Browse Articles

Long-term outcomes after revascularization surgery for adult moyamoya disease: Protocol for systematic review and meta-analysis

Introduction Moyamoya disease (MMD) commonly presents with cerebral ischemia or hemorrhage. Revascularization surgery, including direct, indirect, and combined bypasses, remains the mainstay of MMD treatment aiming to reduce stroke recurrence. However, the long-term outcomes of these interventions are still controversial. Herein, we designed the protocol for a systematic review and meta-analysis comparing the three different revascularization surgeries in adult MMD patients for more than 5 years long-term outcomes. Methods Our systematic review and meta-analysis protocol follows the PRISMA-P guidelines. Bypass surgeries for MMD will be included only if the follow-up time is more than 5 years. The primary outcome is the incidence of recurrent cerebral ischemia or hemorrhage. The secondary outcomes include functional outcomes evaluated by the Moyamoya Disease outcome category, mortality, and angiographic outcomes such as bypass patency, and collateral formation. Results Studies on the postoperative outcomes of revascularization surgeries to treat adult MMD patients will be included and analyzed. This systematic review and meta-analysis will offer evidence to clinicians and researchers on the long-term outcomes of revascularization surgeries in adult MMD patients and help to optimize the selection of bypass modality.

Cluster randomized controlled trial to assess the effectiveness of a package of community-based interventions on continuum of maternal and newborn healthcare in Sidama, Ethiopia: The SiMaNeH trial protocol

Background Maternal and newborn mortality and morbidity remain high in low- and middle-income countries such as Ethiopia. Limited access and dropouts from essential continuum of care interventions are critical factors. In Ethiopia, about one in five completes the continuum of essential care through pregnancy, childbirth, and the postnatal period. Evidence is limited on whether packages of interventions involving key community health actors increase the proportion completing essential maternal and newborn healthcare continuum in rural Sidama regional, state, Ethiopia. Objective This study aims to implement and evaluate the cumulative effectiveness of a package of community-based interventions designed to enhance involvement of key community health actors to improve the completion rate of continuum of maternal care and utilization of essential newborn care. Methods Twenty rural kebeles (clusters) in Sidama Regional State, Ethiopia, are randomly allocated to intervention and control arms. A total of 2000 pregnant women, 1000 per arm, will be recruited between 20 th and 26 th week of gestation after intervention. Then the pregnant mothers and their newborn babies will be followed until six weeks postpartum between June 2024 and February 2025. In the intervention arm, mothers and newborns will receive targeted interventions at home and in their community designed to improve the completion rate of recommended maternal and newborn care. Control clusters will receive normal care from the state public health system. Primary outcomes will be the difference in the completion of continuum of essential maternal and rate of use of essential and emergency newborn care and referrals between intervention and control clusters. These outcomes include rates of antenatal care completion, facility deliveries with skilled care, completion of at least four postnatal care contacts, and the overall completion of all the way from first antenatal visit through the postnatal care. Newborn outcomes will be measured through essential newborn care utilization and emergency (danger sign) identification and referrals. Secondary outcomes will include the effect of the intervention on reducing neonatal mortality and stillbirths. Conclusion This trial will implement and evaluate a package of community-based interventions within existing community healthcare infrastructure. The outcome may inform evidence-based community-based decisions to improve the continuum of essential maternal and newborn care. Trial registration The trial is registered at Pan African Clinical Trial Registry: PACTR202402782261294

The impact of policy incentives and value perception on rural residents’ clean heating behavior: Evidence from northern China

Implementing energy transition in rural areas is crucial for China to achieve its low-carbon transition in energy consumption and dual-carbon goals. This study aimed to elucidate policy effects and further analyze the mediating effect of value perception to provide a reference for building a long-term rural energy transition mechanism. We constructed a “policy incentives–value perception–behavior” theoretical analysis framework and used survey data collected from residents of northern China. A logit model was employed to empirically test the effects of advocacy, demonstration, and subsidy policies on residents’ clean heating behavior. We used a mediation effect model to examine the mediating effects of economic, functional, social, and emotional value perceptions. The results showed that all three policies significantly positively impacted residents’ clean heating choices, with subsidy policies exerting the best effect. These findings suggest that implementing policy incentives can influence residents’ behavior by enhancing their value perceptions. However, different types of policies may act through distinct pathways. Compared with previous studies that focused solely on the impact of policy or value perception on clean heating behavior, this study explored their interactive relationship and found that external policy incentives can be transformed into internal driving forces. Therefore, value perception should be considered during policy formulation to build a long-term mechanism for promoting energy transition in rural areas.

