Low Confidence Research Articles

Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis.

Eczema is the most burdensome skin condition worldwide and topical anti-inflammatory treatments are commonly used to control symptoms. The relative effectiveness and safety of different topical anti-inflammatory treatments is uncertain. Network meta-analysis performed within a Cochrane systematic review to compare and statistically rank efficacy and safety of topical anti-inflammatory eczema treatments. Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to June 2023. Included trials were within-participant or between-participant randomised controlled trials. Participants had eczema that was not clinically infected and was not contact dermatitis, seborrheic eczema or hand eczema. Interventions were topical anti-inflammatory treatments but not complementary treatments, antibiotics alone, wet wraps, phototherapy or systemic treatments. Comparators were no treatment/vehicle or another topical anti-inflammatory. We identified 291 trials (45,846 participants), mainly in high-income countries. Most were industry-funded with median 3 weeks treatment duration. Risk of bias assessed using the Cochrane Risk of Bias 2.0 tool was high in 89% of trials, mainly due to risk of selective reporting. Network meta-analysis of binary outcomes ranked potent and/or very potent topical steroids, tacrolimus 0.1% and ruxolitinib 1.5% among the most effective treatments for improving patient-reported symptoms (40 trials, all low confidence) and clinician-reported signs (32 trials, all moderate confidence). For investigator global assessment, the Janus kinas inhibitors ruxolitinib 1.5%, delgocitinib 0.5% or 0.25%, very potent/potent topical steroids and tacrolimus 0.1% were ranked as most effective (140 trials, all moderate confidence). Continuous outcome data were mixed. Local application site reactions were most common with tacrolimus 0.1% (moderate confidence) and crisaborole 2% (high confidence) and least common with topical steroids (moderate confidence). Skin thinning was not increased with short-term use of any topical steroid potency (low confidence) but skin thinning was reported in 6/2044 (0.3%) participants treated with longer-term (6-60 months) topical steroids. Potent topical steroids, Janus kinase inhibitors and tacrolimus 0.1% were consistently ranked as among the most effective topical anti-inflammatory treatments for eczema.

Confidence in diagnosing and managing care for cognitive impairment in primary care: a survey comparing barriers by primary care clinician type.

As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square. Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care. Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.

Perspectives on managing patients with Down's syndrome among orthodontists in Saudi Arabia: A vignette and a COM-B analysis study.

This study aims to explore perspectives on managing patients with Down's syndrome among orthodontists in Saudi Arabia using a vignette study and COM-B model. This was a cross-sectional study for orthodontists working in Saudi Arabia. Participants were asked about their demographic data. Vignette (clinical scenarios) and COM-B model (C: capability, O: opportunity, M: motivation, and B: behavior) were used to assess orthodontists' perspectives regarding the management of patients with Down's syndrome. A model of Alpha (Cronbach) was used to study the properties of measurement scales. A Pearson's correlation coefficient was used to correlate variables represented by means. An independent t-test and one-way ANOVA, with least significant difference (LSD) as a post hoc test, were used to compare two group means and more than two groups, respectively. Most participants (n = 70, 85.4%) reported that they had no training/exposure to dealing with Down's syndrome patients during their orthodontic clinical training. Participants reported an average of 3.82 (SD = 1.1) when treating moderate Down's syndrome and 2.48 (SD = 1.4) when treating severe Down's syndrome with mild occlusion discrepancies. Participants also showed that their behavior and attitude are significantly related to their capability, opportunity, and motivation regarding the management of patients with Down's syndrome. The average reported agreement ranges from 2.46 (SD = 1) for the hypoplasia of the mandible to 4.38 (SD = 0.8) for the congenitally missing teeth. This study found that orthodontists in Saudi Arabia showed low confidence levels to manage Down's syndrome patients with moderate and severe challenging behavior. Despite this, the likelihood of increasing their confidence levels and attitude regarding the management of patients with Down's syndrome increased by increasing their capability, opportunity, motivation, and knowledge in this field.

