Multidisciplinary Study Research Articles

Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study.

An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life. We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614. DERR1-10.2196/59203.

The Etiopathogenic Mosaic of Suicidal Behaviour.

Suicidality is among the most controversial concepts in multi-disciplinary studies worldwide, regardless of the form and approach. The etiopathological variability in suicidal ideation correlates with the heterogeneity of the clinical and behavioural patterns of self-harm attempts, which significantly impact the prognosis and quality of life of patients. The main objective of the present study was to identify and outline the spectrum of factors predisposing to suicide, with the whole suite of consequences and manifestations in ideation and behaviour. In this regard, the research literature of the last decade contains numerous articles dealing with the theoretical premises pertaining to both the statistical and the profoundly psychological and philosophical dimensions of suicide. The micro-environment favouring the clinical evolution of self-harm/self-destructive thoughts and attempts to the terminal, final act integrates individual medical-biological and psychological factors into the overall social reality. Knowledge of the whole etiopathogenic amalgam with clinical-evolutionary implications allows for the development of methods and tools for the early assessment and prevention of suicidal risk. At the same time, the present study aims to qualitatively focus on the subjective motivation declared by patients regarding the internal, individual catalyst of suicidal ideation and attempts on a predominantly psycho-social coordination.

Closing the air gap: the use of drones for studying wildlife ecophysiology.

Techniques for non-invasive sampling of ecophysiological data in wild animals have been developed in response to challenges associated with studying captive animals or using invasive methods. Of these, drones, also known as Unoccupied Aerial Vehicles (UAVs), and their associated sensors, have emerged as a promising tool in the ecophysiology toolkit. In this review, we synthesise research in a scoping review on the use of drones for studying wildlife ecophysiology using the PRISMA-SCr checklist and identify where efforts have been focused and where knowledge gaps remain. We use these results to explore current best practices and challenges and provide recommendations for future use. In 136 studies published since 2010, drones aided studies on wild animal body condition and morphometrics, kinematics and biomechanics, bioenergetics, and wildlife health (e.g. microbiomes, endocrinology, and disease) in both aquatic and terrestrial environments. Focal taxa are biased towards marine mammals, particularly cetaceans. While conducted globally, research is primarily led by institutions based in North America, Oceania, and Europe. The use of drones to obtain body condition and morphometric data through standard colour sensors and single camera photogrammetry predominates. Techniques such as video tracking and thermal imaging have also allowed insights into other aspects of wildlife ecophysiology, particularly when combined with external sampling techniques such as biologgers. While most studies have used commercially available multirotor platforms and standard colour sensors, the modification of drones to collect samples, and integration with external sampling techniques, have allowed multidisciplinary studies to integrate a suite of remote sensing methods more fully. We outline how technological advances for drones will play a key role in the delivery of both novel and improved wildlife ecophysiological data. We recommend that researchers prepare for the influx of drone-assisted advancements in wildlife ecophysiology through multidisciplinary and cross-institutional collaborations. We describe best practices to diversify across species and environments and use current data sources and technologies for more comprehensive results.

A First Randomized Eight-Week Multidisciplinary Telerehabilitation Study for the Post-COVID-19 Condition: Improvements in Health- and Pain-Related Parameters.

Background/Objectives: This study investigates the effects of multidisciplinary telerehabilitation for the post-COVID-19 condition. Methods: Recruitment was announced during 2021/22 through the COVID patient organisation in Sweden. The key inclusion criteria were persistent symptoms and functional impairments longer than 12 weeks after an acute SARS-CoV-2 infection, a stable health condition, and satisfactory skills to use the Internet. Participants were randomised into a rehabilitation group or a waiting list. Telerehabilitation was performed by a multidisciplinary team. Measured outcomes included health- and pain-related parameters and pain-related disability after eight weeks and when followed up after six months. Results: In total, 164 participants registered for the study. Of them, 67 participated in an eight-week group telerehabilitation programme (mean age 43, 78% women) and 42 stayed on a waiting list (mean age 47, 88% women) after eight weeks. Sixty participants from the rehabilitation group and 21 from the waiting list completed the data at the six-month follow-up. The results show greater improvements in both health- and pain-related parameters within the telerehabilitation group after eight weeks and six months than within the waiting list group (Cohen's d effect size varied between moderate and large). However, no statistically significant differences were found between the groups, except participants being at a lower risk of anxiety measured based on the Hospital Anxiety and Depression Scale after eight weeks of telerehabilitation compared to those on the waiting list. Conclusions: The results indicate that multidisciplinary group telerehabilitation is beneficial for improving health- and pain-related parameters in people suffering from the post-COVID-19 condition and should be further developed and adapted for similar conditions, such as chronic pain, fatigue, etc.

