bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimodality Imaging Evaluation of Diseases of the Pulmonic Valve and Right Ventricular Outflow Tract for the Adult Cardiologist
Authors: Murphy Seán P. , Sultana Sadia , Zern Emily K. , Tower-Rader Albree , Churchill Jessica L. , Stefanescu Schmidt Ada C. , Huang Sihong , Learn Christopher P. , Churchill Timothy W. , DeFaria Yeh Doreen , Yucel Evin
Published: January 2025

Disorders of the pulmonic valve (PV) receive considerably less attention than other forms of valvular heart disease. Due to the dramatically improved survival of children with congenital heart disease over the last 5 decades, there has been a steady increase in the prevalence of adults with congenital heart disease, which necessitates that clinicians become familiar with the anatomy and the evaluation of right ventricular outflow tract and PV anomalies. A multimodality imaging approach using echocardiography, cardiac computed tomography, and magnetic resonance imaging is essential for a comprehensive evaluation of the anatomy and function of the right ventricular outflow tract, PV, and supravalvular region. As clinical presentation is often insidious with nonspecific symptoms, yet morbidity and mortality associated with severe untreated PV disease are significant, a high index of suspicion coupled with appropriate use of imaging techniques is critical in facilitating timely diagnosis and treatment. In this review, we aim to present a comprehensive approach to the diagnosis of PV disease and associated right ventricular outflow tract or supravalvular pulmonary stenosis, including optimal use of multimodality imaging to facilitate timely diagnosis, optimize therapeutic strategies, enhance postprocedural surveillance, and ultimately improve patient outcomes.
Estimating Civic Awareness and Willingness to Pay (WTP) for Rooftop Greenhouses: A Study of Seoul Residents
Authors: Kil Sung-Ho , Park Hye-Mi , Kim Taelyn
Published: January 2025

Background and objective: In hardscape-dominated cities, rooftop greenhouses(RGs) are considered a viable alternative for providing high-quality food, greenery, and experiences to citizens. However, existing research has predominantly focused on conventional urban agriculture, and rooftop greenhouses remain under-researched on an international scale. In this study, we use the contingent valuation method (CVM) to estimate the willingness to pay (WTP) for RGs among residents of Seoul, South Korea, and evaluate their comprehensive value.Methods: A questionnaire including items on respondents’ characteristics, WTP, and civic awareness of RGs was prepared, and WTP was estimated using the double-bounded dichotomous choice (DBDC) model. On the basis of these copies, utility theoretic analysis and the logit model of CVM were employed to estimate the WTP for RG among Seoul residents.Results: The per capita WTP for RG among Seoul residents was 30,260. On the basis of this result, the value of RGs in Seoul was approximately 220 billion KRW. Most respondents preferred a combination of crop production and experiences. This outcome suggests that future RGs in buildings should include spaces for citizen experiences and education. Respondents suggested that the most necessary measure to promote RGs was providing customized education on building and managing rooftop greenhouses, followed by providing and subsidies, and promoting related policies and projects.Conclusion: The findings of this study can be utilized to convey the global importance of RGs and as a basis for establishing related policies and increasing the participation of local residents. In addition, considering that Seoul has recently implemented a project to install RGs on existing commercial buildings, the results of this study will be highly useful.
Using Conjoint Analysis to Investigate Preferences in Horticultural Therapy Programs for Older Adults with Dementia
Authors: Lee Sujeong , Kim Jonghyuck , Chang Taegwon , Yun Sukyoung
Published: January 2025

Background and objective: This study used conjoint analysis to investigate the preferences for various components of a horticultural therapy program for older adults with dementia (OAD). The results of the analysis were used to identify the perceptions and preferences of OAD for horticultural therapy programs to alleviate dementia symptoms, and to provide a basis for the introduction of such programs to alleviate dementia symptoms in OAD.Methods: In this study, a survey was orthogonally designed through SPSS Statistics with four main attributes (intervention goals, number of sessions per week, total number of sessions, and time per session), and profiles that could be presented according to the level of the attributes. The survey was conducted over a 31-day period from January 29 to February 28, 2024, with an offline survey and an online survey, in which 16 profiles were presented to the participants and they were asked to prioritize their preferences and give a score on a 5-point scale.Results: First, when analyzing preferences by attribute, the importance of each attribute was highest for number of sessions per week (28.5%), followed by intervention goals (25.7%), time per session (23.0%), and total number of sessions (22.8%; Pearson’s R = .892, p < .001). Second, once a week (.079) was most preferred for the number of sessions per week, psycho-emotional area (.145) for intervention goals, 60 minutes or less (.125) for time per session, and 10 sessions or less (.097) for total sessions.Conclusion: Dementia facility staff, family caregivers, and horticultural therapists of OAD preferred the following components of horticultural therapy programs for OAD: once a week for number of sessions per week; psychological and emotional domain for intervention goals; 60 minutes or less for time per session; and 10 sessions or less for total number of sessions. It is expected these findings can be used as a basis for developing horticultural therapy programs to alleviate dementia symptoms in OAD.
A Study on Planting Techniques to Enhance the Function of Urban Wind Ventilation Forest: In the Case of Wind-Connecting Forest, Seocho-gu, Seoul
Authors: Kim Geun-Ki , Han Bong-Ho , Park Seok-Cheol
Published: January 2025

