bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental study on ultrasonic assisted milling effect on blade distortion
Authors: Bayat Masuod , Amini Saeid
Published: March 2024

Distortion in milling is a prevalent issue that can arise during material machining. It stems from the forces exerted by the cutting tool on the machined material, resulting in uneven material removal and subsequent warping of the parts. The distortion can be prevented with proper cutting speed, feed rate, and tool selection. Ultrasonic-Assisted Milling (UAM) mitigates distortion in milling processes by optimizing cutting conditions. This machining technique employs high-frequency vibrations to efficiently remove material from a workpiece. In this study, 18 tests according to a full factorial design experiment were used to investigate cutting force and distortion in two modes of conventional milling and ultrasonic-assisted milling. Our findings reveal a direct correlation between cutting force and distortion in UAM. Specifically, UAM exhibited a significant reduction of approximately 28.4% in cutting force compared to conventional milling (CM). Furthermore, distortion in UAM was diminished by about 34.06%. Additionally, a noteworthy improvement of 28.4% in surface roughness was observed. These results collectively help produce accurate workpieces and ensure the production of undamaged and warp-free parts.
Geometric modeling and performance analysis of a combined algebraic spiral scroll compressor
Authors: Liao Zhixiang , Peng Bin , Zhang Pengcheng , Sun Jian , Zhu Bingguo
Published: March 2024

This study proposed a combined algebraic spiral (CAS) scroll compressor with a profile that consists of two algebraic spirals with different parameters smoothly connected by a higher-order curve. The advantage lies in the ability of the ending algebraic spiral to regulate the stroke volume and wrap size, while the starting algebraic spiral can control the discharge volume and the center part of the wrap, thus improving the geometric performance of the scroll compressor. The research established the geometric model of CAS scroll wrap and conducted parametric studies. The results indicate that CAS scroll compressor exhibits the minimum discharge volume, maximum stroke volume, and compression ratio when both the discharge volume chamber and the stroke volume chamber are entirely constructed using the algebraic spiral. Moreover, it was observed that the radial leakage curve length decreases as the polar angle at the connection point increases. Under identical wrap diameters and adequate minimum wall thickness, a larger spiral coefficient may be chosen for the ending algebraic spiral in order to enhance geometric performance. Conversely, a smaller spiral coefficient and spiral index for the starting algebraic spiral can improve compression and reduce leakage. Moreover, in comparison to a single algebraic spiral scroll compressor with an equivalent wrap size, CAS scroll compressor exhibits a 20.62% decrease in discharge volume, a 31.62% rise in compression ratio, a 30.75% reduction in radial leakage curve length, and superior geometric performance when compared to other algebraic spiral scroll compressors.
Scratching beneath the surface: An evaluation of the management of scabies 2017–2023
Authors: Broster Bryony , Clarke Amanda , Iwuji Collins , Soni Suneeta
Published: March 2024

Introduction

Possible resistance to recommended treatments for scabies has emerged recently. In response to anecdotal reports of a recent increase in treatment failure with permethrin, the British Association for Sexual Health and HIV (BASHH) released a statement alerting members to this.

Aims

To examine attendances and the treatment pathways for scabies cases seen at local sexual health clinics.

Methodology

A case note review of scabies attendances between January 2017 and December 2023 was conducted. Data collected included patient demographics, clinical information, and scabies treatment histories. Statistical analysis was performed.

Results

143 patients attended with scabies. The number of scabies cases did not appear to increase significantly from 2017 to 2023 ( p = .09). There was significant increase in median number of treatments per case per year over time ( p = .013). The number of individuals needing second-line treatments increased significantly over time ( p-trend < 0.001).

Discussion

Individuals with scabies are requiring more treatments to clear infection. Use of ivermectin has risen in the last year suggesting that second-line treatment is increasingly needed for eradication. Whilst treatment failure may be due to non-compliance with treatment and decontamination efforts for both index and contacts, the more recent change in findings could be attributed to a fall in permethrin efficacy.
Development and evaluation of the sandwich flexure after impact test
Authors: Kuramoto Bradley K. , Stanfield Marcus L. , Adams Daniel O.
Published: March 2024

A four-point flexure after impact test method has been developed to assess the damage tolerance of sandwich structures under flexural loading. This test method, recently standardized as standard practice ASTM D8388 by ASTM International, is designed for use with sandwich specimens that have been impact damaged per ASTM D7766. The test method utilizes a four-point flexure fixture to test specimens using the methodology from ASTM D7249, along with modifications specified in the practice. The sandwich configurations investigated consisted of carbon/epoxy facesheets with a Nomex® honeycomb core. Mechanical testing was conducted to evaluate the proposed specimen design, fixturing, and test procedure. Finite element analysis was used to finalize the specimen sizing.
Glaucoma awareness, anxiety and its impact on patients undergoing visual field testing and optical coherence tomography
Authors: Maheshwari Devendra , Pillai Madhavi Ramanatha , George Koshy T Nithin , Nagdev Nimrita , Gunaselvi D Ranitha , Uduman Mohammed Sithiq , Kader Mohideen Abdul , Ramakrishnan Rengappa
Published: March 2024

