bluuebunny/crossref_metadata_2025 huggingface dataset:
Port Performance Indicators Construction based on the AIS-generated Trajectory Segmentation and Classification
Authors: Wijaya Wayan Mahardhika , Nakamura Yasuhiro
Published: April 2024

With coverage of worldwide shipping routes and straightforward accessibility, vessels' navigational data from AIS have emerged as a potential leading source of knowledge for maritime stakeholders. However, transforming the raw AIS messages into meaningful indicators requires comprehensive work that involves enrichment with multiple relevant data sources. In this study, a fain-grained technique to process AIS tracks for the purpose of constructing port performance indicators is proposed. The technique involves trajectory segmentation to separate the stopping and underway segments of AIS-generated trajectories and trajectory classification to identify moored and at-anchor vessels from the stopping segments. With the fusion of relevant information, the method estimates the port boundary and identifies the associated berthing and anchorage locations to estimate turnaround time and construct port connectivity indicators. AIS datasets recorded over eight months covering the waters of Indonesia, Malaysia, and Singapore, known as one of the world's busiest shipping routes, are selected to evaluate the proposed method. The trajectory segmentation demonstrated 98 - 99% accuracy, while the classification achieved 95 - 97%. The estimation of the vessel turnaround time closely matched the UNCTAD data with an error rate of 2.9%. These results prove the proposed approach's practicality in contributing to the real-world scenario.
Unveiling the Mechanisms of Action: Investigating the Impact of Deep Eutectic Oil-in Water Nanoemulsion on Cell Membrane Integrity and Morphology of C. gloeosporioides in Fruit Postharvest
Authors: Gidado M. J. , Gunny Ahmad Anas Nagoor , Gopinath Subash C.B. , Salleh Noor Hasyierah Mohd , Pareek Sunil , Balakrishnan Kunasundari
Published: April 2024

This study investigates the impact of HyDEN on cell membrane degradation and disruption of Colletotrichum gloeosporioides. Analysis of C. gloeosporioides cell membrane morphology post-antifungal treatment provides insights into treatment efficacy and mechanisms of action. Physical changes in membrane structure, including disruption, collapse, wrinkling, or lysis, offer understanding of antifungal agents' impact. In this study, the comparison between control and treatment groups, particularly HyDEN and Globus 5.5, reveals significant differences in membrane integrity, with HyDEN inducing pronounced disruption and greater mycelial growth inhibition. Spore germination analysis underscores intact membrane importance in viability and metabolic processes, with HyDEN inhibiting germination pathways effectively compared to Globus 5.5. Intracellular ion leakage tests confirm antifungal treatment disruptive effects on membrane integrity, with HyDEN exhibiting higher conductivity over time. Soluble sugar content analysis reveals sugar release due to membrane disruption, with HyDEN inducing greater release than Globus 5.5. These findings demonstrate HyDEN's potential as an effective antifungal strategy, offering membrane disruption and inhibition of fungal growth.
The Impact of Strict Shunt Protocol on Reducing the Infection Rate Following Shunt Placement: A Prospective Cohort Study
Authors: Alojan Abdulrazaq , Alghamdi Majed , Ammar Ahmed , ElHajeri Haya , Boop Frederic , Alsamin Sarah I
Published: April 2024

Purpose: Shunt insertion is the treatment of choice in many hydrocephalus cases. However, one of its common complications that increases its mortality and morbidity rate is infection, as our center yielded 32% infection rate post-shunting. Thus, this paper aims to develop new shunt protocol to reduce the infection rate post-shunting.
Methods: A prospective cohort study was conducted from 2017 to 2022 in a single institution in Saudi Arabia. Data from ninety-two hydrocephalus patients who required shunt insertion was collected and followed up for 6 months.
Result: Ninety-two procedures for a total number of sixty-five cases were analyzed. The age average was 141.4 months (SD=232.9), and 73.9% of the procedures were done on males. The average compliance to the new protocol was 90.9%. Culture results were missed in 8 cases, and positive in 4.8% only (4 cases) giving a ratio of 1 per 23 cases. All infected patients were males, 75% were aging less than a month when operated. Twenty-eight elements of the new protocol were analyzed by Fisher’s Exact Test. Multilayered wound closure with antibiotic was significantly associated with less infection rate (LR=7.5, Fisher’s Exact Test p-value=.024). Other elements were statistically insignificant.
Conclusion: Development and following new shunt protocols could reduce infection rate especially in areas where they have high post-shunting infection rate. Although, one element was statistically significant, other components were clinically or “financially” significant, particularly those which are technical, and must be considered.
Comparing Outcomes in Patients with Exsanguinating Injuries: An Eastern Association for the Surgery of Trauma, Multi-center, International Trial Evaluating Prioritization of Circulation over Intubation (CAB over ABC)
Authors: Ferrada Paula , García Alberto , Duchesne Juan , Brenner Megan , Liu Chang , Ordóñez Carlos , Menegozzo Carlos , Salamea Juan Carlos , Feliciano David
Published: April 2024

