bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Arrhythmia Diagnosis with Data-Driven Methods: A 12-Lead ECG-Based Explainable AI Model
Authors: Chukwu Emmanuel C. , Moreno-Sánchez Pedro A.
Published: May 2024

Accurate and early prediction of arrhythmias using Electrocardiograms (ECG) presents significant challenges due to the non-stationary nature of ECG signals and inter-patient variability, posing difficulties even for seasoned cardiologists. Deep Learning (DL) methods offer precision in identifying diagnostic ECG patterns for arrhythmias, yet they often lack the transparency needed for clinical application, thus hindering their broader adoption in healthcare. This study introduces an explainable DL-based prediction model using ECG signals to classify nine distinct arrhythmia categories. We evaluated various DL architectures, including ResNet, DenseNet, and VGG16, using raw ECG data. The ResNet34 model emerged as the most effective, achieving an Area Under the Receiver Operating Characteristic (AUROC) of 0.98 and an F1-score of 0.826. Additionally, we explored a hybrid approach that combines raw ECG signals with Heart Rate Variability (HRV) features. Our explainability analysis, utilizing the SHAP technique, identifies the most influential ECG leads for each arrhythmia type and pinpoints critical signal segments for individual disease prediction. This study emphasizes the importance of explainability in arrhythmia prediction models, a critical aspect often overlooked in current research, and highlights its potential to enhance model acceptance and utility in clinical settings.
Real-Time Gait Anomaly Detection Using 1D-CNN and LSTM
Authors: Rostovski Jakob , Ahmadilivani Mohammad Hasan , Krivošei Andrei , Kuusik Alar , Alam Muhammad Mahtab
Published: May 2024

Anomaly detection and fall prevention represent one of the key research areas within gait analysis for patients suffering from neurological disorders. Deep Learning has penetrated into healthcare applications, encompassing disease diagnosis and anomaly prediction. Connected wearable medical sensors are emerging due to computationally expensive machine learning tasks, which traditionally require use of remote PC or cloud computing. However, to reduce needs for wireless communication channel throughput, for data processing latency, and increase service reliability and safety, on device machine learning is gaining attention. This paper presents an innovative approach that leverages one dimensional convolutional neural network (1D-CNN) and long-short term memory (LSTM) neural network for the real-time detection of abnormal gait patterns during the step. Real-time anomaly detection pertains to the algorithm’s ability to promptly detect true gait abnormality occurrence during the swing phase of an ongoing step.

For the experiments, we have collected eight different common gait anomalies, simulated by 22 persons, using motion sensors containing multidimensional inertial measurement units (IMUs).

Results have demonstrated that the proposed 1D-CNN-AD algorithm achieves an average accuracy of 95% and an average F1-score of 88% for all gait types and can run in true real-time. Average earliness for 1D-CNN-AD algorithm was 0.6 s, which is mid-swing phase of the step. Proposed LSTM-AD algorithm achieved average accuracy of 87% and average F1-score of 70% for all gait types.
Research for JYU: An AI-Driven, Fully Remote Mobile Application for Functional Exercise Testing
Authors: Cronin Neil , Lehtiö Ari , Talaskivi Jussi
Published: May 2024

As people live longer, the incidence and severity of health problems increases, placing strain on healthcare systems. There is an urgent need for resource-wise approaches to healthcare. We present a system built using open-source tools that allows health and functional capacity data to be collected remotely. The app records performance on functional tests using the phone’s built-in camera and provides users with immediate feedback. Pose estimation is used to detect the user in the video. The x, y coordinates of key body landmarks are then used to compute further metrics such as joint angles and repetition durations. In a proof-of-concept study, we collected data from 13 patients who had recently undergone knee ligament or knee replacement surgery. Patients performed the sit-to-stand test twice, with an average difference in test duration of 1.12 s (range: 1.16–3.2 s). Y-coordinate locations allowed us to automatically identify repetition start and end times, while x, y coordinates were used to compute joint angles, a common rehabilitation outcome variable. Mean difference in repetition duration was 0.1 s (range: −0.4–0.4 s) between trials 1 and 2. Bland-Altman plots confirmed general test-retest consistency within participants. We present a mobile app that enables functional tests to be performed remotely and without supervision. We also demonstrate real-world feasibility, including the ability to automate the entire process, from testing to analysis and the provision of real-time feedback. This approach is scalable, and could form part of national health strategies, allowing healthcare providers to minimise the need for in-person appointments whilst yielding cost savings.
Finnish Digi-HTA Assessment Model for Digital Health and an International Comparison
Authors: Haverinen Jari , Suominen Jarno , Kaksonen Rauli , Veikkolainen Paula , Voutilainen Merja , Reponen Jarmo , Röning Juha , Falkenbach Petra
Published: May 2024

