Limitations Of Analysis Research Articles

Healthy Village House Program Outcomes in Panggreh Village, Jabon District

Background: This research explores the implementation of the Healthy Village Program, emphasizing local health initiatives' role in public health. Specific Background: It examines communication, resources, disposition, and bureaucratic structures within a particular village context. Knowledge Gap: There is limited analysis of these programs' effectiveness and community engagement in rural areas. Aims: The study aims to assess the program's impact on maternal and child health and its role in reducing stunting risks. Results: Findings reveal significant improvements in community health practices and increased resident participation. Novelty: This research provides new empirical evidence on the effectiveness of local health programs and their bureaucratic structures. Implications: It highlights the necessity for organized bureaucratic frameworks to sustain health initiatives and improve villagers' quality of life, supporting Edward III's theory on policy implementation and bureaucratic structures. Highlights : Local health initiatives enhance community participation in health maintenance. Effective bureaucratic structures are essential for sustaining health programs. The study provides empirical evidence on the impact of rural health interventions. Keywords: Healthy Village Program, maternal health, community engagement, stunting reduction, bureaucratic structure

A-103 Analytical Performance Evaluation of Plasma NfL in a Clinical Diagnostic Laboratory

Abstract Background Neurofilament light chain (NfL) is a neuron-specific intermediate filament that is released at a consistent low level in normal individuals and increases with age and axonal injuries. NfL is a neurodegeneration biomarker in Alzheimer’s disease (AD), multiple sclerosis, stroke, traumatic brain injury and other neurodegenerative diseases (NDD). Here, we report the analytical performance of plasma NfL using high-sensitivity methodology in a clinical diagnostic laboratory. Methods The analytical performance, encompassing precision, detection limits, interference, and linearity, was evaluated. Plasma NfL levels were measured between July and October 2023 at Neurocode USA in Bellingham, WA, using a single Lumipulse G1200 instrument following CLSI guidelines, particularly for the utilization of the Fujirebio NfL Blood RUO assay as a laboratory-developed test for clinical analysis. A total of 100 healthy control samples, near the age of AD onset, were used to validate the reference ranges. Results The average plasma NfL concentrations varied from ≤ 8.4 to ≤ 37.9 ng/L among healthy individuals aged 20 to 80 years. The Plasma NfL assay exhibits analytical measurements, including a limit of blank (LoB) of 0.75 ng/L, a limit of detection (LoD) of 1.99 ng/ml, and a limit of quantification (LoQ) of 3.96 ng/L. Its linearity ranges from 11.08 to 741.58 ng/L, with intra-laboratory precision ≤ 9% CV. Stability is maintained at 4⁰C for ≤ 72 hours, at room temperature for ≤ 4 hours, at -20⁰C for ≤ 4 weeks, and at -80⁰C for ≤ 7 days, with freeze/thaw cycles tolerated within the specified time frame. Additionally, no interference was observed at the maximum concentrations tested for bilirubin, hemoglobin, and intralipid. Conclusions With a reference range between ≤ 8.4 to ≤ 37.9 ng/L and exceptional analytical performance, the measurement of plasma NfL on a state-of-the-art instrument using CLSI guidelines, can be useful in the diagnosis and monitoring of AD and other NDD.

B-094 Assessment of a Live Cell-based Flow Cytometry Assay for MuSK-IgG4 Testing in Myasthenia Gravis

