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Bedside clinical prediction tool for mortality in critically ill children

Introduction Mortality rates among critically ill pediatric patients remain a persistent challenge. It is imperative to identify patients at higher risk to effectively allocate appropriate resources. Our study aimed to develop a prediction score based on clinical parameters and hemogram to predict pediatric intensive care unit (PICU) mortality. Methods We conducted a retrospective study to develop a clinical prediction score using data from children aged 1 month to 18 years admitted for at least 24 hours to the PICU at Chiang Mai University between January 2018 and December 2022. PICU mortality was defined as death within 28 days of admission. The score was developed using multivariable logistic regression and assessed for calibration and discrimination. Results There were 29 deaths in 330 children (8.8%). Our model for predicting 28-day ICU mortality uses four key predictors: male gender, use of vasoactive drugs, red blood cell distribution width (RDW) ≥15.9%, and platelet distribution width (PDW), categorized as follows: <10% (0 points), 10–14.9% (2 points), and ≥15% (4 points). Scores range from 0 to 8, with a cutoff value of 5 to differentiate low-risk (<5) from high-risk (≥5) groups. The tool demonstrates excellent performance with an AuROC curve of 0.86 (95% CI: 0.80–0.91, p<0.001) showing excellent discrimination and calibration, 82.8% sensitivity, and 73.1% specificity, respectively. Conclusions The score, developed from clinical data and hemogram, demonstrated potential in predicting ICU mortality among critically ill children. However, further studies are necessary to externally validate the score before it can be confidentially implemented in clinical practices.

Symbiotic interactions on middle Cambrian echinoderms reveal the oldest parasitism on deuterostomes

How Trump 2.0 is slashing NIH-backed research — in charts

Mapping zero-dose children in Kenya – A spatial analysis and examination of the socio-demographic and media exposure determinants

Despite vaccines’ proven effectiveness in preventing childhood diseases, there remains a significant population of unvaccinated children, often referred to as zero-dose children. This study examines the factors contributing to the prevalence of zero-dose children in Kenya using data from the 2022 Kenya Demographic and Health Survey (KDHS). We included all children aged 1–35 months who had not received any vaccination during the survey. In the analysis, we utilized logistic regression to explore the determinants of zero-dose status, including the mothers’ media exposure. We also employed model-based geostatistical methods to determine the fine-scale spatial distribution of zero-dose children in Kenya. Our findings reveal the disparities in the prevalence of zero-dose children, with specific regions such as Tana River, Marsabit, Turkana, and Isiolo in the north exhibiting distinct hotspots. Children aged 12–23 (aOR = 0.41; 95% CI: 0.24, 0.68) and 24–35 (aOR = 0.33; 95% CI: 0.18, 0.57) had lower odds of being zero dose than those 1–11 months of age. Compared to women who had no antenatal visits, women who attended four and above visits had 88% lower odds of having a zero-dose child (aOR=0.12;95% CI 0.05–0.27; p<0.001), while those who attended three visits had 91% lower odds of having a zero-dose child (aOR=0.09; 95% CI 0.04–0.19; p<0.001). Additional factors associated with zero-dose status included the education level, wealth index, religion, place of delivery, travel time to the nearest facility, listening to the radio, mother’s mobile phone ownership, and mother’s phone use for financial transactions. The results emphasize the unique contextual factors associated with zero-dose status, underscoring the need for tailoring public health interventions to specific socio-cultural and economic environments. While findings should be interpreted with care due to the complexity of relationships between variables, they highlight the necessity for targeted immunization initiatives that cater to the distinct needs of various regions and demographic groups. We recommend implementing enhanced education and awareness campaigns, addressing socio-economic barriers, and considering caregiver socio-behavioral factors as crucial to improving immunization coverage in Kenya.