New health technology assessment (HTA) models for digital health are continuously being developed and are already in use. In Finland, the HTA model for digital health, named Digi-HTA, has been employed since 2020. Internationally and also in Finland, the need for harmonization of these HTA models has been recognized. In order to harmonize the models, it is necessary to first identify the key features and requirements of existing models. In this study, three key assessment models for digital health identified as central in the Finnish context were analyzed. After the analysis, the results were compared to the Finnish Digi-HTA assessment model, and a final synthesis was created regarding the similarities and differences between the assessment models. The comparison includes German DiGA model, the global CEN-ISO/TS 82304-2:2021 technical specification, and the Nordic-designed NordDEC assessment model. There was a great deal of similarity in the evaluated models, although certain differences in emphasis were found. The key differences relate to reimbursement process, maturity of the assessment process and supported product categories as well as cost and effectiveness evaluation. The results of this study can be utilized in harmonizing assessment models for digital health.
Method to Monitor Cough by Employing Piezoelectric Energy Harvesting Configurations
Authors: Palosaari Jaakko , Virta Eetu , Miinala Miika , Bai Yang
Published: May 2024

Cough is the most common symptom prompting individuals to seek medical advice. However, the widespread adoption of autonomous cough monitoring using wearable devices remains limited. This paper introduces a wireless cough monitoring device utilizing piezoelectric energy harvesting technology. The design emphasizes cost-effectiveness and energy efficiency, allowing simple attachment onto human skin using medical-grade tapes. The device's standout feature lies in its departure from continuously recording real-time acoustic data at a high sampling rate, as commonly employed in prior works. Instead, it capitalizes on the energy harvesting capability, utilizing harvested energy from muscle movements induced by coughing as crucial information. The energy harvested within specific intervals translates into a historical record of cough occurrences during that timeframe.
This Energy-as-Data protocol substantially reduces the device's duty cycle, resulting in a remarkable extension of battery life by up to 2100%. Notably, this extension is achieved while maintaining reasonable accuracy in cough monitoring. With this capability, the device can autonomously monitor and analyze cough data from both in- and outpatients, serving daily, research, and clinical purposes. Its potential extends to enhancing prediction and management of severe respiratory diseases.
Microwave Technique Based Noninvasive Monitoring of Intracranial Pressure Using Realistic Phantom Models
Authors: Singh Daljeet , Vihriälä Erkki , Särestöniemi Mariella , Myllylä Teemu
Published: May 2024

Microwave technology is emerging as a promising candidate in the field of medical diagnosis and imaging and has paved the way for a transition from invasive to non-invasive methods of monitoring various biological phenomena inside the human body. Intracranial Pressure (ICP) is considered to be a very important parameter by medical practitioners for assessing the health of a subject. Accurate, prolonged, and noninvasive measurement of ICP is still an open area of research with no clinical success so far. Therefore, in this paper, a microwave-based method for non-invasive monitoring of ICP is proposed. The setup utilizes flexible, thin, small, and lightweight planner antennas that are very suitable for non-invasive monitoring of ICP from the skin without compromising the comfort of subject. The proposed microwave method is tested on a realistic head phantom model which imitates the functioning of hydrodynamics in a real human head. The measurement results from the proposed method are verified using invasive pressure sensors. It is deduced from numerous trials that the proposed microwave system can detect small changes in ICP pressure and its response is analogous to actual pressure values measured by invasive pressure sensors.
Study on Fat as the Propagation Medium in Optical-Based In-Body Communications
Authors: Fuada Syifaul , Särestöniemi Mariella , Katz Marcos , Soderi Simone , Hämäläinen Matti
Published: May 2024

This paper investigates fat tissue as a medium for communication in implantable/ingestible medical device (IMD) systems based on optical wireless communication (OWC). The findings emphasize the importance of tissue characteristics (temperature in particular) for optimizing OWC performance. This study considered Near-infrared (NIR) light with 810 nm wavelength and fresh porcine samples to mimic the human tissue. The study employs a realistic measurement approach in an ex vivo setting using various porcine samples: pure fat and flesh tissues and samples with different thicknesses. This study also investigates the influence of porcine temperature on the optical communication channels, which are measured by comparing the received optical power at 23 °C and 37 °C. In general, tissue samples at warmer temperatures (37 °C) receive higher optical power than colder samples. The results also demonstrate the superior optical power transmission capabilities of pure fat compared to pure flesh in porcine tissue samples in warm conditions. We also found that porcine with multiple layers of fat (fatty sample) yields higher received optical power than porcine with multiple layers of flesh (muscular). The results of this study provide valuable insights and relevant considerations for OWC-based in-body communication conducted using porcine samples.
Preliminary Studies on mm-Wave Radar for Vital Sign Monitoring of Driver in Vehicular Environment
Authors: Singh Daljeet , Eleonye Theresa , Surazynski Lukasz , Ferdinando Hany , Kumar Atul , Joshi Hem Dutt , Särestöniemi Mariella , Myllylä Teemu
Published: May 2024

