bluuebunny/crossref_metadata_2025 huggingface dataset:
The Permissibility of Biased AI in a Biased World: An Ethical Analysis of AI for Screening and Referrals for Diabetic Retinopathy in Singapore
Authors: Muyskens Kathryn , Ballantyne Angela , Savulescu Julian , Nasir Harisan Unais , Muralidharan Anantharaman
Published: October 2024

A significant and important ethical tension in resource allocation and public health ethics is between utility and equity. We explore this tension between utility and equity in the context of health AI through an examination of a diagnostic AI screening tool for diabetic retinopathy developed by a team of researchers at Duke-NUS in Singapore. While this tool was found to be effective, it was not equally effective across every ethnic group in Singapore, being less effective for the minority Malay population than for the Chinese majority. We discuss the problematic normative nature of bias in health AI and explore the ways in which bias can interact with various forms of social inequalities. From there, we examine the specifics of the diabetic retinopathy case and weigh up specific trade-offs between utility and equity. Ultimately, we conclude that it is ethically permissible to prioritise utility over equity where certain criteria hold. Given that any medical AI is more likely than not to have lingering bias due to bias in the training data that may reflect other social inequalities, we argue that it is permissible to implement an AI tool with residual bias where: (1) its introduction reduces the influence of biases (even if overall inequality is worsened), and/or (2) where the utility gained is significant enough and shared across groups (even if unevenly).
Novel insights into PLMN-13PT ceramics: impact of spark plasma sintering on compositional and dielectric properties
Authors: Londoño Fernando , do Nascimento William Junior , Viana Diego Seiti Fukano , Eiras Jose Antonio , Garcia Ducinei
Published: October 2024

This study investigates the effects of Spark Plasma Sintering (SPS) on the physical, structural, microstructural, dielectric, and optical properties of on 87[Pb(1−y)Laₓ(Mg1/3Nb2/3)O3]-13PbTiO3, (PLMN-13PT) ceramics. The primary objective was to evaluate how SPS influences the densification, grain growth, and compositional variations of these ceramics, which are critical for electronic device applications. The results demonstrate that SPS effectively achieves high relative density while suppressing grain growth, leading to a more homogeneous microstructure. However, the rapid densification process also induces compositional variations that significantly impact the dielectric properties, including the reduction of undesirable phases like pyrochlore, which are detrimental to performance. These findings highlight the potential of SPS for optimizing PLMN-13PT ceramics, enhancing their suitability for the miniaturization of multifunctional electronic devices.
Soot formation and laminar combustion characteristics of anisole: ReaxFF MD simulation and kinetic analysis
Authors: Dong Wenlong , Hong Run , Yao Jinfang , Wang Dongyang , Yan Liang , Qiu Bingbing , Chu Huaqiang
Published: October 2024

The application of biomass energy is one of the important ways to achieve carbon neutrality and deal with global warming. The study on the combustion mechanism of anisole, an oxygen-containing fuel, is helpful for biofuel large-scale application. In this study, the soot formation and laminar combustion characteristics of anisole were analyzed by reactive force field molecular dynamics (ReaxFF MD) and kinetic simulation, respectively. ReaxFF MD simulation studies had shown that soot formation of anisole combustion occurred in three stages, stage 1 (0–1 ns), stage 2 (1–2.5 ns), stage 3 (2.5–6 ns). The three stages represented the pyrolysis of the fuel, the developmental stage of the soot, and the graphitization stage of the soot, respectively. During the combustion of anisole, primary mechanisms for the soot formation were as follows: H-abstraction-C2H2-addition, carbon-addition-hydrogen-addition, internal ring formation and long carbon chain link. The formation of soot graphitization exhibited different morphologically behaviors: from flakes to onions to spheres with fewer branched chains. From the study of the laminar combustion characteristics of anisole, it can be found that the laminar burning velocities increased along with the increase of temperature, while the opposite trend was shown along with the increase of pressure. The sensitivity coefficient of naphthalene, the main soot precursor, revealed that the main promotional reactions for soot formation were R5 (O2 + H <  =  > O + OH), R36 (CO + OH <  =  > CO2 + H).
Quality attributes and antioxidant activity of stirred yoghurt fortified with some nano-fruit waste powders
Authors: Taha Soad H. , Elshaghabee Fouad M. F. , Ameen Mostafa A.
Published: October 2024

