 16.5% of all burn injuries, and experience higher morbidity, including neurocognitive decline, and mortality that we and others believe are mediated, in part, by heightened intestinal permeability. Herein we used our clinically relevant model of scald burn injury in young and aged mice to determine whether age and burn injury cooperate to induce heightened colonic damage, alterations to the fecal microbiome, and whether resultant changes in the microbiome correlate with neuroinflammation. We found that aged, burn injured mice have an increase in colonic lymphoid aggregates, inflammation, and pro-inflammatory chemokine expression when compared to young groups and sham injured aged mice. We then performed fecal microbiota sequencing and found a striking reduction in gut protective bacterial taxa, includingAkkermansia, in the aged burn group compared to all other groups. This reduction correlated with an increase in serum FITC-dextran administered by gavage, indicating heightened intestinal permeability. Further, loss ofAkkermansiawas highly correlated with increased mRNA expression of neuroinflammatory markers in the brain, includingccl2, tnfa, cxcl1,ands100a8.Finally, we discovered that post-burn alterations in the microbiome correlated with measures of strength in all treatment groups, and those that performed better on the rotarod and hanging wire tests had higher abundance ofAkkermansiathan those that performed worse. Taken together, these findings indicate that loss of protective bacteria after burn injury in aged mice contributes to alterations in the colon, gut leakiness, neuroinflammation, and strength. Therefore, supplementation of protective bacteria, such asAkkermansia, after burn injury in aged patients may have therapeutic benefit.
How the brain controls decision making in a multisensory world
Authors: Fetsch Christopher R. , Noppeney Uta
Published: August 2023

Sensory systems evolved to provide the organism with information about the environment to guide adaptive behaviour. Neuroscientists and psychologists have traditionally considered each sense independently, a legacy of Aristotle and a natural consequence of their distinct physical and anatomical bases. However, from the point of view of the organism, perception and sensorimotor behaviour are fundamentally multi-modal; after all, each modality provides complementary information about the same world. Classic studies revealed much about where and how sensory signals are combined to improve performance, but these tended to treat multisensory integration as a static, passive, bottom-up process. It has become increasingly clear how this approach falls short, ignoring the interplay between perception and action, the temporal dynamics of the decision process and the many ways by which the brain can exert top-down control of integration. The goal of this issue is to highlight recent advances on these higher order aspects of multisensory processing, which together constitute a mainstay of our understanding of complex, natural behaviour and its neural basis.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Self-motion perception and sequential decision-making: where are we heading?
Authors: Jerjian Steven J. , Harsch Devin R. , Fetsch Christopher R.
Published: August 2023

To navigate and guide adaptive behaviour in a dynamic environment, animals must accurately estimate their own motion relative to the external world. This is a fundamentally multisensory process involving integration of visual, vestibular and kinesthetic inputs. Ideal observer models, paired with careful neurophysiological investigation, helped to reveal how visual and vestibular signals are combined to support perception of linear self-motion direction, or heading. Recent work has extended these findings by emphasizing the dimension of time, both with regard to stimulus dynamics and the trade-off between speed and accuracy. Both time and certainty—i.e. the degree of confidence in a multisensory decision—are essential to the ecological goals of the system: terminating a decision process is necessary for timely action, and predicting one's accuracy is critical for making multiple decisions in a sequence, as in navigation. Here, we summarize a leading model for multisensory decision-making, then show how the model can be extended to study confidence in heading discrimination. Lastly, we preview ongoing efforts to bridge self-motion perception and navigationper se, including closed-loop virtual reality and active self-motion. The design of unconstrained, ethologically inspired tasks, accompanied by large-scale neural recordings, raise promise for a deeper understanding of spatial perception and decision-making in the behaving animal.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Visuo-vestibular heading perception: a model system to study multi-sensory decision making
Authors: Zeng Zhao , Zhang Ce , Gu Yong
Published: August 2023

Integrating noisy signals across time as well as sensory modalities, a process named multi-sensory decision making (MSDM), is an essential strategy for making more accurate and sensitive decisions in complex environments. Although this field is just emerging, recent extraordinary works from different perspectives, including computational theory, psychophysical behaviour and neurophysiology, begin to shed new light onto MSDM. In the current review, we focus on MSDM by using a model system of visuo-vestibular heading. Combining well-controlled behavioural paradigms on virtual-reality systems, single-unit recordings, causal manipulations and computational theory based on spiking activity, recent progress reveals that vestibular signals contain complex temporal dynamics in many brain regions, including unisensory, multi-sensory and sensory-motor association areas. This challenges the brain for cue integration across time and sensory modality such as optic flow which mainly contains a motion velocity signal. In addition, new evidence from the higher-level decision-related areas, mostly in the posterior and frontal/prefrontal regions, helps revise our conventional thought on how signals from different sensory modalities may be processed, converged, and moment-by-moment accumulated through neural circuits for forming a unified, optimal perceptual decision.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Multisensory integration in the mammalian brain: diversity and flexibility in health and disease
Authors: Choi Ilsong , Demir Ilayda , Oh Seungmi , Lee Seung-Hee
Published: August 2023

