bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal maxillary sinus diagnosing on CBCT images via object detection and ‘straight‐forward’ classification deep learning strategy
Authors: Zeng Peisheng , Song Rihui , Lin Yixiong , Li Haopeng , Chen Shijie , Shi Mengru , Cai Gengbin , Gong Zhuohong , Huang Kai , Chen Zetao
Published: September 2023

Background

Pathological maxillary sinus would affect implant treatment and even result in failure of maxillary sinus lift and implant surgery. However, the maxillary sinus abnormalities are challenging to be diagnosed through CBCT images, especially for young dentists or dentists in grassroots medical institutions without systematical education of general medicine.

Objectives

To develop a deep‐learning‐based screening model incorporating object detection and ‘straight‐forward’ classification strategy to screen out maxillary sinus abnormalities on CBCT images.

Methods

The large area of background noise outside maxillary sinus would affect the generalisation and prediction accuracy of the model, and the diversity and imbalanced distribution of imaging manifestations may bring challenges to intellectualization. Thus we adopted an object detection to limit model's observation zone and ‘straight‐forward’ classification strategy with various tuning methods to adapt to dental clinical need and extract typical features of diverse manifestations so that turn the task into a ‘normal‐or‐not’ classification.

Results

We successfully constructed a deep‐learning model consist of well‐trained detector and diagnostor module. This model achieved ideal AUROC and AUPRC of 0.953 and 0.887, reaching more than 90% accuracy at optimal cut‐off. McNemar and Kappa test verified no statistical difference and high consistency between the prediction and ground truth. Dentist‐model comparison test showed the model's statistically higher diagnostic performance than dental students. Visualisation method confirmed the model's effectiveness in region recognition and feature extraction.

Conclusion

The deep‐learning model incorporating object detection and straightforward classification strategy could achieve satisfying predictive performance for screening maxillary sinus abnormalities on CBCT images.
Rabbits (Oryctolagus cuniculus) increase caecal calcium absorption at increasing dietary calcium levels
Authors: Liesegang Annette , Burger Bettina , de Vries de Heekelingen Thérèse , Schroeter‐Vogt Corinne , Hatt Jean‐Michel , Kowalewski Mariusz P. , Clauss Marcus
Published: September 2023

Hindgut fermenting herbivores from different vertebrate taxa, including tortoises, and among mammals some afrotheria, perissodactyla incl. equids, several rodents as well as lagomorphs absorb more calcium (Ca) from the digesta than they require, and excrete the surplus via urine. Both proximate and ultimate causes are elusive. It was suggested that this mechanism might ensure phosphorus availability for the hindgut microbiome by removing potentially complex‐building Ca from the digesta. Here we use Ussing chamber experiments to show that rabbits (Oryctolagus cuniculus) maintained on four different diets (six animals/diet) increase active Ca absorption at increasing Ca levels. This contradicts the common assumption that at higher dietary levels, where passive uptake should be more prevalent, active transport can relax and hence supports the deliberate removal hypothesis. In the rabbits, this absorption was distinctively higher in the caecum than in the duodenum, which is unexpected in mammals. Additional quantification of the presence of two proteins involved in active Ca absorption (calbindin‐D9K CB; vitamin D receptor, VDR) showed higher presence with higher dietary Ca. However, their detailed distribution across the intestinal tract and the diet groups suggests that other factors not investigated in this study must play major roles in Ca absorption in rabbits. Investigating strategies of herbivores to mitigate potential negative effects of Ca in the digesta on microbial activity and growth might represent a promising area of future research.
Learning to see modern slavery in supply chains through paradoxical sensemaking
Authors: Pinnington Bruce , Meehan Joanne
Published: September 2023

Mandatory annual reporting, to improve transparency of working conditions in firms' supply chains, is the favored approach of UK policymakers for reducing modern slavery risks in supply chains. Despite legislation and extensive guidance, annual corporate statements are disappointing, providing little evidence of substantive action. So far though, there has been little primary research of managers' understanding of the phenomenon or their perceived agency in tackling modern slavery. In a qualitative study, employing template analysis, data were drawn from multiple sources, including interviews with 32 managers from three large UK firms in a complex, high‐risk sector (construction). Four focus groups were used to establish credibility of the findings. As managers struggle with how to make sense of where to look, how to look, and what to see, they adopt narrowed perspectives and analogies that inhibit immediate, compelling action. Improved awareness of UK labor supply chain issues has distanced managers further from action relating to global material supply chains. Through analogy with health and safety legislation, which developed over a considerable period, managers justify a wait‐and‐see approach, deferring action. Such convenience framing helps them to avoid issues relating to complexity, control, cost, and (in)visibility. This framing needs to be disrupted for meaningful action to result. Drawing on sensemaking theory relating to paradoxical financial and sustainability objectives, the study suggests how extended legislation and governance may drive more substantive responses that transcend the constraints of business‐case logic.
Loss of attachments in patients during orthodontic therapy with clear aligners: A prospective clinical study
Authors: Li Qiuying , Yang Kai
Published: September 2023

Objective

This study aimed to assess the loss rate of attachments and investigate its probable influencing factors in patients during orthodontic therapy with clear aligners.