Agro-industrial wastes have emerged as a significant source of bioactive compounds. Therefore, this study was conducted to evaluate the feasibility of using nano-powders of some fruit wastes, namely; apricot (Prunus sp.) and peach (Prunus persica L. Batsch) kernels, watermelon (Citrullus lanatus) rind and banana (Musa spp.) peel as functional ingredients (0.5%) in stirred yoghurt, as well as their effect on the antioxidant activity, quality characteristics, viability of yoghurt starter culture and sensory attributes. Results revealed that the fortification process significantly (P < 0.05) elevated the total solids, fat, protein and ash contents, especially with apricot and peach kernels (AK and PK), which distinctly increased fat by average values of 3.46 and 3.40%, and protein by 3.70 and 3.68% during storage compared to control (3.12 and 3.57%), respectively. The addition of watermelon rind (WMR) increased the titratable acidity (0.97%) and viscosity (463.59 cP) with a significant reduction of syneresis (16.38%), increased the total viable count of starter culture, acetaldehyde and diacetyl contents (167.10 and 18.82 mg/100 g) in yoghurt, followed by banana peel (BP). Stirred yoghurt fortified with BP nano-powder had the highest total phenolic content (20.96 mg gallic acid/g) and DPPH scavenging activity (31.93%) as average values during storage compared to the other nano-fruit wastes. Sensory attributes of stirred yoghurt were improved with the addition of WMR and BP during storage periods, compared to those fortified with AK and PK. All the nano-powders of the studied fruit wastes constitute excellent raw materials for the development of novel functional stirred yoghurt.
Understanding Visuals in the Life Sciences
Authors: Yu Han
Published: October 2024

From photographs to micrographs, from the various types of graphs to fun, interactive visuals and games, there are many different forms in which science can be visualised. However, all of these forms of visualisation in the Life Sciences are susceptible to misunderstandings and misinformation. This accessible and concise book demonstrates the misconceptions surrounding the visuals used in popular life science communication. Richly illustrated in colour, this guide is packed with examples of commonly used visual types: photographs, micrographs, illustrations, graphs, interactive visuals, and infographics allowing visual creators to produce more effective visuals that aspire to being both attractive and informative for their target audience. It also encourages non-specialist readers to be more empowered and critical, to ask difficult questions, and to cultivate true engagement with science. This book is an invaluable resource for life scientists and science communicators, and anyone who creates visuals for public or non-specialist readers.
Emergence of carbapenemase-producing Enterobacterales (CPE) in patients with severe COVID-19 infection and successful control in intensive care
Authors: Longhitano Anthony , Campbell Duncan , Mothobi Nomvuyo , McKenzie Alison , Bartolo Caroline , Saha Sajal , Sherry Norelle , Athan Eugene
Published: October 2024

Objective:

We aim to highlight the risks of acquiring carbapenemase-producing Enterobacterales (CPE) resistance genes in patients with severe coronavirus disease 2019 (COVID-19) in intensive care.

Design:

Outbreak analysis to assess for a transmission risk area (TRA) conducted after identification of potential CPE outbreak within shared room spaces in intensive care.

Setting:

Analysis conducted within a 24-bed single-room model intensive-care department within a level-3 tertiary center public hospital in regional Victoria, Australia.

Patients:

3 patients, with severe COVID-19 admitted to intensive care over a 3-month period with shared room spaces requiring prolonged mechanical ventilation and broad-spectrum antimicrobials, identified and were managed for CPE isolated from sputum. Overlap carbapenemase genes were identified among different organisms raising suspicion of transmitted resistance genes. A subsequent case managed for severe community-acquired pneumonia isolated CPE 3 months beyond these cases.

Methods:

Outbreak analysis via weekly cross-sectional point prevalence screening of fecal samples or rectal swabs for CPE from patients admitted to the intensive-care department over a 4-week period.

Results:

34 patients were included in the analysis with 51 tests for CPE screening conducted. No further cases of CPE were identified. Statewide Infection Surveillance team and the Department of Health and Human Services did not find the cases to derive from a TRA. No further action including environmental screening was indicated.

Conclusions:

These cases highlight the independent acquisition of CPE genes in patients with severe COVID-19 and antimicrobial selective pressures resulting in significant morbidity and mortality. Increasing awareness, robust antimicrobial stewardship, and infection prevention measures could reduce pressures driving CPE resistance mutations and the risk of CPE transmission.
A quasi-experimental analysis comparing antimicrobial usage on COVID-19 and non-COVID-19 wards
Authors: Doyle Daniel , Dalton Bruce , Zhang Zuying , Sabuda Deana , Rajakumar Irina , Rennert-May Elissa , Leal Jenine , Conly John M.
Published: October 2024

Objective:

To describe antimicrobial usage (AMU) trends before and during the coronavirus disease 2019 (COVID-19) pandemic, between COVID-19 and non-COVID-19 wards, and if there was any association with a COVID-19 order set.

Design:

Quasi-experimental retrospective interrupted time series analysis of AMU rates with a contemporaneous comparison of COVID-19 versus non-COVID-19 control wards. Analysis using incidence rate ratios (IRR) was conducted using a Poisson regression generalized linear model.

Setting:

Five COVID-19 and 4 comparable non-COVID-19 wards and 6 intensive care units (ICUs) at 4 hospitals during pandemic waves 1–4.

Participants:

All inpatients receiving systemic antimicrobials.

Intervention:

The COVID-19 checkbox antimicrobial order set was implemented in March 2020, to be used only if considered clinically indicated with modification in August 2021.

Main Outcome(s) and Measure(s):

The primary outcome was a change in AMU rates (defined daily dose per 100 patient days per month) comparing pre- versus peri-pandemic periods and COVID-19 versus control non-COVID-19 wards. Secondary outcomes included antifungal usage rate in ICUs and assessing AMUs following implementation and modification of a COVID-19 order set.

