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User perceptions of surgical antimicrobial prophylaxis guidelines in orthopaedic surgery in a tertiary Australian hospital

Background Surgical antimicrobial prophylaxis remains the most common indication for antimicrobial use in Australian hospitals. Despite efforts to improve practice, adherence to guideline recommendations continues to be suboptimal across surgical disciplines, including orthopaedics. The Therapeutic Guidelines: Antibiotic v16 currently advocates for single dose prophylaxis for open reduction internal fixation (ORIF) procedures. Audits undertaken in one Australian tertiary hospital have identified low levels of adherence to this recommendation. It is unclear as to why guidelines are not adhered to in this setting. Aim To understand the factors that influence multidose prescribing for ORIF procedures and the barriers and enablers to guideline use in an Australian tertiary hospital. Materials and methods Interviews (focus groups and one-on-one sessions) were held with orthopaedic surgeons (consultants), orthopaedic registrars, pharmacists, and anaesthetists from a tertiary public hospital in Australia. The Theoretical Domains Framework (TDF) was used to analyse results. Results Six focus groups and three one-on-one interviews were conducted. Data were mapped to 12 TDF domains. Although clinicians were aware of guideline recommendations, this alone did not encourage the use of single dose prophylaxis. The decision to prescribe postoperative antibiotics was influenced by a combination of patient and environmental factors as well as fear of infection development. The lack of guideline specificity was commonly highlighted as a barrier to guideline use, as well as lack of agreement with guideline content. Enablers to guideline use included education that was targeted and repetitive, as well as improved dissemination of guidelines. Conclusion There are myriad factors that influence the decision to prescribe postoperative antibiotics for ORIF procedures. By understanding the social and cultural context of a local setting and the barriers and enablers that pertain to an environment, interventions can be developed to enhance guideline use, thereby improving antimicrobial prescribing.

Urban-rural differences in the successful aging among older adults in China

This study aimed to reveal urban-rural disparities in successful aging among Chinese older adults and the impact of gender and age on aging outcomes. We utilized the Successful Aging Index (SAI), a multidimensional measure encompassing social, economic, bio-clinical, psychological, and lifestyle factors. Scores on the SAI range from 0 to 10, with higher scores signifying better aging. Data was sourced from the 2018 Chinese Longitudinal Healthy Longevity Survey, comprising 7,315 participants. Urban older adults (OU) had significantly higher SAI scores than rural older adults (OR), with averages of 4.32 ±  1.44 and 3.85 ±  1.24, respectively (p < 0.001). Men showed more successful aging than women, regardless of their residence (p < 0.001). OU had better financial and educational status and higher social activity scores, except for friend interaction (p < 0.001). They were more physically active (p < 0.001), more adherent to the Mediterranean diet (p < 0.001), and less likely to smoke (p = 0.018). However, OU had a higher prevalence of cardiovascular disease risk factors compared to OR (p < 0.001). Notably, depression scores were similar between OU and OR (p = 0.129). In summary, significant urban-rural differences in successful aging are evident among Chinese older adults, with urban-dwelling older adults aging more successfully than their rural peers. Men, irrespective of their place of residence, experience more successful aging outcomes than women.

An enhanced iTransformer-based early warning system for predicting automotive rental contract breaches

Economic losses in the car rental industry due to customer breaches remain a critical issue. The rapid growth of the vehicle leasing market has given rise to a pressing concern for enterprises, namely the economic loss, vehicle idleness, and service quality degradation that are often associated with customer default. This study proposes an innovative vehicle rental early warning system that incorporates the improved DBSCAN clustering technique and the iTransformer model. The enhanced DBSCAN technique, which employs a snow ablation optimizer (SAO) algorithm, establishes an electronic barrier and integrates the iTransformer model for trajectory prediction. This enables the real-time monitoring of potential customer defaults and the reduction of economic losses that leasing companies may incur as a result of customer defaults. The system identifies and prevents default risks in a timely manner through a comprehensive analysis of vehicle driving data, thereby safeguarding the interests of corporate entities. The system employs vehicle driving data provided by a Chinese company to accurately identify the vehicle’s resident location and predict future trajectory, effectively preventing customer defaults. The experimental results demonstrate that the model is highly effective in predicting the vehicle’s resident location and future trajectory. The mean square error (MSE), mean absolute error (MAE), and location error reached 0.001, 0.003, and 0.08 kilometers, respectively, which substantiates the model’s efficiency and accuracy. This study has the additional benefit of providing effective warnings to customers of potential default behavior, thereby reducing the economic losses incurred by enterprises. Such an approach not only ensures financial security but also enhances operational efficiency within the industry. Furthermore, it offers robust support for the sustainable development of the car rental industry.