Background and objective: This study was conducted to develop Connecting Forest planting technique suitable for urban structure and target site conditions on Banpo-daero Street in Seocho-gu.Methods: Through simulation analysis of planting techniques by type (computer climate model: ENVI-met), the street types were classified into the following categories: bare ground type (1), currently planted with Platanus occidentalis (square pruning) (2), a type that can realistically create a strip green (3), and a type that grows the tree canopy and applies Platanus occidentalis and a strip green in the center of the road (4).Results: In the case of creating a 2-meter-wide band green on the existing street trees in the first row, and multi-layered vegetation using the step-by-step arrangement method of small tree + shrub + herbaceous plants, the temperature of up to 0.15°C rise in the roadway area and the temperature of up to 0.12°C went down in the sidewalk area, and PMV (Predicted Mean Vote) was reduced by up to 1.32 in the multi-layer trench planting area. Particulate matter was concentrated, resulting in an increase of about 40~80㎍/㎥in roadways and sidewalks. In the case of the ideal planting arrangement of the route applying the original tree tree tree street + the green belt 2m + the central green zone, the effect of reducing the maximum 1.6°C in the roadway area and 0.3°C in the sidewalk area was shown, and the result of lowering the temperature throughout the target area was derived. arise from street trees, trench planting and trees in Green Area at the Center Line the concentration of particulate matter in the roadway area increased to about 150μg/㎥, and the concentration of particulate matter in sidewalks and residential areas decreased. Through simulation analysis, we planted street trees with large trunk widths that are favorable for shade formation (Platanus occidentalis) and maintained the unique tree shape, oval, rather than square pruning, and the composition of the strip greenery consisted of multi-layered plantings based on the terraced layout method by introducing tree species with excellent particulate matter reduction capabilities.Conclusion: This study is meaningful in analyzing the function of connecting forests, which play an important role in urban wind ventilation forests, which are created as a solution to improve the urban environment, such as reducing particulate matter in the city and mitigating heat waves, and suggesting planting techniques that can improve their function.
Investigating the Static and Dynamic Aspects of Polymer Adsorption on Wave-like Surface
Authors: Furi Adugna , Mekonen Gutu , Asfaw Solomon , Tolosa Diriba
Published: January 2025

This study investigates the adsorption of linear polymers onto wave like surfaces using Monte Carlo simulations on 2D lattice. Using the bond fluctuation model (BFM), we analyzed the behavior of polymer chains of length (N) near a surface. We computed the mean-square end-to-end distance ‹R2› and mean-square radius of gyration ‹Rg2› for polymer by varying chains lengths (N). Interestingly, the scaling behavior of these properties with chain length deviates from the expected universal relationships due to the wave like surfaces. The number of adsorbed monomers, the fraction of adsorbed monomers, and the adsorption energy were determined for polymer chains of different lengths on a corrugated surface. The influence of interaction strength on adsorption energy was also investigated. Our findings indicate that the longest chains exhibit the highest surface coverage of adsorbed monomers. Shorter chains, however, display the maximum average adsorbed monomer fraction and optimal surface coverage. The factors affecting polymer adsorption onto surfaces include the strength of polymer-surface interactions, surface properties, length of the polymer chains, and the adsorption energy. For adsorption to occur, the energetic benefit gained from binding to the surface must exceed the loss in conformational freedom of the polymer chain. The influence of surface topography on polymer adsorption has been extensively studied using wave-like surfaces as a model system. Molecular simulations have been used to explore the effects of these surfaces on polymer behavior.
SWOT Data Assimilation with Correlated Error Reduction: Fitting Model and Error Together
Authors: Gille Sarah T. , Gao Yu , Cornuelle Bruce D. , Mazloff Matthew R.
Published: January 2025

The Surface Water Ocean Topography (SWOT) satellite mission provides high-resolution two-dimensional sea surface height (SSH) data with swath coverage. However, spatially correlated errors affect these SSH measurements, particularly in the cross-track direction. The scales of errors can be similar to the scales of ocean features. Conventionally, instrumental errors and ocean signals have been solved for independently in two stages. Here, we have developed a one-stage procedure that solves for the correlated error at the same time that data are assimilated into a dynamical ocean model. This uses the ocean dynamics to distinguish ocean signals from observation errors. We test its performance relative to the two-stage method using simplified dynamics and a data set consisting of westward propagating Rossby waves, along with correlated instrumental errors of varying magnitudes. In a series of tests, we found that the one-stage approach consistently outperforms the two-stage approach when estimating SSH signal and correlated errors. The one-stage approach can recover over 95% of the SSH signal, while skill for the two-stage approach drops significantly as error increases. Our findings suggest that solving for the correlated errors within the assimilation framework can provide an effective analysis approach, reducing the risks of confounding signal and instrument noise.
Effects of short time −30° head-down tilt on time perception
Authors: Ren Weicong , Liu Le , Liang Jin , Zhang Pan , Wu Di , Zhang Zhijie
Published: January 2025

