bluuebunny/crossref_metadata_2025 huggingface dataset:
VisRuler: Visual analytics for extracting decision rules from bagged and boosted decision trees
Authors: Chatzimparmpas Angelos , Martins Rafael M. , Kerren Andreas
Published: January 2023

Bagging and boosting are two popular ensemble methods in machine learning (ML) that produce many individual decision trees. Due to the inherent ensemble characteristic of these methods, they typically outperform single decision trees or other ML models in predictive performance. However, numerous decision paths are generated for each decision tree, increasing the overall complexity of the model and hindering its use in domains that require trustworthy and explainable decisions, such as finance, social care, and health care. Thus, the interpretability of bagging and boosting algorithms—such as random forest and adaptive boosting—reduces as the number of decisions rises. In this paper, we propose a visual analytics tool that aims to assist users in extracting decisions from such ML models via a thorough visual inspection workflow that includes selecting a set of robust and diverse models (originating from different ensemble learning algorithms), choosing important features according to their global contribution, and deciding which decisions are essential for global explanation (or locally, for specific cases). The outcome is a final decision based on the class agreement of several models and the explored manual decisions exported by users. We evaluated the applicability and effectiveness of VisRuler via a use case, a usage scenario, and a user study. The evaluation revealed that most users managed to successfully use our system to explore decision rules visually, performing the proposed tasks and answering the given questions in a satisfying way.
Numerical analysis of the effect of the blade number on the hydrodynamic performance of shaftless rim-driven thruster
Authors: Jiang Wen , Shen Xin , Liu Liangliang , Bian Tao
Published: January 2023

In this work, numerical investigations were performed to the study the effect of blade number on the hydrodynamic performance of shaftless Rim-driven Thruster (RDT) with certain blade area ratio and pitch ratio. The work investigated and compared the thrust coefficient, torque coefficient and efficiency of the RDTs with different blade numbers. Additionally, this work detected and analyzed the pressure distribution on the blade surface and velocity distribution around the blade and in the wake. The results demonstrate that for a certain advance coefficient, the thrust coefficient and torque coefficient of the RDT increase with the blade number, however the efficiency of the RDT decreases with the increase of blade number. For the same cross-section and advance coefficient, the 7-blade RDT has higher thrust and torque than the 3-blade RDT due to the large friction and pressure difference between the suction and pressure surfaces. The high velocity of both RDTs appears at the junction between each blade and the duct, and the 7-blade RDT has higher velocity in the wake and in the cross-section than the 3-blade RDT. The 3-blade RDT has the high pressure at the leading edge on the suction surface of each blade. However, the 7-blade RDT has not only the high pressure at the leading edge, but also the high negative pressure at the blade root on the suction surface of each blade, so 7-blade RDT has higher torque that 3-blade RDT.
Characterization of adhesive content in post-consumer poly(ethylene terephthalate) bottles and assessment of its impact on poly(ethylene terephthalate) recyclability
Authors: Silva Sandro M , Medeiros Eliton S , Galvão Luciana S , Santos Amélia S F
Published: January 2023

Although the consequences of adhesive residues from post-consumer Poly(ethylene terephthalate) (PET) beverage bottles on the performance of recycled products are known, the quantitative effects of these adhesives are not well-stablished in the literature. Therefore, these residues were determined by gravimetry, and the adhesive content range from 200 to 2800 ppm in post-consumer PET bottles, depending on the drink filled. Through FTIR analysis, it was determined that the adhesives for bottles labelling are composed by poly(ethylene- co-vinyl acetate) (EVA). Based on these results, recycled PET with 0, 200, 700, 1500 and 3000 ppm of hot-melt EVA were processed in an internal mixer connected to a torque rheometer at 265°C for 10 min. Tensile tests indicate that 200 ppm of adhesive reduced PET tensile strength by 15%. Furthermore, when about 1500 ppm of adhesive is present, PET mechanical properties are reduced by 50%. Therefore, it is of utmost importance to warn the PET bottle production chain to reduce adhesive content used in labelling so that it should not exceed 200 ppm, if a high quality recycled PET is desirable.
Platelet-rich Plasma (PRP) in the Treatment of Diabetic Foot Ulcers and its Regulation of Autophagy
Authors: Zhao Pengyu , Zhou Guofu , Jiang Jinglun , Li Hong , Xiang Xiaoyan
Published: January 2023