Introduction:
Hemorrhage is a major cause of preventable trauma deaths, and the ABC approach is widely used during the primary survey. We hypothesize that prioritizing circulation over intubation (CAB) can improve outcomes in patients with exsanguinating injuries.
Methods
A prospective observational study involving international trauma centers was conducted. Patients with systolic blood pressure below 90 who were intubated within 30 minutes of arrival were included. Prioritizing circulation (CAB) was defined as delaying intubation until blood products were started, and/or bleeding control was performed before securing the airway. Demographics, clinical data, and outcomes were recorded.
Results
The study included 278 eligible patients, with 61.5% falling within the "CAB" cohort and 38.5% in the "ABC" cohort. Demographic and disease characteristics, including age, sex, ISS, use of blood products, and other relevant factors, exhibited comparable distributions between the two cohorts. The CAB group had a higher proportion of penetrating injuries and more patients receiving intubation in the operating room. Notably, patients in the CAB group demonstrated higher GCS scores, lower SBP values before intubation but higher after intubation, and a significantly lower incidence of cardiac arrest and post-intubation hypotension. Key outcomes revealed significantly lower 24-hour mortality in the CAB group (11.1% vs. 69.2%), a lower rate of renal failure, and a higher rate of ARDS. Multivariable logistic regression models showed a 91% reduction in the odds of mortality within 24 hours and an 89% reduction at 30 days for the CAB cohort compared to the ABC cohort. These findings suggest that prioritizing circulation before intubation is associated with improved outcomes in patients with exsanguinating injuries.
Conclusion
The consideration of prioritizing circulation over intubation in patients with exsanguinating injuries, allowing for resuscitation or bleeding control, appears to be associated with potential improvements in survival. Post-intubation hypotension is observed to be correlated with worse outcomes, and intubation may potentially disrupt compensatory mechanisms in bleeding patients. Emphasizing the importance of circulation and resuscitation is crucial, and this approach might offer benefits for various bleeding-related conditions. Adopting a CAB approach along with early blood product resuscitation may be a strategy to explore for optimizing outcomes.
The prevalence of job satisfaction and its associated factors among medical intern students in University of Gondar comprehensive specialized hospital, Gondar, Ethiopia 2022
Authors: Abebe Tesfaye Birhanu , Balcha Thomas Daba , Melkam Yalew , Andualem Zewudu , kassa Tewodros , Desyalew Tigist , Alemayehu Tekletsadik Tekleslassie , Wassie Yilkal Abebaw
Published: April 2024

Introduction: By considering the importance of job satisfaction to Interns’ well-being and to quality of care, it is important to investigate factors that contribute to or decrease job satisfaction. Although many studies have been conducted worldwide to find out the prevalence of job satisfaction among doctors, yet very few have been conducted in Ethiopia, especially regarding medical interns.
Objective: This study was aimed to assess the prevalence of job satisfaction and its associated factors among medical intern students in University of Gondar comprehensive specialized hospital, Gondar, Ethiopia 2022.
Method: An institution based cross-sectional study was conducted on 320 study participants from November 05-15, 2022. All medical interns registered in 2022 was assessed by using conventional sampling method and data were collected by using pre-tested and structured self-administered questionnaire. Data were entered into Epi-INFO version7 and exported to SPSS version 25.0 for analysis. Logistic regression were carried out to recognize factors associated with medical intern job satisfaction. Adjusted odds ratio with a 95% confidence interval were used to measure the strength of association. Variables having p-value less than 0.2 in bivariable analysis were entered in to multivariable analysis; variables with a p-value< 0.05 were declared significantly associated with job satisfaction.
Results: The overall level prevalence of job satisfaction among medical interns was found to be 32.2% 95%. Being male [AOR=1.84; (1.02, 3.34)], working department [AOR=2.53; (1.2, 5.30)], place of origin [AOR=1.80; (1.01, 3.20)], and number of duties [AOR=2.98; (1.17, 7.59)] factors were significantly associated with job satisfaction.
Conclusion: The prevalence of job satisfaction among medical interns was found to be high. Being male, place of origin, working department, and number of duty were statistically significant associated factors. Its better, managers and policy makers should give due considerations on medical interns’ job satisfaction if they genuinely want to attain institution’s objectives.
Comparison of CROES, Guy's, S.T.O.N.E., and S-ReSC Nephrolithometric Scoring Systems in Predicting Success and Complications in Patients Undergoing Supine Mini Percutaneous Nephrolithotomy
Authors: Ayranci Ali , Erbin Akif , Caglar Ufuk , Meric Arda , Gunay Nazim Furkan , Sarilar Omer
Published: April 2024

