bluuebunny/crossref_metadata_2025 huggingface dataset:
016 An evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis
Authors: Marincowitz Carl , Lecky Fiona , Allgar Victoria , Sheldon Trevor
Published: April 2023

Background

Traumatic brain injury (TBI) is the commonest cause of death and disability in UK Citizens aged 1–40. In England three (National Institute of Health and Care Excellence - NICE) guidelines have been implemented to improve TBI outcomes. All guidelines recommended increased CT imaging. The second guideline recommended the management of patients with severe TBI in specialist neuroscience centres.

This study uses national data and interrupted time series analysis to assess the impact of the NICE guidelines.

Individual level Office of National Statistics (ONS) cause of death data linked to Hospital Episode Statistics for inpatient admissions in England between 1998–2017 were used to estimate the monthly population mortality and admission rate for TBI.

An interrupted time series analysis was conducted with intervention points when each guideline was introduced. The analysis was stratified by guideline recommendation specific age groups (0–15, 16–64 and 65+).

The monthly TBI mortality and admission rate in the 65+ age group increased from 0.5 to 1.5 and 10 to 30 per 100, 000 population respectively. The increasing mortality rate was unaffected by the introduction any of the guidelines.

The introduction of the 2nd NICE Head Injury guideline was associated with a significant reduction in the monthly TBI mortality rate in 16–64 age group (−0.005; 95% CI: −0.002 to −0.007).

In the 0–15 age group the TBI mortality rate fell from around 0.05 to 0.01 per 100 000 population, the trend was unaffected by the guidelines.

Abstract 016 Figure 1

The impact of the NICE head injury guidelines on monthly TBI mortality rate per 100 000 population

Abstract 016 Figure 2

The impact of the NICE head guidelines on monthly TBI hospital admissions per 100,000 population

Conclusion

The introduction of NICE head injury guidelines was associated with reduced population based mortality rates after specialist care was recommended for severe TBI. The improvement was solely observed in 16–64 year olds.

The cause of the observed increased admission and mortality rate in those 65+ and potential treatments for TBI in this age group requires further investigation.
026 How good is your gestalt in diagnosing acute coronary syndrome? A systematic literature review
Authors: Oliver Govind , Berg Patricia van den , Reynard Charles , Body Richard
Published: April 2023

Chest pain accounts for 6% of Emergency Departments (ED) attendances. One of the most serious diagnoses clinicians must consider is Acute Coronary Syndrome (ACS). The challenge of early identification and timely but safe discharge of those without ACS, has led to multiple decision rules being developed. Many clinicians prefer and continue to use clinical judgement alone.

We aimed to examine the current evidence on the diagnostic accuracy of clinical judgement or gestalt for ‘rule in’ and ‘rule out’ of ACS.

A systematic literature review using Ovid Medline, Embase and Cochrane databases was conducted using a pre-defined search strategy. Returned results were independently screened by two reviewers for inclusion followed by a hand search of the grey literature and the references of relevant studies. Quality assessment of potentially eligible studies was carried out using a study-specific QUADAS-2 tool. Results were reported using the PRISMA guidelines.

171 studies were screened, 13 underwent full text review, 6 were quality assessed using QUADAS-2 and 2 included. Meta-analysis plans were limited to a narrative description. The two included prospective cohort studies reported on 255 and 458 ED patients with suspected ACS. Gestalt identified 30.1% and 27.1% of patients as low risk. Sensitivity was 86.7% (95% confidence interval 76.8–93.4%) and 93.0% (86.1–97.1%) and negative predicative values (NPV) of 87.3% (79.0–92.7%) and 94.4% (89.0–97.2%) respectively. For the 30.6% and 38.0% of patients identified as high risk by gestalt in each study, specificity was 81.1% (74.6–86.6%) and 70.4% (65.4–75.1%) with positive predictive values of 56.4% (47.5–64.9%) and 39.1% (34.2–44.2%) respectively. A gestalt based rule out strategy incorporating ECG and arrival troponin performed with a sensitivity and NPV of 99.0%.

A significant evidence gap has been identified. At present there is insufficient information to draw meaningful conclusion. The little evidence supporting a gestalt-based diagnostic strategy urgently needs prospective validation.
029 An exploration of what health care professionals consider to be good clinical shop floor leadership
Authors: Cantle Fleur
Published: April 2023

Background

A successful shop floor leader must perform many tasks, often simultaneously, and hold an array of skills to complete those tasks. They must deliver clinical care, education and teaching and manage flow and performance. Individuals within an organisation will have differing expectations of the shop floor leader depending on how they are positioned within the organisation. The purpose of this study is to explore what team members within a single organisation, perceive to be good clinical shop floor leadership through semi structured interviews.

Method and results

Purposive, convenience sampling was used to find 12 subjects willing to undergo a semi-structured interview. The intention was to interview a cross section of members of the Emergency Department team, regarding what they understand by good shop floor leadership and exploring what are the perceived challenges for shop floor leadership.

A crib of questions was used but this was not strictly adhered to, to allow exploration of themes not predefined by the primary researcher.

The interview audio was transcribed and an iterative thematic analysis was then undertaken, with no predefined coding framework. Each transcript was analysed for themes and emergent patterns of commonality.