Objective: Through clinical trials, this study observes the therapeutic effect of platelet-rich plasma (platelet-rich plasma, PRP) on diabetic foot ulcers and explored the relationship between the relationship between PRP and autophagy. Methods: Thirty patients with diabetic foot ulcer who met the relevant criteria were randomly divided into PRP treatment group and control group. In the PRP treatment group, the formed PRP gel was coated and bandaged on the diabetic foot ulcer wound, and the PRP treatment was repeated on the seventh day. The control group was covered with normal saline sterile gauze. Observe the healing rate of the wound in 7 days, 14 days and 21 days, the pain in 5 consecutive days and the healing time of the wound after treatment, collect wound granulation tissues before and twenty-first days after treatment then detect the expression of autophagy-related proteins (LC-3, P62) and inflammatory factors (IL-6, IL-10) in diabetic foot ulcer wound to investigate the potential relationship between PRP treatment of diabetic foot ulcers and autophagy and inflammatory responses. Results: The wound healing rate of diabetic foot ulcer patients in the PRP treatment group was higher than that in the control group on the seventh, 14th and 21st days, the healing time (31.40 ± 4.47) was better than that in the control group (43.20 ± 5.03) days, and the pain improvement was better than that in the control group ( P < .05). The results of Western blot analysis and quantitative PCR of autophagy-related proteins (LC-3 and p62) in granulation tissue showed that the values of LC3 and LC3-II/LC3-I and the expression of LC3 gene in wound granulation tissue of PRP group were significantly higher than those before treatment ( P < .05). The value and gene expression of P62 protein were lower than those before treatment ( P < .05). In the control group, there was no significant difference in LC3 and P62 protein gray level and gene expression before and after treatment ( P > .05). The level of autophagy in the wound of PRP group increased after treatment, while there was no statistical significance in the control group. The results of ELISA showed that the concentration of IL-6 in granulation tissue of the PRP treatment group was lower than that before treatment ( P < .05), while there was no significant difference in IL-6 in the control group after treatment. The concentration of IL-10 increased in both groups after treatment, but the concentration in PRP group was higher than that in control group ( P < .05). Conclusions: This study shows that PRP gel has advantages in accelerating wound healing, relieving pain, shortening healing time and reducing inflammatory response in treating diabetic foot ulcers wound, which may be related to autophagy, and provides new ideas for the treatment of diabetic foot ulcers.
Automated CT angiography collateral scoring in anterior large vessel occlusion stroke: A multireader study
Authors: Jabal Mohamed Sobhi , Kallmes David F. , Harston George , Campeau Norbert , Schwartz Kara , Messina Steven , Carr Carrie , Benson John , Little Jason , Nagelschneider Alex , Madhavan Ajay , Nasr Deena , Braksick Sherry , Klaas James , Scharf Eugene , Bilgin Cem , Brinjikji Waleed
Published: January 2023

Background

Computed tomography (CT) angiography collateral score (CTA-CS) is an important clinical outcome predictor following mechanical thrombectomy for ischemic stroke with large vessel occlusion (LVO). The present multireader study aimed to evaluate the performance of e-CTA software for automated assistance in CTA-CS scoring.

Materials and Methods

Brain CTA images of 56 patients with anterior LVO were retrospectively processed. Twelve readers of various clinical training, including junior neuroradiologists, senior neuroradiologists, and neurologists graded collateral flow using visual CTA-CS scale in two sessions separated by a washout period. Reference standard was the consensus of three expert readers. Duration of reading time, inter-rater reliability, and statistical comparison of readers’ performance metrics were analyzed between the e-CTA assisted and unassisted sessions.

Results

e-CTA assistance resulted in significant increase in mean accuracy (58.6% to 67.5%, p = 0.003), mean F1 score (0.574 to 0.676, p = 0.002), mean precision (58.8% to 68%, p = 0.007), and mean recall (58.7% to 69.9%, p = 0.002), especially with slight filling deficit (CTA-CS 2 and 3). Mean reading time was reduced across all readers (103.4 to 59.7 s, p = 0.001), and inter-rater agreement in CTA-CS assessment was increased (Krippendorff's alpha 0.366 to 0.676). Optimized occlusion laterality detection was also noted with mean accuracy (92.9% to 96.8%, p = 0.009).

Conclusion

Automated assistance for CTA-CS using e-CTA software provided helpful decision support for readers in terms of improving scoring accuracy and reading efficiency for physicians with a range of experience and training backgrounds and leading to significant improvements in inter-rater agreement.
Three-dimensional printed customized versus conventional plaster brace for trapeziometacarpal osteoarthritis: a randomized controlled crossover trial
Authors: Eyiis Esra , Mathijssen Nina M.C. , Kok Petra , Sluijter Judith , Kraan Gerald A.
Published: January 2023

We investigated the non-operative management of trapeziometacarpal osteoarthritis with a three-dimensional (3-D) printed patient-customized brace compared with a conventional plaster brace. Fifty-two patients with symptomatic trapeziometacarpal osteoarthritis were enrolled in a 9-week crossover study, which was designed as a randomized controlled trial of two periods of 4-week brace therapies. The primary outcome was patient satisfaction measured with the Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire survey. Secondary outcomes included pain, patient-reported function, functional hand strength measured by pinch and grip strength, and compliance assessed through a daily log of self-reported brace usage. The 3-D printed patient-customized brace had higher patient satisfaction and compliance than the conventional plaster brace. Patients preferred the 3-D printed customized brace (93%) rather than the conventional plaster brace (7%). This suggests that the 3-D printed patient-customized brace is effective in the non-operative management of trapeziometacarpal osteoarthritis.

