bluuebunny/crossref_metadata_2025 huggingface dataset:
Epipericardial fat necrosis and COVID-19
Authors: Haseeb Mohsin , Shafiq Abdullah , Sheikh Muhammad A. , Khan Muhammad F.
Published: February 2024

Background: Epipericardial fat necrosis (EFN) is a rare and self-limiting cause of acute chest pain. We describe a case of EFN in a patient with a recent coronavirus disease (COVID-19). Case Presentation: A 55-year-old male presented with a sudden onset of left-sided pleuritic chest pain for the past two days. The patient was diaphoretic, tachypneic, and tachycardic. Acute coronary syndrome was ruled out. A computed tomography (CT) pulmonary angiogram revealed an ovoid encapsulated fatty mass surrounded by dense appearing tissue. Patient symptoms improved remarkably with a short course of non-steroidal anti-inflammatory drugs (NSAIDs). Discussion: EFN typically presents with a sudden onset of excruciating chest pain. Misdiagnosis, under-diagnosis, and mismanagement are unavoidable. EFN is incidentally diagnosed on CT scan. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects visceral adipose tissue and appears to increase the risk of EFN by promoting inflammatory cytokine production and death of adipocytes. Conclusion: EFN is a rare cause of acute chest pain. SARS-CoV-2 is likely to induce EFN. This rare clinical entity should be considered in the differential of acute chest pain especially in patients with active or recent COVID-19.
Working with vulnerable women
Authors: Belshaw Sharon
Published: February 2024

Sharon Belshaw explores a charity's work to support those who have experienced childhood sexual trauma, and how abuse trauma may affect women's experiences of pregnancy
Simulation in midwifery: the role of motivation in designing an undergraduate experience
Authors: Stockdale Janine , Lawther Lorna , Gillespie Mary , Hughes Clare , Murray Rebecca , Cordner Debbie , Anderson Gail , Rice Billie Joan
Published: February 2024

Simulated learning is gaining momentum in midwifery education. Evidence shows that it offers multiple benefits for students, including improved decision making, empathy and interdisciplinary teamworking. Motivational theory can be used to design implementation of simulation at a curriculum level, which is an ongoing process of identifying and implementing appropriate design actions. Using motivational theory as a guide enables relevant actions to be identified for the implementation of simulated learning in midwifery, while also providing a theoretical basis for evaluating the impact of simulated learning in a midwifery curriculum. When implementing simulation, it is important to establish an expert working group, responsible for discussing the appropriate application of motivational learning theories when developing the key design actions. The aim of this article is to share how three main design actions were developed by a simulation expert working group, drawing on key motivational learning theories.
Mental health and the healthcare sector
Authors: Bernstein Adam
Published: February 2024

Mental health issues are as prevalent in healthcare as any other industry. In this article, Adam Bernstein discusses the challenges that mental health issues can pose to employers, and their duty to make reasonable adjustments to accomodate them
Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism
Authors: Majic Tengg Ana , Cigrovski Berkovic Maja , Zajc Ivan , Salaric Ivan , Müller Danko , Markota Iva
Published: February 2024

Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.
Investigating the causal associations between five anthropometric indicators and nonalcoholic fatty liver disease: Mendelian randomization study
Authors: Xiao Xian-Pei , Dai Yong-Jun , Zhang Yu , Yang Meng , Xie Jian , Chen Guo , Yang Zheng-Jun
Published: February 2024

BACKGROUND

Although the etiology of nonalcoholic fatty liver disease (NAFLD) has not been thoroughly understood, the emerging roles of anthropometric indicators in assessing and predicting the risk of NAFLD have been highlighted by accumulating evidence.

AIM

To evaluate the causal relationships between five anthropometric indicators and NAFLD employing Mendelian randomization (MR) design.

METHODS

The Anthropometric Consortium provided genetic exposure data for five anthropometric indicators, including hip circumference (HC), waist circumference (WC), waist-to-hip ratio (WHR), body mass index (BMI), and body fat percentage (BF). Genetic outcome data for NAFLD were obtained from the United Kingdom Biobank and FinnGen Consortium. Genome-wide significant single nucleotide polymorphisms were chosen as instrumental variables. Univariable MR (UVMR) and multivariable MR (MVMR) designs with analytical approaches, including inverse variance weighted (IVW), MR-Egger, weighted median (WM), and weighted mode methods, were used to assess the causal relationships between anthropometric indicators and NAFLD.

RESULTS

Causal relationships were revealed by UVMR, indicating that a higher risk of NAFLD was associated with a per-unit increase in WC [IVW: odds ratio (OR) = 2.67, 95%CI: 1.42-5.02, P = 2.25 × 10−3], and BF was causally associated with an increased risk of NAFLD (WM: OR = 2.23, 95%CI: 1.07-4.66, P = 0.033). The presence of causal effects of WC on the decreased risk of NAFLD was supported by MVMR after adjusting for BMI and smoking. However, no causal association between BF and NAFLD was observed. In addition, other causal relationships of HC, WHR (BMI adjusted), and BMI with the risk of NAFLD were not retained after FDR correction.

