bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of a negative pressure wound therapy system for stoma closure
Authors: Shirakawa Chisato , Sakamoto Yuzuru , Ueki Shinya , Shomura Hiroki , Kazui Keizo , Taketomi Akinobu
Published: February 2025

Objective:

Although wound infection rates after stoma closure have decreased, they remain high. Negative pressure wound therapy (NPWT) for stoma closure wounds can shorten healing time for many wound types. The PICO (Smith+Nephew, UK) wound dressing, a single-use NPWT system that can be used for outpatients, was introduced at the Japan Community Health Care Organization Hokkaido Hospital, Japan in November 2017. We evaluated the effectiveness of this dressing in stoma closure wounds.

Method:

We retrospectively evaluated patients who underwent stoma closure between March 2012 and July 2021. We compared postoperative short-term outcomes (surgical site infection (SSI), number of pain medications, and postoperative hospital stay) by allocating the patients to one of two groups: purse-string closure or purse-string closure with PICO. The purse-string closure group (PC) underwent purse-string closure alone, while the other group underwent purse-string closure and PICO (PCP).

Results:

A total of 35 patients were evaluated; 20 in the PC group and 15 in the PCP group. No significant differences in characteristics were noted between the groups. Comparisons between stoma closure techniques revealed that the PCP group had shorter hospital stays (p=0.04), lower SSI rates (p=0.04), and less pain medication (p<0.01) than the PC group. Comparisons between SSI occurrence revealed that the group of patients with an SSI had a higher number of colostomies compared with ileostomies (37.5% versus 0%, p<0.01, respectively), used more pain medication (p<0.01), and had longer hospital stays (p=0.04) than patients who did not have an SSI.

Conclusion:

After stoma closure, combining PICO with purse-string closure may be effective in preventing SSI and controlling postoperative pain.
Fusion-Ready Steel is UK-First
Authors: Fanning Paul
Published: February 2025

Another step towards fusion energy has been taken with the development of reduced activation steel costing ten times less to produce than previously.
Pulmonary cryptococcosis in immunocompetent children presenting with chest pain: Three case reports
Authors: Li Xiao-Nan , Chen Jie-Hua , Lu Zhi-Wei
Published: February 2025

BACKGROUND

Cryptococcus is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts, with diverse clinical manifestations, ranging from asymptomatic pulmonary lesions to disseminated central nervous system infections. The incidence of pulmonary cryptococcosis (PC) has rapidly increased in recent years, with an increasing proportion of non-human immunodeficiency virus-infected and immunocompetent patients making its diagnosis challenging. If not properly recognized, PC can lead to systemic dissemination and high mortality rates. Early diagnosis and treatment can improve the prognosis. This study summarizes the clinical features of three immunocompetent children with PC who presented with chest pain to raise clinicians' awareness of the disease and reduce mortality.

CASE SUMMARY

Three male pediatric patients in good health were hospitalized because of chest pain without cough or fever. Chest computed tomography (CT) revealed pleural-based nodules and consolidation with cavitation. A lung biopsy was performed in one case, and Cryptococcus was cultured from the pathological tissues. Cryptococcus was detected in the alveolar lavage fluid, and serum Cryptococcus capsular (C. capsular ) polysaccharide antigen was positive in one case, and the other case was positive for serum C. capsular polysaccharide. All patients received oral fluconazole treatment. Follow-up chest CT scans after six months showed significant resolution of the lesions.

CONCLUSION

PC can also occur in immunocompetent children. When encountering children with chest pain only in the clinic, one should be vigilant about PC, promptly complete the relevant examinations, and avoid misdiagnosis.
Diagnosis and surgical challenges of extremely severe head and lumbar disc herniation in young patients: A case report
Authors: Zhou Jun-Ge
Published: February 2025

BACKGROUND

Lumbar disc extrusion, a common spinal disorder, is particularly uncommon in its severely displaced form, especially in young patients. This condition can pose diagnostic challenges due to its nonspecific presentation.

CASE SUMMARY

A 36-year-old male patient presented with persistent low back pain and radiating leg pain lasting half a month, which had worsened over the previous four days. Lumbar magnetic resonance imaging scans showed an abnormal signal within the vertebral canal at the L3 level, suggesting either a disc cyst or an epidural hematoma. Based on these findings, the patient was provisionally diagnosed with either condition. Surgical exploration was conducted, revealing an extruded lumbar disc, which was subsequently excised. Following surgery, the patient's symptoms completely resolved.