Comparison of Outcomes After Cochlear Implantation in a Veteran Versus Nonveteran Population.

To evaluate for equivalence in postoperative changes of speech recognition scores in a veteran patient population undergoing cochlear implantation (CI) compared to matched nonveteran patients. Retrospective chart review. Tertiary referral center. A total of 83 veteran patients who underwent CI at a single Veterans Affairs Medical Center (VA cohort) were matched to 83 nonveteran patients from the Health Insurance Portability and Accountability Act-secure, Encrypted, Research, Management and Evaluation Solution database (HERMES cohort) based on age, sex, and baseline Consonant-Nucleus-Consonant (CNC) scores. Patients underwent CI. Comparison of postoperative CNC and Arizona Biomedical Institute recognition scores. The mean difference and lower confidence interval of CNC scores between matched Veterans Affairs and HERMES cohorts were within a -ΔNI boundary of -15% at the 3-month (mean = 6.15, lower confidence interval = -2.38), 6-month (mean = 7.36, lower confidence interval = -2.21), and 12-month (mean = 4.03, lower confidence interval = -4.88) postoperative time points. The mean difference and lower confidence interval of Arizona Biomedical Institute scores between cohorts were within the -ΔNI boundary of -30% at 3 months (mean = 1, lower confidence interval = -8.71), 6 months (mean = 0.31, lower confidence interval = -12.30), and 12 months (mean = 0.72, lower confidence interval = -10.48). Our veteran population demonstrated improvements in speech recognition scores after CI comparable to a matched nonveteran population. Although veterans face unique factors that affect their hearing, access to medical care, and baseline general health, these findings affirm appropriate veteran candidates should be offered CI.

A Vision for Digitizing Judicial Processes and Integrating Artificial Intelligence in Pakistan’s Judiciary: Enhancing Efficiency and Upholding Judicial Integrity

The judiciary, as the cornerstone of justice and the rule of law, is at a pivotal juncture to harness the transformative power of digital technology and artificial intelligence (AI) to enhance its operations. This essay outlines a comprehensive approach for digitizing judicial processes in Pakistan, incorporating AI integration by drawing parallels with successful international model. The focus is on the need for systemic change to ensure efficiency, transparency, and accessibility in the legal system. Current challenges include a lack of proper implementation of the rule of law, prolonged trials, and low public confidence. Traditional methods of case filing are manual and paper-based, leading to inefficiencies. The essay proposes a step-by-step transformation starting from e-filing to the digitization of the entire lifecycle of a case, aiming to modernize Pakistan’s judiciary. AI can aid in legal research, evidence standards, and sentencing, offering predictive capabilities and streamlining routine case management. Ethical considerations and the need for human judicial discretion are emphasized to balance AI’s assistance with maintaining judicial integrity and fairness. This digital transformation can restore public trust and efficiency in Pakistan’s judiciary, paving the way for a modern, digital legal system. Keywords: Technological Integration in Courts, Predictive Analytics in Law, Transparency in Judicial Processes, Judicial Modernization, Artificial Intelligence in Judiciary, Digital transformation, AI and Legal Ethics, Case Management Systems, E-Filing, Legal Tech Innovation, AI in Legal Research, Efficiency in Judiciary, AI and Evidence Standards, AI in Sentencing, Legal Information Systems

Sex-specific differences in surgical confidence: results of the Endo Workshop of the German Society of Residents in Urology 2022

