bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid modal-machine learning damage identification approach for beam-like structures
Authors: Siow Pei Yi , Ong Zhi Chao , Khoo Shin Yee , Lim Kok-Sing
Published: October 2023

Data-driven damage detection methods are widely researched and implemented due to the availability of advanced sensing and cloud technologies, where machine learning models are used to process the various data collected from the sensors for damage diagnosis. Supervised methods have shown to be accurate in identifying damages given that they are trained with sufficient historical damage samples. As damage events are rare, supervised methods often face the cold-start problem, that is, insufficient labelled damage samples to initiate model training. Unsupervised methods do not require training and have shown to be practical up to detecting damage presence, but prior knowledge or labelled historical damage samples are still required as references to further locate and quantify the damage. To solve the cold-start issue, a modal-based method, which relates the modal parameters with damages, is proposed to bridge the gap between the unsupervised and supervised methods. Therefore, this work proposes an integration strategy of a modal-based method into a hybrid machine learning-based method for damage detection and localisation of beam-like structures. A two-stage scheme with unsupervised, supervised, and modal-based methods is proposed. The first stage detects damage presence using PCA-FRF as the damage-sensitive feature in an unsupervised manner, and the second stage locates the damages using the first mode shape. Mode shape assessment-based damage localisation is performed at the second stage when no trained model is available due to zero or limited damage samples for training to solve the cold-start and manual labelling issue. Supervised model training starts once there are at least two classes of damage, and the trained model is only used for damage localisation when it surpasses the 90% validation accuracy benchmark. Results showed accuracies of 100%, 100%, and 95.85% for the first stage unsupervised detection, second stage mode shape assessment-based damage localisation and the supervised model-based damage localisation, respectively.
Routine use of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment
Authors: Rapizzi Emilio , Barosco Guido , Zemella Nicola , Samassa Francesco , Rassu Nicolò , Frattolillo Antonio , Buratto Lenni
Published: October 2023

Purpose

To evaluate the safety and efficacy of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) and complete drainage of subretinal fluid.

Methods

For this retrospective study, we reviewed the medical charts of 273 patients (275 eyes) who consecutively underwent PPV, subretinal fluid drainage and filtered air tamponade to treat primary RRD between 2018 and 2022. As primary outcome we evaluated the anatomical success considered as retinal reattachment after single surgery. As secondary outcomes: final mean best corrected distance visual acuity (BCDVA), complications, and mean intraocular pressure (IOP) trends.

Results

The anatomical success was reached by 262 (95.6%) of cases. Mean BCDVA improved from 0.73 LogMAR at baseline, to 0.21 LogMAR at the end of follow-up. As complications we recorded: 5 cases of clinically relevant macular pucker, 1 full thickness macular hole, and 1 PFO bubble under the retina. The mean IOP remained on normal values during the overall follow-up period.
Towards a risk-adjusted tourism and travel competitiveness index
Authors: Duro Juan Antonio , Fernández-Fernández Melchor , Pérez-Laborda Alejandro , Rosselló-Nadal Jaume
Published: October 2023

The concept of Tourism Destinations Competitiveness has evolved from a price-focused perspective to the consideration of multiple factors including sustainability, residents’ well-being, or destination image. Regardless of the version used, it is expected that a competitive destination should be able to convert its advantageous position into economic returns. However, the pandemic has come to upset the foundations of the sector, since many of the destinations traditionally classified as highly competitive have also been the most affected by the pandemic. In this paper, we propose to review the notion of competitiveness by considering properly the dimension of inherent risk, using specific composite indexes, and adjusting conventional competitiveness indicators including these dimensions. We revise the results of these new adjusted by risk competitiveness indexes for the organization for economic cooperation and development (OECD) and OECD partner countries. Among other relevant points, the findings indicate relevant changes in rankings when we explicitly include risk in the competitiveness calculations.
Modeling and forecasting listed tourism firms’ risk in China using a trend asymmetric GARCH-MIDAS model
Authors: Yang Peng , Song Haiyan , Wen Long , Liu Han
Published: October 2023

This study employs the multivariate trend asymmetric GARCH-MIDAS (TAGM) model, an extension of the GARCH-MIDAS model, to explore the potential asymmetric impact of uncertainty shocks, including oil and infectious disease shocks, on the long-term volatility of China’s listed tourism firms. Furthermore, we test the out-of-sample forecasting accuracy of uncertainty shocks to China’s listed tourism firms’ risk, which is measured by the volatility of tourism stocks after the outbreak of coronavirus disease 2019 (COVID-19). The results show that uncertainty shocks have a significant asymmetric effect on the long-run volatility of tourism stocks. The included uncertainty shocks improved accuracy in forecasting China’s listed tourism firms’ risk after the pandemic outbreak. The empirical results have important implications for tourism investment strategies in unstable environments.
Environmental factors’ influence on criminal legal involvement for people with serious mental illness
Authors: Frances Kathryn , Epperson Matt , Payton Briana , Thompson Julian
Published: October 2023

Efforts to assess the risk of criminal legal system involvement among people with serious mental illness (SMI) often rely on strategies that locate the risk at the individual level. The present study examines environmental factors that contribute to criminal legal involvement for people with SMI in mental health treatment settings. Thirty-one people with serious mental illness and prior criminal legal involvement were interviewed in this qualitative study. Interviews focused on factors that contributed to and protected against criminal legal involvement. The research team engaged in inductive thematic analysis of interview data.