Multisensory integration (MSI) occurs in a variety of brain areas, spanning cortical and subcortical regions. In traditional studies on sensory processing, the sensory cortices have been considered for processing sensory information in a modality-specific manner. The sensory cortices, however, send the information to other cortical and subcortical areas, including the higher association cortices and the other sensory cortices, where the multiple modality inputs converge and integrate to generate a meaningful percept. This integration process is neither simple nor fixed because these brain areas interact with each other via complicated circuits, which can be modulated by numerous internal and external conditions. As a result, dynamic MSI makes multisensory decisions flexible and adaptive in behaving animals. Impairments in MSI occur in many psychiatric disorders, which may result in an altered perception of the multisensory stimuli and an abnormal reaction to them. This review discusses the diversity and flexibility of MSI in mammals, including humans, primates and rodents, as well as the brain areas involved. It further explains how such flexibility influences perceptual experiences in behaving animals in both health and disease.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Conserved features of eye movement related eardrum oscillations (EMREOs) across humans and monkeys
Authors: Lovich Stephanie N. , King Cynthia D. , Murphy David L. K. , Abbasi Hossein , Bruns Patrick , Shera Christopher A. , Groh Jennifer M.
Published: August 2023

Auditory and visual information involve different coordinate systems, with auditory spatial cues anchored to the head and visual spatial cues anchored to the eyes. Information about eye movements is therefore critical for reconciling visual and auditory spatial signals. The recent discovery of eye movement-related eardrum oscillations (EMREOs) suggests that this process could begin as early as the auditory periphery. How this reconciliation might happen remains poorly understood. Because humans and monkeys both have mobile eyes and therefore both must perform this shift of reference frames, comparison of the EMREO across species can provide insights to shared and therefore important parameters of the signal. Here we show that rhesus monkeys, like humans, have a consistent, significant EMREO signal that carries parametric information about eye displacement as well as onset times of eye movements. The dependence of the EMREO on the horizontal displacement of the eye is its most consistent feature, and is shared across behavioural tasks, subjects and species. Differences chiefly involve the waveform frequency (higher in monkeys than in humans) and patterns of individual variation (more prominent in monkeys than in humans), and the waveform of the EMREO when factors due to horizontal and vertical eye displacements were controlled for.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Multisensory perception constrains the formation of object categories: a review of evidence from sensory-driven and predictive processes on categorical decisions
Authors: Newell F. N. , McKenna E. , Seveso M. A. , Devine I. , Alahmad F. , Hirst R. J. , O'Dowd A.
Published: August 2023

Although object categorization is a fundamental cognitive ability, it is also a complex process going beyond the perception and organization of sensory stimulation. Here we review existing evidence about how the human brain acquires and organizes multisensory inputs into object representations that may lead to conceptual knowledge in memory. We first focus on evidence for two processes on object perception, multisensory integration of redundant information (e.g. seeing and feeling a shape) and crossmodal, statistical learning of complementary information (e.g. the ‘moo’ sound of a cow and its visual shape). For both processes, the importance attributed to each sensory input in constructing a multisensory representation of an object depends on the working range of the specific sensory modality, the relative reliability or distinctiveness of the encoded information and top-down predictions. Moreover, apart from sensory-driven influences on perception, the acquisition of featural information across modalities can affect semantic memory and, in turn, influence category decisions. In sum, we argue that both multisensory processes independently constrain the formation of object categories across the lifespan, possibly through early and late integration mechanisms, respectively, to allow us to efficiently achieve the everyday, but remarkable, ability of recognizing objects.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Multisensory causal inference is feature-specific, not object-based
Authors: Badde Stephanie , Landy Michael S. , Adams Wendy J.
Published: August 2023

