bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Computation Adaptive Saturated Self-Triggered Tracking Control of Uncertain Networked Systems
Authors: Wu Wenjing , Xu Ning , Niu Ben , Zhao Xudong , Ahmad Adil M.
Published: June 2023

In this paper, a low-computation adaptive self-triggered tracking control scheme is proposed for a class of strict-feedback nonlinear systems with input saturation. By introducing two novel error transformation functions, the designed low-computation adaptive control scheme can overcome the problem of complexity explosion in the absence of any filters, such that the developed control scheme is more applicable. In addition, to save communication resources in networked systems, a self-triggered communication strategy is proposed which can predict the next trigger point based on the current information. Compared with traditional event-triggered mechanisms, the computational burden arising from continuous monitoring of threshold conditions was successfully avoided. Furthermore, the input saturation problem considered in this paper prevents the overload phenomenon caused by signal jumps, and the adverse effects are compensated by introducing an auxiliary system. The effectiveness of the developed control scheme is verified through a simulation example.
WYDISWYG: A Method to Design User Interfaces Combining Design Principles and Quality Factors
Authors: Galindo-Losada Julián , Ayala-Tipan Carlos , Santórum Marco , Carrión-Toro Mayra , Acosta-Vargas Patricia
Published: June 2023

The field of human–computer interaction is constantly evolving and facing new challenges. In this study, we propose an experimental method for designing e-commerce user interfaces with varying levels of aesthetics and usability while maintaining a similar level of user experience. The method is based on the Deming Cycle and Nielsen’s framework for design principles. Four e-commerce websites were designed with low/high levels of aesthetics and usability. Based on 160 surveys, the experimental results demonstrated that it is possible to design user interfaces with varying levels of aesthetics and usability while maintaining a similar level of user design perception. Our findings suggest that usability is more crucial than aesthetics in enhancing user experience, which aligns with previous studies. We also emphasize considering aesthetics and usability in UI design and propose the principle “What You Design Is What You Get” (WYDISWYG) as a foundation for future research. Among the evaluated websites, Website1 (the best design) achieved the highest UI quality, with users perceiving it positively at an impressive rate of almost 0.91 percent. In contrast, Website4 (the worst design) had the lowest UI quality, receiving a perception score of only 0.38 percent. The websites designed with a combination of aesthetics and usability, Website2 and Website3, garnered different perception values of 0.79 and 0.51, respectively. While this study has some limitations, such as the subjective selection of features and the focus on e-commerce websites only, it provides a starting point for further investigation into the selection of design principles, consideration of other website domains, and clarification of users’ perception of UI elements to align with Nielsen’s principles.
Optimization of Vibration Parameters for Red Jujube Trees with Different Diameters
Authors: Yu Chenhao , Qiao Yichen , Feng Junzhe , Guo Taifeng , Luo Wenkai , Guo Jiapan , Hu Yaohua
Published: June 2023

Vibratory harvesting is the primary method used to harvest red jujubes. This study aimed to improve the efficiency of vibratory harvesting for red jujubes and identify the optimal parameters for harvesting at different jujube tree diameters. A model for the forced vibration dynamics of jujube trees was established, and a three-dimensional model was constructed for different diameter variations. A kinematic simulation analysis was then conducted to determine the inherent frequency and modal vibration patterns of jujube trees. Harmonic response analysis was performed to study the displacement and acceleration responses of jujube trees with different diameters to different vibration factors. Subsequently, vibration tests were carried out on the jujube trees. The results showed that the vibration characteristics of trees with different diameters were distinct at each vibration order, and the maximum number of vibrating branches differed at different orders of vibration. The vibration frequency ranges for vibration harvesting of jujube trees with 30 mm, 50 mm, and 70 mm diameters were determined as 4–30 Hz, 6–25 Hz, and 17–29 Hz, respectively. Furthermore, the study obtained the optimal vibration parameters for jujube trees by establishing the regression equations of harvest rate and each vibration factor. For jujube trees with a diameter of 30 mm, the optimal parameters included a vibration frequency of 30 Hz and a vibration amplitude of 15 mm. For jujube trees with a diameter of 50 mm, the optimal parameters included a vibration frequency of 18.55 Hz and a vibration amplitude of 12.52 mm. Lastly, for jujube trees with a diameter of 70 mm, the optimal parameters included a vibration frequency of 6 Hz and a vibration amplitude of 15 mm. This study provides a theoretical foundation and technical support for improving the efficiency of vibratory harvesting and identifying the optimal vibration harvesting parameters for jujube trees with different diameters.
MicroRNA-Related Polymorphism and Their Association with Fibromyalgia
Authors: Berg Fabian , Moser Dirk A. , Hagena Verena , Streit Fabian , Mosch Benjamin , Kumsta Robert , Herpertz Stephan , Diers Martin
Published: June 2023