Findings

Findings reveal that understanding of physical, social, and treatment environments is critical to risk assessment with this population. In highlighting the role of the environment, we offer findings that may lead to improved strategies for service delivery with this population. Complicating contemporary approaches to risk assessment, our findings suggest that mental health treatment systems that serve individuals with serious mental illness should engage in meaningful consideration of environmental factors.

Applications

Identification of protective and risk factors in clients’ physical, social, and treatment environments is critical for social work practice with individuals who have a history of criminal legal involvement and serious mental illness. Treatment settings can create opportunities for the development of protective factors by integrating wrap-around services, treatment services that follow an empowerment-participation strengths model, and post-incarceration services with clients.
Measurement of needle and armature dynamics in a gasoline direct injector by high-speed neutron imaging
Authors: Wissink ML , Toops TJ , Splitter DA , Nafziger EJ , Finney CEA , Bilheux HZ , Zhang Y
Published: October 2023

In modern spark ignition engines, precise delivery of fuel with gasoline direct injection has become increasingly important in the effort to meet ever stricter efficiency and emissions regulations. Use of multiple small close-coupled injections has become more common in attempt to precisely control fuel distribution in the cylinder, but these strategies are hindered by nonlinear injection effects due to operation in the ballistic region of the solenoid-operated valve and due to armature bounce at the end of injection. Understanding the internal dynamics of the injector is crucial to minimizing and controlling non-linearity and shot-to-shot variation, but the experimental techniques available to date are capable only of tracking the position of either the top of the needle (via laser sensors or by monitoring current and voltage in the solenoid coil) or the bottom of the needle (via transparent nozzles or high-speed x-ray imaging). A complete picture of the axial and radial motion of valve needle has until now remained elusive. In this work, we present high-speed ensemble neutron transmission imaging of an entire 8-hole gasoline direct injector operating at 200 bar, allowing for both visualization and quantification of the actuation dynamics including lift and wobble of the valve ball, oscillation and bending of the valve needle, lift, rocking, and bounce of the armature, compression of the springs, and radial swelling of the solenoid during energization. Because neutrons offer high penetration through the metal injector while also being sensitive to the 1H nuclei in fuel molecules, it is also possible to simultaneously see the fluid dynamics of the injection process, including filling of the sac volume, emanation of the spray through the nozzle holes and into the downstream gas, and the formation and evolution of fuel films on the tip of the injector and the walls of the spray container.
Experimental evaluation of spark behavior under diluted conditions in an optically accessible engine
Authors: Welch Cooper , Illmann Lars , Schmidt Marius , Dreizler Andreas , Böhm Benjamin
Published: October 2023

An optically accessible single-cylinder spark-ignition engine operated under homogeneous, part-load conditions is experimentally investigated using optical and spark diagnostics to evaluate the relationship between the spark, flow, and flame with increasing dilution using several levels of exhaust gas recirculation (EGR). Voltage and current measurements of the secondary spark circuit are compared with simultaneous high-speed spark plasma imaging, particle image velocimetry measurements of the flow field, and burned gas images. Specifically, characteristic restrike cycles and normal cycles are examined under the 0 % EGR and 12.9 % EGR conditions to reveal a relationship between the magnitude and direction of the velocity near the spark plug and the spark’s behavior coupled with that of the subsequent flame propagation. Through the use of conditional statistics and correlation analysis of data sets of all non-restrike and all restrike cycles, the horizontal velocity across the spark gap was identified as a critical quantity in facilitating more stable and faster combustion under diluted mixture conditions.
Epiphany as a pragmatic response to claims of indoctrination in public schools
Authors: Ballard William Walker
Published: October 2023

This article argues for the need of a new, pragmatic response to claims of indoctrination in public school classrooms across the United States. While attempts at defining indoctrination and moral arguments for and against certain pedagogical practices may be worthwhile, the article maintains that claims of indoctrination, whether substantive or not, are an impediment to effective teaching, especially for educators who are primarily interested in perspective transformation. Drawing on recent scholarship regarding epiphany and transformative education, an argument is presented that teaching for epiphanic experience may be a pragmatic solution for teachers to adopt to remain effective in the classroom amid ever-increasing political polarization and professional scrutiny. After establishing this point, the article turns to arts education as a possible source for understanding the pedagogical technique that may lead to the creation of a classroom ethos for epiphany.
Performance of BeBack Crossing Catheter in Chronic Total Occlusion in Patients With Chronic Limb-Threatening Ischemia: A Single-Center Experience
Authors: Cohen Israel , Raskin Daniel , Barash Yiftach , Silverberg Daniel , Halak Moshe , Khaitovich Boris
Published: October 2023

Purpose:

To describe a single-center experience in the treatment of chronic limb-threatening ischemia (CLTI) with the application of BeBack catheter (Bentley InnoMed, Germany) in patients with arterial chronic total occlusion (CTO).