In addition to the fact that the significance of the nephrolitometric scoring systems (NSSs) remains unclear, no study has been conducted to assess the effectiveness of these scoring systems in percutaneous nephrolithotomy (PNL) performed in the supine position. We aimed to compare the CROES, Guy's scoring system (GSS), S.T.O.N.E., and S-ReSC NSSs for success and complications in patients undergoing supine mini-PNL (m-PNL). The prospectively recorded data of the patients who underwent supine m-PNL was reviewed retrospectively, and a total of 112 patients were included in the study. Demographic, operation, post-procedure data, and CROES, GSS, S.T.O.N.E., and S-ReSC scores were assessed and compared between the stone-free (SF) and residuel groups. There were significant differences between the SF and residual groups in terms of mean CROES, S.T.O.N.E., and S-ReSC scores (p = 0.003, p = 0.009, and p = 0.015, respectively). Similarly, there were significant differences between the grades of these scoring systems and the success of the procedure (p = 0.035, p = 0.007, and p = 0.007, respectively). However, the GSS was insignificant. The area under curve values in ROC analysis of CROES, S.T.O.N.E., and S-ReSC NSSs were 0.695, 0.665, and 0.656, respectively (p = 0.003, p = 0.011, and p = 0.017, respectively). No statistically significant difference was found between the grades of all four NSSs and the complication rates. The study showed a strong correlation between CROES, STONE, and S-ReSC NSSs in predicting SF status after supine m-PNL. However, none of the NSSs could predict the complications.
Anatomical characteristics of mitral isthmus and its spatial relationship with the esophagus in patients undergoing atrial fibrillation ablation using CT angiography
Authors: Pan Yilin , Zeng Hong , Liu Xin , Fu Xiaohang , Pan Liyuan , Wang Yanjing
Published: April 2024

Background
This study examines the anatomical characteristics of the mitral isthmus (MI) and its spatial relationship with the esophagus in patients undergoing atrial fibrillation ablation, using cardiovascular computed tomographic angiography (CTA). Understanding this relationship is crucial to minimize the risk of esophageal injuries during ablation procedures.
Methods
The investigation included 300 participants, divided into 200 subjects in the experimental group undergoing atrial fibrillation ablation and 100 in the control group. Detailed CTA scans were used to assess the MI's structure and proximity to the esophagus, employing various measurements like the MI's endocardial length, depth, and its relation to adjacent esophageal anatomy.
Results
The study revealed significant differences in the MI's length and distance measurements between the experimental and control groups, with the former showing greater dimensions, potentially influencing ablation strategies. A substantial proportion of patients exhibited close proximity or direct contact between the MI and the esophagus, emphasizing the importance of pre-procedural imaging in identifying risks for esophageal damage.
Conclusions
Pre-procedural cardiovascular CTA provides essential insights into the MI's anatomical details and its relation to the esophagus, aiding in the customization of ablation strategies to enhance procedural safety and efficacy. The findings highlight the significance of tailored imaging assessments to mitigate esophageal injury risks in atrial fibrillation ablation.
Bio-Nano Sensor utilizing Single-Layer Graphene for the Detection of Iridovirus
Authors: Makwana Manisha , Patel Ajay M
Published: April 2024

Context:
Graphene and its related compounds have remarkable optical, electrical, and chemical characteristics that make them suitable for biosensing. Nondestructive biological molecule identification is made possible by biosensors based on graphene and its derivatives. The field of biological sensors is expanding to meet the demand for sensitive early detection of disorders. The aim of the present investigation is to develop a sensor by analyzing the vibrational responses of single layer graphene sheets (SLGS) with attached microorganisms, specifically Iridoviridae. Graphene-based virus sensors typically rely on the interaction between the virus and the graphene surface, which lead to changes in the frequency response of graphene. This change can be measured and used to detect the presence of the virus. Its high surface-to-volume ratio and sensitivity to changes in its frequency make it a highly sensitive platform for virus detection.
Methods:
The atomistic finite element method (AFEM) has been used to carry out for dynamic analysis of SLG. Molecular structural analysis has been performed for single-layer graphene. Bridged and simply supported with roller support boundary conditions applied at the ends of SLG structure. Simulations have been performed to see how SLG behaves when used as sensors for biological creatures. A single-layer graphene armchair SLG (5, 5) with 50 nm length, exhibits its highest frequency vibration at 8.66 x 106 Hz, with a mass of 1.2786 Zg. In contrast, a zigzag- SLG with a (18,0) configuration has its lowest frequency vibration at 2.82 x 105 Hz, observed at a length of 10 nm. Finite Element Method (FEM) analysis is utilized to forecast the performance of single-layer graphene (SLG) biosensors under simply supported with roller support and bridged boundary conditions. This aids in comprehending the thresholds of detection and the influence of factors such as size, chirality, and boundary conditions on sensor effectiveness. These biosensors can be especially helpful in biological sciences and the medical field since they can considerably improve the treatment of patients, cancer early diagnosis, and pathogen identification when used in clinical environments. By simulating sensor behavior using FEM, researchers can reduce the need for costly and time-consuming experimental testing, speeding up the development process.
Virulence Plasmid with IroBCDN Deletion Promoted Cross-regional Transmission of ST11-KL64 Carbapenem-resistant Hypervirulent Klebsiella Pneumoniae in Jiangxi Province, China
Authors: Huo Bing-Hui , Hong Hanxu , Xu Ying , Xiang Tian-xin , Wei Dan-Dan , Huang Qi-Sen , Liu Peng , Zhang Wei , Liu Yang
Published: April 2024