Results:

Significantly greater rates of AMU (IRR[95%CI]) were observed on COVID-19 wards versus non-COVID-19 wards during waves 1–4 for all systemic antimicrobials (1.76[1.71–1.81], 1.10[1.07–1.13], 1.48[1.43–1.53], and 1.06[1.03–1.09]); for azithromycin (11.76[9.80–14.23], 10.96[9.49–12.74], 12.41[10.73–14.45], and 4.88[4.31–5.55]); and for ceftriaxone (2.39[2.16–2.65], 3.64[3.29–4.03], 2.94[2.67–3.23], and 1.62[1.49–1.76]).

Conclusions:

We observed significantly increased AMU rates of all systemic agents during the first 4 waves of the pandemic and on COVID-19 wards compared with control wards for azithromycin and ceftriaxone. These agents saw a twofold reduction following order-set removal, suggesting that the clinical decision-support tool order set, as utilized, had influenced prescribing behavior.
Valuing life
Authors: Slovic Paul
Published: October 2024

The heart of prospect theory is the value function, proposing that the carriers of value are positive or negative changes from a reference point. Daniel Kahneman observed that if prospect theory had a flag, the value function would be drawn on it. The function is nonlinear, reflecting diminishing sensitivity to magnitude. When describing how human lives are valued, the function exposes profound incoherence. An individual life is highly valued and thus vigorously protected if it is the only life at risk. But that life loses its value when it is one of many endangered by a larger tragedy. Beyond this insensitivity, the function may actually decline when many lives at risk become mere numbers. The more who die, the less we care. Implications of this deadly ‘arithmetic of compassion’ for understanding and managing the risk from nuclear weapons are briefly discussed.
Impact of neonatal sepsis on serum selenium levels: Evidence of decreased selenium in sepsis-affected neonates
Authors: Saadat Seyed Hossein , Goodarzi Rakhshaneh , Elahi Zeynab , Ameri Aref
Published: October 2024

Introduction:

Essential trace elements and micronutrients are critical in eliciting an effective immune response to combat sepsis, with selenium being particularly noteworthy. The objective of this investigation is to analyze and the levels of serum selenium in neonates within sepsis and control groups.

Methodology:

In 2023, a case–control study was carried out involving 66 hospitalized infants – 33 diagnosed with sepsis forming the case group and 33 free from sepsis constituting the control group – along with their mothers, at Children’s and Shariati Hospitals in Bandar Abbas. The serum selenium concentrations (expressed in micrograms per deciliter) were quantified utilizing atomic absorption spectrometry. Subsequently, the data were processed and analyzed using IBM SPSS statistical software, version 22.

Results:

The average serum selenium level in neonates with sepsis (42.06 ± 20.40 µg/dL) was notably lower compared to the control group (55.61 ± 20.33 µg/dL), a difference that was statistically significant (p-value = 0.009). The levels of serum selenium were comparable between neonates and mothers across both study groups.

Conclusion:

The findings of this research indicate that selenium levels in the sepsis group were reduced compared to the control group, despite similar selenium levels in the mothers and neonates in both groups, suggesting that sepsis could be associated with a decrease in selenium levels.
Accelerating evidence generation: Addressing critical challenges and charting a path forward
Authors: Rim Jeeyon G. , Jackman Jennifer G. , Hornik Christoph P. , Rutter Joni L. , Warraich Haider , Wittes Janet , Fleisher Lee , Anderson Brian S. , Krofah Ester , Kinter Elizabeth , Locke Trevan , Kehoe Lindsay , Abbasi Ali , Marston Hilary , Meeker-O’Connell Ann , Weber Wendy , Wang Tracy , Hernandez Adrian F. , Landray Martin , Palmer Scott M.
Published: October 2024

Efficient evidence generation to assess the clinical and economic impact of medical therapies is critical amid rising healthcare costs and aging populations. However, drug development and clinical trials remain far too expensive and inefficient for all stakeholders. On October 25–26, 2023, the Duke Clinical Research Institute brought together leaders from academia, industry, government agencies, patient advocacy, and nonprofit organizations to explore how different entities and influencers in drug development and healthcare can realign incentive structures to efficiently accelerate evidence generation that addresses the highest public health needs. Prominent themes surfaced, including competing research priorities and incentives, inadequate representation of patient population in clinical trials, opportunities to better leverage existing technology and infrastructure in trial design, and a need for heightened transparency and accountability in research practices. The group determined that together these elements contribute to an inefficient and costly clinical research enterprise, amplifying disparities in population health and sustaining gaps in evidence that impede advancements in equitable healthcare delivery and outcomes. The goal of addressing the identified challenges is to ultimately make clinical trials faster, more inclusive, and more efficient across diverse communities and settings.
Challenges and Resilience in the Lives of Refugees Now Residing in the United States: A Health and Well-Being Perspective
Authors: Rizek Jamla , Taubman Cara B , Issa Fadi
Published: October 2024

Objective

This article explores the health-related challenges for refugees now residing in the United States and highlights strategies for building resilience in this vulnerable population.

Methods

This is a descriptive study identifying six common challenges refugees face when relocating from their country to another country.