Materials and Methods:

A retrospective review of patients who underwent limb revascularizations using the BeBack catheter between 2015 and 2022. All patients had an initial failed attempt using a traditional guidewire and catheter technique. Technical success was considered whenever a successful re-entry or lesion crossing using the study device was achieved. Procedural success was defined as recanalization of the occluded artery with residual stenosis of less than 30%, and improvement in ankle-brachial index (ABI) after 24 hours. A Rutherford score was assigned to each limb and affected anatomical segments and lesion length were documented. Procedural access sites and complications were noted.

Results:

The study included 72 patients who underwent 78 procedures using the BeBack crossing catheter. Procedural success was achieved in 91% of cases, with a technical success rate of 92.3%. The most frequently involved occluded segments were the femoral and popliteal arteries. The average ABI improved from 0.59 to 0.95 after the procedure. The most used access site was the contralateral femoral, and the BeBack catheter was employed on 85 occasions. Only 1 patient suffered a severe immediate adverse effect, and during the 30-day follow-up period, 2 patients needed reintervention. Unfortunately, 3 patients died during the follow-up period.

Conclusion:

The BeBack catheter offers a viable option for the treatment of patients with chronic total occlusion, with high procedural success and a low complication rate.

Clinical Impact

The BeBack catheter presents a notable advancement for clinicians managing chronic limb-threatening ischemia (CLTI) and arterial chronic total occlusion (CTO), showcasing over 90% procedural and technical success rates in this study. Its adept ability to navigate and recanalize occluded segments provides a robust alternative, especially when traditional techniques falter. This innovation may chane clinical strategies in vascular interventions, offering an efficient and reliable option, thereby potentially enhancing patient outcomes in limb revascularizations.
A Ratio Between Infrarenal and Suprarenal Aortic Diameters Corrects for Absolute Aortic Diameter Variations due to Patients’ Sex and Body Size
Authors: Boer Gert Jan , Larbi Nora , Bekken Joost A. , Kuijper Tjallingius M. , Vroegindeweij Dammis , Fioole Bram
Published: October 2023

Objectives:

Aortic diameters may differ significantly between patients with different gender and body size. The aim of this study was to relate absolute aortic diameters to age, sex, height, and weight of the patients and to correct for these factors by calculating the ratio between the infrarenal and the suprarenal aortic diameters.

Methods:

A total of 458 patients who underwent elective endovascular aneurysm repair (EVAR) between 2004 and 2018 were included. The aortic anatomy in this group of elective EVAR patients was compared with a control group of 75 patients without an abdominal aortic aneurysm (AAA). The aortic diameter was measured at 4 suprarenal points and 4 infrarenal points. Ratios were calculated by dividing the mean infrarenal neck diameter by 4 suprarenal measurements.

Results:

Patients in the aneurysm group had significantly larger suprarenal and infrarenal aortic diameters. The ratios between the mean infrarenal neck diameter and all 4 suprarenal measurements were larger in the AAA group than in the control group. In both groups, there was a significant correlation between the mean infrarenal neck diameter and sex, height, weight, and body surface area (BSA). However, in both groups, all 4 ratios between the mean infrarenal neck diameter and suprarenal aortic diameters were not correlated with age, sex, height, weight, or BSA, except for the ratio between the mean infrarenal neck diameter and the aortic diameter measurement proximal to the upper renal artery, which was correlated to weight and BSA in the control group.

Conclusion:

The mean infrarenal neck diameter is correlated with sex, height, weight, and BSA. However, when the suprarenal aortic diameter was used as an internal control for the mean infrarenal neck diameter, we were able to correct for these variations in aortic diameters due to sex and body size. The clinical relevance of this ratio in patients treated by EVAR has yet to be assessed in future research.

Clinical Impact

In the assessment for EVAR suitability the absolute diameter of the aneurysm neck is taken into account. We believe that using absolute diameters is not the appropriate way to assess this suitability, but that patient characteristics such as age, gender and body size, should be factored into this assessment. In this paper, we show that suprarenal and infrarenal aortic diameters are both significantly increased in patients with an aneurysm compared with patients without an aneurysm. Besides, we found that mean infrarenal aortic diameter is correlated with sex, height, weight, and body surface area. Finally, we propose a new ratio system, using suprarenal diameters as an internal control, to correct for aortic diameter variations due to sex and body size.
Neutrophil-to-Lymphocyte Ratio and Early Tumor Shrinkage as Predictive Biomarkers in Unresectable Hepatocellular Carcinoma Patients Treated With Lenvatinib, PD-1 Inhibitors, in Combination With TACE
Authors: Qu Shuping , Wu Dong , Hu Zhiming
Published: October 2023