Simulation-based training is gaining importance in urologic residents training. This prospective study evaluated the influence of the Endo Workshop of the German Society of Residents in Urology e. V. (GeSRU) on surgical confidence. GeSRU Endo Workshop 2022 included 1 h simulation-based training sessions on stone removal using ureteroscopy (URS) and transurethral resection of the bladder (TURB). Using an online questionnaire, surgical confidence was assessed before and after the workshop. Surgical assessment relied on the global rating scale (GRS). Overall, 40residents participated: 25(62.5%) men and 15(37.5%) women. In URS assessment, men vs. women achieved an average of 26.6 vs.26.1/35points on the GRS (p = 0.7) and completed the task in 8.1 ± 1.9 vs.9.9 ± 0.4 min (p < 0.001). In TURB assessment, men vs. women achieved an average of 26.0 vs.27.3/35points on the GRS (p = 0.3) and required 7.6 ± 1.9 vs.7.7 ± 2.2 min (p = 0.9), respectively. Among participants who answered the baseline survey and the evaluation (n = 33), 16(80%) men vs.3 (23%) women had surgical confidence to perform URS before (p = 0.01), and 19(95%) men vs.7 (54%) women after the workshop (p = 0.03). Regarding the performance of TURB, 10(50%) men vs.7 (54%) women reported surgical confidence before (p = 0.1), and 15(75%) men vs.10 (77%) women after the workshop (p = 1.0). An increase in surgical confidence to perform URS and TURB was reported by 9(45%) and 10(50%) men and 9(69%) and 8(62%) women, respectively. Endourologic simulation-based training increases surgical confidence of both female and male residents. Despite comparable surgical outcomes, women approach URS with lower surgical confidence compared to their male counterparts.

Balance confidence classification in people with a lower limb amputation using six minute walk test smartphone sensor signals.

The activities-specific balance confidence scale (ABC) assesses balance confidence during common activities. While low balance confidence can result in activity avoidance, excess confidence can increase fall risk. People with lower limb amputations can present with inconsistent gait, adversely affecting their balance confidence. Previous research demonstrated that clinical outcomes in this population (e.g., stride parameters, fall risk) can be determined from smartphone signals collected during walk tests, but this has not been evaluated for balance confidence. Fifty-eight (58) individuals with lower limb amputation completed a six-minute walk test (6MWT) while a smartphone at the posterior pelvis was used for signal collection. Participant ABC scores were categorized as low confidence or high confidence. A random forest classified ABC groups using features from each step, calculated from smartphone signals. The random forest correctly classified the confidence level of 47 of 58 participants (accuracy 81.0%, sensitivity 63.2%, specificity 89.7%). This research demonstrated that smartphone signal data can classify people with lower limb amputations into balance confidence groups after completing a 6MWT. Integration of this model into the TOHRC Walk Test app would provide balance confidence classification, in addition to previously demonstrated clinical outcomes, after completing a single assessment and could inform individualized rehabilitation programs to improve confidence and prevent activity avoidance.

Knowledge, confidence and clinical reasoning of dental students for diagnosing pediatric periodontal diseases

ObjectiveGiven the importance of diagnosing periodontal diseases in pediatric patients, the objective of this study was to examine knowledge, confidence, and clinical reasoning of third- and fourth-year dental students regarding periodontal diagnosis and treatment planning in pediatric patients. MethodsAn explanatory sequential mixed-method study was conducted in two phases. In the first phase, the survey questions were administered online to the third-and fourth-year dental students. Surveys tested for knowledge, confidence and clinical decision-making using questions and case-studies. Answers from periodontists and the pediatric dentists were used as the gold standard. For the next phase, individual interviews were recorded, transcribed, and coded followed by verbal analysis to assess their clinical reasoning for the specific diagnosis and treatment planning. ResultsWhile there was no overall difference in the knowledge and the confidence level between the students, they differed from the experts for some questions in confidence levels. As measured using the Script Concordance Test (SCT), no significant differences were observed between the participants in their clinical reasoning. The verbal analysis of the interview data showed that the students used three different patterns for searching through the problem space. Most of the students used the forward pattern of search and reported low confidence in diagnosing and treating pediatric periodontal diseases. ConclusionDue to low self-reported confidence in diagnosing periodontal disease in pediatric patients. Providing education solutions will improve the confidence of undergraduate dental students in diagnosing and treating periodontal disease.

