Classification System Research Articles

Optimizing Car License Plate Recognition Through Gray Wolf Optimization Algorithm

License plate recognition is an essential part of contemporary surveillance systems since it is helpful in many applications, including parking management, vehicle access control, traffic control, and law enforcement. This project aims to provide a robust and dependable method for detecting license plates that will outperform existing approaches in accuracy and dependability. This observation method uses contemporary technology to address challenging troubles related to license plate recognition. Our methodology is primarily based on the Faster R-CNN structure, an established model for picture item detection. The novel thing, even though, is how Gray Wolf Optimization—which draws notion from the searching conduct of gray wolves—is mixed with the Faster R-CNN network. The accuracy is greatly improved by this synergistic combination, which also improves detection abilities. Moreover, an improved ResNet-50 model is blanketed to improve the classification system similarly, ensuring accurate license plate detection in several situations. The extensively utilized "car license plate detection" dataset is used to assess the recommended technology very well, confirming its efficacy in practical settings. The empirical outcomes show exceptional performance, with a median precision of 98.21%, demonstrating how nicely the hybrid method works to attain the very best stage of license plate detecting accuracy. This painting establishes a new benchmark in license plate identity using cutting-edge technology and innovative techniques, starting the door for enhanced safety and surveillance.

2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances.

Classification systems for Adolescent Idiopathic Scoliosis (AIS) play an important role in guiding both surgical planning and conservative treatments. Traditional 2D classification systems, such as the Lenke, King and Lehnert-Schroth classifications, have been widely used for the clinical diagnosis and treatment of scoliosis. However, with the growing understanding of the three-dimensional nature of scoliosis and advancements in 3D reconstruction technologies, 3D classification systems are gaining increasing attention. This paper reviews the current applications, advantages, and limitations of different 2D and 3D classification systems, focusing on their clinical significance in treatment planning. While 3D classification systems offer clear advantages in capturing the complexity of spinal deformities, their clinical implementation faces challenges such as high costs and technical complexity. Additionally, studies show that computer-assisted technologies, artificial intelligence can significantly improve the accuracy and consistency of classification systems, reducing human errors. The paper also explores the future directions of classification system development, emphasizing the potential of combining 2D and 3D technologies and the impact of these advancements on personalized scoliosis treatment.

Implementation of the 9th TNM for lung cancer: practical insights for radiologists.

Lung cancer is the most common and deadly cancer worldwide. The 9th edition of the tumor node meta (TNM) classification system, effective from January 1, 2025, introduces significant updates. Notably, the N2 category is newly divided into N2a (single-station involvement) and N2b (multiple-station involvement), which reflects distinct prognostic implications. Additionally, the M1c category is now subcategorized into M1c1 (multiple metastases in a single organ system) and M1c2 (metastases in multiple organ systems), affecting stage classification. This reclassification allows for potential downstaging, which could expand treatment options for affected patients. Accurate imaging remains crucial for the classification of anatomical stages. As the TNM system evolves, enhanced imaging precision will play a key role in implementing these updates and ultimately improve patient outcomes. KEY POINTS: Question The 9th TNM for lung cancer introduces changes in the N2 and M1c descriptors, to better align with new therapeutic options and outcome studies. Findings Proper knowledge of the key changes of the 9th TNM can help radiologists offer clinicians a meaningful report. Clinical relevance Radiologists should incorporate the 9th TNM classification into their reports and discussions in multidisciplinary meetings, thus ensuring a common language across disciplines to enable clearer communication with other specialists, supporting more precise and cohesive decision-making in patient care.

