Lower Scores Research Articles

APF-S2T: Steering to Target Redirection Walking Based on Artificial Potential Fields.

Redirected walking (RDW) enables users to walk naturally within a virtual environment that is larger than the physical environment. Recently, several artificial potential field (APF) and alignment-based redirected controllers have been developed and have been demonstrated to significantly outperform conventional controllers. APF Steer-to-Gradient (APF-S2G) and APF Redirected Walking (APF-RDW) utilize the negative gradient and the total force vector, respectively, which are localized to the user's position. These vectors usually point towards the opposite wall when the user is in corridors, resulting in frequent resets within those regions. This paper introduces the APF Steer-to-Target (APF-S2T), a redirected controller that first finds the target sample point with the lowest score in the user's walkable area in both physical and virtual environments. The score of a sample point is determined by the APF value at the point and the distance from the user's position. The direction from the user's position to the target point is then used as the steering direction for setting RDW gains. We conducted a simulation-based evaluation to compare APF-S2T, APF-S2G, APF-RDW, Visibility Polygon-based alignment (Vis.-Poly.) and Alignment-Optimized controllers in terms of the number of resets and the average distance between resets. The results indicated that APF-S2T significantly outperformed the state-of-the-art controllers.

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy.

This study aimed to identify predictors of 90-day good functional outcome (GFO) in patients with acute ischaemic stroke (AIS) who were treated with mechanical thrombectomy but did not achieve a delayed neurological improvement (DNI). In-hospital neurological improvement in patients with AIS is consistently associated with long- -term GFO. Patients who experience neither early nor delayed neurological improvement can still achieve long-term GFO, but predictors of such an outcome have not been studied. This single-centre retrospective study involved 307 patients with anterior circulation AIS treated with mechanical thrombectomy. Multiple clinical, biochemical, radiological, and treatment-related variables were collected and analysed. DNI on day 7 was defined as at least a 10-point reduction in the National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score < 2. GFO on day 90 was defined as a modified Rankin Scale (mRS) score ≤ 2. We compared the characteristics of patients with and without DNI, with special attention paid to patients who achieved 90-GFO despite a lack of DNI. Multivariate analyses were then performed to establish independent predictors of 90-day GFO among patients without DNI. DNI occurred in 150 out of 307 patients (48.7%) and significantly increased the odds for 90-day GFO (odds ratio [OR]: 13.99; p < 0.001). Among patients without DNI, 41.4% achieved 90-day GFO. Younger age (OR: 0.96; 95% confidence interval [CI]: 0.93-0.99; p = 0.008), lower baseline NIHSS score (OR: 0.80; 95% CI: 0.73-0.89; p < 0.001), treatment with intravenous thrombolysis (OR: 3.06; 95% CI: 1.25-7.49; p = 0.014), lack of an undetermined aetiology (OR: 0.40; 95% CI: 0.16-0.998; p = 0.050), lack of pneumonia (OR: 0.08; 95% CI: 0.02-0.31; p < 0.001), and higher haemoglobin concentration on admission (OR: 1.31; 95% CI: 1.04-1.69; p = 0.024) were identified as predictors of 90-day GFO in this subgroup. Almost half of patients with AIS in anterior circulation treated with mechanical thrombectomy experience DNI, which is a good predictor of 90-day GFO. Furthermore, 40% of patients without DNI achieve 90-day GFO which can be independently predicted by younger age, lower baseline NIHSS score, treatment with intravenous thrombolysis, higher haemoglobin concentration on admission, lack of undetermined ischaemic stroke aetiology, and lack of pneumonia.

Assessing the influence of dopamine and mindfulness on the formation of routines in visual search.