Patterns and predictors of COVID-19 vaccination among young adults at 44 US sites: Secondary analysis of a randomized, controlled, open-label trial, March – December 2021

Background: The introduction of vaccines during the COVID-19 pandemic provided an opportunity to slow transmission of SARS-CoV-2, but initial uptake of COVID-19 vaccination was slow. We analyzed data from a randomized clinical trial of the mRNA-1273 vaccine (NCT04811664) to describe the patterns of uptake of COVID-19 vaccines among young adults.Methods: The CoVPN 3006 trial randomized adults ages 18–29 from 44 sites in the United States to receive 1) immediate mRNA-1273 vaccination from the study site, or 2) standard of care, including the option to seek vaccination at any time in the future. Randomization occurred between March and November 2021, and an observational arm of adults who declined vaccination was enrolled beginning June 2021. Among participants in the standard of care (SoC) or Vaccine Declined arms, we estimated demographic, behavioral, and health history correlates of vaccination, and the four-month cumulative incidence of COVID-19 vaccination using inverse probability weighted Kaplan-Meier estimators.Results: Among 728 SoC and 470 Vaccine Declined participants, 79% and 16% received COVID-19 vaccination, respectively. SoC and Vaccine Declined participants were more likely to seek and receive vaccination if they reported COVID-19 preventive behaviors, including wearing masks, physically distancing, and avoiding large gatherings. We identified strong predictors of vaccination in the Vaccine Declined arm, including attending class in person (adjusted risk ratio [aRR]: 0.47, 95% confidence interval [CI] 0.21, 1.03), having a COVID-19 relevant medical condition (aRR: 1.95, 95% CI: 0.89, 4.26), and avoiding large gatherings (aRR: 2.24, 95% CI: 1.18, 4.25), though low vaccination rates in this arm led to imprecise estimates.Conclusions: Individuals who initially decline vaccination can be convinced to vaccinate, particularly if they are already practicing other forms of COVID-19 prevention. Continued outreach and education from the scientific community can combat low vaccine confidence.

Difficulty level-based knowledge distillation

Knowledge distillation (KD) enables a simple model (student model) to perform as a complex model (teacher model) by distilling the knowledge from a pre-trained teacher model. Existing soft-label distillation methods often use a fixed temperature value in the softmax function to prevent overconfidence in the distillation process. However, this approach can lead to the suppression of important ‘dark knowledge’ for non-target classes in difficult samples, while also over-smoothing the confidence values for easier samples. To address this issue, we propose a novel approach called difficulty level-based knowledge distillation (DLKD), which considers the difficulty level of each sample to distill refined knowledge with high or low confidence, depending on the sample’s complexity. Our method calculates the difficulty level based on the Euclidean distance between the teacher model’s predictions and the pruned teacher model’s predictions. Experimental results demonstrate that our DLKD method outperforms state-of-the-art methods on challenging samples, including those with noisy labels or augmented data, achieving superior results on CIFAR-100, FGVR, and ImageNet datasets for image classification.

Preoperative Atelectasis in Patients with Obesity Undergoing Bariatric Surgery: A Cross-Sectional Study.

Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Spo2 values in the seated position at room air is explained by the extent of atelectasis coverage in the supine position. This was a cross-sectional study in a single center specialized in laparoscopic bariatric surgery. Preoperative chest computed tomographies were reassessed by a senior radiologist to quantify the extent of atelectasis coverage as a percentage of total lung volume. Patients were classified as having atelectasis when the affection was ≥2.5%, to estimate the prevalence of atelectasis. Crude and adjusted prevalence ratios (aPRs) and odds ratios (aORs) were obtained to assess the relative prevalence of atelectasis and percentage coverage, respectively, with increasing obesity category. Inverse probability weighting was used to assess the total, direct (not mediated), and indirect (mediated through atelectasis) effects of body mass index (BMI) on preoperative Spo2, and to quantify the magnitude of mediation (proportion mediated). E-values were calculated, to represent the minimum magnitude of association that an unmeasured confounder with the same directionality of the effect should have to drive the observed point estimates or lower confidence intervals (CIs) to 1, respectively. In 236 patients with a median BMI of 40.3 kg/m2 (interquartile range [IQR], 34.6-46.0, range: 30.0-77.3), the overall prevalence of atelectasis was 32.6% (95% CI, 27.0-38.9) and by BMI category: 30 to 35 kg/m2, 12.7% (95% CI, 6.1-24.4); 35 to 40 kg/m2, 28.3% (95% CI, 17.2-42.6); 40 to 45 kg/m2, 12.3% (95% CI, 5.5-24.3); 45 to 50 kg/m2, 48.4% (95% CI, 30.6-66.6); and ≥50 units, 100% (95% CI, 86.7-100). Compared to the 30 to 35 kg/m2 group, only the categories with BMI ≥45 kg/m2 had significantly higher relative prevalence of atelectasis-45 to 50 kg/m2, aPR = 3.52 (95% CI, 1.63-7.61, E-value lower bound: 2.64) and ≥50 kg/m2, aPR = 8.0 (95% CI, 4.22-15.2, E-value lower bound: 7.91)-and higher odds of greater atelectasis percentage coverage: 45-50 kg/m2, aOR = 7.5 (95% CI, 2.7-20.9) and ≥50 kg/m2, aOR = 91.5 (95% CI, 30.0-279.3). Atelectasis percent alone explained 70.2% of the variation in preoperative Spo2. The proportion of the effect of BMI on preoperative Spo2 values <96% mediated through atelectasis was 81.5% (95% CI, 56.0-100). The prevalence and extension of atelectasis increased with higher BMI, being significantly higher at BMI ≥45 kg/m2. Preoperative atelectasis mediated the effect of BMI on Spo2 at room air in the seated position.

Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones

The 1-year results of the SECURE trial, a randomized trial comparing a restrictive strategy vs usual care for select patients with symptomatic cholelithiasis for cholecystectomy, resulted in a significantly lower operation rate after restrictive strategy. However, a restrictive strategy did not result in more pain-free patients at 1 year. To gauge pain level and determine the proportion of pain-free patients, operation rate, and biliary and surgical complications at the 5-year follow-up. This randomized clinical trial was a multicenter, parallel-arm, noninferiority, prospective study. Between February 2014 and April 2017, patients from 24 hospitals with symptomatic, uncomplicated cholelithiasis were included. Uncomplicated cholelithiasis was defined as gallstone disease without signs of complicated cholelithiasis, ie, biliary pancreatitis, cholangitis, common bile duct stones, or cholecystitis. Follow-up data for this analysis were collected by telephone from July 11, 2019, to September 23, 2023. Patients were randomized (1:1) to receive usual care or a restrictive strategy with stepwise selection for cholecystectomy. The primary, noninferiority end point was proportion of patients who were pain free as evaluated by Izbicki pain score at the 5-year follow-up. A 5% noninferiority margin was chosen. The secondary end points included cholecystectomy rates, biliary and surgical complications, and patient satisfaction. Among 1067 patients, the median (IQR) age was 49.0 years (38.0-59.0 years); 786 (73.7%) were female, and 281 (26.3%) were male. At the 5-year follow-up, 228 of 363 patients (62.8%) were pain free in the usual care group, compared with 216 of 353 patients (61.2%) in restrictive strategy group (difference, 1.6%; 1-sided 95% lower confidence limit, -7.6%; noninferiority P = .18). After cholecystectomy, 187 of 294 patients (63.6%) in the usual care group and 160 of 254 patients (63.0%) in the restrictive strategy group were pain free, respectively (P = .88). The restrictive care strategy was associated with 387 of 529 cholecystectomies (73.2%) compared with 437 of 536 in the usual care group (81.5%; 8.3% difference; P = .001). No differences between groups were observed in biliary and surgical complications or in patient satisfaction. In the long-term, a restrictive strategy results in a significant but small reduction in operation rate compared with usual care and is not associated with increased biliary and surgical complications. However, regardless of the strategy, only two-third of patients were pain free. Further criteria for selecting patients with uncomplicated cholelithiasis for cholecystectomy and rethinking laparoscopic cholecystectomy as treatment is needed to improve patient-reported outcomes. CCMO Identifier: NTR4022.

