bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of shoulder dystocia and risk factors for recurrence in the subsequent pregnancy—A historical register‐based cohort study
Authors: Jeppegaard Maria , Larsen Marie H. , Thams Amalie B. , Schmidt Amalie B. , Rasmussen Steen C. , Krebs Lone
Published: February 2024

Introduction

Shoulder dystocia is a rare obstetric complication, and the risk of recurrence is important for planning future deliveries.

Material and Methods

The objectives of our study were to estimate the incidence and risk factors for recurrence of shoulder dystocia and to identify women at high risk of recurrence in a subsequent vaginal delivery. The study design was a nationwide register‐based study including data from the Danish Medical Birth Registry and National Patient Register in the period 2007–2017. Nulliparous women with a singleton fetus in cephalic presentation were included for analysis of risk factors in index and subsequent delivery.

Results

During the study period, 6002 cases of shoulder dystocia were reported with an overall incidence among women with vaginal delivery of 1.2%. Among 222 225 nulliparous women with vaginal births, shoulder dystocia complicated 2209 (1.0%) deliveries. A subsequent birth was registered in 1106 (50.1%) of the women with shoulder dystocia in index delivery of which 837 (77.8%) delivered vaginally. Recurrence of shoulder dystocia was reported in 60 (7.2%) with a six‐fold increased risk compared with women without a prior history of shoulder dystocia (risk ratio [RR] 5.70, 95% confidence interval [CI]: 4.41 to 7.38; adjusted RR 3.06, 95% CI: 2.03 to 4.68). Low maternal height was a significant risk factor for recurrence of shoulder dystocia. In the subsequent delivery, significant risk factors for recurrence were birthweight >4000 g, positive fetal weight difference exceeding 250 g from index to subsequent delivery, stimulation with oxytocin and operative vaginal delivery. In the subsequent pregnancy following shoulder dystocia, women who underwent a planned cesarean (n = 176) were characterized by more advanced age and a higher prevalence of diabetes in the subsequent pregnancy. Furthermore, they had more often experienced operative vaginal delivery, severe perineal lacerations, and severe neonatal complications at the index delivery.

Conclusions

The incidence of shoulder dystocia among nulliparous women with vaginal delivery was 1.0% with a 7.2% risk of recurrence in a population where about 50% had a subsequent birth and of these 78% had subsequent vaginal delivery. Important risk factors for recurrence were low maternal height, increase of birthweight ≥250 g from index to subsequent delivery and operative vaginal delivery.
Facilitators and constraints to family integrated care in low‐resource settings informed the adaptation in Uganda
Authors: Kabajassi Olive , Reiter Anna , Tagoola Abner , Kenya‐Mugisha Nathan , O'Brien Karel , Wiens Matthew O. , Feeley Nancy , Duby Jessica
Published: February 2024

Aim

Family Integrated Care (FICare) was developed in high‐income countries and has not been tested in resource‐poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda.

Methods

Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints.

Results

Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task‐shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer‐to‐peer support to other mothers.

Conclusion

Uganda FICare shares the core values of FICare but was adapted to be feasible in low‐resource settings.
The impact of venture capital on the digital industry development: evidence from China
Authors: Li Yan , Zhu Qina , Mao Fengfu
Published: February 2024

Promoting digital industry development is an important path to accelerating high‐quality economic development. Using the net growth rate of number of digital enterprises to measure the digital industry development and the data at the city level in China from 2005 to 2016 as a sample, this study analyses the mechanisms through which venture capital impacts on digital industry development. This study finds that the increase in venture capital will promote the digital industry development. The impact of the increase in venture capital on the digital industry development is mainly achieved by reducing the exit rate of digital enterprises. In inland areas and non‐city group, the increase in venture capital can significantly promote the digital industry development and the magnitude of the impact is greater.
How does intellectual property system affect technology entrepreneurship: evidence from Chinese prefecture‐level cities
Authors: Zhao Fusen , Zhao Yuhao , Li Silin
Published: February 2024

Technology entrepreneurship plays a pivotal role in bolstering regional economic vitality, with the intellectual property rights (IPR) system serving as a fundamental safeguard for entrepreneurs' intellectual achievements. Using panel data encompassing 260 prefecture‐level cities in China from 2006 to 2019, we employ the count of registered technology‐based enterprises to construct an indicator of technology entrepreneurship and consider China's IPR policy as a quasi‐natural experiment to examine the impact of the IPR system on technology entrepreneurship. The findings reveal that the pilot policy can significantly stimulate technology entrepreneurship displaying a periodically dynamic promotional effect. This conclusion remains reliable even after undergoing rigorous robustness tests. The mechanism analysis demonstrates that the pilot policy can stimulate technology entrepreneurship by enriching the technological knowledge base and providing financial guarantees. Notably, while the policy's impact on technology entrepreneurship increases with the expansion of the city scale across different scenarios, no discernible regional disparities emerge. This study provides a new perspective on the relationship between the IPR system and entrepreneurship, offering valuable insights into improving the IPR framework in emerging developing countries.
Evaluation of potential hepatic recompensation criteria in patients with PBC and decompensated cirrhosis
Authors: Hofer Benedikt Silvester , Burghart Lukas , Halilbasic Emina , Simbrunner Benedikt , Petrenko Oleksandr , Mandorfer Mattias , Stättermayer Albert Friedrich , Trauner Michael , Reiberger Thomas
Published: February 2024