Given experience in cluttered but stable visual environments, our eye-movements form stereotyped routines that sample task-relevant locations, while not mixing-up routines between similar task-settings. Both dopamine signaling and mindfulness have been posited as factors that influence the formation of such routines, yet quantification of their impact remains to be tested in healthy humans. Over two sessions, participants searched through grids of doors to find hidden targets, using a gaze-contingent display. Within each session, door scenes appeared in either one of two colors, with each color signaling a differing set of likely target locations. We derived measures for how well target locations were learned (target-accuracy), how routine were sets of eye-movements (stereotypy), and the extent of interference between the two scenes (setting-accuracy). Participants completed two sessions, where they were administered either levodopa (dopamine precursor) or placebo (vitamin C), under double-blind counterbalanced conditions. Dopamine and trait mindfulness (assessed by questionnaire) interacted to influence both target-accuracy and stereotypy. Increasing dopamine improved accuracy and reduced stereotypy for high mindfulness scorers, but induced the opposite pattern for low mindfulness scorers. Dopamine also disrupted setting-accuracy invariant to mindfulness. Our findings show that mindfulness modulates the impact of dopamine on the target-accuracy and stereotypy of eye-movement routines, whereas increasing dopamine promotes interference between task-settings, regardless of mindfulness. These findings provide a link between non-human and human models regarding the influence of dopamine on the formation of task-relevant eye-movement routines and provide novel insights into behavior-trait factors that modulate the use of experience when building adaptive repertoires.

Autistic traits and anthropomorphism: the case of vehicle fascia perception.

Individuals high in autistic traits can have difficulties with social interactions which may stem from difficulties with mentalizing abilities, yet findings from research investigating anthropomorphism of non-human objects in high trait individuals are inconsistent. Measuring emotions and attributes of front-facing vehicles, individuals scoring high versus low on the AQ-10 were compared for ratings of angry-happy, hostile-friendly, masculine-feminine, and submissive-dominant, as a function of vehicle size (large versus small). Our results showed that participants perceived large vehicles as more angry, hostile, masculine, and dominant than small vehicles, with no significant difference in ratings between high and low AQ-10 scorers. The current findings support previous research reporting high autistic trait individuals' intact object processing. Our novel findings also suggest high autistic trait individuals' anthropomorphizing abilities are comparable to those found in low autistic trait individuals.

Evaluating Recovery After Two and Three Repeated Concussions Using Growth Curves.

The results of prior research concerning the effects of repeated concussions have been mixed. The aim of this study was to evaluate how concussion outcomes and presentation changed within patients who were evaluated at a concussion specialty clinic multiple times with a concussion. Subjects included 202 patients (54% male) aged 10-21 years (M = 13.17) who presented to a specialty concussion clinic for two and three concussions (77% sport-related) and were followed through formal clearance. First, growth curve models were estimated to determine recovery time and initial symptom burden across the multiple injuries. Second, covariates were added to these models to evaluate which demographic, risk factor, or injury variables predicted any change that did occur in evaluation or outcome variables. Models indicated that each subsequent concussion linearly resulted in significantly fewer days to recovery (-4.62 days, p < 0.047) across three concussions, and significantly lower (and linear) symptom scores on the post-concussion symptom scale (PCSS) (-2.16, p = 0.05). More severe presentation (i.e., days to recovery; higher symptom score) was significantly associated (-.62, p = 0.005) with greater improvement in recovery time (-.62, p = 0.005) and symptom burden (-.56, p < 0.001) at subsequent injuries. No covariates were significantly associated with improvement (or lack thereof) at subsequent injuries. This study adds to evidence suggesting multiple injuries is not associated with protracted recovery at subsequent injuries, in the context of treatment and full clearance for each injury at a multi-disciplinary clinic.