Exposure to microgravity induces abnormal experiences that may affect the perception of time. Head-down tilts (HDTs) are commonly used to investigate the effects of weightlessness. A −30° HDT is considered an appropriate model to simulate the acute phase of microgravity exposure. Temporal performance in a time reproduction task was assessed before and after 30 min of −30° HDT, using 800, 1,000, and 2,000 ms as standard intervals. Absolute error (AE), relative error (ratio), and coefficient of variation (CV) were calculated to quantify performance. Compared to baseline measures obtained prior to HDT, both the mean AE and the ratio were significantly increased after 30 min of −30° HDT at the 800 ms interval. A similar trend was observed at the 1,000 ms interval, but no significant effect was found at the 2,000 ms interval. No significant differences were observed in the CV before and after −30° HDT. Acute exposure to microgravity, simulated by the −30° HDT condition, primarily affects duration perception at sub-second intervals.
The Presidents Club
Authors: Tarricone Paul
Published: January 2025

Those who've ‘sat in the seat’ as IES presidents discuss their unique bond
Development and Validation of a Postprocedure Stroke Screening Tool in Children With Cardiac Disease
Authors: Harrar Dana B. , Salussolia Catherine L. , Keith Louisa G. , Ye Shangyuan , Meadows Julie S. , Fialkow Alexandra , Zhu Guangyu , VanderPluym Christina , Zhang Bo , Rivkin Michael J.
Published: January 2025

Background

Cardiac catheterization in children with heart disease is associated with an increased risk of arterial ischemic stroke. We created and evaluated the diagnostic performance of a bedside screening tool administered postprocedure to identify arterial ischemic stroke.

Methods

We developed a postprocedure stroke screen comprising history of stroke, responsiveness, command following, speech, facial and limb strength symmetry, new seizure, and caregiver concern. We compared the performance of the screening tool in a retrospective cohort of 21 patients with a postcatheterization arterial ischemic stroke and a prospective cohort of 100 consecutive control patients after cardiac catheterization.

Results

The postprocedure stroke screen delivered a maximum Youden index ranging from 0.810 to 0.937 at threshold scores of 2 or 2.5 and gave a sensitivity and specificity >0.9. The area under the receiver operating characteristic curve ranged from 0.931 to 0.946.

Conclusions

We developed a screening tool with high sensitivity and specificity to identify postcatheterization arterial ischemic stroke in children.
A multimodal similarity-aware and knowledge-driven pre-training approach for reliable pneumoconiosis diagnosis
Authors: Ren Xueting , Ji Guohua , Chu Surong , Yoshida Shinichi , Zhao Juanjuan , Jia Baoping , Qiang Yan
Published: January 2025

Background

Pneumoconiosis staging is challenging due to the low clarity of X-ray images and the small, diffuse nature of the lesions. Additionally, the scarcity of annotated data makes it difficult to develop accurate staging models. Although clinical text reports provide valuable contextual information, existing works primarily focus on designing multimodal image-text contrastive learning tasks, neglecting the high similarity of pneumoconiosis imaging representations. This results in inadequate extraction of fine-grained multimodal information and underutilization of domain knowledge, limiting their application in medical tasks.

Objective

The study aims to address the limitations of current multimodal methods by proposing a new approach that improves the precision of pneumoconiosis diagnosis and staging through enhanced fine-grained learning and better utilization of domain knowledge.

Methods

The proposed Multimodal Similarity-aware and Knowledge-driven Pre-Training (MSK-PT) approach involves two stages. In the first stage, we deeply analyze the similar features of pneumoconiosis images and use a similarity-aware modality alignment strategy to explore the fine-grained representations and associated disturbances of pneumoconiosis lesions between images and texts, guiding the model to match more appropriate feature representations. In the second stage, we utilize data-associated features and pre-stored domain knowledge features as priors and constraints to guide the downstream model in the visual domain without annotations. To address potential erroneous labels generated by model predictions, we further introduce an uncertainty threshold strategy to mitigate the negative impact of imperfect prediction labels and enhance model interpretability.

Results

We collected and created the pneumoconiosis chest X-ray (PneumoCXR) dataset to evaluate our proposed MSK-PT method. The experimental results show that our method achieved a classification accuracy of 81.73%, outperforming the state-of-the-art algorithms by 2.53%.

Conclusions

MSK-PT showed diagnostic performance that matches or exceeds the average radiologist's level, even with limited labeled data, highlighting the method's effectiveness and robustness.
Experimental study on enhancing surface integrity and corrosion resistance in additively manufactured 316L stainless steel through vibratory finishing technique
Authors: Nezarati Masoud , Sayadi Daniyal , Hemasian Etefagh Ardeshir , Khajehzadeh Mohsen
Published: January 2025

