Browse Articles
Discover research articles across all indexed journals
Enhancing air quality predictions in Chile: Integrating ARIMA and Artificial Neural Network models for Quintero and Coyhaique cities
In this comprehensive analysis of Chile’s air quality dynamics spanning 2016 to 2021, the utilization of data from the National Air Quality Information System (SINCA) and its network of monitoring stations was undertaken. Quintero, Puchuncaví, and Coyhaique were the focal points of this study, with the primary objective being the construction of predictive models for sulfur dioxide (SO2), fine particulate matter (PM2.5), and coarse particulate matter (PM10). A hybrid forecasting strategy was employed, integrating Autoregressive Integrated Moving Average (ARIMA) models with Artificial Neural Networks (ANN), incorporating external covariates such as wind speed and direction to enhance prediction accuracy. Vital monitoring stations, including Quintero, Ventanas, Coyhaique I, and Coyhaique II, played a pivotal role in data collection and model development. Emphasis on industrial and residential zones highlighted the significance of discerning pollutant origins and the influence of wind direction on concentration measurements. Geographical and climatic factors, notably in Coyhaique, revealed a seasonal stagnation effect due to topography and low winter temperatures, contributing to heightened pollution levels. Model performance underwent meticulous evaluation, utilizing metrics such as the Akaike Information Criterion (AIC), Ljung-Box statistical tests, and diverse statistical indicators. The hybrid ARIMA-ANN models demonstrated strong predictive capabilities, boasting an R2 exceeding 0.90. The outcomes underscored the imperative for tailored strategies in air quality management, recognizing the intricate interplay of environmental factors. Additionally, the adaptability and precision of neural network models were highlighted, showcasing the potential of advanced technologies in refining air quality forecasts. The findings reveal that geographical and climatic factors, especially in Coyhaique, contribute to elevated pollution levels due to seasonal stagnation and low winter temperatures. These results underscore the need for tailored air quality management strategies and highlight the potential of advanced modeling techniques to improve future air quality forecasts and deepen the understanding of environmental challenges in Chile.
Ultrasound pupillometry for the detection of a relative afferent pupillary defect (RAPD): Systematic evaluation in patients with optic neuritis and comparison with infrared video pupillometry
Purpose A relative afferent pupillary defect (RAPD) is a characteristic clinical sign of optic neuritis (ON). Here, we systematically evaluated ultrasound pupillometry (UP) for the detection of an RAPD in patients with ON, including a comparison with infrared video pupillometry (IVP), the gold standard for objective pupillometry. Materials and methods We enrolled 40 patients with acute (n = 9) or past (n = 31) ON (ON+), 31 patients with multiple sclerosis (MS) without prior ON, and 50 healthy controls (HC) in a cross-sectional observational study. Examinations comprised the swinging flashlight test, B-mode UP, IVP, autorefraction to assess the best-corrected visual acuity, optical coherence tomography to determine peripapillary retinal nerve fiber layer thickness, and the 51-item National Eye Institute-Visual Function Questionnaire to determine the vision-related quality of life. Results While UP and IVP measurements of pupil diameter (PD) at rest correlated in ON+ eyes (n = 52, r = 0.56, 95% CI: 0.35; 0.72) and in HC eyes (n = 100, r = 0.60, 95% CI: 0.47; 0.72), PD at rest was smaller in UP than in IVP measurements (difference, mean (SD) ON+ eyes: 0.44 (0.87) mm, HC eyes: 0.69 (0.80) mm). RAPD assessment by UP sharply discriminated acute ON eyes (n = 9) and HC eyes (n = 100, AUC = 1, 95%CI: 1; 1). UP detected an RAPD in 5/31 (16%) patients with MS without prior ON who had not exhibited an RAPD during the swinging flashlight test. In ON+ eyes (n = 52), UP showed stronger correlations with visual acuity (r = 0.66, 95% CI: 0.50; 0.78) and vision-related quality of life (r = 0.47, 95% CI: 0.24; 0.66) than IVP (r = 0.52, 95% CI: 0.36; 0.67 and r = 0.27, 95% CI: 0.03; 0.51). Conclusions B-mode UP allows for objective detection and quantification of an RAPD with performance characteristics similar to IVP. RAPD assessment by UP may detect subclinical optic nerve damage in patients with MS. We propose a standardized protocol for RAPD detection by UP that can be used in routine clinical evaluation of patients with ON or other optic neuropathies.