Materials and Methods

A total of 55 patients treated with clear aligners were enrolled in this prospective clinical study. The loss rate of attachments was evaluated after a 6‐month follow‐up since the initial bonding was finished. The attachment survival curves were gone through Kaplan–Meier estimates. The Cox regression model with shared frailty was conducted to evaluate the hazard ratios (HRs) for the following factors, including sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount, arch, tooth position and attachment type.

Results

There were a total of 47 patients (14 males and 33 females; and mean age: 26.77 ± 8.45) in which 722 attachments were involved in the final analysis. During the 6‐month follow‐up, 99 attachments were lost by 40 participants. The overall loss rate was 13.7%. The loss of attachments was more common in the early months of therapy. During the first 2 months, 71 attachments were lost. The loss rate of attachments was not significantly affected by sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount and attachment type (P > 0.05). The loss rate of mandibular attachments was 1.8 times that of maxillary attachments (HR = 1.8; 95% CI: 1.2–2.8; P = 0.009). The loss rate of molar attachments was 5.5 times that of incisor attachments (HR = 5.5; 95% CI: 1.6–19; P = 0.007).

Conclusion

During the first 6 months, the overall loss rate of attachments was 13.7%. In the early months of therapy, loss of attachments was more common. The loss rate decreased as treatment time increased. Loss of attachments was significantly affected by arch and tooth position, with higher loss rates in the mandibular arch and molars. Besides, loss of attachments was not affected by sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount and attachment type.
PECS II block for cardiac implantable electronic device insertion: A pilot study
Authors: Kilin Mustafa , Kavakli Ali Sait , Karaveli Arzu , Sugur Tayfun , Kus Gorkem , Cagirci Goksel , Arslan Sakir
Published: September 2023

Aim

Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion.

Methods

PECS II blocks were performed on the left side using the ultrasound‐guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block‐related complications.

Results

Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4‐10 [2.5‐12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure.

Conclusions

PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.
Unpacking the effects of burdensome state actions on citizens' policy perceptions
Authors: Sievert Martin , Bruder Jonas
Published: September 2023

Administrative burdens appear to influence citizens' perceptions of welfare policies and attitudes toward beneficiaries. However, empirical evidence that has disentangled different state actions' effects on policy perceptions is scarce. We applied a 2 × 2 × 2 factorial survey experiment and manipulated the conceptually distinct state actions implemented in German unemployment benefits. We investigated whether and how exposure to learning demands, compliance demands, and sanctions affected citizens' prejudices against beneficiaries, policy support, and perceived legitimacy. The results from a sample of 1602 German citizens indicate that those confronted with program sanctions exhibit less policy support and expect higher policy spending. Similarly, sanctions decreased the Federal Employment Agency's perceived legitimacy. These results have implications for administrative burden and policy feedback research. Distinguishing different state actions provides nuances to assess policy feedback effects. Practitioners should consider whether program sanctions are necessary because they evoke unintended policy feedback effects.
Rutin intake mitigates the injury of blue light irradiation by altering aging rates of mortality in Drosophila model
Authors: Tang Hao , Li Xiangyu , Liu Xingyou , Xu Yifan , Shen Jie
Published: September 2023

Blue light is known as one of the harmful light pollution that has complex effects on organisms. The massive use of LED lights in cities has greatly increased the frequency of human exposure to blue light, and therefore the hazards of blue light are receiving widespread attention. In our study, Drosophila was used as the model organism to explore the ability of the flavonoid rutin to resist blue light damage under the intensity of 3000 Lux. Siler model analysis was performed. Our results showed sex‐specific pattern of rutin as an effective antioxidant. Rutin could help female flies to reduce the initial adult mortality and male flies to slow the increase of adult mortality under blue light irradiation, thus prolonging their average lifespan. Furthermore, after the intake of rutin, the locomotor activity of Drosophila under blue light irradiation was significantly increased, and the total sleep time was significantly decreased. In summary, our results provide preliminary support for exploring the mechanism of rutin against blue light damage.
Low predictability in aboveground biomass accumulation in Brazilian semi‐deciduous seasonal Atlantic Forest restoration sites
Authors: Arcanjo Fátima A. , Lemos Giovanna G. , Tartari Letícia G. , Torezan José M. D.
Published: September 2023