The nitrogen removal characterization and ecological risk assessment of Bacillus sp. isolated from mariculture systems in China with spatiotemporal difference

The accumulation of nitrogen compounds may worsen the aquatic environment and cause serious economic losses in the aquaculture industry. In this study, the denitrification performance and ecological safety of 120 Bacillus sp. isolates with spatial and temporal differences were evaluated based on the aspects of hemolysis, drug resistance, denitrification performance, and purification effect for mariculture wastewater. Firstly, 55/120 safe strains with no hemolytic activity were detected through hemolysis testing. Then, based on selective denitrification medium and colorimetric reagent method, 34/55 Bacillus sp. with denitrification effect were screened. For these 34 Bacillus sp. isolates, the drug resistance phenotype and genotype, denitrification genes, and enzyme activities related to the nitrogen metabolizing (AMO, HAO, NAR, NIR) were examined. And the MARI was 0.00-0.25, with a multi-drug resistance rate of 17.6%. The drug resistance genes tetB, blaTEM, and cfr and the denitrification genes nap, nor, and narG were detected. Ultimately, 27/34 strains with denitrification function and ecological safety were obtained. In addition, eight Bacillus sp. showed certain denitrification effects on nitrogen-containing wastewater treatment. Among them, B. subtilis B24 has outstanding denitrification ability, with removal rates of 92%, 62%, 68%, and 30% for NH4 + -N, NO2--N, NO3--N, and TN in simulated wastewater, respectively. It also has a good denitrification effect in practical applications. This study provides candidate bacterial strains for the treatment of mariculture wastewater.

Correction: Organizational and behavioral attributes’ roles in adopting cloud services: An empirical study in the healthcare industry

Performance evaluation of reduced complexity deep neural networks

Deep Neural Networks (DNN) have achieved state-of-the-art performance in medical image classification and are increasingly being used for disease diagnosis. However, these models are quite complex and that necessitates the need to reduce the model complexity for their use in low-power edge applications that are becoming common. The model complexity reduction techniques in most cases comprise of time-consuming operations and are often associated with a loss of model performance in proportion to the model size reduction. In this paper, we propose a simplified model complexity reduction technique based on reducing the number of channels for any DNN and demonstrate the complexity reduction approaches for the ResNet-50 model integration in low-power devices. The model performance of the proposed models was evaluated for multiclass classification of CXR images, as normal, pneumonia, and COVID-19 classes. We demonstrate successive size reductions down to 75%, 87%, and 93% reduction with an acceptable classification performance reduction of 0.5%, 0.5%, and 0.8% respectively. We also provide the results for the model generalization, and visualization with Grad-CAM at an acceptable performance and interpretable level. In addition, a theoretical VLSI architecture for the best performing architecture has been presented.

Correction: National debt management and business sustainability in Africa’s largest economy: A focus on the private sector

Enhanced machine learning predictive modeling for delirium in elderly ICU patients with COPD and respiratory failure: A retrospective study based on MIMIC-IV

Background and objective Elderly patients with Chronic obstructive pulmonary disease (COPD) and respiratory failure admitted to the intensive care unit (ICU) have a poor prognosis, and the occurrence of delirium further worsens outcomes and increases hospitalization costs. This study aimed to develop a predictive model for delirium in this patient population and identify associated risk factors Methods Data for the machine learning model were obtained from the MIMIC-IV database. Feature variable screening was conducted using Lasso regression and the best subset method. Four models—K-nearest neighbor, random forest, logistic regression, and extreme gradient boosting (XGBoost)—were trained and optimized to predict delirium risk. The stability of the model is evaluated using ten-fold cross validation and the effectiveness of the model on the validation set is evaluated using accuracy, F1 score, precision and recall. The SHapley Additive exPlanations (SHAP) method was used to explain the importance of each variable in the model. Results A total of 1,155 patients admitted to the intensive care unit between 2008 and 2019 were included in the study, with a delirium incidence of 12.9% (149/1,155). Among the four ML models evaluated, the XGBoost model demonstrated the best discriminative ability. In the validation set, it achieved an AUC of 0.932, indicating superior performance with high accuracy, precision, recall, and F1 scores of 0.891, 0.839, 0.795, and 0.810, respectively. Key features identified through SHAP analysis included the Glasgow Coma Scale (GCS) verbal score, length of hospital stay, mean SpO₂ on the first day of ICU admission, Modification of Diet in Renal Disease (MDRD) equation score, mean diastolic blood pressure, GCS motor score, gender, and duration of noninvasive ventilation. These findings provide valuable insights for individualized risk management. Conclusions The developed prediction model effectively predicts the occurrence of delirium in elderly COPD patients with respiratory failure in the ICU. This model can assist clinical decision-making, potentially improving patient outcomes and reducing healthcare costs.