Results

Refugees in the United States face many challenges, including language barriers, access to quality education, discrimination based on cultural and religious differences, and inadequate healthcare access. Child refugees, constituting a significant portion of the refugee population, face distinct challenges compared to adults. Many refugees grapple with psychological trauma and access to proper healthcare.

Conclusion

Refugees face many challenges when transitioning to a new country, including losing community, familial support, safety, and cultural norms. To address these challenges in the United States, advocates, and public health advisors must actively engage with refugees to assess their needs and build resilient communities. Proactive outreach tailored to refugees’ vulnerabilities is crucial to ensuring their well-being and successful integration into their new homes.
Preparing for Nuclear Disaster: A Structured Equation Model by Health Professionals
Authors: Redfield-Shakoor Linda J
Published: October 2024

The potential for a radiological disaster from natural environmental causes, human error, aging nuclear power plants, buried radioactive waste, regular ground transport of radioactive materials, a shared international border, and the threat of radiological terrorism make the Western New York region vulnerable for a radiation emergency. A global threat from Russia and intentional uses of nuclear weapons by non-state approved users, such as North Korea, raise public awareness. Limited importance has been given to educating medical providers and emergency planners with radiological knowledge and preparation.

Objective

The goal of this study was to understand the relationships of the peerception of risk, emergency self-efficacy and willingness to respond to a radiation emergency among health professionals.

Method

Two hundred sixty-nine (269) medical and health practitioners were selected for a purposive, convenience sample in an eight-county region of Western New York. Participants identified the need for improved knowledge and preparation for the management of a radiation emergency.

Results

Statistical findings using the author created Structural Equation Model (SEM) revealed a goodness of fit for perception of risk as a strong predictor of willingness to respond to a radiation emergency.

Conclusion

The SEM study names the variables that influence training for global nuclear realities.
Differences in Initial Healthcare Responses Between Turkey and the Conflict-Ridden Area in Syria Following February 2023 Earthquakes
Authors: Santarisi Abeer , Hertelendy Attila J. , Issa Fadi , Woodward Christina , Mathew Dana , Noel Jacob , Franc Jeffery M. , Voskanyan Amalia , Ciottone Gregory R.
Published: October 2024

Objective

This study analyzes disparities in initial healthcare responses in Turkey and Syria following 2023 earthquakes.

Methods

Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. WHO Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.

Results

56,051,096 individuals were exposed, with Turkey having 44 million vs 12 in Syria. Turkey had higher CMR in affected areas (10.5 vs 5.0/10,000), while Syria had higher CMR in intensely seismic regions (9.2 vs 7.7/1,000). Turkey had higher injury rates (24.6 vs 9.9/10,000). Death and injury rates plateaued in Syria after three days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except healthcare facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s six, with significantly more humanitarian aid personnel (23 vs 2/100,000).

Conclusions

Significant disparities in initial healthcare response were observed between Turkey and Syria, highlighting need for policymakers to enhance responses in conflict-affected events to reduce impact on affected populations.
ECHORN: Leveraging a Regional Coordination Network for Disaster-Resilient Noncommunicable Disease Control in the Eastern Caribbean
Authors: Steel Sydney A , Wambugu Vivien , Oladele Carol , Smith Marcella Nunez , Hassan Saria
Published: October 2024

Objective

Small island developing states in the Eastern Caribbean face a dual burden of climate-related disasters and noncommunicable diseases (NCDs). While the relationship between disasters and health has been demonstrated for acute emergencies, there is limited understanding of the impacts of repeated disaster exposure on NCD management and control. The Eastern Caribbean Health Outcomes Research Network (ECHORN) leverages its robust community-driven network for data sharing and implementation science related to furthering our understanding of the intersection of disaster exposure and NCDs.

Methods

The ECHORN cohort study is an ongoing longitudinal cohort study characterizing risk and protective factors for NCDs in the Eastern Caribbean. The cohort (N=2,961) was empaneled between 2013-2018 across four sites. Regional partners identified disaster exposure as a priority for research and coordination moving forward.

Results

ECHORN Wave III includes a disaster exposure survey to analyze the impact of exposure to repeated climate events and natural disasters (COVID19, earthquakes) on NCD management in the Eastern Caribbean. This first-of-its-kind study offers a data-driven approach to sustainable NCD management and climate-resilient policy development.

Conclusion

With the anticipated acceleration of NCDs and disasters across the Caribbean, ECHORN’s work to inform disaster-resilient NCD management and control is imperative and time-sensitive.
What if Nice Terrorist Attack Would Have Happened in Milan? Drawing a Disaster Plan for Mass Casualty Incidents Involving the Pediatric Population
Authors: Difino Margherita , Riccardo Stucchi , Weinstein Eric S. , De Pellegrin Maurizio , Zoli Alberto , Sechi Giuseppe Maria , Faccincani Roberto
Published: October 2024

Objective

Asymmetric warfare, conflict and terrorist attacks involving children raise concerns regarding the preparedness to respond to mass casualty incidents involving pediatric patients. The objective of this project was to assess the resources available in the metropolitan Milan area to develop a priority dispatch plan for a mass casualty incident with pediatric patients.