Purpose: The purpose of this prospective observational study was to investigate the relationship between pretreatment neutrophil-to-lymphocyte ratio (NLR) and posttreatment early tumor shrinkage (ETS), and clinical outcomes in patients with unresectable hepatocellular carcinoma (uHCC) who received lenvatinib, programmed death-1 inhibitors plus transcatheter arterial chemoembolization. Patients and Methods: A total of 63 uHCC patients were treated with this triple combination. Multivariate analyses to determine the independent factors associated with overall survival (OS) were employed. The link between NLR and clinical results was further analyzed. Furthermore, the predictive value of combining NLR with ETS should be investigated to stratify patients receiving treatment for survival benefits. Results: Progression-free survival and OS were 9.8 and 23.0 months, respectively, with a median follow-up of 20.8 months. On a multivariate analysis of OS, NLR was the only independent prognostic factor. Patients with NLR low (NLR < 3.2) had longer progression-free survival (19.3 vs 7.3 months, P < 0.001) and OS (28.9 vs 16.9 months, P < 0.001), higher objective response rate (86.7% vs 39.4%, P < 0.001), and a higher chance of achieving ETS ≥ 10% (ETS high) (73.3% vs 21.1%, P < 0.001) compared with patients with NLR high (NLR ≥ 3.2). The Spearman correlation analysis also showed the strong consistency between NLR and ETS ( R2 = 0.6751). In the subgroup analysis, greater OS benefit was found in the NLR low/ETS high group than the NLR high/ETS low group (χ2 = 31.258, P < 0.001), while there was no survival difference for patients in the NLR low/ETS low group compared with in the NLR high/ETS high group (χ2 = 0.046, P = 0.830). Conclusion: NLR has the potential to identify which patients would benefit from this triple therapy, and when combined with ETS, it has the potential to provide greater predictive power in selecting the appropriate candidates for this combination treatment.
Effect of Perioperative Stroke on Survival After Carotid Intervention
Authors: Cambiaghi Tommaso , Mills Alexander , Leonard Samuel , Husman Regina , Zaidi Syed T. , Koh Ezra Y. , Keyhani Kourosh , Wang S. Keisin
Published: October 2023

Objectives

Perioperative stroke is the most dreaded complication of carotid artery interventions and can severely affect patients’ quality of life. This study evaluated the impact of this event on mortality for patients undergoing interventional treatment of carotid artery stenosis with three different modalities.

Methods

Patients undergoing carotid revascularization at participating Memorial Hermann Health System facilities were captured from 2003-2022. These patients were treated with either carotid endarterectomy (CEA), transfemoral carotid stenting (TF-CAS), or transcarotid artery revascularization (TCAR). Perioperative outcomes, including stroke and mortality, as well as follow-up survival data at 6-month intervals, were analyzed and stratified per treatment modality.

Results

Of the 1681 carotid revascularization patients identified, 992 underwent CEA (59.0%), 524 underwent TCAR (31.2%), and 165 underwent TF-CAS (9.8%). The incidence of stroke was 2.1% (CEA 2.1%, TCAR 1.7%, and TF-CAS 3.6%; P = .326). The perioperative (30-day) death rate was 2.1% (n = 36). The perioperative death rate was higher in patients who suffered from an intraoperative stroke than in those who did not (8.3% vs 1.9%, P = .007). Perioperative death was also different between CEA, TCAR, and TF-CAS for patients who had an intraoperative stroke (.0% vs 33.3% vs .0%, P = .05). TCAR patients were likely to be older ( P < .001), have a higher body mass index ( P < .001), and have diabetes mellitus ( P < .001). Patients who suffered from an intraoperative stroke were more likely to have a symptomatic carotid lesion (58.3% vs 28.8%, P < .001). The TCAR group had a significantly lower survival at 6 months and 12 months when compared to the other two groups (64.9% vs 100% P = .007).

Conclusion

Perioperative stroke during carotid interventions significantly impacts early patient survival with otherwise no apparent change in mid-term outcomes at 5 years. This difference appears to be even more significant in patients undergoing TCAR, possibly due to their baseline higher-risk profile and lower functional reserve.
Assessment of Classical and Non-Classical Quantitative Electroencephalographic Measures in Patients with Substance Use Disorders
Authors: Guerrero-Aranda Alioth , Alvarado-Rodríguez Francisco Javier , Enríquez-Zaragoza Andrea , Carmona-Huerta Jaime , González-Garrido Andrés Antonio
Published: October 2023