Background Carbapenem-resistant and hypervirulent Klebsiella pneumoniae (CR-hvKP) caused infections of high mortality and brought a serious impact on public health. This study evaluated the transmissibility of CR-hvKP among different regions to provide corresponding advice for cross-regional prevention.
Methods Clinical K. pneumoniae strains were collected from Jiujiang region and Nanchang region in Jiangxi province from November 2021 to June 2022. We characterized these strains for their genetic relatedness, virulence phenotype, and dissimilarities in virulence plasmid structures using PFGE, Galleria mellonella, Whole-genome sequencing. Conjugation assay was performed to evaluate the transmissibility of virulence plasmids.
Results Among 609 strains, 45 (7.4%) CR-hvKP were identified, while the strains
isolated from Nanchang and Jiujiang accounted for 10.05% (36/358) and 3.59% (9/251). We observed that ST11-KL64 CR-hvKP had an overwhelming epidemic dominance in these two regions. Significant genetic diversity was identified among all ST11-KL64 CR-hvKP cross-regional transmission between Nanchang and Jiujiang serving as major drivers of clonal clusters. Virulence genes profile revealed that ST11-KL64 CR-hvKP might harbour incomplete pLVPK-like plasmids and primarily evolved from CRKP by acquiring the hypervirulence plasmid. We found the predominance of truncated-IncFIB/IncHI1B type virulence plasmids with a 25kb fragment deletion that encoded iroBCDNclusters. Virulence plasmids harbored in CR-hvKP isolates with iroBCDN deletion fragment exhibited a higher conjugation success rate and efficiency.
Conclusions ST11-KL64 is the most cross-regional prevalent type CR-hvKPs in Jiangxi province, which mainly evolved from CRKPs by acquiring a truncated-IncHI1B/IncFIB virulence plasmid with the deletion of iroBCDN. Stricter surveillance and control measures are urgently needed to prevent the epidemic transmission of ST11-KL64 CR-hvKP.
Evaluation of left atrial dysfunction in pediatric and adult patients with repaired tetralogy of Fallot using two- dimensional speckle-tracking echocardiography
Authors: Sato Keiya , Takahashi Ken , Akatsuka Yusuke , Sato Hiroyuki , Kago Hirohisa , Akiya Azusa , Akimoto Satoshi , Ifuku Mayumi , Hosono Yu , Shigemitsu Sachie , Matsui Kotoko , Nakanishi Keisuke , Kawasaki Shiori , Shimizu Toshiaki
Published: April 2024

Purpose: Although the left atrium (LA) plays a key role in diastolic function, LA dysfunction in patients with repaired tetralogy of Fallot (rTOF) remains unclear. Therefore, we aimed to evaluate left atrial function and investigate changes with age in patients with rTOF using speckle-tracking echocardiography.
Methods: We compared 62 patients with rTOF with 62 healthy similar age- and sex-matched controls divided into three age groups (T1, C1: 3–9 years [children], T2, C2: 10–19 years [adolescents and young adults], and T3, C3: 20–44 years [adults]). LA strain was assessed by two-dimensional speckle-tracking echocardiography and defined according to its three distinct phases, with the LA serving as a reservoir during systole, conduit during early diastole, and booster pump at the end of diastole.
Furthermore, we examined the correlations between LA strains and left ventricular longitudinal strain (LVLS) and conventional echocardiographic parameters.
Results:The LA reservoir and pump strains were lower in the T3 group than in the C3 group. In T1 and T2 groups, no significant differences in any LA strains were reported. LA functions based on LA volume did not show any difference between TOF and controls among all age groups. All LA strains only moderately or weakly correlated with LVLS and mitral E/A, but not with LV lateral e’ nor E/e’.
Conclusions: LA phasic function decreases in adult patients with rTOF. These parameters can potentially be used as sensitive indicators of diastolic dysfunction in patients with rTOF.
Fish consumption in relation to breast cancer: A case-control study
Authors: Akhgarjand Camellia , Fogacci Federica , Benisi-Kohansal Sanaz , Houjaghani Hirad , Azadbakht Leila , Esmaillzadeh Ahmad
Published: April 2024