Purpose

To assess the effect of Glaucoma awareness, knowledge, and anxiety on patients under visual field analysis by Humphrey's visual field analyzer (HFA) and optical coherence tomography(OCT)

Methods

This prospective comparative cohort study included glaucoma patients undergoing HFA (Group A)( n = 150) and OCT(Group B) ( n = 150). Each group consisted of 75 newly diagnosed patients and 75 patients who were on follow-up. Participants completed State trait anxiety inventory form Y2(STAI) before and after the test to assess pre-test and intra-test anxiety. Another validated and structured questionnaire was used to assess patient awareness and knowledge of glaucoma. Anxiety scores were used to make correlations and comparisons between the two groups and also against visual field reliability indices. The impact of awareness on anxiety scores and its correlation with reliability indices were also determined.

Results

Overall pretest and intratest anxiety scores in patients undergoing HFA were 52.39(9.5) and 52.45(8.6)and OCT 53.04(8.0) and 53.83(8.2) respectively.Pretest anxiety was less in follow-up patients of both groups(Group A-51.04,Group B-52.72).There was no statistically significant difference between the groups(pretest p = 0.52,Intratest p = 0.15). Anxiety score was found to be significantly high in female participants(54.07, p = 0.01)and those without awareness( p < 0.001). Patients with education of graduation and above in group B had significantly lower anxiety scores( p = 0.007).

Conclusion

Anxiety levels induced by both diagnostic modalities HFA and OCT appear to be similar and it does not affect the reliability indices.Anxiety score was higher in female participants and participants lacking disease awareness.
Associations between physical educators’ appearance and sex and high school pupils’ cognitive performance and perceptions of teacher characteristics
Authors: Chen YuChun , Myers Brian
Published: March 2024

The importance of physical educators obtaining a discipline-specific appearance as role models is documented in the literature. Previous research has examined the influence of physical education teachers’ body fatness, (dis)ability, and age on pupils’ learning and perceptions of the teachers. To expand the research line, this study focused on teachers’ formal/informal appearance and their sex. Four 20-minute videos consisting of female informal appearance (FIA), female formal appearance (FFA), male informal appearance (MIA), and male formal appearance (MFA) were created to collect data from 533 high school pupils. A content examination and a perception questionnaire were used to measure cognitive performance and perceptions of the teachers. Factorial analysis of variance (ANOVA) was conducted to identify any significant main effects or interaction effects on the tchoukball examination, two content areas (i.e. techniques and strategies), and perceptions of three teacher characteristics (i.e. likability, competence, and appropriateness as a role model). Findings revealed significant main effects for teacher appearance on the overall examination and both content areas. Participants who watched the informal appearance videos scored significantly higher than those who watched the formal appearance videos. Furthermore, there was an interaction effect on the strategy portion of the examination. Participants who watched the MIA video scored the highest, followed by those who watched the FIA, FFA, and MFA videos. Factorial ANOVA found no significant main effect or interaction effect on the three teacher characteristics. One key conclusion indicates that the formal/informal appearance is far more open to interpretation than the (dis)ability and age aspects.
Tale of two requesters: How public records law experiences differ by requester types
Authors: Wagner A. Jay , Cuillier David
Published: March 2024

The journalism industry was central to the materialization of U.S. freedom of information (FOI) laws, yet journalists frequently voice dissatisfaction with the state of FOI laws. The study surveyed 330 public records requesters on their experiences with FOI laws, finding public-interest requesters (journalists, academics, nonprofits, and private individuals) reported a significantly different experience, including a lower likelihood of receiving records, than for-profit requesters (commercial requesters and lawyers). For-profit requesters were less likely to believe FOI laws positively impact government accountability or improve society. The findings suggest reassessing whom the laws serve and whether they meet their original democratic objectives.
Do French speakers have an advantage in learning English vocabulary thanks to familiar suffixes?
Authors: Menut Amélie , Brysbaert Marc , Casalis Séverine
Published: March 2024

Previous research has shown that languages from nearby families are easier to learn as second languages (L2) than languages from more distant families, attributing this difference to the presence of shared elements between the native language (L1) and L2. Building on this idea, we hypothesised that suffixes present in L1 might facilitate complex word acquisition in L2. To test this hypothesis, we recruited 76 late French-English bilinguals and tasked them with learning a set of 80 English-derived words containing suffixes that also exist in French (e.g., -able) or are unique to English (e.g., -ness). Consolidation of the learned words was assessed 1 week after the last learning session. The results showed a significant learning effect across the learning trials and consolidation, suggesting that the bilingual participants were able to acquire the derived words. However, contrary to our hypothesis, suffixes also existing in French did not give a significant advantage over English-unique suffixes. Further analysis revealed that this was due to variations in the consistency of familiar suffixes from L1. While some translation pairs shared the same suffix (e.g., amazement-étonnement), others had different suffixes (e.g., slippage-glissement). The type of translation pair with inconsistent suffix overlap (slippage-glissement) carried learning costs, preventing the bilingual participants from benefitting from the presence of familiar suffixes in L2 words. These findings suggest that shared information can be used effectively for L2 learning only if the mapping between L1 and L2 is consistent.
Effects of Eccentric Versus Concentric Strengthening in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial
Authors: Karabay Damla , Yeşilyaprak Sevgi Sevi , Erduran Mehmet , Ozcan Cem
Published: March 2024

Background:

Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS.