Effects of recombinant human growth hormone in severe neurosurgical patients: A single center, retrospective study
Purpose To explore the effects of recombinant human growth hormone (r-hGH) on inflammatory mediators, immune cells and prognosis in severe neurosurgical patients. Methods From August 2020 to June 2021, a total of 236 patients who admitted to the neurosurgical intensive care unit (NSICU) were retrospectively analyzed. The patients were divided into GH group (97 cases) and nGH group (139 cases) according to whether they received r-hGH treatment. Parameters including CD4+ T cell counts, inflammatory mediators and prognosis were recorded and assessed. Results The results showed that the cure time of pneumonia and intracranial infection in GH group patients was significantly shorter than in the nGH group (24.25 ± 4.89 days and 21.33 ± 1.53 days versus 29.13 ± 7.43 days and 25.17 ± 2.32 days, respectively). However, there was no significant difference in GOS scores between two groups (31.96% ≤ 3 and 68.04% > 3 vs 39.57% ≤ 3 and 60.43% > 3) (P = 0.232). Furthermore, the number of CD4+ T cells and CD8+ T cells in the GH group showed a significant upward trend. Last but not least, significant differences were also observed in IL-6 and IL-10 levels between two groups at days 1, 3, and 7. Conclusion The application of r-hGH in severe neurosurgical patients was effective in increasing the number of CD4+ T cells, down-regulating inflammatory mediators, shortening the cure time of pneumonia, intracranial infections and urinary tract infections, and improving patients’ prognosis.
Effects of spectral manipulations of music mixes on musical scene analysis abilities of hearing-impaired listeners
Music pre-processing methods are currently becoming a recognized area of research with the goal of making music more accessible to listeners with a hearing impairment. Our previous study showed that hearing-impaired listeners preferred spectrally manipulated multi-track mixes. Nevertheless, the acoustical basis of mixing for hearing-impaired listeners remains poorly understood. Here, we assess listeners’ ability to detect a musical target within mixes with varying degrees of spectral manipulations using the so-called EQ-transform. This transform exaggerates or downplays the spectral distinctiveness of a track with respect to an ensemble average spectrum taken over a number of instruments. In an experiment, 30 young normal-hearing (yNH) and 24 older hearing-impaired (oHI) participants with predominantly moderate to severe hearing loss were tested. The target that was to be detected in the mixes was from the instrument categories Lead vocals, Bass guitar, Drums, Guitar, and Piano. Our results show that both hearing loss and target category affected performance, but there were no main effects of EQ-transform. yNH performed consistently better than oHI in all target categories, irrespective of the spectral manipulations. Both groups demonstrated the best performance in detecting Lead vocals, with yNH performing flawlessly at 100% median accuracy and oHI at 92.5% (IQR = 86.3–96.3%). Contrarily, performance in detecting Bass was arguably the worst among yNH (Mdn = 67.5% IQR = 60–75%) and oHI (Mdn = 60%, IQR = 50–66.3%), with the latter even performing close to chance-levels of 50% accuracy. Predictions from a generalized linear mixed-effects model indicated that for every decibel increase in hearing loss level, the odds of correctly detecting the target decreased by 3%. Therefore, baseline performance progressively declined to chance-level at moderately severe degrees of hearing loss thresholds, independent of target category. The frequency domain sparsity of mixes and larger differences in target and mix roll-off points were positively correlated with performance especially for oHI participants (r = .3, p < .01). Performance of yNH on the other hand remained robust to changes in mix sparsity. Our findings underscore the multifaceted nature of selective listening in musical scenes and the instrument-specific consequences of spectral adjustments of the audio.
Predicting the polyspecificity of aminoacyl-tRNA synthetase for non-canonical amino acids using molecular dynamics simulation and MM/PBSA
With the advancement of genetic code expansion, the field is progressing towards incorporating multiple non-canonical amino acids (ncAAs). The specificity of aminoacyl-tRNA synthetases (aaRSs) towards ncAAs is a critical factor, as engineered aaRSs frequently show polyspecificity, complicating the precise incorporation of multiple ncAAs. To address this challenge, predicting binding affinity can be beneficial. In this study, we expressed sfGFP using an orthogonal aaRS/tRNA pair with 4-Azido-L-phenylalanine (AzF) and another four different ncAAs. The experimental results showed specificity with O-Methyl-L-tyrosine as well as AzF, and these results were compared with computational predictions. We constructed a mutant aaRS structure specific for AzF through homology modelling and conducted docking studies with tyrosine and five ncAAs, followed by molecular dynamics simulations. The binding affinity was calculated using the molecular mechanics/Poisson–Boltzmann surface area, focusing on nonpolar solvation terms. While the analysis is based on the incorporation of limited number of ncAAs, the cavity and dispersion term method showed consistency with experimental data, highlighting its potential utility compared to the surface area term method. These findings enhance understanding of the ncAA specificity of aaRS in relation to computer simulations and energy calculations, which can be utilized to rationally design or predict the specificity of aaRS.