Large recoverable elastic energy in chiral metamaterials via twist buckling

Effect of intraoperative intravenous remimazolam on the postoperative quality of recovery after noncardiac surgery: A meta-analysis of randomized controlled trials

Objectives The postoperative quality of recovery holds significant economic and prognostic implications. Numerous studies have investigated the postoperative quality of recovery following surgery. However, the impact of intraoperative intravenous remimazolam on postoperative recovery has yielded conflicting results. Methods In this qualitative review of randomized controlled clinical trials assessing the use of intraoperative remimazolam, we present the effects of intravenous remimazolam on postoperative recovery quality in noncardiac surgery patients. We conducted a comprehensive search of PubMed, MEDLINE, Web of Science and Cochrane Library for randomized controlled trials published up to September 23, 2024, without any language restrictions, to investigate the impact of intraoperative intravenous remimazolam on the quality of postoperative recovery following noncardiac surgery. The primary outcome measure was the quality of postoperative recovery assessed using global QoR-40 scores or QoR-15 scores. Secondary outcomes included five dimensions of quality of postoperative recovery: physical comfort, emotional state, physical independence, psychological support, and pain. As well as time to extubation, VAS score, PACU stay, and days in hospital. We analyzed the pooled data using a random-effects model. Results This meta-analysis included 18 studies published between 2022 and 2024 involving 1720 patients. The quality of postoperative recovery was assessed using the QoR-15 or QoR-40 questionnaires. The pooled results showed no significant difference in QoR scores between the two groups on the first postoperative day (SMD =  0.12; 95% CI -0.13-0.36; I2 = 78%; p =  0.35). Furthermore, differences in QoR dimensions, PACU duration, extubation time, and length of hospital stay were not observed. Conclusion Our analysis showed that the quality of recovery after general anaesthesia in the remimazolam group was similar to that of conventional sedation. Therefore, remimazolam may be used as a potential anaesthetic agent as an alternative to conventional sedation for non-cardiac surgical anaesthesia.

Phase-transfer-catalyst enabled enantioselective C–N coupling to access chiral boron-stereogenic BODIPYs

Initial aortic repair versus medical therapy for early uncomplicated type B dissections

Background Uncomplicated type B aortic dissections was regarded benign and treated with optimal medical therapy (OMT). However, studies showed highly unpredictable of disease progression, which suggested the need of earlier intervention. To search for features associated with worse outcomes with OMT is important due to risk of intervention. We investigated mortality and aortic remodeling between aggressive (OMT and pre-emptive endovascular intervention) and conservative therapy (OMT and necessary operations). Methods Retrospective analysis was performed in acute and subacute uncomplicated type B dissections patients, including typical aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer, diagnosed between June 2005 and May 2021. Patients with Marfan, traumatic, iatrogenic, zone 0 (ascending aorta) involvement, and maximal aortic diameter > 45mm were excluded. Patients are classified according to initial management. Results 77 and 33 patients in the aggressive and conservative groups were included respectively. There was no differences in baseline clinical and radiological characteristics between them. During mid-term follow-up (median 62.5 months), there was no difference in the mortality but the incidence of 30-day acute kidney injury was significantly higher in aggressive group. Positive aortic remodeling was noted in aggressive group, with development to complete or incomplete false lumen thrombosis (p < 0.01). Conclusion Aggressive pre-emptive endovascular therapy though has acceptable outcomes and positive aortic remodelling in early uncomplicated type B dissection with maximal aortic diameter ≤ 45mm. However, it could not translate into better mid-term survival than conservative therapy, but with higher risk of 30-day acute kidney injury. Aggressive pre-emptive endovascular intervention should be cautious in these patients.

Uncooled near- to long-wave-infrared polarization-sensitive photodetectors based on MoSe2/PdSe2 van der Waals heterostructures

“In Weapons We Trust?” Four-culture analysis of factors associated with weapon tolerance in young males

Addressing the under-researched issue of weapon tolerance, the paper examines factors behind male knife and gun tolerance across four different cultures, seeking to rank them in terms of predictive power and shed light on relations between them. To this end, four regression and structural equation modelling analyses were conducted using samples from the US (n = 189), India (n = 196), England (n = 107) and Poland (n = 375). Each sample of male participants indicated their standing on several dimensions (i.e., predictors) derived from theory and related research (i.e., Psychoticism, Need for Respect, Aggressive Masculinity, Belief in Social Mobility and Doubt in Authority). All four regression models were statistically significant. The knife tolerance predictors were: Aggressive Masculinity (positive) in the US, Poland and England, Belief in Social Mobility (negative) in the US and England, Need for Respect (positive) in India and Psychoticism (positive) in Poland. The gun tolerance predictors were: Psychoticism (positive) in the US, India and Poland, Aggressive Masculinity (positive) in the US, England and Poland, and Belief in in Social Mobility (negative) in the US, Belief in Social Mobility (positive) and Doubt in Authority (negative) in Poland. The Structural Equation Weapon Tolerance Model (WTM) suggested an indirect effect for the latent factor Perceived Social Ecological Constraints via its positive relation with the latent factor Saving Face, both knife and gun tolerance were predicted by Psychoticism.