Hypothesis:

Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP.

Study Design:

Randomized controlled trial.

Level of Evidence:

Level 2.

Methods:

A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24.

Results:

For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG ( P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant ( P > 0.05).

Conclusion:

In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS.

Clinical Relevance:

Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.
A first step to clarity: Review of ECJ judgment of 19 October 2023, C-660/20(MK vs Lufthansa CityLine GmbH), ECLI:EU:C:2023:789
Authors: Kocher Eva
Published: March 2024

This article finds that the ECJ, in its judgment of 19 October 2023 (C-660/20), has succeeded in achieving a good degree of legal clarity by stating that difference in treatment of part-time workers can be established on the basis of a comparison of individual components of the remuneration. It calls on the ECJ to avoid treating a formal assessment as a decisive issue, and highlights the substantive arguments the ECJ makes about the justification of differential treatment.
The war on flags: The opposition to state-sponsored LGBTQ+ symbols
Authors: López Ortega Alberto
Published: March 2024

Negativity against LGBTQ+ and gender equality symbols is escalating across Western European countries, including those at the forefront of sexual modernism. Drawing on data from Spain, this paper theorizes and finds that state-sponsored LGBTQ+ symbols receive significantly more negativity than other aspects of LGBTQ+ issues related to general and specific attitudes toward formal rights. The negativity is primarily explained by support for Vox, a radical right-wing party, and age. The study provides insights into the complexities of public opinion surrounding LGBTQ+ symbols, offering a nuanced understanding of the challenges faced by the LGBTQ+ community in terms of acceptance and visibility. Furthermore, it highlights the influence of political affiliations and generational factors in shaping these attitudes.
Educational improvement to whose images? – A coloniality perspective of higher education policy in Taiwan
Authors: Liang Jingwun
Published: March 2024

The recent reform movement of higher education policies, which are modeled on the top-ranked Western higher education institutions globally, has significantly impacted the administrative model among universities in Taiwan. This study takes the Higher Education Sprout Project, one of the current governmental higher education policies, as an example to examine the problem representation of the policy discourse and how one regionally selective university responds to the policy. This study aims to provide an alternative perspective to unpack how the global university rankings and the entrenched “world-class” imaginary have represented higher education improvement agenda in Taiwan. By bringing light to a coloniality perspective, this study argues that the ongoing colonial logic has been promoted and perpetuated by current higher education policies, which have reshaped the institutional mission of Taiwanese universities. The long-term misinterpreted connotation of “internationalization” and the entrenched “world-class” ideology within policy discourses have overlooked and systemically denied the Western hegemony of epistemic violence, as well as the Anglo-American dominated academic coloniality.
Practice patterns in reporting and documentation of Charles Bonnet syndrome: a retrospective review following COVID-19
Authors: Abdulhussein Dalia , Jones Lee , Dintakurti Sri Harsha , Moosajee Mariya
Published: March 2024

Background:

Charles Bonnet syndrome (CBS) is characterized by visual hallucinations occurring in people with visual impairment. CBS can negatively impact psychological well-being, and the COVID-19 pandemic period was associated with an exacerbation of symptoms.

Objectives:

To compare clinical practice patterns and reporting of CBS at a tertiary eye care center between an interval prior to the COVID-19 pandemic and an interval during the pandemic.

Design:

Retrospective chart review.

Methods:

A search of electronic medical records for all suspected CBS cases was conducted between 1 March 2019 and 29 February 2020 (prior pandemic interval) and between 1 September 2020 and 29 August 2021 (peri-pandemic interval). Data retrieved from records included patient demographics, visual acuity at the time of CBS onset, type of hallucinations, reporting healthcare professional, management strategies and patient-reported impact of hallucinations.

Results:

In total, 223 appointments referred to CBS in 156 patients at the prior interval, while 239 appointments referred to CBS in 155 patients at the peri-pandemic interval, representing 0.07% and 0.09% of all hospital attendance, respectively. Clinical subspecialty where CBS was most commonly reported was medical retina, and a greater proportion of patients at both time intervals were female. Types of hallucinations, management strategies and patient-reported impact were seldom reported, although documentation improved at the latter interval.