Background

Aetiological therapy improves liver function and may enable hepatic recompensation in decompensated cirrhosis.

Aims

We explored the potential for recompensation in patients with decompensated primary biliary cholangitis (PBC) – considering a biochemical response to ursodeoxycholic acid (UDCA) according to Paris‐II criteria as a surrogate for successful aetiological treatment.

Methods

Patients with PBC were retrospectively included at the time of first decompensation. Recompensation was defined as (i) resolution of ascites and hepatic encephalopathy (HE) despite discontinuation of diuretic/HE therapy, (ii) absence of variceal bleeding and (iii) sustained liver function improvement.

Results

In total, 42 patients with PBC with decompensated cirrhosis (age: 63.5 [IQR: 51.9–69.2] years; 88.1% female; MELD‐Na: 13.5 [IQR: 11.0–15.0]) were included and followed for 41.9 (IQR: 11.0–70.9) months after decompensation. Seven patients (16.7%) achieved recompensation. Lower MELD‐Na (subdistribution hazard ratio [SHR]: 0.90; p = 0.047), bilirubin (SHR per mg/dL: 0.44; p = 0.005) and alkaline phosphatase (SHR per 10 U/L: 0.67; p = 0.001) at decompensation, as well as variceal bleeding as decompensating event (SHR: 4.37; p = 0.069), were linked to a higher probability of recompensation. Overall, 33 patients were treated with UDCA for ≥1 year and 12 (36%) achieved Paris‐II response criteria. Recompensation occurred in 5/12 (41.7%) and in 2/21 (9.5%) patients with vs. without UDCA response at 1 year, respectively. Recompensation was linked to a numerically improved transplant‐free survival (HR: 0.46; p = 0.335). Nonetheless, 4/7 recompensated patients presented with liver‐related complications after developing hepatic malignancy and/or portal vein thrombosis and 2 eventually died.

Conclusions

Patients with PBC and decompensated cirrhosis may achieve hepatic recompensation under UDCA therapy. However, since liver‐related complications still occur after recompensation, patients should remain under close follow‐up.
A method of calculating weighted values of objective traits for BLUP of breeding values to achieve relative desired changes
Authors: Satoh Masahiro
Published: February 2024

A method of calculating weighted values for objective traits from the phenotypic records of all animals in a population was devised as an alternative to the conventional method of calculating weighted values from a family selection index. The genetic improvement of this method was verified by Monte Carlo computer simulation. A base population consisting of 10 males and 50 females, and five separate generations, other than the base population that had been randomly selected, was bred for two traits with different heritabilities. The breeding values of animals in generation five were estimated using the bivariate BLUP method. The three different weighted values obtained from this method and two conventional methods for estimated breeding values of the objective traits were used to estimate aggregate breeding values for selection. The results showed that selection using weighted values calculated from all animals in a population resulted in a greater response to selection, especially when the genetic correlation between the two traits was positive, than selection using other conventional methods. The use of the method devised in this study was expected to result in a greater genetic improvement than the conventional family selection index method for pig breeding programs applied in closed herds in Japan.
Linking school‐ and classroom‐level characteristics to child adjustment: A representative study of children from Hong Kong, China
Authors: Li Xiaomin , Lam Chun Bun , Chung Kevin Kien Hoa
Published: February 2024

Background

The school is one of the most salient developmental contexts for children. However, little is known about the associations linking the school environment to child adjustment in a non‐Western context, not to mention the potential processes that may mediate these associations.

Aims

This study examined the associations of school‐ and classroom‐level characteristics with child adjustment and tested whether these associations were mediated by teacher–child relationship qualities.

Sample

Cross‐sectional data were collected on a representative sample of 1777 children (mean age = 55.14 months; 50% of them were girls) from 100 kindergartens in Hong Kong, China.

Methods

Using self‐reported questionnaires, teachers rated their school‐level environments, their classroom chaos, their closeness and conflict with children and children's socioemotional competence and academic ability. Meanwhile, parents rated children's behavioural problems.