CONCLUSION

This study establishes a causal relationship, indicating that an increase in WC is associated with a higher risk of NAFLD. This demonstrates that a suitable decrease in WC is advantageous for preventing NAFLD.
Efficacy of borneol-gypsum in skin regeneration and pain control in toxic epidermal necrolysis: A case report
Authors: Yang Lu-Wei , Zhang Li-Juan , Zhou Bin-Bin , Lin Xin-Yu , Chen Yu-Ting , Qin Xiao-Yu , Tian Hui-Ying , Ma Li-Li , Sun Ying , Jiang Lin-Di
Published: February 2024

BACKGROUND

Toxic epidermal necrolysis (TEN) is a life-threatening dermatological emergency mainly induced by drug hypersensitivity reactions. Standard management includes discontinuation of culprit drug and application of immunomodulatory therapy. However, mortality remains high due to complications like septic shock and multiorgan failures. Innovative approaches for skin care are crucial. This report introduces borneol-gypsum, a traditional Chinese drug but a novel dressing serving as an adjuvant of TEN therapy, might significantly improve skin conditions and patient outcomes in TEN.

CASE SUMMARY

A 38-year-old woman diagnosed with eosinophilic granulomatosis with polyangiitis experienced gangrenous complications and motor nerve involvement. After initial treatment of high-dose corticosteroids and cyclophosphamide, symptom of foot drop improved, absolute eosinophil counts decreased, while limb pain sustained. Duloxetine was added to alleviate her symptom. Subsequently, TEN developed. Additional topical application of borneol-gypsum dressing not only protected the skin lesions from infection but also significantly eased localized pain. This approach demonstrated its merit in TEN management by promoting skin healing and potentially reducing infection risks.

CONCLUSION

Borneol-gypsum dressing is a promising adjuvant that could significantly improve TEN management, skin regeneration, and patient comfort.
Heterochronous multiple primary prostate cancer and lymphoma: A case report
Authors: Liang Jin-Long , Bu Yu-Qing , Peng Li-Li , Zhang Hong-Zhen
Published: February 2024

BACKGROUND

Multiple primary malignant tumors (MPMTs) are rare type of cancer, especially when solid tumors are the first and lymphoma is the second primary malignancy. We report a patient with heterochronous MPMTs consisting of prostate cancer and rectal diffuse large B-cell lymphoma (DLBCL).

CASE SUMMARY

We report a 77-year-old male patient diagnosed with prostate cancer who was treated with radiation therapy and one year of endocrine therapy with bicalutamide (50 mg per day) and an extended-release implant of goserelin (1/28 d). Seven years later, rectal DLBCL with lung metastases was found.

CONCLUSION

Although rare, the possibility of prostate cancer combined with a double primary cancer of DLBCL can provide a deeper understanding.
Ethnomedicinal and Phytochemical Studies of Eclipta alba (A Review)
Authors: Goya Srishti , Mani Munesh , Kumar Prevesh
Published: February 2024

Traditional plants have tremendous benefits for many ailments and illnesses that are typically inexpensive and side-effect-free. We highlight in this review comparatively extensive data on the ethnomedicinal applications, phytochemistry, pharmacology, and toxicity of Eclipta alba. The scientific data was gathered from books and online bibliographic sources like PubMed, Google Scholar, SciFinder, and Scopus. The phytochemical analysis of this plant has afforded an important category of natural products such as coumestans, terpenoids, alkaloids, volatile oils, flavonoids, and thiopenes. According to reports, coumestans are the most often used components among them. Potential pharmacological effects, including wound healing, diabetes, obesity, antioxidants, cancer, hair growth, and neuroprotective properties, have been reported for the extracted crude extract and independent component. Subsequent research ought to concentrate on in-depth mechanism-based investigations using clinical trials and animal models.
A pH Responsive and Selective Complex Formation analysis of Catechol Based Dipodal Chelator ligand N1,N3-bis(2-(((Z)-2,3-dihydroxybenzylidene)amino)ethyl) malonamide with Trivalent Metal Ions
Authors: Amardeep Amardeep , Dangi Vijay , Kumar Pramod , Meenakshi Meenakshi , Baral Minati , Arya Brahamdutt , Sheoran Taruna
Published: February 2024

In the present study, we have explored the binding abilities of powerful dipodal chelator ligand N1,N3-bis(2-(((Z)-2,3-dihydroxybenzylidene)amino)ethyl)malonamide (MEC) to trivalent metal ions. We have investigated the coordination behavior of the dipodal ligand MEC with the trivalent metal ions Al3+, Fe3+, and Cr3+ in aqueous media ranging from pH 2 to 11, employing potentiometry and spectrophotometry techniques. Results shows the higher binding ability of Cr+3 metal ion among all metal ions with largest formation constant value, log β = 28.56.
Acompañando las emociones en familia. Percepciones del estudiantado universitario sobre un proyecto de aprendizaje-servicio virtual desarrollado en Perú
Authors: Méndez-Cañón María , Ornellas-Rios-da-Silva Adriana
Published: February 2024