Comparison of 1D and 3D volume measurement techniques in NF2-associated vestibular schwannoma monitoring

To compare 1D (linear) tumor volume calculations and classification systems with 3D-segmented volumetric analysis (SVA), focusing specifically on their effectiveness in the evaluation and management of NF2-associated vestibular schwannomas (VS). VS were clinically followed every 6 months with cranial, thin-sliced (< 3 mm) MRI. We retrospectively reviewed and used T1-weighted post-contrast enhanced (gadolinium) images for both SVA and linear measurements. 3D-SVA was performed manually or combined with semiautomated segmentation by using axial planes. The maximum linear dimensions (MLD) were determined in three dimensions (anteroposterior, transverse, and craniocaudal planes) using axial and coronal planes. The MLD was cubed (MLD3), and orthogonal analysis (OA) was derived to establish comparability with the SVA. The Hannover and Koos classification was used to depict the size ratio in each MRI and tumor. A linear regression model was performed to compare 1D/classification systems to SVA, and the percentage deviation change of MLD3 and OA to SVA was established using a one-way multivariate variance analysis. 2586 SVA and 10344 linear measurements were performed in a cohort of 149 NF2 patients and 292 associated VS. All measurement techniques (MLD3, OA, KOOS, and Hannover) significantly (and strongly, r2 > 0.5) correlated with SVA (p < 0.001). The OA showed an even stronger positive correlation than the MLD3 to SVA. Smaller classified tumors (T1/T2, K1/K2) exhibited a low-moderate positive correlation (r2 = 0.23–0.44) compared to medium-sized (T3, K2/3) and large tumors (T4, K4; r2 = 0.54–0.76). Pre- and postoperative MLD3 and OA statistically significantly predict SVA (p < 0.001), but the postoperative correlation was weaker, particularly for MLD3 to SVA values. All analyses showed a large scatter range. In the percentage deviation analysis of MLD3 and OA from SVA, small tumors (K1/K2, T1/T2) were overestimated. Compared to the SVA, the MLD3 and especially the OA are a time-saving alternative for monitoring the tumor volume of NF2-associated VS. However, the scatter range in small/surgically reduced tumors is enormous. For this reason, they are not recommended for monitoring off-label therapy with Bevacizumab or for treatment decisions depending on a precise assessment of tumor volume and growth. Developing deep learning-based volume determinations in the future is essential to reduce SVA’s time intensity.

Improving Industrial Quality Control: A Transfer Learning Approach to Surface Defect Detection

To automate the quality control of painted surfaces of heating devices, an automatic defect detection and classification system was developed by combining deflectometry and bright light-based illumination on the image acquisition, deep learning models for the classification of non-defective (OK) and defective (NOK) surfaces that fused dual-modal information at the decision level, and an online network for information dispatching and visualization. Three decision-making algorithms were tested for implementation: a new model built and trained from scratch and transfer learning of pre-trained networks (ResNet-50 and Inception V3). The results revealed that the two illumination modes employed widened the type of defects that could be identified with this system, while maintaining its lower computational complexity by performing multi-modal fusion at the decision level. Furthermore, the pre-trained networks achieved higher accuracies on defect classification compared to the self-built network, with ResNet-50 displaying higher accuracy. The inspection system consistently obtained fast and accurate surface classifications because it imposed OK classification on models trained with images from both illumination modes. The obtained surface information was then successfully sent to a server to be forwarded to a graphical user interface for visualization. The developed system showed considerable robustness, demonstrating its potential as an efficient tool for industrial quality control.

Epilepsy and employment: A qualitative interview study with heads of human resources and occupational physicians in Austria - A call for legislative optimization according to the WHO Intersectoral Global Action Plan.

People with epilepsy (PWEs) often face difficulties in obtaining or keeping employment. To determine the views on this topic of the heads of human resources (HHRs) and occupational physicians (OCPs). Twelve HHRs and five OCPs underwent a telephone interview concerning the opportunities and limitations of job applications for PWEs. The interviews were performed in May 2020, in the federal state of Salzburg, Austria, and they were analyzed using the qualitative method of content analysis (Kuckartz). The legal situation was investigated according to Global target 5.2 of the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders 2022-2031 by WHO. Employers were confident that employees with epilepsy could be managed well in a positive company culture and with first responders in place. The Austrian law predisposes to uncertainty among both employers and employees. In particular, it allows only retrospective juridical clarification of health-related questions in the job interview. The authors developed a classification system of workplaces, with "D0" (D-zero) meaning no health or financial danger, for example, office workers and "D1" posing still no health hazard but includes regular work with cash, for example, salespersons. "D2" means potential medical implications for the person with epilepsy or any other person at the workplace, for example, industrial worker. Measures taken to abandon the risk in D2 workplaces, for example, a total sheath for a machine, leads to reclassification as "D2-0." With D2, OCPs evaluate the applicant's medical fitness for the job without disclosing medical details to the employer. The "compartment model of medical information in the job application process" guarantees that OCPs are the only persons who learn about the applicant's medical details. The practical and simple classification of workplaces according to the D-system, and the concept of making medical information accessible only to OCPs may diminish stigma and discrimination in the working world for PWEs.