Conclusions

The theme of clinical leadership was explored, and the breadth of expectation placed on clinical leaders was evident. The importance of role modelling and credibility were highlighted. Clinical leaders described their strategy for shop floor leadership, and those who were led on the shop floor highlighted factors they valued, in particular education and teaching. The tensions between conflicting demands on the shop-floor leaders were demonstrated. The output from the interview enabled recommendations to be made regarding shop floor leadership for the organisation.
039 Peripheral administration of vasopressors in transport
Authors: Gervin Kevin , Corfield Alasdair , Queen Anton
Published: April 2023

Background

Management of shocked patients frequently requires vasopressor (epinephrine/norepinephrine) administration. Although less potent vasoactive agents are commonly delivered peripherally, historical concerns surround peripheral epinephrine and particularly norepinephrine use; these are primarily administered as infusions via central venous catheter (CVC). Concerns centre on potential extravasation and subsequent skin or tissue necrosis. However, recent studies suggest risks maybe lower than perceived. In the pre-hospital setting, circumstance may demand use of epinephrine/norepinephrine but preclude CVC insertion.

In this study we assessed current practice for peripheral vasopressor usage in a national pre-hospital and retrieval service and associated complications.

Method and results

A retrospective, cohort study, using routinely collected data from the EMRS electronic record, cross-referenced against contemporaneous paper medical records from 2004–2018. All primary (pre-hospital) and secondary (from remote/rural healthcare facilities) patients over the age of 16 requiring peripheral vasopressors for shock were included.

Data was collected on demographic information, retrieval site and mode of transport, vasopressor used, shock type, duration of use and subsequent complications. Complications were defined as immediate, noted by retrieval team on mission paperwork; or delayed, noted at 24-hour follow-up.

Descriptive statistics for cohort study have been used and all analyses conducted using Stata v12.0

Conclusions

6093 missions were reviewed. Vasopressors were administered to 6.8% (417/6093) of patients. Epinephrine infusions were administered to 129 patients and 307 required norepinephrine (19 received both). Peripheral vasopressor infusions were used in 16.1% (67/417) of infusions. Of peripheral infusions, 40 patients received epinephrine and 30 received norepinephrine (three received both). Three epinephrine infusions were during primary missions, all norepinephrine infusions were on secondary retrievals.

Distributive shock was the commonest indication for both (47.5% & 73.3%). There were no reported complications during missions or at 24-hours.

Results suggest pre-hospital use of peripheral epinephrine/norepinephrine is relatively common and safe, with no complications reported across 15 years of practice.
004 Improving the consideration of non accidental injury in under 1s presenting to the emergency department with apparent trauma
Authors: Lowry Chris , Burton Fiona
Published: April 2023

Non-accidental injury (NAI) is recognised as a common cause for injuries in children, especially in the very young, immobile child. STAG data from the RHC in Glasgow showed that 8% of paediatric trauma cases were due to NAI. All were under 2 years of age.

It is vital that any clinician working in the Emergency Department considers NAI as a differential for the injured child.

At Hairmyres it was noted through previous audit work that documentation and understanding of NAI was poor, and the process for highlighting concerns both difficult and confusing. These conclusions showed that consideration of NAI needed to be improved among clinicians

A QIP was undertaken to improve each of the areas identified.

A proforma was created to allow a tick–sheet approach to documentation for NAI.

A new referral process was introduced to facilitate sharing of information with social work with clear guidance for staff using the Notification of Concern (NOC) form.

A multidisciplinary child protection meeting was set up to include staff from social work, paediatrics, child protection and emergency medicine.

Over a 8 month period (November 2017 to June 2018):

clear documentation of any child protection concerns rose from 0 to 70%.

Documenting who accompanied a child rose from 20 to 100%

checking for social work involvement rose from 0 to 70%.

Documenting time of injury rose from 40 to 85%.

Attendance at the child protection meeting improved to the extent that it will extend to be inclusive of two other sites in NHS Lanarkshire.

Social work has received 46 NOCs (3 for under 1s), all deemed appropriate.

Conclusion

Documentation for consideration of NAI has improved.Communication between respective departments has improved since the meetings commenced allowing collaboration to ensure we are getting it right for every child.
051 The ACUTE (ambulance CPAP: use, treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure
Authors: Fuller Gordon , Keating Sam , Goodacre Steve , Herbert Esther , Perkins Gavin , Ward Matthew , Rosser Andy , Gunson Imogen , Miller Josh , Bradburn Mike , Harris Tim , Marsh Maggie , Cooper Cindy
Published: April 2023

Background

Acute respiratory failure (ARF) is a common and life-threatening medical emergency. Continuous positive airway pressure (CPAP) is a potentially beneficial prehospital treatment, but it is uncertain whether this could improve important outcomes in NHS ambulance services.

Methods

An individually randomised, external pilot study was conducted to test the feasibility of a definitive pragmatic trial. Adults with respiratory distress and peripheral oxygen saturations below British Thoracic Society target levels were recruited from the West Midlands Ambulance Service between August 2017 and July 2018. Participants were randomised 1:1 to prehospital CPAP or standard oxygen therapy. Feasibility objectives estimated the: incidence of eligible patients; proportion recruited and allocated to treatment appropriately; adherence to allocated treatment; retention and data completeness; and 30-day mortality, as a potential primary outcome for a definitive trial.