El aprendizaje-servicio virtual (ApSv) es una innovación pedagógica del aprendizaje servicio que integra las tecnologías digitales. En los últimos años, como consecuencia de la expansión de las tecnologías y la docencia remota de emergencia, se ha observado un aumento de estas experiencias en la educación superior. Sin embargo, la literatura científica muestra que sus posibilidades todavía se encuentran en proceso de investigación. En concreto, en Perú, el contexto de la investigación, la evidencia sobre experiencias de ApSv en la universidad es escasa. En este sentido, el objetivo del presente trabajo fue analizar las percepciones de un grupo de estudiantes sobre una experiencia de ApSv. Para ello, se planteó un estudio exploratorio de caso, utilizando un diseño de métodos mixtos. Se recolectaron los datos utilizando un cuestionario diseñado ad hoc con el fin de recoger las percepciones y valoraciones del proyecto. Se analizaron los datos cuantitativos utilizando estadística descriptiva básica, y se realizó un análisis de contenido para extraer los datos cualitativos. Los resultados muestran que la metodología ApSv es valorada positivamente, y se percibe como una herramienta para desarrollar las competencias curriculares y transversales. No obstante, coinciden en que se deben buscar estrategias digitales que incrementen la participación por parte de las personas usuarias del servicio.
Colonial City, Global Entanglements: Intra-and Trans-Imperial Networks in George Town, 1786–1937
Authors: Keo Bernard Z.
Published: February 2024

Abstract: The city of George Town, Penang has always been enmeshed in complex circulations of trade, people, and ideas. By the end of the nineteenth century, George Town developed a multicultural and polyglot society that included a kaleidoscopic mix of ethnic groups. This article investigates the role played by George Town’s cosmopolitan population in developing the port-city into a global hub for commercial, intellectual, and physical interchange. In particular, this article argues that the city’s success depended on intricate webs of personal and professional connections developed by George Town’s residents across Southeast Asia and beyond. It hones in on how one community, the Peranakan Chinese, built and leveraged networks across the British, Dutch, and Japanese Empires. By exploring these intra-and trans-imperial networks, this article makes the case for studying colonial cities like George Town not as passive nodes of empire but as active sites within overlapping imperial networks.
The Launch of a Political Satellite: Constructing the Ming Tombs Reservoir and "Mass Engineering" in Communist China
Authors: Ge Yejing , Xiong Weimin
Published: February 2024

abstract: Archives and oral histories show that the Ming Tombs Reservoir was a showcase project in Communist China directed by and involving the country's top leaders. This was one of the first projects to rely on the mobilization of physical labor rather than specialized machinery, driven by a belief in self-reliance and the use of local resources. It argues that the focus on the "masses," rather than engineers or scientists, challenged established engineering procedures and technical traditions. Historical evidence suggests that adopting a "build while being designed" mindset and mobilizing the "masses," projects could be completed, but often in ways that ultimately proved less than optimal. The case study suggests that innovations fail when local enthusiasm and technical knowledge are not balanced. By focusing on the role of the "masses" in shaping a novel technological landscape, this article highlights "mass engineering" to better understand this model of native innovations and economic autarky.
Fixing the Huai River: Technology of Labor Formation in Maoist China, 1950–53
Authors: Li Yujie
Published: February 2024

abstract: This article contributes to the large-scale engineering scholarship by revealing the labor practices involved and the state's role in shaping them. It provides a history of labor formation through earthwork technology in China's 1950s Huai River Control Project. The Communist Party's approach to engineering and labor differed from its Nationalist predecessor's. The party mobilized millions of peasants to dig and move an astronomical amount of soil in a few years. This herculean feat was made possible by promoting "work methods" to encourage peasants' self-Taylorization. The campaign aimed to cultivate a habit to work efficiently in mass-scale collaboration under external instructions. Through promoting work methods, state-appointed cadres assumed a tutelage role that allowed them to replace labor foremen. A hierarchical cadre-laborer relationship emerged from the same labor process that changed the nation's landscape.
Nuclear Imaginaries and Power in Oppenheimer
Authors: Slaughter Aimee
Published: February 2024

abstract: Christopher Nolan's Oppenheimer is in awe of physics and the power it can bestow. Its central character is both mythic and human, and the film critiques and constructs the mythology surrounding him. The film presents science and technology as the individualized work of masculine genius, though it is ultimately more interested in nuclear weapons as political objects than as technological ones. Its nuclear imaginaries contain personal anxieties and stunning spectacle but also forget the nuclear uncanny and the human scale of nuclear weapons.
Ebola virus VP35 interacts non-covalently with ubiquitin chains to promote viral replication
Authors: Rodríguez-Salazar Carlos A. , van Tol Sarah , Mailhot Olivier , Gonzalez-Orozco Maria , Galdino Gabriel T. , Warren Abbey N. , Teruel Natalia , Behera Padmanava , Afreen Kazi Sabrina , Zhang Lihong , Juelich Terry L. , Smith Jennifer K. , Zylber María Inés , Freiberg Alexander N. , Najmanovich Rafael J. , Giraldo Maria I. , Rajsbaum Ricardo
Published: February 2024