The effectiveness of driving simulator training on driving skills and safety in young novice drivers: A systematic review of interventions

Introduction: This systematic review evaluated the effectiveness of driving simulator training on simulated/on-road driving skills and safety in young novice drivers. Method: Searches were performed in Embase, Global Health, Medline, Scopus, and Web of Science databases, and on Google advanced, Google Scholar, and the Transport Research International Documentation websites. A total of 1,630 unique sources (titles and abstracts) were screened by two reviewers independently with 99 full-text articles reviewed for inclusion. Studies were included if they were a primary driving simulator intervention study that consisted of a randomized controlled trial, quasi-experimental, prospective cohort, and case-control design, published in English between January 1, 2010 and January 26, 2024. Results: The review included 15 studies published in 2010–2022 (study sample size ranged from 30 to 183,197). Findings showed that driving simulator training (compared to control conditions) can immediately improve simulated driving skills (e.g., adjustment to stimuli, lane maintenance, and speed regulation), although it was unclear whether simulator training can improve on-road driving skills or safety, immediately or longitudinally. Studies showed low quality of evidence with increased risks of selection bias, confounding factors, and type I errors influencing findings. Practical Applications: Since it is not known whether driving simulator training has short-term or long-term benefits on drivers’ real-world driving skills or safety, it should not replace any training offered in driver education programs. However, driving simulator training can be included in driver education programs to supplement the in-class and on-road training. Conclusions: The quality of evidence in this review shows low confidence on whether findings accurately reflect true effects on driving skills or safety. Further research should enhance the quality of evidence and demonstrate the transfer effects of driving simulator training to valid measures of real-world driving before recommending any integration of simulator training into standard practice.

ACAN: A plug-and-play Adaptive Center-Aligned Network for unsupervised domain adaptation

Domain adaptation is an important topic due to its capability in transferring knowledge from source domain to target domain. However, many existing domain adaptation methods primarily concentrate on aligning the data distributions between the source and target domains, often neglecting discriminative feature learning. As a result, target samples with low confidence are embedded near the decision boundary, where they are susceptible to being misclassified, resulting in negative transfer. To address this problem, a novel Adaptive Center-Aligned Network dubbed ACAN is proposed for unsupervised domain adaptation in this work. The main innovations of ACAN are fourfold. Firstly, it is a plug-and-play module and can be easily incorporated into any domain alignment methods without increasing the model complexity and computational burden. Secondly, in contrast to conventional softmax plus cross-entropy loss, angular margin loss is called to enhance the discrimination power for classifier. Thirdly, entropy regularization is exploited to highlight the probability of potential related class, which renders our learned feature representation far away from the decision boundary. Fourthly, to improve the discriminative capacity of model to the target domain, we propose to align the target domain samples to the corresponding class center via pseudo labels. Incorporating ACAN, the performance of baseline domain alignment methods is significantly improved. Extensive ablation and comparison experiments on four widely adopted databases demonstrate the effectiveness of our ACAN. Code is available at: https://github.com/Cloudfly-Z/ACAN

Detection Limits of Insect Fragments in Spiked Whole Wheat Flour Using Multiplex Polymerase Chain Reaction (PCR)