CONCLUSION

High-grade lumbar disc extrusion in young patients is rare but should be considered in sedentary, physically inactive individuals presenting with lumbocrural pain and abnormal magnetic resonance imaging findings. Early and accurate diagnosis is crucial to avoid misdiagnosis, and prompt open surgery may be necessary in severe cases to alleviate symptoms. The case highlights the impotance of a thorough diagnostic workup and timely surgical intervention in managing such rare but potentially severe spinal disorders.
DOES RETURN TO PHYSICAL ACTIVITY DIFFER BETWEEN ANKLE ARTHRODESIS AND TOTAL ANKLE ARTHROPLASTY: ONE-YEAR FOLLOW-UP STUDY
Authors: Jabbar Faizan , Nicolas Andrea , Chambers Simon , Torres Paulo , Qasim Sultan , Siddique Malik , Ramaskandhan Jayasree
Published: February 2025

Background

The ability to return to physical activity is an important indicator of surgical success for end-stage ankle arthritis. There is paucity of literature comparing outcomes between surgical procedures. This study aimed to compare outcomes for physical activity and return to function between total ankle replacement (TAR) and ankle arthrodesis (AA) at 1-year follow-up.

Methods

This was a single-centre prospective follow-up study. Patients who underwent TAR (n=33) or AA (n=25) between 2022–2023 completed questionnaires on FAOS scores (Pain, Symptoms, ADL and QOL domains), International Physical Activity Questionnaire (IPAQ), satisfaction scores and return to work/driving. IPAQ physical activities were compared across domains of work, transportation, domestic and leisure activities.

Results

AA patients were younger (59.1 vs. 65.8). The AA group had better average FAOS scores for pain, symptoms, ADL, and QOL compared to TAR (51.2 vs. 29.2; 40.6 vs. 67.8, 46.8 vs. 66.4, 31.3 vs. 48.3) (p=0.526), but the TAR group reported higher overall satisfaction (77% vs. 66.6%). Earliest return to work was reported at 2 weeks (TAR) vs. 3 weeks (AA) group and driving at 3 weeks (TAR) vs. 4 weeks (AA). More TAR patients returned to vigorous (25%) and moderate (17.6%) physical activity versus AA (0% and 0%). For transport, 4 AA patients vs. 12 TAR patients returned to this activity. AA patients travelled 30 minutes to 2 hours per week, while TAR patients travelled 30 minutes to 5 hours. For household activities, 15.7% of TAR patients reported vigorous activity versus 0% in AA. AA patients spent less time on average leisure walking (1.25 hrs vs. 2 hrs), and more time sitting per day (9.2 hrs vs. 5.9 hrs).

Conclusion

The TAR group demonstrated earlier return to work, driving, and higher levels of physical activity compared to AA patients at 1-year follow-up, despite the AA group having better FAOS scores.
SINGLE-STAGE REVISION TOTAL ANKLE ARTHROPLASTY: IS IT SAFE?
Authors: Pekhale Parikshit , Raglan Martin , Dhar Sunil
Published: February 2025

Background

The number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle arthroplasty (RAA). The preferred option in our center, following network discussion, is to convert the failing TAR to a RAA. There is uncertainty whether this is best done in a single staged approach or two stages.

The aim of this review was to assess the safety of single to two staged approaches in RAA

Method

A review was carried out of the prospectively collected data of all RAA performed in our center between Nov 2016 and Jan 2024. We reviewed; preoperative micro sampling, intraop micro and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone single staged RAA, compared to two staged.

Results

We identified 88 RAA patients, with mean age of 71.4 (38–88) with a minimum of 2 year follow up, range 2 – 6 years. There were 44 Left and 44 Right failing total ankle replacements. 14 were two staged procedures and 74 were single staged. Neither group had any significant intraoperative microbiology growth. There was a significant difference in tourniquet times but with no associated significant complication rate in single stage group. There was one infection in the single staged group that went onto have a successful DAIR. There was no difference in wound complications post op. Both groups showed improvement in PROMS, with no difference between the groups or in increase in length of hospital stay.

Conclusion

In our series, which is the largest in the literature, we have found single staged revision arthroplasty to be safe and effective compared to two stage in patients where there is a low index of suspicion of infection.
MORTALITY, RE-AMPUTATION, AND POSTOPERATIVE COMPLICATION RATES FOLLOWING 28,000 BELOW-KNEE AMPUTATIONS IN DIABETIC PATIENTS IN ENGLAND: A NATIONAL POPULATION STUDY, 2002–2022
Authors: Hennessy Conor , Abram Simon , Loizou Con , Brown Rick , Sharp Bob , Kendal Adrian
Published: February 2025

Introduction

Global data on BKA mortality is dominated by US Veterans population studies, while smaller single-centre UK cohorts observe a wide range of 1 year mortality (13.8%-61.1%). There is no consensus on mortality rates, perioperative complications and at-risk groups post diabetic BKA in England.

Methods

England Hospital Episodes Statistics (HES) data was combined with ONS mortality data (2000–2022) and cleaned using STATA 18. The primary outcome was the rate of all cause mortality. Secondary outcomes were causes of death, re-amputation rates, temporal variation in mortality, and 90 day peri-operative complications.

Mortality and amputation free survival was calculated with Kaplan-Meier curve analysis using R, STATA 18. Multivariate logistic regression stratified patient variables associated with mortality and/or re-amputation rate.