Ebolavirus (EBOV) belongs to a family of highly pathogenic viruses that cause severe hemorrhagic fever in humans. EBOV replication requires the activity of the viral polymerase complex, which includes the cofactor and Interferon antagonist VP35. We previously showed that the covalent ubiquitination of VP35 promotes virus replication by regulating interactions with the polymerase complex. In addition, VP35 can also interact non-covalently with ubiquitin (Ub); however, the function of this interaction is unknown. Here, we report that VP35 interacts with free (unanchored) K63-linked polyUb chains. Ectopic expression of Isopeptidase T (USP5), which is known to degrade unanchored polyUb chains, reduced VP35 association with Ub and correlated with diminished polymerase activity in a minigenome assay. Using computational methods, we modeled the VP35-Ub non-covalent interacting complex, identified the VP35-Ub interacting surface, and tested mutations to validate the interface. Docking simulations identified chemical compounds that can block VP35-Ub interactions leading to reduced viral polymerase activity. Treatment with the compounds reduced replication of infectious EBOV in cells and in vivo in a mouse model. In conclusion, we identified a novel role of unanchored polyUb in regulating Ebola virus polymerase function and discovered compounds that have promising anti-Ebola virus activity.
Is it selfish to be filamentous in biofilms? Individual-based modeling links microbial growth strategies with morphology using the new and modular iDynoMiCS 2.0
Authors: Cockx Bastiaan J. R. , Foster Tim , Clegg Robert J. , Alden Kieran , Arya Sankalp , Stekel Dov J. , Smets Barth F. , Kreft Jan-Ulrich
Published: February 2024

Microbial communities are found in all habitable environments and often occur in assemblages with self-organized spatial structures developing over time. This complexity can only be understood, predicted, and managed by combining experiments with mathematical modeling. Individual-based models are particularly suited if individual heterogeneity, local interactions, and adaptive behavior are of interest. Here we present the completely overhauled software platform, the individual-based Dynamics of Microbial Communities Simulator, iDynoMiCS 2.0, which enables researchers to specify a range of different models without having to program. Key new features and improvements are: (1) Substantially enhanced ease of use (graphical user interface, editor for model specification, unit conversions, data analysis and visualization and more). (2) Increased performance and scalability enabling simulations of up to 10 million agents in 3D biofilms. (3) Kinetics can be specified with any arithmetic function. (4) Agent properties can be assembled from orthogonal modules for pick and mix flexibility. (5) Force-based mechanical interaction framework enabling attractive forces and non-spherical agent morphologies as an alternative to the shoving algorithm. The new iDynoMiCS 2.0 has undergone intensive testing, from unit tests to a suite of increasingly complex numerical tests and the standard Benchmark 3 based on nitrifying biofilms. A second test case was based on the “biofilms promote altruism” study previously implemented in BacSim because competition outcomes are highly sensitive to the developing spatial structures due to positive feedback between cooperative individuals. We extended this case study by adding morphology to find that (i) filamentous bacteria outcompete spherical bacteria regardless of growth strategy and (ii) non-cooperating filaments outcompete cooperating filaments because filaments can escape the stronger competition between themselves. In conclusion, the new substantially improved iDynoMiCS 2.0 joins a growing number of platforms for individual-based modeling of microbial communities with specific advantages and disadvantages that we discuss, giving users a wider choice.
HormoneBayes: A novel Bayesian framework for the analysis of pulsatile hormone dynamics
Authors: Voliotis Margaritis , Abbara Ali , Prague Julia K. , Veldhuis Johannes D. , Dhillo Waljit S. , Tsaneva-Atanasova Krasimira
Published: February 2024