Background: People diagnosed with substance use disorders (SUDs) are at risk for impairment of brain function and structure. However, physicians still do not have any clinical biomarker of brain impairment that helps diagnose or treat these patients when needed. The most common method to study these patients is the classical electroencephalographic (EEG) analyses of absolute and relative powers, but this has limited individual clinical applicability. Other non-classical measures such as frequency band ratios and entropy show promise in these patients. Therefore, there is a need to expand the use of quantitative (q)EEG beyond classical measures in clinical populations. Our aim is to assess a group of classical and non-classical qEEG measures in a population with SUDs. Methods: We selected 56 non-medicated and drug-free adult patients (30 males) diagnosed with SUDs and admitted to Rehabilitation Clinics. According to qualitative EEG findings, patients were divided into four groups. We estimated the absolute and relative powers and calculated the entropy, and the alpha/(delta + theta) ratio. Results: Our findings showed a significant variability of absolute and relative powers among patients with SUDs. We also observed a decrease in the EEG-based entropy index and alpha/(theta + delta) ratio, mainly in posterior regions, in the patients with abnormal qualitative EEG. Conclusions: Our findings support the view that the power spectrum is not a reliable biomarker on an individual level. Thus, we suggest shifting the approach from the power spectrum toward other potential methods and designs that may offer greater clinical possibilities.
Inexact fixed-point iteration method for nonlinear complementarity problems
Authors: Song Xiaobo , Zhang Xu , Zeng Yuhua , Peng Zheng
Published: October 2023

Based on the modulus decomposition, the structured nonlinear complementarity problem is reformulated as an implicit fixed-point system of nonlinear equations. Distinguishing from some existing modulus-based matrix splitting methods, we present a flexible modulus-based inexact fixed-point iteration method for the resulting system, in which the subproblem can be solved approximately by a linear system-solver. The global convergence of the proposed method is established by assuming that the system matrix is positive definite. Some numerical comparisons are reported to illustrate the applicability of the proposed method, especially for large-scale problems.
Enabling mothers of young children in a low SES area to co-design the support they are seeking for the adoption of healthy behaviours
Authors: Wittels P , Kay T , Mansfield L
Published: October 2023

Aims:

There is a need for interventions that meet the needs of low socioeconomic status (SES) groups, to encourage the adoption of healthy diets and physical activity, in line with current public health guidance. This qualitative research used co-production, a method which actively involves the relevant community, to identify and describe public health interventions to support a group of mothers of young children living in a low SES area.

Methods:

A group of 20 mothers took part in three in-depth qualitative interviews to discuss in detail the type of support that would be of value to them for the adoption and maintenance of healthy behaviours. The mothers were subsequently invited to take part in a public engagement project, a community-based self-help group.

Results:

Four themes explained the principles of interventions that would be of value in supporting the mothers with the adoption of healthy behaviours, namely, a community-based self-help group, support for the whole family and support in the home and influencing the environment. These were then further developed into two types of intervention (1) learning for self-help and family care, which encompassed the first three learning-based themes and (2) community of support, which covered influencing the environment and the experience of the community-based self-help group.

Conclusion:

Co-production enabled a group of mothers of young children, from a low SES area, to describe the type of support that would help them with the establishment and maintenance of healthy lifestyle behaviours. A community-based self-help group warrants further research.
Analysis of “Hybrid Closed Loop Using a Do-It-Yourself Artificial Pancreas System in Adults With Type 1 Diabetes”
Authors: Wilkinson Tom M. , de Bock Martin
Published: October 2023

In an article in Journal of Diabetes Science and Technology, Nanayakkara and colleagues assessed the glycemic efficacy and safety of AndroidAPS, an open-source automated delivery (AID) system, in a crossover randomized controlled trial. Although the trial included only 20 participants during a relatively short 4-week intervention period, glycemic outcomes attained were similar to commercial AID systems and there were no safety concerns. Validation of open-source AID systems in studies such as this should help address clinician hesitancy regarding these systems, and affirms the role of patient-centered innovation and self-management in diabetes care.
Discovery of a suburban wetland refuge for a depleted American crocodile (Crocodylus acutus) population in northwestern Mexico, using a commercial Unmanned Aerial Vehicle
Authors: Marín-Enríquez Emigdio , Charruau Pierre , Félix-Salazar Luis Adán
Published: October 2023

Background and Research Aims

The Urías Coastal Lagoon (UCL) is a heavily modified and polluted lagoon near Mazatlán, in northwestern Mexico. Once abundant in the UCL, the American crocodile ( Crocodylus acutus) is now rarely seen in the area. A healthy population of apex predators is essential to maintain the trophic balance of ecosystems. Our research aim was to lay the groundwork for studies of American crocodile population ecology in the UCL.

Methods

Traditional boat surveys (day and night) of crocodiles were undertaken in the UCL in May-July 2022. Two exploratory aerial (∼ 30 m altitude) surveys of a small wetland located close to a habitational complex in the vicinity of the UCL were performed in June and December 2022, using a commercial Unmanned Aerial Vehicle (UAV). We used images obtained with the UAV to estimate the size of the crocodiles detected in the wetland.