Effect of virtual interactions through avatar agents on the joint Simon effect
The joint Simon effect refers to inhibitory responses to spatially competing stimuli during a complementary task. This effect has been considered to be influenced by the social factors of a partner: sharing stimulus-action representation. According to this account, virtual interactions through their avatars would produce the joint Simon effect even when the partner did not physically exist in the same space because the avatars are intentional agents. To investigate this, we conducted two joint experiments in which participants controlled avatars as their agents in immersive virtual environments. In Experiment 1, participants were asked to touch a virtual button through their avatars when a target color of an object was presented. The target position was manipulated to be compatible with the button (compatible stimulus) or incompatible with the button (incompatible stimulus). In Experiment 2, the task was identical to that in Experiment 1 except that participants’ gaze position was either visualized or not during the task. We hypothesized that visualizing the partner’s gaze would enhance the joint Simon effect because gaze is a cue to mentalize others’ internal states. The results showed that avatar-based interactions more significantly delayed responses for the incompatible than for the compatible stimulus. However, inconsistent with our hypothesis, visualizing the partner’s gaze position did not influence responses for spatially competing stimuli. These results suggest that virtual interactions through avatar agents can produce the joint Simon effect even when the partner does not physically exist in the same space.
Muscle relaxation enhances motor imagery capacity in people with anxiety: A randomized clinical trial
Background Motor imagery is the mental representation of a movement without physical execution. When motor imagery is performed to enhance motor learning and performance, participants must reach a temporal congruence between the imagined and actual movement execution. Identifying factors that can influence this capacity could enhance the effectiveness of motor imagery programs. Anxiety frequently occurs in sports and rehabilitation where motor imagery is a relevant technique. It is associated with increased muscle tension and impairs the memory processes involved in motor imagery. This study aimed to determine whether muscle relaxation before motor imagery practice can influence motor imagery capacity and temporal congruence in anxious individuals, during internal and external visual imagery, and kinesthetic imagery. Methods A randomized clinical trial was conducted in 55 young adults (20.3±2.8 years; 40 females; 15 males) with anxiety (percentile ≥75% on the State-Trait Anxiety Inventory). 26 participants were assigned to the relaxation group and 29 to the control group through stratified randomization. Motor imagery capacity and temporal congruence were assessed using the Movement Imagery Questionnaire-3 at 2 points (t1 and t2). Between t1 and t2, participants in the relaxation group underwent abbreviated progressive relaxation training. Electrodermal activity and heart rate variability were recorded to evaluate the relaxation effect. Results Data revealed a significant improvement in motor imagery capacity in the relaxation group, while the temporal congruence was not impaired in both groups. Conclusion Pre-motor imagery muscle relaxation might improve motor imagery capacity in anxious individuals. This finding may contribute to better tailor motor imagery programs and to adjust motor imagery guidelines and recommendations for people with anxiety. This study has been registered in ClinicalTrials.gov (NCT04973956).
Identification of biomarkers associated with ferroptosis in macrophages infected with Mycobacterium abscessus using bioinformatic tools
Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium that causes severe pulmonary infections. Recent studies indicate that ferroptosis may play a critical role in the pathogenesis of M. abscessus pulmonary disease. We obtained gene expression microarray data from the Gene Expression Omnibus database, focusing on THP-1-derived macrophages infected with M. abscessus and uninfected controls. Differentially expressed genes related to ferroptosis were identified through weighted gene co-expression network analysis and the "limma" package, followed by gene set variation analysis and gene set enrichment analysis for enrichment assessment. To explore regulatory network relationships among hub genes, we constructed RBP-mRNA, ceRNA, and TF-mRNA networks. Additionally, a protein-protein interaction network was built, and functional enrichment analyses were conducted for the hub genes. The diagnostic value of these genes was assessed using receiver operating characteristic curves. Six differentially expressed genes associated with ferroptosis were identified in M. abscessus infection. The receiver operating characteristic curves demonstrated that these genes had excellent predictive value for the infection. Functional enrichment analysis showed that these genes were involved in immune responses, inflammation, cellular metabolism, cell death, and apoptosis. Pathway enrichment analysis revealed significant enrichment in pathways related to apoptosis, inflammation, and hypoxia. The RBP-mRNA network highlighted significant interactions between hub genes and key RNA-binding proteins, while the ceRNA network predicted that miRNAs and lncRNAs regulate ferroptosis-related genes NACC2 and ITPKB. Furthermore, interactions between the hub gene HSD3B7 and transcription factors LMNB1 and ASCL1 may promote ferroptosis in macrophages by influencing iron metabolism and reactive oxygen species production, contributing to the M. abscessus infection process. Our findings identified biomarkers linked to ferroptosis in M. abscessus infection, providing new insights into its pathogenic mechanisms and potential therapeutic strategies.