MicroRNAs are tissue-specific expressed short RNAs that serve post-transcriptional gene regulation. A specific microRNA can bind to mRNAs of different genes and thereby suppress their protein production. In the context of the complex phenotype of fibromyalgia, we used the Axiom miRNA Target Site Genotyping Array to search genome-wide for DNA variations in microRNA genes, their regulatory regions, and in the 3’UTR of protein-coding genes. To identify disease-relevant DNA polymorphisms, a cohort of 176 female fibromyalgia patients was studied in comparison to a cohort of 162 healthy women. The association between 48,329 markers and fibromyalgia was investigated using logistic regression adjusted for population stratification. Results show that 29 markers had p-values < 1 × 10−3, and the strongest association was observed for rs758459 (p-value of 0.0001), located in the Neurogenin 1 gene which is targeted by hsa-miR-130a-3p. Furthermore, variant rs2295963 is predicted to affect binding of hsa-miR-1-3p. Both microRNAs were previously reported to be differentially expressed in fibromyalgia patients. Despite its limited statistical power, this study reports two microRNA-related polymorphisms which may play a functional role in the pathogenesis of fibromyalgia. For a better understanding of the disease pattern, further functional analyses on the biological significance of microRNAs and microRNA-related polymorphisms are required.
Drainage Pattern Recognition of River Network Based on Graph Convolutional Neural Network
Authors: Xu Xiaofeng , Liu Pengcheng , Guo Mingwu
Published: June 2023

Drainage network pattern recognition is a significant task with wide applications in geographic information mining, map cartography, water resources management, and urban planning. Accurate identification of spatial patterns in river networks can help us understand geographic phenomena, optimize map cartographic quality, assess water resource potential, and provide a scientific basis for urban development planning. However, river network pattern recognition still faces challenges due to the complexity and diversity of river networks. To address this issue, this study proposes a river network pattern recognition method based on graph convolutional networks (GCNs), aiming to achieve accurate classification of different river network patterns. We utilize binary trees to construct a hierarchical tree structure based on river reaches and progressively determine the tree hierarchy by identifying the upstream and downstream relationships among river reaches. Based on this representation, input features for the graph convolutional model are extracted from both spatial and geometric perspectives. The effectiveness of the proposed method is validated through classification experiments on four types of vector river network data (dendritic, fan-shaped, trellis, and fan-shaped). The experimental results demonstrate that the proposed method can effectively classify vector river networks, providing strong support for research and applications in related fields.
Gender Influences Gut Microbiota among Patients with Irritable Bowel Syndrome
Authors: Pecyna Paulina , Gabryel Marcin , Mankowska-Wierzbicka Dorota , Nowak-Malczewska Dorota M. , Jaskiewicz Katarzyna , Jaworska Marcelina M. , Tomczak Hanna , Rydzanicz Malgorzata , Ploski Rafal , Grzymislawski Marian , Dobrowolska Agnieszka , Gajecka Marzena
Published: June 2023

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disease that affects approximately 11% of the general population. The gut microbiota, among other known factors, plays a substantial role in its pathogenesis. The study aimed to characterize the gut microbiota differences between patients with IBS and unaffected individuals, taking into account the gender aspect of the patients and the types of IBS determined on the basis of the Rome IV Criteria, the IBS-C, IBS-D, IBS-M, and IBS-U. In total, 121 patients with IBS and 70 unaffected individuals participated in the study; the derived stool samples were subjected to 16S rRNA amplicon sequencing. The gut microbiota of patients with IBS was found to be more diverse in comparison to unaffected individuals, and the differences were observed primarily among Clostridiales, Mogibacteriaceae, Synergistaceae, Coriobacteriaceae, Blautia spp., and Shuttleworthia spp., depending on the study subgroup and patient gender. There was higher differentiation of females’ gut microbiota compared to males, regardless of the disease status. No correlation between the composition of the gut microbiota and the type of IBS was found. Patients with IBS were characterized by more diverse gut microbiota compared to unaffected individuals. The gender criterion should be considered in the characterization of the gut microbiota. The type of IBS did not determine the identified differences in gut microbiota.
Mind the Move: Developing a Brain-Computer Interface Game with Left-Right Motor Imagery
Authors: Prapas Georgios , Glavas Kosmas , Tzimourta Katerina D. , Tzallas Alexandros T. , Tsipouras Markos G.
Published: June 2023

Brain-computer interfaces (BCIs) are becoming an increasingly popular technology, used in a variety of fields such as medical, gaming, and lifestyle. This paper describes a 3D non-invasive BCI game that uses a Muse 2 EEG headband to acquire electroencephalogram (EEG) data and OpenViBE platform for processing the signals and classifying them into three different mental states: left and right motor imagery and eye blink. The game is developed to assess user adjustment and improvement in BCI environment after training. The classification algorithm used is Multi-Layer Perceptron (MLP), with 96.94% accuracy. A total of 33 subjects participated in the experiment and successfully controlled an avatar using mental commands to collect coins. The online metrics employed for this BCI system are the average game score, the average number of clusters and average user improvement.
Potential Global Invasion Risk of Scale Insect Pests Based on a Self-Organizing Map
Authors: Deng Jun , Li Junjie , Zhang Xinrui , Zeng Lingda , Guo Yanqing , Wang Xu , Chen Zijing , Zhou Jiali , Huang Xiaolei
Published: June 2023