The last decade has witnessed significant improvements in vehicular technology, especially in providing a safer and more enjoyable environment for drivers and passengers. Fully autonomous vehicles are no longer a dream but are now a successful technology across the globe. Features such as autopilot, assisted parking, speed warning, and lane change assistance have improved the quality of user experience while using an automobile. Apart from this, e-health services have also become a prime aspect of the modern vehicular industry. Therefore, this research presents preliminary studies on mm-wave radar setup based on Frequency Modulated Continuous Wave (FMCW) technology in the 76 to 81 GHz band for vital sign monitoring of drivers and passengers in a vehicular environment. The effect of system parameters and the driver’s location with respect to radar is studied using human subjects to determine the optimum setup for vital sign monitoring. Measurement results showcase that mm-wave radars can be utilized for accurate and efficient measurement of the vital signs of drivers in vehicular environments.
Dual-Perspective Modeling of Patient Pathways: A Case Study on Kidney Cancer
Authors: Larsen Anna Grøndahl , Halvorsrud Ragnhild , Berg Rolf Eigil , Vesinurm Märt
Published: May 2024

Patient pathway has become a key concept in the organization of healthcare. However, the materialization and operationalization of pathways often focus on work processes of health personnel, clinical decision-making, and deadlines, contradicting the strong patient-oriented perspective that is inherent in their definition. In this paper, we introduce a patient-centered perspective of kidney cancer pathways, reporting on a dual-perspective strategy to map and model patient pathways. Utilizing a multi-method approach, we map and model pathways from the perspectives of both healthcare personnel and patients and investigate the feasibility of the Customer Journey Modeling Language (CJML) for modeling patient pathways. To prevent confusion, the planned pathway as seen from the hospital perspective and the actual pathway experienced by the patient are referred to as ‘pathway’ and ‘journey’, respectively. In the paper, we describe methods to engage with healthcare professionals and patients to collect the necessary information to create precise models, and we show how precise modeling of patient pathways requires the integration of several information sources. Moreover, the study underlines the value of examining pathways from a dual perspective, as the two perspectives corroborate and supplement each other, illustrating the complexity of patient journeys. Finally, the findings provide insights into the feasibility of CJML, firstly underlining that the usefulness of visual models is context-dependent, and secondly, suggesting that the methods and subsequent visualizations may be useful as organizational, instructional, and communicative tools.
Effectiveness of Robot-Assisted Lower Limb Rehabilitation on Balance in People with Stroke: A Systematic Review, Meta-analysis, and Meta-regression
Authors: Yli-Ikkelä Riku , Rintala Aki , Köyhäjoki Anna , Hakonen Harto , Korpi Hilkka , Kantola Mirjami , Honkanen Sari , Ilves Outi , Sjögren Tuulikki , Karvanen Juha , Aartolahti Eeva
Published: May 2024

The objective of this study was to evaluate the effectiveness of robot-assisted lower-limb rehabilitation on balance in stroke patients and to explore the covariates associated with these effects.

A systematic literature search was carried out in four databases (MEDLINE (Ovid), CINAHL, PsycINFO, and ERIC) for studies published from inception to 25th of March 2022. Studies on robot-assisted lower-limb rehabilitation with a randomized controlled trial (RCT) design, participants with stroke, a comparison group with conventional training, and balance-related outcomes were included. Studies were assessed for Cochrane Risk of Bias 2 and quality of evidence. Meta-analysis and meta-regression were performed.

A total of 48 (RCT) with 1472 participants were included. The overall risk of bias in the included studies was unclear (n = 32), high (n = 15) or low (n = 1). Compared to conventional rehabilitation, robot-assisted lower-limb rehabilitation interventions were more effective for balance improvement (Hedges’ g = 0.25, 95% CI: 0.10 0.41). In meta-regression, a relationship between the training effect was observed with the time since stroke, explaining 56% of the variance (p = 0.001), and with the ankle robots, explaining 16% of the variance (p = 0.048). No serious adverse events related to robot-assisted training were reported.

