Standard Protocol Research Articles

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial

Background Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. Objective The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. Methods This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Results Approval was granted by the university’s institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Conclusions Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant’s progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults’ compliance and engagement in intensive longitudinal studies. International Registered Report Identifier (IRRID) DERR1-10.2196/57664

Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?

OBJECTIVES: To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed if intrawound vancomycin powder modified the association of closed surgical drains with infection. METHODS: Design: Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO) trial. Setting: 36 academic trauma centers. Patient Selection Criteria: All patients with high-risk tibia fractures (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon’s discretion. Patients were randomly assigned to received 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center. Outcome Measures and Comparisons: Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder. RESULTS: Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% versus 8%, p=0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction p=0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% CI, 6% to 19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% CI, 2% to 17%, p=0.01). CONCLUSIONS: This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used. LEVEL OF EVIDENCE: Level III

Evaluation of the Effectiveness of Neonatal Resuscitation Protocols in Reducing Infant Mortality

A systematic review was carried out on the scientific production related to neonatal resuscitation protocols and their impact on infant mortality, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology. The main purpose of this analysis was to identify and characterize the relevant publications registered in the Scopus and WoS databases, evaluating their scope and contribution to the study of these critical variables in neonatal health. During the review process, 28 publications were initially identified that addressed the topic, which were refined through the use of specific keywords, such as Neonatal Resuscitation Protocols and Infant Mortality. After excluding duplicates and documents that did not meet the inclusion criteria, a total of 17 studies were selected for detailed analysis. The identification and evaluation of these publications made it possible to observe global trends in research on the effectiveness of neonatal resuscitation protocols. A key finding was that, although standardized protocols have proven to be fundamental tools for reducing infant mortality, their effectiveness is conditioned by contextual factors such as the training of health personnel, the availability of technological resources, and inequalities in access to neonatal health services. This analysis confirmed that, in low- and middle-income countries, structural barriers limit the effective implementation of these protocols, highlighting the need to adapt them to local realities. In addition, one of the most relevant aspects identified in the review was the increasing incorporation of technological advances in resuscitation protocols, such as the use of monitoring devices and innovative tools that optimize interventions in critically ill neonates. However, these technological developments are mostly concentrated in developed country contexts, posing a global challenge to ensure that these innovations are accessible and applicable in resource-limited regions. This approach underscores the importance of advancing equity in neonatal care through public health policies that promote universal access to essential technologies. In summary, this systematic analysis not only made it possible to identify the main characteristics of recent research, but also evidenced the need to strengthen the strategies for the implementation of neonatal resuscitation protocols to maximize their impact on the reduction of infant mortality. This work provides a solid foundation for future research and highlights priority areas for improvement, including training of medical personnel, optimization of resource use, and technological innovation adapted to diverse socio-economic contexts.

Protocol development and feasibility of the PEACH in Asia study: A pilot study on PEri‐anesthetic morbidity in CHildren in Asia

AbstractBackgroundComprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings.AimsThe PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.MethodsThis multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.ResultsThe pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2–16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource‐limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e‐CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).ConclusionsThe PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e‐CRF technical difficulties, and ensuring consistent institutional support.

Changes in the functional connections of the brain in patients with hypersomnia in acute ischemic stroke