Use of patient-centred outcome measures alongside the personal wheelchair budget process in NHS England: A mixed methods approach to exploring the staff and service user experience of using the WATCh and WATCh-Ad
Background and objective Personal wheelchair budgets (PWBs) are offered to everyone in England eligible for a wheelchair provided through the National Health Service (NHS) to support their choice of equipment. The WATCh (Wheelchair outcomes Assessment Tool for Children) and related WATCh-Ad for adults are patient-centred outcome measures (PCOMs) developed to help individual users express their main outcome needs when obtaining a wheelchair and rate their satisfaction with subsequent outcomes after receiving their equipment. Use was explored in a real-world setting, aiming to produce guidance for use alongside the PWB process. Methods Three wheelchair service provider organisations across four sites participated. Staff and users completed surveys about their experience of assessments using the WATCh and/or WATCh-Ad. Selected patients were interviewed after receipt of their equipment, and staff were interviewed after experiencing a number of assessments. Thematic analysis was undertaken using the tool, survey and interview data. Results of pre- and post-equipment provision were presented graphically. Results Information on 75 assessments by 15 staff was obtained. Three-quarters of users or their carers rated the use of the tools in the assessment process as ‘helpful’ or ‘very helpful’. Staff reported that the WATCh or WATCh-Ad had been considered ‘useful’ in developing individual care plans in around 1 in 3 cases and affected the prescription in 1 in 4 cases. Concerns were expressed about the length of time taken to administer the tools in clinic. However, some staff noted this reduced with more hands-on experience and by providing the tools to users in advance of the appointment. Conclusions The WATCh and WATCh-Ad PCOMs are suitable for routine use by wheelchair service providers to assist the assessment process. It is recommended that tool materials are provided in advance to users/carers and that staff are allowed time to develop their ways of working with them.
Fitting of Soil-Water Characteristic Curves (SWCC) of Bukit Mewah, Malaysia soil using field monitoring dataset
Rainfall-induced landslides are a frequent geohazard for tropical regions with prevalent residual soils and year-round rainy seasons. The water infiltration into unsaturated soil can be analyzed using the soil-water characteristic curve (SWCC) and permeability function which can be used to monitor and predict incoming landslides, showing the necessity of selecting the appropriate model parameter while fitting the SWCC model. This paper presents a set of data from six different sections of the studied slope at varying depths that are used to test the performance of three SWCC models, the van Genuchten-Mualem (vG-M), Fredlund-Xing (F-X) and Gardner (G). The dataset is obtained from field monitoring of the studied slope, over a duration of 6 months. The study discovered that the van Genuchten-Mualem model provided the best estimation based on RMSE and evaluation metric, R2 followed by Fredlund and Xing, and Gardner, however, the difference between them is minor. The R2 obtained varies as the value at the crest with 1.0 m depth has a mean of 0.44, the lowest among the overall data fitted but it also has the best RMSE value with a mean of 0.00473. Whereas the location mid-section at a depth of 1.0 m has the highest R2 with a mean of 0.97, and an average value of RMSE of 0.0145 which is the middle of the group that was fitted. This indicates that R2 measurement for model performance relies highly on the dispersion of the variables collected. The dispersion of the data set is mainly due to the sensors’ inability to detect effectively at exceedingly high matric suction and zero matric suction. The investment in improving the equipment’s precision will boost reliability and reduce the number of assumptions as the data is collected from the site rather than laboratory testing.