Methods

A focused search of the medical literature and clinical guidelines established a minimal standard requirements of care of pediatric patients involved in an MCI to determine the surge capabilities in terms of number of patients and severity of injuries for each study hospital in the metropolitan Milan area.

Results

The hospitals that took part in the study were either adult trauma centers or pediatric hospitals in the metropolitan Milan area. The overall surge capability identified was of 40-44 pediatric patients involved in an MCI involving pediatric patients, distributed based on age and severity and based on the hospital resources and expertise.

Conclusions

The findings from the metropolitan Milan area shows the basis for non-Pediatric Trauma Center adult and pediatric hospitals to work in synergy to develop MCI response plans involving pediatric patients. Simulations exercises will need to be carried out to evaluate and validate the plans.
Painful Call About the Under-Reporting of Children’s Pain During Humanitarian Crises
Authors: Levy Einav , Alkan Michael , Gidron Yori
Published: October 2024

Humanitarian crises often require urgent medical care to people of concern. Such medical aid includes assessing and treating acute medical needs and ongoing chronic health conditions. Among the people of concern there are children, who are often the most vulnerable population in humanitarian contexts because they often lack the experience, independence, and cognitive and verbal skills to deal with the ordeals they are facing. These limitations might prevent identification and diagnosis of pain. The under-diagnosis and under-treated pain by health care providers might be also due to the perceived urgency of more acute or life-threatening medical needs with limited medical equipment and personnel, lack of awareness, or assessment tools in such contexts. Additionally, due to issues of anonymity and lack of formal guidelines, there is a severe lack of standardized registration of children’s pain conditions in humanitarian crises. Finally, acute pain is also a predictor of post-traumatic stress disorder, a common outcome in such disasters. We call on health care providers to use standardized scales to assess children’s pain intensity, frequency, and duration, and to treat it appropriately. These will not only reduce children’s physical suffering but may also prevent subsequent risk of PTSD.
Odd viscous flow past a sphere at low but non-zero Reynolds numbers
Authors: Lier Ruben
Published: October 2024

The measurement of lift on symmetrically shaped obstacles immersed in low Reynolds number flow is the quintessential way to signal odd viscosity. For flow past cylinders, such a lift force does not arise if incompressibility and no-slip boundary conditions are fulfilled, whereas for spheres, a lift force has been found in Stokes flow, which is valid for cases where the Reynolds numbers are negligible and convection can be ignored. When considering the role of convection at low but non-zero Reynolds numbers, two hurdles arise, the Whitehead paradox and the breaking of axial symmetry, which are overcome by the method of matched asymptotic expansions and the Lorentz reciprocal theorem, respectively. We also consider the case where axial symmetry is preserved because the translation of the sphere is aligned with the axis of chirality of odd viscosity. We find that while lift vanishes, the interplay between odd viscosity and convection gives rise to a stream-induced torque.
Regularized Regression Can Reintroduce Backdoor Confounding: The Case of Mass Polarization
Authors: MELLON JONATHAN , PROSSER CHRISTOPHER
Published: October 2024

Regularization can improve statistical estimates made with highly correlated data. However, any regularization procedure embeds assumptions about the data generating process that can have counterintuitive consequences when those assumptions are untenable. We show that rather than simply shrinking estimates, regularization can reopen backdoor causal paths, inflating the estimates of some effects, and in the wrong circumstances, even reversing their direction. Recently, Cavari and Freedman (2023), argued that declining cooperation rates in surveys have inflated measures of mass polarization. We show that this finding is driven by large penalty terms in their regularized regressions, which leads to the estimates being confounded with time. Alternative methods do not show a clear positive or negative effect of declining cooperation on estimated levels of mass polarization.
A Late Antique Decorated Casket and Jewellery from the Roman Villa at Fordham, Essex
Authors: Greep Stephen , Henig Martin , Lockwood Frank
Published: October 2024

During excavations of a Roman villa at Fordham, Essex, a remarkable series of decorated bone and antler veneer plaques were recovered from villa destruction deposits. They are datable to the later fourth or fifth centuries a.d. and probably once adorned a casket holding bathing equipment and jewellery. Spread through the three main rooms of the villa, fragments were recovered from at least 10 metres apart, so the object is likely already to have been broken when deposited. The plaques are decorated with ‘late antique’ style figural, zoomorphic, vegetal and architectural motifs on a cross-hatched background, with the best-preserved design probably relating to female bathing.
A clinical algorithm for diagnosis and treatment of insomnia in adults: an updated review
Authors: Khazaie Habibolah , Sharafkhaneh Amir , Zakiei Ali , Crew Earl Charles
Published: October 2024

Difficulty falling asleep and/or maintaining sleep are common complaints in patients visiting medical clinics. Insomnia can occur alone or in combination with other medical or psychiatric disorders. Diagnosis and management of insomnia at times are perplexing. This updated study review aimed at a clinical algorithm for diagnosis and treatment of insomnia in adults. We developed an easy-to-apply algorithm to diagnose and manage insomnia that can be used by general practitioners and non-sleep specialists. To this end, our team reviewed the previous studies to determine the prevalence, evaluation, and treatment of insomnia. We used the results to develop a clinical algorithm for diagnosing and managing insomnia.