There are high expectations about the role of active reforestation in mitigating climate change, by means of carbon sequestration and storage, fueling the carbon credit market. Carbon credits are calculated in advance based on the number of planted trees or, at best, the expected size and wood density of planted trees. However, the contribution of tropical reforestations with native species for carbon sequestration in the long term is still unclear, since most sites being monitored are less than 20 years old, thus limiting the ability to make forecasts of what is a dynamic, multifactor restoration outcome. We used a chronosequence to analyze aboveground biomass (AGB) accumulation in 30 Brazilian semi‐deciduous seasonal Atlantic Forest restoration sites sharing the same climate, soil type, and restoration technique. We evaluated the entire age range of 1–19 years, and three age intervals, 1–3 years, 4–8 years, and over 9 years. AGB, basal area, and tree density increased considering all ages (1–19 years). Our results showed, however, that the AGB, tree density, and basal area can increase linearly from 1 to 3 years but present no significant trend after 4 years. Adjusted model r2 values decreased with time, suggesting that the controlled effects of active restoration are quickly replaced by other natural, uncontrolled, and, to some extent, unknown factors. Although continued efforts are needed to make more realistic predictions of long‐term carbon stocks based on tree planting, high levels of biomass estimates for time intervals as short as 20 years may never be achieved.
Adaptation regulatory regimes to address climate change challenges in transboundary water basins: Can multilateral regionalism help?
Authors: Vinogradov Sergei , Wouters Patricia
Published: September 2023

Global climate change threatens regional water security in various ways. The transboundary waters flowing across Asia from their source in the Himalayan 'water towers' are finite resources, already adversely impacted by rising temperatures. China and India share many of the river basins of this region, and both countries implement ambitious national development plans that rely on these resources. Global approaches to address climate change issues on transboundary waters have emerged, but require national and regional cooperative actions, supported by coherent regulatory regimes with adaptation at the core. In the absence of transboundary water agreements between China and India, how will they meet the impacts of changing climatic conditions on their shared freshwaters? This article considers the multilateral and bilateral regulatory frameworks that govern China and India’s transboundary waters in the context of global warming challenges. The findings suggest the emergence of an incomplete adaptation regulatory regime that has yet to coalesce, but which nonetheless shows some promise within a multilateral regionalism context. The hallmarks of an ideal transboundary water adaptation regulatory regime include two main components—comprehensive cooperation and basin‐wide resilience management regime. Neither of these exist in the transboundary waters shared between China and India, but there is reason for hope.
Politics and policy of Artificial Intelligence
Authors: Ulnicane Inga , Erkkilä Tero
Published: September 2023

While recent discussions about Artificial Intelligence (AI) as one of the most powerful technologies of our times tend to portray it as a predominantly technical issue, it also has major social, political and cultural implications. So far these have been mostly studied from ethical, legal and economic perspectives, while politics and policy have received less attention. To address this gap, this special issue brings together nine research articles to advance the studies of politics and policy of AI by identifying emerging themes and setting out future research agenda. Diverse but complementary contributions in this special issue speak to five overarching themes: understanding the AI as co‐shaped by technology and politics; highlighting the role of ideas in AI politics and policy; examining the distribution of power; interrogating the relationship between novel technology and continuity in politics and policy; and exploring interactions among developments at local, national, regional and global levels. This special issue demonstrates that AI policy is not an apolitical field that can be dealt with just by relying on knowledge and expertise but requires an open debate among alternative views, ideas, values and interests.
Degenerate Cauchy–Goursat problem for 2‐D steady isentropic Euler system with van der Waals gas
Authors: Srivastava H. , Zafar M.
Published: September 2023

This study concerns with the existence–uniqueness of local classical sonic‐supersonic solution to a degenerate Cauchy–Goursat problem that arises in transonic phenomena. The flow is governed by 2‐D steady isentropic Euler system with a polytropic van der Waals gas. The idea of characteristic decomposition has been used to convert the Euler system into a new system involving the angle variables . To overcome the parabolic degeneracy caused at the sonic curve, the partial hodograph transformation and a variety of dependent–independent variables have been introduced to transform the nonlinear system into a linear one with explicit singularity–regularity structure. The uniform convergence of the sequences has been discussed by employing the mathematical induction. Eventually, the inversion of the solution from partial hodograph plane to the original plane has been established.
Preparing students to address the social determinants of health in integrated care settings
Authors: McGinley Jacqueline M. , Pauling Erin E. , Rouhana Nicole , Podolak Christine E. , Cowen Nannette , Hennig Kelsey , Shipe Stacey L. , Young Sarah R. , Rattinger Gail B.
Published: September 2023

Background

Health professionals are increasingly being called to address the social determinants of health (SDOH) and, to do so effectively, often requires an integrated approach to care. As a result, accreditation standards across multiple professions have emphasised the importance of interprofessional education (IPE).

Approach

This paper describes large‐scale, community‐engaged learning that is required annually of students from nursing, pharmacy, public health, and social work. Through a series of asynchronous and synchronous activities that are informed by the Interprofessional Education Collaborative core competencies, students are trained to be SDOH change makers who can readily adopt integrated care service delivery frameworks into their future practice.

Evaluation

Approximately 1000 students have participated in this event since the University launched its IPE curriculum in 2017. Student consistently report achievement of the course learning objectives, with 91% of students reporting that the learning activities enhanced their understanding of their professional roles/responsibilities in regards to addressing poverty and food insecurity.