Results

28,045 BKA were performed for diabetes in the 20-year period; decreasing from 8.1/100,000 (2002) to 6.5/100,000 (2022). The rates were significantly higher in white males aged 60–79 years old (14/100,000 in 2023).

The mortality rates following BKA for diabetic foot disease were 7.1% at 30 days, 12.7% at 90 days, 24.6% at 1 year, and 61.2% at 5 years. Only 17% of patients survived to 10 years post BKA.

The 90-day reoperation rate for any cause was 20.7%. The ipsilateral re-amputation rate at any time was 10.4% (n=2909), and the contralateral amputation rate was 8.2% (n=2304). Additional 90-day complications included PE (0.75%, n=211), MI (3.6%, n=1019) and Stroke (1.1%, n=316).

Multi-regression analysis demonstrated significantly higher BKA associated mortality rates at all time points in male, British-Asians with higher deprivation status.

Conclusions

This landmark 20-year England diabetic population study has revealed high rates of death, further amputation and peri-operative morbidity post BKA. Asian Males in their 60s have the highest mortality rates and represent an at-risk group. Overall, there has been little improvement in post BKA mortality over the last 20 years.
VR-Based Workplace Training and Spaces of Learning: A Social Space Study of VR Training for Apprentice Electricians
Authors: Kraus Katrin , Berger Martin , Keller Thomas , Brucker-Kley Elke
Published: February 2025

Context: This study uses a social space approach to investigate Virtual Reality (VR)-based workplace learning in the context of apprenticeship training in the electronics industry in Switzerland. It was one part of a project which developed a prototype VR environment that enables apprentices to practice testing an electrical installation in a virtual garage using VR headsets. The study uses a spatial theory perspective to understand how the apprentices use the VR environment to develop their vocational competence and how spaces of learning are created through this process. 
Approach: The study applies a socio-spatial perspective to a triangulation of the results of a qualitative content analysis of structured interviews with 16 apprentices and their 11 trainers and a quantitative analysis of a close-ended apprentice survey questionnaire (N = 16). 
Results: When a VR environment is used for workplace learning, spaces of learning are created from the interplay of four spatial dimensions: The regulation and practices of use of the VR environment, the locality of use, the educational potential of the VR environment, and a mental representation of the real workplace represented in the VR environment. The VR headset acts as a boundary object in the training relationship. Other important findings of the study are: Automated access to learning opportunities reduces pressure on the teaching-learning relationship; the haptic dimension of work is important for competence development; the VR environment enables personalized learning with unlimited opportunities for practice; the lack of variety in the operational scenario enables apprentices to focus on practicing and perfecting procedures but does not reflect the complexity of the real world. 
Conclusion: Our socio-spatial analysis shows that when VR environments are used in workplace training the interplay of physical, mental, and virtual spatial dimensions leads to the emergence of learning spaces. The access to the VR environment, the location where it is used, and the active use of its learning features interact with the mental representations of the depicted environment. Spaces of learning created using a VR environment can complement traditional workplace training by facilitating the development of specific aspects of vocational competence.
Intracranial dural arteriovenous fistula presenting like longitudinally extensive transverse myelitis
Authors: Yuliatri Nia , Widjaya Ingrid Ayke , Wibawa Gibran Aditiara , Harlyjoy Alphadenti , Satyanegara
Published: February 2025

Intracranial dural arteriovenous fistula (DAVF) that drains into spinal perimedullary veins can generate longitudinally extensive transverse myelitis (LETM)-like lesion, which often represents a significant diagnostic and therapeutic challenge. This is a case report of a 50-year-old male referred with all extremity weaknesses. Despite receiving high-dose intravenous steroids for suspected myelitis, no improvement was recorded. Spinal imaging showed abnormal hyperintensity extending from the T6 vertebral level to the medulla, and a flow void lesion from the cervicomedullary junction up to the L3 level. Angiography confirmed a Cognard type V spinal DAVF, which was treated with transarterial embolization of the feeding vessel. Follow-up angiography showed complete occlusion of the fistula without any backflow. Flow voids are no longer visible on MRI conducted 3 weeks post-procedure. Unfamiliarity with these disorders often leads to delays in diagnosis and treatment. Therefore, it is essential to consider intracranial DAVF as a differential diagnosis for LETM-like lesions.
Lightweight denoising speckle contrast image GAN for real-time denoising of laser speckle imaging of blood flow
Authors: Sang Xu , Cao Ruixi , Niu Liushuan , Chen Bin , Li Dong , Li Qiang
Published: February 2025