Results

Multilevel structural equation modelling revealed that the school‐level environment and classroom chaos were uniquely associated with children's socioemotional, behavioural and academic adjustment. Moreover, the associations of the school‐level environment and classroom chaos with child socioemotional and academic adjustment were mediated by teacher–child closeness and conflict, whereas the associations of the school‐level environment and classroom chaos with child behavioural problems were mediated by teacher–child conflict only.

Conclusions

Findings indicated how school‐ and classroom‐level characteristics may be uniquely associated with child adjustment and how teacher–child relationships may be implicated in the underlying mechanism, highlighting the potential utility of targeting school‐ and classroom‐level environments and teacher–child relationships in promoting child development.
Effect of an AI‐based chatbot on students' learning performance in alternate reality game‐based museum learning
Authors: Liang Hsin‐Yi , Hwang Gwo‐Jen , Hsu Tien‐Yu , Yeh Jen‐Yuan
Published: February 2024

Recently, alternate reality games (ARGs) have been applied in museum learning to encourage learners' active engagement through playful problem‐solving activities. However, most learners have insufficient prior knowledge and metacognitive skills to complete the learning tasks in such games. To support learning with ARGs, there is a need to provide proper feedback so that the learners are capable of self‐regulated learning and solving the problems encountered during the learning process. Considering the influences of individual differences, this research developed a chatbot as a learning partner in ARG‐based learning to support students’ learning with adaptive feedback in a museum. A quasi‐experimental study was conducted to evaluate the effectiveness with and without the proposed approach. The results showed that the AI‐based chatbot approach could significantly improve learners' metacognition awareness, emotional engagement and behavioural engagement. Besides, it is helpful to facilitate students' double‐loop learning.

Practitioner notes

What is already known about this topic

Alternate reality games (ARGs) enable students to interact with real‐world contexts.

The complexities of real contexts and ambiguities of the ARGs could frustrate students and demotivate their engagement in problem‐solving activities.

Conventional corrected feedback may fail to match individual students' requirements in solving encountered problems.

What this paper adds

An AI‐based chatbot was designed as a smart learning partner to support the students in solving encountered problems.

The experimental results showed that the proposed approach improved students' metacognitive awareness and engagement.

A drawing analysis and a behaviour sequential analysis were applied to further examine the students' perceptions and behavioural patterns.

Implications for practice and/or policy

It is potentially worth integrating AI‐based chatbots into game‐based learning to promote students' metacognitive awareness and engagement.

AI‐based chatbots provide adaptive feedback to effectively facilitate students' self‐regulated learning and double‐loop learning.
A novel grading approach predicts worse outcomes in stage pT1 non‐muscle‐invasive bladder cancer
Authors: Haas Maximilian , Engelmann Simon U. , Mayr Roman , Gossler Christopher , Pickl Christoph , Kälble Sebastian , Yang Yushan , Otto Wolfgang , Hartmann Valerie , Burger Maximilian , Hartmann Arndt , Breyer Johannes , Eckstein Markus
Published: February 2024

Objective

To develop a prognostically relevant scoring system for stage pT1 non‐muscle‐invasive bladder cancer (NMIBC) incorporating tumour budding, growth pattern and invasion pattern because the World Health Organisation grading system shows limited prognostic value in such patients.

Patients and Methods

The tissue specimens and clinical data of 113 patients with stage pT1 NMIBC who underwent transurethral resection of bladder tumour were retrospectively investigated. Tumour budding, and growth and invasion patterns were evaluated and categorised into two grade groups (GGs). GGs and other clinical and histopathological variables were investigated regarding recurrence‐free survival (RFS), progression‐free survival (PFS), cancer‐specific survival (CSS) and overall survival (OS) using univariable and multivariable Cox regression analyses.

Results

The integration of two tumour budding groups, two growth patterns, and two invasion patterns yielded an unfavourable GG (n = 28; 24.7%) that had a high impact on oncological outcomes. The unfavourable GG was identified as an independent RFS and OS predictor (P = 0.004 and P = 0.046, respectively) and linked to worse PFS (P = 0.001) and CSS (P = 0.001), irrespective of the European Association of Urology risk group. The unfavourable GG was associated with higher rates of BCG‐unresponsive tumours (P = 0.006). Study limitations include the retrospective, single‐centre design, diverse therapies and small cohort.