Implications

Two key lessons learned from these efforts are described, including the benefits of a trauma‐informed pedagogical approach and special considerations for large‐scale learning.
The role of centromeric repeats and transcripts in kinetochore assembly and function
Authors: Ramakrishnan Chandra Jothipriya , Kalidass Manikandan , Demidov Dmitri , Dabravolski Siarhei A. , Lermontova Inna
Published: September 2023

Centromeres are the chromosomal domains, where the kinetochore protein complex is formed, mediating proper segregation of chromosomes during cell division. Although the function of centromeres has remained conserved during evolution, centromeric DNA is highly variable, even in closely related species. In addition, the composition of the kinetochore complexes varies among organisms. Therefore, it is assumed that the centromeric position is determined epigenetically, and the centromeric histone H3 (CENH3) serves as an epigenetic marker. The loading of CENH3 onto centromeres depends on centromere‐licensing factors, chaperones, and transcription of centromeric repeats. Several proteins that regulate CENH3 loading and kinetochore assembly interact with the centromeric transcripts and DNA in a sequence‐independent manner. However, the functional aspects of these interactions are not fully understood. This review discusses the variability of centromeric sequences in different organisms and the regulation of their transcription through the RNA Pol II and RNAi machinery. The data suggest that the interaction of proteins involved in CENH3 loading and kinetochore assembly with centromeric DNA and transcripts plays a role in centromere, and possibly neocentromere, formation in a sequence‐independent manner.
Cytologic, histopathologic, and immunohistochemical features of keloidal fibroma in a dog
Authors: Palić Jelena , Saey Veronique , van der Lugt Jaco , Baumgärtner Wolfgang , Hülskötter Kirsten
Published: September 2023

A five‐year‐old male English Bulldog was presented with a firm, well‐circumscribed, 1 cm in diameter cutaneous mass on the left flank. Fine‐needle aspiration (FNA) biopsy samples were collected for cytologic analysis. Cytology revealed a highly cellular sample consisting of spindle cells, numerous bundles of thick, glassy eosinophilic material (hyalinized collagen), and inflammatory cells. Spindle cells showed moderate anisocytosis and anisokaryosis, had oval nuclei with coarsely stippled chromatin, 1–3 prominent round nucleoli, and moderate amounts of wispy cytoplasm. Cells were occasionally associated with an eosinophilic extracellular matrix. Binucleated and trinucleated spindle cells were often noted. Low numbers of macrophages, small lymphocytes, and individual well‐granulated mast cells were also present. The lesion was excised and submitted for histopathologic examination, revealing a well‐delineated, nonencapsulated mass composed of hyalinized collagen fibers separated by spindle‐shaped mesenchymal cells in the deep dermis and subcutis. Mild anisocytosis and anisokaryosis and less than one mitosis per 10 × high power fields were present. Excision of the mass was complete. The findings were consistent with a keloidal fibroma, a rare benign variant of fibroma. Neoplastic cells showed positive immunoreactivity for vimentin, and a small‐to‐moderate number of tumor cells showed positive immunoreactivity for α‐smooth muscle actin. This is the first cytologic description of a keloidal fibroma correlated with histopathologic findings and immunolabeling. In cases where keloidal neoplasia is suspected, and since moderate cellular atypia can be present on cytologic examination even in cases of keloidal fibroma, histopathologic examination is necessary to differentiate between keloidal fibroma and keloidal fibrosarcoma.
ROWAN WILLIAMS ON ATTENTION AND MEMORY IN THE SPIRITUAL LIFE
Authors: Watts Fraser
Published: September 2023

In a series of recent articles, including his Boyle Lecture, Rowan Williams has developed a theology of the role of intelligence and attention in spiritual life. There is a sense in which all intelligence is spiritual activity. Current approaches to intelligence are often mechanistic, but intelligence in spiritual life needs to be understood in a more embodied and organic way. Attention is often thought of as a matter of choosing which already‐formed objects to focus on. That overlooks the fact that sensory information is often confusing and ambiguous, and neglects how habits of attention make the world appear more atomized than it really is. If we can learn restraint in how we impose order upon the world around us in attending to it, there is an opportunity to encounter the divine Spirit which is the source of all that we experience. That leads to a more participatory, less objectifying, way of engaging with the world.
Comparative Study of Pixel-Based and Object-Based Classifications in Benthic Mapping
Authors: Othman Ainon Nisa , Hashim Nurhanisah , Mohamad Salim Pauziyah , Mohd Zaidi Puteri Norsarifah Suhada
Published: September 2023