Insomnia occurs in a short (less than 3 months duration) or chronic form (≥3 months duration). Insomnia management includes both pharmacological and non-pharmacological interventions. There is ample research evidence for the impact of a variety of non-pharmacological treatments, but both types of treatments can be used for each patient. If there are any contradictions in the diagnosis process, therapists should use objective instruments, such as polysomnography, but they should not be in a hurry to use these instruments.
The current state of primary healthcare in Pakistan: a way forward for low-to-middle income countries
Authors: Ahmed Syed Hassan , Zahid Maha , Waseem Summaiyya , Zafar Amna , Shaikh Taha Gul , Sabri Taha , Arshad Ainan
Published: October 2024

Background:

Primary healthcare (PHC) plays a crucial role in improving health outcomes and reducing healthcare burden, especially in low-to-middle-income countries (LMICs). However, PHC has not received adequate attention in Pakistan despite its recognized importance. This study aims to examine the current state of PHC in Pakistan, identifying factors compromising its quality and effectiveness.

Methods:

To find relevant data, the authors conducted a thorough literature search on PubMed, Google Scholar, and Cochrane Library from inception till 2 July 2022, without any language restriction. The following keywords were employed during the literature search, separated by Boolean operators AND, OR: “Primary Healthcare”, “PHC”, “Healthcare primary”, “Primary Health”, and “Pakistan”.

Results:

Pakistan’s PHC infrastructure shows promise, with a considerable number of healthcare facilities in place. However, various factors hinder its effectiveness and compromise the quality of care provided. Insufficient investment, resource constraints, inadequate training of healthcare providers, lack of oversight, and limited access to essential medicines and equipment are some of the key challenges observed. Improving PHC in Pakistan is vital for addressing the population’s healthcare needs, particularly in rural areas. Adequate investment, enhanced training programs, improved oversight mechanisms, and increased availability of essential resources are necessary to strengthen the PHC system. By prioritizing PHC and addressing the identified challenges, Pakistan can enhance healthcare access, reduce healthcare burden, and improve overall health outcomes for its population.

Conclusion:

It is high time LMICs like Pakistan recognize PHC as the most economically feasible pathway toward accomplishing healthcare targets and adopt adequate measures to elevate its standards.
Radicalised Conservatism in the Hungarian Constitution: An Analysis of Justifications for Rule of Law Backsliding
Authors: Cohen Mateo I.
Published: October 2024

Introduction: the Scruton-Fidesz connection – Literature: Hungary’s rule of law backsliding and the Hungarian constitution – Methods: analysing ideological justifications and contemporary conservatism – Findings: the traditional family as the base for the existence of the nation – Individual rights’ dependency on communal obligations – Constitutional originalism and limitations on judicial review – History as a moral guide and historical revisionism – An exclusionary Hungarian constitutional identity – Analysis: traditionalist conservative values in the Hungarian Constitution and their manipulation – The radicalisation of conservatism – The struggle over the centre-right, and its implications on the future of democracy
Influence of Trichoderma species on the reduction of heavy metal levels in bean plants irrigated with wastewater: a case study from the Mezquital Valley, Hidalgo, Mexico
Authors: Landero-Valenzuela Nadia , Hernández-Nataren Edith , Chávez-Cerón Lizeth , Granados-Echegoyen Carlos Alejandro , Alonso-Hernández Nancy , Mayek-Pérez Netzahualcoyotl , Lara-Viveros Francisco Marcelo , Ponce-Lira Brenda , Calderón-Cortés Nancy
Published: October 2024

Contamination by heavy metals resulting from irrigation with wastewater is an important global concern, as it can lead to crop contamination, posing serious threats to human health. Despite the advances in bioremediation of soils, sustainable strategies that use beneficial microorganisms to reduce the accumulation of heavy metals in contaminated crops remain underexplored. The aim of this study was to evaluate the potential reduction of heavy metal concentration in different structures of bean plants cultivated in soils irrigated with untreated wastewater on an agricultural land located in Hidalgo, Mexico, through the inoculation of a ubiquitous soil fungus. Bean plants were inoculated with three Trichoderma spp. and distributed across eight treatments, with an additional untreated control group, following a random full design. The percentage of root colonization and concentration of heavy metals in the leaves, pods, grains, and soil were determined. The results revealed that root colonization exceeded 75%. The treatments T. harzianum + T. asperellum and T. harzianum with 3 × 106 spores ml−1 showed the greatest decrease in Cd (64.7%) and Pb (66.1%) concentrations in the grains. T. viride with 2 × 106 spores ml−1 was the most effective treatment for copper reduction (72.9%) in grains; T. harzianum with 3 × 106 spores ml−1 showed the best performance for chromium reduction (75.7%), which was below the detection limit in leaves. In conclusion, inoculation of bean plants with Trichoderma spp. effectively reduced the accumulation of heavy metals. Future research in this area could contribute to the development of sustainable strategies to mitigate heavy metal contamination in agricultural ecosystems, thereby promoting food and environmental safety.
Machine learning enabled compact flexible full ground UWB antenna for wearable applications
Authors: Praveena Alladi , Umamaheswari Govindaswamy , Rai Jayant Kumar , Ranjan Pinku
Published: October 2024