Level of evidence: I
Cleft lip and palate
Authors: Lotfallah Andrew , Shahidi Shayan , Odelberg Sven Wilhelm , Darr Adnan
Published: January 2023

The term ‘oral cleft’ describes a spectrum of oro-facial developmental malformations in which there is an abnormal anatomical opening or division of the lip, palate or both. There are three main types: cleft lip (CL) alone, cleft lip with cleft palate (CL/CP), and cleft palate (CP) alone. They represent the most common facial anomaly worldwide. This article describes the embryological theory, aetiology, diagnosis and management of oral clefting, focusing on the functional impact of the condition, how patients may present, and clinical findings which may raise suspicion in primary care.
Lean manufacturing practices for operational and business performance: A PLS-SEM modeling analysis
Authors: Panigrahi Shrikant , Al Ghafri Khaloud Khalfan , Al Alyani Wafa Rashid , Ali Khan Muhammad Waris , Al Madhagy Taufiq , Khan Asadullah
Published: January 2023

Objective

The main objective of the study is to empirically investigate the influence of lean manufacturing (LM) practices on the operational and business performance of manufacturing companies in Oman.

Methods

Empirical data on LM practices and performance were collected using a self-administered structured survey questionnaire and the sampling frame was manufacturing companies in Oman. In total 300 questionnaires were distributed among 185 companies and a total of 107 with a response rate of 35.6 percent.

Findings

The statistical analysis obtained from structural equation modeling found that lean manufacturing practices can explain operational performance, however, were unable to benefit overall business performance. Out of eight LM practices considered, small-lot production and quick setups were found to be the most adopted practices in manufacturing companies.

Novelty

Even though LM has become a fundamental aspect of industrial manufacturing processes; little is known about its impact on performance. This study adds value to the literature by examining the key LM practices-performance relationships within the manufacturing companies in Oman. These findings have significant implications for improving manufacturing organizations' operational and business performance through lean manufacturing strategies.
Hematological parameters and early-onset coronary artery disease: a retrospective case–control study based on 3366 participants
Authors: Wang Huan , Li Hui , Wang Yan , Zhao Cong , Tian Qing-Wu , Wang Qing , He Guo-Wei , Lun Li-Min , Xuan Chao
Published: January 2023

Background:

Thrombosis and inflammation are crucial elements in the pathogenesis of cardiovascular disease. Hematological parameters elucidate information involving the inflammatory and blood coagulation processes.

Objectives:

The current study explored the association of hematological parameters with EOCAD to identify specific risk factors.

Design:

A single-center retrospective case–control study was conducted with 1693 coronary artery disease patients and 1693 controls.

Methods:

Hematological parameters were examined through an automated analyzer.

Results:

The basophil percentage was significantly reduced in EOCAD (0.43 ± 0.26, p < 0.001) and MI (0.33 ± 0.24, p < 0.001) groups compared with controls (0.54 ± 0.28). The eosinophil percentage was also significantly lower in EOCAD (2.21 ± 1.71, p < 0.001) and MI (1.71 ± 2.44, p < 0.001) groups compared with controls (2.41 ± 1.75). The lymphocyte percentage in patients of EOCAD and MI and controls was 31.65 ± 7.93, 25.48 ± 9.43, and 34.82 ± 7.28, respectively. A significant difference was observed among the groups ( p < 0.001). Except for the mean corpuscular hemoglobin (MCH), other red blood cell (RBC) parameters significantly differed between EOCAD patients and controls. The red blood cell distribution width (RDW), hematocrit (HCT), RBC count, mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), and hemoglobin level were associated with EOCAD prevalence after adjusting for baseline differences. Platelet volume distribution width (PDW) also correlated with EOCAD prevalence (ORadjust = 1.087, 95% CI: 1.044–1.131).

Conclusions:

Hematological parameters are closely associated with EOCAD. Moreover, leukocyte parameters correlated with the presence and severity of the disease. In addition, erythrocyte parameters were associated with the disease presence but not with the disease severity. Among the platelet parameters, only PDW was related to the disease presence.
Population-Based Analysis of Nonsteroidal Anti-inflammatory Drug Prescription in Subjects With Chronic Kidney Disease
Authors: Armstrong Marni J. , Zhang Kevin , Ye Feng , Klarenbach Scott W. , Pannu Neesh I.
Published: January 2023

Background:

Pain is a prevalent symptom experienced by patients with chronic kidney disease (CKD) and appropriate management of pain is an important element of comprehensive care. Nonsteroidal anti-inflammatory drugs (NSAID) are known to be nephrotoxic in persons with CKD.

Objective:

This study examined the pattern of NSAID prescribing practices in a population based-cohort of patients with CKD.

Design:

Retrospective cohort study using linked population-based health care data.

Setting:

Entire province of Alberta, Canada.

Participants:

All adults in Alberta with eGFR defined CKD G3 or greater between 2009 and 2017 were included.