Coral reefs have been degrading rapidly throughout the last decade due to climate change and other human activities. Classification and mapping of benthic floors and associated ecosystems such as coral reefs are both inefficient and expensive using traditional ground-based methods. New technologies using publicly available and commercial satellite imageries are crucial for accurate classification and mapping of coral reefs' distribution, management and monitoring. The study utilized the medium (Sentinel 2B with 20 m) and high (SPOT 7 with 1.5m) resolution satellite imageries for benthic mapping of Mabul island’s benthic using pixel-based and object-based classification methods. Results of the study show that the overall accuracy of the pixel-based classification method for Sentinel 2 and SPOT 7 were 97.5% and 90%, respectively. For the object-based technique, the overall classification was slightly lower with 87.05% and 82.81%, respectively. This study suggests pixel-based classification provides better overall accuracy than object-based classification. However, conducting more assessments at different water depths and field surveys is necessary to determine accurate results. This can be achieved in the future by using more advanced technology such as drones and lidar data.
Assessing Precision and Dependability of Reconstructed Three-Dimensional Modeling for Vehicles at Crash Scenes using Unmanned Aircraft System
Authors: Jalal Akmal Jauhari , Mohd Ariff Mohd Farid , Razali Ahmad Firdaus , Chen Keng Razak Wong , Wook Mohamad Ariff , Idris Mohamad Ikhwan
Published: September 2023

This study focuses on the accuracy assessment of 3D reconstructions of crime scenes using Unmanned Aircraft Systems (UAS) and Terrestrial Laser Scanners (TLS) data for forensic crash investigation. Forensic crash investigation involves meticulously analyzing physical evidence, vehicles, and human factors in road collisions to determine the sequence of events. Preserving the original state of the crash scene before cleaning is essential for accurate forensic analysis. However, this preservation process can disrupt normal activities and demand considerable time. Geomatic technology, specifically UAS or drones, offers a potential solution for efficient and precise forensic mapping. The application of UAS technology enables swift data collection, leading to cost savings, enhanced safety, and data utilization. This study aims to assess the suitability of UAS techniques for forensic mapping, encompassing both relative and absolute accuracy. This research uses a UAS to rapidly and comprehensively capture evidence from a simulated crash site using predefined flight paths. The acquired image data is then processed utilizing Agisoft Metashape software, generating a detailed 3D model of the crash scene. This model can be enriched with annotations, measurements, and pertinent information. A comparative analysis is performed by preparing a table that contrasts the absolute and relative accuracy of UAS-collected data with that obtained from TLS, which serves as a benchmark. The results reveal that the UAS demonstrates a relative accuracy Root Mean Square Error (RMSE) of approximately ±4.1 cm compared to TLS. Concerning absolute precision, the UAS-produced RMSE values are determined as ±0.20719 for the X coordinate, ±0.164 for the Y coordinate, and ±0.001584 for the Z coordinate compared to GNSS data, which functions as the benchmark. The utilization of UAS technology offers a non-invasive measurement approach that eliminates direct physical contact between the operator and the documented object. This non-intrusive method ensures the preservation of the original scene characteristics and has shown its superiority over conventional approaches in managing crash scenes. Overall, this study underscores the potential of UAS technology in accurately reconstructing crime scenes for forensic investigation purposes.
Positivity and nonstandard graded Betti numbers
Authors: Brown Michael K. , Erman Daniel
Published: September 2023

A foundational principle in the study of modules over standard graded polynomial rings is that geometric positivity conditions imply vanishing of Betti numbers. The main goal of this paper is to determine the extent to which this principle extends to the nonstandard ‐graded case. In this setting, the classical arguments break down, and the results become much more nuanced. We introduce a new notion of Castelnuovo–Mumford regularity and employ exterior algebra techniques to control the shapes of nonstandard ‐graded minimal free resolutions. Our main result reveals a unique feature in the nonstandard ‐graded case: the possible degrees of the syzygies of a graded module in this setting are controlled not only by its regularity, but also by its depth. As an application of our main result, we show that given a simplicial projective toric variety and a module over its coordinate ring, the multigraded Betti numbers of are contained in a particular polytope when satisfies an appropriate positivity condition.
Control charts to establish and monitor proficiency in the detection of pulmonary B-lines with Point of Care Ultrasound
Authors: Usaquén-Perilla Sandra Patricia , Ropero-Rojas Deliana , Mosquera-Restrepo Jaime , Kirsch Jonathan D. , Kaltenborn Zachary P. , García-Melo José Isidro , Osorio-Amaya Lyda Elena
Published: September 2023

Objective: Point of care ultrasound (POCUS) is a widely used clinical tool. This operator-dependent technique requires methods to establish individual benchmarks and to monitor the learning process. We present the use of the learning curve standard cumulative summation (LC-CUSUM) and CUSUM control charts to establish and monitor, respectively, the proficiency of a physician to detect pulmonary B-lines with POCUS. Materials and Methods: A training course for general practitioners was conducted to detect plasma leakage using POCUS. The trainees and an expert radiologist identified the number of pulmonary B-lines in the POCUS images of 53 hospitalized patients. The interpretation of one trainee was compared to that of the expert radiologist using LC-CUSUM and CUSUM considering image quality and anatomical site. Results and Discussion: We found that image quality was better in the apices than the bases of the lungs. The trainee learning curve differed by anatomical site and the results of LC-CUSUM and CUSUM differed when only high-quality (first scenario) or all images (second scenario) were included in the analysis. Conclusion: The LC-CUSUM and CUSUM control charts were useful to evaluate the learning curve in this case and to identify image quality as an important factor in the evaluation process. They warrant further study as graphical tools for real-time monitoring of POCUS training.
Specifications Grading in the Sport Management Classroom: Breakdown of the System and Reflections Upon Implementation With Relation to Outcomes Assessment
Authors: Trachsler Tracy A. , Morris Erin , Mahoney Tara Q.
Published: September 2023