Consistency between the geographic distributions of overweight and obesity among children and adults in China

BackgroundChildhood obesity is associated with obesity in adulthood, but the consistency between the geographic distributions of obesity among children and adults in China is not fully understood. We aimed to examine the consistency of the geographic distributions of overweight and obesity between adults and children in China.MethodsThis was a cross-sectional study including 11,940 adults. Data were from the China Health and Nutrition Survey conducted in 2015. Body mass index (BMI) and waist circumference (WC) were measured. The geographical areas were categorized as low-, middle- or high-epidemic areas according to the prevalence of overweight and obesity in children at the provincial level, based on the classification system determined by the National Health Commission. We examined the differences in adult BMI, WC, prevalence of overweight and obesity, abdominal overweight and obesity across the three classification areas.ResultsIn this study, the overall prevalence of overweight/obesity and abdominal overweight/obesity were 49.8% and 61.0% respectively. We observed the prevalence of overweight and obesity among adults increased from low- to middle- and high- epidemic areas. Compared with adults from low-epidemic areas, those from middle- and high-epidemic areas had a higher odds of having overweight or obesity (odds ratio [95% confidence interval]: 1.518 [1.362, 1.692] and 2.190 [1.972, 2.433], respectively). Similar results were observed for abdominal overweight and obesity in adults.ConclusionOur study confirmed the consistency in the geographical clustering of overweight and obesity among adults and children, which suggests that interventions addressing overweight and obesity should be targeted at both local children and adults simultaneously.

Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings.

This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity. Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention) and study protocol for a comparative effectiveness trial titled: A Comparison: High Intensity periodic vs. Every week therapy in children with cerebral palsy (ACHIEVE) for children ages 2 to 8years with cerebral palsy. Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study- specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity. Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity. Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with cerebral palsy within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children. With training, physical therapists can deliver high-fidelity intervention to children with cerebral palsy across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.

A Risk Analysis Model for Biosecurity in Brazil Using the Analytical Hierarchy Process (AHP)

This study proposes a risk analysis model based on the principles of ISO 31000 and decision theory for biological agents with potential for offensive use in Brazil. Bibliographic research was conducted on the main models already published on the subject. The German risk classification system was adopted as the main reference because it is adjustable and adopts a semiquantitative approach. After translating and adapting this model to the Brazilian context, the analytic hierarchy process (AHP) was applied to generate a hierarchical tree with criteria and subcriteria to be considered in the risk assessment. A questionnaire was administered to a group of experts to evaluate the relevant criteria and subcriteria and the risks related to three biological agents (Bacillus anthracis, Yersinia pestis, and Francisella tularensis), which were selected in an exploratory manner to exemplify the application of the model. According to the results, the criterion of impact of a biological attack was given greater importance when compared with the probability of occurrence of this event. According to the subcriteria, the greatest weight was attributed to human health when compared with agriculture, the environment, or the economy. Finally, in the evaluation of the three pathogens, B. anthracis was identified as having the highest risk for offensive use in Brazil. This research is focused on a practical approach and can be implemented by competent agencies to foster their capacity for biological defense by determining which pathogens represent the greatest risk to society.

S8 Navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression to reduce postoperative neurological deterioration in thoracic ossification of the ligamentum flavum.