High Antimicrobial Susceptibility of Cloacal Enterococci and Escherichia coli from Free-Living Dalmatian and Great White Pelicans with Detection of Cefotaximase CTX-M-15 Producing Escherichia coli ST69.

Background/Objectives: In 2022, an outbreak of H5N1 highly pathogenic avian influenza (HPAI) killed 60% of the largest breeding colony of Dalmatian pelicans (DPs) in the world at Mikri Prespa Lake (Greece), prompting a multidisciplinary study on HPAI and other pathogens. This study determines the antimicrobial resistance rates of cloacal enterococci and Escherichia coli in DPs. Methods: Fifty-two blood and cloacal swab samples were collected from 31 nestlings (20 DP/11 great white pelicans) hatched after the H5N1 outbreak at the Prespa colony and 21 subadult/adult DPs captured at a spring migration stopover. The swabs were inoculated in non-selective and chromogenic-selective media. Identification was performed using MALDI-TOF, and antimicrobial susceptibility was tested. The genetic content was characterized using PCR and sequencing, and the clonality of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates was characterized using Multilocus Sequence Typing. Results: Twenty-eight non-repetitive E. coli and 45 enterococci isolates were recovered in non-selective media; most of them were susceptible to all antibiotics tested (85.7% E. coli/91.1% enterococci). Three of the fifty-two samples (6%, all adults) contained ESBL-E. coli isolates (detected in chromogenic ESBL plates), all carrying the blaCTX-M-15 gene and belonging to the lineage ST69. Conclusions: Despite the susceptibility of most fecal E. coli and enterococci isolates to all antibiotics tested, the finding that E. coli of lineage ST69 carry blaCTX-M-15 is of concern. This high-risk clone needs further investigation to elucidate its primary sources and address the growing threat of antimicrobial resistance from an integrated "One Health" perspective. Furthermore, it is imperative to study the potential impacts of ESBL-E. coli on the endangered DP further.

Temporal Evolution of the Hydrodynamics of a Swimming Eel Robot Using Sparse Identification: SINDy-DMD

Anguilliform swimming is one of the most complex locomotion modes, involving various interacting phenomena, necessitating multidisciplinary studies. Eel robots are designed to incorporate biological principles and achieve efficient locomotion by replicating natural anguilliform swimming. These robots are simpler to engineer and study compared to their natural counterparts. Nevertheless, characterizing the robot–environment interaction is complex, demanding computationally expensive fluid dynamics simulations. In this study, we employ machine learning strategies to investigate the temporal evolution of the system and discover a data-driven model. Three methods were studied, including dynamic mode decomposition (DMD), sparse system identification (SINDy using PySINDy package), and autoencoder neural network (AE NN), as a general function approximator. The models were simulated using MATLAB® R2022 to obtain the prediction errors. The results show that the SINDy model presents less error within the regression range and performs better in extrapolation. Additionally, the SINDy model has a compact form and can explicitly formulate the coupling phenomena amongst the modes. Thus, instead of the standard DMD, we propose the SINDy-DMD approach to describe the anguilliform locomotion of the soft robot. The identified model was employed to recover the system state data matrix. It is concluded that the proposed model with quadratic terms provides a parsimonious representation of the system dynamics.

Infection-Related Stillbirths: A Detailed Examination of a Nine-Year Multidisciplinary Study.

Although several conditions and specific risk factors have been associated with stillbirth (SB), in most of the cases it is difficult to identify the definitive etiopathology and cause of death. Specifically, the role of infections in SB is still debated. Our aim was to study maternal, placental, and fetal tissues in cases of SB in order to define the causative link between infections and fetal death, through a multidisciplinary clinical audit. Between 2014 and 2022, microbiological investigations on maternal, placental and fetal samples of SB cases were performed according to a standardized protocol including serology, cultures, and molecular biology. Autopsies and placental examination were mandatory in all SB cases. A total of 182 cases of SB were investigated. Bacteria were detected in 22.2% of vaginal swabs, 65% of placental biopsies, 29% of fetal blood, and 14.1% of oropharyngeal swabs. Vaginal and oropharyngeal swabs were positive for urogenital mycoplasmas in 25.2% and 8.6%, respectively. Positive results of microbiological investigations, in association with histological features suggestive of infection, were observed in six cases, indicating that fetal death was likely related to a bacterial infection. In one case, a high SARS-CoV-2 load was found in the placenta of a SB due to placental abruption. Infections were likely associated with fetal death in 3.8% of cases. Thus, in developed countries, an infection, defined when positive microbiological findings are associated with histological evidence of organ damage, is a minor contributory factor in SB.