With increased interest in outcomes-based assessment in sport management programs, the Specifications Grading model can be implemented within individual courses to facilitate the process. Specific requirements that are articulated at course onset with explicit directions, samples of high-scoring work, and access to evaluation rubrics can set students on the path for achieving measurable benchmarks. Thus, the submissions become objective expressions of learning instead of a points-based bargaining tool. Implemented into an Introduction to Sport Management class, the model provided opportunities for consistent engagement with assessment tools in which students had agency and multiple chances to focus on improving the assessment to meet the benchmarks. The instructor reflected upon the experience, noting administrative elements to change to assist the overall implementation of the system but discovered that the Specifications Grading model centered the students in the learning process while providing meaningful outcome data for assessment purposes. Recommendations are provided for faculty interested in implementing it in their own classrooms.
Synthesis and Antiproliferative Activity of New Copper, Cobalt, and Zinc Complexes with Abiraterone Acetate
Authors: Antonenko T. A. , Gracheva Yu. A. , Zazdravnykh A. V. , Mazur D. M. , Shpakovsky D. B. , Lyssenko K. A. , Milaeva E. R.
Published: September 2023

New complexes CuCl2[AbAc]2 (I), CoCl2[AbAc]2 (II), and ZnCl2[AbAc]2 (III) with abiraterone acetate (AbAc) are synthesized. The molecular structure of complex II is determined by X-ray diffraction (XRD) (CIF file CCDC no. 2252346). The cobalt atom coordinates with abiraterone acetate due to the N‑donor pyridine atom. The model processes of hydrolysis of the compounds in acidic and neutral media and their ability to interact with the superoxide radical anion generated in the xanthine–xanthine oxidase enzymatic system are studied. A high activity of complexes I and II is found. The MTT test shows that the antiproliferative activity of compounds I–III against the HCT-116, MCF-7, A-549, and WI-38 cells is comparable with the activity of cisplatin and exceeds that of the initial AbAc for the PC-3 cell line. Complex II also induces cell cycle arrest in the G0/G1 phase of RNA protein synthesis.
Making health insurance responsive to citizens: the management of members’ complaints by mutual health organisations in Kinshasa, Democratic Republic of Congo
Authors: Ngo Bebe Dosithee , Kwilu Fulbert Nappa , Mavila Arlette , Mafuta Eric Musalu , Mangalu José Mobhe , Jessani Nasreen S , Criel Bart
Published: September 2023

Introduction

In moving towards universal health coverage, a number of low-income and middle-income countries have adopted community-based health insurance (CBHI) as a means to reduce both the inequity in healthcare access and the burden of catastrophic health expenditures linked to user fees. However, organisations managing CBHIs face many challenges, including a poor relationship with their members. In the Democratic Republic of the Congo, CBHI schemes are managed by mutual health organisations (MHOs) and are in the process of enhancing their accountability and responsiveness to members’ needs and expectations. This study assessed how MHOs have managed member complaints and their performance in grievance redressal.

Methods

Using a sequential mixed-methods approach, we drew insights from four types of sources: review of approximately 50 relevant documents, 25 in-depth interviews (IDIs) with CBHI managers, 9 IDIs with health facility managers, 1063 surveys of MHO members and 15 focus group discussions (FGDs) comprising an additional 153 MHO members. MHO members in this study belonged to three different MHOs (Lisanga, La Borne and Mutuelle de santé des Enseignants de l’Enseignement Primaire, Secondaire et Professionnel) in the capital, Kinshasa.

Results

The document review showed that there were no clear administrative processes for the implementation of the grievance redressal arrangement measures resulting in low member awareness of these measures. These results were confirmed by the IDIs. Of 1044 members surveyed, only 240 (23%) were aware of the complaint measures, and 201 (84%) of these declared they had used the measures at some point in time, 181/201 (90%) users who had used the measures declared being satisfied with the response provided. The FGDs confirmed that most members lack knowledge on the grievance redressal procedures, but those who were aware had made use of them and were often satisfied with the response provided.