Rational design of synthetic antimicrobial peptides based on the Escherichia coli ShoB toxin

Abstract Antibiotic resistance is an escalating global concern, necessitating the development of novel antibiotics with unique mechanisms of action, and preferably also with a lowered propensity for resistance development. Type-I Toxin-Antitoxin (TA) systems that are ubiquitous in bacterial genomes consist of a genetic toxin element encoding a hydrophobic peptide and an antitoxin element producing an sRNA that inhibits the toxin translation. Although the biological roles of these membrane-associated toxins remain incompletely understood, their inherent lethality upon overexpression suggests a potential as antimicrobial agents. In this study, we explore the ShoB toxin from the shoB-ohsC TA system in Escherichia coli (E. coli) as a basis for designing synthetic antimicrobial peptides for exogenous delivery. We demonstrate that ShoB-derived peptides can retain antimicrobial efficacy when modified into shorter, cationic analogs with enhanced solubility. Our most promising hits exhibit rapid bactericidal action and frequency of resistance within E. coli cultures indicate a limited tendency for resistance development. These findings highlight that type-I TA systems constitute a novel source of potential peptide-based antibiotics, thereby offering an alternative largely unexplored strategy to combat antibiotic-resistant bacterial infections.

Single Joint Hybrid Assistive Limb (HAL-SJ) robotic exoskeleton therapy in improving functional outcomes among workers with wrist fractures: Study protocol for a randomized controlled trial

Introduction Robotic technologies have been developed for motor rehabilitation and such robots have shown favourable results when compared with equivalent doses of usual clinical therapy. Recently, robotic interventions have been suggested to be applied in orthopaedic rehabilitation with upper extremity disorders, especially those related to hand and wrist. This study aims to determine the effectiveness of combined conventional therapy and HAL-SJ robotic therapy in restoring the wrist functionality following the fractures as compared to the standard conventional therapy solely. Methods and analysis Workers with wrist fractures will be randomized in two groups, i.e., the control group (conventional therapy) and intervention group (combination of conventional therapy and robotic HAL-SJ intervention). All participants will receive 5-day/week therapy sessions for four weeks. Primary outcomes of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and secondary outcomes of range of motion, grip and pinch strengths, fine and gross hand dexterity as well as pain and the Lam Assessment of Stages of Employment Readiness (LASER) will be assessed at baseline assessment and upon completion of the therapy program after 4 weeks. Data from the baseline and post intervention outcome measures will be analysed using a Repeated Measures ANOVA to compare the therapy effectiveness of both control and intervention groups. Results Participants recruitment and data collection are in progress Discussion Wrist fractures can produce some residual disability and pain that may impact the functionality of a person. The application of robotic technology in facilitating upper limb movement and functional recovery training is extensive and shows positive outcomes in the field of neurorehabilitation. However, there is a lacking of published evidence about the effectiveness of robotic intervention in orthopaedic rehabilitation, especially in the field of hand therapy. Conclusion Participants recruitment and data collection are still ongoing Clinical trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (registration number: ACTRN12622000413729).

Movement patterns of invasive red swamp crayfish vary with sex and environmental factors

Abstract Invasive species disproportionately invade freshwater ecosystems, threatening biodiversity. Defining when, where, and why aquatic invasive species move can help inform management strategies, yet the movement ecology of some of the most pervasive invasive species remains unknown. Red swamp crayfish (Procambarus clarkii; RSC) are the most widespread invasive crayfish and negatively affect ecosystems worldwide. We employed high-dimensional acoustic telemetry to investigate the movement patterns of 24 individual RSC across three months in an invaded water body. We assessed the effects of various extrinsic factors, such as time of day, temperature, precipitation, and proximity to the water’s edge, along with intrinsic factors, such as sex, reproductive form, and size, at different scales, including movement steps, range distribution, and behavioral states. We found that movement patterns across all scales were overwhelmingly driven by sex and reproductive form. Furthermore, RSC showed increased overall activity at night and near the water’s edge. By establishing baseline movement patterns and identifying key contributing factors, these findings provide a foundation for the development of adaptive management strategies for controlling invasive RSC populations.

Long-term neuropsychiatric and neuropsychological impact of the pandemic in Italian COVID-19 family clusters, including children and parents