Abstract Background Myasthenia gravis (MG) is caused by disrupting the function of postsynaptic acetylcholine receptors (AChRs) at the neuromuscular junction. 85% of MG patients have autoantibodies targeting AChRs, while 6% of MG patients have autoantibodies targeting the muscle-specific receptor tyrosine kinase (MuSK). MuSK is located on the muscle membrane and is activated by the low-density lipoprotein receptor-related protein 4 (LRP4) upon the binding with ligand Agrin. Activated MuSK undergoes autophosphorylation and stimulates downstream signaling to cluster AChRs, which is important for the formation and maintenance of neuromuscular synapses. IgG4 antibodies that bind MuSK are thought to directly disrupt the ability of MuSK to cluster AChR. The gold standard methodology for MuSK antibody testing is radioimmunoprecipitation assay (RIA) using anti-human IgG secondary antibodies. Performing RIA methods in the clinical laboratory is a burden due to radioactive biohazard concerns and the analytical limitations of these assays. This study is to assess the analytical and clinical performance of a live cell-based flow cytometry assay as a potential replacement for the MuSK RIA. Methods HEK293T cells were transiently transfected with a vector co-expressing human MuSK protein and GFP. Patient sera were incubated with a mix of HEK293 cells (GFP-positive cells that express MuSK protein on the cell surface and GFP-negative cells that do no express MuSK) followed by incubation with anti-human IgG4 secondary antibody conjugated with alexa fluor 647 (AF647). An IgG binding index (IBI) was calculated for each sample as the ratio of the median AF647 fluorescence intensity (MFI) of the MuSK-expressing cells (GFP+) to the MFI of the non-MuSK expressing cells (GFP-). An arbitrary positive IBI cut-off of 2.0 was selected. A preliminary assessment of assay imprecision was performed for the flow cytometry assay, as well as a method comparison study to compare this assay to RIA utilizing a cohort of 130 (34 positive and 96 negative) residual samples previously tested by the gold-standard assay. 133 disease control samples were also tested to assess the clinical specificity of the flow cytometry-based assay. Results To assess the imprecision, eight samples with varying IBIs were tested with 5 replicates in each assay over five days. The coefficient of variation (CV) for intra-assay replicates ranged from 1% to 7% for all samples, while CV for inter-assay replicates ranged from 2% to 15%. Based on the 130 samples previously tested by RIA, the Positive Percentage Agreement (PPA) between these two assays was 76.5% and the negative Percentage Agreement (NPA) was 100%. Of the discordant samples (n=8), clinical information was available for only 1 sample (positive by RIA, negative by flow). This patient had a final non-MG diagnosis (ALS). All control samples were negative on the flow cytometry-based assay. Conclusions The live cell-based flow cytometry MuSK IgG4 assay demonstrated encouraging preliminary analytical performance that warrants further development and validation.

Teleworking and Psychological Well-being:Insights and Applications for TVETInstitutions

The shift to teleworking has reshaped the work environment, introducing new dynamics and challenges. This transition is particularly relevant in the context of Technical and Vocational Education and Training (TVET), where preparing students for the evolving job market is essential.This study addresses the limited scientific analysis of how teleworking affects psychological well-being. Understanding these impacts is crucial for TVET institutions to equip students with the skills needed to thrive in remote working environments.The objectives are to identify the determinants of psychological well-being related to teleworking, analyze their impact, and propose a conceptual model linking these determinants to well-being. This study aims to fill the gap in existing research by providing concrete evidence and insights.The methodology involves a quantitative approach,using a survey questionnaire administered to 107 participants from a selected area. Data collection focuses on various factors influencing psychological well-being, and the analysis employs statistical methods to identify significant determinants and their relationships.The findings reveal key determinants of psychological well-being in teleworking, such as resilience, time management, and technology proficiency. These determinants are synthesized into a conceptual model that highlights their impacts and interconnections.The study's significance extends toTVET institutions by enhancing support services, providing mental health resources and counseling, establishing mentorship programs, and fostering partnerships with employers. These initiatives aim to better prepare students for teleworking, contributing to a healthier, more resilient workforce.