Robot-assisted lower-limb rehabilitation may improve balance more than conventional training in people with stroke, especially in the acute stage. Robot-assisted lower-limb rehabilitation seems to be a safe rehabilitation method for patients with stroke. To strengthen the evidence, more high-quality RCTs with adequate sample sizes are needed.
Virtual Reality in Rehabilitation of Executive Functions in Children (VREALFUN) – Study Protocols for Randomized Control Trials
Authors: Nikula Merja , Mäntymaa Mirjami , LaValle Steven M. , Pouttu Ari , Jaekel Julia , Aronen Eeva T. , Pokka Tytti , Salmi Juha , Uusimaa Johanna
Published: May 2024

Children with attention and executive function disabilities often have a long-lasting need for rehabilitation to support their functional ability. Yet the availability of rehabilitation services is insufficient, regionally unevenly distributed, and unequal in terms of access to rehabilitation. There is a need for easily accessible services. In this paper, we present the VREALFUN project where the major aim is to develop a novel Virtual Reality (VR) rehabilitation method for children with deficits in attention and executive functions. This ongoing Randomized Control Study (RCT) includes two arms, one in children with attention deficit hyperactivity disorder (ADHD) and the other in children with mild to moderate traumatic brain injury (TBI).
Out-of-time-ordered correlators in the IP matrix model
Authors: Iizuka Norihiro , Nishida Mitsuhiro
Published: May 2024

Abstract

We study the out-of-time-ordered correlators (OTOCs) in the IP matrix model [1]. It was shown in [2] that OTOCs do not grow when the adjoint is massless. We generalize the analysis of OTOCs to general nonzero masses m > 0 for the adjoint, where we give a new prescription for analytic continuation in time such that we can evaluate OTOCs numerically using the retarded Green function. Despite the fact that the behaviors of the two-point functions, spectral density, and the Krylov complexity change drastically depending on whether the adjoint is massless or not, in the parameter ranges we study, we do not see the exponential growth of OTOCs for the massive adjoint cases. We end with a discussion of the comparison of this model with the SYK model and possible modification of the model.
Probing the interference between non-linear, axionic and space-time-anisotropy effects in the QED vacuum
Authors: Paixão J. M. A. , Ospedal L. P. R. , Neves M. J. , Helayël-Neto J. A.
Published: May 2024

Abstract

In this paper, we pursue the investigation of a generic non-linear extension of axionic electrodynamics in a Carroll-Field-Jackiw (CFJ) scenario that implements Lorentz-symmetry violation (LSV). The model we inspect consists of an arbitrary non-linear electrodynamic action coupled to the axion field in presence of an anisotropy four-vector that realizes the breaking of Lorentz symmetry under the particle point of view. For the sake of our considerations, the non-linear electromagnetic field is expanded around a constant and uniform magnetic background up to second order in the propagating photon field. The focus of our attention is the study of the material properties of the vacuum in the particular case of a space-like CFJ 4-vector. The dispersion relations associated to the plane wave solutions are explicitly worked out in two situations: the magnetic background perpendicular and parallel to the wave direction. We extend these results to consider the analysis of the birefringence phenomenon in presence of non-linearity, the axion and the LSV manifested through the spatial anisotropy. Three specific proposals of non-linear electrodynamics are contemplated: Euler-Heisenberg (EH), Born-Infeld (BI) and the Modified Maxwell electrodynamics (ModMax). Throughout the paper, we shall justify why we follow the unusual path of connecting, in a single Lagrangian density, three pieces of physics beyond the Standard Model, namely, non-linearity, axions and LSV. We anticipate that we shall not be claiming that the simultaneous introduction of these three topics beyond the Standard Model will bring new insights or clues for the efforts to detect axions or to constrain parameters associate to both non-linear electrodynamics and LSV physics. Our true goal is to actually inspect and describe how axionic, non-linear and LSV effects interfere with one another whenever physical entities like group velocity, refraction indices, birefringence and effective masses of physical excitations are computed in presence of an external constant and homogeneous magnetic field.
Minimal flavour deconstruction
Authors: Barbieri Riccardo , Isidori Gino
Published: May 2024

Abstract

We construct two concrete examples of flavour non-universal gauge theories which, after the inclusion of all d ≤ 4 gauge invariant operators, allow to describe the observed pattern of flavour in the charged fermion sector without any small Yukawa coupling (y ≳ 0.1). Guided by the criterium of minimality, we assume that flavour non universality is confined to the Abelian sector of the gauge group: the universal hypercharge emerges after a sequence of symmetry-breaking steps characterised by two high mass scales, Λ[23]< Λ[12], where the second and the first fermion generations get their mass respectively. At least in one of the two models the smaller of these scales can be in the 10 TeV range, consistently with current bounds from flavour observables. Both models are extended to include as well neutrino masses and mixings.
Three-loop inverse scotogenic seesaw models
Authors: Abada Asmaa , Bernal Nicolás , Cárcamo Hernández A. E. , Kovalenko Sergey , de Melo Téssio B.
Published: May 2024