This work introduces a novel compact ultra-wideband (UWB) antenna designed for wearable applications, employing a bioinspired structure and machine learning (ML) techniques to achieve exceptional performance in the 3.10–10.42 GHz range. The antenna is fabricated by positioning conductive fabric on a polydimethylsiloxane polymer of 1 mm thickness to augment high flexibility and durability. Additionally, it pioneers integrating a complete ground plane to mitigate back radiation toward the human body, presenting a compact (35.5 × 30.5 × 1 mm3) UWB antenna design compliant with IEEE 802.15.6 standards. The design methodology includes using bandwidth enhancement techniques such as chamfering edges, slots, and adding stubs in the feed, along with applying ML to optimize the antenna’s dimensions for desired return loss characteristics. The proposed antenna demonstrates exceptional resilience to human body loading and physical deformation. The simulation and measurement results have good agreement. The K-nearest neighbour method beat the other ML algorithms maximum accuracy of 99.62% to predict the S11. According to the author’s best knowledge, this is the first compact UWB antenna with full ground specified by IEEE.802.15.6 with ML reported.
Implications of Asymmetric Loss Cone Distribution on Whistler‐Driven Electron Precipitation at Mercury
Authors: Ozaki Mitsunori , Kondo Takeru , Yamada Yuto , Yagitani Satoshi , Hikishima Mitsuru , Omura Yoshiharu
Published: October 2024

Mercury has a large loss cone difference in its two hemispheres due to the northward shifted magnetic dipole. The precipitation difference of energetic electrons in both hemispheres is poorly understood. We show that the northern precipitation is 2.5‐times higher than for a symmetric loss cone due to the effects of the enhanced whistler instability at the southern hemisphere with the larger loss cone. Simulations including nonlinear pitch angle scattering by the whistler‐mode waves show rapid (tens of milliseconds) electron flux modulation related to the wave subpacket structures by repeated interactions within a discrete wave element. The difference in the nonlinear whistler instability in the two hemispheres should enhance the electron precipitation, which, along with the direct impact effects of solar wind, contributes to Mercury's surface–magnetosphere coupling. Electrons hitting the planet's surface may be a possible factor in the formation of water through the formation of hydroxyl groups.
Dynamic synthetic-scanning photoacoustic tracking monitors hepatic and renal clearance pathway of exogeneous probes in vivo
Authors: Lv Jing , Lan Hengrong , Qin Aoji , Sun Tong , Shao Dan , Gao Fei , Yao Junjie , Avanaki Kamran , Nie Liming
Published: October 2024

Advancements in precision medicine necessitate understanding drug clearance pathways, especially in organs like the liver and kidneys. Traditional techniques such as PET/CT pose radiation hazards, whereas optical imaging poses challenges in maintaining both depth penetration and high resolution. Moreover, very few longitudinal studies have been performed for drug candidates for different symptoms. Leveraging non-ionizing photoacoustic tomography for deep tissue imaging, we developed a spatiotemporally resolved clearance pathway tracking (SRCPT) method, providing unprecedented insights into drug clearance dynamics within vital organs. SRCPT addresses challenges like laser fluence attenuation, enabling dynamic visualization of drug clearance pathways and essential parameter extraction. We employed a novel frequency component selection based synthetic aperture focusing technique (FCS-SAFT) with respiratory-artifacts-free weighting factors to enhance three-dimensional imaging resolutions. Inspired by this, we investigated the clearance pathway of a clinical drug, mitoxantrone, revealing reduced liver clearance when hepatic function is impaired. Furthermore, immunoglobulin G clearance analysis revealed significant differences among mice with varying renal injury degrees. The accuracy of our method was validated using a double-labeled probe [68Ga]DFO-IRDye800CW, showing a strong positive correlation between SRCPT and PET. We believe that this powerful SRCPT promises precise mapping of drug clearance pathways and enhances diagnosis and treatment of liver and kidney-related diseases.
The calculated voyage: benchmarking optimal strategies and consumptions in the Japanese eel’s spawning migration
Authors: Li Gen , Chang Yu-Lin , Miyazawa Yasumasa , Müller Ulrike K.
Published: October 2024

Eels migrate along largely unknown routes to their spawning ground. By coupling Zermelo’s navigation solution and data from the Japan Coastal Ocean Predictability Experiment 2 (JCOPE2M), we simulated a range of seasonal scenarios, swimming speeds, and swimming depths to predict paths that minimize migration duration and energy cost. Our simulations predict a trade-off between migration duration and energy cost. Given that eels do not refuel during their migration, our simulations suggest eels should travel at speeds of 0.4–0.6 body-length per second to retain enough energy reserves for reproduction. For real eels without full information of the ocean currents, they cannot optimize their migration in strong surface currents, thus when swimming at slow swimming speeds, they should swim at depths of 200 m or greater. Eels swimming near the surface are also influenced by seasonal factors, however, migrating at greater depths mitigates these effects. While greater depths present more favorable flow conditions, water temperature may become increasingly unfavorable, dropping near or below 5 °C. Our results serve as a benchmark, demonstrating the complex interplay between swimming speed, depth, seasonal factors, migration time, and energy consumption, to comprehend the migratory behaviors of Japanese eels and other migratory fish.
Effective encoder-decoder network for pupil light reflex segmentation in facial photographs of ptosis patients
Authors: Lee Sanghyuck , Song Taekyung , Lee Jeong Kyu , Lee Jaesung
Published: October 2024