Remote Ischemic Conditioning With Medical Management or Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Remote ischemic conditioning (RIC) is a low-cost, accessible, and noninvasive neuroprotective treatment strategy, but its efficacy and safety in acute ischemic stroke are controversial. With the publication of several randomized controlled trials (RCTs) and the recent results of the RESIST trial, it may be possible to identify the patient population that may (or may not) benefit from RIC. This systematic review and meta-analysis aims to evaluate the effectiveness and safety of RIC in patients with ischemic stroke receiving different treatments by pooling data of all randomized controlled studies to date. We searched the PubMed, Embase, Cochrane, Elsevier, and Web of Science databases to obtain articles in all languages from inception until May 25, 2023. The primary outcome was the modified Rankin Scale (mRS) score at the specified endpoint time in the trial. The secondary outcomes were change in NIH Stroke Scale (NIHSS) and recurrence of stroke events. The safety outcomes were cardiovascular events, cerebral hemorrhage, and mortality. The quality of articles was evaluated through the Cochrane risk assessment tool. This study was registered in PROSPERO (CRD42023430073). There were 7,657 patients from 22 RCTs included. Compared with the control group, patients who received RIC did not have improved mRS functional outcomes, regardless of whether they received medical management, reperfusion therapy with intravenous thrombolysis (IVT), or mechanical thrombectomy (MT). In the medical management group, patients who received RIC had decreased incidence of stroke recurrence (risk ratio 0.63, 95% CI 0.43-0.92, p = 0.02) and lower follow-up NIHSS score by 1.72 points compared with the control group (p < 0.00001). There was no increased risk of adverse events including death or cerebral hemorrhage in the IVT or medical management group. In patients with ischemic stroke who are not eligible for reperfusion therapy, RIC did not affect mRS functional outcomes but significantly improved the NIHSS score at the follow-up endpoint and reduced stroke recurrence, without increasing the risk of cerebral hemorrhage or death. In patients who received IVT or MT, the benefit of RIC was not observed.

Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study.

Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown. Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model. In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation. The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

Maternal childhood trauma and observed maternal care behaviors with 4-month-old infants.

To examine the relationship between maternal childhood trauma and early maternal caregiving behaviors (MCB). Participants included 74 mother-infant dyads (maternal age 20-45 years; ethnicity 64.9% Latina) from a longitudinal pregnancy cohort study. Maternal childhood trauma was assessed during pregnancy with the childhood trauma questionnaire (CTQ). Observed mother-infant interactions at infant age 4 months were coded utilizing modified Ainsworth's MCB rating scales that assessed a range of behaviors (e.g., acceptance, soothing, and delight) which we analyze grouped together and will summarize using the term "maternal sensitivity." Linear regressions tested the associations between maternal childhood trauma and MCB. Primary analyses examined the relationships of MCB with (a) any maternal childhood trauma (moderate or greater exposure to physical abuse, sexual abuse, emotional abuse, physical neglect, and/or emotional neglect) and (b) cumulative childhood trauma. Secondary analyses examined the relationships between each type of childhood trauma and MCB. Exposure to childhood trauma was not associated with MCB (p = .88). Cumulative childhood trauma score was associated with lower scores on MCB (β = -1.88, p < .05). Emotional abuse and emotional neglect were individually associated with lower scores on MCB (β = -1.78, p = .04; β = -1.55, p = .04, respectively). Physical abuse, sexual abuse, and physical neglect were not associated with MCB. Many mothers exposed to childhood trauma may be resilient to negative effects on parenting behaviors, while specific experiences of childhood trauma (emotional abuse, emotional neglect, and cumulative childhood trauma) may predict less sensitive early parenting behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Construction of RNA Methylation Modification-immune-related lncRNA Molecular Subtypes and Prognostic Scoring System in Lung Adenocarcinoma.

RNA methylation modification is not only intimately interrelated with cancer development and progression but also actively influences immune cell infiltration in the tumor microenvironment (TME). RNA methylation modification genes influence the therapeutic progression of lung adenocarcinoma (LUAD), and mining RNA methylation modification prognosis-related markers in LUAD is crucial for its precise prognosis. RNA-Seq data and Gene sets were collected from online databases or published literature. Genomic variation analysis was conducted by the Maftools package. RNA methylation-immune-related lncRNAs were obtained by Pearson correlation analysis. Then, Consistent clustering analysis was performed to obtain RNA methylation modification- immune molecular subtypes (RMM-I Molecular subtypes) in LUAD based on selected lncRNAs. COX and random survival forest analysis were carried out to construct the RMM-I Score. The receiver operating characteristic (ROC) curve and Kaplan Meier survival analysis were used to assess survival differences. Tumor immune microenvironment was assessed through related gene signatures and CIBERSORT algorithm. In addition, drug sensitivity analysis was executed by the pRRophetic package. Four RNA methylation modified-immune molecular subtypes (RMM-I1, RMM- I2, RMM-I3, RMM-I4) were presented in LUAD. Patients in RMM-I4 exhibited excellent survival advantages and immune activity. HAVCR2, CD274, and CTLA-4 expression were activated in RMM-I4, which might be heat tumors and a potential beneficial group for immunotherapy. OGFRP1, LINC01116, DLGAP1-AS2, CRNDE, LINC01137, MIR210HG, and CYP1B1-AS1 comprised the RMM-I Score. The RMM-I Score exhibited excellent accuracy in the prognostic assessment of LUAD, as patients with a low RMM- I Score exhibited remarkable survival advantage. Patients with a low RMM-I score might be more sensitive to treatment with Docetaxel, Vinorelbine, Paclitaxel, Cisplatin, and immunotherapy. The RMM-I molecular subtype constituted the novel molecular characteristic subtype of LUAD, which complemented the existing pathological typing. More refined and accurate molecular subtypes provide help to reveal the mechanism of LUAD development. In addition, the RMM-I score offers a reliable tool for accurate prognosis of LUAD.