Conclusions

We present a morphology‐based grading system for stage pT1 NMIBC that correlates with disease aggressiveness and oncological patient outcomes. It therefore identifies a highest risk group of stage pT1 NMIBC patients, who should be followed up more intensively or receive immediate radical cystectomy. The grading incorporates objective variables assessable on haematoxylin and eosin slides and immunohistochemistry, enabling an easy‐to‐use low‐cost approach that is applicable in daily routine. Further studies are needed to validate and confirm these results.
Acid‐sensing receptor GPR4 plays a crucial role in lymphatic cancer metastasis
Authors: Nakanishi Masako , Ibe Akiya , Morishita Kiyoto , Shinagawa Kazutaka , Yamamoto Yushi , Takahashi Hibiki , Ikemori Kyoka , Muragaki Yasuteru , Ehata Shogo
Published: February 2024

Cancer tissues exhibit an acidic microenvironment owing to the accumulation of protons and lactic acid produced by cancer and inflammatory cells. To examine the role of an acidic microenvironment in lymphatic cancer metastasis, gene expression profiling was conducted using human dermal lymphatic endothelial cells (HDLECs) treated with a low pH medium. Microarray and gene set enrichment analysis revealed that acid treatment induced the expression of inflammation‐related genes in HDLECs, including genes encoding chemokines and adhesion molecules. Acid treatment‐induced chemokines C‐X3‐C motif chemokine ligand 1 (CX3CL1) and C‐X‐C motif chemokine ligand 6 (CXCL6) autocrinally promoted the growth and tube formation of HDLECs. The expression of vascular cell adhesion molecule 1 (VCAM‐1) increased in HDLECs after acid treatment in a time‐dependent manner, which, in turn, enhanced their adhesion to melanoma cells. Among various acid‐sensing receptors, HDLECs basally expressed G protein‐coupled receptor 4 (GPR4), which was augmented under the acidic microenvironment. The induction of chemokines or VCAM‐1 under acidic conditions was attenuated by GPR4 knockdown in HDLECs. In addition, lymph node metastases in a mouse melanoma model were suppressed by administering an anti‐VCAM‐1 antibody or a GPR4 antagonist. These results suggest that an acidic microenvironment modifies the function of lymphatic endothelial cells via GPR4, thereby promoting lymphatic cancer metastasis. Acid‐sensing receptors and their downstream molecules might serve as preventive or therapeutic targets in cancer.
Buprenorphine microdosing regimen using transdermal buprenorphine patches to transition from methadone to buprenorphine
Authors: Naren Thileepan , Cook Jon , MacCartney Paul , Membrey Dean
Published: February 2024

Introduction

This case series records a cohort of patients treated with transdermal buprenorphine patches as part of a buprenorphine microdose induction protocol to transition from methadone to buprenorphine in a community setting. This has historically been a difficult process to manage in community settings and this case series explored a method to gradually manage this in an outpatient setting.

Method

A retrospective file audit was conducted of the electronic medical records of cohealth Innerspace patients who had undergone buprenorphine microdose induction using transdermal patches. A total of 32 patients were identified.

Results

In this case series 23 of the 32 patients successfully transitioned from methadone to sublingual or long‐acting injectable depot buprenorphine preparations utilising the transdermal buprenorphine microdosing technique. All patients in this case series regardless of the success of the transition were retained in treatment.

Discussion and Conclusions

A fixed‐dose transdermal buprenorphine patch regimen enabled 23 of 32 patients in this case series transition from methadone to buprenorphine in an outpatient setting. Given the small sample size further research is required to demonstrate the effectiveness of this technique.
Improving employee acceptability of performance management across borders: A reciprocity perspective
Authors: Neher Alain , Maley Jane , Wuersch Lucia , Krivokapic‐Skoko Branka
Published: February 2024

This conceptual work critically examines how employees in multinational corporations (MNCs) receive performance management (PM) systems. Employee acceptance of the PM system across MNCs' subsidiaries is critical for PM effectiveness. Furthermore, the context plays a significant role in determining employee acceptance of the PM, and this varies widely across borders. The paper uses the lens of reciprocity theory to propose a conceptual PM framework to advance employee acceptability of PM. Four key steps in the framework assess the acceptability of PM at different stages, ensuring the PM system evolves and improves with each stage. These steps include analysing the context of the subsidiary, developing and applying management actions that reflect the goals of the MNC, its subsidiaries and individual employees and embedding the customised PM process across the MNC to foster trust and the perception of fairness. The framework's value for practitioners is to increase employees' probability of accepting the PM. We conclude that multinationals must pay more attention to the PM context across their borders, particularly the cultural context.
Clinical variables contributing to the identification of biologically defined subgroups within cognitively unimpaired and mild cognitive impairment individuals
Authors: Marcolini Sofia , Mondragón Jaime D. , Dominguez‐Vega Zeus T. , De Deyn Peter P. , Maurits Natasha M. ,   for the Alzheimer's Disease Neuroimaging Initiative
Published: February 2024

Background

A lack of consensus exists in linking demographic, behavioral, and cognitive characteristics to biological stages of dementia, defined by the ATN (amyloid, tau, neurodegeneration) classification incorporating amyloid, tau, and neuronal injury biomarkers.