National assessment on the frequency of pain medication prescribed for intrauterine device insertion procedures within the Veterans Affairs Health Care System
Background The intrauterine device (IUD) is a highly effective form of long-acting reversible contraception, widely recognized for its convenience and efficacy. Despite its benefits, many patients report moderate to severe pain during and after their IUD insertion procedure. Furthermore, reports suggest significant variability in pain control medications, including no adequate pain medication. The aim of this evaluation was to assess the pharmaceutical pain medication types, proportions, and trends related to IUD insertion procedures within the Veterans Health Administration (VHA). Methods IUD insertion procedures documented in the VA electronic health record were assessed from 1/1/2018 to 10/13/2023. Descriptive statistics described patient and facility characteristics while annual trends were assessed using linear regression. Results Out of the 28,717 procedures captured, only 11.4% had any form of prescribed pain medication identified. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were the most frequently prescribed pain medication category (8.3%), with ibuprofen being the most common pain medication overall (6.1%). Over the assessment period, there was an average annual increase of 0.52% ( p = 0.038) of procedures with prescribed pain medication, increasing from 10.3% in 2018 to 13.3% in 2023. Conclusions Although IUD insertion procedures have been seeing an increase in prescribed pain medication, the overall proportion remains disproportionality low relative to the pain experienced. Additionally, when pain interventions were initiated, they disproportionally utilized medication that have been shown to be ineffective. The intent of the work is that the information will help guide data driven pain medication strategies for patients undergoing IUD insertion procedures within the VHA.
Evaluation of endothelialization of an occluder device with cardiac computed tomography and assessment of the pathological validation
Background Assessing the endothelialization of occlusive devices noninvasively remains a challenge. Cardiac computed tomography angiography (CTA) can be employed to evaluate device endothelialization based on contrast uptake within the occluder. Objective This study examined device endothelialization using cardiac CTA and investigated the pathological associations. Methods From January 2010 to May 2022, we retrospectively analyzed 25 patients (age: 50.00 [17.00, 52.00] years; 12 Female) who underwent surgical device removal within 1 month after cardiac CTA examination (implantation period: 29.00[0.50, 108.00] months). The contrast uptake within the occluder was determined using cardiac CTA. The relationship between contrast uptake within the occluder and the endothelialization status with pathology was analyzed. Results Contrast uptake within the occluder was identified in 76.00% of patients. Pathological examination confirmed incomplete coverage of fibrotic tissue and superposed neoendothelium on the surface of all devices exhibiting contrast uptake. This included no coverage in 47.37% of patients and partial coverage in the remaining cases. On the surface of all devices without contrast uptake, a complete range of fibrotic tissue was observed, with an incomplete range of superposed neoendothelium in 66.67% of patients. On the surface of devices with an implantation period > 6 months, 71.43% of patients had incomplete coverage of fibrotic tissue and superposed neoendothelium on the left disc, 42.86% of patients occurred the same on the right disc. Conclusions Contrast uptake within the occluder indicated incomplete endothelialization, as confirmed by pathological validation. Late endothelialization of the device occurs frequently, and further research is required to investigate related mechanisms.
Preliminary characterisation of the spatial immune and vascular environment in triple negative basal breast carcinomas using multiplex fluorescent immunohistochemistry
Triple negative breast cancers often contain higher numbers of tumour-infiltrating lymphocytes compared with other breast cancer subtypes, with their number correlating with prolonged survival. Since little is known about tumour-infiltrating lymphocyte trafficking in triple negative breast cancers, we investigated the relationship between tumour-infiltrating lymphocytes and the vascular compartment to better understand the immune tumour microenvironment in this aggressive cancer type. We aimed to identify mechanisms and signaling pathways responsible for immune cell trafficking in triple negative breast cancers, specifically of basal type, that could potentially be manipulated to change such tumours from immune “cold” to “hot” thereby increasing the likelihood of successful immunotherapy in this challenging patient population. We characterised the spatial immune environment in 10 basal breast cancers showing a range of tumour-infiltrating lymphocytes using multiplex fluorescent immunohistochemistry and quantitative digital analysis of CD3+ T cells. We examined their relationship to blood vessels and their activation status as defined by VCAM-1, ICAM-1 and PD-L1. Confirmation of the relationship between tumour-infiltrating lymphocytes and endothelial activation was performed through in silico analysis on TCGA BRCA RNA-seq data (N = 808). Significantly higher CD3+ T cell densities were observed in the stromal compartment compared with the neoplastic cell compartment (P = 0.003). ICAM-1 activated blood vessels were spatially associated with higher CD3+ T cell densities only within 30 microns of blood vessels compared with more distal activated and non-activated blood vessels (P = 0.041). In silico analysis confirmed higher numbers of tumour-infiltrating lymphocytes in basal breast cancers and that higher numbers were significantly associated with endothelial cell activation molecules, co-clustering with upregulated ICAM-1 and VCAM-1 amongst others. PD-L1 was also identified in a subset of blood vessels, suggesting an additional immune regulatory mechanism in endothelial cells. Regulating the activation status of tumour-associated vascular endothelial cells may improve T cell trafficking into basal breast tumours and enhance immunotherapeutic response.