Comparison of firocoxib and meloxicam for pain mitigation in goats undergoing surgical castration.

This study sought to determine whether firocoxib (FIRO) or meloxicam (MEL) was effective at providing analgesia after surgical castration in goats. 18 intact male crossbred goats (6 to 8 months old) were enrolled with a mean weight of 32.6 (± 2.9) kg. Surgical castration was done under injectable anesthesia by a licensed veterinarian. Twelve bucks were surgically castrated and given either FIRO (n = 6) or MEL (n = 6). Six bucks served as controls (CNTLs) and were not castrated. Outcome measurements included visual analogue scale, infrared thermography, plasma cortisol, plasma substance P, and kinetic gait analysis. All outcome measurements were obtained at -24, 4, 8, 24, 48, and 72 hours. All 3 treatments were significantly different from each other at the 24- and 48-hour time points, with MEL animals having lower visual analogue scale scores when compared to FIRO animals; CNTL animals exhibited the lowest plasma cortisol levels (3.19 ng/mL; 95% CI, -1.21 to 7.59 ng/mL) followed by FIRO (7.45 ng/mL; 95% CI, 3.10 to 11.80 ng/mL) and MEL (10.24 ng/mL; 95% CI, 5.87 to 14.60 ng/mL). FIRO had an average mean decrease in gait velocity change (-54.17 cm/s; 95% CI, -92.99 to -15.35 cm/s), while MEL had an increase in gait velocity when compared to baseline values (14.54 cm/s; 95% CI, -24.27 to 53.36 cm/s). Control animals had an average mean of -3.06 cm/s (95% CI, -41.88 to 35.75 cm/s). Results from this study showed that there were some analgesic effects from administering MEL when compared to bucks that received a placebo treatment (CNTL).

The acceptability, feasibility, and preliminary effectiveness of group cognitive behavioral therapy for Chinese children with posttraumatic stress disorder: A pilot randomized controlled trial.

The psychological need for traumatized children is huge in China. However, evidence-based treatments designed for Chinese children are scarce. This study aimed to test the feasibility and preliminary effectiveness of a cognitive-behavioral program (Power up Children's Psychological Immunity; PCPI) in Chinese children. A total of 87 children with posttraumatic stress disorder (PTSD) symptoms in grades 3 to 5 were randomly allocated (1:1) to the PCPI group or the treatment as usual (TAU) group. The feasibility was assessed by participant adherence, satisfaction, and acceptability. The severity of PTSD, depression and anxiety were assessed at pre- and posttreatment and the 3-month follow-up. A high level of satisfaction (81.82%) and retention rate of each session (more than 93.33%) were found. Qualitative feedback reported a high level of acceptance. At posttreatment, the PCPI group had lower mean scores than the TAU group for PTSD (adjusted mean difference [AMD], -6.18; 95% CI, -12.21 to -.14; p = .048), and anxiety (AMD, -2.05; 95% CI, -3.81 to -.28; p = .026). However, little change was found from posttreatment to 3-month follow-up. The findings indicated that the school-based group PCPI intervention was feasible and acceptable. Further evaluation is needed to examine its effectiveness in a larger sample size. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preoperative Temporary Fixation for Fractures around the Ankle Using a Simple Extensible External Fixator Significantly Improves Patient Comfort