Aim This study investigated the long-term neuropsychiatric and neuropsychological impact of COVID-19 on children and their parents in households with COVID-19 exposure. Methods A prospective cohort study was conducted on 46 families attending the COVID-19 Follow-up Clinic at the Department for Women’s and Children’s Health, Padua (Italy) from December 2021 to November 2022. Self-perceived stress-related, emotional-behavioral, and post-traumatic stress (PTSD-related) symptoms were assessed in both children and parents. Children with underlying neuropsychiatric conditions were excluded from the study. Results A total of 81 parents (median age = 38 years [IQR: 43–48], females = 44 [54.3%]), and 77 children (median age = 8 years [IQR: 5–11], females = 33 [42.9%]) participated in the study. Overall,125 (79%) and 33 (21%) participants were classified as COVID-19 cases and non-COVID-19 cases, respectively. The time interval between the COVID-19 family outbreak and the neuropsychiatric and psychological assessment was ≤4 months (median=3 months [IQR=0]) for 89 (56.3%) participants and >4 months for 69 (43.8%) (median=11.5 months [IQR=5–12]) participants. A total of 136 (86.1%) participants reported stress-related symptoms, with emotional stress being the most common. A positive correlation was observed between self-perceived stress-related symptoms in children and their parents within the same family (r=0.53, p=0.0005). Among children aged 6–18 years, 16 (37.2%) had clinical scores for internalizing symptoms at the Child Behavior Checklist (CBCL), while none children aged 1.5–5 years showed clinical score for internalizing symptoms. Similarly, total difficulty scores at the Strengths and Difficulties Questionnaire (SDQ 4–17) and assessment of PTSD-related symptoms through the Trauma Symptom Checklist for Young Children (TSCYC) questionnaire were within non-clinical cut-offs in 45 (84.9%) and 43 (75.4%) children aged 3–12 years, respectively. The Trauma Symptom Checklist for Children (TSCC) resulted in the non-clinical cut-off for 36 (92.3%) children aged 8–18 years. While a higher prevalence of self-perceived stress-related symptoms was found in COVID-19 cases compared to non-COVID-19 cases (p=.01), no differences were observed for emotional-behavioral and PTSD-related symptoms between the two groups. Conclusions This study documented the impact of the COVID-19 pandemic on Italian children and their family’s stress levels. Further research is needed to confirm our findings and explore the long-term effects of the pandemic on families.

Publisher Correction: Metabarcoding identifies macroalgal composition as a driver of benthic invertebrate assemblages in restored habitats

Identification of Large Japanese field mouse Apodemus speciosus food plant resources in an industrial green space using DNA metabarcoding

DNA metabarcoding was employed to identify the food plant resources of the Large Japanese field mouse Apodemus speciosus inhabiting an artificial green space on reclaimed land on the Chita Peninsula in Aichi Prefecture, Central Japan, from 2012 to 2014. DNA metabarcoding was performed using high-throughput sequencing of partial rbcL sequences extracted from fecal samples collected in the study area. The obtained sequences, which were analyzed using a constructed local database, revealed that a total of 72 plant taxa were utilized as food plant resources by A. speciosus. Of these plant taxa, 43 could be assigned to species (59.7%), 16 to genus (22.2%), and 13 to family (18.1%). Of the 72 plant taxa identified in this study, the dominant families throughout all collection periods were Lauraceae (81.0% of 100 fecal samples), followed by Fagaceae (70.0%), Rosaceae (68.0%), and Oleaceae (48.0%). Fifty of the 72 plant taxa identified as food plant resources were woody plants. The findings showed that DNA metabarcoding using a local database constructed from the National Center for Biotechnology Information (NCBI) database and field surveys was effective for identifying the dominant food plants in the diet of A. speciosus. The results of this study provided basic information that can be applied to the formulation and implementation of management and conservation strategies for local wildlife.

Toxicogenomic profiling of endocrine disruptor 4-Nonylphenol in male catfish Heteropneustes fossilis with respect to gonads

Adaptive lift chiller units fault diagnosis model based on machine learning

The early minor faults generated by the chiller in operation are not easy to perceive, and the severity will gradually increase with time. The traditional fault diagnosis method has low accuracy and poor stability for early fault diagnosis. In this paper, a fault diagnosis model of Chiller is designed by combining least squares support vector machine (LSSVM) optimized by hybrid improved northern goshawk optimization algorithm (HINGO) and improved IAdaBoost ensemble learning algorithm. HINGO enhances the uniformity of the initial population distribution by means of refraction opposition-based learning strategy in initialization, and improves the local and global search ability of the algorithm by means of sine and cosine strategy, Lévy flight and nonlinear decreasing factor in the search stage. The HINGO-LSSVM-IAdaBoost model is trained and validated on the typical air conditioning fault samples of ASHRAE RP-1043. Compared with the traditional methods, the HINGO-LSSVM-IAdaBoost model shows obvious advantages for the early fault diagnosis of chiller units.