Multisensory integration depends on causal inference about the sensory signals. We tested whether implicit causal-inference judgements pertain to entire objects or focus on task-relevant object features. Participants in our study judged virtual visual, haptic and visual–haptic surfaces with respect to two features—slant and roughness—against an internal standard in a two-alternative forced-choice task. Modelling of participants' responses revealed that the degree to which their perceptual judgements were based on integrated visual–haptic information varied unsystematically across features. For example, a perceived mismatch between visual and haptic roughness would not deter the observer from integrating visual and haptic slant. These results indicate that participants based their perceptual judgements on a feature-specific selection of information, suggesting that multisensory causal inference proceeds not at the object level but at the level of single object features.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
The role of conflict processing in multisensory perception: behavioural and electroencephalography evidence
Authors: Marly Adrià , Yazdjian Arek , Soto-Faraco Salvador
Published: August 2023

To form coherent multisensory perceptual representations, the brain must solve a causal inference problem: to decide if two sensory cues originated from the same event and should be combined, or if they came from different events and should be processed independently. According to current models of multisensory integration, during this process, the integrated (common cause) and segregated (different causes) internal perceptual models are entertained. In the present study, we propose that the causal inference process involves competition between these alternative perceptual models that engages the brain mechanisms of conflict processing. To test this hypothesis, we conducted two experiments, measuring reaction times (RTs) and electroencephalography, using an audiovisual ventriloquist illusion paradigm with varying degrees of intersensory disparities. Consistent with our hypotheses, incongruent trials led to slower RTs and higher fronto-medial theta power, both indicative of conflict. We also predicted that intermediate disparities would yield slower RTs and higher theta power when compared to congruent stimuli and to large disparities, owing to the steeper competition between causal models. Although this prediction was only validated in the RT study, both experiments displayed the anticipated trend. In conclusion, our findings suggest a potential involvement of the conflict mechanisms in multisensory integration of spatial information.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Different types of uncertainty in multisensory perceptual decision making
Authors: Aston Stacey , Nardini Marko , Beierholm Ulrik
Published: August 2023

Efficient decision-making requires accounting for sources of uncertainty (noise, or variability). Many studies have shown how the nervous system is able to account for perceptual uncertainty (noise, variability) that arises from limitations in its own abilities to encode perceptual stimuli. However, many other sources of uncertainty exist, reflecting for example variability in the behaviour of other agents or physical processes. Here we review previous studies on decision making under uncertainty as a function of the different types of uncertainty that the nervous system encounters, showing that noise that is intrinsic to the perceptual system can often be accounted for near-optimally (i.e. not statistically different from optimally), whereas accounting for other types of uncertainty can be much more challenging. As an example, we present a study in which participants made decisions about multisensory stimuli with both intrinsic (perceptual) and extrinsic (environmental) uncertainty and show that the nervous system accounts for these differently when making decisions: they account for internal uncertainty but under-account for external. Human perceptual systems may be well equipped to account for intrinsic (perceptual) uncertainty because, in principle, they have access to this. Accounting for external uncertainty is more challenging because this uncertainty must be learned.

This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Profiling abuse and neglect of women with disabilities: a step towards prevention of mistreatment of vulnerable populations
Authors: Savard Josephine , Gavriilidis Georgios , Lindblad Anna , Huang Jesse , Adzemovic Milena Zeitelhofer
Published: August 2023

Women with disabilities are at increased risk of violence and neglect, and the physical and psychological barriers to seeking help often lead to prolonged periods of abuse. In addition to being a leading cause of acute injuries and numerous chronic diseases, exposure to violence also negatively affects mental health.

In this cross-sectional quantitative data analysis on experiences of violence among women with physical disabilities resulting from cerebral palsy (CP), multiple sclerosis (MS), traumatic brain injury (TBI), stroke and arthritis, a high prevalence of abuse and neglect can be confirmed. These groups were also compared with women who have visual- and hearing impairment. We could observe that type of mistreatment, perpetrators and required personal assistance differ between disability groups. Interestingly, the highest frequency of abuse was observed among women with hearing impairment, including number of ongoing incidences at the time of response. Moreover, denial of help with basic needs or prevented use of assistive devices was again more commonly associated with hearing impairment but also with MS. Since it has been shown that hearing impairment is related to the risk for cognitive decline and one of the greatest risks for dementia, it is tempting to speculate that cognitive impairment may not only enhance but pose a higher risk factor for abuse than physical disability itself, hence calling for further research and more targeted interventions to prevent violence and support victims among women with disabilities.
Maternal Postpartum Stress Scale: Translation and validation study of the Chinese version
Authors: Wang Yanchi , Gao Qian , Liu Jin , Zhang Feng , Xu Xujuan
Published: August 2023

Objective

This study aimed to translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women.