BackgroundThe authors developed a simple extensible external fixator, which has the advantages of easy application and inexpensiveness. The present study aimed to make a comparison between this external fixator and calcaneal traction in preoperative temporary fixation for malaligned ankle fractures and pilon fractures. MethodsFrom May 2020 to February 2022, patients with malaligned ankle fractures or Rüedi-Allgöwer type 2 or 3 pilon fractures with obvious soft tissue swelling were retrospectively reviewed and divided into the calcaneal traction group and the external fixation group. The two groups of patients were matched 1:1 before making comparisons. ResultsA total of 38 patients were included. Higher General Comfort Questionnaire score and lower visual analog scale score were noticed in the external fixation group during hospitalization (p<0.05), while the operation latency time, total cost, patient satisfaction, and functional outcomes one year after surgery were not significantly different between the two groups. No wound complications were observed. ConclusionPreoperative temporary fixation for fractures around the ankle using this simple extensible external fixator significantly improves patient comfort when compared to calcaneal traction. Level of EvidenceIII, retrospective comparative study.

Identification of Novel Stemness-based Subtypes and Construction of a Prognostic Risk Model for Patients with Lung Squamous Cell Carcinoma.

Although cancer stem cells (CSCs) contribute to tumorigenesis, progression, and drug resistance, stemness-based classification and prognostic signatures of lung squamous cell carcinoma (LUSC) remain unclarified. This study attempted to identify stemness-based subtypes and develop a prognostic risk model for LUSC. Based on RNA-seq data from The Cancer Genome Atlas (TCGA), Gene-Expression Omnibus (GEO) and Progenitor Cell Biology Consortium (PCBC), mRNA expression-based stemness index (mRNAsi) was calculated by one-class logistic regression (OCLR) algorithm. A weighted gene coexpression network (WGCNA) was employed to identify stemness subtypes. Differences in mutation, clinical characteristics, immune cell infiltration, and antitumor therapy responses were determined. We constructed a prognostic risk model, followed by validations in GEO cohort, pan-cancer and immunotherapy datasets. LUSC patients with subtype C2 had a better prognosis, manifested by higher mRNAsi, higher tumor protein 53 (TP53) and Titin (TTN) mutation frequencies, lower immune scores and decreased immune checkpoints. Patients with subtype C2 were more sensitive to Imatinib, Pyrimethamine, and Paclitaxel therapy, whereas those with subtype C1 were more sensitive to Sunitinib, Saracatinib, and Dasatinib. Moreover, we constructed stemness-based signatures using seven genes (BMI1, CCDC51, CTNS, EIF1AX, FAM43A, THBD, and TRIM68) and found high-risk patients had a poorer prognosis in the TCGA cohort. Similar results were found in the GEO cohort. We verified the good performance of risk scores in prognosis prediction and therapy responses. The stemness-based subtypes shed novel insights into the potential roles of LUSC-stemness in tumor heterogeneity, and our prognostic signatures offer a promising tool for prognosis prediction and guide therapeutic decisions in LUSC.

317 Automated Diffusion Tensor Tractography: Quantitative Tract Counts Predict 90-Day Change in Motor Function by Baseline Deficit in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

INTRODUCTION: Ischemic stroke causes persistent motor deficits in roughly half of survivors. Although mechanical thrombectomy (MT) optimizes stroke outcomes, not all patients improve. Commercially available diffusion tensor tractography (DTT) software increases access to robust tractometric software. Automation and seamless clinical integration of diffusion tensor imaging (DTI) and tractography protocols standardizes data acquisition in high-throughput and high-resolution manners. METHODS: Between June 2020 and 2021, a total of 28 patients with M1 and M2 ischemic strokes underwent a standardized DTT protocol following MT. Patients were stratified by their baseline deficits, defined as the averaged upper and lower extremity motor testing scores at the time of initial presentation (MTS severe = 0, intermediate = 0.5–3.5, and mild = 4+). Multivariable linear regression analysis included demographics, clinical characteristics, and tractometrics of the lesioned CST with MTS at 90-days as the outcome. RESULTS: There were 12 patients with severe, 12 with intermediate, and 4 with mild baseline deficits. Stratification by baseline deficits revealed no significant difference between mean effected tract counts (5.20, 5.08, and 5.78 in the severe, intermediate, and mild groups, respectively, p = 0.377). When controlling for demographics and clinical characteristics, baseline deficits (β = -0.838, SE = 0.913, p &lt; 0.001) and effected mean tract count (β = 1.755, SE = 0.407, p = 0.001) of the CST significantly predicted the change in MTS at 90-day follow-up (adjusted R2 = 0.727 p = 0.002). CONCLUSIONS: Our study suggests automated tractometrics predict the change in motor function at 90 days when controlling for the patient’s baseline motor deficit. Although larger cohort studies should be conducted, commercially available DTI software could yield novel avenues into rehabilitation optimization for post-stroke patients with persistent motor deficits.