Preclinical validation of TGFβ inhibitors as a novel therapeutic strategy for post-traumatic heterotopic ossification

Well-being and emotional labor for preschool teachers: The mediation of career commitment and the moderation of social support

Background According to the broaden-and-build theory of positive emotions, well-being is a protective factor against emotional labor. However, it is unclear whether and how well-being contributes to emotional labor for preschool teachers. To investigate the influence of well-being on emotional labor, this study aimed to examine the mediating effect of career commitment between preschool teachers' well-being and emotional labor and whether this effect is moderated by social support. Method This study included 363 preschool teachers (M = 30.17 years, SD = 5.94) in a Chinese province. All participants completed the General Well-Being Schedule, the Emotional Labor Strategy, the Career Commitment Scale, and the Social Support Rating Scale. The data were analyzed using SPSS 26.0. Results Correlation analysis revealed a significant positive relationship between well-being, career commitment, social support, and emotional labor. The results of path analysis show that career commitment plays a completely mediating role in the relationship between well-being and emotional labor, which is moderated by social support. The mediating effect of career commitment was significantly greater for individuals with high social support than for those with low social support. Conclusion Well-being can promote the emotional labor of preschool teachers by bolstering career commitment, while this process is influenced by social support.

Optimizing feasibility and reproducibility of pacing-induced heart failure model in pigs

Abstract Heart failure (HF) is a major health problem worldwide, where gene therapy could provide promising new approaches for effective treatments. Pacing-induced tachycardiomyopathy in large animals is a well-established HF model but it suffers from poor tolerability and variable outcomes. In this study, we developed a reproducible, feasible, and tolerable pacing protocol for HF gene therapy studies. Single-chamber pacemakers were implanted in pigs. HF development was monitored with trans-thoracic echocardiography (TTE), invasive left-ventricular (LV) pressure measurements, and a treadmill exercise stress test. Four weeks of rapid right-ventricular pacing at over 200 bpm produced a significant impairment of cardiac function (LV stroke volume index 11.8 ± 1.22 (mL/m2) at day 28 vs 18.1 ± 0.99 (mL/m2) at day 0, p < 0.01, mean ± SEM, paired t-test), and reduced exercise capacity (− 14 ± 3.19% change in 15-min treadmill exercise stress test at day 28 compared to day 0, p = 0.02, mean ± SEM, paired t-test). Further pacing at 150 bpm was a well-tolerated way to prevent functional recovery. Good tolerability and reproducibility of the pacing were achieved by a gradual increase in the pacing rate, no higher than 200 bpm. Global left ventricular adenoviral (Ad) gene transfer via cardiac veins was performed after three weeks of rapid pacing and found well-tolerated and feasible. In this study, the protocols of pacemaker implantation and TTE in pigs were also optimized. In conclusion, the optimized pacing protocol considerably increases the feasibility and reproducibility of the pacing-induced HF for testing of new therapeutic applications.

Primary care physicians’ perceptions of hypertension management in Qatar: A qualitative study using the theoretical domains framework

Antihypertensive medications are known to reduce the incidence of hypertension complications. While the benefits of these medications are recognized, the factors influencing the prescribing practices of primary care physicians in Qatar have not been assessed. This study investigated Qatar primary care physicians’ experiences, practices, and perceptions regarding hypertension management. The study further evaluated the factors that influence their prescribing behaviors and identified strategies for improving hypertension management in primary healthcare settings. A qualitative case study was conducted through one-to-one semi-structured interviews with physicians practicing at the 31 Primary Health Care Corporation (PHCC) centers in Qatar. Due to the small population size, there was no need for sample size calculation and whole population sampling was used (N=179). Physician leads at each PHCC center helped identify eligible participants. Study information were shared via email and interested candidates were contacted to arrange for interviews at their convenience. The interview guide questions were designed based on the 14 domains of the Theoretical Domains Framework (TDF) of behavior change. Interviews were conducted virtually and transcribed verbatim. Thematic analysis was undertaken using inductive and deductive approaches. Twelve themes emerged, including physicians’ knowledge, skills, goals and role in hypertension management, confidence about prescribing decisions, optimism that prescriptions yield positive results, methods to ensure the appropriateness of prescriptions, emotions, and experiences when prescribing antihypertensives, perceived barriers, and facilitators when prescribing and social influences. Strategies for improving hypertension management were also suggested. In conclusion, multiple factors were identified that affect participants’ antihypertensive prescribing. Further research is needed to evaluate the suggested strategies’ effectiveness and to explore other improvements.