Results

Over 12 months, 77 patients were enrolled (CPAP arm 42, standard oxygen arm 35 cases, target 120). CPAP was fully delivered as planned in 74% (target 75%). There were no major protocol violations/non-compliances (target 0%). Full data were available for key outcomes (target ≥90%). Mortality was higher than expected (overall 27.3%, CPAP arm 28.6% n=12/42, standard care arm 25.7% n=9/35). Of deceased patients, 14/21 (68%) either did not have a respiratory condition or had ceiling of treatment decisions excluding hospital non-invasive ventilation and critical care. Two patients required emergency department treatment for a pneumothorax, neither having received prehospital CPAP. There were no other serious adverse events.

Conclusions

The lower than expected recruitment rate, limited compliance with CPAP, and the difficulty in identifying patients who could benefit from CPAP, indicate limited potential for prehospital CPAP to reduce mortality. A definitive effectiveness trial is therefore not recommended. These findings also argue against routine implementation of CPAP into NHS ambulance services.
Helicobacter pyloripromotes colorectal carcinogenesis by deregulating intestinal immunity and inducing a mucus-degrading microbiota signature
Authors: Ralser Anna , Dietl Alisa , Jarosch Sebastian , Engelsberger Veronika , Wanisch Andreas , Janssen Klaus Peter , Middelhoff Moritz , Vieth Michael , Quante Michael , Haller Dirk , Busch Dirk H , Deng Li , Mejías-Luque Raquel , Gerhard Markus
Published: April 2023

Objective

Helicobacter pyloriinfection is the most prevalent bacterial infection worldwide. Besides being the most important risk factor for gastric cancer development, epidemiological data show that infected individuals harbour a nearly twofold increased risk to develop colorectal cancer (CRC). However, a direct causal and functional connection betweenH. pyloriinfection and colon cancer is lacking.

Design

We infected twoApc-mutant mouse models and C57BL/6 mice withH. pyloriand conducted a comprehensive analysis ofH. pylori-induced changes in intestinal immune responses and epithelial signatures via flow cytometry, chip cytometry, immunohistochemistry and single cell RNA sequencing. Microbial signatures were characterised and evaluated in germ-free mice and via stool transfer experiments.

Results

H. pyloriinfection accelerated tumour development inApc-mutant mice. We identified a uniqueH. pylori-driven immune alteration signature characterised by a reduction in regulatory T cells and pro-inflammatory T cells. Furthermore, in the intestinal and colonic epithelium,H. pyloriinduced pro-carcinogenic STAT3 signalling and a loss of goblet cells, changes that have been shown to contribute—in combination with pro-inflammatory and mucus degrading microbial signatures—to tumour development. Similar immune and epithelial alterations were found in human colon biopsies fromH. pylori-infected patients. Housing ofApc-mutant mice under germ-free conditions ameliorated, and early antibiotic eradication ofH. pyloriinfection normalised the tumour incidence to the level of uninfected controls.

Conclusions

Our studies provide evidence thatH. pyloriinfection is a strong causal promoter of colorectal carcinogenesis. Therefore, implementation ofH. pyloristatus into preventive measures of CRC should be considered.
Elevated plasma p-tau181 levels unrelated to Alzheimer’s disease pathology in amyotrophic lateral sclerosis
Authors: Vacchiano Veria , Mastrangelo Andrea , Zenesini Corrado , Baiardi Simone , Avoni Patrizia , Polischi Barbara , Capellari Sabina , Salvi Fabrizio , Liguori Rocco , Parchi Piero
Published: April 2023

Background

Phosphorylated-tau181 (p-tau181), a specific marker of Alzheimer’s disease (AD) pathology, was found elevated in plasma but not in cerebrospinal fluid (CSF) of patients with amyotrophic lateral sclerosis (ALS). We expanded these findings in a larger patient cohort, exploring clinical/electrophysiological associations, prognostic value and longitudinal trajectories of the biomarker.

Methods

We obtained baseline plasma samples from 148 ALS, 12 spinal muscular atrophy (SMA), and 88 AD patients, and 60 healthy controls. Baseline CSF and longitudinal plasma samples were from 130 and 39 patients with ALS. CSF AD markers were measured with the Lumipulse platform, and plasma p-tau181 with SiMoA.

Results

Patients with ALS showed higher plasma p-tau181 levels than controls (p<0.001) and lower than AD participants (p=0.02). SMA patients had higher levels than controls (p=0.03). In patients with ALS, CSF p-tau and plasma p-tau181 did not correlate (p=0.37). Plasma p-tau181 significantly increased with the number of regions showing clinical/neurophysiological lower motor neurons (LMN) signs (p=0.007) and correlated with the degree of denervation in the lumbosacral area (r=0.51, p<0.0001). Plasma p-tau181 levels were higher in classic and LMN-predominant than in bulbar phenotype (p=0.004 and p=0.006). Multivariate Cox regression confirmed plasma p-tau181 as an independent prognostic factor in ALS (HR 1.90, 95% CI 1.25 to 2.90, p=0.003). Longitudinal analysis showed a significant rise in plasma p-tau181 values over time, especially in fast progressors.