Supramolecular docking structure determination of alkyl-bearing molecules

Modeling lifetime and count data using a unified flexible family: Its discrete counterpart, properties, and inference

In this article, two flexible classes called the modified Kavya–Manoharan-G (MKM-G) and discrete modified Kavya–Manoharan-G (DMKM-G) families are investigated. The two proposed families provide more flexibility for modeling real-lifetime and count data from environmental, medical, engineering, and educational fields. Due to the new extra shape parameter of the two proposed families, their special sub-models are capable of modeling monotonic and non-monotonic hazard rates. The basic properties of the MKM-G family are studied. Eight classical approaches of estimation are used for estimating the MKM-exponential (MKME) parameters. The performances of the estimators are explored using simulation results. Additionally, the DMKM-exponential (DMKME) distribution is defined. Finally, the importance and flexibility of the MKME and DMKME distributions are addressed by fitting seven real-lifetime and count data from aforementioned applied fields. The real data analysis shows that the special models of the two classes are good candidates and can provide close fit as compared to well-known competing continuous and discrete distributions.

Exploring mobility patterns and social health of older Canadians living at home to inform decision aids about housing: A mixed-methods study

Introduction Many tools support housing decisions for older adults but often overlook mobility patterns and social health. We explored these factors in older Canadians living at home to inform housing decisions. Methods We conducted a mixed-methods study with 20 older adults (65+) from Quebec and Alberta living independently or in senior residences with outdoor mobility. Data collection included sociodemographic information, GPS tracking, walking interviews, daily journals, and in-depth interviews. Data from interviews, which explored physical and social assets and barriers to social health and mobility, were analyzed using deductive content analysis in NVivo 12. GPS data were subjected to spatial analysis in QGIS (Quantum Geographic Information System) to map activity spaces and mobility patterns by the number and distance of activities, activity types, and modes of transportation. Daily journals were transcribed into an Excel spreadsheet and compared with GPS data. Overall analysis was guided hierarchically by qualitative data, utilizing verbatim narratives and visualization (activity space maps) to illustrate data convergence. Results Among 20 participants, 14 completed all activities, including GPS trackers. GPS maps showed participants mostly left home to drive for shopping or walking. Over 14 days, participants made an average of 10.4 (±5.8) trips and traveled 186.9 km (±130.4), averaging 16.8 km (±29.8) per day. Transportation modes included car (n=9), walking (n=5), and bus (n=2). Daily journals revealed that participants typically traveled alone. Interviews identified physical assets as libraries and supermarkets (n=10), while social assets were family support when desired (n=13) neighborhood familiarity (n=14), both contributing to social health. Winter weather was the most cited mobility barrier (n=13). Conclusions These findings provide actionable insights to guide the development of user-informed decision support tools tailored to the housing decisions of Canadian older adults.

Job satisfaction mediates the effect of self-efficacy on work engagement among physical education teachers in economically disadvantaged areas

The unequal distribution of educational resources across regions with varying levels of socioeconomic development remains a global issue. Teachers in economically disadvantaged areas often exhibit lower levels of work engagement due to constraints in resources and limited opportunities for professional growth. This issue is particularly pronounced among physical education (PE) teachers, as PE is frequently regarded as a marginal subject. As a result, PE teachers receive less recognition from administrators and parents, encounter greater professional challenges, and experience diminished work engagement. Enhancing self-efficacy and job satisfaction has been identified as a critical strategy for improving work engagement. However, these relationships among PE teachers in underdeveloped regions remain insufficiently explored. To address this gap, this survey collected 472 questionnaire responses from rural primary school teachers, using a 5-point Likert scale survey. A path analysis model was employed to examine the direct and indirect effects of self-efficacy and job satisfaction on work engagement. The findings reveal that self-efficacy exerts an indirect influence on work engagement, with job satisfaction serving as a key mediating factor. These results suggest that fostering self-efficacy among PE teachers in economically disadvantaged areas can enhance job satisfaction, thereby leading to increased work engagement.