Methods

Using a random forest classifier we investigated whether 27 demographic, behavioral, and cognitive characteristics allowed distinction between ATN‐defined groups with the same cognitive profile. This was done separately for three cognitively unimpaired (CU) (112 A‐T‐N‐; 46 A+T+N+/−; 65 A‐T+/‐N+/−) and three mild cognitive impairment (MCI) (128 A‐T‐N‐; 223 A+T+N+/−; 94 A‐T+/‐N+/−) subgroups.

Results

Classification‐balanced accuracy reached 39% for the CU and 52% for the MCI subgroups. Logical Delayed Recall (explaining 16% of the variance), followed by the Alzheimer's Disease Assessment Scale 13 (14%) and Everyday Cognition Informant (10%), were the most relevant characteristics for classification of the MCI subgroups. Race and ethnicity, marital status, and Everyday Cognition Patient were not relevant (0%).

Conclusions

The demographic, behavioral, and cognitive measures used in our model were not informative in differentiating ATN‐defined CU profiles. Measures of delayed memory, general cognition, and activities of daily living were the most informative in differentiating ATN‐defined MCI profiles; however, these measures alone were not sufficient to reach high classification performance.
An enhanced method for surface defect detection in workpieces based on improved MobileNetV2‐SSD
Authors: Qiu Junlin , Shen Yongshan , Lin Jianchu , Qin Yuxin , Yang Jian , Lei Hengdan , Li Minghui
Published: February 2024

In the process of workpieces production, surface defects are prone to occur, and these defects come in a wide variety and are often intermixed, making defect detection and classification exceptionally challenging. With the development of artificial intelligence and deep learning, to tackle this problem, this paper introduces an enhanced single shot multibox detector algorithm based on MobileNetV2 for the detection of surface defects. The method utilizes MobileNetv2 as the backbone of the feature extraction network to obtain six feature layers with different detection scales from the baseline network, that is, the original 1 × 1 feature prediction layer is deleted and a 75 × 75 feature prediction layer is added, which is closer to the specific features of the defects on the surface of the workpiece. In the additional feature layer, two parallel dilated convolution structures are connected, introducing depth‐separable convolution and dilated convolution, combining skip connections and pixel‐wise addition operations. A special feature fusion structure is proposed to perform feature fusion for small, medium and large target detection layers, which effectively solves the problem of missed and false detection. Moreover, it refines candidate bounding box aspect ratios within the training set through the utilization of the K‐means clustering algorithm, ensuring a better match with real boxes. The experimental results demonstrate the effectiveness of the enhanced model, and the mean average precision value reaches 88.72%. Compared to other state‐of‐the‐art detection methods, it exhibits superior capabilities.
Partner and social support in childbearing and rearing in a Gulf Coast Native American community
Authors: Liddell Jessica L. , Hicks Emily C.
Published: February 2024

Objective

This study sought to understand the roles of partners in pregnancy, childbirth, and childrearing in Indigenous communities. It explores supportive and unsupportive attitudes in the relationships mothers experienced, and how these relationships affected their lives.

Background

Settler colonialism has negatively impacted Indigenous communities. However, little research has explored how it has influenced partner and social support during the perinatal time period.

Methods

Through 31 semistructured interviews with women from a tribe in the southeastern United States, participants described their experiences with supportive and unsupportive partners and how that shaped their experiences during pregnancy, childbirth, and childrearing.

Results

Participants described themes of (a) supportive and unsupportive partner relationships, (b) importance of partner support in childbirth, and (c) mothers as primary caregivers.

Conclusion

Results suggest that women experienced a wide range of partner relationships, and they relied more on their female family members to provide support during this time, rather than counting on their male counterparts.

Implications

Health care providers may want to take these findings into consideration when approaching their patient's care. These findings indicate that the impacts of settler colonialism continue to impact family relationships for the participants in this study.
Experimental investigation on mechanical behavior of silane‐modified polyurethane sealant under biaxial cyclic loading
Authors: Zhang Jun , Zhang Meng Jie
Published: February 2024

The biaxial tension–tension cyclic loading experiments were conducted on the cruciform specimens prepared using a silane‐modified polyurethane sealant to investigate their mechanical behavior. The finite element method was employed to validate the mechanical behavior of cruciform specimens under the biaxial cyclic loading conditions. It is shown that the highest stress concentration is in the central region of the cruciform specimens, indicating that the shape design of the specimen is suitable for the biaxial tension–tension cyclic tests. Additionally, the effects of loading path, mean stress, and stress amplitude on ratcheting strain and dissipated energy were analyzed through the experimental data. The experimental results demonstrated that the loading path had an influence on the mechanical behavior of the cruciform specimen. The additional ratcheting strain caused by the non‐proportional loading path was found to be loading path dependent of the adhesive. Moreover, the mean stress and stress amplitude greatly affected the strain response curves of the specimen under biaxial cyclic loading. The ratcheting strain and dissipated energy increased with increasing mean stress and stress amplitude; nevertheless, stress amplitude had more influence on the mechanical behavior than the mean stress.
Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability
Authors: Ogino Tomoyuki , Nozoe Masafumi , Inoue Tatsuro , Ishida Mitsuru , Yamamoto Kenta
Published: February 2024

Aim

How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability.