The hypothalamus is the central regulator of reproductive hormone secretion. Pulsatile secretion of gonadotropin releasing hormone (GnRH) is fundamental to physiological stimulation of the pituitary gland to release luteinizing hormone (LH) and follicle stimulating hormone (FSH). Furthermore, GnRH pulsatility is altered in common reproductive disorders such as polycystic ovary syndrome (PCOS) and hypothalamic amenorrhea (HA). LH is measured routinely in clinical practice using an automated chemiluminescent immunoassay method and is the gold standard surrogate marker of GnRH. LH can be measured at frequent intervals (e.g., 10 minutely) to assess GnRH/LH pulsatility. However, this is rarely done in clinical practice because it is resource intensive, and there is no open-access, graphical interface software for computational analysis of the LH data available to clinicians. Here we present hormoneBayes, a novel open-access Bayesian framework that can be easily applied to reliably analyze serial LH measurements to assess LH pulsatility. The framework utilizes parsimonious models to simulate hypothalamic signals that drive LH dynamics, together with state-of-the-art (sequential) Monte-Carlo methods to infer key parameters and latent hypothalamic dynamics. We show that this method provides estimates for key pulse parameters including inter-pulse interval, secretion and clearance rates and identifies LH pulses in line with the widely used deconvolution method. We show that these parameters can distinguish LH pulsatility in different clinical contexts including in reproductive health and disease in men and women (e.g., healthy men, healthy women before and after menopause, women with HA or PCOS). A further advantage of hormoneBayes is that our mathematical approach provides a quantified estimation of uncertainty. Our framework will complement methods enabling real-time in-vivo hormone monitoring and therefore has the potential to assist translation of personalized, data-driven, clinical care of patients presenting with conditions of reproductive hormone dysfunction.
Glycan strand cleavage by a lytic transglycosylase, MltD contributes to the expansion of peptidoglycan in Escherichia coli
Authors: Kaul Moneca , Meher Suraj Kumar , Nallamotu Krishna Chaitanya , Reddy Manjula
Published: February 2024

Peptidoglycan (PG) is a protective sac-like exoskeleton present in most bacterial cell walls. It is a large, covalently crosslinked mesh-like polymer made up of many glycan strands cross-bridged to each other by short peptide chains. Because PG forms a continuous mesh around the bacterial cytoplasmic membrane, opening the mesh is critical to generate space for the incorporation of new material during its expansion. In Escherichia coli, the ‘space-making activity’ is known to be achieved by cleavage of crosslinks between the glycan strands by a set of redundant PG endopeptidases whose absence leads to rapid lysis and cell death. Here, we demonstrate a hitherto unknown role of glycan strand cleavage in cell wall expansion in E. coli. We find that overexpression of a membrane-bound lytic transglycosylase, MltD that cuts the glycan polymers of the PG sacculus rescues the cell lysis caused by the absence of essential crosslink-specific endopeptidases, MepS, MepM and MepH. We find that cellular MltD levels are stringently controlled by two independent regulatory pathways; at the step of post-translational stability by a periplasmic adaptor-protease complex, NlpI-Prc, and post-transcriptionally by RpoS, a stationary-phase specific sigma factor. Further detailed genetic and biochemical analysis implicated a role for MltD in cleaving the nascent uncrosslinked glycan strands generated during the expansion of PG. Overall, our results show that the combined activity of PG endopeptidases and lytic transglycosylases is necessary for successful expansion of the cell wall during growth of a bacterium.
PET/CT and SPECT/CT imaging of 90Y hepatic radioembolization at therapeutic and diagnostic activity levels: Anthropomorphic phantom study
Authors: Budzyńska Anna , Kubik Agata , Kacperski Krzysztof , Pastusiak Patrycja , Kuć Michał , Piasecki Piotr , Konior Marcin , Gryziński Michał , Dziuk Mirosław , Iller Edward
Published: February 2024

Purpose

Prior to 90Y radioembolization procedure, a pretherapy simulation using 99mTc-MAA is performed. Alternatively, a small dosage of 90Y microspheres could be used. We aimed to assess the accuracy of lung shunt fraction (LSF) estimation in both high activity 90Y posttreatment and pretreatment scans with isotope activity of ~100 MBq, using different imaging techniques. Additionally, we assessed the feasibility of visualising hot and cold hepatic tumours in PET/CT and Bremsstrahlung SPECT/CT images.

Materials and methods

Anthropomorphic phantom including liver (with two spherical tumours) and lung inserts was filled with 90Y chloride to simulate an LSF of 9.8%. The total initial activity in the liver was 1451 MBq, including 19.4 MBq in the hot sphere. Nine measurement sessions including PET/CT, SPECT/CT, and planar images were acquired at activities in the whole phantom ranging from 1618 MBq down to 43 MBq. The visibility of the tumours was appraised based on independent observers’ scores. Quantitatively, contrast-to-noise ratio (CNR) was calculated for both spheres in all images.

Results

LSF estimation. For high activity in the phantom, PET reconstructions slightly underestimated the LSF; absolute difference was <1.5pp (percent point). For activity <100 MBq, the LSF was overestimated. Both SPECT and planar scintigraphy overestimated the LSF for all activities.

Lesion visibility. For SPECT/CT, the cold tumour proved too small to be discernible (CNR <0.5) regardless of the 90Y activity in the liver, while hot sphere was visible for activity >200 MBq (CNR>4). For PET/CT, the cold tumour was only visible with the highest 90Y activity (CNR>4), whereas the hot one was seen for activity >100 MBq (CNR>5).