Posterior laminectomy is a standard treatment for thoracic ossification of the ligamentum flavum (TOLF), but it often leads to neurological deterioration during surgery. This study aimed to reduce iatrogenic neurological deterioration by using an S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression. A retrospective analysis was conducted on patients who underwent laminectomy and internal fixation for TOLF in our centre from January 2016 to January 2023. Patients were divided into a visualization group (S8 navigation + ultrasonic bone scalpel) and a control group (ultrasonic bone scalpel) based on the use of three-dimensional real-time dynamic visualization decompression technology. Intraoperative multimodal neuroelectrophysiological monitoring (IONM) was used to collect somatosensory evoked potential and motor evoked potential data. We compared the incidence of intraoperative neurological deterioration indicated by IONM alarms between the two groups. Neurological and motor functions were assessed via the American Spinal Injury Association (ASIA) classification system and the modified Japanese Orthopaedic Association (m-JOA) score for thoracic myelopathy. Follow-ups were conducted at 1, 3, 6, and 12months postsurgery, and the data from both groups were compared. Other clinical indicators included decompression time per laminectomy segment, intraoperative blood loss, intraoperative dural ossification, hospitalization duration, and drainage tube placement time. We also analysed intraoperative and postoperative complications. A total of 91 patients with thoracic ossification of the ligamentum flavum were included, with a follow-up period of 12-18months. The visualization group consisted of 41 patients, and the control group included 50 patients. The incidence of neurological deterioration indicated by IONM in the visualization group (9.8%) was significantly lower than that in the control group (30.0%) (P = 0.014). The immediate postoperative ASIA grade change value ≤ - 1 was lower in the visualization group (9.8%) than in the control group (34.0%) (P = 0.006); A similar trend was observed at the 12month follow-up (2.4% vs. 20.0%, P = 0.022). The m-JOA scores at 1, 3, 6, and 12months postsurgery were higher in the visualization group than in the control group (P < 0.05). The visualization group also had shorter lamina decompression times per segment and less intraoperative blood loss (P < 0.05). The incidence of nondural ossification cerebrospinal fluid leakage was lower in the visualization group (2.4%) than in the control group (18.0%) (P = 0.018). Additionally, nerve root injury was lower in the visualization group (0%) than in the control group (10.0%) (P = 0.037). Postoperative CT scans revealed no ossification residue in the visualization group, whereas 7 cases (14.0%) were observed in the control group (P = 0.013). The S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression significantly reduces the incidence of intraoperative neurological deterioration, improves postoperative motor function recovery, and reduces decompression time per vertebral segment, intraoperative bleeding, and complications such as cerebrospinal fluid leakage. This technology is safe and reliable and offers a promising option for spinal surgeons in treating thoracic ossification of the ligamentum flavum.

Clinical SANTI classification of arthrogenic muscle inhibition has an excellent inter-rater and intra-rater reliability in preoperative and post-operative anterior cruciate ligament rupture.

Arthrogenic muscle inhibition (AMI) is a reflexive shutdown of the quadriceps muscles following a knee injury or surgery that presents with or without hamstring contracture. This complication can be classified according to the SANTI classification, but the reproducibility of this clinical classification has not yet been demonstrated. This single-centre longitudinal observational study included 140 patients who were within 6 weeks of an ACL rupture. The presence of AMI was assessed separately and blindly during the preoperative consultation and at 3 weeks post-operative by an Orthopaedic Surgeon, an Orthopaedic Resident, a Sports Medicine Physician and a Physiotherapist. AMI was also assessed a second time by the physiotherapist, 10 days after the first assessment, before and after reconstruction surgery, in order to measure intra-rater reliability. The inter-rater and intra-rater reliability of the AMI classification was determined by calculating the intraclass correlation coefficient (ICC). Agreement for the AMI classification between different examiners was excellent pre-operatively (ICC = 0.99 [95% confidence interval, CI: 0.99-0.99]) and post-operatively (ICC = 0.98 [95% CI: 0.98-0.99]). Agreement in the AMI classification, when determined repeatedly by the same assessor (physiotherapist), was excellent pre-operatively (ICC = 0.92 [95% CI: 0.89-0.94]) and post-operatively (ICC = 0.98 [95% CI: 0.97-0.99]). Excellent intra-rater and inter-rater reliability of the AMI classification system was found in patients with recent ACL rupture and post-operatively. Level II, diagnostic study prospective cohort study.