Live-cell super-resolution microscopy reveals how molecules enter and exit the nucleus

Impact of diabetes mellitus on 30-day mortality among acute stroke patients in northern Tanzania

Background Among acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania. Materials and methods This was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted, Results Out of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73–3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality, Conclusion This study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.

Protocol to evaluate the effectiveness of the implementation of transdiagnostic cognitive behavioural therapy for emotional disorders in primary care and its mechanisms of change: a randomized step-wedge clinical trial (PsicAP-CV)

Introduction Emotional disorders (ED) are highly prevalent worldwide. The PsicAP trial, conducted in Spain, demonstrated the benefits of adding transdiagnostic cognitive behavioural therapy (TD-CBT) to treatment as usual (TAU) for the attention of these disorders in primary care (PC). Here we describe the design of a stepped wedge randomized controlled trial (RCT), inspired by the PsicAP project. This RCT has two main aims: 1) to test the implementation of the PsicAP protocol in a real clinical setting, further evaluating possible mechanisms of change underlying the efficacy of TD-CBT (emotional regulation, alliance, and therapist experience and training), and 2) to assess the impact of psychotropic medication use on neuropsychological function and treatment outcomes. Methods A single-blind multicentre RCT with a stepped wedge design will be conducted. Participants (N=320) will be randomly assigned to an experimental group (EG1) or to a waiting list group (WG). The EG1 will receive immediate treatment and the WG will remain on the waiting list for 3 months. After this time, the WG will become a second experimental group (EG2) that will receive the same treatment as EG1 (PsicAP protocol). Patients will be assessed at post-treatment, at 3 and 9 months. Before starting treatment, a random subsample of patients (n=90) will undergo a neuropsychological assessment. These patients will be assigned to three groups based on their use of psychotropic medication at the time of randomization: no psychotropic medication, short-term use (< 3 months) and long-term use (≥ 3 months). All 90 participants will undergo the same neuropsychological assessment at one year. The RCT is expected to run from 01/05/23 to 01/10/25. Discussion The results of this trial are expected to provide further support for the efficacy of the PsicAP TD-CBT protocol, as well as insight into the mechanisms of change that lead to the positive therapeutic outcomes of this protocol. In addition, this study will help determine the effects of short- and long-term psychotropic use on neuropsychological function and therapeutic outcomes. In short, it is hoped that this RCT will help to better understand how to implement evidence-based psychological treatment in the PC setting. Trial registration EURADICT 2013-001955-11/ ISRCTN58437086.

An early precursor CD8+ T cell that adapts to acute or chronic viral infection

The essential calcium channel of sperm CatSper is temperature-gated

Abstract The flagellar calcium channel CatSper is essential for male fertility, as it regulates calcium influx to trigger the hyperactive motility required for sperm to fertilize the egg. Precise activation of CatSper is critical, as premature activation can impair sperm function. While optimal temperature is known to influence fertilization, its effect on CatSper remains unknown. By directly recording from mouse spermatozoa, we reveal that CatSper functions as a temperature-gated ion channel, with a thermal threshold of 33.5 °C and a temperature coefficient Q10 of 5.1. Additionally, we show that physiological levels of spermine reversibly inhibit CatSper’s temperature gating, protecting against premature activation. Our findings highlight for the first time the presence of the temperature-gating modality of CatSper and reveal the protective role of spermine, a major component of seminal plasma. These results emphasize the need to maintain testes below 34 °C for optimal fertility and advance understanding of CatSper regulation in male fertility.

CFD based design optimization of dimples induced on Blended Wing Body airframe using the Taguchi method