This study explores the impact of vibratory finishing (VF) on the surface characteristics and corrosion resistance of stainless steel 316L produced via selective laser melting (SLM). SLM, a common technique in aerospace and biomedical industries, often struggles to achieve optimal corrosion resistance in stainless steel parts. VF, a widely used post-processing method, was evaluated using different media shapes and processing times. The findings showed that cylindrical media over a 12-h VF process resulted in significant edge rounding, surface smoothing, and a weight reduction of 0.178 g, while triangular media produced a minimal weight change, decreasing from 9.315 to 9.230 g. A significant improvement in surface roughness (Ra) was observed, with up to a 90% reduction, reaching a minimum Ra value of 0.95 μm. Additionally, microhardness improved by 8.1%, reaching 225 HV. The best corrosion resistance was achieved using triangular media, where the corrosion rate dropped from 82.5 µm/year to 7.45 µm/year after 12 h of VF. The study concludes that prolonged VF treatments, especially with cylindrical media, effectively enhance the surface integrity and corrosion resistance of SLM-produced stainless steel 316L components.
Comparison of Functional Electrical Stimulation Cycle vs. Conservative Rehabilitation on Functional Status and Muscle Features in Stroke Patients
Authors: İbişoğlu Zeynep Şafak , Kilinc Serdar
Published: January 2025

Background

Functional Electrical Stimulation (FES) Cycle is used in the rehabilitation of stroke.

Objective

The aim of this study is to investigate the effects of CR and FES cycle therapy on the functional status and muscle features in stroke patients

Methods

The 1st Group(n = 15) received only CR for 6 weeks, and the 2nd Group(n = 15) received FES cycle 3 days a week for 4 weeks in addition to the CR treatment. Brunnstrom recovery staging(BRS), Fugl-Meyer lower extremity evaluation(FME); Berg Balance Scale(BBS), Functional Ambulation Classification(FAC), Barthel Index(BI), Fatigue Severity Scale(FSS), 6 min walk test(6mWT), knee extensor and knee flexor muscle strengths(KEMS, KFMS) in both groups were assessed before and after treatment(6th week). Pennate angle(PA) and rectus femoris muscle thickness(RFT) were measured.

Results

Significant improvement was detected in BBS, FAS, BI, FME, 6mWT, KEMS, RFT scores after intra-group treatment compared to before treatment in both groups. Only the 2nd Group showed a significant difference in KFMS, FSS, BRS lower extremity, PA values after treatment compared to before. No significant superiority of the groups over each other was detected.

Conclusions

CR and FES Cycle contribute to the improvement of the functional status of the patients, but their superiority over each other was not observed.
One Size Does Not Fit All: Mechanisms of Employees’ Acceptance of Robotic Lower-Level Managers
Authors: Wolf Franziska D. , Stock-Homburg Ruth M.
Published: January 2025

Organizations are facing fundamental changes in digitized work environments. These changes include the introduction of android and humanoid social robots designed to assist employees. The current research addresses whether and under what conditions employees accept such robots as lower-level managers, not just as assistants. The authors extend research on social robots with the expectation-disconfirmation paradigm. They examine how the interplay of expected and experienced performance-related and relational characteristics of robot-supervisors affect employees’ willingness to work with the robotic manager. Results from an online experiment with 7061 U.S. office workers reveal different effects for perceived performance-related and relational characteristics of a robot manager. For performance-related characteristics, employees’ willingness to work with robot managers follows an S-shaped pattern. A slight overfulfillment of expectations is associated with the highest levels of readiness. For relational characteristics, the results instead follow a degressive curve. Increasing positive experiences are associated with decreasing positive evaluations of willingness. Overall, employees indicate a preference for android robots over humanoid robots as managers. This research thus suggests tactics for the successful implementation of mixed human-robot teams and the effective introduction of social robots into lower-level management roles.
Where in the World? Creating a Map Application to Support Nursing Students
Authors: Montgomery Keden , Davis Monica , Biles Jessica
Published: January 2025

Background: Successful completion of professional experience placement is a key factor for student progress through pre-licensure nursing programmes and subsequent registration as a nurse. Professional experience placement can be a time when students feel the impact of intersectional challenges, and is a point in which attrition occurs. A regional university partnered with their spatial analysis unit to create a customised, interactive, digital map application to support students undertaking professional experience placement. Purpose: This research aimed to identify whether a custom-designed digital map application reduced student self-perceived stress, promoted ongoing connection with theoretical learning, and facilitated more reliable access to internet technology during professional experience placement. Methods: An online survey using homogenous purposive sampling was used to gather data. Quantitative analysis used the Exact Wilcoxon-Pratt Signed Rank Test and the Kruskal-Wallis Rank Sum Test to further analyse the data in accordance with specific demographics. Conclusions: Difference between pre- and post-intervention response rates was suggestive, indicating that the map application contributed to improving students’ experience in two key areas: self-reported personal, financial, and family stress; and ongoing connection with theoretical learning using technology while undertaking professional experience placement. Implications for Practice: This research evidences one way in which universities can support students during professional experience placement, opening opportunities for other disciplines who use work-integrated learning opportunities to explore the impact a customised digital map application may have on student experiences.
The association between dual sensory impairment and dementia: A systematic review and meta-analysis
Authors: Yoshida Yuto , Hiratsuka Yoshimune , Umeya Reiko , Ono Koichi , Nakao Shintaro
Published: January 2025

Background

Sensory impairments have been linked to dementia. However, the impact of dual sensory impairment (DSI), combining both vision impairment and hearing impairment, on dementia has shown inconsistent results.

Objective

To systematically review the evidence on the association DSI and dementia.