Measurements:

CKD was defined using at least 2 outpatient serum creatinine (SCr) greater than 90 days apart; the date of second SCr measurement was used as index date. We determined the incidence of hyperkalemia using the peak serum potassium. Prescription drug information was obtained from the Pharmaceutical Information Network (PIN) database.

Methods:

All patients were followed from the index date until March 31, 2019, with a minimum follow-up of 2 years. Prescription drug information and the follow-up laboratory testing of serum creatinine and serum potassium were obtained. Patients with kidney failure defined as eGFR < 15 mL/min per 1.73 m2, receiving chronic dialysis, or prior kidney transplant at baseline were excluded.

Results:

A total of 170 574 adults (mean age 76.3; 44% male) with CKD were identified and followed for a median of 7 years; 27% were dispensed at least 1 NSAID prescription. While there was a trend toward fewer prescriptions in patients with more advanced CKD ( P < .001), 16% of those with CKD G4 were prescribed an NSAID. Primary care providers provided 79% of the prescriptions. Among NSAID users, 21% had a follow-up serum creatinine (SCr) within 30 days of the index prescription.

Limitations:

Data collected were from clinical and administrative databases not created for research purposes. The study cohort is limited to subjects who sought medical care and had a serum creatinine measurement obtained. Measurement of NSAID use is limited to those who were dispensed a prescription, over-the-counter NSAIDs use is not captured.

Conclusions:

Despite guidelines advocating cautious use of NSAIDs in patients with CKD, this study indicates that there is a discrepancy from best practice recommendations. Effective strategies to better support and educate prescribers, as well as patients, may help reduce inappropriate prescribing and adverse events.
Behind Blue Skies: A Multimodal Automated Content Analysis of Islamic Extremist Propaganda on Instagram
Authors: Clever Lena , Schatto-Eckrodt Tim , Clever Nico Christoph , Frischlich Lena
Published: January 2023

Social media platforms, such as Instagram, are regularly misused for spreading covert (Islamic) extremist propaganda. Affect and emotion are central tools used in extremist propaganda, but there is little research into the combined employment of different social media elements, such as hashtags, visuals, and texts, in the context of propaganda. This study contributes to closing this gap. Using the German group Generation Islam as a case study, we examined the group’s Instagram activity ( N = 1,187 posts) over the course of 2 years. To reflect the platform users’ logic, we (a) examined affect in hashtag networks in which users can come across propagandistic content, (b) employed deep learning to examine the emotional valence transmitted in the visuals, and (c) used automated linguistic analysis to describe collective action cues contained within the texts. The results are novel, as they provide nuanced insights into extremist propaganda’s employment of affect and emotions across Instagram’s affordances.
Justifiable narratives: The rise and fall of family politicians in South Korea
Authors: Park Jung Hoon
Published: January 2023

Like other Asian democracies, family politics is not unknown to South Korea. The triumph of Park Geun–hye, daughter of former authoritarian ruler Park Chung–hee, in the 2012 presidential election was in particular interpreted as a precursor of ‘dynastization’ in Korean politics. Nevertheless, up to the present day, political families in South Korea have been significantly less successful in securing offices through electoral competition than their Asian counterparts. Using extensive evidence from statistical and documentary sources, I argue the following: First, South Korean family politicians are more likely to face unfavorable popular sentiment towards their candidacies in elections than family politicians in other Asian democracies. Second, in addition to inheriting their predecessors' political advantages, they are required to enhance their own electoral appeal by properly justifying that their electoral participation is compatible with popular demands for meritocracy and procedural fairness. This argument highlighting politico–cultural requirements, or what I call justifiable narratives, for dynastic succession is empirically supported by case studies of four South Korean family politicians.
The Impact of COVID-19 Pandemic on Flipped Classroom for EFL Courses: A Systematic Literature Review
Authors: Linling Zhong , Abdullah Rohaya
Published: January 2023

The outbreak of the COVID-19 pandemic has had a significant impact on education. The closure of schools and the cessation of face-to-face classrooms have affected schools and students worldwide. The current need is to transform the traditional classroom to adapt to the new social and educational background. The flipped classroom is usually defined as a strategy to subvert the conventional academic environment; that is, the information transmission part of the traditional face-to-face lecture is removed from the classroom time for online self-learning. The flipped classroom is a highly flexible classroom mode, which has brought significant changes to education. Therefore, this study aims to examine the studies’ research trends, advantages, and challenges concerning the flipped classroom for EFL courses during the COVID-19 epidemic. For this purpose, databases including the web of Science (WOS) and Scopus were reviewed, and 15 articles were analyzed. A systematic review was used as the research methodology. The study’s findings revealed the effectiveness of flipped classrooms for EFL courses during the pandemic. Based on the review, this paper puts forward suggestions for future research and points out the future development direction.
Analysis of Context-Dependent Errors in the Medical Domain in Spanish: A Corpus-Based Study
Authors: Hernández Jésica López , Molina Fernando Molina , Almela Ángela
Published: January 2023