Federated learning-based misbehavior classification system for VANET intrusion detection

Federated learning-based misbehavior classification system for VANET intrusion detection

Mobility Intensive Training (Mob-IT) Protocol for Children with Cerebral Palsy: Feasibility and Fidelity Results

The Mobility Intensive Training (Mob-IT) protocol is an innovative intervention focused on motor learning to improve the mobility of children with cerebral palsy (CP). The objective was to describe the feasibility and intervention fidelity of Mob-IT. A single-subject experimental study was conducted with four children with CP, a median age of 11 (7–13) years, and a Gross Motor Function Classification System I–III. The Mob-IT included 24 h of practice of mobility goals, delivered three times a week in 2 h sessions over four weeks. Feasibility was assessed using the Qualitative Feedback Questionnaire (QFQ), evaluating adherence, acceptability, adverse effects, the clarity of procedures, and intervention time. The Canadian Occupational Performance Measure (COPM) was used to assess participant and caregiver satisfaction. Fidelity was measured by the type of feedback provided (intrinsic vs. extrinsic), task challenge level, and intervention volume. Participants reported good acceptance, few adverse effects, and satisfaction with the outcomes. The intervention adhered to the proposed principles, with a focus on extrinsic feedback and tasks showing progression over time. Time was well spent, being 78% focused on activities and using mostly extrinsic-focused feedback. The Mob-IT protocol was considered feasible and faithful to its principles. As this is a feasibility study, the results indicate the need to expand the intervention to a larger, randomized study.

Clinical implementation of next-generation sequencing testing and genomically-matched therapy: a real-world data in a tertiary hospital

Next-generation sequencing (NGS) cancer profiling has gained traction in routine clinical practice in South Korea. Here, we evaluated the use of NGS testing and genomically-matched therapies for patients with advanced solid tumors in a real-world clinical practice. We analyzed results from NGS cancer panel tests (SNUBH pan-cancer version 2) ordered from June 2019 to June 2020. Genomically-matched treatment was determined based on the novel information obtained from NGS testing, while results from conventional molecular tests were excluded. A total of 990 patients were included in the analysis (median age: 62, Stage IV: 82.5%). Using the Association for Molecular Pathology genetic variant classification system, we found that 257 (26.0%) patients harbored tier I variants, and 859 (86.8%) patients carried tier II variants. Among the tier I cases, the most frequently altered genes we detected were KRAS (106 patients, 10.7%), followed by EGFR (27 patients, 2.7%) and BRAF (17 patients, 1.7%). Of patients with tier I variants, 13.7% received NGS-based therapy as follows: Thyroid cancer (2/7, 28.6%), skin cancer (2/8, 25.0%), gynecologic cancer (7/65, 10.8%), and lung cancer (12/112, 10.7%). Of 32 patients with measurable lesions who received NGS-based therapy, 12 (37.5%) achieved a partial response, and 11 (34.4%) achieved stable disease. The median treatment duration was 6.4 months (95% CI, 4.4–8.4), and the median OS was not reached. In conclusion, NGS tumor profiling was successfully implemented in real-world clinical practice. This enabled the use of molecular profiling-guided therapy which improved survival outcome of selected patients.

Comprehensive care processes for substance use disorders in adult mental health services: A systematic review.

Assessment and care of substance use disorder within mental health services are essential due to the high prevalence and harms associated with comorbidity. Substance use disorder assessment and care are routinely recommended in clinical guidelines; however, processes are not agreed. This systematic review of routine clinical practice in relation to substance use disorders in adult mental health service aims to identify routine assessment and diagnosis processes, the proportion of patients and service episodes in which they occur and their outputs. We searched MEDLINE, PsycINFO, Embase and relevant Cochrane databases for articles until July 2024 reporting on substance use assessment, diagnosis or treatment in adults receiving routine mental health service and locating additional articles by snowballing. Variables including setting, study method, period, cohort, substances, clinical assessment type, diagnosis and care pathways were compared. In 137 heterogeneous studies reporting routine practice within a wide variety of adult mental health service from 29 nations, 44 (32%) expected or reported on substance use assessment in domains of pattern or impact. However, 23 studies (17%) reported structured approaches to substance use disorder assessment, while 67 (49%) reported a diagnostic structure, including classification system. Diagnostic prevalence varied markedly. Treatment was reported in 16 studies (12%) and no substance use disorder outcomes were reported. This systematic review shows marked variation in routine practice in mental health service across a range of substance use disorder assessment and diagnosis processes. To better identify substance use disorder, enhance its care and reduce associated morbidity, adult mental health service may benefit from standardising expectations and systematically monitoring the performance of substance use assessment and diagnosis.