Methods

This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group.

Results

This study included 456 patients with acute stroke (median age, 80 years). In the premorbid‐disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid‐disability group (β = −0.054, P = 0.346).

Conclusions

The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359–363.
Blood pressure elevation in erenumab‐treated patients with migraine: A retrospective real‐world experience
Authors: Chhabra Nikita , Mead‐Harvey Carolyn , Dodoo Christopher A. , Iser Courtney , Taylor Hallie , Chaudhary Hira , Vanood Aimen , Dodick David W.
Published: February 2024

Background

Erenumab is a monoclonal antibody that targets the calcitonin gene‐related peptide (CGRP) receptor and is approved for the preventative treatment of migraine in adults. CGRP is involved in the regulation of vasomotor tone under physiologic and pathologic conditions, including hypertension. While there has not been evidence of hypertension in preclinical models or clinical trials, post‐marketing data suggest erenumab may be associated with hypertension. This led to a warning in the United States Food and Drug Administration prescribing information for erenumab.

Objective

To determine the frequency of worsening blood pressure (BP) after initiation of erenumab in patients with migraine and how this is associated with hypertension.

Methods

This is an observational retrospective cohort study evaluating patients at a tertiary headache or neurology department. Systolic and diastolic BPs were compared between the initial visit prior to initiation of erenumab, and follow‐up visit while on erenumab. Worsening BP was defined as moving from a lower stage to a higher stage of BP, as defined by the American Heart Association. Serious adverse vascular events were also recorded.

Results

A total of 335 patients were included in the final analysis (mean [SD] age of 45.7 [14.40] years, 83.9% [281/335] female). At baseline, 20.9% (70/335) of patients had a prior diagnosis of hypertension. The median (interquartile range) time to follow‐up appointment from initial appointment was 20.5 (13.3–35.3) weeks. The mean (SD) BP at baseline was systolic 124.7 (15) mmHg and diastolic 77 (11) mmHg, and at follow‐up was systolic 124.0 (15) mmHg and diastolic 77.8 (9) mmHg. Overall, 23.3% (78/335) of all patients had worsening BP, whereas 13/225 (3.9%) patients had improvement in their BP. Patients with atrial fibrillation were more likely to develop worsening BP (odds ratio, 4.9, 95% confidence interval 1.12–21.4; p = 0.035). There was no association between worsening BP and pre‐existing hypertension, sex, body mass index, or age. One patient had non‐ST elevation myocardial infarction attributed to a hypertensive emergency while on erenumab.

Conclusion

We found that 23.3% of patients initiated on erenumab may have developed worsening BP, suggesting the need for BP monitoring in patients initiated on erenumab.
A pilot study evaluating high dose esomeprazole, bismuth subcitrate and amoxicillin for eradicating Helicobacter pylori infection in Iran
Authors: Tirgar Fakheri Sepehr , Shokri‐Afra Hajar , Graham David Y. , Bari Zohreh , Fakheri Hafez
Published: February 2024

Background

Helicobacter pylori (H. pylori) is strongly associated with peptic ulcer disease and gastric cancer. We evaluated two triple therapy regimens comprising esomeprazole, high dose bismuth, and different doses of amoxicillin for first‐line H. pylori eradication.

Materials and Methods

Two hundred patients with dyspepsia and naive H. pylori infection were randomly assigned into two groups (n = 100). Both groups were treated for 14 days similarly with esomeprazole (40 mg, twice daily) and bismuth subcitrate (240 mg, three times daily), but the dose of amoxicillin was varied between Groups A (750 mg) and B (1000 mg) three times daily. Treatment compliance and side effect were evaluated following the therapies and after 8 weeks, a negative test of stool H. pylori antigen confirmed eradication.

Results

The two groups were comparable with respect to sex and age. According to intention to treat analysis, eradication rates were 80% (95% CI: 77.2%–82.8%) and 90% (95% CI: 84.1%–95.9%) in A and B groups, respectively (p = 0.22). Per‐protocol eradication rates were 87% (95% CI: 80.4%–93.6%) and 92.8% (95% CI: 87.7%–97.9%), respectively (p = 0.23). Severe adverse effects were 3% and 2%, respectively (p = 0.34).