Conclusion

MHOs should urgently improve communication with their members on the range of redressal measures put in place to address grievances. Attention should be given to properly monitor existing arrangements, and possibly adapt them with well-documented and communicated standard operating procedures.
Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets
Authors: Boccolini Cristiano Siqueira , Lacerda Elisa Maria de Aquino , Bertoni Neilane , Oliveira Natália , Alves-Santos Nadya Helena , Farias Dayana Rodrigues , Crispim Sandra Patricia , Carneiro Leticia Barroso Vertulli , Schincaglia Raquel Machado , Giugliani Elsa Regina Justo , Castro Inês Rugani Ribeiro de , Kac Gilberto
Published: September 2023

Background

The comprehension of breastfeeding patterns and trends through comparable indicators is essential to plan and implement public health policies.

Objective

To evaluate the trends of breastfeeding indicators in Brazil from 1996 to 2019 and estimate the gap to achieve the WHO/UNICEF 2030 targets in children under 5 years.

Methods

Microdata from two National Surveys on Demography and Health of Women and Children (PNDS-1996 and PNDS-2006) and the Brazilian National Survey on Child Nutrition-2019 were used. The indicators of early initiation of breastfeeding (EIBF), exclusive breastfeeding of infants 0–5 months of age (EBF<6 mo), continued breastfeeding at 1 year of age (CBF1yr) and CBF at 2 years of age (CBF2yr) were analysed using prevalence and 95% CI. The average annual variation and years to achieve the WHO/UNICEF 2030 targets were calculated for Brazil and the macroregions. Statistical analyses considered the survey’s complex sample design for each database.

Results

EIBF increased from 36.3% (95% CI 33.6% to 39.0%) in 1996 to 60.9% (95% CI 56.5% to 65.3%) in 2006 (statistically significant) and 62.5% (95% CI 58.3% to 66.6%) in 2019. EBF<6 mo increased from 26.9% (95% CI 21.3% to 31.9%) in 1996 to 39.0% (95% CI 31.0% to 47.1%) in 2006 and 45.8% (95% CI 40.9% to 50.7%) in 2019 (significant increases for 1996–2019 for Brazil, Northeast and Midwest regions). CBF1yr rose from 36.6% (95% CI 30.8% to 42.4%) in 1996 to 48.7% (95% CI 38.3% to 59.0%) in 2006, and 52.1% (95% CI 45.4% to 58.9%) in 2019. CBF2yr increased from 24.7% (95% CI 19.5% to 29.9%) in 1996 to 24.6% (95% CI 15.7% to 33.5%) in 2006 and 35.5% (95% CI 30.4% to 40.6%) in 2019 (significant increase for 1996–2019). The South and Southeast regions need to double the 2019 prevalence to reach the target for the CBF1yr and CBF2yr; the Northeast and North need to increase 60% the current prevalence for the indicator of EBF<6 mo.

Conclusion

A substantial improvement in breastfeeding indicators occurred in Brazil from 1996 to 2019, although at an insufficient rate to achieve the WHO/UNICEF 2030 targets.
Governance for injury care systems in Ghana, South Africa and Rwanda: development and pilot testing of an assessment tool
Authors: Odland Maria Lisa , Abdul-Latif Abdul-Malik , Ignatowicz Agnieszka , Bekele Abebe , Chu Kathryn , Howard Anthony , Tabiri Stephen , Byiringiro Jean Claude , Davies Justine
Published: September 2023

Objectives

This study aims to evaluate health systems governance for injury care in three sub-Saharan countries from policymakers’ and injury care providers’ perspectives.

Setting

Ghana, Rwanda and South Africa.

Design

Based on Siddiqiet al’s framework for governance, we developed an online assessment tool for health system governance for injury with 37 questions covering health policy and implementation under 10 overarching principles of strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness of institutions, equity, effectiveness or efficiency, accountability, ethics and intelligence and information. A literature review was also done to support the scoring. We derived scores using two methods—investigator scores and respondent scores.

Participants

The tool was sent out to purposively selected stakeholders, including policymakers and injury care providers in Ghana, Rwanda and South Africa. Data were collected between October 2020 and February 2021.

Primary and secondary outcomes

Investigator-weighted and respondent percentage scores for health system governance for injury care. This was calculated for each country in total and per principle.

Results

Rwanda had the highest overall investigator-weighted percentage score (70%), followed by South Africa (59%). Ghana had the lowest overall investigator score (48%). The overall results were similar for the respondent scores. Some areas, such as participation and consensus, scored high in all three countries, while other areas, such as transparency, scored very low.

Conclusion

In this multicountry governance survey, we provide insight into and evaluation of health system governance for trauma in three low- and middle-income countries (LMICs) in sub-Saharan Africa. It highlights areas of improvement that need to be prioritised, such as transparency, to meet the high burden of trauma and injuries in LMICs.
Predicting residual neoplasia after a non-curative gastric ESD: validation and modification of the eCura system in the Western setting: the W-eCura score
Authors: Morais Rui , Libanio Diogo , Dinis Ribeiro Mario , Ferreira Aníbal , Barreiro Pedro , Bourke Michael J , Gupta Sunil , Amaro Pedro , Küttner Magalhães Ricardo , Cecinato Paolo , Boal Carvalho Pedro , Pinho Rolando , Rodríguez de Santiago Enrique , Sferrazza Sandro , Lemmers Arnaud , Figueiredo Mariana , Pioche Marhieu , Gallego Francisco , Albéniz Eduardo , Ramos Zabala Felipe , Uchima Hugo , Berr Frieder , Wagner Andrej , Marques Margarida , Pimentel-Nunes Pedro , Gonçalves Margarida , Mascarenhas André , Soares Elisa Gravito , Xavier Sofia , Faria-Ramos Isabel , Sousa-Pinto Bernardo , Gullo Irene , Carneiro Fatima , Macedo Guilherme , Santos-Antunes João
Published: September 2023

Objective

To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease.