Conclusion:

Practice patterns and patient characteristics were similar between the two intervals; however, subtle differences suggest a growing awareness of CBS. Targeted interventions in high-burden clinical subspecialties may encourage reporting and improve documentation of CBS.
A multicenter study of venetoclax-based treatment for patients with Richter transformation of chronic lymphocytic leukemia
Authors: Hampel Paul J. , Swaminathan Mahesh , Rogers Kerry A. , Parry Erin M. , Burger Jan A. , Davids Matthew S. , Ding Wei , Ferrajoli Alessandra , Hyak Jonathan M. , Jain Nitin , Kenderian Saad S. , Wang Yucai , Wierda William G. , Woyach Jennifer A. , Parikh Sameer A. , Thompson Philip A.
Published: March 2024

Patients with chronic lymphocytic leukemia (CLL) who develop Richter transformation (RT) have a poor prognosis when treated with chemoimmunotherapy regimens used for de novo diffuse large B-cell lymphoma. Venetoclax, a BCL2 inhibitor, has single-agent efficacy in patients with RT and is potentially synergistic with chemoimmunotherapy. In this multicenter, retrospective study, we evaluated 62 patients with RT who received venetoclax-based treatment outside of a clinical trial, in combination with a Bruton tyrosine kinase inhibitor (BTKi; n=28), rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) (n=13), or intensive chemoimmunotherapy other than R-CHOP (n=21). The best overall and complete response rates were 36%/25%, 54%/46%, and 52%/38%, respectively. The median progression-free and overall survival estimates for the same treatment groups were 4.9/14.3 months, 14.9 months/not reached, and 3.3/9 months, respectively. CLL with del(17p) was associated with a lower complete response rate in the total cohort (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.04-0.6; p=0.01) and venetoclax-naïve subgroup (OR 0.13; 95%CI 0.02-0.66; p=0.01). TP53 mutated CLL was associated with a lower complete response rate (OR 0.15; 95%CI 0.03-0.74; p=0.02) and shorter progression-free survival (hazard ratio 3.1; 95%CI 1.21-7.95; p=0.02) only in venetoclax-naïve subgroup. No other clinical or baseline characteristics, including prior venetoclax treatment for CLL, showed statistically significant association with outcomes. Grade 3-4 neutropenia and thrombocytopenia events were most frequent with intensive chemoimmunotherapy + venetoclax; grade 3-4 infection rates were similar across treatment groups. In this difficult-to-treat RT patient population, venetoclax-based combination regimens achieved high response rates, with durable remission and survival observed in a subset of patients.
Central sleep apnoea: not just one phenotype
Authors: Randerath Winfried , Baillieul Sébastien , Tamisier Renaud
Published: March 2024

Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have prompted investigations aiming to achieve a more precise differentiation and description of the entities of central sleep apnoea (CSA). There is increasing evidence for the heterogeneity of CSA in terms of underlying aetiology, pathophysiological concepts, treatment response and outcome. Assigning patients to these phenotypes allows for the selection of individualised therapies. Major pathophysiological characteristics include loop gain, apnoeic threshold, breathing regulation and neuromuscular mechanics. Chronic heart failure is the most important underlying disease, leading to nonhypercapnic CSA based on increased loop and controller gain. Although many questions remain, this review tries to describe the current knowledge on the pathophysiology of the clinical entities. The description of prognostic aspects may guide treatment indication and the selection of pharmacotherapy and invasive options. In addition, the paper provides an update on the current understanding of adaptive servo-ventilation and its role in the treatment of CSA.
The effects of flow settings during high-flow nasal cannula oxygen therapy for neonates and young children
Authors: Li Jie , Deng Ni , He Wan Jia Aaron , Yang Cui , Liu Pan , Albuainain Fai A. , Ring Brian J. , Miller Andrew G. , Rotta Alexandre T. , Guglielmo Robert D. , Milési Christophe
Published: March 2024

Background

During neonatal and paediatric high-flow nasal cannula therapy, optimising the flow setting is crucial for favourable physiological and clinical outcomes. However, considerable variability exists in clinical practice regarding initial flows and subsequent adjustments for these patients. Our review aimed to summarise the impact of various flows during high-flow nasal cannula treatment in neonates and children.

Methods

Two investigators independently searched PubMed, Embase, Web of Science, Scopus and Cochrane forin vitroandin vivostudies published in English before 30 April 2023. Studies enrolling adults (≥18 years) or those using a single flow setting were excluded. Data extraction and risk of bias assessments were performed independently by two investigators. The study protocol was prospectively registered with PROSPERO (CRD42022345419).

Results

38 406 studies were identified, with 44 included.In vitrostudies explored flow settings’ effects on airway pressures, humidity and carbon dioxide clearance; all were flow-dependent. Observational clinical studies consistently reported that higher flows led to increased pharyngeal pressure and potentially increased intrathoracic airway pressure (especially among neonates), improved oxygenation, and reduced respiratory rate and work of breathing up to a certain threshold. Three randomised controlled trials found no significant differences in treatment failure among different flow settings. Flow impacts exhibited significant heterogeneity among different patients.