Conclusion

High dose esomeprazole, amoxicillin and bismuth achieved 92.8% cure rates per protocol in a country with a high background rate of resistance. Additional studies are needed to ascertain whether this therapy can be further improved. Until then, it can be recommended as a first‐line H. pylori eradication in north of Iran.
Automated curation of large‐scale cancer histopathology image datasets using deep learning
Authors: Hilgers Lars , Ghaffari Laleh Narmin , West Nicholas P , Westwood Alice , Hewitt Katherine J , Quirke Philip , Grabsch Heike I , Carrero Zunamys I , Matthaei Emylou , Loeffler Chiara M L , Brinker Titus J , Yuan Tanwei , Brenner Hermann , Brobeil Alexander , Hoffmeister Michael , Kather Jakob Nikolas
Published: February 2024

Background

Artificial intelligence (AI) has numerous applications in pathology, supporting diagnosis and prognostication in cancer. However, most AI models are trained on highly selected data, typically one tissue slide per patient. In reality, especially for large surgical resection specimens, dozens of slides can be available for each patient. Manually sorting and labelling whole‐slide images (WSIs) is a very time‐consuming process, hindering the direct application of AI on the collected tissue samples from large cohorts. In this study we addressed this issue by developing a deep‐learning (DL)‐based method for automatic curation of large pathology datasets with several slides per patient.

Methods

We collected multiple large multicentric datasets of colorectal cancer histopathological slides from the United Kingdom (FOXTROT, N = 21,384 slides; CR07, N = 7985 slides) and Germany (DACHS, N = 3606 slides). These datasets contained multiple types of tissue slides, including bowel resection specimens, endoscopic biopsies, lymph node resections, immunohistochemistry‐stained slides, and tissue microarrays. We developed, trained, and tested a deep convolutional neural network model to predict the type of slide from the slide overview (thumbnail) image. The primary statistical endpoint was the macro‐averaged area under the receiver operating curve (AUROCs) for detection of the type of slide.

Results

In the primary dataset (FOXTROT), with an AUROC of 0.995 [95% confidence interval [CI]: 0.994–0.996] the algorithm achieved a high classification performance and was able to accurately predict the type of slide from the thumbnail image alone. In the two external test cohorts (CR07, DACHS) AUROCs of 0.982 [95% CI: 0.979–0.985] and 0.875 [95% CI: 0.864–0.887] were observed, which indicates the generalizability of the trained model on unseen datasets. With a confidence threshold of 0.95, the model reached an accuracy of 94.6% (7331 classified cases) in CR07 and 85.1% (2752 classified cases) for the DACHS cohort.

Conclusion

Our findings show that using the low‐resolution thumbnail image is sufficient to accurately classify the type of slide in digital pathology. This can support researchers to make the vast resource of existing pathology archives accessible to modern AI models with only minimal manual annotations.
Defendants' experiences: Video hearings from prison(s) to court(s)
Authors: Walker Charlotte
Published: February 2024

The focus of this article is the experiences that defendants – both represented and unrepresented – have when appearing via video link(s) from prison(s) to court(s), in England and Wales. This exploration is based on second‐hand accounts. In this study, 20 interviews were conducted with a range of court actors, and 403 court hearings at two magistrates' courts were observed. The findings demonstrate that while video hearings were initially introduced to promote managerialism values (i.e., increase efficiency and reduce costs), due process rights have in some instances been undermined. It will be argued that although appearing via video has advantages for defendants and can enhance their ability to effectively participate in the process, challenges also arise in relation to this. This is due to managerialism values generally being prioritised over participation concerns.
Differential response of plant and insect pollinator communities to fragmentation in coastal dune slacks
Authors: Devriese Arne , Janssens Sam , Brys Rein , Jacquemyn Hans
Published: February 2024

Habitat destruction and fragmentation are one of the main drivers of pollinator decline and biodiversity loss in general. However, the exact effects of habitat fragmentation on pollinator communities are still poorly understood, and it remains unclear which patch characteristics are most important in driving pollinator diversity and community composition.

In this study, we inventoried plant and insect diversity in a total of 19 fragmented dune slacks in Belgium. Specifically, we assessed the effects of dune slack area and connectivity on plant and pollinator diversity and community composition. Additionally, we investigated to what extent plant diversity had an impact on insect pollinator communities.

The results indicated that species richness of both plants and insects was significantly related to patch area, whereas patch connectivity only had a significant effect on plant diversity. Nestedness analyses showed that plant communities of small dune slacks were a subset of the communities of large patches, but no such patterns were found for insect communities. Turnover in pollinator communities was high and significantly related to the distance separating dune slacks.

Overall, our results highlight the importance of large patches for sustaining both plant and pollinator communities. Additionally, enhancing connectivity has the potential to promote plant diversity and consequently benefit pollinator species.
Evolution of the use of intraosseous vascular access in prehospital advanced cardiopulmonary resuscitation: The IOVA‐CPR study
Authors: Agostinucci Jean‐Marc , Alhéritière Armelle , Metzger Jacques , Nadiras Pierre , Martineau Laurence , Bertrand Philippe , Gentilhomme Angélie , Petrovic Tomislav , Adnet Frédéric , Lapostolle Frédéric
Published: February 2024

Introduction

Obtaining vascular access is crucial in critically ill patients. The EZ‐IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased.