To tackle real-time denoising of noisy laser speckle blood flow images, a novel lightweight denoising speckle contrast image generative adversarial network (LDSCI-GAN) is proposed. In the framework, a lightweight denoiser removes noise from the original image, and a discriminator compares the denoised result with the reference one, enabling efficient learning and optimization of the denoising process. With a multi-scale loss function in the log-transformed domain, the training process significantly improves accuracy and denoising by using only five frames of raw speckle images while well-preserving the overall pixel distribution and vascular contours. Animal and phantom experimental results indicate that the LDSCI-GAN can eliminate vascular artifacts while retaining the accuracy of relative blood flow velocity. In terms of peak signal-to-noise ratio (PSNR), mean structural similarity index (MSSIM), and Pearson correlation coefficient (R), the LDSCI-GAN outperforms other deep-learning methods by 3.07 dB, 0.10 (p < 0.001), and 0.09 (p = 0.023), respectively. It has been successfully applied to the real-time monitoring of laser-induced thrombosis. Through conducting tests on the denoising performance of blood flow images of a moving subject, our proposed method achieved enhancements of 23.6% in PSNR, 30% in MSSIM, and 6.5% in the metric R, respectively, when compared to DRSNet. This means that the LDSCI-GAN also shows possible application in handheld devices, offering a potent tool for investigating blood flow and thrombosis dynamics more efficiently and conveniently.
Wave function reconstruction based on complex weak values
Authors: Gao Yang , Luo Wenqiang , Yang Qiang , Liu Jiawei , Zheng Zhiwei , Luo Hailu
Published: February 2025

The wave function is important for understanding and predicting the behavior of photons. Recent studies have shown that wave function can be reconstructed through weak measurement. But currently, the relationships of wave function, weak value, and probe are single and not complete. Here, we propose a wave function reconstruction method based on complex weak values and complex shift probes. Four relationships of them are built and the wave function can be reconstructed by position and momentum shift probes. The complex weak values can be obtained by adjusting the pre- and post-selection in weak measurement, while the complex shift probes originate from the complex nature of the Fresnel coefficient in total internal reflection. To demonstrate the feasibility of the proposed scheme, an experiment of phase distribution reconstruction is achieved by a real weak value and a momentum shift probe; the experimental results agree well with the theory and show a high contrast. Therefore, the wave function can be conveniently reconstructed by our scheme and the relationships between the wave function, weak values, and probes become more complete. This work provides a valuable reference for the application of weak measurement in image processing, quantitative phase imaging, and label-free biological imaging.
Source entropy controlled enumerative sphere shaping for a probabilistic shaping coherent optical transmission system
Authors: Wang Xuezhen , Bai Chenglin , Chen Bin , Yang Lishan , Xu Hengying , Sun Weibin , Zhang Yining , Cui Yuanhao , Wang Guizhen
Published: February 2025

We propose a source entropy controlled enumerative sphere shaping (EC-ESS) scheme to address inflexible source entropy control in sphere shaping. The proposed scheme employs a model-driven interval search algorithm to establish the relationship between the source entropy of one-dimensional and two-dimensional symbols. Data analysis indicates that within various ranges of source entropy, the number of achievable source entropies for EC-ESS surpasses that of optimum ESS (OESS). The experimental results indicate that EC-ESS provides considerable OSNR gains compared to the reference schemes, with gains of 0.04 dB, 0.27 dB, and 0.52 dB compared to OESS, BL-DM, and CCDM, respectively.
Mapping the learning curves of deep learning networks
Authors: Jiang Yanru , Dale Rick
Published: February 2025

There is an important challenge in systematically interpreting the internal representations of deep neural networks (DNNs). Existing techniques are often less effective for non-tabular tasks, or they primarily focus on qualitative, ad-hoc interpretations of models. In response, this study introduces a cognitive science-inspired, multi-dimensional quantification and visualization approach that captures two temporal dimensions of model learning: the “information-processing trajectory” and the “developmental trajectory.” The former represents the influence of incoming signals on an agent’s decision-making, while the latter conceptualizes the gradual improvement in an agent’s performance throughout its lifespan. Tracking the learning curves of DNNs enables researchers to explicitly identify the model appropriateness of a given task, examine the properties of the underlying input signals, and assess the model’s alignment (or lack thereof) with human learning experiences. To illustrate this method, we conducted 750 runs of simulations on two temporal tasks: gesture detection and sentence classification, showcasing its applicability across different types of deep learning tasks. Using four descriptive metrics to quantify the mapped learning curves—start, end - start, max, tmax—, we identified significant differences in learning patterns based on data sources and class distinctions (all p’s  <  .0001), the prominent role of spatial semantics in gesture learning, and larger information gains in language learning. We highlight three key insights gained from mapping learning curves: non-monotonic progress, pairwise comparisons, and domain distinctions. We reflect on the theoretical implications of this method for cognitive processing, language models and representations from multiple modalities.
Public health implications of satellite-detected widespread damage to WASH infrastructure in the Gaza Strip
Authors: Perlman Brian , Collins Shalean M. , Van Den Hoek Jamon
Published: February 2025