Methods

A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library databases. Included studies were prospective or retrospective cohort studies and a case-control study. The primary outcome was the onset of dementia or its various subtypes, including Alzheimer's disease (AD) and vascular dementia (VaD). Effect sizes, including hazard ratios (HRs), were pooled through a random-effects model.

Results

A total of 11 observational studies with 346,659 participants were included. DSI was significantly associated with the incidence of dementia compared to no sensory impairment (9 studies; HR: 1.46; 95% confidence interval [CI]: 1.29–1.65). Among subtypes of dementia, DSI was associated with AD onset (4 studies; HR: 2.07; 95% CI: 1.45–2.94); however, this association was not found in VaD (2 studies; HR: 1.65; 95% CI: 0.96–2.85).

Conclusions

These findings suggest that DSI is significantly associated with an increased risk of dementia. Further research is required to identify preventive strategies to decrease the incidence of dementia in individuals with sensory impairment.
Shielding properties of hybrid knitted fabrics: reflection and absorption
Authors: Arabuli Svitlana , Arabuli Arsenii , Kyzymchuk Olena , Tunakova Veronika , Bajzik Vladimir , Halavska Liudmyla
Published: January 2025

Last decade a lot of research was done in the development and investigation of textile-based shielding materials against electromagnetic radiation. Still, there is a gap in understanding the effect of knitted structure (i.e., stitch type and shape) on shielding effectiveness by different shielding mechanisms: reflection and absorption. Seven knitted fabrics were produced on 8-gauge flat knitting machines, using 0.12 mm diameter stainless steel (SS) wire and 30 x 2 tex cotton yarn. The fabrics differ by the method of incorporation of conductive element (SS wire) into the knitted structure: separately and simultaneously with cotton yarn and used interloopings. The effect of stitch type (loop, float, or tuck) was studied as well. It was found that both the method of SS wire incorporation and the shape of its positioning in the knitted structure affect the EMR shielding effectiveness while only the method of SS wire incorporation determines the shielding mechanism: absorption or reflection. The half Milano rib knitted structures demonstrate the best shielding efficiency due to the additional floats behind held loops.
Investigating leadership attributes and strategies during times of crisis and educational change: A story of public primary school principals in Lombok, Indonesia
Authors: Mazhabi Zobi
Published: January 2025

This research aims to investigate the attributes of school principals and how the principals of public primary schools in rural areas in Lombok, West Nusa Tenggara, Indonesia, demonstrated effective leadership strategies at their respective schools during times of crisis and educational change. This study is based on the stories of school principals’ encounters with challenges during a crisis situation and educational change. The research used a qualitative methodology, namely narrative inquiry, involving four principals from public primary schools in Pringgarata District, Central Lombok, West Nusa Tenggara, Indonesia. Data were gathered via semi-structured and in-depth interviews with the participants, conducted either online or in person. The interview data were transcribed manually and then evaluated thematically through a six-step approach. The study found that the school principals attributes are seizing opportunity to learn, openness, collaboration, and inclusivity; driving innovation; meanwhile, the effective strategies that were demonstrated are intra-school and inter-school leadership strategies. The intra-school strategy includes promoting sustainability, maintaining an efficient educational model for the students, employing a home visit program, and distributing leadership responsibilities among school members. The inter-school strategy involves sharing experiences and resources with others, adapting indigenous perspectives, facilitating connections, and establishing strategic partnerships with the local community.
Cooling down AI regulation controversies: Three closure processes in the Chilean legislative arena
Authors: Humeres Mónica , Cotoras Dusan , Moretti Renato , Oyarzún-Merino Iñaki , Correa Teresa , López Claudia
Published: January 2025

According to social studies of artificial intelligence (AI), public AI controversies tend to dissipate relatively quickly despite well-documented risks and harms. The reasons for this lack of controversiality are beginning to be studied. Drawing on the framework of sociotechnical controversies, we analyze the de-escalation of contentious discussions observed in the AI legislative process by Chile's National Congress. Utilizing a qualitative approach, we tracked the deliberations hosted by the Chamber of Deputies and the Senate of Chile across 51 sessions between 2023 and 2024. We describe three processes of cooling down in the AI debates: (1) deflection of technology liability, (2) instrumentalization of technology policy, and (3) moralization of technology use. However, constructive exchanges appear in some circumstances, which allow us to foresee some favorable conditions for participation in the debates on AI regulation. This paper contributes to AI controversy studies by outlining cooling-down processes and conditions that foster dialogue and providing a critical perspective on the formation of AI regulation.
Artificial Intelligence for Cervical Spine Fracture Detection: A Systematic Review of Diagnostic Performance and Clinical Potential
Authors: Liawrungrueang Wongthawat , Cholamjiak Watcharaporn , Promsri Arunee , Jitpakdee Khanathip , Sunpaweravong Sompoom , Kotheeranurak Vit , Sarasombath Peem
Published: January 2025

Study Design

Systematic review.

Objective

Artificial intelligence (AI) and deep learning (DL) models have recently emerged as tools to improve fracture detection, mainly through imaging modalities such as computed tomography (CT) and radiographs. This systematic review evaluates the diagnostic performance of AI and DL models in detecting cervical spine fractures and assesses their potential role in clinical practice.