RNA m7G methylation regulators and targets significantly contribute to chronic obstructive pulmonary disease

Integrative single-cell metabolomics and phenotypic profiling reveals metabolic heterogeneity of cellular oxidation and senescence

Correction: Exploring facial expressions and action unit domains for Parkinson detection

Static scheduling method for aircraft flat-tail assembly production based on improved bi-level genetic algorithm

Abstract Aircraft flat-tail assembly is a complex process that involves multiple assembly processes, multiple parallel frames, and multi-configuration mixed flow assembly, and its assembly processes exhibit extended processing times (typically measured in days) combined with temporal fluctuations arising from human factors, leading to a certain degree of uncertainty in single-process durations, thereby presenting a complicated flexible flow-shop scheduling problem (FFSP), which is a typical NP-hard problem. Despite its significance, the research on FFSP in aircraft flat-tail assembly production scheduling is limited. This study proposes an improved bi-level genetic algorithm to address the two sub-problems of flat-tail assembly production scheduling: frame assignment and assembly task sequencing. The objective is to minimize the maximum delay penalty cost. A two-stage coding scheme is introduced for frame assignment and task sequencing, respectively. To mitigate genetic algorithms’ convergence to local optima and enhance positive feedback, we implement a variable neighborhood search mechanism combined with elite retention. The efficacy of the improved bi-level genetic algorithm is evaluated through experiments and case studies in enterprises, indicating a significant impact on the assembly production scheduling of flat-tail, with potential applications to similar large and complex equipment. Overall, this study contributes to FFSP research in aircraft flat-tail assembly production scheduling by offering a novel solution approach to effectively address the sub-problems of frame assignment and assembly task sequencing.

Structural recognition and stabilization of tyrosine hydroxylase by the J-domain protein DNAJC12

Abstract Pathogenic variants of the J-domain protein DNAJC12 cause parkinsonism, which is associated with a defective interaction of DNAJC12 with tyrosine hydroxylase (TH), the rate-limiting enzyme in dopamine biosynthesis. In this work, we characterize the formation of the TH:DNAJC12 complex, showing that DNAJC12 binding stabilizes both TH and the variant TH-p.R202H, associated with TH deficiency. This binding delays their time-dependent aggregation in an Hsp70-independent manner, while preserving TH activity and feedback regulatory inhibition by dopamine. DNAJC12 alone barely activates Hsc70 but synergistically stimulates Hsc70 ATPase activity when complexed with TH. Cryo-electron microscopy supported by crosslinking-mass spectroscopy reveals two DNAJC12 monomers bound per TH tetramer, each embracing one of the two regulatory domain dimers, leaving the active sites available for substrate, cofactor and inhibitory dopamine interaction. Our results also reveal the key role of the C-terminal region of DNAJC12 in TH binding, explaining the pathogenic mechanism of the DNAJC12 disease variant p.W175Ter.

Bilateral ankle dorsiflexion force control impairments in older adults

Age-related impairments in ankle dorsiflexion force modulation are associated with gait and balance control deficits and greater fall risk in older adults. This study aimed to investigate age-related changes in bilateral ankle dorsiflexion force control capabilities compared with those for younger adults. The study enrolled 25 older and 25 younger adults. They performed bilateral ankle dorsiflexion force control at 10% and 40% of maximum voluntary contraction (MVC), for vision and no-vision conditions, respectively. Bilateral force control performances were evaluated by calculating force accuracy, variability, and complexity. To estimate bilateral force coordination between feet, vector coding and uncontrolled manifold variables were quantified. Additional correlation analyses were performed to determine potential relationships between age and force control variables in older adults. Older adults demonstrated significantly lower force accuracy with greater overshooting at 10% of MVC than those for younger adults. At 10% and 40% of MVC, older adults significantly showed more variable and less complex force outputs, and these patterns appeared in both vision and no-vision conditions. Moreover, older adults revealed significantly less anti-phase force coordination patterns and lower bilateral motor synergies with increased bad variability than younger adults. The correlation analyses found that lower complexity of bilateral forces was significantly related to increased age. These findings suggest that aging may impair sensorimotor control capabilities in the lower extremities. Considering the importance of ankle dorsiflexion for executing many activities of daily living, future studies may focus on developing training programs for advancing bilateral ankle dorsiflexion force control capabilities.