SiReN: Sign-Aware Recommendation Using Graph Neural Networks.

In recent years, many recommender systems using network embedding (NE) such as graph neural networks (GNNs) have been extensively studied in the sense of improving recommendation accuracy. However, such attempts have focused mostly on utilizing only the information of positive user-item interactions with high ratings. Thus, there is a challenge on how to make use of low rating scores for representing users' preferences since low ratings can be still informative in designing NE-based recommender systems. In this study, we present SiReN, a new Sign-aware Recommender system based on GNN models. Specifically, SiReN has three key components: 1) constructing a signed bipartite graph for more precisely representing users' preferences, which is split into two edge-disjoint graphs with positive and negative edges each; 2) generating two embeddings for the partitioned graphs with positive and negative edges via a GNN model and a multilayer perceptron (MLP), respectively, and then using an attention model to obtain the final embeddings; and 3) establishing a sign-aware Bayesian personalized ranking (BPR) loss function in the process of optimization. Through comprehensive experiments, we empirically demonstrate that SiReN consistently outperforms state-of-the-art NE-aided recommendation methods.

Lesson plan analysis protocol in assessing mathematics and science lessons

Lesson planning is important in an educational setting. This study assessed how Rwandan tutors and teachers prepare lesson plans (LPs) before implementing them in a classroom. We employed a current and standard lesson plan analysis protocol (LPAP) developed by researchers from Rwanda to code data. We collected a representative sample of 119 mathematics and science subject lesson plans from teacher training college tutors and secondary school teachers for analysis to serve its usability. The study results revealed that only 11% of collected LPs were teachable as they were rated in both a good (70-79% scores) and very good (80-89% scores) range of LPAP interpretation. It was also found that the special education needs, lesson approaches, and lesson evaluation components got low mean scores (below 50%). These components were not given appropriate attention in developed LPs. Therefore, this study suggests that tutors and teachers build a quality lesson plan based on the standard LPAP.

Efficacy of bilateral catheter superficial parasternal intercostal plane blocks using programmed intermittent bolus for opioid-sparing postoperative analgesia in cardiac surgery with sternotomy: A randomized, double-blind, placebo-controlled trial

Study objectiveThis study investigated whether catheter superficial parasternal intercostal plane (SPIP) blocks, using a programmed intermittent bolus (PIB) with ropivacaine, could reduce opioid consumption while delivering enhanced analgesia for a period exceeding 48 h following cardiac surgery involving sternotomy. DesignA double-blind, prospective, randomized, placebo-controlled trial. SettingUniversity-affiliated tertiary care hospital. Patients60 patients aged 18 or older, scheduled for cardiac surgery via sternotomy. InterventionsThe patients were randomly assigned in a 1:1 ratio to either the ropivacaine or saline group. After surgery, patients received bilateral SPIP blocks for 48 h with 0.4% ropivacaine (20 mL per side) for induction, followed by bilateral SPIP catheters using PIB with 0.2% ropivacaine (8 mL/side, interspersed with a 2-h interval) or 0.9% normal saline following the same administration schedule. All patients were administered patient-controlled analgesia with hydromorphone. MeasurementsThe primary outcome was the cumulative morphine equivalent consumption during the initial 48 h after the surgery. Secondary outcomes included postoperative pain assessment using the Numeric Rating Scale (NRS) at rest and during coughing at designated intervals for three days post-extubation. Furthermore, recovery indicators and ropivacaine plasma levels were diligently documented. Main resultsCumulative morphine consumption within 48 h in ropivacaine group decreased significantly compared to saline group (25.34 ± 31.1 mg vs 76.28 ± 77.2 mg, respectively; 95% CI, −81.9 to −20.0, P = 0.002). The ropivacaine group also reported lower NRS scores at all recorded time points (P < 0.05) and a lower incidence of nausea and vomiting than the saline group (3/29 vs 12/29, respectively; P = 0.007). Additionally, the ropivacaine group showed significant improvements in ambulation (P = 0.018), respiratory exercises (P = 0.006), and self-reported analgesia satisfaction compared to the saline group (P = 0.016). ConclusionsBilateral catheter SPIP blocks using PIB with ropivacaine reduced opioid consumption over 48 h, concurrently delivering superior postoperative analgesia in adult cardiac surgery with sternotomy.