Exploring the Relationship Between Sleep Apnea, Myocardial Infarct Size, and Coronary Collaterals in Acute Myocardial Infarction: A Multidisciplinary Study.

We designed a study investigating the cardioprotective role of sleep apnea (SA) in patients with acute myocardial infarction (AMI), focusing on its association with infarct size and coronary collateral circulation. We recruited adults with AMI, who underwent Level-III SA testing during hospitalization. Delayed-enhancement cardiac magnetic resonance (CMR) imaging was performed to quantify AMI size (percent-infarcted myocardium). Rentrop Score quantified coronary collateralization (scores 0-3, higher scores indicating augmented collaterals). Group differences in Rentrop grade and infarct size were compared using the Wilcoxon Rank-Sum test and Fisher's Exact test as appropriate, with a significance threshold set at p <0.05. Among 33 adults, mean age was 54.4±11.5 and mean BMI was 28.4±5.9. 8 patients (24%) had no SA, and 25 (76%) had SA (mild n=10, moderate n=8, severe n=7). 66% (n=22) underwent CMR, and all patients had Rentrop scores. Median infarct size in the no-SA group was 22% versus 28% in the SA group (p=0.79). While we did not find statistically significant differences, moderate SA had a trend toward a smaller infarct size (median 15.5%; IQR 9.23) compared to the other groups (no SA [22.0%; 16.8,31.8], mild SA [27%; 23.8,32.5], and severe SA [34%; 31.53], p=0.12). A higher proportion of moderate SA patients had a Rentrop grade >0, with a trend toward significance (moderate SA versus other groups: 62.5% versus 28%, p=0.08). Our study did not find statistically significant differences in cardiac infarct size and the presence of coronary collaterals by sleep apnea severity among patients with AMI. However, our results are hypothesis-generating, and suggest that moderate SA may potentially offer cardioprotective benefits through enhanced coronary collaterals. These insights call for future research to explore the heterogeneity in ischemic preconditioning by SA severity and hypoxic burden to guide tailored clinical strategies for SA management in patients with AMI.

Sand and dust storms: a growing global health threat calls for international health studies to support policy action.

Sand and dust storms increasingly threaten global environmental and public health. To date, 150 countries are directly affected, with more than 100 classified as non-dust source regions. With climate change, these storms are expected to become more frequent and severe. Despite international awareness and initiatives, such as those led by the UN, crucial knowledge gaps continue to hinder effective, evidence-based public responses to sand and dust storms. In this Viewpoint, we review existing gaps in health research and highlight four key research priorities: the comprehensive health effects of sand and dust storms, including short-term and long-term exposures, diseases, regions, and health outcomes; the key particle sizes and toxic components of particles during sand and dust storms; the design of multicentre studies accounting for region-specific exposure patterns; and research on health outcomes attributable to particulate matter mixtures dominated by windblown dust versus other sources. We urgently call for international, collaborative, and multidisciplinary health studies considering sand and dust storm exposure characteristics and for the adoption of scientifically robust epidemiological methods in these studies.

The development of preterm infants from low socio-economic status families: The combined effects of melatonin, autonomic nervous system maturation and psychosocial factors (ProMote): A study protocol.

Preterm births constitute a major public health issue and a chronic, cross-generational condition globally. Psychological and biological factors interact in a way that women from low socio-economic status (SES) are disproportionally affected by preterm delivery and at increased risk for the development of perinatal mental health problems. Low SES constitutes one of the most evident contributors to poor neurodevelopment of preterm infants. Maternal perinatal mental health disorders have persistent effects on behavioral and physiological functioning throughout the lifespan and may even be evident across generations. The overall objective of the proposed longitudinal, multi-disciplinary and multi-method study is to compare the association of psychosocial (maternal mental health, intersubjectivity, attachment, family functioning, dyadic coping and perceived social support), and biological factors (melatonin and heart rate variability) with preterm infants' development at 9 months (corrected age), between low and high SES families. We will collect data from preterm neonates (<37 weeks gestational age) hospitalized in the Department of Neonatology/Neonatal Intensive Care Unit of the University General Hospital of Heraklion, Greece, and their mothers. Data collection of psychosocial and biological factors will be carried out at birth, and at the corrected age of 6 and 9 months, while preterm infants' cognitive and social development will be assessed at 9 months corrected age. The findings of this study may highlight the need for early interventions for new mothers coming from low SES in order to promote their preterm infants' optimal early neurodevelopment and for community-evidence-based prevention efforts to restrict the cycle of health inequities and intergenerational mental disorders.