Methods

A systematic search of PubMed/Medline, Embase, Scopus, and Web of Science was conducted for studies published between January 2000 and July 2024. Studies that evaluated AI models for cervical spine fracture detection were included. Diagnostic performance metrics were extracted and included sensitivity, specificity, accuracy, and area under the curve. The PROBAST tool assessed bias, and PRISMA criteria were used for study selection and reporting.

Results

Eleven studies published between 2021 and 2024 were included in the review. AI models demonstrated variable performance, with sensitivity ranging from 54.9% to 100% and specificity from 72% to 98.6%. Models applied to CT imaging generally outperformed those applied to radiographs, with convolutional neural networks (CNN) and advanced architectures such as MobileNetV2 and Vision Transformer (ViT) achieving the highest accuracy. However, most studies lacked external validation, raising concerns about the generalizability of their findings.

Conclusions

AI and DL models show significant potential in improving fracture detection, particularly in CT imaging. While these models offer high diagnostic accuracy, further validation and refinement are necessary before they can be widely integrated into clinical practice. AI should complement, rather than replace, human expertise in diagnostic workflows.
Therapeutic alliance during trauma focused treatment in adolescent and young adult patients with PTSD
Authors: Grass Anne , Rosner Rita , Ciner Angelina , Renneberg Babette , Steil Regina
Published: January 2025

Background

Greater therapeutic alliance has been associated with an improved treatment outcome in various clinical populations. However, there is a lack of evidence for this association in posttraumatic stress disorder (PTSD) in young patients. We therefore investigated the development of the therapeutic alliance during Developmentally adapted cognitive processing therapy (D-CPT) in adolescents and young adults with PTSD following abuse to answer the question whether there was a connection between the therapeutic alliance and symptom reduction.

Methods

Weekly assessments of therapeutic alliance, rated by patients and their therapists, as well as PTSD symptom severity from a randomized controlled trial (RCT) of D-CPT were analyzed with multilevel modelling. The sample consisted of n = 39 patients aged 14–21 with a history of sexual and/or physical abuse.

Results

Therapeutic alliance increased during D-CPT. The ratings of the therapeutic alliance by patients and therapists were strongly correlated (r = .512, p < .01); however, at session level, there was a significant difference between the patients’ and their therapists’ alliance assessments. Patients with a higher perceived therapeutic alliance showed a greater reduction in self-reported symptoms over the course of therapy, compared to patients with lower alliance ratings. However, this only applied to the therapeutic alliance assessed by the patients.

Discussion

The therapeutic alliance plays a crucial role in D-CPT with young patients, contributing to a reduction in symptom severity over the course of treatment. It is essential that therapists prioritize the development of a strong alliance and seek feedback from their patients. The results suggest that patients’ perceptions, which often differ from therapists’ assessments, were more important in determining treatment success in the sample. Studies with larger samples sizes and additional independent ratings of alliance are needed to further examine the alliance-outcome link.

Trial registration

The trial was registered at the German Clinical Trial Registry, DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787.
Time-dependent, patient-centered perceptions of quality measures for total joint arthroplasty: a cross-sectional, choice modeling study
Authors: Lemos Jacie L. , Welch Jessica M. , Amanatullah Derek F. , Shapiro Lauren M. , Harris Alex H. S. , Kamal Robin N.
Published: January 2025

Background

As value-based care arrangements continue to assess quality of care and costs, comprehensive and patient-centered definitions of quality of care are required. While patient-reported outcome measures are increasingly integrated into quality assessments following total joint arthroplasty (TJA), patient perceptions of quality paired with the phase of surgical care has not been described. The purpose of this study was to assess how TJA patients perceive measures of quality of care and assess if these perceptions change based on the phase of care.

Methods

Patients who had undergone a TJA within the past two years or had a scheduled TJA within the next 6 months completed a questionnaire designed using best-worst scaling, a method used to measure individuals’ priorities by asking participants to make repeated selections of the best and worst items in a series of subsets of items. Subanalyses were calculated to compare each phase of care (preoperative, short term postoperative, and long term postoperative).

Results

A total of 153 patients completed the questionnaire; 36 were preoperative, 55 were short term postoperative, and 62 were long term postoperative. Patients placed the highest value on improving activities of daily living (β = 1.03, CI = 0.90-1.16), decreasing pain (β = 0.65, CI = 0.53-0.76), and avoiding re-intervention (β = 0.64, CI = 0.52-0.76). Decreasing pain ranked as a higher priority preoperatively compared to short term postoperatively, and subsequently increased in priority again after 6 months. Avoiding reintervention was less important to patients preoperatively compared to postoperatively. Avoiding complications was more important to patients preoperatively compared to postoperatively.

Conclusions

Matching outcome assessments with how patients assess their quality of care throughout the TJA recovery process can inform phase-specific quality improvement initiatives and value definitions. Activities of daily living should be measured across phases of care and into long-term recovery. TJA value dashboards should align with these patient-driven perceptions of quality.