The Israeli military offensive in the Gaza Strip since October 7, 2023, has resulted in widespread attacks across the territory, damaging water, sanitation, and hygiene (WASH) infrastructure. Recent public health assessments show an increased prevalence of waterborne diseases — including polio, Hepatitis A, and gastrointestinal conditions — linked to curtailed access to safe water, exposure to contaminated water, and non-functional WASH infrastructure. However, there is a persistent lack of information on the locations and details of damaged WASH infrastructure across the Gaza Strip that can guide short-term water interventions and inform long-term recovery efforts. This study provides an assessment of the status of Gaza Strip WASH infrastructure through analysis of damage using open-source earth observation and geospatial data. Drawing from six sources, we identified 239 WASH sites spanning 11 types of infrastructure across the Gaza Strip and analyzed very-high resolution satellite imagery at each site to assess indicators of damage incurred through late February 2024. We found that 49.8% (n = 119) of sites had been damaged, including at least half of the desalination plants, water pumping stations, and water towers that formed the backbone of Gaza’s WASH infrastructure prior to the escalation of conflict. We observed WASH infrastructure damage in all five governorates, though damage was most pronounced in North Gaza, Gaza, and Khan Yunis Governorates. Due to limited access to multiple sources of satellite imagery, the practical impossibility of creating a comprehensive pre-conflict WASH infrastructure dataset, and the limitation of our scope amid ongoing hostilities, these findings likely represent a conservative underestimate of total WASH infrastructure damage. While this research does not attribute any individual attack to a specific belligerent, the breadth of WASH infrastructure damage as a result of Israel’s invasion in the Gaza Strip points to grave public health consequences, which will have long-lasting repercussions for morbidity and mortality.
Intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean: Insights and pathways forward – A scoping review
Authors: Malika Nipher , Bogart Laura M. , Matovu Joseph K. B. , Phaladze Nthabiseng , Mubiru Kuraish , Leon Rhandomy Maria , Donastorg Yeycy , Valencia Huamani Javier , Mpebe Onalethata , Chisonga Nixon , Fonki Emelda , Lockett Lejeune Y. , Lee David
Published: February 2025

Research has recently surged on intersectional HIV stigma, including how intersecting stigmatized identities and socio-structural conditions influence HIV prevention and treatment outcomes. However, most of this work has been concentrated in high-income settings. This scoping review aimed to provide an overview of research on intersectional HIV stigma in Sub-Saharan Africa, Latin America and the Caribbean. A search was conducted using five databases for articles published between January 2008 and April 2023. Two reviewers independently screened all identified studies, sorted the included studies, and conducted descriptive analyses. Of 1907 retrieved studies, 73 met inclusion criteria, of which 16% were intervention studies and 84% were non-intervention studies. Stigma was propagated through structural factors (e.g., anti-sexual and gender minority laws), institutional factors, and socio-demographic factors. Moreover, place-based differences emerged. Findings of the scoping review were discussed and interpreted by a community advisory board composed of activists and researchers from Sub-Saharan Africa, Latin America, and the Caribbean, which provided recommendations on the pathways forward in research for intersectional HIV stigma. Future research on intersectional stigma should encompass social marketing studies for promoting inclusive HIV services, strategies to transform the narrative in media, and investigations into the impact of laws against sexual and gender minority (SGM) individuals on HIV service participation, all approached from the perspective of those affected by the intersectional stigma.
Determinants of pressure to conceive among reproductive age women in Sub-Saharan Africa: A multilevel analysis of recent Demographic and Health Surveys in five countries
Authors: Kassie Alemneh Tadesse , Zegeye Alebachew Ferede , Bazezew Astewil Moges , Mamo Ephrata Yetayeh , Gebru Demiss Mulatu , Tamir Tadesse Tarik
Published: February 2025

Globally, 40% of pregnancies are unplanned, with higher rates in Sub-Saharan Africa, often ending in abortion. Women face pressure from spouses/families to conceive, leading to unintended pregnancies and violations of reproductive rights, jeopardizing women’s autonomy and well-being. Respecting individual decisions is crucial during this pivotal life stage. The study conducted a secondary data analysis using information from the latest Demographic and Health Surveys, encompassing five Sub-Saharan African nations from 2021 to 2023. The research focused on a weighted sample of 97,350 married women of reproductive age. Data analysis was performed using Stata 14, employing a multilevel mixed-effects logistic regression model to uncover the factors contributing to the pressure exerted by husbands and families on women to conceive. The study highlights that in Sub-Saharan Africa, approximately one in ten women experience pressure to conceive. Factors like age (20-35 years; AOR = 1.6, 95% CI: 1.46, 1.87), socioeconomic status (middle/affluent; AOR = 1.12, 95% CI: 1.04, 1.2 and AOR = 1.12, 95% CI: 1.03, 1.21), parity (childless; AOR = 4.65, 95% CI: 4.1, 5.2), and community literacy (low; AOR = 1.44, 95% CI: 1.25, 1.66) significantly influence this pressure. Notably, women in Tanzania have a 55% lower risk (AOR = 0.45, 95% CI: 0.41, 0.49), while those in Mozambique face a 1.88 times higher risk. The study highlights the substantial pressure faced by reproductive-age women to conceive in Sub-Saharan Africa. Addressing these challenges through targeted policies and interventions is crucial to empower women and promote their reproductive autonomy.
Global availability of medications and health technologies for kidney care: A multinational study from the ISN-GKHA
Authors: Kelly Dearbhla M. , Jones Erika S. W. , Barday Zibya , Arruebo Silvia , Caskey Fergus J. , Damster Sandrine , Donner Jo-Ann , Jha Vivekanand , Levin Adeera , Nangaku Masaomi , Saad Syed , Tonelli Marcello , Ye Feng , Okpechi Ikechi G. , Bello Aminu K. , Johnson David W.
Published: February 2025