Results

This study confirms the presence of American crocodiles in the UCL and presents the first information on individuals of this species for this area. Aerial surveys revealed the presence of 17 individuals in the wetland; the mean size of nine of those individuals was 183.3 ± 60 cm (range: 130-310 cm). Two yearlings (∼37 cm length), possibly born in June 2022, were captured in the same wetland in September 2022. We also surveyed 50.7 km of UCL coastline by boat, but no crocodiles were sighted.

Conclusion

The crocodiles seem to avoid the human-impacted UCL and likely use the less impacted surrounding wetlands as a refuge area, which they also use to reproduce. The presence of both yearlings and adults is a good sign for the survival of this vulnerable population.

Implications for Conservation

We believe that the surveyed wetland should be closely monitored for conservation purposes because it might be one of the last crocodile breeding refuges in the heavily modified and polluted coastal environment of the UCL. We summarize our results with a series of recommendations for local and federal authorities. These recommendations would likely help the conservation of the American crocodile population in the UCL.
A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm
Authors: Angthong Chayanin , Younger Alastair S.E. , Chuckpaiwong Bavornrit , Harnroongroj Thos , Veljkovic Andrea
Published: October 2023

Objective

Müller-Weiss disease (MWD) is a challenging condition involving the perinavicular region in the initial stages and subsequently the entire foot in the later stages. The goal of this article is to describe the pathomechanics, clinical evaluation, and nonoperative and operative treatment, including a treatment algorithm, based on current evidence and the combined authors’ experience.

Design

We review the related articles and summarize the information about this condition.

Results

A number of related articles reveal that the treatments should focus on the management of degenerative regions and deformity correction to restore normal foot alignment and provide pain relief.

Conclusion

This systematic review proposes a treatment algorithm that is comprehensive and practical to apply for the management of MWD.
Impact of the COVID-19 pandemic on the prevalence of postnatal depression in Singapore
Authors: Chen Kaddie K , Umboh Sandy Julianty , Chua Tze-Ern , Chua Min S , Yik Chow M , Poon Ngar Y , Ch’ng Ying Chia , Chen Helen
Published: October 2023

Postnatal depression is a critical public health issue with substantial impact on child development outcomes and family functioning. With the additional stressors that arose during the COVID-19 pandemic, the impact on global mental health has been marked. This study aims to examine the change in the prevalence of postnatal depression (PND) in Singaporean women before the onset of the pandemic and during the pandemic period. A single-center observational cross-sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital (KKH) where women were screened for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS). High scorers on EPDS (EPDS≥13) were considered probable cases of postnatal depression. The prevalence of high EPDS scorers increased from 4.9% in 2019 to 6.5% in 2021, which was statistically significant ( p = .028). The total number of women who received screening for postnatal depression at KKH increased by 42.6% in 2021 compared to 2019, whilst the numbers identified as probable cases increased by 91% over the same period. The prevalence of PND in Singapore significantly increased during the COVID-19 pandemic.
Rilzabrutinib versus placebo in adults and adolescents with persistent or chronic immune thrombocytopenia: LUNA 3 phase III study
Authors: Kuter David J. , Bussel James B. , Ghanima Waleed , Cooper Nichola , Gernsheimer Terry , Lambert Michele P. , Liebman Howard A. , Tarantino Michael D. , Lee Michelle , Guo Hailing , Daak Ahmed
Published: October 2023

Background:

Immune thrombocytopenia (ITP) is characterized by primarily autoantibody-mediated platelet destruction and impaired platelet production resulting in thrombocytopenia and an increased risk of bleeding. Other manifestations include increased risk of thrombosis and diminished quality of life. Current treatment approaches are directed toward lowering the rate of platelet destruction or stimulating platelet production to prevent bleeding. Rilzabrutinib is an oral, reversible, potent Bruton tyrosine kinase inhibitor that was specifically designed to treat immune-mediated diseases and mediates its therapeutic effect through a dual mechanism of action: (1) inhibiting B-cell activation and (2) interrupting antibody-coated cell phagocytosis by Fc gamma receptor in spleen and liver. A 24-week dose-finding phase I/II study of rilzabrutinib in patients with ITP showed a 40% platelet response (⩾2 consecutive platelet counts of ⩾50 × 109/L and increase from baseline ⩾20 × 109/L without rescue medication use) and a well-tolerated safety profile with only grade 1/2 transient adverse events across dose levels.

Objectives:

Assess the efficacy and safety of oral rilzabrutinib in adult and adolescent patients with persistent or chronic ITP.

Design:

Rilzabrutinib 400 mg BID is being evaluated in the ongoing LUNA 3 multicenter, double-blind, placebo-controlled phase III study.

Methods and analysis:

The primary endpoint is durable platelet response, defined as achieving platelet counts of ⩾50 × 109/L for at least two-thirds of ⩾8 available weekly scheduled platelet measurements during the last 12 weeks (including ⩾2 available measurements within the last 6 weeks) of the 24-week blinded treatment period in the absence of rescue therapy.

Ethics:

Ethical guidelines and informed consent are followed.