This corpus-based study aimed to investigate the presence of context-dependent linguistic errors in a corpus of clinical reports. The data were taken from a corpus comprising more than 2 million words and made up of clinical reports from emergency medicine, intensive care unit, general surgery, and psychiatry. Quantitative and qualitative analyses were carried out. A language model based on n-grams was developed for the detection of errors, parameters for the selection of cases were defined, and a classification tool was implemented. The findings indicated that emergency medicine was the medical specialty with the highest number of context-dependent errors and that the most frequent type of error was omission of written accent. Furthermore, the analysis revealed the presence of errors of competence due to the incorrect application of the linguistic norm of Spanish, phenomena of phonetic similarity, and composition of words; it is also worth noting that performance errors occurred due to rapid typing on the keyboard. This study constituted the first analysis and creation of a typology of context-dependent errors for the medical domain in Spanish. It contributed to the design of a module based on linguistic knowledge that can be used for the development and improvement of automatic correction systems that, in turn, are used for data processing in medicine.
Modeling Individual Beliefs to Transfigure Technology Readiness into Technology Acceptance in Financial Institutions
Authors: Mahmood Asif , Imran Muhammad , Adil Kamran
Published: January 2023

Over the past few decades, financial institutions have been considerably influenced by swift technological advancements. Therefore, it is critical to understand employees’ reactions and adoption of cutting-edge technologies in order to build up their morale, efficiency and work quality. Furthermore, there is slow technology adoption and learning in Pakistani financial institutions owing to a lack of infrastructure, lack of trust, improper knowledge, security, and quality of services offered by financial institutions. Thus, this study intentions to empirically examine the effects of personality dimensions (optimism, innovativeness, discomfort, and insecurity) of TRI (Technology Readiness Index) on the cognitive dimensions of TAM (Technology Acceptance Model) for online readiness, as well as to investigate this relationship with the moderating role of individual beliefs (subjective norms and self-efficacy) in financial institutions of Pakistan. In this study, a self-administered questionnaire was utilized to acquire 351 valid responses from the employees of financial institutions in Pakistan. The model was tested employing the collected data with the help of the Partial Least Structural Equation Modeling (PLS-SEM) technique applied through SmartPLS 3.3.2 software. The findings reveal that both technology readiness and technology acceptance are cardinal in shaping employees’ behavioral intentions toward the internet banking system. Furthermore, the results posit that individual beliefs significantly concatenate TRI and TAM into TRAM. This study suggests that integrating TRI with TAM in relationship with moderating roles of subjective norms and self-efficacy would give countenance to the employees of financial institutions in adopting avant-garde technology to boost their efficiency and work quality.
How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis
Authors: Koster Marc , Luzier Anton D , Temmerman Olivier PP , Vos Stan J (CJ) , Benner Joyce L
Published: January 2023

Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.
Examining the Diagnosis and Treatment Experiences of People Living With Autoimmune Gastritis and Pernicious Anemia
Authors: Cotton Martine , McCaddon Andrew
Published: January 2023

There is limited research evaluating the diagnosis and treatment of patients with autoimmune gastritis (AIG) and pernicious anemia (PA). We used a 2-phase data collection process to examine the literature and individual patient accounts. Phase one comprised a systematically conducted literature review focusing on diagnosis and treatment, relationships with healthcare practitioners and health-related quality of life (HRQOL). Phase two involved analysis of individual accounts via posts in online patient forums. We identified 6 main themes: the diagnosis journey, seeking treatment, patient-provider relationships, HRQOL, patient disempowerment, and the “expert patient.” Our findings confirm significant knowledge gaps concerning AIG/PA across the healthcare community. These have a cascading effect starting with delays in diagnosis and poor treatment protocols and often lead to complete withdrawal from care seeking. The establishment of standard consensus guidelines and improved clinical awareness should be urgently addressed. Interventions that better help patients understand their illness are also needed to improve psychological health. Without these changes disengagement from health systems, and poor health outcomes, will continue for this population group.
Arthroscopic Superior Capsular Reconstruction
Authors: Greiner Justin J. , Carrazana-Suarez Luis F. , Dunn Robin , Lin Albert
Published: January 2023

Background:

Limited options exist for young patients with massive, irreparable rotator cuff tears. While several treatment options exist, superior capsular reconstruction (SCR) was developed to restore glenohumeral joint stability by preventing superior humeral head migration during glenohumeral motion.

Indications:

Arthroscopic SCR is indicated in young patients with a massive, irreparable rotator cuff tear. Patients require a functioning deltoid muscle with minimal to no glenohumeral joint arthritis. In addition, patients should have Hamada grade 2 or less and should have an intact or repairable subscapularis tendon.