A core feature of universal health coverage is equitable access to affordable care not exposing people to financial hardship. This study aims to provide a global overview on availability and access to medications and health technologies for delivery of optimal kidney care. An international survey of stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated to the International Society of Nephrology was conducted from July to September 2022 on availability of tools and services for all aspects of kidney care and access to essential medications. Of 167 participating countries (97.4% of the global population), there were significant disparities in kidney care funding and service availability. Only 5 (n = 1) and 10% (n = 4) of countries in Latin America and Africa, respectively, publicly funded non-dialysis CKD care free at the point of delivery, compared to73% (n = 16) in Western Europe. Public funding (and free at point of delivery) for medications for dialysis and kidney transplantation was available in only 24% (n = 39) and 30% (n = 50) of countries worldwide, with the proportion increasing in line with country income levels. There was reduced capacity for the management of CKD mineral bone disease in low-income countries (LICs) - serum parathyroid hormone was available in only 26% (n = 5) of LICs and the ability to administer non-calcium-based phosphate binders and cinacalcet was also very limited in LICs [16% (n = 3) and 5% (n = 1), respectively]. Nutritional services like oral supplements were accessible in 32% (n = 6) of LICs versus 97% (n = 61) of high-income countries. This study highlights significant gaps in the global methods of funding and availability of medications, capacity for kidney disease monitoring, and capacity to treat complications of kidney disease to improve outcomes. Achieving universal and equitable access to essential medications and health technologies for kidney care is vital to tackle the rapidly growing global burden of kidney disease.
Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature
Authors: Tianyi Frank-Leonel , Ngari Cecilia , Wilkinson Mark , Parkurito Stanley , Chebet Elizabeth , Mumo Evans , Trelfa Anna , Otundo Denis , Crittenden Edouard , Kephah Geoffrey Maranga , Harrison Robert A. , Stienstra Ymkje , Casewell Nicholas R. , Lalloo David G. , Oluoch George O.
Published: February 2025

Introduction

The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.

Methods

We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features.

Results

Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient’s description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases—swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings.

Conclusion

We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species.
Climate change effects on ecosystem services: Disentangling drivers of mixed responses
Authors: Delos Marcy C. , Johnson Ciara G. , Weiskopf Sarah R. , Cushing Janet A.
Published: February 2025

Climate change is a pervasive hazard that impacts the supply and demand of ecosystem goods and services (EGS) that maintain human well-being. A recent review found that the impacts of climate change on EGS are sometimes mixed, posing challenges for managers who need to adapt to these changes. We expand on earlier work by exploring drivers of varying responses of EGS to climate within studies. We conducted a systematic review of English-language papers directly assessing climate change impacts on the supply, demand, or monetary value of ‘provisioning EGS’, ‘regulating EGS’, or ‘cultural EGS’. Ultimately, 44 papers published from December 2014 to March 2018 were analyzed. Nearly 66% of EGS were assessed for higher-income countries despite how lower-income countries disproportionately face negative climate impacts. Around 59% of observations or projections were mixed responses of EGS to climate change. Differences in climate impacts to EGS across space or climate scenarios were the most common causes of mixed responses, followed by mixed responses across time periods assessed. Disaggregating findings by drivers is valuable because mixed responses were often due to multiple drivers of variation. Carefully considering the decision context and desired outcome of a study will help select appropriate methodology to detect EGS variation. Although studies have often assessed relevant drivers of variation, assessing interactions of other sources of uncertainty and both climate and non-climate drivers may support more effective management decisions that holistically account for different values in the face of uncertainty.
Metarhizium mendonceae sp. nov.: An important biological control agent for insect pests
Authors: da Costa Silva Jayara Dayany , Silva Paulo Roberto Ramalho , de França Solange Maria , Saleh Ibrahim A. , de Alcântara Neto Francisco , El-Tayeb Mohamed A. , Matos Kedma da Silva , Abdel-Maksoud Mostafa A. , Guimarães Sarah da Silva Costa , Zuffo Alan Mario , da Silva Gilvan Ferreira , de Farias Antônio Roberto Gomes , Briozo Marcus Eugênio Oliveira , AbdElgawad Hamada , de Melo Maruzanete Pereira
Published: February 2025