Ensemble learning approach for prediction of early complications after radiotherapy for head and neck cancer using CT and MRI radiomic features

The impact of the rural digital economy on China’s new-type urbanization

The Chinese government is vigorously implementing the rural revitalization strategy and accelerating the process of new-type urbanization. The rapid development of the rural digital economy has emerged as a new driving force for new-type urbanization. This study aims to explore how the rural digital economy impacts China’s new-type urbanization from direct, heterogeneous, and indirect perspectives. Using the provincial-level panel data in China from 2014 to 2022, a mixed-methods approach is employed for the empirical research. The CRITIC and Entropy TOPSIS are used to assess the comprehensive development level and temporal characteristics of the rural digital economy and new-type urbanization. Moreover, a global-local auto-correlation analysis is carried out to depict the spatial distribution of the two variables. Subsequently, a two-way fixed effects model is constructed to verify the direct impact of the rural digital economy on new-type urbanization, as well as its structural and spatial heterogeneity characteristics. Finally, an mediating effect model is established to explore the impact paths through which the rural digital economy impacts new-type urbanization. The results show that the rural digital economy has significantly promoted new-type urbanization. Specifically, rural digital infrastructure, digital transformation of agriculture, agricultural production service informatization have a significant positive effect, while the role of rural life digitization is not significant. The rural digital economy has more significant positive impact on population agglomeration and economic growth, followed by social public service, but has no significant impact on ecological environmental protection and urban-rural coordination. Additionally, the qualitative analysis identifies geographical region, poverty, demographic structure and social equality as notable influencing factors in this impact. Further mechanism analysis result indicates that the rural digital economy impacts new-type urbanization through rural human capital improvement, agricultural economic growth and rural industrial structure upgrading. This research contributes to the existing body of knowledge by providing the practical path of rural development to promote new-type urbanization in the context of the digital economy, also clarifies the weak points and key links in this process. It also highlights the need for further research into the institutional factors that influence this relationship to enhances the policy applicability.

Investigation of heavy metals adsorbed on microplastics in drinking water and water resources of Zabol

Investigating omega-3 fatty acids’ neuroprotective effects in repetitive subconcussive neural injury: Study protocol for a randomized placebo-controlled trial

Soccer (football) is the most popular sport globally, with 265 million players across all ages and sexes. Repetitive subconcussive head impacts due to heading of the soccer ball can pose threats to healthy brain development and aging. Omega-3 fatty acids, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have neuroprotective effects, but it remains unclear what aspects of neural health benefit from DHA+EPA when faced with subconcussive head impacts. In a randomized placebo-controlled trial, 208 soccer players will complete baseline measures including demographics, blood sampling, dietary recalls, and psychological assessment. Participants will be randomly assigned to ingest DHA+EPA [3.4g/d: DHA 2.4g+EPA 1.0g] or placebo daily for 8 weeks followed by a subconcussion intervention phase. During the subconcussion intervention, participants will perform a session of 20 controlled soccer headings, with a second session 24 hours later. Blood samples, neuroimaging data, autonomic reactivity, and clinical measures (symptoms, oculomotor, cognition) will be collected pre-heading and 24-hour post-1st session, 24-hour post-2nd session, and 7-day post-2nd session. The primary hypothesis is that DHA+EPA pretreatment will promote neuronal and astrocyte resiliency to subconcussive head impacts, as assessed by blood biomarkers of brain injury, axonal microstructure measured by diffusion tensor imaging, and whole-brain resting-state connectivity. It is proposed that pretreatment will preserve autonomic function, as assessed by the cold pressor test (CPT), as well as oculomotor and cognitive function, even after head impacts. Data from this trial will help clarify the combined effect of DHA+EPA on brain molecular, cellular, and physiological health in response to subconcussive head impacts. If the hypotheses are confirmed, the findings will support a highly practical intervention for mitigating the neurodegenerative cascade triggered by head impacts. Trial registration: ClinicalTrials.gov NCT06736925