Technique Description:

The patient is positioned in the beach chair position. Standard anterior, posterior, and mid-lateral portals are established. An accessory posterior-superior lateral portal is used for visualization. Three 3.0 mm knotless anchors are placed in the glenoid through lateral percutaneous incisions. Two 4.75 mm anchors are placed adjacent to the humeral articular cartilage for medial row fixation. The graft dimensions are measured using the distance between the anchors. The graft is prepared using a gown card as a template with 5 mm added to the medial, posterior, and anterior graft dimensions, and 10 mm added to the lateral dimension. Sutures are passed through the graft in an inverted horizontal mattress for the glenoid anchors to diminish friction and allow appropriate suture passage through the knotless mechanism of the anchor. The graft is then shuttled into the joint through a lateral PassPort button cannula. Two lateral row anchors are used to secure the lateral graft on the humerus. Native rotator cuff tissue is repaired to the graft using sutures from the medial row anchors as well as free SutureTape.

Results:

Outcomes following SCR have demonstrated improvements in clinical outcomes and shoulder range of motion. Similar outcomes have been identified between the use of allograft and autograft. Patients generally are able to return to light recreational activities and work.

Discussion/Conclusion:

Arthroscopic SCR yields favorable results in the setting of a massive, irreparable rotator cuff tear. Meticulous surgical technique is needed to avoid intraoperative surgical complications. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
How I approach bleeding in hospitalized patients
Authors: Bannow Bethany Samuelson , Konkle Barbara A.
Published: January 2023

Excessive bleeding is relatively common in adult inpatients, whether as the primary reason for admission or as a development during the hospital stay. Common causes include structural issues, medication effects, and systemic illnesses; occasionally, unexpected bleeding can develop as a result of an undiagnosed or newly acquired bleeding disorder. The first step in caring for the inpatient who is bleeding is to determine whether the bleeding symptom is truly new or whether the patient has a history of abnormal bleeding. Patients with a history of abnormal bleeding may warrant evaluation for inherited bleeding disorders, such as platelet function disorders, von Willebrand disease, hemophilia, or rare factor deficiencies. Patients with no history of bleeding, for whom other causes, such as liver dysfunction, medication effect, disseminated intravascular coagulation, or certain vitamin deficiencies have been ruled out may require evaluation for acquired coagulopathies, such as acquired hemophilia or acquired von Willebrand disease. Here, we present 3 cases to discuss the diagnosis and management of the 2 most common acquired bleeding disorders as well as a patient with a congenital bleeding disorder with a historical diagnosis.
A practical approach to curate clonal hematopoiesis of indeterminate potential in human genetic datasets
Authors: Vlasschaert Caitlyn , Mack Taralynn , Heimlich Jonathan Brett , Niroula Abhishek , Uddin Md Mesbah , Weinstock Joshua S , Sharber Brian , Silver Alexander J. , Xu Yaomin , Savona Michael R. , Gibson Christopher J. , Lanktree Matthew B. , Rauh Michael J , Ebert Benjamin L. , Natarajan Pradeep , Jaiswal Siddhartha , Bick Alexander G.
Published: January 2023

Clonal hematopoiesis of indeterminate potential (CHIP) is a common form of age-related somatic mosaicism that is associated with significant morbidity and mortality. CHIP mutations can be identified in peripheral blood samples sequenced using approaches that cover the whole genome, whole exome or targeted genetic regions; however, differentiating true CHIP mutations from sequencing artifacts and germline variants is a considerable bioinformatic challenge. We present a stepwise method that combines filtering based on sequencing metrics, variant annotation, and population-based associations to increase the accuracy of CHIP calls. We apply this approach to ascertain CHIP in ~550,000 individuals in the UK Biobank complete whole exome cohort and the All of Us Research Program initial whole genome release cohort. CHIP ascertainment on this scale unmasks recurrent artifactual variants and highlights the importance of specialized filtering approaches for several genes including TET2 and ASXL1. We show how small changes in filtering parameters can considerably increase CHIP misclassification and reduce the effect size of epidemiological associations. Our high-fidelity call set refines prior population-based associations of CHIP with incident outcomes. For example, the annualized incidence of myeloid malignancy in individuals with small CHIP clones is 0.03%/year, which increases to 0.5%/year amongst individuals with very large CHIP clones. We also find a significantly lower prevalence of CHIP in individuals of self-reported Latino or Hispanic ethnicity in All of Us, highlighting the importance of including diverse populations. The standardization of CHIP calling will increase the fidelity of CHIP epidemiological work and is required for clinical CHIP diagnostic assays.
MultiScale-CNN-4mCPred: a multi-scale CNN and adaptive embedding-based method for mouse genome DNA N4-methylcytosine prediction
Authors: Zheng Peijie , Zhang Guiyang , Liu Yuewu , Huang Guohua
Published: January 2023