In the present study, a global presence/absence dataset including 2486 scale insect species in 157 countries was extracted to assess the establishment risk of potential invasive species based on a self-organizing map (SOM). According to the similarities in species assemblages, a risk list of scale insects for each country was generated. Meanwhile, all countries in the dataset were divided into five clusters, each of which has high similarities of species assemblages. For those countries in the same neuron of the SOM output, they may pose the greatest threats to each other as the sources of potential invasive scale insect species, and therefore, require more attention from quarantine departments. In addition, normalized ζi values were used to measure the uncertainty of the SOM output. In total, 9 out of 63 neurons obtained high uncertainty with very low species counts, indicating that more investigation of scale insects should be undertaken in some parts of Africa, Asia and Northern Europe.
Maternal Cigarette Smoking and Congenital Upper and Lower Limb Differences: A Systematic Review and Meta-Analysis
Authors: Cevik Jevan , Salehi Omar , Gaston James , Rozen Warren M.
Published: June 2023

Maternal smoking during pregnancy has been associated with adverse effects on foetal development, including congenital limb anomalies. This systematic review aimed to provide an updated assessment of the association between maternal smoking during pregnancy and the risk of congenital limb anomalies. A systematic search was conducted to identify relevant studies published up to February 2023. Studies reporting on the relationship between maternal smoking during pregnancy and congenital digital anomalies or congenital limb reduction defects were included. Two independent reviewers screened the studies, extracted data, and assessed the quality of the included studies. Meta-analyses were performed to estimate the pooled odds ratios with 95% confidence intervals using fixed and random-effects models. In total, 37 publications comprising 11 cohort and 26 case-control studies were included in the systematic review. The meta-analysis demonstrated a significant increased risk of congenital limb reduction defects (pooled OR: 1.27, 95% CI: 1.18–1.38) in infants born to mothers who smoked during pregnancy. Similarly, a significant relationship was observed for the development of polydactyly/syndactyly/adactyly when considered as a single group (pooled OR: 1.32, 95% CI: 1.25–1.40). Yet, in contrast, no significant association was observed when polydactyly (pooled OR: 1.06, 95% CI: 0.88–1.27) or syndactyly (pooled OR: 0.91, 95% CI: 0.77–1.08) were considered individually. This systematic review provides updated evidence of a significant relationship between maternal smoking during pregnancy and increased risk of congenital limb anomalies. These findings highlight the potential detrimental effects of smoking on foetal limb development and underscore the importance of smoking cessation interventions for pregnant women to mitigate these risks.
Effect of COVID-19 on Musculoskeletal Performance in Gait and the Timed-Up and Go Test
Authors: Kowal Mateusz , Morgiel Ewa , Winiarski Sławomir , Gieysztor Ewa , Madej Marta , Sebastian Agata , Madziarski Marcin , Wedel Nicole , Proc Krzysztof , Madziarska Katarzyna , Wiland Piotr , Paprocka-Borowicz Małgorzata
Published: June 2023

Introduction: The total number of confirmed cases of COVID-19 caused by the SARS-CoV-2 virus infection is over 621 million in the world. In approximately 63% of cases, the patient still experiences persistent symptoms 30 days after the onset of symptoms or hospitalisation, and 45.9% of patients have experienced or will experience symptoms for at least three months. Despite the prevalence of chronic symptoms and pathological changes that may affect gait and functional mobility in people with a history of COVID-19, there are few publications investigating the impact of these abnormalities. This study aims to determine the long-term effects of COVID-19 on gait and the Timed-Up and Go Task. Material and Methods: A total of 30 individuals took part in the experiment. The subjects in the study group were infected with the COVID-19 virus and required hospital treatment. Prior to the study, the subjects had no chronic diseases or other conditions affecting the musculoskeletal system. The non-infected by COVID-19 group was a healthy population with no history of COVID-19 disease. The study used the inertial system wireless motion analysis system based on 15 inertial sensors (inertial measurement units, IMUs). IMU sensors were placed on the following body segments: head, sternum, middle and lower spine, shoulder, arm, forearm, hand, shank, for the left and right limb. Movement task reports generated from the recording were created using myoRESEARCH 3.10. The subjects in the study group were asked to perform a movement task test—the Timed-Up and Go Test (TUG): sit-to-stand, walk (3 m) without change in direction, walk termination, and stand-to-sit. Results: It took 46% longer for those infected by COVID-19 (participants) to complete the entire movement task compared to those in the not-infected by COVID-19 group. Sit-to-Stand Time [s] was greater in the infected by COVID-19 group and was 2.1 ± 0.7. Mean Walking Speed [m/s] was lower than in the not-infected by COVID-19 group and was 0.26 ± 0.07. Walking cadence [steps/min] was lower and was 21.2 ± 1.2. Infected by COVID-19 participants achieved a smaller anterior pelvic tilt angle (p < 0.001) and a smaller hip flexion angle (p = 0.025), with an increase in knee (p < 0.001) and ankle (p < 0.001) flexion angles. Conclusions: Individuals in the infected by COVID-19 group present changes in the ranges of motion and the time to complete the TUG task, despite the fact that at least eight weeks passed after hospital discharge.
Revolutionizing Spinal Care: Current Applications and Future Directions of Artificial Intelligence and Machine Learning
Authors: Yagi Mitsuru , Yamanouchi Kento , Fujita Naruhito , Funao Haruki , Ebata Shigeto
Published: June 2023