The influencing factors of willingness to participate in crop rotation and fallow: A behavioural economics perspective

AbstractCrop rotation and fallow practices are increasingly adopted to mitigate ecological resource pressures and accelerate the development of modern agriculture. These practices have significant implications for environmental protection, soil quality enhancement and the promotion of sustainable, high‐quality agricultural development. Despite their importance, empirical research on the factors influencing participation in crop rotation and fallow remains limited and comparative analyses of different compensation scenarios are scarce. This study, grounded in behavioural economics, utilizes data from the China Rural Revitalization Survey (CRRS) and employs propensity score matching (PSM) and binary logistic regression models to analyse farmers' behaviour regarding both induced and voluntary crop rotation and fallow. The research aims to identify the factors that influence farmers' decisions to engage in these practices. The findings indicate that, under a fixed subsidy standard, the participation rates for crop rotation and fallow were 14.5% and 5.4%, respectively. Among the farmers participating in crop rotation, 43.8% were induced, while 56.2% were voluntary. For fallow practices, 47.9% of the participants were induced and 52.1% were voluntary. In the context of induced crop rotation and fallow, ecological subsidies significantly increased farmers' willingness to participate (p‐value <.001). Conversely, in voluntary contexts, resource endowment had a significantly positive impact on crop rotation behaviour (p‐value <.1), whereas path dependence and policy awareness significantly constrained fallow behaviour (p‐value <.05). The impact of ecological subsidies on farmers' crop rotation and fallow behaviour varied significantly across different ecological regions, with other factors also exhibiting notable heterogeneity. The results of this research offer valuable guidance for the implementation of future crop rotation and fallow programmes. Additionally, they provide insights into the relationship between ecological subsidy systems and farmers' welfare in other underdeveloped areas, suggesting improvements and offering new perspectives for further research.

Greenhouse gas emission and denitrification kinetics of woodchip bioreactors treating onsite wastewater

The accurate evaluation of denitrification rate and greenhouse gas (GHG) emission in field-scale woodchip bioreactors for onsite wastewater treatment are problematic due to inevitably varied environmental conditions and underestimated GHG production with limited analysis of dissolved gas in field samples. To address these problems, batch incubation experiments were conducted with controlled conditions to precisely evaluate the denitrification kinetics and N2O and CH4 emission of both gaseous and dissolved phases in fresh (6 months) and aged (5 years) woodchip bioreactors treating onsite wastewater at high (1–3 mg L-1) and no (0 mg L-1) dissolved oxygen (DO) levels. NO3- removal rate decreased from 37.5–119.0 g NO3--N m-3d-1 at no DO to 8.8–16.6 g NO3--N m-3d-1 at high DO (1–3 mg L-1) due to the growth suppression of NO2- reducing microorganisms (37–55 % lower nirS+nirK abundance). However, the presence of high DO increased N2O emission level from 5.6–6.9 mg N2ON m-3 at no DO to 179.5–273.6 mg N2ON m-3) due to the enhanced growth of NO reducing microorganisms (1–7 times higher norB levels) and the decreased abundance of N2O reducing microorganisms (53–75 % lower nosZ abundance). On the other hand, increased DO level negatively correlated with CH4 production (1.0–3.9 g CH4-C m-3d-1) in fresh woodchips, while showed insignificant impact on CH4 production (0.1–1.4 g CH4-C m-3d-1) in aged woodchips. Woodchip age increase (5 years) negatively impacted the NO3- removal rate (75–85 % lower than fresh woodchips) and CH4 production rate (>3 times lower than fresh woodchips), probably due to the reduced biomass density of NO2- reducing microorganisms (52–58 % lower nirS+nirK abundance) and methanogens (95–98 % lower mcrA levels). The incubation results suggested that long hydraulic retention time (>2–5 days) and anaerobic/anoxic condition are preferred for the optimal NO3- removal and low N2O emission potential of woodchip bioreactors treating onsite wastewater.