N4-methylcytosine (4mC) is an important epigenetic mechanism, which regulates many cellular processes such as cell differentiation and gene expression. The knowledge about the 4mC sites is a key foundation to exploring its roles. Due to the limitation of techniques, precise detection of 4mC is still a challenging task. In this paper, we presented a multi-scale convolution neural network (CNN) and adaptive embedding-based computational method for predicting 4mC sites in mouse genome, which was referred to as MultiScale-CNN-4mCPred. The MultiScale-CNN-4mCPred used adaptive embedding to encode nucleotides, and then utilized multi-scale CNNs as well as long short-term memory to extract more in-depth local properties and contextual semantics in the sequences. The MultiScale-CNN-4mCPred is an end-to-end learning method, which requires no sophisticated feature design. The MultiScale-CNN-4mCPred reached an accuracy of 81.66% in the 10-fold cross-validation, and an accuracy of 84.69% in the independent test, outperforming state-of-the-art methods. We implemented the proposed method into a user-friendly web application which is freely available at: http://www.biolscience.cn/MultiScale-CNN-4mCPred/.
Molecular characterization of SPL gene family during flower morphogenesis and regulation in blueberry
Authors: Feng Xin , Zhou Bingjie , Wu Xinliang , Wu Huiling , Zhang Suilin , Jiang Ying , Wang Yaping , Zhang Yaqian , Cao Man , Guo Baoshi , Su Shuchai , Hou Zhixia
Published: January 2023

The SPL gene is a plant-specific transcription factor involved in the regulation of plant growth and development, which have been identified in woody plants. The process of floral bud differentiation affects the timing of flowering and fruit set and regulates plant growth, however, the mechanism of regulation of flower development by SPL genes is less studied. In this study, 56 VcSPL genes were identified in the tetraploid blueberry. The VcSPL gene family was classified into six subfamilies, and analysis of cis-elements showed that VcSPL genes were regulated by light, phytohormones (abscisic acid, MeJA), and low temperature. In the evolutionary analysis, segmental replication may play an important role in VcSPL gene amplification. Interestingly, we also studied diploid blueberry (Bilberry), in which 24 SPL genes were identified, and 36 homologous pairs were found, suggesting a high degree of convergence in the syntenic relationship between blueberry (Vaccinium corymbosum L) and bilberry (Vaccinium darrowii). Based on the expression profile, VcSPL genes were expressed at high levels in flowers, shoots, and roots, indicating a diversity of gene functions. Then we selected 20 differentially-expressed SPL genes to further investigate the role of VcSPL in floral induction and initiation. It showed that the genes VcSPL40, VcSPL35, VcSPL45, and VcSPL53 may play a crucial role in the blueberry floral transition phase (from vegetative growth to flower initiation). These results provided important information for understanding and exploring the role of VcSPLs in flower morphogenesis and plant growth.
Music therapy for pain and anxiety in patients after cardiac valve replacement: a randomized controlled clinical trial
Authors: Dong Yi , Zhang Lin , Chen Liang-Wan , Luo Zeng-Rong
Published: January 2023

Objective

This study aimed to assess how listening to music after cardiac valve replacements affected patients' pain, anxiety, and vital signs.

Method

In Fuzhou, China's Fujian Medical University Union Hospital, the cardiac surgery division conducted a randomized controlled clinical experiment. 86 patients were enrolled, and 43 were assigned randomly to each group (control and experimental group). The standard treatment was given to the control group, while the experimental group was given standard treatment + a 15-min music intervention 3 times. Indicators include pain, anxiety and vital signs (respiratory rate, heart rate, and blood pressure).

Results

In comparison to the control group, the experimental group, over time, demonstrated a statistically substantial decrease in pain, anxiety, systolic blood pressure, heart rate and respiratory rate (all P < 0.001), yet, there were no discernible variations (P > 0.05) in diastolic blood pressure.

Conclusions

In conclusion, these results provide additional proof for using music therapy to minimize cardiac postoperative pain and anxiety, as well as systolic blood pressure, heart rate and respiratory rate. Moreover, it should be regarded as a supplementary treatment for pain and anxiety after cardiac valve replacement and other medical procedures with comparable postoperative pain.
Short- to mid-term outcomes after transcatheter aortic valve replacement in patients with ascending aorta dilation: a single-centre retrospective analysis
Authors: Yu Jun , Wang Wei
Published: January 2023

Objectives

Ascending aorta dilation (AAD) is frequently associated with aortic stenosis (AS). This study investigated the procedural and clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with AAD for tricuspid AS.

Methods

This is a single-centre retrospective study that included patients with tricuspid AS and who underwent TAVR between January 1, 2018 and December 31, 2021. A total of 239 patients met the inclusion criteria. The ascending aortic diameter was measured on computed tomography (CT) scans before TAVR, and AAD was identified as a maximal ascending aortic diameter of ≥ 40 mm. The outcomes were in line with the Valve Academy Research Consortium (VARC)-3 criteria.