Background: Even though regular fish consumption is highly recommended to reduce the risk of developing several cancers, available evidence on the association between breast cancer and fish is inconclusive. We aimed to explore the association between fish consumption and breast cancer in a well-characterized population of Iranian women.
Methods: This study enrolled 350 newly diagnosed stage I-IV breast cancer patients and 700 cancer-free controls living in Isfahan. Controls had no family history of breast cancer and were matched to cancer patients in term of age and socioeconomic status (SES). Dietary intakes were determined using a validated food frequency questionnaire (DS-FFQ). In addition, data on potential confounding factors were collected using pre-tested questionnaires.
Results: After adjusting for potential confounders, women in the highest quartile of fish consumption had a lower odds of breast cancer than those in the lowest quartile (OR: 0.57, 95% CI: 0.34-0.95). The stratified analysis by menopausal status revealed an inverse association in postmenopausal women (OR: 0.53, 95% CI: 0.30-0.94).
Conclusions: Our findings suggest higher fish consumption is associated with a lower likelihood of having breast cancer, particularly in post-menopause. The findings should be interpreted with caution due to the case-control study design. To further examine this association, prospective studies are needed.
Trace metals pollution and trophic position of three sea urchin species in the Gulf of California
Authors: Acosta-Pachón Tatiana A. , López-Vivas Juan Manuel , Mazariegos-Villareal Alejandra , Méndez-Rodríguez Lía C. , León-Cisneros Karla , Martínez-Rincón Raul O. , Serviere-Zaragoza Elisa
Published: April 2024

Sea urchin species are ecologically important in the Gulf of California and are becoming popular as a local fishery due their commercial value. The most abundant species are Echinometra vanbrunti, Eucidaris thouarsii, and Tripneustes depressus. The aim of this study was to evaluated cadmium, lead, copper, zinc, and iron concentrations as well as stable isotope values in these sea urchin species in mining area of Santa Rosalia (STR). Metal concentrations were analyzed by atomic absorption spectrophotometry and stable nitrogen and carbon isotopes were estimated using mass spectrophotometry. Highest values of Fe (108.8 mg Kg−1), was found in E. vanbrunti, while highest values of Pb (15.4 mg Kg−1), Cu (14.5 mg Kg−1), and Zn (347.7 mg Kg−1) were found in E. thouarsii; and highest values of Cd (10.8 mg Kg−1) was found in T. depressus. The main ecological risk of trace metal pollution in STR may be caused by Cd and Pb. d15N values were higher in E. thouarsii and d13C in T. depressus, and E. thouarsii have the highest trophic position. There is not relationship between size and metal concentrations, but a positive relation exists between size and isotopic values in T. depressus. The three species showed different bioaccumulation pattern for the metals analyzed. Additionally, collection site and season play an important role in the metal concentration variability. Given that these species are consumed by humans, some risk of trace metals toxicity could be expected due to the accumulation patterns and characteristics of the sites studied.
The Impact of Childhood Obesity on Traumatic Injury Outcomes
Authors: Lewis Briana T. , Leung Willie , Olsen Rebecca , Nelson Julie , Casatelli Jennifer
Published: April 2024

Introduction
Globally, traumatic injury and obesity are significantly linked to pediatric health. The relationship between traumatic injury outcomes and childhood obesity remains poorly understood. This study assesses the potential correlation between childhood obesity and patient outcomes following trauma injuries, with a particular focus on elucidating the intricate interplay among childhood obesity, trauma injury outcomes, and patterns of healthcare utilization, which will address the gap in literature and lays the groundwork for further investigation into the complex relationship between childhood obesity and traumatic injury outcomes.
Methods
The current study is a retrospective cohort study analyzing data from St. Jospeh’s Children’s Hospital’s Emergency and Trauma Center in Tampa, Florida, between 2010 to 2021. Participants aged 2 to 18 were included and stratified by obesity categories, normal weight, overweight, and obese, based on their BMI. Associations between obesity categories and trauma outcomes such as Length of Hospital Stay (LOS), days in Intensive Care Unit (ICU), Injury Severity Score (ISS), and mortality were examined.
Results
Among 1965 participants, 48.85% of participants were of normal weight, 19.49% were overweight, and 31.65% were obese. No significant differences in the included trauma outcomes across obesity classifications were found among analyses. Linear regressions showed no association between trauma outcomes and obesity (P>.05). Mortality outcomes were not analyzed due to insufficient data on deceased participants (P>.05).
Conclusion
Childhood obesity did not independently predict adverse trauma outcomes in this study. The findings challenge previous assumptions and emphasize the multifactorial nature of trauma outcomes in pediatric patients. Further research with larger sample sizes and comprehensive data collection is needed to fully understand this relationship.
LEVEL OF EVIDENCE
Level V, Retrospective cohort study
A New Method of Archaeological Ruins Identification Based on CORONA Stereo Pairs
Authors: Zhang Yixin , Wang Ningyuan , He Jie , Zhang Tao , Zhang Xin , Luo Hongpeng
Published: April 2024

Three-dimensional (3D) stereo images can be generated via the computer-based image processing of CORONA stereo pairs. To a certain extent, important terrain and surface feature data extracted from these stereo images can improve the survey of archaeological sites and the identification and mapping of major landscapes. This study focuses on the identification of the Archaeological Ruins of Liangzhu City. An optical stereo model (red/blue stereo image) of the Liangzhu site was created through the computer-based mosaicking and processing of CORONA remote-sensing stereo pairs taken in the 1960s and 1970s. By importing the optical stereo model into mobile phones, tablet computers, and other mobile devices, the research team undertook real-time locating via human observation, on-site investigation, and image overlayduring field survey and identified several Liangzhu-period dams, some of which have been confirmed via archaeological field investigations. The research team later applied the same method to the identification of tombs in the site of the Mausoleums of the Six Emperors of the Southern Song Dynasty. The results further proved that this method is feasible and reliable and can be widely promoted and used for the identification of archaeological ruins.
Frailty in older adults admitted to hospital: outcomes from the Western Sydney Clinical Frailty Registry.
Authors: McDonagh Julee , Lindley Richard I , Byth Karen , John Reejamol , Ferguson Caleb
Published: April 2024