Pengaruh Economic Value Added , Market Value Added, dan Kebijakan Dividen terhadap Nilai Perusahan

Purpose: The current study aims to envestigate the influence of Economic Value Added (EVA), Market Value Added (MVA), and dividend policy on the value of enterprises classified as LQ45 that were publicly listed on the Indonesia Stock Exchange from 2020 to 2022. The study encompasses a dependent variable, Firm Value, alongside independent variables comprising Economic Value Added (EVA), Market Value Added (MVA), and dividend policy. Methodology: Quantitative research is what this study is all about. Information gathered from stock prices and yearly reports utilizing documentation methodologies. Twenty businesses were chosen the Purposive Sampling technique. Multiple Linear Regression in SPSS Version 27 was employed to examine in data. Results: Findings demonstrated that EVA has no influence on company value, but MVA has a large positive effect on firm value, and dividend policy has a massive positive effect on firm value. Meanwhile, the EVA, MVA, and Dividend Policy have a major beneficial influence on the firm's worth. Limitations: One of its drawbacks is the limited three-year analysis time; perhaps, future researchers will be able to employ a longer study period. Contribution: The study's findings may help businesses and investors weigh EVA, MVA and dividend policy factors when making choices.

Unsupervised Machine Learning in the Analysis of Nonadiabatic Molecular Dynamics Simulation.

The all-atomic full-dimensional-level simulations of nonadiabatic molecular dynamics (NAMD) in large realistic systems has received high research interest in recent years. However, such NAMD simulations normally generate an enormous amount of time-dependent high-dimensional data, leading to a significant challenge in result analyses. Based on unsupervised machine learning (ML) methods, considerable efforts were devoted to developing novel and easy-to-use analysis tools for the identification of photoinduced reaction channels and the comprehensive understanding of complicated molecular motions in NAMD simulations. Here, we tried to survey recent advances in this field, particularly to focus on how to use unsupervised ML methods to analyze the trajectory-based NAMD simulation results. Our purpose is to offer a comprehensive discussion on several essential components of this analysis protocol, including the selection of ML methods, the construction of molecular descriptors, the establishment of analytical frameworks, their advantages and limitations, and persistent challenges.

Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020

Chordomas of the skull base are rare, slow growing, locally invasive cancers with limited long-term survival analysis reported in the literature. We seek to provide comparative survival analysis of patients on a long-term (20-year) basis using population-level data. The Surveillance, Epidemiology, and End Results (SEER) program was queried for cases of chordoma relegated to the base of the skull, diagnosed between 2000 and 2020. Demographic, disease, and treatment information were analyzed using Cox proportional hazards and log-rank comparisons. 630 patients with chordoma of the skull base were identified. Age ≤ 49 years at diagnosis was associated with increased five-, 10-, and 20-year overall survival (hazard ratio (HR) = 0.39, 0.33, and 0.30, respectively; p < 0.001 for all). Treatment with surgery and adjuvant radiotherapy was associated with increased five-, 10-, and 20-year survival (HR = 0.71, 0.79, and 0.79, respectively; p < 0.001 for all). On univariate analysis, widowed patients had decreased survival (20-year overall survival = 34.8% [15.3%-34.8%] compared to married patients (74.4% [68.1%-80.8%]. Surgery remains the primary treatment associated with increased survival among patients with chordoma of the skull base, with adjuvant radiotherapy serving a complimentary role. Demographic factors such as marital status are also associated with changes in survival.

Towards more realistic evaluations: The impact of label delays in malware detection pipelines

Developing and evaluating malware classification pipelines to reflect real-world needs is as vital to protect users as it is hard to achieve. In many cases, the experimental conditions when the approach was developed and the deployment settings mismatch, which causes the solutions not to achieve the desired results. In this work, we explore how unrealistic project and evaluation decisions in the literature are. In particular, we shed light on the problem of label delays, i.e., the assumption that ground-truth labels for classifier retraining are always available when in the real world they take significant time to be produced, which also causes a significant attack opportunity window. In our analyses, among diverse aspects, we address: (1) The use of metrics that do not account for the effect of time; (2) The occurrence of concept drift and ideal assumptions about the amount of drift data a system can handle; and (3) Ideal assumptions about the availability of oracle data for drift detection and the need for relying on pseudo-labels for mitigating drift-related delays. We present experiments based on a newly proposed exposure metric to show that delayed labels due to limited analysis queue sizes impose a significant challenge for detection (e.g., up to a 75% greater attack opportunity in the real world than in the experimental setting) and that pseudo-labels are useful in mitigating the delays (reducing the detection loss to only 30% of the original value).