Conclusions

PET/CT may accurately estimate the LSF in a 90Y posttreatment procedure. However, at low activities of about 100 MBq it seems to provide unreliable estimations. PET imaging provided better visualisation of both hot and cold tumours.
Blockchain-secure patient Digital Twin in healthcare using smart contracts
Authors: Amofa Sandro , Xia Qi , Xia Hu , Obiri Isaac Amankona , Adjei-Arthur Bonsu , Yang Jingcong , Gao Jianbin
Published: February 2024

Modern healthcare has a sharp focus on data aggregation and processing technologies. Consequently, from a data perspective, a patient may be regarded as a timestamped list of medical conditions and their corresponding corrective interventions. Technologies to securely aggregate and access data for individual patients in the quest for precision medicine have led to the adoption of Digital Twins in healthcare. Digital Twins are used in manufacturing and engineering to produce digital models of physical objects that capture the essence of device operation to enable and drive optimization. Thus, a patient’s Digital Twin can significantly improve health data sharing. However, creating the Digital Twin from multiple data sources, such as the patient’s electronic medical records (EMR) and personal health records (PHR) from wearable devices, presents some risks to the security of the model and the patient. The constituent data for the Digital Twin should be accessible only with permission from relevant entities and thus requires authentication, privacy, and provable provenance. This paper proposes a blockchain-secure patient Digital Twin that relies on smart contracts to automate the updating and communication processes that maintain the Digital Twin. The smart contracts govern the response the Digital Twin provides when queried, based on policies created for each patient. We highlight four research points: access control, interaction, privacy, and security of the Digital Twin and we evaluate the Digital Twin in terms of latency in the network, smart contract execution times, and data storage costs.
Uncertainty in serious illness: A national interdisciplinary consensus exercise to identify clinical research priorities
Authors: Etkind Simon N. , Barclay Stephen , Spathis Anna , Hopkins Sarah A. , Bowers Ben , Koffman Jonathan
Published: February 2024

Background

Serious illness is characterised by uncertainty, particularly in older age groups. Uncertainty may be experienced by patients, family carers, and health professionals about a broad variety of issues. There are many evidence gaps regarding the experience and management of uncertainty.

Aim

We aimed to identify priority research areas concerning uncertainty in serious illness, to ensure that future research better meets the needs of those affected by uncertainty and reduce research inefficiencies.

Methods

Rapid prioritisation workshop comprising five focus groups to identify research areas, followed by a ranking exercise to prioritise them. Participants were healthcare professionals caring for those with serious illnesses including geriatrics, palliative care, intensive care; researchers; patient/carer representatives, and policymakers. Descriptive analysis of ranking data and qualitative framework analysis of focus group transcripts was undertaken.

Results

Thirty-four participants took part; 67% female, mean age 47 (range 33–67). The highest priority was communication of uncertainty, ranked first by 15 participants (overall ranking score 1.59/3). Subsequent priorities were: 2) How to cope with uncertainty; 3) healthcare professional education/training; 4) Optimising clinical approaches to uncertainty; and 5) exploring in-depth experiences of uncertainty. Research questions regarding optimal management of uncertainty were given higher priority than questions about experiences of uncertainty and its impact.

Conclusions

These co-produced, clinically-focused research priorities map out key evidence gaps concerning uncertainty in serious illness. Managing uncertainty is the most pressing issue, and researchers should prioritise how to optimally manage uncertainty in order to reduce distress, unlock decision paralysis and improve illness and care experience.
Investigation of the reasons for delayed presentation in proliferative diabetic retinopathy patients
Authors: Zhao Meng , Chandra Aman , Liu Lin , Zhang Lin , Xu Jun , Li Jipeng
Published: February 2024

Aim

To investigate reasons for delayed presentation in patients with proliferative diabetic retinopathy (PDR).

Methods

A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors.

Results

A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73–26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70–83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36–3.09, p<0.001).

Conclusions

This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.
Enhancing the landing guidance of a reusable launch vehicle by improving genetic algorithm-based deep reinforcement learning using Hybrid Deterministic-Stochastic algorithm
Authors: Nugroho Larasmoyo , Andiarti Rika , Akmeliawati Rini , Wijaya Sastra Kusuma
Published: February 2024

The PbGA-DDPG algorithm, which uses a potential-based GA-optimized reward shaping function, is a versatiledeep reinforcement learning/DRLagent that can control a vehicle in a complex environment without prior knowledge. However, when compared to an established deterministic controller, it consistently falls short in terms of landing distance accuracy. To address this issue, the HYDESTOC Hybrid Deterministic-Stochastic (a combination of DDPG/deep deterministic policy gradient and PID/proportional-integral-derivative) algorithm was introduced to improve terminal distance accuracy while keeping propellant consumption low. Results from extensive cross-validated Monte Carlo simulations show that a miss distance of less than 0.02 meters, landing speed of less than 0.4 m/s, settling time of 20 seconds or fewer, and a constant crash-free performance is achievable using this method.
Centrality measures in psychological networks: A simulation study on identifying effective treatment targets
Authors: Castro Daniel , Gysi Deisy , Ferreira Filipa , Ferreira-Santos Fernando , Ferreira Tiago Bento
Published: February 2024