Level of evidence

Level III, cohort study.
The potential of a population register for addressing health inequities: an observational study using data linkage to improve breast cancer screening enrolment and participation in Indigenous Māori women in Aotearoa New Zealand
Authors: Aye Phyu Sin , Bartholomew Karen , Walsh Michael , Pritchard Kathy , Pierce Maree , Richards Jenny , Chambers Erin , Haggie Aroha , Solomon Jesse , Lord Gabrielle , Soloai Tiffany , Symons Lorraine , Tipene Roimata , Jansen Rawiri McKree
Published: January 2025

Background

Breast cancer screening in Aotearoa New Zealand (NZ) still has persistent inequitable coverage by ethnicity, especially for Indigenous Māori women. This project aimed to undertake systematic data linkage to identify and invite eligible Māori women to participate in breast screening.

Methods

This is a cross-sectional observational study conducted in Northern New Zealand between 1/01/2020 and 30/06/2021. The BreastScreen Aotearoa (BSA) register was linked with the primary care data to identify and invite eligible Māori women (aged 45–69 years) to breast screening, who were not currently enrolled in BSA, and who were enrolled in BSA but had not been screened or overdue for breast screening. Invitations were sent through invitation letters, text messages and phone calls. Enrolment to BSA and screening participation at 15 and 18 months from the project’s start date were reported.

Results

Through the data linkage, 2295 women who were not enrolled in BSA were identified eligible for breast screening. Approximately half (n = 1086) of the women were contactable within 5 contact attempts. Of these contactable, 345 (32%) women were enrolled in BSA, 421 (39%) were screened at 15 months, increasing to 441 (41%) at 18 months from the project start. Among women who were previously enrolled but never screened or overdue for screening, 1470 women were eligible. Their contact details were updated through the data linkage, which facilitated BSA to contact them successfully for breast screening. Consequently, 305 (21%) of these eligible were screened at 15 months, and increased to 332 (23%) at 18 months.

Conclusions

The data linkage approach has evidenced the benefit of a population register to facilitate equitable access to breast screening services. Further work is needed on choices of combined approaches for optimising screening uptake equitably.
Co-creation of a gender responsive TB intervention in Nigeria: a researcher-led collaborative study
Authors: Ugwu Chukwuebuka , Adekeye Oluwatoyosi , Ringwald Beate , Thomson Rachael , Chijioke-Akaniro Obioma , Anyaike Chukwuma , Squire S Bertel , Bimba John , Wingfield Tom
Published: January 2025

Background

In Nigeria, men constitute over half of the people notified with tuberculosis (TB), experience longer delays before reaching care, and are estimated to account for two thirds of people who miss out on care. The higher TB risk and burden in men has implications for the whole population and reaching them earlier with TB services will reduce onward transmission in households, communities, and workplaces. The absence of a comprehensive guidance and the lack of substantial empirical evidence on TB care approaches that are responsive to the needs of men in Nigeria exacerbates this problem. Therefore, this research aimed to co-create a gender-responsive intervention for men in peri-urban communities in Nigeria.

Methods

Our study utilised a researcher-led collaborative approach to engage local TB stakeholders including communities adversely affected by the disease to co-create a gender-responsive TB intervention. Between March and November 2022, we engaged 13 local TB stakeholders in a three-phase participatory intervention design process. This engagement involved two iterative cycles of Delphi research online, and an in-person workshop. In the first and second phases, participants described the potential impact of 15 listed interventions and prioritised combinations of nine interventions deemed to be effective in overcoming identified gendered barriers. Responses were analysed using a combination of qualitative framework approach, content analysis, and summary descriptive statistics assisted by NVivo software. Stakeholder consensus on a preferred intervention package was reached during the participatory workshop.

Results

Overall, participants prioritised approaches that sought to actively find and systematically screen men for TB including awareness creation as a crucial component. The stakeholders placed significant considerations on the synergy between interventions and their programmatic sustainability when making their final choices. Consequently, a complex intervention package comprising three components was developed. These included targeted awareness creation among men in communities; TB screening in male-dominated socio-cultural congregate settings; and the use of digital chest X-ray screening. Anticipated early outputs of this intervention included improved TB knowledge, increased care-seeking, reduced TB-related costs and TB stigma, and accelerated early diagnosis among men in Nigeria.

Conclusion

Leveraging the insights and experiences of local stakeholders through iterative engagements yielded consensus on a viable gender-responsive TB intervention.
Triglyceride-glucose index: carotid intima-media thickness and cardiovascular risk in a European population
Authors: Pavanello Chiara , Ruscica Massimiliano , Castiglione Sofia , Mombelli Giuliana Germana , Alberti Antonia , Calabresi Laura , Sirtori Cesare Riccardo
Published: January 2025

Background

The triglyceride-glucose (TyG) index is now widely recognized as a marker of insulin resistance and has been linked to the development and prognosis of atherosclerotic cardiovascular diseases (ASCVD) in numerous populations, particularly in the Eastern world. Although there are fewer reports from the Western world, and they are sometimes contradictory, the absence of definitive data on the relationship between a raised TyG index and cardiovascular risk suggested the opportunity of testing this biochemical marker against a well-established vascular marker such as the carotid intima media thickness (c-IMT).