A multi-disciplinary study of yttrium effect on the electronic structure of hafnia

A multi-disciplinary study of yttrium effect on the electronic structure of hafnia

Research Status and Development Trends of Inorganic Salt Lake Resource Extraction Based on Bibliometric Analysis

Salt lake resources are unique and valuable minerals on Earth associated with specific elements. The advancement of technology and the rise of new industries are progressively showcasing their strategic significance for economic development. This study used bibliometrics and visualization techniques to analyze the current state and developmental trends of research on salt lake resource exploitation, both domestically and globally. A total of 760 articles from Science Citation Index Expanded (SCIE) were analyzed. The research findings reveal that the processes of salt lake separation and extraction have progressed through three distinct stages: the germination stage, the stable development stage, and the rapid development stage. China has offered robust policy support for research in this domain at the national level. China possesses a centrality score of 1.08 in the separation and extraction of salt lakes, with 50% of the 10 most active nations in this domain situated in Asia and South America. The prominent institutions comprise the Chinese Academy of Sciences (centrality score of 0.32), the Qinghai Salt Lake Study Institute (centrality score of 0.22), and the University of the Chinese Academy of Sciences (centrality score of 0.14), encompassing a diverse array of study subjects. Keywords from 2003 signify the initial advancement of lithium extraction from saline lakes, whereas those from 2011 underscore the heightened focus on integrated resource utilization and multidisciplinary study. Keywords from 2015 indicate an intensified emphasis on the extraction of lithium and other elements. The terms “tributyl phosphate” (citation strength of 6.05) and “nanofiltration” (citation strength of 4.29) exhibit significant interest in magnesium–lithium separation research and water treatment technologies employed in salt lake separation and extraction, receiving the highest number of citations. The persistent emphasis on “lithium ions” signifies the increasing demand for raw materials propelled by advancements in the new energy sector. Research trend analysis indicates that sodium resource utilization has stabilized, whereas magnesium, a byproduct of lithium extraction, is presently a key focus for downstream product applications. Rare elements remain at the experimental research stage. The industrialization of salt lake resources, including potassium, lithium, and boron, is notably advanced. Future research should focus on the mineralization and enrichment patterns of potassium resources, developing improved extraction methods for lithium, and advancing technologies for the cost-effective and environmentally friendly separation of boron resources. The future objective for resource extraction in salt lakes is to transition from a crude methodology to a refined, sustainable, and intelligent development framework.

Therapeutic Insights into Black Pepper (Piper nigrum): Phytochemical Composition, Bioactive Properties, and Health Benefits

Black pepper (Piper nigrum L.), hailed as the "King of Spices," holds a prominent place not only in culinary practices but also in traditional and modern medicine. This review brings together new information about the different phytochemicals in black pepper, its bioactive properties, and its medical uses. It focuses on piperine and essential oils, which are two of its main bioactive components. The spice encompasses a rich composition of alkaloids, terpenoids, phenolics, and flavonoids, contributing to its antioxidant, antimicrobial, anti-inflammatory, and anticancer activities. The botanical characteristics, cultivation patterns, and economic importance of Piper nigrum are reviewed, alongside its extensive use in treating respiratory conditions, gastrointestinal disorders, and inflammation. The bioavailability-enhancing effects of piperine, which amplify the absorption of drugs and nutrients, are emphasized. Also, black pepper essential oil has many health benefits, such as protecting neurons, lowering blood sugar, and fighting cancer. These benefits are mostly due to compounds like β-caryophyllene, sabinene, and limonene. While the pharmacological potential of black pepper is well-recognized, this review highlights critical research gaps, including the need for standardized methodologies and robust clinical trials. By synthesizing data from multidisciplinary studies, this work provides a comprehensive outlook on the multifaceted applications of black pepper, laying a foundation for future innovations in health and industry.