The Metarhizium anisopliae complex consists of 34 formally described phylogenetic species. Metarhizium anisopliae sensu lato has been used for decades in Brazil as a biological control agent for controlling spittlebugs in sugarcane plantations. We investigated the identities of the Metarhizium isolates used in mycoinsecticide formulations through multilocus phylogenetic analyses and morphological characterization for species delimitation. A well-supported clade containing only isolates from this study formed a sister group with species of M. anisopliae sensu stricto, which we described as a new taxon, M. mendonceae sp. nov. Isolates URM 8144 and URM 8145 are used in the formulation of various brands of biological insecticides; however, they have always been referred to as M. anisopliae. According to the antibiosis assay, all the isolates of this new species were able to colonize and kill Mahanarva spectabilis nymphs. Therefore, M. mendonceae has been used in the formulation of mycoinsecticides for several decades under the name M. anisopliae.
Modelling the impact of behavioural interventions during pandemics: A systematic review
Authors: Gebretekle Tsega Kahsay , Albers Casper
Published: February 2025

Background

Many studies examined the impact of behavioural interventions on COVID-19 outcomes. We conducted a systematic review to gain insight into transmission models, following PRISMA 2020 guidelines. We included peer-reviewed studies published in English until December 31, 2022, focusing on human subjects, modelling, and examining behavioural interventions during COVID-19 using real data across diverse geographical regions.

Methods

We searched seven databases. We used descriptive analysis, network analysis for textual synthesis, and regression analysis to identify the relationship between the basic reproduction number R0 and various characteristics. From 30, 114 articles gathered, 15, 781 met the inclusion criteria. After deduplication, 7, 616 articles remained. The titles and abstracts screening reduced these to 1, 764 articles. Full-text screening reduced this to 270, and risk-of-bias assessment narrowed it to 245 articles. We employed combined criteria for risk of bias assessment, incorporating domains from ROBINS-I and principles for modeling.

Results

Primary outcomes focused on R0, COVID-19 cases, and transmission rates. The average R0 was 3.184. The vast majority of studies (90.3%) used compartmental models, particularly SEIR models. Social distancing, mask-wearing, and lockdowns were frequently analyzed interventions. Early and strict implementation of these interventions significantly reduced transmission rates. Risk of bias assessment revealed that 62.6% of studies were of low risk, 24.1% moderate, and 9.3% high risks. Common issues included transparency, attrition bias, and confounding factors.

Conclusions

This comprehensive review highlights the importance of behavioural interventions in reducing COVID-19 transmission and areas for improving future research transparency and robustness. Our risk of bias criteria offers an important framework for future systematic reviews in modeling studies of interventions. We recommend that future studies enhance transparency in reporting and address common biases such as attrition and confounding.
Research on the construction of a sustainable scientific research capability evaluation model for university teachers based on the T-S fuzzy neural network
Authors: Wen Jia , Zeng Pinhong
Published: February 2025

Introduction

This study aims to enhance educational quality and academic standards by proposing a model based on critical research ability indicators to objectively evaluate the sustainable scientific research capabilities of university teachers.

Methods

Using T-S fuzzy neural network technology, we developed an evaluation model to measure the sustainability of university teachers’ research capabilities. We collected data from 126 university teachers, using 90 samples for training and 36 for testing, to ascertain the model’s applicability and accuracy.

Results

The T-S fuzzy neural network showcased exceptional learning efficiency and achieved a 98.15% accuracy rate in assessing the sustainable scientific research capabilities of university teachers, outperforming both Naive Bayes and BP neural networks in effectiveness.

Conclusion

The research successfully constructs a T-S fuzzy neural network-based evaluation model for assessing the sustainable scientific research capabilities of university teachers. With high accuracy and broad applicability, this model is an effective tool for objectively evaluating university teachers’ research capabilities, clearly achieving the study’s objective.
The impact of climate variability on agricultural employment in Mexico from 1980–2017
Authors: Sánchez Guijosa Karla Arlae , Murray-Tortarolo Guillermo , Martínez Salgado Mario
Published: February 2025

Employment in the agricultural sector is highly dependent on climate. Most agricultural jobs worldwide rely on predictable precipitation, in terms of both quantity and seasonality. Mexico is a largely agrarian country, with at least 20 million people directly reliant on food production for the livelihoods. However, research on the relationship between climate variability and agrarian employment is limited in the nation, complicating the development of effective adaptation strategies to drought and climate change. This study aims to address this gap, by analyzing the employment changes of farmers and livestock producers at a national level in the past five decades (1980 to 2017) and its relationship to long-term precipitation variability. We employed governmental datasets from national agrarian surveys and national precipitation, both at the annual scale and seasonally within each year. We found a negative relationship between agricultural employment and total annual precipitation. In particular, employment in the livestock sector showed a negative correlation with current-year precipitation (p = 0.06, cor = -0.33), while employment in rainfed agriculture was linked to the previous year’s rainfall (p = 0.07, cor = -0.33). It is likely that this pattern was driven by the positive relationship of precipitation with planted cropland area (p<0.05, cor = 0.19) and agrarian income (p<0.05, cor = 0.18). We also found that as many as 10 million people left the agrarian employments each year during the dry season. Finally, as precipitation continues to pose a challenge, it may have contributed to people of ages 23 to 35 to leave in recent years, compared to 15 and 19 in the 1990s. These findings underscore the need for national policies to mitigate the impacts of dry years on livelihoods and to inform strategies for building resilience in the agricultural sector.
Family correlates of behavioral problems among adolescents in Rwanda
Authors: Harerimana Eugene , Muziki Jean d’Amour , Nshimyumuremyi Eric , Uwera Thaoussi , Nshimiyimana Augustin , Mutabaruka Jean
Published: February 2025