Conclusion

Individualising flow settings in neonates and young children requires consideration of the patient's peak inspiratory flow, respiratory rate, heart rate, tolerance, work of breathing and lung aeration for optimal care.
Decoding epitranscriptomic regulation of viral infection: mapping of RNA N6-methyladenosine by advanced sequencing technologies
Authors: Fan Xiangdong , Zhang Yitong , Guo Ruiying , Yue Kuo , Smagghe Guy , Lu Yongyue , Wang Luoluo
Published: March 2024

Elucidating the intricate interactions between viral pathogens and host cellular machinery during infection is paramount for understanding pathogenic mechanisms and identifying potential therapeutic targets. The RNA modification N6-methyladenosine (m6A) has emerged as a significant factor influencing the trajectory of viral infections. Hence, the precise and quantitative mapping of m6A modifications in both host and viral RNA is pivotal to understanding its role during viral infection. With the rapid advancement of sequencing technologies, scientists are able to detect m6A modifications with various quantitative, high-resolution, transcriptome approaches. These technological strides have reignited research interest in m6A, underscoring its significance and prompting a deeper investigation into its dynamics during viral infections. This review provides a comprehensive overview of the historical evolution of m6A epitranscriptome sequencing technologies, highlights the latest developments in transcriptome-wide m6A mapping, and emphasizes the innovative technologies for detecting m6A modification. We further discuss the implications of these technologies for future research into the role of m6A in viral infections.

Graphical Abstract
SurvConvMixer: robust and interpretable cancer survival prediction based on ConvMixer using pathway-level gene expression images
Authors: Wang Shuo , Liu Yuanning , Zhang Hao , Liu Zhen
Published: March 2024

Cancer is one of the leading causes of deaths worldwide. Survival analysis and prediction of cancer patients is of great significance for their precision medicine. The robustness and interpretability of the survival prediction models are important, where robustness tells whether a model has learned the knowledge, and interpretability means if a model can show human what it has learned. In this paper, we propose a robust and interpretable model SurvConvMixer, which uses pathways customized gene expression images and ConvMixer for cancer short-term, mid-term and long-term overall survival prediction. With ConvMixer, the representation of each pathway can be learned respectively. We show the robustness of our model by testing the trained model on absolutely untrained external datasets. The interpretability of SurvConvMixer depends on gradient-weighted class activation mapping (Grad-Cam), by which we can obtain the pathway-level activation heat map. Then wilcoxon rank-sum tests are conducted to obtain the statistically significant pathways, thereby revealing which pathways the model focuses on more. SurvConvMixer achieves remarkable performance on the short-term, mid-term and long-term overall survival of lung adenocarcinoma, lung squamous cell carcinoma and skin cutaneous melanoma, and the external validation tests show that SurvConvMixer can generalize to external datasets so that it is robust. Finally, we investigate the activation maps generated by Grad-Cam, after wilcoxon rank-sum test and Kaplan–Meier estimation, we find that some survival-related pathways play important role in SurvConvMixer.
Prediction accuracy of genomic estimated breeding values for fruit traits in cultivated tomato (Solanum lycopersicum L.)
Authors: Yeon Jeyun , Nguyen Thuy Tien Phan , Kim Minkyung , Sim Sung-Chur
Published: March 2024

Background

Genomic selection (GS) is an efficient breeding strategy to improve quantitative traits. It is necessary to calculate genomic estimated breeding values (GEBVs) for GS. This study investigated the prediction accuracy of GEBVs for five fruit traits including fruit weight, fruit width, fruit height, pericarp thickness, and Brix. Two tomato germplasm collections (TGC1 and TGC2) were used as training populations, consisting of 162 and 191 accessions, respectively.

Results

Large phenotypic variations for the fruit traits were found in these collections and the 51K Axiom™ SNP array generated confident 31,142 SNPs. Prediction accuracy was evaluated using different cross-validation methods, GS models, and marker sets in three training populations (TGC1, TGC2, and combined). For cross-validation, LOOCV was effective as k-fold across traits and training populations. The parametric (RR-BLUP, Bayes A, and Bayesian LASSO) and non-parametric (RKHS, SVM, and random forest) models showed different prediction accuracies (0.594–0.870) between traits and training populations. Of these, random forest was the best model for fruit weight (0.780–0.835), fruit width (0.791–0.865), and pericarp thickness (0.643–0.866). The effect of marker density was trait-dependent and reached a plateau for each trait with 768−12,288 SNPs. Two additional sets of 192 and 96 SNPs from GWAS revealed higher prediction accuracies for the fruit traits compared to the 31,142 SNPs and eight subsets.