Abstract

We propose a class of models providing an explanation of the origin of light neutrino masses, the baryon asymmetry of the Universe via leptogenesis and offering viable dark matter candidates. In these models the Majorana masses of the active neutrino are generated by the inverse seesaw mechanism with the lepton number violating right-handed Majorana neutrino masses μ arising at three loops. The latter is ensured by the preserved discrete symmetries, which also guarantee the stability of the dark matter candidate. We focus on one of these models and perform a detailed analysis of the phenomenology of its leptonic sector. The model can successfully accommodate baryogenesis through leptogenesis in both weak and strong washout regimes. The lightest heavy fermion turns out to be a viable dark matter candidate, provided that the entries of the Majorana submatrix μ are in the keV to MeV range. The solutions are consistent with the experimental constraints, accommodating both mass orderings for active neutrinos, in particular charged-lepton flavor violating decays μ → eγ, μ → eee, and the electron-muon conversion processes get sizable rates within future sensitivity reach.
Three evolution problems modeling the interaction between acoustic waves and non-locally reacting surfaces
Authors: Vitillaro Enzo
Published: May 2024

The paper deals with three evolution problems arising in the physical modeling of small amplitude acoustic phenomena occurring in a fluid, bounded by a surface of extended reaction. The first one is the widely studied wave equation with acoustic boundary conditions, but its derivation from the physical model is mathematically not fully satisfactory. The other two models studied in the paper, in the Lagrangian and Eulerian settings, are physically transparent. In the paper the first model is derived from the other two in a rigorous way, also for solutions merely belonging to the natural energy spaces.
Insights into fluid evolution and Re enrichment by mineral micro-analysis and fluid inclusion constraints: Evidence from the Maronia Cu-Mo ± Re ± Au porphyry system in NE Greece
Authors: Falkenberg Jan J. , Keith Manuel , Melfos Vasilios , Hohl Max , Haase Karsten M. , Voudouris Panagiotis , Höss Alica , Wenske Julia , Klemd Reiner , Beier Christoph , Kutzschbach Martin , Strauss Harald
Published: May 2024

Porphyry-epithermal veins hosting Re-rich molybdenite and rheniite (ReS2) from the Maronia Cu-Mo ± Re ± Au porphyry in Thrace, NE Greece, provide new insights into the hydrothermal processes causing extreme Re enrichment. Quartz trace element chemistry (Al/Ti, Ge/Ti), Ti-in-quartz thermometry, and cathodoluminescence imaging reveal multiple quartz generations in consecutive hydrothermal quartz-sulfide veins associated with potassic, sericitic, and argillic alteration. Fluid inclusions in different quartz generations indicate that phase separation and fluid cooling are the main ore-forming processes in the porphyry stage (~ 500 – 350 °C), whereas mixing of a vapor-rich fluid with metalliferous (e.g., Pb, Zn, Au) meteoric water forms the epithermal veins (~ 280 °C). These processes are recorded by trace element ratios in pyrite that are sensitive to changes in fluid temperature (Se/Te), fluid salinity (As/Sb, Co/As), and mixing between fluids of magmatic and meteoric origin (Se/Ge). Highly variable intra-grain δ34S values in pyrite record S isotope fractionation during SO2 disproportionation and phase separation, emphasizing the importance of in situ δ34S analysis to unravel ore-forming processes. High δ34S (~ 4.5‰) values of sulfides are indicative of low SO42−/H2S fluid ratios buffered by the local host rocks and mixing of the magma-derived fluid with meteoric water. The formation of Re-rich molybdenite (~ 6600 ppm) is favored by cooling and reduction of a magma-derived, high-temperature (~400 °C), oxidized, and Re-rich fluid triggering efficient Re precipitation in early veins in the potassic alteration zone. The systematic temporal fluid evolution therefore reveals that coeval cooling and reduction of oxidized Re-rich fluids cause extreme Re enrichment at the Maronia porphyry system.
Comparative analysis of late gadolinium enhancement assessment techniques for monitoring fibrotic changes in myocarditis follow-up
Authors: Károlyi Mihály , Polacin Malgorzata , Kolossváry Márton , Sokolska Justyna M. , Matziris Ioannis , Weber Lucas , Alkadhi Hatem , Manka Robert
Published: May 2024

Objectives

To compare the repeatability and interrelation of various late gadolinium enhancement (LGE) assessment techniques for monitoring fibrotic changes in myocarditis follow-up.

Materials and methods

LGE extent change between baseline and 3-month cardiovascular magnetic resonance (CMR) was compared in patients with acute myocarditis using the full width at half maximum (FWHM), gray-scale thresholds at 5 and 6 standard deviations (SD5 and SD6), visual assessment with threshold (VAT) and full manual (FM) techniques. In addition, visual presence score (VPS), visual transmurality score (VTS), and a simplified visual change score (VCS) were assessed. Intraclass-correlation (ICC) was used to evaluate repeatability, and methods were compared using Spearman’s correlation.