The need for a sensitive molecular method to detect specific species of insect contaminants in food products remains a significant challenge in the food industry. This study evaluated the detection limit of a multiplex end-point PCR assay for detecting insects in food. The assay amplifies two fragments of the cytochrome oxidase subunit I gene (COI-Fa and COI-Fb) and one fragment of the protein-coding wingless (wg) gene found in insects. Five insect species, comprising three vectors of foodborne pathogens (the housefly, Musca domestica, the American cockroach, Periplaneta americana, and the pharaoh ant, Monomorium pharaonis) and two storage insect pests (the red flour beetle, Tribolium castaneum and the Indian meal moth, Plodia interpunctella), were spiked separately and in combination at levels of 1, 0.1, 0.01, and 0.001% in whole wheat flour. At spike levels greater than 0.01%, amplicon bands of expected sizes were seen in 100% of samples containing fragments from distinct insect species. At least 25% of spiked samples at the lowest spike level had amplicon bands, except for samples spiked with M. domestica. Results showed an 18.9% probability (with 11.3% and 30% lower and upper confidence limits, respectively) of detecting insect fragments at the lowest spike level (0.001%, corresponding to 3–22 fragments), which is far below the FDA’s regulatory level of less than 75 fragments per 50 g of wheat flour. The intensity of amplicon bands in the gel images was higher at higher spike levels. However, this method is not quantitative enough to extrapolate the intensity of the amplicon bands to the number of insect fragments present in a sample. This multiplex assay was also evaluated in a variety of market food samples derived from plants and animals, showing its potential use in various food types. Overall, the sensitivity and specificity of this molecular approach suggest that it could be used in the future as a screening tool for detecting insect contaminants in food.

Endoscopic detection and diagnostic strategies for minute gastric cancer: A real-world observational study

BACKGROUND Minute gastric cancers (MGCs) have a favorable prognosis, but they are too small to be detected by endoscopy, with a maximum diameter ≤ 5 mm. AIM To explore endoscopic detection and diagnostic strategies for MGCs. METHODS This was a real-world observational study. The endoscopic and clinicopathological parameters of 191 MGCs between January 2015 and December 2022 were retrospectively analyzed. Endoscopic discoverable opportunity and typical neoplastic features were emphatically reviewed. RESULTS All MGCs in our study were of a single pathological type, 97.38% (186/191) of which were differentiated-type tumors. White light endoscopy (WLE) detected 84.29% (161/191) of MGCs, and the most common morphology of MGCs found by WLE was protruding. Narrow-band imaging (NBI) secondary observation detected 14.14% (27/191) of MGCs, and the most common morphology of MGCs found by NBI was flat. Another three MGCs were detected by indigo carmine third observation. If a well-demarcated border lesion exhibited a typical neoplastic color, such as yellowish-red or whitish under WLE and brownish under NBI, MGCs should be diagnosed. The proportion with high diagnostic confidence by magnifying endoscopy with NBI (ME-NBI) was significantly higher than the proportion with low diagnostic confidence and the only visible groups (94.19% &gt; 56.92% &gt; 32.50%, P &lt; 0.001). CONCLUSION WLE combined with NBI and indigo carmine are helpful for detection of MGCs. A clear demarcation line combined with a typical neoplastic color using nonmagnifying observation is sufficient for diagnosis of MGCs. ME-NBI improves the endoscopic diagnostic confidence of MGCs.

An Analysis of Students’ Low Confidence in Speaking, As the Attribute of Pronunciation Context

An Analysis of Students’ Low Confidence in Speaking, As the Attribute of Pronunciation Context

Identifying and responding to fetal alcohol spectrum disorder in child and family health: Lessons from an exploratory mixed methods study.

Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills. Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD. The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers 'patching together' care planning in a 'referral black hole'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge. Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

Recommendations for Improving End-User Programming Education: A Case Study with Undergraduate Chemistry Students.

Programming is widespread in multiple domains and is being integrated into various discipline-specific university courses where, like students in a typical introductory computing course, students from other disciplines face challenges with learning to program. We offer a case study in which we study undergraduate students majoring in either chemistry or biochemistry as they learn programming in a physical chemistry course sequence. Using surveys and think-aloud sessions with students, we conducted a thematic content analysis to explain the challenges they face in this endeavor. We found that students struggled to transfer their programming knowledge to new representations and problems, and they did not have strategies in place for solving problems with programming. These facts combine to lower students' confidence in their programming abilities, making it less likely that they will reach for computing to help solve domain-specific problems. We recommend that students in end-user programming contexts be explicitly taught the skills of abstraction, decomposition, and metacognitive awareness as they pertain to programming.