Artificial intelligence (AI) and machine learning (ML) are rapidly becoming integral components of modern healthcare, offering new avenues for diagnosis, treatment, and outcome prediction. This review explores their current applications and potential future in the field of spinal care. From enhancing imaging techniques to predicting patient outcomes, AI and ML are revolutionizing the way we approach spinal diseases. AI and ML have significantly improved spinal imaging by augmenting detection and classification capabilities, thereby boosting diagnostic accuracy. Predictive models have also been developed to guide treatment plans and foresee patient outcomes, driving a shift towards more personalized care. Looking towards the future, we envision AI and ML further ingraining themselves in spinal care with the development of algorithms capable of deciphering complex spinal pathologies to aid decision making. Despite the promise these technologies hold, their integration into clinical practice is not without challenges. Data quality, integration hurdles, data security, and ethical considerations are some of the key areas that need to be addressed for their successful and responsible implementation. In conclusion, AI and ML represent potent tools for transforming spinal care. Thoughtful and balanced integration of these technologies, guided by ethical considerations, can lead to significant advancements, ushering in an era of more personalized, effective, and efficient healthcare.
Applicability of Fractal Analysis for Quantitative Evaluation of Midpalatal Suture Maturation
Authors: Darawsheh Ali Farid , Kolarovszki Béla , Hong Da Hye , Farkas Nelli , Taheri Soroush , Frank Dorottya
Published: June 2023

Background: The treatment of transversal maxillary deficiency usually aims at skeletal expansion. The treatment option highly depends on the maturation stage of the midpalatal suture (MPS), which may vary between individuals at the same chronological age. Therefore, the individual determination of the MPS maturation is crucial. Aims: Our aim was to investigate the applicability of fractal analysis for the quantitative evaluation of MPS maturation. Methods: Nine experienced orthodontists were asked to evaluate the MPS maturation on 51 cone beam computed tomography (CBCT) scans according to the Angelieri classification method. Intra- and inter-examiner reliability was measured using Cohen’s Kappa coefficient. The stages were agreed upon according to the results of the examiners with the highest strength of agreement. Fractal analysis was then performed on the CBCTs and the correlation between the fractal dimension values and maturation stages was then evaluated. Optimal fractal dimension cut-off values were determined using a receiver operating characteristic curve. Results: The cut-off point was found at 1.073, at which the use of fractal dimension for predicting MPS maturation showed 100% sensitivity, 93.7% specificity, 9.5% false positive, 0% false negative rate. Conclusion: Our results provided further evidence that fractal analysis is a reliable tool to determine MPS maturation stage.
Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder
Authors: Alwhaibi Monira
Published: June 2023

Background: Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder. Methods: This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson’s chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS® 9.4). Results: The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy. Conclusions: Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.
Exploring the Experiences of Family Members When a Patient Is Admitted to the ICU with a Severe Traumatic Brain Injury: A Scoping Review
Authors: Hayes Kati , Harding Sam , Buckley Kirsten , Blackwood Bronagh , Latour Jos M.
Published: June 2023

The needs of family members of patients in the intensive care unit (ICU) with a severe traumatic brain injury (TBI) remain unmet. To date, no review has been performed to explore the experiences of relatives of adults who have been admitted to the ICU for treatment of a TBI. The aim of this scoping review is to explore and map the evidence of the experiences of family members when an adult relative is admitted to an ICU with a severe TBI. This review follows a combination of guidelines from Arksey and O’Malley and the Joanna Briggs Institute. Five electronic databases, Medline, Emcare, Embase, CINAHL, and PsycInfo were searched in February 2023, as were a number of grey literature sources. The population, concepts, and context framework were used to define the inclusion and exclusion criteria. From 4077 records, nine studies were retained, which represented seven discrete studies. The experiences of family members were thematically analyzed. The narrative synthesis of findings revealed three themes: communication with the clinical team, uncertainty, and involvement in care. These results offer richness and depth of understanding to clinicians regarding the experiences of families during this traumatic time. This review provides direction for targeted interventions aimed at supporting family members while in the ICU.
Is Modular Dual Mobility Superior to Standard Bearings for Reducing Dislocation Risk after Primary Total Hip Arthroplasty? A Retrospective Comparative Multicenter Study
Authors: Ciriello Vincenzo , La China Roberta , Chirillo Danilo Francesco , Bianco Giuseppe , Fusini Federico , Scarlato Ugo , Albanese Carlo , Bonzanini Giancarlo , Banci Lorenzo , Piovani Lucio
Published: June 2023