Conclusions

Plasma p-tau181 is elevated in patients with ALS, independently from CSF levels, and is firmly associated with LMN dysfunction. The finding indicates that p-tau181 of putative peripheral origin might represent a confounding factor in using plasma p-tau181 for AD pathology screening, which deserves further investigation.
Training obstetrician gynaecologists in HIV PrEP (pre-exposure prophylaxis): a 2-year experience
Authors: Silvestri Francesca , Alvarez Natalie , Afzal Omara , Urbina Antonio E , Dolan Siobhan M , Ramirez Zamudio Andres
Published: April 2023

Objective

We aimed to evaluate the efficacy of PrEP (pre-exposure prophylaxis) training sessions for OBGYN (obstetrician gynaecologist) providers given underutilisation of PrEP among women despite a high HIV burden.

Methods

Three separate training sessions were held for providers in the OBGYN department at an academic medical centre in New York City from 2019 to 2021. The 1-hour training sessions were conducted by HIV specialists as in-person lectures or online live lectures. Participants were surveyed after the training on metrics of PrEP awareness, knowledge and comfort with management. Two-sample t-tests were used to compare difference in proportions of binomial variables and difference in means of Likert-scored answers pretraining and post-training events.

Results

63 respondents completed the surveys. There were low rates (13%) of past PrEP prescription among the respondents, while awareness of PrEP as an HIV prevention strategy was high before (95%) and after (98%) the training. After the training, there was an increase in understanding the epidemiology of HIV transmission (40% to 97%, p<0.00), familiarity with the PrEP clinical trials (18% to 97%, p<0.00), comfort in determining PrEP candidacy (mean score 2.3 to 4.1, p<0.00) and comfort prescribing PrEP (mean score 2.0 to 3.6, p<0.00). After the trainings, the majority of participants reported feeling ‘comfortable’ or ‘very comfortable’ in determining candidacy for PrEP and prescribing PrEP with follow-up.

Conclusion

Implementation of PrEP training courses for OBGYN providers increased knowledge and comfort in identifying and managing patients who may benefit from PrEP services. Increasing training among OBGYN providers serving women at risk for HIV infection is an effective tool to narrow gaps in PrEP access.
Cumulative cigarette discount coupon exposure and trajectories of cigarette smoking: a longitudinal analysis in US adults
Authors: Hamilton-Moseley Kristen R , McNeel Timothy S , Choi Kelvin
Published: April 2023

Introduction

Exposure to cigarette discount coupons is associated with short-term increase in cigarette smoking; however, long-term impact is unclear. This study examined associations of cumulative exposure to cigarette coupons with trajectories of cigarette smoking in US adults.

Methods

Data were from the US Population Assessment of Tobacco and Health Study Adult Surveys (n=19 824; waves 2–5). We examined the number of waves participants received cigarette discount coupons/promotions during waves 2–4 and smoking behaviours at wave 5. Weighted logistic multivariable regression models were used, adjusting for wave 2 demographics and stratified by wave 2 smoking status.

Results

Among wave 2 adults who never smoked, each increment wave of exposure to cigarette discount coupons was associated with greater odds of wave 5 current smoking (adjusted OR (aOR)=2.09, 95% CI 1.24–3.52). Among wave 2 adults who smoked daily, each wave of coupon exposure was associated with lower odds of quitting smoking at wave 5 (aOR=0.67, 95% CI 0.62—0.73). Among wave 2 adults who had quit smoking, each increment wave of exposure was associated with greater odds of wave 5 current smoking (aOR=1.61, 95% CI 1.41—1.85). Additionally, women (vs men) and adults with lower socioeconomic status (SES) (vs higher SES) were more frequently exposed to cigarette coupons for a higher number of waves (p<0.05).

Discussion

Exposure to cigarette coupons exhibited a dose–response relationship with changes in cigarette smoking behaviours over time, promoting smoking progression and hindering smoking cessation especially among women and people with lower SES. Prohibiting these coupons can be an important tobacco control strategy.
A Variational Neural Architecture for Skill-based Team Formation
Authors: Hamidi Rad Radin , Fani Hossein , Bagheri Ebrahim , Kargar Mehdi , Srivastava Divesh , Szlichta Jaroslaw
Published: April 2023

Team formation is concerned with the identification of a group of experts who have a high likelihood of effectively collaborating with each other to satisfy a collection of input skills. Solutions to this task have mainly adopted graph operations and at least have the following limitations: (1) they are computationally demanding, as they require finding shortest paths on large collaboration networks; (2) they use various types of heuristics to reduce the exploration space over the collaboration network to become practically feasible; therefore, their results are not necessarily optimal; and (3) they are not well-suited for collaboration network structures given the sparsity of these networks. Our work proposes a variational Bayesian neural network architecture that learns representations for teams whose members have collaborated with each other in the past. The learned representations allow our proposed approach to mine teams that have a past collaborative history and collectively cover the requested desirable set of skills. Through our experiments, we demonstrate that our approach shows stronger performance compared to a range of strong team formation techniques from both quantitative and qualitative perspectives.
VISCOUNTH: A Large-scale Multilingual Visual Question Answering Dataset for Cultural Heritage
Authors: Becattini Federico , Bongini Pietro , Bulla Luana , Bimbo Alberto Del , Marinucci Ludovica , Mongiovì Misael , Presutti Valentina
Published: April 2023