This research focuses on optimizing the design of dimples on a Blended-Wing-Body (BWB) airframe to enhance aerodynamic efficiency. Dimples serve as a passive flow control method intended to improve aerodynamic properties. Employing the Design of Experiments (DOE) framework and utilizing the Taguchi method, we examined five dimple design variables across three distinct levels. These variables included dimple placement, indentation depth, diameter, spacing between dimples, and the number of dimple rows on the BWB wing. An L18 orthogonal array (OA) was implemented to assess the impact of these variables on the drag coefficient (CD), lift coefficient (CL), and lift-to-drag ratio (L/D), which were used as performance metrics. High-fidelity Computational Fluid Dynamics (CFD) simulations were conducted for each of the eighteen configurations outlined by the L18 OA, across angles of attack ranging from 0° to 8°. Signal-to-Noise Ratio (SNR) analysis and Pareto Analysis of Variance (ANOVA) revealed that the dimple diameter had the most significant impact on both CD and L/D, contributing 35.19% and 40%, respectively, while the indentation depth showed the least influence. The study identified an optimal combination of design variables (A1B1C1D3E3), which minimizes CD and maximizes L/D. This work provides actionable guidelines for dimple design as a passive flow control method in aerospace applications.

Direct observation and control of non-classical crystallization pathways in binary colloidal systems

Urdu adaptation and validation of a disease-specific quality-of-life questionnaire in a Pakistani population of Achalasia

Background Achalasia, a rare esophageal disease marked by dysphagia, impacts health-related quality-of-life (HRQoL), measurable by disease-specific tools like achalasia-specific questionnaire (ASQ) that assess symptom severity and QoL. However, to ensure its reliability and validity across different populations, cross-cultural adaptation is necessary. So, for this reason, this study aimed to validate an Urdu-translated version of an ASQ in a Pakistani population of achalasia patients. Methodology A prospective cross-sectional study involving 52 participants was conducted at the Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi. ASQ was translated into the Urdu language by a forward-backwards translation process with expert input. Validation included factor analysis, known-group techniques, Cronbach’s alpha for reliability, and an independent t-test comparing ASQ scores with Eckardt scores for criterion validity. Results Among 52 participants (27 males, median age 30 years; 25 females, median age 48 years), 63.5% had Achalasia type I, 26.9% type II, and 9.6% type III. Factor analysis confirmed a well-defined construct with good validity, and internal consistency was strong (Cronbach’s alpha = 0.89). The ASQ scores significantly correlated with Eckardt scores (p < 0.05), confirming its validity. 73.1% of participants found the translated version easy and completed in a short time duration. Conclusion Urdu-translated ASQ proved to have good psychometric properties, with strong evidence of validity, reliability, and feasibility regarding health status in Pakistani achalasia patients. It can be recommended as a reliable QoL measure for clinical and research purposes. Future studies should explore its application in larger, more diverse cohorts and further refine its use in achalasia management.

Warming leads to both earlier and later snowmelt floods over the past 70 years

Identification of visible and near-infrared signature peaks for arboviruses and Plasmodium falciparum

Arbovirus and malaria infections affect more than half of the world’s population causing major financial and physical burden. Current diagnostic tools such as microscopy, molecular and serological techniques are technically demanding, costly, or time consuming. Near-infrared spectroscopy has recently been demonstrated as a potential diagnostic tool for malaria and Dengue virus and as a screening tool for disease vectors. However, pathogen specific absorption peaks that allow detection of these infections are yet to be described. In this study, we identified unique visible and near-infrared peaks from existing laboratory strains of four major arboviruses including Barmah Forest virus, Dengue virus, Ross River virus, Sindbis virus and Plasmodium falciparum. Secondly, to determine the diagnostic ability of these peaks, we developed machine learning algorithms using artificial neural networks to differentiate arboviruses from media in which they were grown. Signature peaks for BFV were identified within the visible region at 410, 430, 562 and 588 nm and the near-infrared region at, 946, 958, 1130, 1154 and 1780 nm. DENV related peaks were seen at 410nm within the visible region and 1130 nm within the near-infrared region. Signature peaks for Ross River virus were observed within the visible region at 410 and 430 nm and within the near-infrared region at 1130 and 1780 nm, while Sindbis virus had a prominent peak at 410 nm within the visible region. Peaks at 514, 528, 547, 561, 582, and 595 nm and peaks at 1388, 1432, 1681, 1700, 1721, 1882, 1905, 2245, 2278, 2300 nm were unique for P. falciparum. Near-infrared spectroscopy predictive sensitivity defined as the ability to predict an arbovirus as an infection was 90% (n=20) for Barmah Forest virus, 100% (n=10) for Ross River virus and 97.5% (n=40) for Dengue virus, while infection specificity defined as the ability to predict media as not-infected was 100% (n=10). Our findings indicate that spectral signatures obtained by near-infrared spectroscopy are potential biomarkers for diagnosis of arboviruses and malaria.