Results

Self-expandable (SE) valves were used in 88.7% of the total cohort (89.0% in the AAD group and 88.6% in the non-AAD group). Seventy-three patients (30.5%) were diagnosed with concomitant AAD (mean age 73.7 ± 7.3 years, 57.5% male). The median ascending aortic diameter was 36.0 mm (interquartile range [IQR]: 34.0–37.0 mm) in the non-AAD group and 44.0 mm (IQR: 42.0–46.0 mm) in the AAD group (p < 0.001). The baseline characteristics were comparable across the groups. No significant difference was observed in cumulative all-cause mortality at 30 days (2.4% vs. 1.4%, p = 0.609), 1 year (9.2% vs. 5.0%, p = 0.191), or 3 years (13.1% vs. 9.5%, p = 0.201) between the non-AAD and AAD groups. The device success rate was not different between the non-AAD and AAD groups (74.7% vs. 82.2%, p = 0.205). The multivariable analysis identified prior percutaneous coronary intervention, prior stroke, and length of intensive care unit as independent predictors of 3-year all-cause mortality among the total cohort.

Conclusion

AAD does not appear to be associated with the procedural and mid-term clinical outcomes in patients undergoing TAVR.
Decision-making process about prenatal genetic screening: how deeply do moms-to-be want to know from Non-Invasive Prenatal Testing?
Authors: Oliveri Serena , Ongaro Giulia , Cutica Ilaria , Menicucci Giulia , Belperio Debora , Spinella Francesca , Pravettoni Gabriella
Published: January 2023

Background

Prenatal information may be obtained through invasive diagnostic procedures and non-invasive screening procedures. Several psychological factors are involved in the decision to undergo a non-invasive prenatal testing (NIPT) but little is known about the decision-making strategies involved in choosing a specific level of in-depth NIPT, considering the increased availability and complexity of NIPT options. The main aim of this work is to assess the impact of psychological factors (anxiety about pregnancy, perception of risk in pregnancy, intolerance to uncertainty), and COVID-19 pandemic on the type of NIPT chosen, in terms of the number of conditions that are tested.

Methods

A self-administered survey evaluated the decision-making process about NIPT. The final sample comprised 191 women (Mage = 35.53; SD = 4.79) who underwent a NIPT from one private Italian genetic company. Based on the test date, the sample of women was divided between “NIPT before COVID-19” and “NIPT during COVID-19”.

Results

Almost all of the participants reported being aware of the existence of different types of NIPT and more than half reported having been informed by their gynecologist. Results showed no significant association between the period in which women underwent NIPT (before COVID-19 or during COVID-19) and the preferences for more expanded screening panel. Furthermore, regarding psychological variables, results showed a significant difference between perceived risk for the fetus based on the NIPT type groups, revealing that pregnant women who underwent the more expanded panel had a significantly higher level of perceived risk for the fetus than that reported by pregnant women who underwent the basic one. There was no statistically significant difference between the other psychological variables and NIPT type.

Conclusions

Our findings indicate the paramount role of gynecologist and other health care providers, such as geneticists and psychologists, is to support decision-making process in NIPT, in order to overcome people’s deficits in genetic knowledge, promote awareness about their preferences, and control anxiety related to the unborn child. Decision-support strategies are critical during the onset of prenatal care, according to the advances in prenatal genomics and to parent’s needs.
Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care
Authors: Sialubanje Cephas , Kaiser Jeanette L. , Ngoma Thandiwe , Mwananyanda Lawrence , Fong Rachel M. , Hamer Davidson H. , Scott Nancy A.
Published: January 2023

Background

Postnatal care (PNC) is an important set of services offered to the mother and her newborn baby immediately after birth for the first six weeks to prevent maternal and neonatal complications and death. This qualitative study explored user and provider perspectives on quality of PNC services in the selected health facilities within the context of the Maternity Homes Access in Zambia project in the Saving Mothers Giving Life districts in rural Zambia.

Methods

Between October 2018 and February 2019, forty focus group discussions (FGDs) (n = 160 participants) and twelve in-depth interviews (IDIs) were conducted in four districts in Southern and Eastern provinces. FGDs comprised women who delivered within the last year, fathers, community elders, and volunteers. IDIs comprised health workers at facility, district, and provincial levels. Data were analysed using content analysis guided by the international quality of care domains derived from the World Health Organization quality of care framework. Findings were triangulated to understand perceptions.

Results

Overall, study participants perceived PNC services to be beneficial. Nevertheless, respondents had mixed feelings on the quality of PNC services and expressed a stark difference in their perception of factors affecting service quality. Service users described challenges arising from ineffective communication about the new PNC guidelines, and non-adherence of service providers to quality standards regarding respect, preservation of dignity and emotional support. Other factors were long waiting hours, small examination rooms providing inadequate privacy, and low levels of confidentiality. In contrast, service providers attributed poor service quality to various health system-related factors including low staffing levels, dysfunctional referral services, low supply of essential medicines, supplies, vaccines and equipment for optimal routine emergency obstetric and newborn care and management of complications.

Conclusion

These findings highlight important intervention opportunities to improve quality of PNC services in Zambia through better communication and raising awareness on PNC guidelines, respect, preservation of dignity and emotional support to mothers. Interventions should also focus on addressing contextual health system challenges including staffing levels, supply chain for essential medicines and commodities, shortening waiting time, and ensuring functional referral system.