Hemodynamic management of acute kidney injury.

To discuss the role of hemodynamic management in critically ill patients with acute kidney injury. Acute kidney injury (AKI) may be associated with persistent alterations in renal perfusion, even when cardiac output and blood pressure are preserved. The effects of interventions aiming at increasing renal perfusion are best evaluated by renal Doppler or contrast enhance ultrasound. However, limited data have been acquired with these techniques and the essential of the literature is based on surrogates of renal function such as incidence of use of renal replacement therapy. Fluids may increase renal perfusion but their effects are quite unpredictable and can be dissociated from their impact on cardiac output and arterial pressure. Inotropes can also be used in selected conditions. At the de-escalation phase, fluid withdrawal should be considered. Safe fluid withdrawal may be achieved when applied in selected patients with preserved tissue perfusion presenting signs of fluid intolerance. When applied, stopping rules should be set. Dobutamine, milrinone and levosimendan increase renal perfusion in AKI associated with cardiac failure or after cardiac surgery. However, the impact of these agents in sepsis is not well defined. Regarding vasopressors, norepinephrine is the first-line vasopressor agent, but vasopressin derivative may limit the requirement of renal replacement therapy. Angiotensin has promising effects in a limited size post-Hoc analysis of a RCT, but these data need to be confirmed. While correction of severe hypotension is associated with improved renal perfusion and function, the optimal mean arterial pressure (MAP) target level remains undefined, Systematic increase in MAP results in variable changes in renal perfusion. It sounds reasonable to individualize MAP target, paying attention to central venous and intraabdominal pressures, as well as to the response to an increase in MAP. Recent studies have refined the impact of the various hemodynamic interventions on renal perfusion and function in critically ill patients with AKI. Though several of these interventions improve renal perfusion, their impact on renal function is more variable.

Electrophoresis-Correlative Data-Independent Acquisition (Eco-DIA) Improves the Sensitivity of Mass Spectrometry for Limited Proteome Amounts.

Capillary zone electrophoresis (CE) combines high separation power, scalability, and speed to limited proteome analyses by mass spectrometry (MS). However, compressed separation in CE challenges the duty cycle of tandem MS, even during data-independent acquisition (DIA). To help remedy this limitation, we introduce the concept of electrophoresis-correlative (Eco) data acquisition for CE-MS. We recognize CE electrospray ionization (ESI) to sort peptide ions into reproducible mass-to-charge (m/z) vs migration time (MT) trends in the solution phase, before subsequent ionization and m/z analysis. We proposed that such a correlation can be leveraged to improve the economy of data acquisition. We test this hypothesis using DIA frames that are tailored to the observed m/z-MT trends. The resulting Eco-DIA method substantially improves the bandwidth utilization of tandem MS during CE-MS. In proof-of-principle studies, Eco-DIA identified and quantified ∼38% more proteins from 1 ng of the HeLa proteome digest compared to the classical DIA, without the assistance of a project-specific tandem MS spectral library. Eco-DIA was able to quantify ∼51% more proteins with <10% coefficient of variation vs the control DIA approach. Based on label-free quantification, the proteins that were exclusively measured by Eco-MS occupied the lower dynamic range of the detected proteome concentration, revealing sensitivity enhancement. In addition to marking the inception of Eco-MS, this work lays the foundation for the development of next-generation data acquisition strategies that leverage electrophoretic ion sorting for high-sensitivity proteomics.

Design and research of face gear central limited slip differential and analysis of its influence on vehicle performance

In this paper, a new design scheme of face gear central limited-slip differential (F-LSD) is proposed, which aims to unveil the technical veil of central limited-slip differential and fill the research blank of face gear application in the field of central limited-slip differential. Through the analysis of structural principle and motion characteristics, the dynamic equilibrium equation and locking coefficient model of F-LSD are established. The Simulink simulation model based on F-LSD dynamics and the torque distribution model of the whole transmission system are established. A 7-DOF vehicle dynamics model was established, and the performance of F-LSD vehicle in four conditions of acceleration, climbing, chassis twist sine wave and double line change was studied by using simulation software. At the same time, four groups of four-wheel drive vehicles with different central differential speeds were set as the control test group. The simulation results show that F-LSD system can effectively improve the vehicle's dynamic performance and extrication performance, and will not reduce the vehicle's handling stability, which provides a reference for the practical application of the face gear central limited slip differential.