Background: Dual mobility (DM) has been proven to reduce dislocation risk after total hip arthroplasty (THA). In the last decade modular DM (modDM) constructs have been introduced to allow the use of DM articulation with standard cementless acetabular shells. However, clinical evidence of modDM effectiveness is still low in primary THA and concerns about implant-related complications are increasing. This retrospective comparative multicenter study is aimed to investigate if the dislocation rate after primary THA could be reduced with modDM in comparison to standard bearing (SB). Methods: 262 THAs were performed between 2017 and 2019, using SB (129 hips) or modDM (133) with the same cementless highly porous modular acetabular cup. Dislocations, complications and revisions were recorded and implant survival was analyzed. Results: At 2.5-year mean follow-up, dislocation occurred in 4 hips (3.1%) within the SB group while intraprosthetic dislocation in 2 hips (1.5%) within the modDM group (p = 0.44). Implant survivals with revision due to dislocation were 95.2% and 95.9% at 4-year follow-up for SB and modDM, respectively (p = 0.50). Conclusions: modDM used in primary THA might reduce dislocation rate in comparison to SB, even in high-risk patients, however, caution is advocated due to specific intraprosthetic dislocation.
Awareness and Interest in Uterus Transplantation over Time: Analysis of Those Seeking Surgical Correction for Uterine-Factor Infertility in the US
Authors: Johannesson Liza , Testa Giuliano , Beshara Menas M. , da Graca Briget , Walter Jessica R. , Quintini Cristiano , Latif Nawar , Hashimoto Koji , Richards Elliott G. , O’Neill Kathleen
Published: June 2023

This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted any of the three US UTx programs from 2015 to July 2022. The three centers received 5194 inquiries about becoming a UTx recipient during the study timeframe. Among those reporting a cause of infertility, almost all of the reports (4066/4331, 94%) were absence of a uterus, either congenitally (794/4066, 20%) or secondary to hysterectomy (3272/4066, 80%). The mean age was 34 years, and 49% (2545/5194) had at least one child at the time of application. The two centers using living donors received 2217 inquiries about becoming living donors. The mean age was 34 years, and 60% (1330/2217) had given birth to ≥1 child. While most of the UTx clinical trial evidence has focused on young women with congenital absence of the uterus, these results show interest from a much broader patient population in terms of age, cause of infertility, and parity. These results raise questions about whether and to what extent the indications and eligibility criteria for UTx should be expanded as the procedure transitions from the experimental phase to being offered as a clinical treatment.
Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope
Authors: Pérez-Denia Laura , Claffey Paul , O’Reilly Ailbhe , Delgado-Ortet Maria , Rice Ciara , Kenny Rose Anne , Finucane Ciarán
Published: June 2023

Vasovagal syncope (VVS) is common in young adults and is attributed to cerebral hypoperfusion. However, during active stand (AS) testing, only peripheral and not cerebral hemodynamic responses are measured. We sought to determine whether cerebral oxygenation responses to an AS test were altered in young VVS patients when compared to the young healthy controls. A sample of young healthy adults and consecutive VVS patients attending a Falls and Syncope unit was recruited. Continuous beat-to-beat blood pressure (BP), heart rate, near-infrared spectroscopy (NIRS)-derived tissue saturation index (TSI), and changes in concentration of oxygenated/deoxygenated Δ[O2Hb]/Δ[HHb] hemoglobin were measured. BP and NIRS-derived features included nadir, peak, overshoot, trough, recovery rate, normalized recovery rate, and steady-state. Multivariate linear regression was used to adjust for confounders and BP. In total, 13 controls and 27 VVS patients were recruited. While no significant differences were observed in the TSI and Δ[O2Hb], there was a significantly smaller Δ[HHb] peak-to-trough and faster Δ[HHb] recovery rate in VVS patients, independent of BP. A higher BP steady-state was observed in patients but did not remain significant after multiple comparison correction. Young VVS patients demonstrated a similar cerebral circulatory response with signs of altered peripheral circulation with respect to the controls, potentially due to a hyper-reactive autonomic nervous system. This study sets the grounds for future investigations to understand the role of cerebral regulation during standing in VVS.
Hyperbilirubinemia as a Risk Factor for Mortality and Morbidity in Trauma Patients
Authors: Lee Mina , Jang Myungjin , Jo Jayun , Yu Byungchul , Lee Giljae , Lee Jungnam , Lee Seunghwan , Jeon Yangbin , Choi Kangkook
Published: June 2023