Single-shot magnon interference in a magnon-superconducting-resonator hybrid circuit

Abstract Magnon interference is a hallmark of coherent magnon interactions. In this work, we demonstrate single-shot magnon interference using up to four magnon pulses in two remotely coupled yttrium iron garnet spheres mediated by a coplanar superconducting resonator. By exciting one YIG sphere with injected microwave pulses, we achieve coherent energy exchange between the two spheres, facilitating their interference processes, including Rabi-like oscillation with a single pulse, constructive and destructive interference with two pulses, and interference peak sharpening with up to four pulses—analogous to diffraction grating in optical interference. The resulting interference patterns can be precisely controlled by changing the frequency detuning and time delay of the magnon pulses. The demonstration of time-domain coherent control of remote magnon interference opens new pathways for advancing coherent information processing through multi-operation, circuit-integrated hybrid magnonic networks.

CT features and histogram analysis of non-contrast images for differentiating malignant and benign mediastinal lymph nodes in Non-Small Cell Lung Cancer (NSCLC)

Objective To evaluate the diagnostic value of CT features and histogram analysis in distinguishing between malignant and benign mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC). Method This retrospective study analyzed non-contrast chest CT images from 40 NSCLC patients, comprising 80 pathology-proven mediastinal lymph nodes (46 benign, 34 metastasis). Morphologic features, including size, shape, margins, and internal composition, were independently assessed by two radiologists. Histogram analysis was conducted using the Synapse Vincent system with six parameters: mean attenuation, mean positive pixel (MPP), standard deviation (SD), skewness, kurtosis, and entropy. Statistical analysis included the Mann-Whitney test for continuous data, Fisher’s exact test for categorical data, and receiver-operating characteristic (ROC) curve analysis to assess diagnostic accuracy, with statistical significance set at p < 0.05. Results Malignant lymph nodes demonstrated significantly larger sizes (p < 0.001), ill-defined margins (p = 0.024), irregular shapes (p < 0.001), and the presence of necrotic areas (p < 0.001). A nodal size cutoff of 13.0 mm and volume of 1.632 ml were strongly associated with malignancy, yielding high diagnostic accuracy with sensitivities of 70.6% and 73.5% and specificities of 95.7% and 87.0%, respectively. Significant differences were observed between benign and malignant lymph nodes in several CT histogram parameters, including mean attenuation (p = 0.004), skewness (p = 0.041), kurtosis (p = 0.005), and entropy (p < 0.001). The integrating all CT histogram parameters yielded an area under the curve (AUC) of 0.870 for differentiating between benign and malignant lymph nodes. Conclusion The combination of morphologic CT features and CT histogram analysis offers a robust method for differentiating malignant from benign mediastinal lymph nodes in NSCLC patients, potentially enhancing diagnostic accuracy and informing treatment strategies.

Observation of plastic ice VII by quasi-elastic neutron scattering

Abstract Water is the third most abundant molecule in the universe and a key component in the interiors of icy moons, giant planets and Uranus- and Neptune-like exoplanets1–3. Owing to its distinct molecular structure and flexible hydrogen bonds that readily adapt to a wide range of pressures and temperatures, water forms numerous crystalline and amorphous phases4–6. Most relevant for the high pressures and temperatures of planetary interiors is ice VII (ref. 4), and simulations have identified along its melting curve the existence of a so-called plastic phase7–12 in which individual molecules occupy fixed positions as in a solid yet are able to rotate as in a liquid. Such plastic ice has not yet been directly observed in experiments. Here we present quasi-elastic neutron scattering measurements, conducted at temperatures between 450 and 600 K and pressures up to 6 GPa, that reveal the existence of a body-centred cubic structure, as found in ice VII, with water molecules showing picosecond rotational dynamics typical for liquid water. Comparison with molecular dynamics simulations indicates that this plastic ice VII does not conform to a free rotor phase but rather shows rapid orientational jumps, as observed in jump-rotor plastic crystals13,14. We anticipate that our observation of plastic ice VII will affect our understanding of the geodynamics of icy planets and the differentiation processes of large icy moons.