The network theory of psychopathology suggests that symptoms in a disorder form a network and that identifying central symptoms within this network might be important for an effective and personalized treatment. However, recent evidence has been inconclusive. We analyzed contemporaneous idiographic networks of depression and anxiety symptoms. Two approaches were compared: a cascade-based attack where symptoms were deactivated in decreasing centrality order, and a normal attack where symptoms were deactivated based on original centrality estimates. Results showed that centrality measures significantly affected the attack’s magnitude, particularly the number of components and average path length in both normal and cascade attacks. Degree centrality consistently had the highest impact on the network properties. This study emphasizes the importance of considering centrality measures when identifying treatment targets in psychological networks. Further research is needed to better understand the causal relationships and predictive capabilities of centrality measures in personalized treatments for mental disorders.
Comprehensive environmental impact assessment and irrigation wastewater suitability of the Arab El-Madabegh wastewater treatment plant, ASSIUT CITY, EGYPT
Authors: M. El-Feky Ahmed , Saber Mohamed , Abd-el-Kader Mahmoud M. , Kantoush Sameh A. , Sumi Tetsuya , Alfaisal Faisal , Abdelhaleem Amal
Published: February 2024

The presence of a wastewater treatment plant in the Arab El-Madabegh region, which discharges excessive amounts of raw effluent toward the nearby farming fields, is the area’s main issue. Examining the harmful implications of raw effluent releases on groundwater quality, determining if treated wastewater effluent complies with regulations for discharge into the aquatic environment, and assessing irrigation appropriateness by the effluent are the main goals of this work. In order to accomplish these targets, twelve treated effluent samples from the Arab El-Madabegh wastewater treatment plant were gathered every two weeks starting in January 2012 and finishing in June 2012. They were tested to determine pH, Total Dissolved Solids (TDS), Total Suspended Solids (TSS), Temperature (Temp), Conductivity (EC), Turbidity (Turb.), Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD), Total Organic Carbon (TOC), NO3-, SO42-, Cl-, Ca2+, PO43-, HCO3-, Na+, Mg2+, and heavy metals such as (Fe, Mn, K+, Cr, Pb, Zn, Ni, Cu, and Cd). The outcomes revealed that all Egyptian and Food and Agricultural Organization (FAO) standards for unrestricted irrigation were met by the treated effluents, except for COD, which exceeded than the Egyptian allowed limit. The evaluation indices of the effluent’s EC, SAR, PI, MR, and MH were in the low-risk category according to indicators of water quality for irrigation, nevertheless, The SSP and RSC both showed slightly higher values (67.9% and 2.76, respectively). As well, The average values of heavy metals in treated wastewater effluent were found to be below permitted limits, with the exception of lead and phosphate, which exceeded permissible limits in Egypt. The environmental sustainability (ecological friendliness) of reusing and recycling tertiary treated wastewater can be achieved in agriculture to reduce the adverse impacts on the aquatic environment.
Multi-level barriers to early detection of breast cancer among rural midlife women in Tanzania: A qualitative case study
Authors: Nyamhanga Tumaini , Eustace Rosemary W. , Makoye Janeth Philip , Mutalemwa Katunzi
Published: February 2024

Background

Breast cancer is the second most common cause of cancer mortality among women in Tanzania and thus, early detection and treatment methods are central to improving breast cancer outcomes. However, in low- and middle-income countries in Sub-Saharan Africa, the survival rates remains low due to late presentation. Hence, a significant number of deaths could be prevented if barriers and facilitators to early detection are known.

Purpose

This qualitative case descriptive study explored the possible barriers to awareness and early breast cancer diagnostic services among midlife women in rural Tanzania.

Methods

Ten key informant interviews with health systems managers and community health workers and eight focus group discussions with women aged 40–65 years and their spouses were conducted to elicit the study data conducted from July to August 2021.

Results

The data revealed nine themes describing the barriers to early detection methods across five Socio-Ecological levels of influence, namely: 1) limited knowledge and 2) witchcraft beliefs (individual level); 3) limited male support (interpersonal level); 4) age and gender factors and 5) procrastination (community level) 6) limited availability of services 7) emphasis of curative over preventive care (institutional level); 8) poverty/inability to pay and 9) limitations of health insurance (societal/policy level).

Conclusions

The study findings suggest a need to further the design, implementation and evaluation of evidence-based community breast health awareness and education interventions to promote early detection of breast cancer in Tanzania. Specifically, the study highlights the need to address multiple level determinants of influence in breast cancer control as part of the country’s Community Health Strategy.
Metabolic-dysfunction associated steatotic liver disease-related diseases, cognition and dementia: A two-sample mendelian randomization study
Authors: Li Yao-Shuang , Xia Yu-Ge , Liu Yan-Lan , Jiang Wei-Ran , Qiu Hui-Na , Wu Fan , Li Jing-Bo , Lin Jing-Na
Published: February 2024

Background

The results of current studies on metabolic-dysfunction associated steatotic liver disease (MASLD)-related diseases, cognition and dementia are inconsistent. This study aimed to elucidate the effects of MASLD-related diseases on cognition and dementia.