Visual question answering has recently been settled as a fundamental multi-modal reasoning task of artificial intelligence that allows users to get information about visual content by asking questions in natural language. In the cultural heritage domain, this task can contribute to assisting visitors in museums and cultural sites, thus increasing engagement. However, the development of visual question answering models for cultural heritage is prevented by the lack of suitable large-scale datasets. To meet this demand, we built a large-scale heterogeneous and multilingual (Italian and English) dataset for cultural heritage that comprises approximately 500K Italian cultural assets and 6.5M question-answer pairs. We propose a novel formulation of the task that requires reasoning over both the visual content and an associated natural language description, and present baselines for this task. Results show that the current state of the art is reasonably effective but still far from satisfactory; therefore, further research in this area is recommended. Nonetheless, we also present a holistic baseline to address visual and contextual questions and foster future research on the topic.
Independent Spanning Trees in Networks: A Survey
Authors: Cheng Baolei , Wang Dajin , Fan Jianxi
Published: April 2023

The problem of constructing independent spanning trees (ISTs) dates back to as early as the late 1980s. Given a network
G
of a certain topology, the question is whether we can, as well as how to, construct a set of ISTs in
G
. ISTs have proven to be of great importance in many network tasks. The past decade has seen a particularly remarkable increase in the literature on ISTs, manifesting a significant growth of interest. ISTs can be classified into edge-independent spanning trees (edge-ISTs), node-independent spanning trees (node-ISTs), and completely independent spanning trees (CISTs). For a network
G
, node-ISTs (edge-ISTs) rooted at
u
are a set of spanning trees rooted at
u
in
G
such that there are no common internal nodes (edges) between
u
and any other node among the paths in these spanning trees. If every node in a set of node-ISTs can act as a root node, the set of trees is called
CISTs
. This survey aims at bringing together important works on ISTs that have been reported in the literature. It provides a historical perspective of how the field has evolved, and can serve as an integrated useful resource of references for future research on ISTs.
Synergetic Effect of Three-in-One Nanocomposite Based on AuNPs and rGO-MWCNTs for Ultrasensitive Electrochemical Bio-Diagnostic Applications
Authors: Zewdu Mesfin , Sandhu Taniya , Kaur Navjeet , Abebe Mulualem , Olu Femi , Sabherwal Priyanka
Published: April 2023

A simple, two-step AuNPs/rGO-MWCNTs nanocomposite fabrication methodology, via drop-casting of rGO-MWCNTs on bare screen printed electrode (SPE) followed by electrodeposition of AuNPs through voltammetric scanning, without using any toxic reducing agents is reported. Each step of the synthesized nanocomposite is characterized using state-of-art spectroscopic and electrochemical methods. Our results demonstrate that the nanostructured AuNPs/rGO-MWCNTs/SPE showed synergistic effects of high electrocatalytic and electron transfer activity, high surface area to volume ratio, that confirms our synthesized material is the best material to fabricate a portable device for rapid, inexpensive, and sensitive electrochemical biosensors. For validation, the fabricated material subjected to electrochemical sensing of BSA protein. Our AuNPs/rGO-MWCNTs nanocomposite exhibited significant and good linear response over 2.5–12.5 μg ml−1 BSA concentration range, with sensitivity of 1.723 μAμg ml−1 and limit of detection (LOD) 0.23 μg/ml. This portable sensing system with enhanced performance demonstrates great potential for our synthesized AuNPs/rGO-MWCNs/SPE nanocomposite in application of point of care applications, and offers a universal and reliable platform for in biomarker detection.
Inflammatory Mechanisms in Heart Failure with Preserved Ejection Fraction
Authors: Daou Daniel , Gillette Thomas G. , Hill Joseph A.
Published: April 2023

Heart failure with preserved ejection fraction (HFpEF) is now the most common form of heart failure and a significant public health concern for which limited effective therapies exist. Inflammation triggered by comorbidity burden is a critical element of HFpEF pathophysiology. Here, we discuss evidence for comorbidity-driven systemic and myocardial inflammation and the mechanistic role of inflammation in pathological myocardial remodeling in HFpEF.
CLDN4 as a Novel Diagnostic and Prognostic Biomarker and Its Association with Immune Infiltrates in Ovarian Cancer
Authors: Hu Pan , Lei Li , Wang Ying , Tian Xue , Wei Xia , Jiang Ni , Liu Lubin
Published: April 2023