Cognition and Quality of Life in Parkinson's Disease

Parkinson's disease is a neurodegenerative disease known for its progressive prognosis which may be associated with delay in diagnosis. Its etiology can be composed of different modalities involving genetic, psychiatric, and social factors. Findings and observations from clinical settings, motor symptoms such as bradykinesia, tremor, and rigidity have been reported. In addition, non-motor symptoms, such as depression and cognitive dysfunctions have been demonstrated. Moreover, decrease in quality of life has been reported in people with Parkinson’s disease diagnosis. Although multidisciplinary studies on Parkinson's disease indicated general the molecular and radiological findings of the disease, inconsistent data are reported in terms of modalities such as cognitive functioning, depression, and quality of life. The present study aims to present the current perspective in the context of quality of life by examining the findings reported in the cognitive and psychiatric context of Parkinson's disease. According to the findings of this study, cognitive impairments that can be identified based on the course of the disease, manifesting in various forms such as attention, memory, and visual-spatial skills, negatively impact the quality of life for patients. The emergence of depression or depression-like symptoms can further decrease the overall quality of life for individuals diagnosed with Parkinson's disease.

Restoration of Posidonia oceanica Meadow Using Cuttings from an Area Impacted by Harbor Extension Project

In the Mediterranean Sea, restoration of marine habitats has mostly focused on the endemic seagrass Posidonia oceanica. Despite several transplanting experiments, large-scale projects are rare, and their success is poorly known. The present work describes a restoration project of a large, degraded area in northern Sardinia (Italy) using cuttings harvested from a donor meadow that was destined for destruction due to harbor expansion. The receiving site was selected through a multidisciplinary study including acoustic mapping, ROV surveys, sediment assessment, and analyses of satellite images across ten years to evaluate the site suitability. Plants were manually uprooted from the donor meadow and cuttings were selected and transplanted within 24 h by environmental engineering techniques. The cuttings were transplanted onto degradable mats of natural coconut nets coupled with a double-twist steel mesh and anchored to the bottom. Overall, 7000 patches, each containing 20 cuttings, were transplanted in three periods: June–July 2022, October–November 2022, and February–March 2023. One year after the restoration, all the patches were in situ, with an overall cutting survival of 59%. The results are comparable to those of previous small-scale projects using the same technique and also endorse its suitability for the restoration of large, degraded areas.

The VExUS score and mortality in patients with Acute Kidney Injury: findings from a multidisciplinary prospective study.

The utility of the venous excess ultrasound (VExUS) score in predicting mortality remains uncertain in acute kidneyinjury (AKI) patients. This was a post-hoc study involving 246 AKI patients presenting to a tertiarycare emergency department. Venous ultrasound assessments were conducted to determine the VExUS score. Cox regressionanalysis was used to identify predictors of 6-month mortality. The study found no significant association between theVExUS score and 6-month mortality in AKI patients in the regression analyses. However, in the subgroup analyses, VExUSgrades 2-3 were associated with lower survival rates in the cardiorenal subgroup (HR: 3.98 [95% CI: 1.33-11.93]), and in AKIgrade 1 (HR: 4.07 [95% CI: 1.74-9.49]). This association was not present in other AKI subgroups. The predictors of mortalityincluded higher age (OR: 1.024; 95% CI 1.005-1.043), malignancy (OR: 2.186; 95% CI 1.408-3.392), lower systolic bloodpressure (OR: 0.990; 95% CI 0.982-0.998), elevated pulse (OR: 1.013; 95% CI 1.005-1.022), and higher lactate levels (OR:1.210; 95% CI 1.097-1.334). The VExUS score did not predict 6-month mortality in the general cohort of AKIpatients in the emergency department. However, VExUS grades 2-3 were associated with lower survival rates in the cardiorenalsubgroup and patients with AKI grade 1.

Scope 2 estimates of carbon dioxide emissions from electricity consumption at the US census block group scale

This paper introduces and describes a dataset representing United States carbon dioxide (CO2) emissions from electricity consumption (scope 2 CO2 emissions) for the 2019–2021 time period separately for the residential, commercial, and industrial sectors. The spatial resolution is the U.S. census block group at annual time resolution. We also provide state-scale aggregate data. Given the increased interest in greenhouse gas mitigation at the urban landscape scale, this data offers the opportunity to better understand the emitting landscape and craft more targeted, efficient policy instruments. The approach starts with well-established estimates of scope 2 CO2 emissions at larger scales and performs a series of downscaling steps to allocate scope 2 emissions into block groups. This open-access scope 2 CO2 emissions dataset and methodology is valuable for a wide range of multidisciplinary studies, including climate science, environmental policy, urban planning, and socioeconomic research.

Study Protocol Evaluating Breastfeeding for Mother-Infant Dyads Experiencing Infant Ankyloglossia.