Technological disasters in Asia: Epidemiological profile from the year 2000 to 2021.

Technological disasters in Asia have significant public health and environmental implications, but there is limited epidemiological analysis of these events. This study aims to characterize the epidemiological profile of technological disasters in Asia from 2000 to 2021, focusing on morbidity and mortality trends. A retrospective descriptive observational analysis was conducted using data from emergency events database (EM-DAT), DesInventar, NatCAt, and Sigma. The study categorized disasters into transport, industrial, and miscellaneous accidents. Statistical analyses were used to examine frequencies, trends, and correlations among the different disaster types. From 2000 to 2021, Asia experienced 2333 technological disasters, with transport accidents being the most frequent (55.77%), followed by industrial (26.10%) and miscellaneous accidents (18.13%). The overall trend showed a statistically significant decrease in the frequency of these disasters and in average mortality and injury rates. The study highlighted the varying impact of different disaster types, with industrial accidents causing the highest fatality and affected rates despite being less frequent than transport accidents. The study indicates a declining trend in the frequency and severity of technological disasters in Asia, reflecting improved safety measures and disaster management. However, the high impact of industrial accidents underscores the need for targeted prevention strategies.

Steady-state properties of multi-orbital systems using quantum Monte Carlo.

A precise dynamical characterization of quantum impurity models with multiple interacting orbitals is challenging. In quantum Monte Carlo methods, this is embodied by signproblems. A dynamical signproblem makes it exponentially difficult to simulate long times. A multi-orbital signproblem generally results in a prohibitive computational cost for systems with multiple impurity degrees of freedom even in static equilibrium calculations. Here, we present a numerically exact inchworm method that simultaneously alleviates both signproblems, enabling simulation of multi-orbital systems directly in the equilibrium or nonequilibrium steady-state. The method combines ideas from the recently developed steady-state inchworm Monte Carlo framework [Erpenbeck et al., Phys. Rev. Lett. 130, 186301 (2023)] with other ideas from the equilibrium multi-orbital inchworm algorithm [Eidelstein et al., Phys. Rev. Lett. 124, 206405 (2020)]. We verify our method by comparison with analytical limits and numerical results from previous methods.

Safety evaluation of Avicenna germinans leaf extracts in rats

BackgroundAvicenna germinans is one of Nigeria's dominant mangrove plants and has valuable pharmacological and therapeutic activity. It is widely employed in traditional medicine to treat many ailments and diseases, including cancer. However, little is known about the safety of the plant. Acute and sub-acute toxicity profiles of the plant extracts were assessed in this study. MethodsThe oral acute toxicity was determined with 5000 mg/kg body weight each of n-hexane, ethyl acetate, and ethanol extracts of Avicenna germinans leaf in rats. The rats were monitored for mortality, clinical manifestations, and weight changes over 14 days. During the sub-acute toxicity study, twenty-five female rats were fed with 0–1000 mg/kg ethanol extracts of Avicenna germinans for 21 days. The body weight was monitored during treatment, while changes in gross organ morphology, relative organ weights, hematology, serum biochemistry, and limited histological analysis were evaluated after treatment. ResultsAcute administration of the three extracts did not result in mortality or any obvious adverse effects. The gross pathology, relative organ weights, hematology, serum biochemistry, and histopathology were similar to the control, except for the 1000 mg/kg dose that evoked marked increases in relative heart, intestinal, thymus, and adrenal weights. In addition, foci of inflammatory cells in the interstitium and lymphoid hyperplasia were found in the heart and lungs, respectively, in the 1000 mg/kg group. ConclusionThe findings indicate that LD50 of the three extracts of Avicenna germinans were > 5000 mg/kg and sub-acute administration of the ethanol extract is relatively safe at least up to 750 mg/kg body weights.