Ovarian cancer (OC) is the seventh most prevalent type of cancer in women and the second most common cause of cancer-related deaths in women worldwide. Because of the high rates of relapse, there is an immediate and pressing need for the discovery of innovative sensitive biomarkers for OC patients. Using TCGA and GSE26712 datasets, we were able to identify 17 survival-related DEGs in OC that had differential expression. CLDN4 was the gene that caught our attention the most out of the 17 important genes since its expression was much higher in OC samples than in nontumor samples. The findings of the ROC assays then confirmed the diagnostic utility of the test in screening OC specimens to differentiate them from nontumor specimens. Patients with high CLDN4 expression predicted a shorter overall survival (OS) and disease-specific survival (DSS) than those with low CLDN4 expression, according to clinical research. Patients with low CLDN4 expression predicted longer OS and DSS. Analysis using both univariate and multivariate techniques revealed that CLDN4 expression was an independent factor associated with a poor prognosis for OS and DSS. Based on multivariate analysis, the

C

-indexes and calibration plots of the nomogram suggested an effective predictive performance for OC patients. After that, we investigated whether or not there was a link between the infiltration of immune cells and the expression of the CLDN4 gene. We found that the expression of CLDN4 was positively associated with Th17 cells, NK CD56bright cells, while negatively associated with Th2 cells, pDC, and T helper cells. In the end, we carried out RT-PCR on our cohort and confirmed that the level of CLDN4 expression was noticeably elevated in OC specimens in comparison to nontumor tissues. The diagnostic usefulness of CLDN4 expression for OC was also validated by the findings of ROC tests. Thus, our findings revealed that CLDN4 may serve as a predictive biomarker in OC to assess both the clinical outcome of OC patients and the level of immune infiltration.
Magnitude and Associated Factors of Psychoactive Substance Use among Youths at Selected Administrative Towns of North Shewa Zone, Amhara Region, Ethiopia
Authors: Admasu Basha Elyas , Semu Tefera Aklil , Tesema Tilahun Alemnesh , Fenta Amede Asrat
Published: April 2023

Youth and adolescent psychoactive substance use is a major public health problem worldwide which affects the health of individuals, families, and the community as a whole. This study was aimed at assessing the level of psychoactive substance use and the associated factors among the youths of North Sowa zone, Amhara region, Ethiopia, 2020/21. Community based cross-sectional study design with a multistage sampling technique was used. A total of 632 youths were involved in the study. Linear logistic regression analysis was used for both bivariate and multivariate analysis. The prevalence of life time and current psychoactive substance use was found to be 66.1% and 65%, respectively. Male sex and history of substance use from family members and friends were significantly associated with psychoactive substance use. In this study, the prevalence of life time and current psychoactive substance use was high as compared to other studies conducted in Ethiopia.
Learning to Drive in the NGSIM Simulator Using Proximal Policy Optimization
Authors: Zhou Yang , Chen Yunxing
Published: April 2023

As a popular research field, autonomous driving may offer great benefits for human society. To achieve that, current studies often applied machine learning methods like reinforcement learning to enable an agent to interact and learn in a stimulating environment. However, most simulators lack realistic traffic which may cause a deficiency in realistic interaction. The present study adopted the SMARTS platform to create a simulator in which the trajectories of the vehicles in the NGSIM I-80 dataset were extracted as the background traffic. The built NGSIM simulator was used to train a model using the proximal policy optimization method. The actor-critic neural network was applied, and the model takes inputs including 38 features that encode the information of the host vehicle and the nearest surrounding vehicles in the current lane and adjacent lane. A2C was selected as a comparative method. The results revealed that the PPO model outperformed the A2C model in the current task by collecting more rewards, traveling longer distances, and encountering less dangerous events during model training and testing. The PPO model achieved an 84% success rate in the test which is comparable to the related studies. The present study proved that the public driving dataset and reinforcement learning can provide a useful tool to achieve autonomous driving.
Numerical Simulation of the Effect of Reservoir Properties on Oil Production from the Low-Permeability Formation by Extended Reach Wells
Authors: Li Yanlai
Published: April 2023

At present, extended reach wells (ERWs) are widely applied on oil and gas exploitation in numerous reservoirs around the globe, and this is attributed to their superiority in the development of marginal oil and gas fields and cost-effectiveness. Identifying the effects of reservoir properties on production is significant to the operation of ERWs for oil and gas extraction. This work utilizes numerical modeling techniques to simulate the application of ERWs in low-permeability formations. The impacts of low permeability on the oil production and the pressure distribution of the reservoirs with different formation properties are analyzed, and the simulation results of the oil exploitation by ERWs are compared with the oil production and pressure distribution of that by horizontal wells (HWs). A test scheme is designed to analyze the effect of reservoir properties on oil extraction through ERWs and quantify the sensitivity of oil production to reservoir properties. The reservoir properties of formation rock compressibility, formation fluid compressibility, initial reservoir pressure, reservoir saturation pressure, formation porosity, and absolute permeability are studied through 66 ERW cases. The results illustrate that low permeability leads to a fast decrease of oil production rates and significantly uneven pressure distribution. The pressure is lower at the center of the ERW but is higher at both ends of the ERW, while the pressure is evenly distributed along the horizontal well in the HW cases. In addition, the oil production is in direct proportion with the initial reservoir pressure, formation rock compressibility, formation porosity, and formation fluid compressibility but is in an inverse ratio with the reservoir saturation pressure. Furthermore, the initial reservoir pressure has the largest impact on both the total cumulative oil production driven out by natural energy and the cumulative oil production after the development of ten years by natural energy; on the contrary, the absolute permeability has no effect on the total cumulative oil production driven out by natural energy.
Evaluation of Spatial Spillover Effect of Multidimensional Hybrid Financial Risk Contagion Based on the DAI Spatial Econometric Model
Authors: Li Shanshen , Dong Zhonghui
Published: April 2023