Discussion:

The LUNA 3 trial will further investigate rilzabrutinib’s safety and efficacy in adult and adolescent patients, with the primary goal of addressing a major objective in treating patients with ITP: durability of platelet response.

Trail Registration:

ClinicalTrials.gov NCT04562766: https://clinicaltrials.gov/ct2/show/NCT04562766 ; EU Clinical Trials Register EudraCT 2020-002063-60: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2020-002063-60 .
Wearable witnesses: Deathlogging and framing wearable technology data in “Fitbit murders”
Authors: Gilmore James N. , Gruber Cassidy
Published: October 2023

Wearable self-tracking devices such as Fitbit and Apple Watch have begun to be featured in high-profile criminal cases such as murder trials for the ways the data from these devices supposedly give access to objective truths about a victim's physiological state and time of death. Drawing from the concepts of deathlogging and datafication, we argue that an examination of media framing around wearables in criminal investigations and court rooms helps demonstrate how technologies become connected to different domains and practices. A discourse analysis of five case studies and 57 news stories showed how the framing of wearables in this context emphasized both enchantment with the capacity for datafication to witness, as well as contestation around how to define and interpret this witnessing. This study demonstrated how reporting around the incorporation of mobile media technologies into institutional practices often reproduced desires for digital technologies to provide access to “the truth” of social reality.
Analysis of the learning curve for Retzius-sparing robot-assisted radical prostatectomy for a single surgeon
Authors: Hussein Hany , Maitra Neil , Tay Li June , Saxionis Ioannis , Makin Robert , Sivathasan Sailantra , Smart Sonny , Warren Anne , Shah Nimish , Lamb Benjamin Wilfrid
Published: October 2023

Background:

The learning curve for Retzius-sparing robotic radical prostatectomy is not fully understood.

Objective:

This study attempts to identify the learning curve across the first 130 cases of a single surgeon.

Design, Setting and Participants:

All Retzius-sparing robotic radical prostatectomy cases performed by a single surgeon at a high-volume tertiary hospital between April 2019 and July 2022 were included.

Outcome Measurements and Statistical Analysis:

Outcome measures included positive surgical margin rate, complication rates and unplanned readmission to hospital, postoperative urinary continence, erectile function and prostate-specific antigen (PSA) measurement. Cases were divided chronologically into three groups and differences between groups assessed.

Results and Limitation:

A total of 130 Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) cases were identified. Differences were found between groups in several areas. Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Safety, postoperative continence, erectile function and PSA remained stable. Median patient age increased between Group 1 (59 years) and Group 3 (66.5 years) ( p = 0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) ( p = 0.036). Median console time increased between Group 1 (120 minutes) and Group 2 (150 minutes) ( p = 0.01). Median gland weight increased between Group 1 (28 g) and Group 3 (35.5 g) ( p < 0.001).

Conclusions:

The positive surgical margin rate improved over the learning curve, despite the complexity of cases increasing, reflected in older patients, larger prostates and higher stage disease. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease.

Patient Summary:

We analysed the learning curve for Retzius-sparing robotic radical prostatectomy. Across the first 130 cases, positive surgical margin rate fell; safety and continence remained excellent. Selection of smaller and less advanced cases may facilitate learning.

Level of evidence:

III
Atypical ADPKD Due to a DNAJB11 Pathogenic Variant: An Educational Case Report
Authors: Kachmar Jessica , El-Haffaf Zaki , Bollée Guillaume
Published: October 2023

Rationale:

Due to next-generation sequencing, variants in new genes such as DNAJB11 are recently being identified as causing atypical autosomal dominant polycystic kidney disease (ADPKD). It is important to describe phenotypes associated with these variants in order to increase awareness among clinicians, especially since genetic variability affects ADPKD severity.

Presenting Concerns of the Patient:

We describe a 55-year-old female patient of Haitian origin who presented with slowly deteriorating kidney function, microscopic hematuria, proteinuria, enlarged kidneys with innumerable small cysts, and a family history of chronic kidney disease and cysts. The phenotype was atypical for ADPKD caused by PKD1 or PKD2 variants, since cysts were of small size, kidneys were only moderately enlarged, and the patient had no extra-renal involvement suggestive of typical ADPKD such as liver cysts, pancreatic cysts, cranial aneurysms, or cardiac abnormalities.

Diagnoses:

A panel of genes was analyzed by next-generation massive sequencing techniques, including DNAJB11, DZIP1L, GANAB, HNF1B, PKD1, PKD2, and PKHD1. Genetic testing revealed a heterozygous variant in the DNAJB11 gene (c.123 dup), which is predicted to result in premature protein termination (p. Lys42*) and was classified by the laboratory as likely pathogenic.

Interventions:

She was treated with candesartan 16 mg once daily to address her proteinuria.

Outcomes:

At the time of the most recent follow-up, her proteinuria has increased, and her kidney function continues to slowly deteriorate.