Effective and durable repigmentation for stable vitiligo: A randomized within-subject controlled trial assessing treatment with autologous skin cell suspension transplantation

BackgroundVitiligo lesions are often challenging to repigment with conventional medical therapies. Surgical autologous melanocyte transfer methods can be utilized for stable vitiligo but demand specialized skills and equipment. A point-of-care autologous cell harvesting device was designed enabling simple preparation of autologous skin cell suspension (ASCS) containing melanocytes, keratinocytes, and fibroblasts providing a straightforward approach for cellular transplantation. ObjectiveTo evaluate the safety and effectiveness of ASCS for repigmentation of stable vitiligo lesions among adults. MethodsA US multicenter, randomized, within-subject controlled trial compared ASCS to NB-UVB only (Control) in similar vitiligo lesions. ASCS was applied after laser skin resurfacing and followed by NB-UVB treatment. The primary effectiveness endpoint was the proportion of lesions achieving ≥80% repigmentation at week-24. Repigmentation durability was assessed at week-52. ResultsAmong 25 subjects, 36% of ASCS-treated lesions achieved ≥80% repigmentation at week-24 compared to 0% for Control (p<0.025), with durability through week-52. The safety profile of ASCS was acceptable, with favorable patient- and investigator-reported outcomes. LimitationsStudy sample size limited robust subgroup analyses. ConclusionApplication of ASCS is a safe and effective treatment for repigmentation of stable vitiligo lesions with the potential to improve health-related quality of life and reduce burden of disease.

Trends in the integration of medical corporation hospitals in Japan: a national wide longitudinal study between 2017 and 2021

BackgroundMedical corporations, which are non-profit organizations that aim to operate hospitals, clinics, or long-term care facilities, account for more than half of all hospital beds and play a central role in the health care system in Japan. However, limited analysis of hospital integration has been performed. Examining the hospital integration trends of medical corporations can provide valuable insights for optimizing health care delivery and resource allocation in Japan. This study conducted a comprehensive analysis of trends in the hospital integration of medical corporations and market concentration in Japan using nationwide longitudinal data.MethodsThis longitudinal study evaluated the hospital integration of medical corporations in Japan between 2017 and 2021 using medical corporation financial data provided by the Neostage Company. The target population was medical corporations that own hospitals in Japan. The primary outcomes were the horizontal and vertical integration of medical corporation hospitals. Horizontal integration was defined as the integration of two or more hospitals within the same corporation, while vertical integration was defined as the integration of a hospital with different types of health care facilities, such as clinics or long-term care facilities, within a single medical corporation. The Herfindahl–Hirschman Index (HHI) was calculated to measure hospital market concentration using hospital bed data for medical corporations in all prefectures.ResultsThe number of hospitals and hospital beds within medical corporations decreased from 5,670 to 848,174 in 2017 to 5,486 and 814,462 in 2021, respectively. Both horizontal and vertical integration among medical corporation facilities showed a gradual upward trend, increasing from 24.92% to 55.75% in 2017 to 26.92% and 59.42% in 2021, respectively. The mean (standard deviation [SD]) HHI increased slightly from 262.7 (178.6) in 2017 to 275.2 (187.9) in 2021, with rural areas being more concentrated than urban areas, although both remained unconcentrated.ConclusionsThis longitudinal study revealed a gradual downward trend in the number of hospitals and hospital beds owned by medical corporations, while horizontal and vertical integration gradually progressed without any particular medical corporation dominating the market. These findings are expected to contribute to policymaking efforts aimed at providing optimal health care services in Japan.