Objectives
To report the baseline profile, clinical management, all-cause rehospitalisation, and mortality at 12 months of adults enrolled into the Western Sydney Clinical Frailty Registry.
Design:
Prospective observational cohort study
Setting and Participants:
592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study.
Methods
The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months.
Results
Median age 82 years; half the cohort were classified as mild-moderately frail and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p < 0.001) and Clinical Frailty Scale (CFS) scores (p < 0.001). Compared to the ‘non-frail’ group (CFS 1–4), those who were severely frail (CFS 7–9) had an 85% increased risk of rehospitalisation and/or death, and those who were mild-moderately frail (CFS 5–6) had a 52% increased risk after adjusting for effects of the other variables.
Conclusions
Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.
Differences in Clinical Profiles and Outcomes Between Early-onset and Older Patients Hospitalized for Coronary Artery Disease: A Prospective Cohort Study.
Authors: Shali Shalaimaiti , Yao Kang , Luo Linfeng , Wu Hongyi , Zhang Shuning , Xu Lili , Gao Wei , Li Jianxuan , Xu Rende , Chang Shufu , Li Chenguang , Qian Juying , Zheng Yan , Dai Yuxiang , Ge Junbo
Published: April 2024

Background
Contemporary data on age-dependent differences in risk factors, hospital care and outcomes between early-onset and older patients with coronary artery disease (CAD) is limited in Han Chinese.
Methods
In this nation-wide, prospective cohort study, a total of 1524 early-onset patients (onset age ≤ 45 years) and 1374 older patients (onset age ≥ 65 years) with angiographically established severe atherosclerotic obstructive CAD were included from 38 hospitals across China. Participants were followed three years for major adverse cardiovascular events (MACE).
Results
Compared to older patients, male sex (95.6%), smoking (74.8%), drinking (43.6%), and obesity (30.1%) were more prevalent, whereas hypertension and diabetes were less common among young patients (all P < 0.001). Early-onset patients were more likely to present with ST-segment elevation myocardial infarction (MI), and to undergo revascularization, but be treated with suboptimal guideline-directed medications than their older counterparts (all P < 0.001). During the follow-up, 96 (6.3%) early-onset patients developed MACE. Female sex (adjusted hazard ratio [HR] = 2.40; 95% confidence interval [CI]: 1.07–5.38), previous MI (adjusted HR = 2.23; 95%CI:1.44–3.45), and the number of diseased vessels (adjusted HR = 1.93; 95%CI:1.12–3.34) were strong baseline determinants of subsequent MACE. Early-onset patients were at a greater risk of non-target lesion acceleration than the older patients (adjusted HR = 2.39; 95%CI:1.83–3.09).
Conclusion
Early-onset CAD patients in China carried a heavier burden of modifiable risk factors pertaining to unhealthy behaviors and had a higher risk of aggressive progression of non-target lesions than older patients. Intensive secondary prophylactic measures are recommended among young adults against future ischemic events.
Trial registration:
www.clinicaltrials.gov (NCT 02496858)
Individualized Prediction of Stroke-Associated Pneumonia and its severity for Patients with Acute Ischemic Stroke
Authors: Zhang Lulu , Wang Qi , Li Yidan , Ding Dongxue , Zhu Juehua , Fang Qi , Yao Ye , Tang Xiang
Published: April 2024

Background: Stroke-associated pneumonia (SAP) remains a neglected area despite its high morbidity and mortality. We aimed to establish an easy-to-use model for predicting SAP and SAP severity.
Methods: 275 acute ischemic stroke (AIS) patients were enrolled, and 73 (26.55%) patients were diagnosed with SAP. T-test, Chi-square test and Fisher’s exact test were used to investigate the associations of patient characteristics with pneumonia and its severity, and multivariable logistic regression models were used to construct a prediction scale.
Results: Three variables with the most significant associations, including age, NGT placement, and right cerebral hemisphere lesions combined with gender, were used to construct a dysphagia prediction scale with high accuracy (AUC = 0.93). Youden index of our SAP prediction model was 0.77. The sensitivity and specificity of our SAP prediction model were 0.89 and 0.88, respectively.
Conclusions: We identified the best predictive model for SAP and SAP severity in AIS patients. Our study was as clinically relevant as possible, focusing on features that are routinely available. The contribution of selected variables is visually displayed through SHapley Additive exPlanations (SHAP). Our model can help to distinguish AIS patients of high-risk, provide specific management, reduce healthcare costs and prevent life-threatening complications or even death.
Application of TLBO for Optimal AGC of Interconnected Multi-Area Multi-Source Hybrid Power System with DRC
Authors: Kumar Rajan , Prasad Lal Bahadur
Published: April 2024