Results

Forty-seven patients (38 male, median age: 27 [IQR: 21; 38] years) were included. LGE extent change differed among quantitative techniques (p < 0.01), with variability in the proportion of patients showing LGE change during follow-up (FWHM: 62%, SD5: 74%, SD6: 66%, VAT: 43%, FM: 60%, VPS: 53%, VTS: 77%, VCS: 89%). Repeatability was highest with FWHM (ICC: 0.97) and lowest with SD5 (ICC: 0.89). Semiquantitative scoring had slightly lower values (VPS ICC: 0.81; VTS ICC: 0.71). VCS repeatability was excellent (ICC: 0.93). VPS and VTS correlated with quantitative techniques, while VCS was positively associated with VPS, VTS, VAT, and FM, but not with FWHM, SD5, and SD6.

Conclusion

FWHM offers the least observer-dependent LGE follow-up after myocarditis. VPS, VTS, and VCS are practical alternatives, showing reliable correlations with quantitative methods. Classification of patients exhibiting either stable or changing LGE relies on the assessment technique.

Clinical relevance statement

This study shows that LGE monitoring in myocarditis is technique-dependent; the FWHM method yields the most consistent fibrotic tracking results, with scoring-based techniques as reliable alternatives.

Key Points

Recognition of fibrotic changes during myocarditis follow-up is significantly influenced by the choice of the quantification technique employed.

The FWHM technique ensures highly repeatable tracking of myocarditis-related LGE changes.

Segment-based visual scoring and the simplified visual change score offer practical, reproducible alternatives in resource-limited settings.
Fair group decisions via non-deterministic proportional consensus
Authors: Heitzig Jobst , Simmons Forest W. , Constantino Sara M.
Published: May 2024

Are there group decision methods which (i) give everyone, including minorities, an equal share of effective decision power even when voters act strategically, (ii) promote consensus and equality, rather than polarization and inequality, and (iii) do not favour the status quo or rely too much on chance? We describe two non-deterministic group decision methods that meet these criteria, one based on automatic bargaining over lotteries, the other on conditional commitments to approve compromise options. Using theoretical analysis, agent-based simulations and a behavioral experiment, we show that these methods prevent majorities from consistently suppressing minorities, which can happen in deterministic methods, and keeps proponents of the status quo from blocking decisions, as in other consensus-based approaches. Our simulations show that these methods achieve aggregate welfare comparable to common voting methods, while employing chance judiciously, and that the welfare costs of fairness and consensus are small compared to the inequality costs of majoritarianism. In an incentivized experiment with naive participants, we find that a sizable fraction of participants prefers to use a non-deterministic voting method over Plurality Voting to allocate monetary resources. However, this depends critically on their position within the group. Those in the majority show a strong preference for majoritarian voting methods.
Laser interstitial thermal therapy (LITT) for pediatric low-grade glioma—case presentations and lessons learned
Authors: Strauss Ido , Gabay Segev , Roth Jonathan
Published: May 2024

Background

The surgical treatment of brain tumors has developed over time, offering customized strategies for patients and their specific lesions. One of the most recent advances in pediatric neuro-oncological surgery is laser interstitial thermal therapy (LITT). However, its effectiveness and indications are still being evaluated. The aim of this work is to review the current literature on LITT for pediatric low-grade gliomas (pLGG) and evaluate our initial results in this context.

Methods

We retrospectively reviewed our pediatric neurosurgery database for patients who received LITT treatment between November 2019 and December 2023. We collected data on the indications for LITT, technical issues during the procedure, and clinical and radiological follow-up.

Results

Three patients underwent 5 LITT procedures for pLGG. The lesion was thalamo-peduncular in one patient, cingulate in one, and deep parietal in one patient. Two patients had a previous open resection done and were diagnosed with pLGG. One patient underwent a stereotaxic biopsy during the LITT procedure that was non-diagnostic. The same patient underwent a later open resection of the tumor in the cingulate gyrus. There were no surgical complications and all patients were discharged home on the first post-operative day. The follow-up period was between 20 and 40 months. Radiological follow-up showed a progressive reduction of the tumor in patients with LGG.

Conclusion

Laser interstitial thermal therapy is a minimally invasive treatment that shows promise in treating deep-seated pLGG in children. The treatment has demonstrated a reduction in tumor volume, and the positive results continue over time. LITT can be used as an alternative treatment for tumors located in areas that are difficult to access surgically or in cases where other standard treatment options have failed.
Ankle fracture surgery performed by orthopaedic residents without supervision has comparable outcomes to surgery performed by fellowship trained orthopaedic surgeons
Authors: Tenenbaum Shay A. , Shenkar Yorye , Fogel Itay , Maoz Or , Balziano Snir , Barzilai Yuval , Prat Dan
Published: May 2024

Background

Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons.

Methods

A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes.

Results

A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001).

Conclusion

The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education.