Testing a Prioritization Tool to Identify Older Adults in Need of Home-Delivered Meals and Nutrition-Related Services

The Expanded Food Security Screener (FSS-Exp) determines food insecurity risk based on physical, economic, and social access to food. It categorizes individuals into 5 priorities based on need for a home-delivered meal. Concurrent and construct validity were applied to the tool. For concurrent validity, partial correlations between FSS-Exp and health- and food-related measures were significant and ranged between 0.20 and 0.33. For construct validity, analysis of variance was used to examine scores of the health- and food-related tools by priority level. The 2 highest priority levels had significantly lower mean scores for all the health variables except for dietary intake. The FSS-Exp tool effectively identifies those most in need of meal services.

Early development of infants born prematurely who were conceived through assisted reproductive technologies

ObjectiveThis study aims to determine physical and psychomotor development characteristics during the first 24 months of life in prematurely born children conceived with assistive reproductive technologies and to determine specific risk factors for deviation from typical development. Patients and methodsThe study included 308 prematurely born children (154 conceived with assistive reproductive technologies – ART group and 154 conceived naturally – NC group) hospitalized at the Institute for the Health Care of Children and Adolescents of Vojvodina in Serbia. The physical and psychomotor development was monitored during the first two years of life. ResultsBirth weight was statistically significantly higher in the NC group than in the ART group, and IUGR was more often present in the ART group than in the NC group of newborns. The mean values of body weight, length, and head circumference of children from both groups did not differ statistically significantly at 18 months. At 12 and 18 months, children from the ART group significantly more often had below-average scores on the test for assessment of psychomotor development (corrected GDQ <90) than children from the NC group, but not at 24 months. Logistic regression analysis has shown that at 12 and 18 months, multiple pregnancy is an independent risk factor for lower GDQ. ConclusionAt the age of 12 months, prematurely born children conceived with ART do not differ in physical development from prematurely born children after natural conception. At 12 and 18 months, prematurely born children conceived with ART achieve lower global developmental scores than children conceived naturally, but not at 24 months of age. Multiple pregnancies are an independent risk factor for lower achievement on the test for assessment of psychomotor development in prematurely born children.

Mitigating Label Bias in Machine Learning: Fairness through Confident Learning

Discrimination can occur when the underlying unbiased labels are overwritten by an agent with potential bias, resulting in biased datasets that unfairly harm specific groups and cause classifiers to inherit these biases. In this paper, we demonstrate that despite only having access to the biased labels, it is possible to eliminate bias by filtering the fairest instances within the framework of confident learning. In the context of confident learning, low self-confidence usually indicates potential label errors; however, this is not always the case. Instances, particularly those from underrepresented groups, might exhibit low confidence scores for reasons other than labeling errors. To address this limitation, our approach employs truncation of the confidence score and extends the confidence interval of the probabilistic threshold. Additionally, we incorporate with co-teaching paradigm for providing a more robust and reliable selection of fair instances and effectively mitigating the adverse effects of biased labels. Through extensive experimentation and evaluation of various datasets, we demonstrate the efficacy of our approach in promoting fairness and reducing the impact of label bias in machine learning models.