As a first attempt this article investigates the load frequency regulation, an automatic generation control (AGC) problem of an interconnected multi-area multi-source hybrid power system (MAMS-HPS) with demand response contribution (DRC) using the teaching learning-based optimisation (TLBO) algorithm. Here, the MAMS-HPS is configured containing the micro-hydro, biogas, biodiesel, solar-thermal, and wind turbine generating units arranging in interconnected two-unequal areas. Due to the increased presence and penetration of RES in power system, a high degree of unpredictability and dependence on the nature significantly introduces the difficulty in balancing the generation and load demand. To address this problem, an approach is taken to optimize proportional-integral-derivative (PID) controller gains using optimisation algorithms namely the particle swarm optimisation (PSO) and TLBO to accessing the responses under various realistic scenarios of availability and variations of RES as well as load variations. The responses are accessed by adding a DRC system also. The MATLAB-Simulink model is developed for the system simulation and comparative performance analysis of control schemes in terms of time domain specifications observing the responses of the system states.
Association between ABO blood type and periodontal disease: a cross-sectional study
Authors: Saito Mizuki , Shimazaki Yoshihiro , Yoshii Saori , Kojima Tetsuhito
Published: April 2024

Background
Several studies have investigated the association between the ABO blood type and periodontal disease. However, the results have been inconsistent and no scientific consensus has been reached. This study examined the association between ABO blood type and periodontal disease using health-examination data from a large population, considering the influence of confounding factors.
Methods
The study included 2,374 individuals who underwent health examinations, including oral-health examinations and blood-type tests. The Community Periodontal Index was used to evaluate periodontal status. Logistic regression analysis was performed with periodontal status as the dependent variable and age, sex, body mass index, diabetes, smoking status, blood type, and number of teeth as independent variables; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Results
The numbers of participants with blood types A, B, AB, and O were 879 (38.0%), 500 (21.6%), 234 (10.1%), and 698 (30.2%), respectively. Individuals with blood types A and AB had significantly higher ORs for severe periodontitis compared with individuals who had blood type B (OR: 1.46 [95% CI: 1.02–2.09] and 1.89 [95% CI: 1.18–3.02], respectively).
Conclusions
Individuals with blood types A and AB had an increased risk of periodontitis. Assessments of conventional risk factors are crucial for preventing the onset and progression of periodontal disease. Additionally, future studies should consider the potential influence of blood type on periodontal status.
Geological evidence: New insights into rock avalanche dynamics
Authors: Wang Yufeng , Chen Mei , Liu Yuanyuan , Wünnemann Bernd , Cheng Qiangong , Ming Jie , Hu Liwen , Li Kun , Lin Qiwen
Published: April 2024

Rock avalanches (RAs) are among the most enigmatic geological processes on Earth and other planets, characterized by extremely high mobility1-7. Although great work has been conducted with many hypotheses being proposed8-19, the mechanism for its high mobility remains a challenging issue due to a lack of geological evidence20-21. Microscope observations and mineral analysis of the basal and body facies of the Nyixoi Chongco RA on the Tibetan Plateau, China, revealed that grains in the RA deform by brittle fracturing with the frictional temperatures ranging from 270 ~ 300 ℃. The basal facies features a dilated regime with a high fragmentation degree, but the body facies displays a dense regime with relatively low fragmentation, although their temperatures are similar. A jigsaw structure characterized by intense collision is observed in the basal facies but is lacking in the body facies. With these geological evidences, we propose that the frictional temperature of most RAs characterized by brittle fracturing should be low that cannot cause thermal decomposition or melt. A mechanism similar to the Leidenfrost effect should occur in the basal facies, which is related to landquakes and dominates the high mobility of RAs by the generation of a relatively dilated regime with the main mass propagating as a cataclastic flow.
Association between lipid biomarkers and bone mineral density: a cross-sectional study from NHANES 2007–2010
Authors: Liu Zhiwen , Zhong Yelin , Peng Zijing , Zhong Wei , Zhang Zhihai
Published: April 2024