DOse and administration Time of Indocyanine Green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): a randomized clinical trial.

Different techniques have been proposed to reduce the incidence of the intraoperative bile duct injury during laparoscopic cholecystectomy (LC). Among these, Near-Infrared Fluorescence Cholangiography (NIFC) with Indocyanine Green (ICG) represents a relatively recent addition. At present, there is considerable variation in the protocols for the administration of ICG. The aim of this randomized multicenter clinical trial (RCT) is to ascertain whether there are differences between the dosage and administration intervals of ICG, with a view to optimizing a good-quality NIFC during LC. Furthermore, an analysis was conducted to determine the potential impact of different factors on the outcomes of this technique. The trial was approved by the local institutional Ethics Committee. From June 2022 to June 2023, 200 patients were randomized in four arms (G1: 2.5mg ICG > 3h prior to surgery, G2: 2.5mg ICG 15-30min prior to surgery, G3: 0.05mg/kg ICG > 3h prior to surgery and G4: 0.05mg/kg ICG 15-30min prior to surgery). We found differences in the DISTURBED score between the groups (p < 0.001), suggesting that ICG administration 15-30min before surgery was worse than administration > 3h after LC (p = 0.02). Additionally, it was observed that body mass index (BMI), gender, ASA Classification System, previous liver and biliary disease and the type of surgery had influence on NIFC. Finally, the NIFC had an impact in intraoperative and postoperative complications, operative time and hospital length of stay. The administration of ICG > 3h improve liver background fluorescence in the NIFC during LC. There are different factors may affect NIFC results (BMI, ASA grade, previous liver disease, presence of gallbladder inflammation and type of surgery). Finally, high-quality NIFC was associated with fewer surgical complications, shorter surgical time and shorter length of hospital stay.

Mapping the landscape of Hospital at home (HaH) care: a validated taxonomy for HaH care model classification

BackgroundHospital at home (HaH) care models have gained significant attention due to their potential to reduce healthcare costs, improve patient satisfaction, and lower readmission rates. However, the lack of a standardized classification system has hindered systematic evaluation and comparison of these models. Taxonomies serve as classification systems that simplify complexity and enhance understanding within a specific domain.ObjectiveThis paper introduces a comprehensive taxonomy of HaH care models, aiming to categorize and compare the various ways HaH services are delivered as an alternative to traditional hospital care.MethodsWe developed a taxonomy of characteristics for HaH care models based on scientific literature and by applying a taxonomy development framework. To validate the taxonomy, and to analyze the current landscape of HaH models we matched the taxonomy to HaH care models described in literature. Finally, to identify types of HaH care implementations, we applied the k-means clustering method to care models represented using the taxonomy.ResultsOur taxonomy consists of 12 unique dimensions structured into 5 perspectives following the progression from triaging, through care delivery, operational processes, and metrics for success: Persons and roles (2 dimensions), Target population (1 dimension), Service delivery and care model (6 dimensions), outcomes and quality metrics (2 dimensions), and training and education (1 dimension). Cluster analysis of 34 HaH care models revealed three distinct types: One cluster (50%, 17/34) focuses on patient eligibility and home environment suitability, a care model to be chosen for clinically complex patients. A second cluster (29.4%, 10/34) aggregates technology-enabled models using telemedicine and remote monitoring that are adaptable across settings. This type could be chosen for generalizable care. The third cluster (20.6%, 7/34) includes complex interventions involving informal caregivers and advanced medical devices, requiring caregiver training, supportive policies, and user-friendly technology to reduce caregiver burden and improve safety.ConclusionsThe clusters identified highlight practical considerations for adapting HaH care approaches to patient and contextual needs. These findings can guide policymakers in developing guidelines and assist practitioners in tailoring HaH care models to specific patient populations. The challenges encountered in collecting information on different characteristics of the taxonomy underscore the urgent need for more comprehensive and standardized reporting in scientific papers on HaH interventions.