Value chain interventions for improving women's economic empowerment: A mixed-methods systematic review and meta-analysis: A systematic review.

Value chain interventions have become widespread throughout the international development sector over the last 20 years, and there is a need to evaluate their effectiveness in improving women's welfare across multiple dimensions. Agricultural value chains are influenced by socio-cultural norms and gender dynamics that have an impact on the distribution of resources, benefits, and access to opportunities. While women play a critical role in agriculture, they are generally confined to the least-valued parts of the value chain with the lowest economic returns, depending on the local, social and institutional contexts. The review assesses the effectiveness of approaches, strategies and interventions focused on women's engagement in agricultural value chains that lead to women's economic empowerment in low- and middle-income countries. It explores the contextual barriers and facilitators that determine women's participation in value chains and ultimately impact their effectiveness. We searched completed and on-going studies from Scopus, Web of Science Core Collection (Social Sciences Citation Index [SSCI], Science Citation Index Expanded [SCI-EXPANDED], Conference Proceedings Citation Index - Science [CPCI-S], Conference Proceedings Citation Index - Social Science & Humanities [CPCI-SSH], and Emerging Sources Citation Index [ESCI]), International Bibliography of the Social Sciences, EconLit, Business Source Premier, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane, Database of Systematic Reviews, CAB Abstracts and Sociological Abstracts. We also searched relevant websites such as Consortium of International Agricultural Research Centers (CGIAR); the International Fund for Agricultural Development (IFAD); AgriProFocus; the Bill & Melinda Gates Foundation (BMGF); Donor Committee for Enterprise Development; the UN Food and Agriculture Organisation (FAO); the International Labour Organisation (ILO); the Netherlands Development Organisation; USAID; the Swiss Agency for Development and Cooperation; the International Food Policy Research Institute; World Agroforestry; the International Livestock Research Institute; the Foreign, Commonwealth & Development Office; the British Library for Development Studies (BLDS); AGRIS; the IMMANA grant database; the 3ie impact evaluation database; Innovations for Poverty Action (IPA); The Abdul Latif Jameel Poverty Action Lab (J-PAL); the World Bank IEG evaluations; the USAID Development Data Library; Experience Clearinghouse; the proceedings of the Agriculture, Nutrition and Health Academy conference; the proceedings of the Centre for the Study of African Economies (CSAE) Conference; the proceedings of the North East Universities Development Consortium (NEUDC) Conference; and the World Bank Economic Review. The database search was conducted in March 2022, and the website search was completed in August 2022. The review includes value chain interventions evaluating the economic empowerment outcomes. The review includes effectiveness studies (experimental and non-experimental studies with a comparison group) and process evaluations. Two review authors independently assessed studies for inclusion, extracted data, critically appraised the studies, and synthesised findings. We found that value chain interventions are successful in improving the economic conditions of their intended beneficiaries. The interventions were found to improve women's economic outcomes such as income, assets holdings, productivity, and savings, but these effects were small in size and limited by low confidence in methodological quality. The meta-analysis suggests that this occurs more via the acquisition of skills and improved inputs, rather than through improvement in access to profitable markets. The qualitative evidence on interventions points to the persistence of cultural barriers and other constraints. Those interventions implemented in Sub-Saharan Africa and South Asia are consistently more successful for all outcomes considered, although there are few studies conducted in other areas of the world. The review concludes that value chain interventions empower women, but perhaps to a lesser extent than expected. Economic empowerment does not immediately translate into empowerment within families and communities. Interventions should either moderate their expectations of empowerment goals, or they should be implemented in a way that ensures higher rates of participation among women and the acquisition of greater decision-making power.