Methods

Primary prevention patients were selected from a cohort of individuals who underwent c-IMT measurement between 1984 and 2018 at the Dyslipidemia Center at the ASST Grande Ospedale Metropolitano Niguarda in Milan, Italy. The TyG index was calculated as the Ln [fasting TG (mg/dL)×fasting glucose (mg/dL)/2]. Carotid ultrasonography was performed using echographic measurements of the far walls of the left and right common, internal carotids, and bifurcations. Patients were followed for up to 20 years with periodic evaluation of biochemical parameters. ASCVD events were monitored through hospital records, where all patients were regularly examined.

Results

The analysis included 3108 individuals with a mean age of 54.9 ± 13.1 years. Participants were generally non-obese, with an average BMI of 24.6 ± 3.5 Kg/m2. Among the women, 83.1% were postmenopausal. The mean TyG index was 8.65 ± 0.59. There was a significant association between the TyG index and all c-IMT measurements. Those in the highest TyG index quartiles had significantly higher IMTmean and IMTmax compared to those in the lower quartiles. These associations were consistent across all vascular sites examined and remained significant after adjusting for all potential confounders. Kaplan-Meier survival analysis revealed an increased incidence of ASCVD events in the two highest TyG index quartiles.

Conclusions

TyG index is a sensitive marker of risk in a European population with moderate ASCVD risk, as assessed by c-IMT measurements, in a large cohort of Lipid Clinic patients.
Uncovering the genetic basis of antiviral polyketide limocrocin biosynthesis through heterologous expression
Authors: Melnyk Sofiia , Stierhof Marc , Bratiichuk Dmytro , Fries Franziska , Müller Rolf , Rebets Yuriy , Luzhetskyy Andriy , Ostash Bohdan
Published: January 2025

Background

Streptomyces roseochromogenes NRRL 3504 produces clorobiocin, an aminocoumarin antibiotic that inhibits DNA replication. No other natural products have been isolated from this bacterium so far, despite the presence of a rich repertoire of specialized metabolite biosynthesis gene clusters (smBGCs) within its genome. Heterologous expression of smBGCs in suitable chassis speeds up the discovery of the natural products hidden behind these sets of genes.

Results

In this work we focus on one intriguing smBGC of NRRL 3504 bearing some similarity to gene clusters involved in production of manumycin family polyketides. Through heterologous expression in Streptomyces chassis strains S. albus Del14 and S. lividans ΔYA9, this smBGC (hereafter referred to as lim BGC) was shown to direct the production of unusual polyketide limocrocin (LIM) known for its ability to interfere with viral reverse transcriptases. The organization of lim BGC, data on the structures of revealed metabolites as well as manipulations of lim genes allowed us to put forward an initial hypothesis about a biosynthetic pathway leading to LIM. We provide initial data on two LIM derivatives as well as updated NMR spectra for the main product.

Conclusion

This study reveals the genetic control of biosynthesis of LIM that remained hidden for the last 70 years. This, in turn, opens the door to biological routes towards overproduction of LIM as well as generation of its derivatives.
Klebsiella pneumoniae-derived extracellular vesicles impair endothelial function by inhibiting SIRT1
Authors: Li Xinxin , Cui Jinghua , Ding Zanbo , Tian Ziyan , Kong Yiming , Li Linghai , Liu Yang , Zhao Wen , Chen Xueying , Guo Han , Cui Zhengshuo , Li Xinwei , Yuan Jing , Zhang Huina
Published: January 2025

Background

The potential role of Klebsiella pneumoniae (K.pn) in hypertension development has been emphasized, although the specific mechanisms have not been well understood. Bacterial extracellular vesicles (BEVs) released by Gram-negative bacteria modulate host cell functions by delivering bacterial components to host cells. Endothelial dysfunction is an important early event in the pathogenesis of hypertension, yet the impact of K.pn-secreted EVs (K.pn EVs) on endothelial function remains unclear. This study aimed to investigate the effects of K.pn EVs on endothelial function and to elucidate the underlying mechanisms.

Methods

K.pn EVs were purified from the bacterial suspension using ultracentrifugation and characterized by transmission electron microscopy nanoparticle tracking analysis, and EV marker expression. Endothelium-dependent relaxation was measured using a wire myograph after in vivo or ex vivo treatment with K.pn EVs. Superoxide anion production was measured by confocal microscopy and HUVEC senescence was assessed by SA-β-gal activity. SIRT1 overexpression or activator was utilized to investigate the underlying mechanisms.

Results

Our data showed that K.pn significantly impaired acetylcholine-induced endothelium-dependent relaxation and increased superoxide anion production in endothelial cells in vivo. Similarly, in vivo and ex vivo studies showed that K.pn EVs caused significant endothelial dysfunction, endothelial provocation, and increased blood pressure. Further examination revealed that K.pn EVs reduced the levels of SIRT1 and p-eNOS and increased the levels of NOX2, COX-2, ET-1, and p53 in endothelial cells. Notably, overexpression or activation of SIRT1 attenuated the adverse effects and protein changes induced by K.pn EVs on endothelial cells.

Conclusion

This study reveals a novel role of K.pn EVs in endothelial dysfunction and dissects the relevant mechanism involved in this process, which will help to establish a comprehensive understanding of K.pn EVs in endothelial dysfunction and hypertension from a new scope.