Design

Retrospective multicentre multinational study of prospectively collected registries from 19 Western centres. Patients who had been submitted to surgery or had at least one follow-up endoscopy were included. The eCura system was applied to assess its accuracy in the Western setting, and a modified version was created according to the results (W-eCura score). The discriminative capacities of the eCura and W-eCura scores to predict LNM were assessed and compared.

Results

A total of 314 NC gastric ESDs were analysed (72% high-risk resection (HRR); 28% local-risk resection). Among HRR patients submitted to surgery, 25% had parietal disease and 15% had LNM in the surgical specimen. The risk of LNM was significantly different across the eCura groups (areas under the receiver operating characteristic curve (AUC-ROC) of 0.900 (95% CI 0.852 to 0.949)). The AUC-ROC of the W-eCura for LNM (0.916, 95% CI 0.870 to 0.961; p=0.012) was significantly higher compared with the original eCura. Positive vertical margin, lymphatic invasion and younger age were associated with a higher risk of parietal residual lesion in the surgical specimen.

Conclusion

The eCura scoring system may be applied in Western countries to stratify the risk of LNM after a gastric HRR. A new score is proposed that may further decrease the number of unnecessary surgeries.
Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis
Authors: Santoro Francesco , Sharkey Scott , Citro Rodolfo , Miura Tetsuji , Arcari Luca , Urbano-Moral Jose Angel , Stiermaier Thomas , Nuñez-Gil Ivan Javier , Silverio Angelo , Di Nunno Nicola , Ragnatela Ilaria , Cetera Rosa , Nishida Junichi , Eitel Ingo , Brunetti Natale Daniele
Published: September 2023

Introduction

Takotsubo syndrome (TTS) is an acute heart failure syndrome, featured by transient left ventricular systolic dysfunction. Recurrences of TTS are not infrequent and there is no standard preventive therapy. The aim of this study was to evaluate in a network meta-analysis if beta-blockers (BB) and ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs), in combination or not, can effectively prevent TTS recurrences.

Methods

We performed a systematic network meta-analysis, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials for clinical studies published between January 2010 and September 2022. We considered all those studies including patients receiving medical therapy with BB, ACEi/ARBs. The primary outcome was TTS recurrence.

Results

We identified 6 clinical studies encompassing a total of 3407 patients with TTS. At 40±10 months follow-up, TTS recurrence was reported in 160 (4.7%) out of 3407 patients. Mean age was 69.8±2 years and 394 patients (11.5%) out of 3407 were male. There were no differences in terms of TTS recurrence when comparing ACEi/ARBs versus control (OR 0.83; 95% CI 0.47 to 1.47, p=0.52); BB versus control (OR 1.01; 95% CI 0.63 to 1.61, p=0.96) and ACEi/ARBs versus BB (OR 0.88; 95% CI 0.51 to 1.53, p=0.65).

Combination of BB and ACEi/ARBs was also not effective in reducing the risk of recurrence versus control (OR 0.91; 95% CI 0.58 to 1.43, p=0.68) vs ACEi/ARBs (OR 0.79; 95% CI 0.46 to 1.34, p=0.38)) and vs BB (OR 0.77; 95% CI 0.49 to 1.21, p=0.26).

Conclusions

Our study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence.
Using the NEISS database to understand pressure cooker related injuries in the USA
Authors: Shields Wendy , Dong Yanan , Jager Leah , Shiang Evelyn , Frattaroli Shannon , Omaki Elise
Published: September 2023

Objective

To determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried to identify injuries associated with pressure cookers between 1 January 2003 and 31 December 2019. Case narratives were reviewed to identify precipitating or contributing factors of pressure cooker related injuries. Negative binomial regression was employed to test for trends over time.

Results

The NEISS query identified 759 actual pressure cooker injuries between 2003 and 2019, yielding a national estimate of 28 337 (95% CI 24 588 to 32,086) injuries treated in US emergency departments, 1667 cases annually. Analysis of case narratives resulted in the identification of four predominant precipitating or contributing factors to injury: burning agent, struck by product, injured while opening and other.

Conclusion

NEISS is a valuable tool for determining injury incidence and understanding common injury patterns associated with specific products. Consumers and manufacturers of pressure cookers can develop safety strategies targeted at preventing the product’s main injury risks.