Methods

By using single-nucleotide polymorphisms (SNPs) associated with different traits of NAFLD (chronically elevated serum alanine aminotransferase levels [cALT], imaging-accessed and biopsy-proven NAFLD), metabolic dysfunction-associated steatohepatitis, and liver fibrosis and cirrhosis, we employed three methods of mendelian randomization (MR) analysis (inverse-variance weighted [IVW], weighted median, and MR-Egger) to determine the causal relationships between MASLD-related diseases and cognition and dementia. We used Cochran’s Q test to examine the heterogeneity, and MR-PRESSO was used to identify outliers (NbDistribution = 10000). The horizontal pleiotropy was evaluated using the MR-Egger intercept test. A leave-one-out analysis was used to assess the impact of individual SNP on the overall MR results. We also repeated the MR analysis after excluding SNPs associated with confounding factors.

Results

The results of MR analysis suggested positive causal associations between MASLD confirmed by liver biopsy (p of IVW = 0.020, OR = 1.660, 95%CI = 1.082–2.546) and liver fibrosis and cirrhosis (p of IVW = 0.009, OR = 1.849, 95%CI = 1.169–2.922) with vascular dementia (VD). However, there was no evidence of a causal link between MASLD-related diseases and cognitive performance and other types of dementia (any dementia, Alzheimer’s disease, dementia with lewy bodies, and frontotemporal dementia). Sensitivity tests supported the robustness of the results.

Conclusions

This two-sample MR analysis suggests that genetically predicted MASLD and liver fibrosis and cirrhosis may increase the VD risk. Nonetheless, the causal effects of NAFLD-related diseases on VD need more in-depth research.
Can using a pre-trained deep learning model as the feature extractor in the bag-of-deep-visual-words model always improve image classification accuracy?
Authors: Xu Ye , Zhang Xin , Huang Chongpeng , Qiu Xiaorong
Published: February 2024

This article investigates whether higher classification accuracy can always be achieved by utilizing a pre-trained deep learning model as the feature extractor in the Bag-of-Deep-Visual-Words (BoDVW) classification model, as opposed to directly using the new classification layer of the pre-trained model for classification. Considering the multiple factors related to the feature extractor -such as model architecture, fine-tuning strategy, number of training samples, feature extraction method, and feature encoding method—we investigate these factors through experiments and then provide detailed answers to the question. In our experiments, we use five feature encoding methods: hard-voting, soft-voting, locally constrained linear coding, super vector coding, and fisher vector (FV). We also employ two popular feature extraction methods: one (denoted as Ext-DFs(CP)) uses a convolutional or non-global pooling layer, and another (denoted as Ext-DFs(FC)) uses a fully-connected or global pooling layer. Three pre-trained models—VGGNet-16, ResNext-50(32×4d), and Swin-B—are utilized as feature extractors. Experimental results on six datasets (15-Scenes, TF-Flowers, MIT Indoor-67, COVID-19 CXR, NWPU-RESISC45, and Caltech-101) reveal that compared to using the pre-trained model with only the new classification layer re-trained for classification, employing it as the feature extractor in the BoDVW model improves the accuracy in 35 out of 36 experiments when using FV. With Ext-DFs(CP), the accuracy increases by 0.13% to 8.43% (averaged at 3.11%), and with Ext-DFs(FC), it increases by 1.06% to 14.63% (averaged at 5.66%). Furthermore, when all layers of the pre-trained model are fine-tuned and used as the feature extractor, the results vary depending on the methods used. If FV and Ext-DFs(FC) are used, the accuracy increases by 0.21% to 5.65% (averaged at 1.58%) in 14 out of 18 experiments. Our results suggest that while using a pre-trained deep learning model as the feature extractor does not always improve classification accuracy, it holds great potential as an accuracy improvement technique.
A new demand function graph: Analysis of retailer-to-individual customer product supply strategies under a non-essential demand pattern
Authors: Zhuo Zhiyi , Chen Shuhong , Yan Hong , He Yue
Published: February 2024

The core objective of a successful product supply strategy is to determine the mechanism through which consumers’ psychological effects influence customer demand. As stated in the theory of supply and demand, a higher level of dynamic equilibrium should be formed in which demand drives supply and supply creates demand. There is a lack of systematic research in the literature on the identification of consumer goods demand attributes and the formation of influencing factors in consumer goods supply chains. In this paper, we use the literature on demand functions and product pricing functions to establish three mathematical models to study the factors that influence retailers in designing and planning product supply strategies for different customers under nonessential demand patterns and to solve the profit maximization problem. The results of numerical examples validate the validity of the model. The research results can help retailers develop different supply strategies according to different types of customers and different demand patterns, thereby improving business performance. The theoretical contribution of this study is the construction of value ranges and a demand function diagram for identifying consumer product demand attributes.