The process of global integration has accelerated, and the international financial market has become increasingly closely linked. The financial risks that come with them are becoming more complex and difficult to guard against. Multimedia modeling in Health Cloud biometric authentication and data management systems can be applied to the analysis of financial markets. Most of the current financial risk analysis models are based on a single time, and the models are relatively simple and cannot adapt to the current complex multidimensional mixed financial risk environment. Therefore, this paper aimed to analyze the spatial spillover effect of financial risk contagion based on the directed asymmetric (DAI) spatial econometric model. This paper proposed to transfer entropy information weight information and introduce the GARCH (generalized auto-regressive conditional heteroskedasticity) model to improve the traditional econometric model. By constructing a DAI measurement model, the spatial contagion of multidimensional mixed financial risks was analyzed, and on this basis, a generalized multidimensional economic space was established to analyze spatial spillover effects and analyze the specific path of spatial spillover effects. The model results in this paper showed that the degree of correlation between the stock and bond market varied greatly between countries. Among them, the change coefficient

W

s
⟶
b

r

s

D

of the event period was judged to have a large degree of negative change in the United Kingdom, Germany, and France in the European Union, which were −0.9885, −0.9876, and −0.9748, respectively. This showed that the model in this paper had a good and reliable ability to cope with the current multidimensional mixed complex financial risk environment and could be used as a reference for financial risk-related research. At the same time, it also proved that multimedia modeling in health cloud biometric authentication and data management system could provide a role in financial risk contagion analysis.
Human Umbilical Cord Mesenchymal Stem Cells Inhibit Pyroptosis of Renal Tubular Epithelial Cells through miR-342-3p/Caspase1 Signaling Pathway in Diabetic Nephropathy
Authors: Zheng Shuo , Zhang Ke , Zhang Yaqi , He Jing , Ouyang Yu , Lang Ruibo , Ao Chunchun , Jiang Yijia , Xiao Huan , Li Yu , Li Mao , Li Changyong , Wu Dongcheng
Published: April 2023

Diabetic nephropathy (DN) is one of the microvascular complications of diabetes. Recent studies suggest that the pyroptosis of renal tubular epithelial cell plays a critical role in DN. Currently, effective therapeutic strategies to counteract and reverse the progression of DN are lacking. Mesenchymal stem cells (MSCs) represent an attractive therapeutic tool for tissue damage and inflammation owing to their unique immunomodulatory properties. However, the underlying mechanisms remain largely unknown. In the present study, we found that human umbilical cord MSCs (UC-MSCs) can effectively ameliorate kidney damage and reduce inflammation in DN rats. Importantly, UC-MSC treatment inhibits inflammasome-mediated pyroptosis in DN. Mechanistically, we performed RNA sequencing and identified that miR-342-3p was significantly downregulated in the kidneys of DN rats. Furthermore, we found that miR-342-3p was negatively correlated with renal injury and pyroptosis in DN rats. The expression of miR-342-3p was significantly increased after UC-MSC treatment. Moreover, miR-342-3p decreased the expression of Caspase1 by targeting its 3

′

-UTR, which was confirmed by double-luciferase assay. Using miRNA mimic transfection, we demonstrated that UC-MSC-derived miR-342-3p inhibited pyroptosis of renal tubular epithelial cells through targeting the NLRP3/Caspase1 pathway. These findings would provide a novel intervention strategy for the use of miRNA-modified cell therapy for kidney diseases.
A Novel Alu Element Insertion in ATM Induces Exon Skipping in Suspected HBOC Patients
Authors: Klein Janin , Allister Aldrige B. , Schmidt Gunnar , Otto Annette , Heinecke Kai , Bax-Knoche Jördis , Beger Carmela , Becker Sarah , Bartels Stephan , Ripperger Tim , Bohne Jens , Dörk Thilo , Schlegelberger Brigitte , Hofmann Winfried , Steinemann Doris
Published: April 2023

The vast majority of patients at risk of hereditary breast and/or ovarian cancer (HBOC) syndrome remain without a molecular diagnosis after routine genetic testing. One type of genomic alteration that is commonly missed by diagnostic pipelines is mobile element insertions (MEIs). Here, we reanalyzed multigene panel data from suspected HBOC patients using the MEI detection tool Mobster. A novel Alu element insertion in ATM intron 54 (ATM:c.8010+30_8010+31insAluYa5) was identified as a potential contributing factor in seven patients. Transcript analysis of patient-derived RNA from three heterozygous carriers revealed exon 54 skipping in 38% of total ATM transcripts. To manifest the direct association between the Alu element insertion and the aberrant splice pattern, HEK293T and MCF7 cells were transfected with wild-type or Alu element-carrying minigene constructs. On average, 77% of plasmid-derived transcripts lacked exon 54 in the presence of the Alu element insertion compared to only 4.7% of transcripts expressed by the wild-type minigene. These results strongly suggest ATM:c.8010+30_8010+31insAluYa5 as the main driver of ATM exon 54 skipping. Since this exon loss is predicted to cause a frameshift and a premature stop codon, mutant transcripts are unlikely to translate into functional proteins. Based on its estimated frequency of up to 0.05% in control populations, we propose to consider ATM:c.8010+30_8010+31insAluYa5 in suspected HBOC patients and to clarify its role in carcinogenesis through future epidemiological and functional analyses. Generally, the implementation of MEI detection tools in diagnostic sequencing pipelines could increase the diagnostic yield, as MEIs are likely underestimated contributors to genetic diseases.
Stability Analysis of Roof and Rib and Source Control Countermeasures of Ultrahigh Roadway in Deep Coal Mine
Authors: Zhu Ye , Hua Xinzhu , Li Weiyu
Published: April 2023