Accurate segmentation of pupil light reflexes is essential for the reliable assessment of ptosis severity, a condition characterized by the drooping of the upper eyelid. This study introduces a novel encoder-decoder network specialized in reflex segmentation by focusing on addressing issues related to very small regions of interest from an architectural perspective. Specifically, the proposed network is designed to exploit low-level features effectively by integrating a multi-level skip connection and a 1 × 1 convolution-enhanced initial encoding stage. Assessed using a photograph image dataset from Chung-Ang University Hospital, which includes 87 healthy subjects, 64 with ptosis, and 257 with Graves’ orbitopathy (collected between January 2010 and February 2023), the proposed network outperforms five conventional encoder-decoders. Over 30 trials, the proposed network achieved a mean Dice coefficient of 0.767 and an Intersection over Union of 0.653, indicating a statistically significant improvement in the segmentation of reflex. Our findings show that an elaborate design based on the lowest-level skip connection and 1 × 1 convolution at initial stage enhances the segmentation of pupil light reflexes. The source code of the proposed network is available at https://github.com/tkdgur658/ReflexNet.
Spatiotemporal wind speed forecasting using conditional local convolution and multidimensional meteorology features
Authors: Wang Meng , Wang Juanle , Yu Mingming , Yang Fei
Published: October 2024

Wind speed prediction is crucial for precisely wind power forecasting and reduced maintenance costs. Highland regions, which possess a considerable wind potential, present complex meteorological conditions, making wind speed prediction challenging. Traditional weather forecasting relies on complex statistical methods and extensive prior knowledge. While recent deep learning models have improved prediction accuracy, they often assume uniform influence weight structure, limiting model effectiveness. This study introduces an enhanced Conditional Local Convolution Recurrent Network (CLCRN) model to improve spatiotemporal wind speed forecasting using multidimensional meteorological inputs such as temperature, pressure, and dew point, alongside wind components. This model addresses uniform influence model weight issue by redesigning convolution kernels to better capture local meteorological features and integrating multiple influencing factors. Our model consistently achieves lower Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) values across various prediction intervals (3, 6, 9, and 12 h) compared to other models, supported by the meteorological station data from 2019 to 2021. Furthermore, the spatial distribution of the local convolution weights aligns with local wind velocity patterns in Inner Mongolia, enhancing model interpretability. These results demonstrate potential for practical applications in renewable energy planning and wind dynamics simulation.
Preventing ischemic heart disease in women: a systematic review of global directives and policies
Authors: Wang Laureen Yi-Ting , Chiang Grace Shu Hui , Wee Caitlin Fern , Chan Sarah Wye Kit , Lau Jacqueline Xiao Xuan , Taeihagh Araz
Published: October 2024

Cardiovascular disease is the leading cause of mortality in women worldwide. Yet cardiovascular disease in women remains underdiagnosed and undertreated, especially among vulnerable populations such as older women, low-income populations, and ethnic minorities. Resultantly, reduction in cardiovascular mortality among women has stagnated. To examine, consolidate current research findings and policies to identify gaps in women’s heart health practice, this review screened 21476 records and synthesized results from 124 English language publications worldwide. Using a life course approach, we assessed the connection between clinical recommendations and policy, and documented global recommendations and policies addressing prevention of cardiovascular disease in women. Key recommendations include fostering environments that encourage sustainable health behaviors for young women, advocating for national surveillance systems and guidelines for monitoring and increasing the understanding of cardiovascular health in high-risk pregnancy/postpartum groups, developing community prevention programs for midlife/menopause, and implementing direct population health management initiatives for elderly women, with an emphasis on higher risk groups. Inequalities still exist among women with varying socioeconomic status and race between countries, and even within countries.
The Dectin-1 and Dectin-2 clusters: C-type lectin receptors with fundamental roles in immunity
Authors: Malamud Mariano , Brown Gordon D
Published: October 2024

The ability of myeloid cells to recognize and differentiate endogenous or exogenous ligands rely on the presence of different transmembrane protein receptors. C-type lectin receptors (CLRs), defined by the presence of a conserved structural motif called C-type lectin-like domain (CTLD), are a crucial family of receptors involved in this process, being able to recognize a diverse range of ligands from glycans to proteins or lipids and capable of initiating an immune response. The Dectin-1 and Dectin-2 clusters involve two groups of CLRs, with genes genomically linked within the natural killer cluster of genes in both humans and mice, and all characterized by the presence of a single extracellular CTLD. Fundamental immune cell functions such as antimicrobial effector mechanisms as well as internalization and presentation of antigens are induced and/or regulated through activatory, or inhibitory signalling pathways triggered by these receptors after ligand binding. In this review, we will discuss the most recent concepts regarding expression, ligands, signaling pathways and functions of each member of the Dectin clusters of CLRs, highlighting the importance and diversity of their functions.