Cerebral blood flow and histological analysis for the accurate differentiation of infiltrating tumor and vasogenic edema in glioblastoma
Background Glioblastoma is characterized by neovascularization and diffuse infiltration into the adjacent tissue. T2*-based dynamic susceptibility contrast (DSC) MR perfusion images provide useful measurements of the biomarkers associated with tumor perfusion. This study aimed to distinguish infiltrating tumors from vasogenic edema in glioblastomas using DSC-MR perfusion images. Methods Data were retrospectively collected from 48 patients with primary IDH-wild-type glioblastoma and 24 patients with meningiomas (Edemas-M). First, we attempted histological verification of cell density, Ki-67 index, and microvessel areas to distinguish between non-contrast-enhancing tumors (NETs) and edema (Edemas) which were obtained from stereotactically fused T2-weighted and perfusion images. This was performed for evaluating enhancing tumors (ETs), NETs, and Edemas. Second, we also performed radiological verification to distinguish NETs from Edemas. Two neurosurgeons manually assigned the regions of interests (ROIs) to ETs, NETs, and Edemas. The DSC-MR perfusion imaging-derived parameters calculated for each ROI included the cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT). Results Cell density and microvessel area were significantly higher in NETs than those in Edemas (p<0.01 and p<0.05, respectively). Regarding radiological analysis, the mean CBF ratio for Edemas was significantly lower than that for NETs (p<0.01). The mean MTT ratio for Edemas was significantly higher than that for NETs. The receiver operating characteristic (ROC) analysis showed that CBF (area under the curve [AUC] = 0.890) could effectively distinguish between NETs and Edemas. The ROC analysis also showed that MTT (AUC = 0.946) could effectively distinguish between NETs and Edemas. Conclusions DSC-MR perfusion images may prove useful in differentiating NETs from Edemas in non-contrast T2 hyperintensity regions of glioblastoma.
Perceptual link between inadequate water, sanitation, and hygiene (WASH) stressors and common mental symptoms in Ethiopian health workers: A qualitative study
Background Despite the rising prevalence of common mental symptoms, information is scarce on how health workers make sense of symptoms of mental disorders and perceive a link with inadequate water, sanitation, and hygiene (WASH) as work stressors to understand causation and produce useful knowledge for policy and professionals. Therefore, this study aimed to explore how health workers perceive the link between inadequate WASH and common mental symptoms (CMSs) at hospitals in central and southern Ethiopian regions. Methods We used an interpretive and descriptive phenomenological design guided by theoretical frameworks. Three focus group discussions (FGDs) and 10 in-depth interviews with health workers were conducted. We explored the perceived link with inadequate WASH after assessing health workers’ conceptualization of common mental health symptoms. The interviews and FGDs were audio recorded, transcribed, and translated into English. Coding and categorizing were supported by MaxQDA software 2020. Thematic analysis was performed and themes were supported by participants’ quotes when necessary. Results Four themes emerged from the data based on the guiding theoretical models relevant to the research questions. Most health workers believed and frequently suggested that inadequate water supply, functional hand hygiene, environmental cleaning, and waste management services at the points of care increased the risk of occupational stress, job anxiety, and occupational depression symptoms. Many participants believed that inadequate WASH would cause them to experience negative professional quality of life including burnout, compassion dissatisfaction, and compassion fatigue at work despite believing that WASH problems cannot be solved at the individual level. Participants recurrently listed many individual, organizational, and system-level barriers to reducing and coping with inadequate WASH as stressors. Conclusions Healthcare workers perceived inadequate WASH components as contributing to symptoms of common mental disorders and negatively impacting their professional quality of life. They faced multiple barriers at individual, organizational, and health system levels, which hindered their ability to manage work-related stress and seek mental health support. The findings suggest the implementation of integrated WASH and mental health services for healthcare workers, ranging from establishing individual-level interventions to increasing access to WASH around care areas through collaborative efforts with healthcare administration, broader health systems, water supplies, and sewerage services.