Conclusion

Our study explored several factors to increase the prediction accuracy of GEBVs for fruit traits in tomato. The results can facilitate development of advanced GS strategies with cost-effective marker sets for improving fruit traits as well as other traits. Consequently, GS will be successfully applied to accelerate the tomato breeding process for developing elite cultivars.
A mapping review of interventions to address patients who frequently seek care in the emergency department
Authors: Memedovich Ally , Asante Benedicta , Khan Maha , Eze Nkiruka , Holroyd Brian R. , Lang Eddy , Kashuba Sherri , Clement Fiona
Published: March 2024

Background

The high utilization of acute care services, particularly emergency departments (ED), continues to be a significant concern for healthcare providers. Numerous approaches have been studied to meet the care needs of patients who frequently seek care in the ED; however, there is no comprehensive review of the current literature base. As such, a current understanding of the interventions initiated within the ED to address the needs of frequent users is required. This mapping review had three objectives: identify the characteristics associated with the need to frequently seek care in the ED; identify interventions implemented to address the needs of this population; and identify gaps in the current evidence base.

Methods

A knowledge map was created by scoping the literature to identify characteristics associated with frequent ED use and interventions implemented to address frequent use. Then, a literature search was conducted to determine what has been implemented by EDs to reduce frequent ED use. The literature was searched from 2013 to January 2023. MeSH terms and keywords were used to identify relevant studies. Studies implementing an intervention for those with characteristics associated with frequent ED use and reporting on ED use were included.

Results

Twenty-three (23) controlled trials and 35 observational studies were included. The most common populations were older adults, those with chronic conditions, and generic “frequent users”. No studies assessed Indigenous Peoples or racial minorities, and few assessed patients with a disability or patients experiencing homelessness. The most common interventions were referrals, care plans, case management, care coordination, and follow-up phone calls. Most studies reported ED revisits, hospitalization, costs, length-of-stay, or outpatient utilization. Few assessed patient or staff perspectives. About one-third of studies (n = 24) reported significant reductions in ED revisits.

Conclusions

Similar interventions, mainly focused on care coordination and planning, have been implemented to address frequent use of the ED. There are still significant gaps in the populations that have been studied. Efforts now must be undertaken to study more diverse populations whose care needs are not being met elsewhere and thus frequent the ED often.
Evaluating methods for risk prediction of Covid-19 mortality in nursing home residents before and after vaccine availability: a retrospective cohort study
Authors: Aryal Komal , Mowbray Fabrice I. , Miroshnychenko Anna , Strum Ryan P. , Dash Darly , Hillmer Michael P. , Malikov Kamil , Costa Andrew P. , Jones Aaron
Published: March 2024

Background

SARS-CoV-2 vaccines are effective in reducing hospitalization, COVID-19 symptoms, and COVID-19 mortality for nursing home (NH) residents. We sought to compare the accuracy of various machine learning models, examine changes to model performance, and identify resident characteristics that have the strongest associations with 30-day COVID-19 mortality, before and after vaccine availability.

Methods

We conducted a population-based retrospective cohort study analyzing data from all NH facilities across Ontario, Canada. We included all residents diagnosed with SARS-CoV-2 and living in NHs between March 2020 and July 2021. We employed five machine learning algorithms to predict COVID-19 mortality, including logistic regression, LASSO regression, classification and regression trees (CART), random forests, and gradient boosted trees. The discriminative performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) for each model using 10-fold cross-validation. Model calibration was determined through evaluation of calibration slopes. Variable importance was calculated by repeatedly and randomly permutating the values of each predictor in the dataset and re-evaluating the model’s performance.

Results

A total of 14,977 NH residents and 20 resident characteristics were included in the model. The cross-validated AUCs were similar across algorithms and ranged from 0.64 to 0.67. Gradient boosted trees and logistic regression had an AUC of 0.67 pre- and post-vaccine availability. CART had the lowest discrimination ability with an AUC of 0.64 pre-vaccine availability, and 0.65 post-vaccine availability. The most influential resident characteristics, irrespective of vaccine availability, included advanced age (≥ 75 years), health instability, functional and cognitive status, sex (male), and polypharmacy.

Conclusions

The predictive accuracy and discrimination exhibited by all five examined machine learning algorithms were similar. Both logistic regression and gradient boosted trees exhibit comparable performance and display slight superiority over other machine learning algorithms. We observed consistent model performance both before and after vaccine availability. The influence of resident characteristics on COVID-19 mortality remained consistent across time periods, suggesting that changes to pre-vaccination screening practices for high-risk individuals are effective in the post-vaccination era.
A database for oncological research and quality assurance: implementation and first experiences with the University Clinical Cancer Registry Regensburg
Authors: Saibold Anna , Koller Michael , Mueller Karolina , Koelbl Oliver , Vielsmeier Veronika , Pukrop Tobias , Spies Oliver , Eilers Vivian , Brese Cathleen , Amann Denise , Maurer Julia
Published: March 2024