Level of evidence

Level III – retrospective cohort study.
Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures
Authors: Colcuc Christian , Miersbach Marco , Cienfuegos Miguel , Grüneweller Niklas , Vordemvenne Thomas , Wähnert Dirk
Published: May 2024

Introduction

Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning.

Materials and methods

Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons’ subjective confidence in surgical planning.

Results

The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min).

Conclusion

The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.
Patient satisfaction and sexual issues in vulvar lichen sclerosus treatment: a monocentric certified dysplasia unit survey analysis
Authors: Meyer-Wilmes Philipp , Wittenborn Julia , Kupec Tomáš , Caspers Rebecca , Stickeler Elmar , Iborra Séverine
Published: May 2024

Objective

Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic.

Methods

This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023.

Results

This study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient’s perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation.

Conclusion

This study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines.
Is breathing frequency a potential means for monitoring exercise intensity in people with atrial fibrillation and coronary heart disease when heart rate is mitigated?
Authors: Buckley John P. , Terada Tasuku , Lion Anna , Reed Jennifer L.
Published: May 2024

Purpose

Moderate-intensity aerobic exercise is safe and beneficial in atrial fibrillation (AF) and coronary heart disease (CHD). Irregular or rapid heart rates (HR) in AF and other heart conditions create a challenge to using HR to monitor exercise intensity. The purpose of this study was to assess the potential of breathing frequency (BF) to monitor exercise intensity in people with AF and CHD without AF.

Methods

This observational study included 30 AF participants (19 Male, 70.7 ± 8.7 yrs) and 67 non-AF CHD participants (38 Male, 56.9 ± 11.4 yrs). All performed an incremental maximal exercise test with pulmonary gas exchange.

Results

Peak aerobic power in AF ($${\dot{\text{V}}}$$

V
˙

O2peak; 17.8 ± 5.0 ml.kg−1.min−1) was lower than in CHD (26.7 ml.kg−1.min−1) (p < .001). BF responses in AF and CHD were similar (BF peak: AF 34.6 ± 5.4 and CHD 36.5 ± 5.0 breaths.min−1; p = .106); at the 1st ventilatory threshold (BF@VT-1: AF 23.2 ± 4.6; CHD 22.4 ± 4.6 breaths.min−1; p = .240). %$${\dot{\text{V}}}$$

V
˙

O2peak at VT-1 were similar in AF and CHD (AF: 59%; CHD: 57%; p = .656).

Conclusion

With the use of wearable technologies on the rise, that now include BF, this first study provides an encouraging potential for BF to be used in AF and CHD. As the supporting data are based on incremental ramp protocol results, further research is required to assess BF validity to manage exercise intensity during longer bouts of exercise.
Long-term continuous monitoring of arrhythmias in pigs with insertable cardiac monitors
Authors: Airaksinen Jonna , Siimes Satu , Hartikainen Juha , Ylä-Herttuala Seppo
Published: May 2024

Arrhythmia detection is essential when assessing the safety of novel drugs and therapies in preclinical studies. Many short-term arrhythmia monitoring methods exist, including non-invasive ECG and Holter. However, there are no reliable, long-term, non-invasive, or minimally invasive methods for cardiac arrhythmia follow-up in large animals that allows free movement with littermates. A long follow-up time is needed when estimating the impact of long-lasting drugs or therapies, such as gene therapy. We evaluated the feasibility and performance of insertable cardiac monitors (ICMs) in pigs for minimally invasive, long-term monitoring of cardiac arrhythmias that allows free movement and species-specific behavior. Multiple implantation sites were tested to assess signal quality. ICMs recognized reliably many different arrhythmias but failed to detect single extrasystoles. They also over-diagnosed T-waves, resulting in oversensing. Muscle activity and natural startles of the animals caused noise, leading to a heterogeneous signal requiring post-recording evaluation. In spite of these shortcomings, the ICMs showed to be very useful for minimally invasive long-term monitoring of cardiac rhythm in pigs.
The reliability of using gingival crevicular blood to measure blood glucose and hba1c levels in the dental setting: a systematic review and meta-analysis
Authors: Fakheran Omid , Bencze Bulcsu , Mischak Irene , Vegh Daniel , Payer Michael
Published: May 2024

Objective

There are 500 million patients living with diabetes mellitus worldwide and 50% of them remain undiagnosed. Routine periodontal probing provides gingival crevicular blood in patients with gingivitis. Gingival blood may be useful for diabetes screening without the need for any expensive, painful or time-consuming method by using convenient glucometers. Therefore, the objective of this systematic review and meta-analysis is to answer the question to “is there a difference in glucose or HbA1c levels (O) in patients with positive gingival bleeding (P) measured on gingival crevicular blood (GCB) (I) compared to finger prick capillary blood (CB) (C).