Hyperbilirubinemia is frequently reported in trauma patients. However, few studies have investigated the effects of hyperbilirubinemia on patients’ clinical trajectories. This study aimed to evaluate the relationship between hyperbilirubinemia and patient outcomes following trauma. Our study included 387 patients who were admitted to the trauma bay with severe trauma between January 2017 and December 2021. We categorized patients into two groups based on their peak bilirubin levels: the low-bilirubin (LB) group, with levels below 3 mg/dL, and the high-bilirubin (HB) group, with levels above 3 mg/dL. We then compared the rates of complications and mortality between these two groups. The incidence of pneumonia (10.8% vs. 32.3%, p < 0.001), acute kidney injury (AKI) (2.8% vs. 19.2%, p < 0.001), sepsis (2.8% vs. 10.1%, p = 0.003), and wound infections (8.3% vs. 30.3%, p < 0.001) was significantly higher in the HB group. Additionally, the mortality rate was significantly higher (4.2% vs. 10.1%, p = 0.028) in the HB group. Multivariate analysis revealed that the higher the bilirubin level, the greater the risk of complications (pneumonia: odds ratio [OR] = 3.238; 95% confidence interval [CI] = 1.68–6.22; p < 0.001, AKI: OR = 4.718; 95% CI = 1.65–13.44; p = 0.004, sepsis: OR = 3.087; 95% CI = 1.00–9.52; p = 0.04, wound infection: OR = 3.995; 95% CI = 2.073–7.700; p < 0.001). In conclusion, hyperbilirubinemia was associated with poorer outcomes in trauma patients.
Time Spent with Saturation below 80% versus 90% in Patients with Obstructive Sleep Apnoea
Authors: Bikov András , Frent Stefan , Deleanu Oana , Meszaros Martina , Birza Mariela Romina , Popa Alina Mirela , Manzur Andrei Raul , Gligor Loredana , Mihaicuta Stefan
Published: June 2023

Background: Nocturnal hypoxaemia measured as the percentage of total sleep time spent with saturation below 90% (TST90%) may better predict cardiovascular consequences of obstructive sleep apnoea (OSA) than the number of obstructive respiratory events measured with the apnoea–hypopnea index (AHI). Deeper hypoxaemia may potentially induce more severe pathophysiological consequences. However, the additional value of the percentage of total sleep time spent with saturation below 80% (TST80%) to TST90% is not fully explored. Methods: Comprehensive medical history was taken and fasting lipid and C-reactive protein levels were measured in 797 volunteers participating in two cohort studies in Hungary and Romania. Sleep parameters, including AHI, TST90% and TST80%, were recorded following a polysomnography (PSG, n = 598) or an inpatient cardiorespiratory polygraphy (n = 199). The performance of TST80% to predict cardiovascular risk was compared with TST90% using linear and logistic regression analyses as well receiver operating characteristics curves. Sensitivity analyses were performed in patients who had PSG, separately. Results: Both parameters are significantly related to cardiovascular risk factors; however, TST80% did not show better predictive value for cardiovascular risk than TST90%. On the other hand, patients with more severe hypoxaemia reported more excessive daytime sleepiness. Conclusions: TST80% has limited additional clinical value compared to TST90% when evaluating cardiovascular risk in patients with OSA.
Are Graduate Medical Trainees Prepared for the Personalized Genomic Medicine Revolution? Trainee Perspectives at One Institution
Authors: Kudron Elizabeth L. , Deininger Kimberly M. , Aquilante Christina L.
Published: June 2023

Although the use of genomics to inform clinical care is increasing, clinicians feel underprepared to integrate personalized medicine (PM) into care decisions. The educational needs of physician residents and fellows, also known as graduate medical trainees (GMTs), have been overlooked. We administered an anonymous, web-based survey to all GMTs participating in training programs affiliated with our institution to evaluate their knowledge, skills, and attitudes toward PM. Of the 1190 GMTs contacted, 319 (26.8%) returned surveys. Most (88.4%) respondents reported receiving PM education in the past. Although the respondents agreed that knowledge of disease genetics (80.9%) or pharmacogenetics (87.1%) would likely lead to improved clinical outcomes, only 33.2% of the respondents felt sufficiently informed about PM. The respondents who had received PM education in residency and/or fellowship had significantly higher self-reported knowledge, ability, awareness, and adoption of PM than those who had not received this education (p < 0.0001, p < 0.0001, p < 0.0001, and p < 0.01, respectively). Targeted training is needed to improve GMTs’ confidence in interpreting and explaining genetic test results. The ideal timing for this education appears to be in residency and/or fellowship rather than in medical school.
Parents’ Perspectives on the Utility of Genomic Sequencing in the Neonatal Intensive Care Unit
Authors: Lemke Amy A. , Thompson Michelle L. , Gimpel Emily C. , McNamara Katelyn C. , Rich Carla A. , Finnila Candice R. , Cochran Meagan E. , Lawlor James M. J. , East Kelly M. , Bowling Kevin M. , Latner Donald R. , Hiatt Susan M. , Amaral Michelle D. , Kelley Whitley V. , Greve Veronica , Gray David E. , Felker Stephanie A. , Meddaugh Hannah , Cannon Ashley , Luedecke Amanda , Jackson Kelly E. , Hendon Laura G. , Janani Hillary M. , Johnston Marla , Merin Lee Ann , Deans Sarah L. , Tuura Carly , Hughes Trent , Williams Heather , Laborde Kelly , Neu Matthew B. , Patrick-Esteve Jessica , Hurst Anna C. E. , Kirmse Brian M. , Savich Renate , Spedale Steven B. , Knight Sara J. , Barsh Gregory S. , Korf Bruce R. , Cooper Gregory M. , Brothers Kyle B.
Published: June 2023