DAMPs prognostic signature predicts tumor immunotherapy, and identifies immunosuppressive mechanism of pannexin 1 channels in pancreatic ductal adenocarcinoma

BackgroundDamage-associated molecular patterns (DAMPs) induced by immunogenic cell death (ICD) may be useful for the immunotherapy to patients undergoing pancreatic ductal adenocarcinoma (PDAC). The aim of this study is to predict the prognosis and immunotherapy responsiveness of PDAC patients using DAMPs-related genes.MethodsK-means analysis was used to identify the DAMPs-related subtypes of 175 PDAC cases. The significance of gene mutation and immune status in different subtypes was detected. LASSO regression was used to construct a DAMPs-related prognostic signature to predict the immunotherapy responsiveness of PDAC. Subsequently, in vivo and in vitro experiments and Bulk-RNA seq were used to verify the effect of hub gene pannexin 1 (PANX1) on PDAC.ResultsTwo subtypes were clustered based on the expression levels of DAMPs genes from 175 PDAC patients. Besides, the prognosis and immune landscape in up-regulated DAMPs expression subtypes was poor. In addition, we constructed a DAMPs-related prognostic signature that correlated with immune cell infiltration and predicted immunotherapy or chemotherapy responsiveness of patients with PDAC. Mechanically, through Bulk-RNA sequencing and experiments, we found that PANX1 promoted tumor progression and immune regulation via the ATP release to active NOD1/NFκB signaling pathway in PDAC.ConclusionOur in silico analyses established a classification system based on ICD-related DAMPs genes in PDAC, and constructed a DAMPs-related prognostic model to predict the efficacy of immunotherapy. This study will provide a new perspective for targeting the DAMPs-related molecule PANX1 in the treatment of PDAC.

Pretreatment red blood cell distribution width as a predictive marker for postoperative complications after laparoscopic pancreatoduodenectomy.

Red blood cell distribution width (RDW) is associated with the development and progression of various diseases. To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy (LPD). A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed. Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated. Patients with higher pretreatment RDW were older, had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW. High pretreatment RDW was an independent risk factor for postoperative complications (POCs) (hazard ratio = 2.973, 95% confidence interval: 2.032-4.350, P < 0.001) and severe POCs of grade IIIa or higher (hazard ratio = 3.138, 95% confidence interval: 2.042-4.824, P < 0.001) based on the Clavien-Dino classification system. Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classification grade IIIb or higher POCs, a comprehensive complication index score ≥ 26.2, severe postoperative pancreatic fistula, severe bile leakage and severe hemorrhage. High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index. Pretreatment RDW was a special parameter for patients who underwent LPD. It was associated with malnutrition, severe inflammatory status and poorer short-term outcomes. RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.

Assessing juicy elements in interactive infographics

Introduction: Juiciness refers to the use of various audiovisual effects that are triggered in response to user interactions. This study explores the presence of juicy elements in interactive infographics, thereby extending the investigation of juiciness beyond traditional gaming contexts. Methodology: A descriptive research approach, employing content analysis, was used to evaluate a sample of interactive infographics published between 2010 and 2024. The sample was collected from four prominent sources, and each visualization was analyzed using a binary classification system (YES or NO) to indicate the presence of the identified juiciness elements: animation, particles, audio feedback, screen shake, and persistence. Results: Overall, the findings indicate that juicy elements are present in certain interactive visualizations, though not universally across all examples. The data revealed that animation appeared most frequently, with an occurrence rate of 73.85%, followed by particles (20.51%), audio feedback (5.64%), persistence (4.1%), and screen shake (1.03%). Furthermore, 25.64% of the visualizations contained no juicy elements. Discussion: The findings from the analysis reveal that juicy elements are present in a significant number of interactive visualizations, but none of the visualizations analyzed incorporated all five juicy elements simultaneously. Despite the presence of some juicy elements, no single visualization captured the full essence of juicy design, which ideally offers a high level of feedback from minimal user input. Conclusions: While no single visualization incorporated all five juicy elements, combinations of up to four were observed, suggesting that juiciness does not require a uniform or exhaustive application of all elements.