Driven by the high original rock stress and engineering disturbance, the ultrahigh roadways of about 7∼8 m appear in the deep coal mine. Based on the field measured data, the stability in different zones of roof and rib is divided. From shallow to deep, the roof forms potential leakage and falling zone, metastable zone, and stable zone, and the coal rib forms potential spalling zone, crack developed zone, and transition zone. Based on the theory of transverse isotropy, the mechanical analysis model of layered roof is established, the real stress state at any point of layered roof is deduced, the roof failure criterion is constructed, and the theoretical solution of the failure depth of layered roof is obtained. The mechanical model of pillar bar of the splitting coal body in the potential spalling zone is established, and the deflection deformation expression of the pillar bar is derived. In view of the deformation and failure characteristics of the roof and rib, this paper puts forward the cooperative integrated support technology based on high-strength prestressed cables and deep-shallow hole grouting, which effectively reduce the hidden danger of roof falling and eliminate the formation of ultrahigh roadway from the source.
Robot Fault Detection Based on Big Data
Authors: Luo Fei
Published: April 2023

In order to improve the reliability of robot electrical fault detection and diagnosis, the author proposes a robot electrical fault detection and diagnosis method based on deep learning. Taking the return power and active power as constraints, the electrical fault data collection of the robot is carried out. Taking the resonant inductance and resonant capacitance of the robot electrical equipment as identification parameters, we conduct electrical fault differential feature mining. The fault features are extracted according to the time-delay distribution sequence of the electrical fault data of the robot, and the electrical fault detection and diagnosis results are output by using the deep learning function. Simulation results show that the author's method has a high accuracy probability for robot electrical fault diagnosis. The author's method is on average 14.7% higher than the neural network-based method and 24.5% higher than the expert system-based method. The accuracy rate of the author's method for robot electrical fault diagnosis is high. The author’s method is 16.6% higher than the neural network-based method on average and 34.2% higher than the expert system-based method. It is proved that the robot electrical fault detection and diagnosis based on deep learning has high accuracy and short time.
Density Gradient Centrifugation Alone or the Combination of DGC with Annexin V Magnetic-Activated Cell Sorting Prior to Cryopreservation Enhances the Postthaw Quality of Sperm from Infertile Male Patients with Poor Sperm Quality
Authors: Yang Sijie , Gao Xuan , Zhang Taijian , Cai Feifei , Zhang Haobo
Published: April 2023

Objective. To examine whether density gradient centrifugation (DGC) alone or its combination with annexin V magnetic-activated cell sorting (DGC-MACS) can be used to process semen samples from infertile male patients with poor sperm quality prior to subjecting these to freeze/thaw process in order to optimize the outcomes of sperm freezing. Methods. This study enrolled sixteen patients with sperm

concentration
≥
20
×

10

6

/
mL

, sperm

motility
<
30

%, and/or <4% normal sperm morphology. Sperms were processed by DGC or DGC-MACS prior to the freeze/thaw process. Sperm motility, hyperosmotic swelling test (HOS), TUNEL test, and morphological analysis were performed before and after the freeze/thaw process. Results. The freeze/thaw process had a detrimental effect on sperm motility, viability, morphology, and DNA integrity in all three groups (RAW, DGC, and DGC + MACS groups). The DGC and DGC + MACS groups showed increased sperm motility, viability, and normal morphology following freeze/thaw than untreated frozen controls. The motility and viability were not significantly different between DGC-MACS-CPT (cryopreservation-thawing) and DGC-CPT groups. Moreover, almost no grade A or grade B sperm was observed in the DGC-MACS-CPT groups. The sperm selected by DGC or DGC + MACS showed decreased levels of sperm DNA fragmentation than RAW samples following freeze/thaw. Moreover, the sperm DNA fragmentation following freeze/thaw in the DGC-MACS-CPT group was significantly lower than that in the DGC-CPT group. Conclusions. Sperm preparation by DGC before cryopreservation improved the quality of sperm postthaw in infertile males with poor sperm quality. If the sperm quality following freeze/thaw is foreseen to be insufficient for artificial insemination with husband’s sperm or in vitro fertilization, or if there is high DNA fragmentation in RAW sperm, DGC + MACS should be used prior to cryopreservation to reduce sperm DNA fragmentation and improve the quality of sperm available for intracytoplasmic sperm injection.