Background: It is critical to understand the wide-ranging clinical and non-clinical effects of genome sequencing (GS) for parents in the NICU context. We assessed parents’ experiences with GS as a first-line diagnostic tool for infants with suspected genetic conditions in the NICU. Methods: Parents of newborns (N = 62) suspected of having a genetic condition were recruited across five hospitals in the southeast United States as part of the SouthSeq study. Semi-structured interviews (N = 78) were conducted after parents received their child’s sequencing result (positive, negative, or variants of unknown significance). Thematic analysis was performed on all interviews. Results: Key themes included that (1) GS in infancy is important for reproductive decision making, preparing for the child’s future care, ending the diagnostic odyssey, and sharing results with care providers; (2) the timing of disclosure was acceptable for most parents, although many reported the NICU environment was overwhelming; and (3) parents deny that receiving GS results during infancy exacerbated parent–infant bonding, and reported variable impact on their feelings of guilt. Conclusion: Parents reported that GS during the neonatal period was useful because it provided a “backbone” for their child’s care. Parents did not consistently endorse negative impacts like interference with parent–infant bonding.
Extraction of Chitin from Black Soldier Fly (Hermetia illucens) and Its Puparium by Using Biological Treatment
Authors: Xiong Anqi , Ruan Linsen , Ye Kaiyu , Huang Zhiyong , Yu Chan
Published: June 2023

Chitin is the second-largest natural polymer polysaccharide in nature. Due to its important physical and chemical properties and excellent biocompatibility, safety, and biodegradability, it is widely used in agriculture, medicine, food, environmental protection, and other fields. However, traditional extraction methods cause environmental pollution and damage the structure of chitin. Bioprocessing is an emerging technology that shows great potential. In this research, the puparia and adults of black soldier fly (BSF) (Hermetia illucens L.) were used as raw materials. A continuous fermentation method was designed to extract chitin, by using Bacillus subtilis S4 and Acetobacter pasteurianus AS1.41. The Fourier transform infrared spectroscopy identification results showed that the extracted sample was α-chitin. Under continuous fermentation conditions, the deproteinization (DP) rate, demineralization (DM) rate, chitin yield (CY), and deacetylation degree (DD) of puparium chitin were 33.33%, 94.92%, 59.90%, and 18.52%, respectively. Meanwhile, the DP rate, DM rate, CY, and DD of adult chitin were 46.63%, 90.93%, 47.31%, and 37.38%, respectively. For BSF, B. subtilis S4 had a certain DP ability, and A. pasteurianus AS1.41 had a good DM effect. Moreover, BSF at different developmental stages could affect CY, and a higher concentration of NaOH was more favorable for deacetylation. Overall, simultaneous continuous fermentation could be a new biological approach to extract chitin from BSF.
Imaging Diagnosis and Management of Carpal Trauma and Instability—An Illustrated Guide
Authors: Okoro Chukwuemeka K. , Skalski Matthew R. , Patel Dakshesh B. , White Eric A. , Matcuk George R.
Published: June 2023

Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.
Investigation of Water Absorption Behavior of Recycled Aggregates and its Effect on Concrete Strength
Authors: Ding Yangfei , She Anming , Yao Wu
Published: June 2023

The water–cement ratio (w/c) has a significant effect on the strength of recycled concrete. In this study, considering the effects of water/cement ratio, strength, and water content of recycled aggregates, two kinds of pulse sequences of low-field nuclear magnetic resonance (LF-NMR) were applied to investigate the water migration behavior between simulated recycled aggregates (SRA) and water or fresh mortar. Three sets of concrete strength tests were designed and the results were used to verify the findings of LF-NMR imaging tests. The results showed that the depth of water migration in the SRA increases with time: at first the change rate is rapid, then slows down, and eventually tends to remain stable. When the SRA is in contact with fresh mortar with low w/c, no water migration occurs because the hydration of the cement in the mixture consumes a large amount of water, resulting in the inability of water to migrate into the SRA through capillary pressure. For the recycled aggregate concrete with high strength, the addition of extra water will increase the effective w/c and reduce the compressive strength of the concrete.
Development and Analysis of High-Modulus Asphalt Concrete Predictive Model
Authors: Bartkowiak Mikołaj , Słowik Mieczysław
Published: June 2023