Methods

A total of 406 postpartum women were recruited from 6 hospitals in Nantong, Jiangsu, China. Cronbach’s α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postpartum Depression Scale (EPDS), the anxiety subscale of the Depression-Anxiety-Stress Scale (DASS-21) and the Perceived Stress Scale (PSS-10) were used as calibration scales to measure the correlation of MPSS.

Results

The Cronbach’s α co-efficient of the Chinese version of MPSS was 0.940 and the Cronbach’s α co-efficient of the three subscales ranged from 0.882 to 0.911. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The content validity index of the scale (S-CVI) was 0.926. A total of three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators fitted well (χ2/df = 2.167, comparative fit index = 0.918, tucker-lewis index=0.907, incremental fit index=0.919 and root mean square error of approximation = 0.075).

Conclusion

With superb reliability and validity, the Chinese version of MPSS can be used to assess postpartum stress in Chinese women, which is expected to lay a scientific basis for the early identification of postpartum women’s stress, thus providing a basis for the development of early individualized interventions. Equally importantly, with specific clinical value and practical significance for postpartum women’s physical and mental health, future replication studies of the Chinese version of MPSS should be carried out in diverse samples and clinical populations.
Household food insecurity, living conditions, and individual sense of security among Burkina Faso refugees in Ghana: a cross-sectional survey using in-person data collection
Authors: Inusah Abdul-Wahab , Brackstone Ken , Head Michael , Ahmed Tahiru Issahaku , Nartey David Tetteh , Ziblim Shamsu-Deen
Published: August 2023

Food insecurity and adequate nutrition is a major global challenge, especially in vulnerable groups such as refugee communities. In West Africa, due to conflict and instability in their home country, thousands of Burkina Faso refugees have crossed the border into northern Ghana. We conducted a cross-sectional study aimed at assessing household food insecurity, living conditions, and sense of security among Burkina Faso refugees currently residing in the upper east region of Ghana. Study data was collected from 19-29 October 2022 from 498 refugee households. Results revealed that almost 100% of households experienced food insecurity, with 80.3% experiencing severe food insecurity. Refugees from rural areas were more food secure compared to urban refugees. Refugees residing in host communities experienced lesser food insecurity than those in designated refugee camps. Further, refugees who were dissatisfied with the size of their accommodation were more likely to experience food insecurity. More than half of the refugees felt safe and welcomed by the host communities. The study underscores the critical need for targeted intervention to avert hunger and malnutrition among vulnerable groups such as children, pregnant women, and the aged in the refugee population. The study also emphasizes the importance of community support systems and social amenities for refugees’ well-being. Long-term measures should include improving logistics for food distribution, providing suitable accommodation, and strengthening healthcare services. Follow-up research, such as repeated community surveys, can track this evolving situation to continuously inform decision-making for refugee support.
Statistical Analysis Plan: The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes An Observational Study
Authors: Andersen Lars W. , Holmberg Mathias J. , Granfeldt Asger , Stankovic Nikola , Høybye Maria , Folke Fredrik , Caulley Lisa
Published: August 2023

This document describes the statistical analysis plan for the study “The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes”. This will be an observational study using prospectively collected data from the CARES registry in the United States. We will include patients with an out-of-hospital cardiac arrest in a private home. The exposure will be application of an AED and the primary outcome will be survival to hospital discharge. Assuming that there is no causal effect of AED application in those with a non-shockable rhythm, we will use a “difference-in-difference” approach to estimate the causal effect of AED application in those with a shockable rhythm.
Enhanced Conduit Flow Compensates for the Reduction in Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction
Authors: Aronson Doron , Sliman Hend , Abadi Sobhi , Maiorov Ida , Perlow Daniel , Mutlak Diab , Lessick Jonathan
Published: August 2023

Background

Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction.

Methods

We performed volumetric and flow analyses of LA function across the spectrum of LV diastolic dysfunction, derived from a set of consecutive patients undergoing multiphasic cardiac CT scanning (n=489). From LA and LV time-volume curves we calculated 3 volumetric components: 1) early “passive” emptying volume; 2) late “active” (booster) volume; and 3) conduit volume. Results were prospectively validated on a group of patients with severe aortic stenosis (n=110).