Teaching Points:

DNAJB11 variants are a rare cause of atypical ADPKD. It is important to recognize the clinical features that help distinguish DNAJB11 from PKD1 and PKD2 variants. Atypical ADPKD due to DNAJB11 variants is usually characterized by small cysts, normal kidney size, proteinuria, progressive chronic kidney disease, and phenotypic overlap with autosomal dominant tubulointerstitial kidney disease (ADTKD). It may, however, present itself with enlarged kidneys as was seen in our patient. Genetic testing should be offered whenever a patient presents atypical features of ADPKD, which also requires increased awareness among clinicians regarding the various phenotypes of atypical ADPKD.
Loneliness and happiness in the face of the COVID-19 lockdown: Examining the pathways through somatic symptoms and psychological distress
Authors: Olawa Babatola Dominic , Idemudia Erhabor Sunday , Omolayo Benjamin Oluwabunmi , Azikiwe Judith Chineye
Published: October 2023

Studies show that loneliness was higher during the pandemic than in the pre-pandemic periods, with negative consequences on individual happiness. This study extends current knowledge by investigating the indirect effects of somatic symptoms and psychological distress in the loneliness-happiness relationship during the COVID-19 lockdown. The cross-sectional sample comprises 538 Nigerian adults (Meanage = 36.48 ± 12.03) with 43% females. Data were collected using structured self-report instruments and subjected to path analyses in SPSS AMOS. Results showed that loneliness and happiness were negatively related. Loneliness and happiness were indirectly related through the successive association between somatic symptoms and psychological distress. Specifically, greater loneliness was associated with increased somatic symptoms, which in turn were associated with greater psychological distress and reduced happiness levels. Clinicians can manage the decline in happiness from loneliness during the pandemic lockdown by administering treatments that mitigate somatic symptoms and psychological distress in concerned clients.
Will Using Social Media Benefit or Harm Users’ Self-Esteem? It Depends on Perceived Relational-Closeness
Authors: Han Yang , Yang Feng
Published: October 2023

Prior research concerning social media use and self-esteem showed inconsistent findings. In the current research, two studies were conducted to examine the moderating role of perceived relational-closeness between social media use and self-esteem, and the underlying mediating mechanisms. In Study 1 (a quasi-experimental study), by assigning participants to the weak (reporting TikTok use intensity) or strong (reporting WeChat use intensity) relational-closeness condition, we found that using social media with weak relational-closeness harmed users’ self-esteem, while using social media with strong relational-closeness benefited users’ self-esteem. Moreover, participants in the strong relational-closeness condition reported higher social support perception and self-esteem than those in the weak relational-closeness condition. Further analyses showed that upward social comparison mediated the relationship between social media use and self-esteem in the weak relational-closeness; in the strong relational-closeness condition, upward social comparison and perceived social support both mediated the relationship between social media use and self-esteem, but perceived social support played a dominant role in the mediating effects. In Study 2 (an experimental study), we presented the same examination experiences-sharing for all participants. We found that, even exposed to the same stimuli, participants in the strong relational-closeness condition (declaring that the experiences-sharing was extracted from QQ) still reported higher social support perception and self-esteem than those participants in the weak relational-closeness condition (declaring that the experiences-sharing was extracted from Bilibili). The current research provided a possible explanation to reconcile previously inconsistent findings about social media use and self-esteem.
An Assessment of the World’s Contribution to Spine Trauma Care: A Bibliometric Analysis of Classifications and Surgical Management; An AO Spine Knowledge Forum Trauma Initiative
Authors: Chhabra Harvinder Singh , Phadke Vandana , Manghwani Jitesh , El-Sharkawi Mohammad , Butler Joseph S. , Benneker Lorin M. , Vialle Emiliano , Hazenbiller Olesja , Bransford Richard
Published: October 2023

Study Design

Bibliometric analysis.

Objectives

An analysis of the literature related to the assessment and management of spinal trauma was undertaken to allow the identification of top contributors, collaborations and research trends.

Methods

A search to identify original articles published in English between 2011 and 2020 was done using specific keywords in the Web of Science database. After screening, the top 300 most cited articles were analyzed using Biblioshiny R software.

Results

The highest number of contributions were from the Thomas Jefferson University, USA, University of Toronto and University of British Columbia, Canada. The top 3 most prolific authors were Vaccaro AR, Arabi B, and Oner FC. The USA and Canada were among the top contributing countries; Switzerland and Brazil had most multiple country co-authored articles. The most relevant journals were the European Spine Journal, Spine and Spine Journal. Three of the 5 most cited articles were about classification systems of fractures. The keyword analysis included clusters for different spinal regions, spinal cord injury, classification agreement and reliability studies, imaging related studies, surgical techniques and outcomes.

Conclusions

The study identified the most impactful authors and affiliations, and determined the journals where most impactful research is published in the field. Study also compared the productivity and collaborations across countries. The study highlighted the impact of development of new classification systems, and identified research trends including instrumentation, fixation and decompression techniques, epidemiology and recovery after spinal trauma.