Legal requirements, certification specifications, as well as the demand for real world data on cancer research and treatment led to the decision to establish the University Clinical Cancer Registry Regensburg. The first organizational step in the implementation process of this oncological data registry was the evaluation and acquisition of suitable tumor documentation and database software. For this purpose, an evaluation matrix comprising required database software criteria was designed and consented by a multidisciplinary group of experts. Next, a yearly report of the Institute for Cancer Center Certification (OnkoZert 2019) was considered to identify database software already in use. The identified systems were rated according to the established criteria matrix and other relevant aspects. Onkostar was the system considered most suited for building up an oncological data repository. In the second step, the central IT department implemented Onkostar on-premise and migrated digitally available data after an adaptation and verification process. In parallel, a uniformed process for handling emerging oncological research questions was established. For research requirements, a data analysis concept was established comprising a proposal for data extraction, procedural instructions, and statistical training materials. In the final step, the implemented software and the process for handling research requirements in practice were evaluated by using two exemplary use cases with the focus on clinic-wide analyses and currently relevant scientific topics. A 2-month test phase conducted by various user groups showed a preference for Onkostar tumor documentation software from IT-Choice, mainly because of its adjustability to support research and treatment. Newly added and migrated data can be used for certification and research purposes. This software also provides support in current tumor documentation by displaying the course of cancer disease for individual patients over time. Such oncological data registries can be a powerful tool for legally required cancer registration, the certification of medical centers, as well as for additional oncological research. Tumor databases can be helpful in projects on cancer treatment and scientific aims. The experiences made at the University Hospital Regensburg may be used as a guidance for implementing clinical databases in similar settings with interdisciplinary responsibilities.
Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care: a cross-sectional study
Authors: Spek Michelle , Venekamp Roderick P. , de Groot Esther , Geersing Geert-Jan , Erkelens Daphne C. A. , van Smeden Maarten , Dobbe Anna S. M. , Delissen Mathé , Rutten Frans H. , Zwart Dorien L.
Published: March 2024

Background

In out-of-hours primary care (OHS-PC), semi-automatic decision support tools are often used during telephone triage. In the Netherlands, the Netherlands Triage Standard (NTS) is used. The NTS is mainly expert-based and evidence on the diagnostic accuracy of the NTS’ urgency allocation against clinically relevant outcomes for patients calling with shortness of breath (SOB) is lacking.

Methods

We included data from adults (≥18 years) who contacted two large Dutch OHS-PC centres for SOB between 1 September 2020 and 31 August 2021 and whose follow-up data about final diagnosis could be retrieved from their own general practitioner (GP).

The diagnostic accuracy (sensitivity and specificity with corresponding 95% confidence intervals (CI)) of the NTS’ urgency levels (high (U1/U2) versus low (U3/U4/U5) and ‘final’ urgency levels (including overruling of the urgency by triage nurses or supervising general practitioners (GPs)) was determined with life-threatening events (LTEs) as the reference. LTEs included, amongst others, acute coronary syndrome, pulmonary embolism, acute heart failure and severe pneumonia.

Results

Out of 2012 eligible triage calls, we could include 1833 adults with SOB who called the OHS-PC, mean age 53.3 (SD 21.5) years, 55.5% female, and 16.6% showed to have had a LTE. Most often severe COVID-19 infection (6.0%), acute heart failure (2.6%), severe COPD exacerbation (2.1%) or severe pneumonia (1.9%).

The NTS urgency level had a sensitivity of 0.56 (95% CI 0.50–0.61) and specificity of 0.61 (95% CI 0.58–0.63). Overruling of the NTS’ urgency allocation by triage nurses and/or supervising GPs did not impact sensitivity (0.56 vs. 0.54, p = 0.458) but slightly improved specificity (0.61 vs. 0.65, p < 0.001).

Conclusions

The semi-automatic decision support tool NTS performs poorly with respect to safety (sensitivity) and efficiency (specificity) of urgency allocation in adults calling Dutch OHS-PC with SOB. There is room for improvement of telephone triage in patients calling OHS-PC with SOB.

Trial registration

The Netherlands Trial Register, number: NL9682.
Communication barriers faced by pharmacists when managing patients with hypertension in a primary care team: a qualitative study
Authors: Tan Reuben , Kawaja Ariffin , Ooi Swee Phaik , Ng Chirk Jenn
Published: March 2024

Background

As primary care pharmacists take on an increasingly important and collaborative role in managing patients with chronic diseases, communication barriers with patients and healthcare colleagues have emerged. This study aimed to explore the communication barriers faced by pharmacists when managing patients with hypertension in a primary care team.

Methods

Twelve pharmacists working in five government primary care clinics were interviewed by a researcher using a topic guide. The interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis.

Results

Pharmacists’ management of patients with hypertension was found to be affected by communication challenges at three different levels: between pharmacists and patients, pharmacists and physicians, and physicians and patients. Barriers to communication between pharmacists and patients include language barrier, physical disabilities, medication brand changes, and specific challenges faced during video consultations. Barriers to communication between pharmacists and physicians include lack of access to patient information across institutions on the electronic medical records (EMR), inadequate and inappropriate documentation by physicians, and disruptive and ineffective phone calls by pharmacists to physicians. Barriers to communication between physicians and patients had a spillover effect on pharmacists; these barriers included language barrier, patients not discussing medication nonadherence with physicians, and conflicting advice given by physicians and pharmacists.