Results

The early passive filling progressively decreased with worsening diastolic function (P<0.0001). The atrial booster contribution to stroke volume (SV) modestly increases in impaired relaxation (P<0.05) and declined with more advanced diastolic function (P<0.001), thus failing to compensate for the reduction in early filling. The conduit volume increased progressively (P<0.0001), accounting for 75% of SV (IQR 63–81%) with restrictive filling pattern, compensating for the reduction in both early and booster functions. Similar results were obtained in patients with severe aortic stenosis. The pulmonary artery systolic pressure increased in a near-linear fashion when the conduit contribution to SV increased above 60%. Maximal conduit flow rate strongly correlated with mitral E-wave velocity (r=0.71,P<0.0001), indicating that the increase in mitral E-wave in diastolic dysfunction represents the increased conduit flow.

Conclusion

An increase in conduit volume contribution to SV represents a compensatory mechanism to maintain LV filling in advanced diastolic dysfunction. The increase in conduit volume despite increasing LV diastolic pressures is accomplished by an increase in pulmonary venous pressure.
Surgical versus Non-Surgical Treatment for Esophageal Squamous Cell Carcinoma in Patients Older than 70 years: A Propensity Score Matching Analysis
Authors: Li Kexun , Li Changding , Nie Xin , He Wenwu , Du Kunyi , Liu Kun , Wang Chenghao , Li Jialong , Han Yongtao , Peng Lin , Wang Qifeng , Leng Xuefeng
Published: August 2023

Background: With the rising life expectancy and an ageing population, it has become increasingly important to investigate treatments suitable for older adult patients with esophageal cancer. This study investigated whether older adult patients who underwent esophagectomy had better clinical outcomes than those who were non-surgically treated. Materials and methods: We retrospectively analyzed patients with esophageal squamous cell carcinoma (ESCC) who were 70 years or older and underwent esophagectomy, radiotherapy (RT), and/or chemotherapy (CT) from January 2018 to December 2019. Patients were divided into two groups: the surgery group (S group) and non-surgery group (NS group). Then compared the clinical outcomes of the two groups. Results: After a median follow-up duration of 36.6 months, the S group showed better OS. The 3-year OS was 59% in the S group and 27% in the NS group (HR, 0.397; 95% CI, 0.278-0.549; P<0.0001). In the S group, the median progression free survival was 38.3 months (95% CI, 30.6-46.1) compared to 12.3 months in the NS group (HR, 0.511; 95% CI, 0.376-0.695; P<0.0001). In addition, the number of adverse events in the NS group was higher than that in the S group (P<0.001) Conclusion: Overall, patients with ESCC ≥70 years who underwent esophagectomy had significantly better clinical outcomes than those who underwent non-surgical treatment with RT and/or CT.
Edge Artificial Intelligence for real-time automatic quantification of filariasis in mobile microscopy
Authors: Lin Lin , Dacal Elena , Díez Nuria , Carmona Claudia , Ramirez Alexandra Martin , Argos Lourdes Barón , Bermejo-Peláez David , Caballero Carla , Cuadrado Daniel , Darias Oscar , García-Villena Jaime , Bakardjiev Alexander , Postigo Maria , Recalde-Jaramillo Ethan , Flores-Chavez Maria , Santos Andrés , Ledesma-Carbayo María Jesús , Rubio José M. , Luengo-Oroz Miguel
Published: August 2023

Filariasis, a neglected tropical disease caused by roundworms, is a significant public health concern in many tropical countries. Microscopic examination of blood samples can detect and differentiate parasite species, but it is time consuming and requires expert microscopists, a resource that is not always available. In this context, artificial intelligence (AI) can assist in the diagnosis of this disease by automatically detecting and differentiating microfilarias. In line with the target product profile for lymphatic filariasis as defined by the World Health Organization, we developed an edge AI system running on a smartphone whose camera is aligned with the ocular of an optical microscope that detects and differentiates filarias species in real time without the internet connection. Our object detection algorithm that uses the Single-Shot Detection (SSD) MobileNet V2 detection model was developed with 115 cases, 85 cases with 1903 fields of view and 3342 labels for model training, and 30 cases with 484 fields of view and 873 labels for model validation before clinical validation, is able to detect microfilarias at 10x magnification and distinguishes four species of them at 40x magnification:Loa loa, Mansonella perstans, Wuchereria bancrofti, andBrugia malayi. We validated our augmented microscopy system in the clinical environment by replicating the diagnostic workflow encompassed examinations at 10x and 40x with the assistance of the AI models analyzing 18 samples with the AI running on a middle range smartphone. It achieved an overall precision of 94.14%, recall of 91.90% and F1 score of 93.01% for the screening algorithm and 95.46%, 97.81% and 96.62% for the species differentiation algorithm respectively. This innovative solution has the potential to support filariasis diagnosis and monitoring, particularly in resource-limited settings where access to expert technicians and laboratory equipment is scarce.