Background

Globally, 20% of adolescents exhibit behavioral problems. Behavioral problems are associated with individual and environmental factors. However, little is known about the contribution of the nuclear family to the development of behavioral problems in adolescents from sub-Saharan Africa. This study aimed to explore family-based correlates influencing behavioral problems among adolescents in Rwanda.

Methods

With an institutional-based cross-sectional study design, a convenience sample of 158 participants {107 males and 51 females; Mean age (M) = 16.96, Standard Deviation (SD) = 1.86; age ranging from 13 to 23 years} was selected in secondary schools in the Nyarugenge district. Participants filled out Behavioral Problems Scale (BPS), Child and Adolescent Trauma Screen (CATS), University of California, Los Angeles Loneliness Scale (UCLA Loneliness Scale), Multidimensionality of Perceived Social Support Scale (MSPSS), Multidimensional Neglectful Behavior Scale (MNBS), and Paediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) to record pertinent scores. Socio-demographic information was also collected. SPSS version 24 was used for statistical analysis.

Results

Females exhibited more behavioral problems than males. Child and adolescent trauma (β = 0.705, t = 8.21, p < .001) and neglect (β = 0.147 t = 2.15, p < .05) were two significant family correlates in our sample. Poor quality of life enjoyment and satisfaction, loneliness, and poor parental perceived social support were not identified as family-based factors that influence behavioral problems in our sample.

Conclusions

Results highlighted the importance of implementing family and community-based interventions to sustain family well-being, change parenting behaviors, and help children and adolescents adopt positive behaviors.
Automated gait event detection for exoskeleton-assisted walking using a long short-term memory model with ground reaction force and heel marker data
Authors: Chen Xiaowen , Martin Anne E.
Published: February 2025

Traditional gait event detection methods for heel strike and toe-off utilize thresholding with ground reaction force (GRF) or kinematic data, while recent methods tend to use neural networks. However, when subjects’ walking behaviors are significantly altered by an assistive walking device, these detection methods tend to fail. Therefore, this paper introduces a new long short-term memory (LSTM)-based model for detecting gait events in subjects walking with a pair of custom ankle exoskeletons. This new model was developed by multiplying the weighted output of two LSTM models, one with GRF data as the input and one with heel marker height as input. The gait events were found using peak detection on the final model output. Compared to other machine learning algorithms, which use roughly 8:1 training-to-testing data ratio, this new model required only a 1:79 training-to-testing data ratio. The algorithm successfully detected over 98% of events within 16ms of manually identified events, which is greater than the 65% to 98% detection rate of previous LSTM algorithms. The high robustness and low training requirements of the model makes it an excellent tool for automated gait event detection for both exoskeleton-assisted and unassisted walking of healthy human subjects.
DeepKymoTracker: A tool for accurate construction of cell lineage trees for highly motile cells
Authors: Fedorchuk Khelina , Russell Sarah M. , Zibaei Kajal , Yassin Mohammed , Hicks Damien G.
Published: February 2025

Time-lapse microscopy has long been used to record cell lineage trees. Successful construction of a lineage tree requires tracking and preserving the identity of multiple cells across many images. If a single cell is misidentified the identity of all its progeny will be corrupted and inferences about heritability may be incorrect. Successfully avoiding such identity errors is challenging, however, when studying highly-motile cells such as T lymphocytes which readily change shape from one image to the next. To address this problem, we developed DeepKymoTracker, a pipeline for combined tracking and segmentation. Central to DeepKymoTracker is the use of a seed, a marker for each cell which transmits information about cell position and identity between sets of images during tracking, as well as between tracking and segmentation steps. The seed allows a 3D convolutional neural network (CNN) to detect and associate cells across several consecutive images in an integrated way, reducing the risk of a single poor image corrupting cell identity. DeepKymoTracker was trained extensively on synthetic and experimental T lymphocyte images. It was benchmarked against five publicly available, automatic analysis tools and outperformed them in almost all respects. The software is written in pure Python and is freely available. We suggest this tool is particularly suited to the tracking of cells in suspension, whose fast motion makes lineage assembly particularly difficult.