BACKGROUND: The Disorders of cerebral circulation and sleep are inextricably related, since sleep disorders, including hypersomnia, are closely intertwined with cardiovascular diseases and increase the risk of stroke. Research works on visualization of functional brain changes in patients with sleep disorders and acute ischemic stroke are very few and need more study. AIM: to determine the functional connections of the brain in hypersomnia in patients with acute ischemic stroke by performing functional magnetic resonance imaging at rest. A study of 40 patients with acute ischemic stroke and sleep disorders was performed on the basis of the Federal State Budgetary Institution Almazov Research Center of the Ministry of Health of the Russian Federation. All patients underwent neurological examination, assessment of sleepiness, worry and depression, magnetic resonance imaging was performed on tomographs with a magnetic field induction force of 1.5T, using a standard protocol and special pulse sequences of T-gradient echo 3D MPRAGE and BOLD. Functional magnetic resonance imaging of the brain at rest was used to assess functional connections. Postprocessing was performed using specialized CONN-TOOLBOX software with an appropriate graphical representation of quantitative results based on the selection of areas of interest. RESULTS: Among the examined patients, 23 had hypersomnolence; of these, 8 patients were diagnosed with secondary hypersomnia associated with sleep apnea syndrome. Thus, in the examined sample, post-stroke hypersomnolence was detected in 15 patients (34%). Patients with an unspecified subtype of stroke and right-sided lesions showed a high degree of drowsiness (p 0.05). With the help of functional magnetic resonance imaging of the brain at rest, changes in functional connections between the main nodes of the default mode network with the left temporal pole, cerebellum, central cerebral cortex on the left, angular gyrus on the left, with the dorsal attention network on the right are determined (p 0.05). CONCLUSION: The use of complex magnetic resonance imaging, which includes structural and functional magnetic resonance imaging in patients with acute ischemic stroke and sleep disorders, allows us to identify structural changes and changes in functional connectivity and identify neuroimaging markers of this pathology. Hypersomnolence is typical for patients with an unspecified subtype of ischemic stroke and damage to the right hemisphere of the brain.

Prevalence and Association of Components of Metabolic Syndrome and Uric Acid among Commercial Drivers in South-West Nigeria

Abstract Introduction: Metabolic syndrome (MetS) is a complex cluster of metabolic abnormalities characterized by central obesity, dyslipidemia, hypertension, and impaired glucose metabolism. Emerging evidence suggests a potential link between uric acid levels and MetS, and commercial drivers are exposed to unique occupational hazards that may predispose them to MetS and hyperuricemia. Objectives: The objective of this study was to determine the prevalence of MetS and its relationship with serum uric acid among commercial drivers in Ado-Ekiti, Nigeria. Materials and Methods: A cross-sectional study was conducted among commercial drivers in Ado-Ekiti. Relevant information was obtained with a questionnaire, and anthropometry and blood pressure were measured. Fasting plasma glucose and lipid profiles were determined by the standard protocol. MetS was determined with the harmonized criteria. Bivariate correlation and Chi-square were used to determine the relationship between serum uric acid and MetS and its components. Results: There were 106 participants with a median age (interquartile range) of 50 (11) years, with no difference between those with or without MetS. More than 70% of the participants drank alcohol and 75 (70.8%) participants had hyperuricemia. There was no significant correlation between serum uric acid and components of MetS. The prevalence of MetS among all the participants was 21.7% (23/106), with no difference among men with normal uric acid (25.8%) and those with elevated uric acid (20.0%), P = 0.509. Similarly, there was no statistical difference in the prevalence of the components of MetS between the two groups. Conclusions: The prevalence of MetS among the commercial drivers was high, with no difference among men with or without hyperuricemia. Given the importance of this group of people, a system-level public health approach should be adopted to promote a healthy lifestyle to save the lives of the populace.

Bilateral Corneal Endotheliitis Following Corneal Cross-linking with Riboflavin and Ultraviolet A

Abstract This case report aims to document a case of bilateral endotheliitis occurring shortly after riboflavin-assisted cross-linking (CXL) in a young male patient with progressive keratoconus. The objective is to identify potential risk factors, treatment strategies, and outcomes while considering relevant literature on similar cases. A male in his late adolescence with bilateral progressive keratoconus underwent bilateral CXL using riboflavin and ultraviolet A light exposure. Postoperatively, the patient received moxifloxacin drops, prednisolone acetate drops, and artificial tears. Seven days later, the patient presented with decreased vision, photophobia, and corneal findings consistent with endotheliitis. Treatment with prednisolone acetate and moxifloxacin eye drops was initiated. Two months later, visual acuity deteriorated, but anterior slit-lamp findings improved, and the intraocular pressure measurement was high. Prednisolone acetate was tapered, whereas loteprednol etabonate gel, brimonidine eye drops, and cyclosporine eye drops were initiated. After 7 months, visual acuity improved, and endotheliitis resolved, although mild residual central haze persisted. This case highlights the occurrence of acute idiopathic endotheliitis following routine CXL and its successful management. Although limited cases have been reported, a standardized treatment protocol is lacking. In our patient, the utilization of loteprednol etabonate gel, cyclosporine eye drops, brimonidine eye drops, and regular follow-up examinations led to improved clinical findings and visual acuity. Further studies are warranted to establish optimal treatment approaches for similar cases of endotheliitis following CXL.