Materials and methods

The authors performed an electronic search of six databases using identical MeSH phrases. Only human clinical studies without limitations on the year of publication were considered. Data extraction was done by using standardized data collection sheets. Risk of bias assessment were conducted using QUADAS-2 and QUADAS-C. Meta-analyses were carried out with the random effects model to aggregate the correlation coefficients and the difference between the means between gingival and capillary blood reading, using 95% confidence intervals.

Results

The database and manual search yielded 268 articles, from which the selection procedure provided 36 articles for full-text screening, and the final pool of eligible articles composed of 23 studies with 1680 patients. Meta-analysis results on glycemic levels showed differences between the GCB and CB procedures in patients with and without diabetes with values of -6.80 [-17.35; 3.76] and − 4.36 [-9.89; 1.18], respectively. Statistically significant correlations were found (p = 0.001) between GCB and CB measurements in patients with (0.97 [0.927; 0.987]) and without diabetes (0.927 [0.873; 0.958]).

Conclusion

Gingival blood could prove to be useful to identify patients with undiagnosed diabetes when the necessary amount of uncontaminated blood is present. However, this technique is limited by the possibility of contamination, prandial status and inaccuracies, so it is unsuited to address the patient’s glycemic control accurately.
Effects of changing water content of clay-content rocks on field cutter consumption rate of roadheaders: a case study of porous ignimbrites
Authors: Comakli Ramazan , Bayramov Jahid
Published: May 2024

The changing formation characteristics during excavation can cause a higher cutter consumption rate (CCR) of mechanical excavators than theoretically estimated before the project begins. This study investigates the adhesive potential of clay-content porous ignimbrites in increasing water content and their effects on the CCR of roadheaders. For this purpose, the actual field CCR data of roadheaders were recorded for ten cold storage caverns (CSC) projects during the excavation in dry and wet conditions. Then, laboratory tests were carried out on the rock samples collected from project areas. CCRs of roadheaders were theoretically estimated based on the Cerchar abrasivity index of rocks using three different empirical models. The laboratory test results showed that increasing water content reduces the abrasivity and strength of the rocks. The theoretically estimated results also showed that CCR is to be less under saturated conditions. However, actual field data revealed higher CCRs for all CSC projects in wet conditions. Therefore, the adhesion potential of rocks in different water contents was analyzed, and positive relationships were obtained between the field CCR in wet conditions and the adhesion potentials of excavated rocks with 15%, 20%, and 25% water content. New equations were developed to estimate the CCR of roadheaders, especially in excavating rocks that have an adhesive potential to cutters, such as clay-content rocks. It has been concluded that for an accurate CCR estimation, more than theoretical calculations will be required, and changing formation conditions should also be analyzed in detail.
Immune cell signatures and inflammatory mediators: unraveling their genetic impact on chronic kidney disease through Mendelian randomization
Authors: Hu Yongzheng , Hao Fengyun , An Qian , Jiang Wei
Published: May 2024

Prior research has established associations between immune cells, inflammatory proteins, and chronic kidney disease (CKD). Our Mendelian randomization study aims to elucidate the genetic causal relationships among these factors and CKD. We applied Mendelian randomization using genetic variants associated with CKD from a large genome-wide association study (GWAS) and inflammatory markers from a comprehensive GWAS summary. The causal links between exposures (immune cell subtypes and inflammatory proteins) and CKD were primarily analyzed using the inverse variance-weighted, supplemented by sensitivity analyses, including MR-Egger, weighted median, weighted mode, and MR-PRESSO. Our analysis identified both absolute and relative counts of CD28 + CD45RA + CD8 + T cell (OR = 1.01; 95% CI = 1.01–1.02; p < 0.001, FDR = 0.018) (OR = 1.01; 95% CI = 1.00–1.01; p < 0.001, FDR = 0.002), CD28 on CD39 + CD8 + T cell(OR = 0.97; 95% CI = 0.96–0.99; p < 0.001, FDR = 0.006), CD16 on CD14–CD16 + monocyte (OR = 1.02; 95% CI = 1.01–1.03; p < 0.001, FDR = 0.004) and cytokines, such as IL-17A(OR = 1.11, 95% CI = 1.06–1.16, p < 0.001, FDR = 0.001), and LIF-R(OR = 1.06, 95% CI = 1.02–1.10, p = 0.005, FDR = 0.043) that are genetically predisposed to influence the risk of CKD. Moreover, the study discovered that CKD itself may causatively lead to alterations in certain proteins, including CST5(OR = 1.16, 95% CI = 1.09–1.24, p < 0.001, FDR = 0.001). No evidence of reverse causality was found for any single biomarker and CKD. This comprehensive MR investigation supports a genetic causal nexus between certain immune cell subtypes, inflammatory proteins, and CKD. These findings enhance the understanding of CKD's immunological underpinnings and open avenues for targeted treatments.