Conclusions

The communication barriers pharmacists faced when managing patients with hypertension involved multiple stakeholders. Many of the challenges resulted in patients having difficulty understanding and adhering to their management plan. Effective interventions to foster stronger interprofessional relationships and create a conducive platform of communication should be developed to address these communication barriers.
Comparative efficacy and safety of subcutaneous infliximab and vedolizumab in patients with Crohn’s disease and ulcerative colitis included in randomised controlled trials
Authors: Peyrin‐Biroulet Laurent , Arkkila Perttu , Armuzzi Alessandro , Danese Silvio , Ferrante Marc , Jordi Guardiola  , Jahnsen Jørgen , Louis Edouard , Lukáš Milan , Reinisch Walter , Roblin Xavier , Smith Philip J , Kwon Taek , Kim Jeeyoung , Yoon Sangwook , Kim Dong-Hyeon , Atreya Raja
Published: March 2024

Background

While indirect comparison of infliximab (IFX) and vedolizumab (VDZ) in adults with Crohn’s disease (CD) or ulcerative colitis (UC) shows that IFX has better effectiveness during induction, and comparable efficacy during maintenance treatment, comparative data specific to subcutaneous (SC) IFX (i.e., CT-P13 SC) versus VDZ are limited.

Aim

Pooled analysis of randomised studies to compare efficacy and safety with IFX SC and VDZ in moderate-to-severe inflammatory bowel disease.

Methods

Parallel-group, randomised studies evaluating IFX SC and VDZ in patients with moderate-to-severe CD or UC were identified. Eligible studies reported ≥ 1 prespecified outcome of interest at Week 6 (reflecting treatment during the induction phase) and/or at 1 year (Weeks 50-54; reflecting treatment during the maintenance phase). Prespecified efficacy and safety outcomes considered in this pooled analysis included the proportions of patients achieving disease-specific clinical responses, clinical remission, or discontinuing due to lack of efficacy, and the proportions of patients experiencing adverse events (AEs), serious AEs, infections, serious infections, or discontinuing due to AEs. Data from multiple studies or study arms were extracted and pooled using a random-effect model; comparative analyses were performed separately for patients with CD and UC.

Results

We identified three eligible CD trials and four eligible UC trials that assigned over 1200 participants per disease cohort to either IFX SC or VDZ. In patients with CD, intravenous induction therapy with IFX demonstrated better efficacy (non-overlapping 95% confidence intervals [CIs]) compared with VDZ; during the maintenance phase, IFX SC showed numerically better efficacy (overlapping 95% CIs) than VDZ. A lower proportion of IFX SC-treated patients discontinued therapy due to lack of efficacy over 1 year. In patients with UC, efficacy profiles were similar with IFX SC and VDZ during the induction and maintenance phases, and a lower proportion of IFX SC-treated patients discontinued therapy due to lack of efficacy over 1 year. In both cohorts, safety profiles for IFX SC and VDZ were generally comparable during 1 year.

Conclusion

IFX SC demonstrated better efficacy than VDZ in patients with CD, and similar efficacy to VDZ in patients with UC; 1-year safety was comparable with IFX SC and VDZ.
Validation of a fall rate prediction model for community-dwelling older adults: a combined analysis of three cohorts with 1850 participants
Authors: Wapp Christina , Mittaz Hager Anne-Gabrielle , Rikkonen Toni , Hilfiker Roger , Biver Emmanuel , Ferrari Serge , Kröger Heikki , Zwahlen Marcel , Zysset Philippe
Published: March 2024

Background

Fragility fractures in older adults are often caused by fall events. The estimation of an expected fall rate might improve the identification of individuals at risk of fragility fractures and improve fracture prediction.

Methods

A combined analysis of three previously developed fall rate models using individual participant data (n = 1850) was conducted using the methodology of a two-stage meta-analysis to derive an overall model. These previously developed models included the fall history as a predictor recorded as the number of experienced falls within 12 months, treated as a factor variable with the levels 0, 1, 2, 3, 4 and ≥ 5 falls. In the first stage, negative binomial regression models for every cohort were fit. In the second stage, the coefficients were compared and used to derive overall coefficients with a random effect meta-analysis. Additionally, external validation was performed by applying the three data sets to the models derived in the first stage.

Results

The coefficient estimates for the prior number of falls were consistent among the three studies. Higgin’s I2 as heterogeneity measure ranged from 0 to 55.39%. The overall coefficient estimates indicated that the expected fall rate increases with an increasing number of previous falls. External model validation revealed that the prediction errors for the data sets were independent of the model to which they were applied.

Conclusion

This analysis suggests that the fall history treated as a factor variable is a robust predictor of estimating future falls among different cohorts.