Aim

We aim to determine how IOVA was integrated into management of vascular access during out‐of‐hospital cardiac arrest (OHCA) resuscitation.

Methods

Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation.

Results

Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4–10) versus 5 (3–8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001.

Conclusion

The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.
From provider to partner? Main elements of the relationship between schools and small‐ and medium‐sized firms in vocational education work placements in the Basque and Navarre regions (Spain)
Authors: Lavía Cristina , Otero Beatriz , Olazaran Mikel , Albizu Eneka
Published: February 2024

This paper seeks to contribute to the knowledge of the relationship established between firms and vocational education and training (VET) schools around work placements in companies (both standard and extended, so‐called ‘dual’, models) in Spain. An ad hoc survey of 332 small and medium enterprises (SMEs) from two industrial regions was conducted and a categorical principal components analysis was applied to identify the main dimensions or components of those relationships. The main elements found are related to (i) staff selection and social responsibility; (ii) trust, reciprocity and knowledge sharing with schools; and (iii) the organizational culture of the companies. The results obtained illustrate an evolution from a ‘provider‐client’ scheme towards a more strategic partnership between schools and firms, thus contributing new aspects to the literature available on the Spanish case.
NRP1 downregulation correlates with enhanced ILC2 responses during IL‐33 challenge
Authors: Wang Ying , Liu Gaoyu , Wang Jianye , Zhou Pan , Zhang Lijuan , Liu Qiang , Zhou Jie
Published: February 2024

Group 2 innate lymphoid cells (ILC2s) play critical roles in driving the pathogenesis of allergic airway inflammation. The mechanisms underlying the regulation of ILC2s remain to be fully understood. Here, we identified neuropilin‐1 (NRP1) as a surface marker of ILC2s in response to IL‐33 stimulation. NRP1 was abundantly expressed in ILC2s from lung under steady state, which was significantly reduced upon IL‐33 stimulation. ILC2s with high expression of NRP1 (NRP1high) displayed lower response to IL‐33, as compared with NRP1low ILC2s. Transcriptional profiling and flow cytometric analysis showed that downregulation of AKT–mTOR signalling participated in the diminished functionality of NRP1high ILC2s. These observations revealed a potential role of NRP1 in ILC2s responses under allergic inflammatory condition.
The extension of social health protection to refugees
Authors: Ron Aviva , Nitzan Dorit
Published: February 2024

The target populations to be covered in this article on the extension of social protection coverage are refugees, as defined by the United Nations High Commissioner for Refugees. Our approach to their coverage is based on the pillars of public health and social protection, which together provide the rationale and legislative basis for coverage. The social protection benefits to be covered are comprehensive health services, providing entitlement to services without conditions such as prior contributions or duration of residence. Refugees are vulnerable since they come from conflict areas or go through persecution and personal threat. They carry grief from the loss of family members and friends, property and livelihood, and social and cultural support. Some have sustained injuries before rescue and evacuation and need additional care. They may have chronic diseases and need medications they can no longer access. Some may have communicable diseases, such as tuberculosis, and children may have missed scheduled mandatory vaccinations. Refugees are vulnerable to new and re‐emerging infections, as seen in the COVID–19 pandemic. While the focus in this article is on providing health care, the social determinants of health are addressed, including access to education, employment with decent working conditions, and safe environments. We focus on coverage by national authorities and institutions, legislative amendments to enable entitlement to non‐citizens, and provide national examples. Experience has shown that coverage is feasible with the assistance and guidance of international and local organizations and associations and with an acceptance by the existing social protection institutions of the benefits of extending coverage to new members. This article concurs with the principle and pledge of the 2030 Social Development Goals of the United Nations to “leave no one behind”.
A heuristic for the non‐unicost set covering problem using local branching
Authors: Beasley J.E.
Published: February 2024

In this paper, we present a heuristic for the non‐unicost set covering problem using local branching. Local branching eliminates the need to define a problem specific search neighbourhood for any particular (zero‐one) optimisation problem. It does this by incorporating a generalised Hamming distance neighbourhood into the problem, and this leads naturally to an appropriate neighbourhood search procedure. We apply our approach to the non‐unicost set covering problem. Computational results are presented for 65 test problems that have been widely considered in the literature. Our results indicate that our heuristic is better than six of the eight other heuristics we examined, slightly worse than that of one heuristic, but that there is a single heuristic that outperforms all others. We believe that the work described here illustrates that the potential for using local branching, operating as a stand‐alone matheuristic, has not been fully exploited in the literature.