Tongue-tie is associated with nipple pain and early breastfeeding cessation. To date, research has been limited by small sample sizes and a dearth of evidence on the effects of tongue-tie on infant feeding symptoms and physiologic breastfeeding mechanics. In this article, we describe the protocol for our study exploring infant feeding, negative breastfeeding symptoms, maternal anatomy, and physiologic sucking data between infants with and without tongue-tie. A prospective cohort study design is being employed. Over 8 weeks, three visits will be conducted with a sample of mothers and their infants without tongue-tie and a sample of mothers and their infants diagnosed with tongue-tie undergoing treatment via frenotomy. The aims of the study are to compare breastfeeding symptoms, breast anatomy, infant feeding symptoms, feeding efficiency, and nutritive sucking parameters between infants with and without tongue-tie, further comparing these metrics pre- and post-treatment via frenotomy with the non-tongue-tied age-matched counterparts. This study is currently ongoing. Tongue-tie is an everyday problem; clear guidelines are needed to decide whether to treat it. This novel, innovative, and multidisciplinary research study aims to fill critical gaps in understanding the physiological and functional effects of tongue-tie on breastfeeding, offering evidence to inform better clinical decisions and support effective interventions.

Integrating Metadiscourse Analysis with Transformer-Based Models for Enhancing Construct Representation and Discourse Competence Assessment in L2 Writing: A Systemic Multidisciplinary Approach

In recent years, large-scale language test providers have developed or adapted automated essay scoring systems (AESS) to score L2 writing essays. While the benefits of using AESS are clear, they are not without limitations, such as over-reliance on frequency counts of vocabulary and grammar variables. Discourse competence is one important aspect of L2 writing yet to be fully explored in AEE application. Evidence of discourse competence can be seen in the use of Metadiscourse Markers (MDM) to produce reader-friendly texts. The article presents a multidisciplinary study to explore the feasibility of expanding the construct representation of automated scoring models to assess discourse competence in L2 writing. Combining machine learning, automated textual analysis and corpus-linguistic methods to examine 2000 scripts across two tasks and five proficiency levels, the study investigates (1) in addition to frequency and range, whether accuracy of MDM is worth pursuing as a predictive feature in L2 writing, and (2) how identification and classification of MDM use might be fed into developing an automated scoring model using machine learning techniques. The contributions of this study are three-fold. Firstly, it offers valuable insights within the context of Explainable AI. By integrating MDM usage and accuracy into the scoring framework, this research moves beyond frequency-based evaluation. This study also makes significant contributions to the current understanding of L2 writing development that even lower-proficiency learners exhibit evidence of discourse competence through their accurate use of MDMs as well as their choice of MDMs in response to genre. From the perspective of expanding the construct representation in automated scoring systems, this study provides a critical examination of the limitations of many AEE models, which have heavily relied on vocabulary and grammar features. By exploring the feasibility of incorporating MDMs as predictive features, this research demonstrates the potential for construct expansion of L2 AEE. The results would support test providers in developing competence tests in various contexts and domains including manufacturing, medicine and so on.

A Photo-Narrative Intervention for Children With Severe Neurological Impairment in the PICU.

Parents of children with severe neurological impairment (SNI) face barriers in the pediatric intensive care unit (PICU) to humanistic care. Photo-narratives are a promising strategy to share perspectives about well-being. This study describes the iterative refinement and lessons learned in adapting a photo-narrative intervention for children with SNI in the PICU. This qualitative study was conducted at an academic children's hospital. Participants included parents of children with SNI who completed the photo-narrative during interviews after their child's PICU discharge and provided feedback on intervention design, implementation, and impact. Parents then selected one to three of their child's PICU clinicians to participate. Data from sets of five parents and their corresponding clinicians were transcribed, deidentified, summarized using rapid qualitative analysis, and presented to our multidisciplinary study team who either accepted or dismissed changes. This cycle was repeated a total of three times with new participants to arrive at the final prototype. Fifteen parents and 19 clinicians participated. Parents were a median of 39 years-old (range 28-55); 20% (n = 3) were fathers. Over half (n = 11) of clinicians had >5 years in their profession. Themes of refinement focused on: enhancing flexibility and ease for families; eliciting information to diminish disability-based biases; and streamlining integration in the PICU environment. Lessons learned included the ability of photos to share family perspectives on quality-of-life, contextualize the child's health status, and enhance child-clinician connection. Themes and lessons learned from the successful adaptation and refinement of a photo-narrative can inform other interventions designed to humanize care.