Mass spectrometry-complemented molecular modeling predicts the interaction interface for a camelid single-domain antibody targeting the Plasmodium falciparum circumsporozoite protein’s C-terminal domain

BackgroundBioanalytical methods that enable rapid and high-detail characterization of binding specificities and strengths of protein complexes with low sample consumption are highly desired. The interaction between a camelid single domain antibody (sdAbCSP1) and its target antigen (PfCSP-Cext) was selected as a model system to provide proof-of-principle for the here described methodology. Research design and methodsThe structure of the sdAbCSP1 – PfCSP-Cext complex was modeled using AlphaFold2. The recombinantly expressed proteins, sdAbCSP1, PfCSP-Cext, and the sdAbCSP1 – PfCSP-Cext complex, were subjected to limited proteolysis and mass spectrometric peptide analysis. ITEM MS (Intact Transition Epitope Mapping Mass Spectrometry) and ITC (Isothermal Titration Calorimetry) were applied to determine stoichiometry and binding strength. ResultsThe paratope of sdAbCSP1 mainly consists of its CDR3 (aa100–118). PfCSP-Cext’s epitope is assembled from its α-helix (aa40–52) and opposing loop (aa83–90). PfCSP-Cext’s GluC cleavage sites E46 and E58 were shielded by complex formation, confirming the predicted epitope. Likewise, sdAbCSP1’s tryptic cleavage sites R105 and R108 were shielded by complex formation, confirming the predicted paratope. ITEM MS determined the 1:1 stoichiometry and the high complex binding strength, exemplified by the gas phase dissociation reaction enthalpy of 50.2 kJ/mol. The in-solution complex dissociation constant is 5 × 10-10 M. ConclusionsCombining AlphaFold2 modeling with mass spectrometry/limited proteolysis generated a trustworthy model for the sdAbCSP1 – PfCSP-Cext complex interaction interface.

Surgically Treated Ischial Tuberosity Avulsion Fractures in Adolescents: Risks and Outcomes of 3 Fixation Constructs.

Avulsion fractures of the ischial tuberosity (AFIT) are uncommon injuries that sometimes require operative fixation with screws, suture anchors, or cortical suspensory buttons. This study reviewed a series of surgically managed AFITs at a single institution and compared outcomes among fixation strategies. We hypothesized there would be no difference in outcomes between fixation types. We conducted a retrospective review of all patients treated operatively at a single institution from 2010 to 2022 for AFIT identified by CPT code (27215). We collected patient demographics, injury characteristics, Revised Modified Oxford Bone Score, radiographic measures, fracture classification (type 1-lateral vs. type 2-complete), surgical fixation technique, postoperative complications (Modified Clavien-Dindo-Sink [M-CDS] Complication Classification), and time to return to sport (RTS). Descriptive statistics and univariate analyses were performed. Study criteria identified 16 patients with surgically treated AFITs during the study period. Patients were predominantly male (88%) with a mean age of 14.8±0.8 years. Injured patients most commonly participated in soccer (38%), with the most common mechanism of injury being running/sprinting (50%). The avulsed fracture fragments were a mean of 42.6mm in size, with an average maximal displacement of 21.1mm and predominantly type 1-lateral (75%). Surgical constructs included: screws (4), suture anchors (5), cortical suspensory buttons (6), and combined (1, screw and suture anchor). Postoperative complications occurred in 8 patients (50%) including 7 type 1 and 1 type 3 M-CDS. No statistically significant difference was found between fixation types among the studied outcome variables; however, re-fracture (1 case [M-CDS type 3]) was only observed with a combined (screw and suture anchor) construct. This retrospective cohort study demonstrated that postoperative complications after ORIF for AFIT were not infrequent but were largely low in severity. Refracture occurred only with a combined screw and suture anchor construct. Consistent return to sport was achieved across all fixation types, with no significant difference in complication rate between constructs, although the available study sample limited robust analysis. This study is also, of note, one of the first to report outcomes from cortical suspensory buttons (CSB)-a relatively novel intervention for AFIT. Findings from this retrospective case series of multiple surgical techniques serve to bolster the limited literature base regarding the operative treatment of AFITs in adolescents.