The main purpose of this paper is to present the development of a new predictive model intended for the calculation of stiffness modulus |E*| determined by a four-point bending beam test (4PBB or 4PB-PR). The model developed, called model A, was based on the Witczak model, which was developed for the dynamic-modulus (DM) method. Most of the asphalt mixtures used to develop the model were high-modulus asphalt concrete (HMAC). The most commonly used methods for determining the stiffness modulus |E*| of asphalt mixtures were also discussed. The paper presents the results of the study for 10 asphalt mixtures but 8 of them were used to develop the predictive model. In addition, the results of complex shear modulus G* tests on neat and modified bituminous binders carried out in a dynamic shear rheometer (DSR), necessary for the development of a predictive model, are presented. The tests carried out in the dynamic shear rheometer had significant measurement uncertainties. The results of the volumetric parameters of the asphalt mixtures are also reported. The developed model A has maximum absolute errors e = 1930 MPa (p = 95%) and maximum relative errors re = 50% (p = 95%). The distribution of the absolute errors of the model, after discarding outliers, has a normal distribution as in the development of other models of this type, which was confirmed by appropriate statistical tests. On the basis of the tests and calculations carried out, it was concluded that, in order to increase the precision of the predictive models, it is advisable to reduce the measurement uncertainty of the bitumen complex shear modulus G*. For the developed model A, the limiting values of the stiffness modulus |E*| are also shown, within which the determined stiffness modulus should fall.
The Application of Finite Element Method for Analysis of Cross-Wedge Rolling Processes—A Review
Authors: Pater Zbigniew
Published: June 2023

The aim of this article is to review the application of the finite element method (FEM) to cross-wedge rolling (CWR) modeling. CWR is a manufacturing process which is used to produce stepped axles and shafts as well as forged parts for further processing on forging presses. Although the concept of CWR was developed 140 years ago, it was not used in industry until after World War 2. This was due to the limitations connected with wedge tool design and the high costs of their construction. As a result, until the end of the twentieth century, CWR tools were constructed by rolling mill manufacturers as they employed engineers with the most considerable experience in CWR process design. The situation has only changed recently when FEM became widely used in CWR analysis. A vast number of theoretical studies have been carried out in recent years, and their findings are described in this overview article. This paper describes nine research areas in which FEM is effectively applied, namely: the states of stress and strain; force parameters; failure modes in CWR; material fracture; microstructure modeling; the formation of concavities on the workpiece ends; CWR formation of hollow parts; CWR formation of parts made of non-ferrous materials; and new CWR methods. Finally, to show the potential of FEM on CWR modeling, a CWR process for manufacturing a stepped shaft used in car gearboxes is simulated numerically. This numerical simulation example shows that FEM can be used to model very complex cases of CWR, which should lead to a growing interest in this advanced manufacturing technique in the future.
Characterization and Short-Term Outcome of Potential Celiac Disease in Children
Authors: Kori Michal , Topf-Olivestone Chani , Rinawi Firas , Lev-Tzion Raffi , Ziv-Sokolovskaya Nadya , Lapidot Alon Noy , Guz-Mark Anat , Shamir Raanan
Published: June 2023

Background and Objectives: Potential Celiac Disease (PCD) is defined by positive celiac serology without villous atrophy. We aimed to describe the short-term outcome of pediatric PCD while consuming a gluten-containing diet (GCD). Materials and Methods: Retrospective analysis of pediatric PCD patients continuing GCD, between December 2018–January 2022. Baseline demographics, celiac serology and duodenal biopsy results were reviewed. Follow-up data included repeated serology and biopsy results when performed. Minimum follow-up was 12 months unless celiac disease (CeD) was diagnosed earlier. Results: PCD was diagnosed in 90 children (71% females) with a mean age of 7.2 (range 1.8–16.5) years. Baseline anti-tissue transglutaminase (TTG) levels were above 10 times the upper limit of normal (ULN) in 17/90 (18.9%), 3–10 × ULN in 56/90 (62.2%) and 1–3 × ULN in 17/90 (18.9%). During follow-up, the mean time was 17.6 (range 5–35) months, TTG normalized in 34/90 (37.8%), was stable in 48/90 (53.3%), and increased or remained >10 × ULN in 8/90 (8.9%). In 20/90 (22.2%) patients, a repeat endoscopy was performed, leading to CeD diagnosis in 12/20 (60%). Thus, at the end of follow-up, CeD was diagnosed in 12/90 (13.3%). In patients with TTG >10 × ULN at diagnosis, TTG normalized in 5/17, decreased to 3–10 × ULN in 8/17, and remained above 10 × ULN in 4/17. Conclusions: During the short-term follow-up of pediatric PCD patients, less than 15% progressed to CeD. A third had normalized TTG levels, including children with TTG >10 × ULN, indicating the need for periodic serological and histological follow-up among PCD patients.