Patterns of belatacept use and risk of post-transplant lymphoproliferative disorder in US kidney transplant recipients: An analysis of the Organ Procurement and Transplantation Network database
Background Belatacept is approved for the prophylaxis of organ rejection in Epstein-Barr virus (EBV)-seropositive kidney transplant recipients and is associated with a risk of post-transplant lymphoproliferative disorder (PTLD). Methods Data from the Organ Procurement and Transplantation Network were used to examine patterns of belatacept use, describe patient characteristics, and estimate risk of PTLD in EBV-seropositive, kidney-only transplant recipients receiving belatacept- or calcineurin inhibitor (CNI)-based immunosuppression as part of US Food and Drug Administration-mandated safety monitoring. Results During the study period (June 15, 2011–June 14, 2016), 94.9% (1631/1719) of belatacept-treated and 89.7% (59,992/66,905) of CNI-treated patients with known EBV serostatus were EBV seropositive. Among EBV-seropositive patients, 50.2% (belatacept) and 56.8% (CNI) received a standard criteria donor kidney, 59.5% and 18.7% received basiliximab induction, and 22.9% and 50.8% received antithymocyte globulin induction. PTLD developed in nine belatacept-treated patients (two with central nervous system [CNS] involvement) and 225 CNI-treated patients (nine with CNS involvement). Four and 81 patients, respectively, died due to PTLD. Kaplan–Meier analysis did not show a significant between-group difference in PTLD estimated incidence rates within 5 years (0.70% versus 0.48%, respectively; p = 0.18). Additionally, estimated PTLD incidence was not significantly different between treatment groups in a propensity score matched cohort. Conclusions The majority of adult kidney-only transplant recipients treated with belatacept in routine clinical practice are EBV seropositive. In this study, the risk of PTLD in these patients, while higher than for CNI-based immunosuppression, remained low after adjusting for differences in patient characteristics. Trial registration These studies are registered at ClinicalTrials.gov: NCT01670058 and NCT01656343.
Effect of pig breeding scale on manure resource utilization-The moderating effect based on technology cognition
The utilization of manure resources is an important measure to promote the development of agricultural green low-carbon cycle and solve the challenges associated with the current large-scale development of the livestock and poultry breeding industry. Based on the survey data of pig farmers in Qingdao, Shandong Province, China, this paper constructs a theoretical analysis framework of pig breeding scale and technical cognition on the utilization behavior of livestock and poultry manure resources of pig farmers. The binary Logit model and the moderating effect model are used to deeply explore the scale effect of breeding scale on the utilization behavior of pig farmers’ manure resources, and the moderating effect of technical cognition on the influence of breeding scale on the utilization behavior of manure resources. First, at the present stage, pig farmers show certain differences in the resource utilization of manure. Due to the differences in the personal characteristics, family characteristics, and breeding characteristics of pig farmers, the influencing factors of resource utilization of pig farmers of different scales are different; Second, the scale of pig breeding has a significant positive promoting effect on the resource utilization of manure, increasing the probability of pig farmers to treat manure, guiding retail and small-scale farmers to moderately expand the scale of breeding, gradually moving to large-scale breeding, realizing centralized management and resource utilization of manure, and reducing the unit cost of manure treatment. Third, technical ease of use has a positive regulatory effect on pig breeding scale and manure resource utilization behavior. When pig farmers perceive that the technology of manure resource utilization is easy to use, they will increase the probability of participating in the resource utilization of manure, reduce the environmental pollution caused by improper disposal of manure, and promote the low-carbon and circular development of livestock and poultry industry. Based on the above findings, this paper aims to provide practical enlightenment for policy makers and researchers to strengthen the environmental governance and sustainable development of livestock industry.