Background: Bone mineral density (BMD) is an established indicator of bone health, with lower BMD associated with increased risk of osteoporosis and fractures. Triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) are acknowledged as novel lipid biomarkers. However, the relationship between lipid biomarkers and BMD remains uncertain. This study examines the association between lipid biomarkers and BMD in a representative US population.
Methods: Utilizing cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010, we analyzed BMD measurements at the total femur, femoral neck, and lumbar spine. Serum lipid levels, including TG, TC, LDL and HDL, were assessed. Multivariable regression models adjusted for confounders such as age, gender, race, BMI, laboratory indices, and lifestyle factors were used to explore the association between lipid biomarkers and BMD. In addition, several subgroup analyses were conducted to assess the robustness of the outcomes.
Results: Our cross-sectional analysis included a total of 3213 participants from the NHANES 2007–2010 dataset, representing a diverse adult population, identified significant associations between lipid biomarkers and bone mineral density (BMD) at key anatomical sites. This study found that TC and HDL were negatively correlated with femoral BMD, and TG was positively correlated with femoral BMD. After fully adjusting for covariates, the negative association between TC and lumbar BMD remained significant (β= -0.0002,95%CI: -0.0004 to -0.0001, p<0.001). After transforming TC into categorical variables (quartiles), participants in the highest quartile of TC showed significantly lower BMD measurements compared with those in the lowest quartile (β= -0.019,95%CI: -0.033 to -0.005, p=0.007). Subgroup analysis showed that the association between TC and lumbar BMD was more pronounced in women (β= -0.042,95%CI: -0.053 to -0.030, p<0.001) and Mexican Americans (β= -0.093,95%CI: -0.109 to -0.076, p<0.001). Gender and ethnic differences were prominent in the lipid-BMD association, highlighting the importance of considering demographic factors when assessing the risk of osteoporosis.
Conclusions: HDL and TC were negatively correlated with total femoral BMD, and TG was positively correlated with femoral BMD. And TC might serve as a potential lipid biomarkers of osteoporosis outperforming HDL, TG and LDL. The complex correlation between the lipid biomarkers and bone metabolism requires further evaluation in large prospective studies. The observed gender and racial differences in these associations underscore the need for personalized approaches in osteoporosis risk assessment and management.
Effects of acute bouts of exercise on balance and the influence of aerobic capacity on fall risk in older adults: a scoping review
Authors: Gashi Arbër , Zieschang Tania , Koschate Jessica
Published: April 2024

Background:
Falls are a major health concern among older adults causing around 684,000 deaths annually. By 2050, 16% of the world population is projected to be 65 years and older hence effective fall prevention strategies are crucial for the health systems. The World Falls Guidelines from 2022 classified cardiovascular disease as a potential risk factor while recommending multidomain fall-prevention intervention strategies in older community dwelling adults. Individual cardiorespiratory fitness was not further discussed leading to the aim of this scoping review which is to (1) assess the effects acute bouts of aerobic exercise on balance, fall risk or fall rate and to (2) assess the relationship between aerobic capacity, balance, fall risk and fall rate in older adults.
Methods: A scoping review was conducted, including peer-reviewed articles written in in English language, dating from 1957 to February 2024 that are listed in the databases PubMed, Scopus, Web of Science, and Cochrane. Eligible for inclusion were articles using the following keywords and their synonyms: aerobic capacity, falls, balance, exercise, and older adults. The references were categorized in two topics: (1) effects of acute bouts of exercise on balance or gait performance as fall risk factors in older persons and (2) the direct relation between aerobic capacity, balance and fall rate in older adults. The findings were systematically summarized, using the PRISMA-ScR reporting guidelines.
Results: Twelve articles with a total of 11,109 persons aged between 20 and 94 years old were included. Eight publications reported impaired balance after moderate to strenuous exercise in older adults. The direct relationship of aerobic capacity and fall risk was described in four publications, suggesting an inverse relationship.
Conclusions: After acute bouts of aerobic exercise, an intensity-related impairment of balance in older persons was observed, a finding worth acknowledging when prescribing strenuous exercise with increased lactate levels to older adults. Since the effects lasted from 10 to 30 minutes, it is recommended to avoid balance challenging tasks after moderate to strenuous exercise in this demographic.
Enablers and Barriers to Achieving Clinical Competency among Dental Students: Lessons for Teaching and Learning
Authors:   Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA, Nik-Azis Nik-Madihah , Chia Jasmine ,   School of Pharmacy, Management and Science University, Selangor, MALAYSIA, Abdullah Dalia ,   Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA, Baharin Badiah ,   Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA
Published: April 2024

Adaptations to the teaching and learning during the pandemic affected dental students’ ability to achieve clinical competency. This study aimed to: (1) assess the self-reported competencies of dental students affected by the pandemic; (2) describe the enablers and barriers to achieving clinical competency among these students; and (3) to elucidate factors related to the resilience of the teaching and learning system during the pandemic for future adaptations and implementations. A questionnaire consisting of eight domains with 43 questions was sent to Universiti Kebangsaan Malaysia’s (UKM) recent dental graduates from the 2021 cohort. Eight students from the cohort were also interviewed. The semi-structured, in-depth interviews were recorded and transcribed. A total of 56 questionnaires were returned, resulting in a 100% response rate. Seven out of the eight studied domains had a high self-perceived competency score, while only six of the 43 skills had a self-perceived competency score of less than 80%. Eight participants were interviewed for the second part of the study. Multiple enablers and barriers were identified and categorised into five themes, which were clinical time, student mental health, clinical teaching, cross-infection protocols, and communication and other faculty policies. Dental graduates affected by the COVID-19 pandemic had a good level of self-perceived clinical competency. The multiple factors identified as enablers and barriers to achieving clinical competency can be utilised as references in curriculum development, planning and policymaking, especially with regards to adaptations made to the undergraduate dental curricula worldwide.