Automated quantitative pupillometry as a predictor for transtentorial brain herniation in patients with malignant acute ischemic stroke
Brain herniation can be a life-threatening condition, resulting in poor prognosis and higher fatality rates. We examined whether quantitative characteristics of sequential pupillary light reflex (PLR) could serve as biomarkers for identifying brain herniation in fatal acute stroke cases with anterior circulation involvement admitted to neurological intensive care unit (Neuro-ICU). Automatic pupillometer assessed PLR automatically every 4–6 hours, measuring eight specific features: NPi (Neurological pupil index) score, initial resting and constriction pupil size, constriction change, constriction velocity, constriction latency, and dilation velocity. Generalized estimating equations were used to analyze the main effects of assessment time (3-to-0 hours, just before brain herniation, and 27-to-21 hours, considerably before) and clinical groups. The study involved 59 patients (mean age 68.8 ± 1.6 years, 23 females) divided into herniation (n = 10) and non-herniation (n = 49) groups. The herniation group exhibited significantly lower ipsilateral NPi scores at 3-to-0 hours (1.80 ± 0.44, p < 0.0001) compared to 27-to-21 hours (4.26 ± 2.21). Additionally, the herniation group had a larger ipsilateral pupil size at constriction at 3-to-0 hours (4.01 ± 0.40 mm) compared to 27-to-21 hours (2.11 ± 0.17 mm). Specifically, at 3-to-0 hours, the herniation group had lower NPi scores (1.80 ± 0.44 vs. 3.97 ± 0.13, p < 0.0001) and larger pupil size at constriction (4.01 ± 0.04 mm vs. 2.90 ± 0.10 mm, p = 0.007) compared to the non-herniation group. These findings suggest that evaluating PLR characteristics can aid in the early identification of brain herniation, facilitating timely triage and appropriate surgical management.
A qualitative exploration of the enablers of and barriers to conformance with antibiotic withdrawal periods on smallholding, peri-urban pig farms in Kiambu County, Kenya
Non-conformance with antibiotic withdrawal period guidelines represents a food safety concern, with potential for antibiotic toxicities and allergic reactions as well as selecting for antibiotic resistance. In the Kenyan domestic pig market, conformance with antibiotic withdrawal periods is not a requirement of government legislation and evidence suggests that antibiotic residues may frequently be above recommended limits. In this study, we sought to explore enablers of and barriers to conformance with antibiotic withdrawal periods for pig farms supplying a local independent abattoir in peri-urban Nairobi. We drew upon semi-structured interviews with farmers and government animal health professionals as well as focus groups which involved private animal health professionals. We also explored farmers’ engagement with antibiotic withdrawal periods by visiting thirteen pig farms (supplying one of two local independent abattoirs) weekly for one month in order to capture instances of antibiotic use. We analysed data using reflexive thematic analysis. All farmers participating in the study demonstrated an awareness of the concept of antibiotic withdrawal periods and described intentions to conform, motivated by caring for others, wanting to prevent harm or a perception that regulation around antibiotic withdrawal periods existed for local independent abattoirs. The antibiotic use practices that we identified showed limited opportunities for non-conformance with antibiotic withdrawal periods. Farmers and veterinarians reported that instances of antibiotic use were uncommon, especially in slaughter-weight pigs, and were mainly restricted to the treatment of clinical signs under the supervision of an animal health professional. Local factors presented barriers to antibiotic withdrawal period conformance including farmers’ economic constraints, lack of formal medicine recording, an absence of consistent abattoir monitoring and resource emergency, such as water scarcity on farms. This study demonstrates the importance of these contextual factors to conformance with antibiotic withdrawal periods. We highlight the need to account for farm-level influences when planning future research and interventions aimed at reducing the presence of antibiotic residues in meat from smallholding pig farms in peri-urban Nairobi.
Cardiac MR image reconstruction using cascaded hybrid dual domain deep learning framework
Recovering diagnostic-quality cardiac MR images from highly under-sampled data is a current research focus, particularly in addressing cardiac and respiratory motion. Techniques such as Compressed Sensing (CS) and Parallel Imaging (pMRI) have been proposed to accelerate MRI data acquisition and improve image quality. However, these methods have limitations in high spatial-resolution applications, often resulting in blurring or residual artifacts. Recently, deep learning-based techniques have gained attention for their accuracy and efficiency in image reconstruction. Deep learning-based MR image reconstruction methods are divided into two categories: (a) single domain methods (image domain learning and k-space domain learning) and (b) cross/dual domain methods. Single domain methods, which typically use U-Net in either the image or k-space domain, fail to fully exploit the correlation between these domains. This paper introduces a dual-domain deep learning approach that incorporates multi-coil data consistency (MCDC) layers for reconstructing cardiac MR images from 1-D Variable Density (VD) random under-sampled data. The proposed hybrid dual-domain deep learning models integrate data from both the domains to improve image quality, reduce artifacts, and enhance overall robustness and accuracy of the reconstruction process. Experimental results demonstrate that the proposed methods outperform than conventional deep learning and CS techniques, as evidenced by higher Structural Similarity Index (SSIM), lower Root Mean Square Error (RMSE), and higher Peak Signal-to-Noise Ratio (PSNR).