Bayesian optimization for state engineering of quantum gases

Abstract State engineering of quantum objects is a central requirement for precision sensing and quantum computing implementations. When the quantum dynamics can be described by analytical solutions or simple approximation models, optimal state preparation protocols have been theoretically proposed and experimentally realized. For more complex systems such as interacting quantum gases, simplifying assumptions do not apply anymore and the optimization techniques become computationally impractical. Here, we propose Bayesian optimization based on multi-output Gaussian processes to learn the physical properties of a Bose-Einstein condensate within few simulations only. We evaluate its performance on an optimization study case of diabatically transporting the quantum gas while keeping it in its ground state. Within a few hundred executions, we reach a competitive performance to other protocols. While restricting this benchmark to the well known Thomas-Fermi approximation for straightforward comparisons, we expect a similar performance when employing more complex theoretical models, which would be computationally more challenging, rendering standard optimal control theory protocols impractical. This paves the way for efficient state engineering of complex quantum systems including mixtures of interacting gases or cold molecules.

Epineural Scarring Visualization and Noninvasive Quantification of a Severe Posttraumatic Complication

Aim Peripheral nerve scarring is a severe yet common complication following nerve injury or surgery that can lead to impaired nerve function, including chronic pain and sensory or motor deficits. In this study, we aimed to establish high-resolution magnetic resonance neurography (MRN) to accurately visualize and monitor de novo–formed epineural fibrotic adhesions (EFAs) of the sciatic nerve in a rat nerve injury model. Methods Employing an established model to induce overshooting EFA, the study included 3 experimental groups of animals (n = 6 each): a positive control group (PC), an intervention group (IG), and a sham group. All groups underwent surgical nerve exposure: both PC and IG received an application of 10 μL 2.5% glutaraldehyde to induce EFA, but only IG received an additional preventive wrapping of the nerve with a collagen-containing matrix. Magnetic resonance imaging was performed 6, 8, and 12 weeks postoperatively using a standardized protocol including T2w and T1w without and with contrast media. Motor function and nerve regeneration was assessed using the visual static sciatic index. Histological specimens were obtained 12 weeks postoperatively and correlated with imaging. Results On high-resolution MRN, prominently contrast-enhancing epineural sleeves were present in vivo, which corresponded to histologically confirmed EFA (ratio of EFA to nerve area MRN 1.512 ± 0.106 vs histological ratio 1.459 ± 0.208, nonsignificant). As expected, average EFA in IG (0.310 ± 0.118 mm2) was smaller than in PC (0.909 ± 0.212 mm2, P < 0.01). Also, the average EFA in sham (0.386 ± 0.030 mm2) was less pronounced than in PC (P < 0.01). There was no significant difference in the average EFA between IG und sham. The EFA correlated with the functional outcome, which was measured by visual static sciatic index (correlation coefficient −0.59, P < 0.05). Conclusions The results of the present study for the first time confirm the clinical observation that epineural thickening on contrast-enhanced T1w imaging following manipulation to a nerve indeed corresponds to overshooting epineural scarring, which may be linked to impaired nerve function. This can be followed noninvasively in vivo over time providing an important basis for clinical decision-making in cases where further invasive therapies may be necessary.

Transfer learning for accurate description of atomic transport in Al-Cu melts.

Machine learning interatomic potentials (MLIPs) provide an optimal balance between accuracy and computational efficiency and allow studying problems that are hardly solvable by traditional methods. For metallic alloys, MLIPs are typically developed based on density functional theory with generalized gradient approximation (GGA) for the exchange-correlation functional. However, recent studies have shown that this standard protocol can be inaccurate for calculating the transport properties or phase diagrams of some metallic alloys. Thus, optimization of the choice of exchange-correlation functional and specific calculation parameters is needed. In this study, we address this issue for Al-Cu alloys, in which standard Perdew-Burke-Ernzerhof (PBE)-based MLIPs cannot accurately calculate the viscosity and melting temperatures at Cu-rich compositions. We have built MLIPs based on different exchange-correlation functionals, including meta-GGA, using a transfer learning strategy, which allows us to reduce the amount of training data by an order of magnitude compared to a standard approach. We show that r2SCAN- and PBEsol-based MLIPs provide much better accuracy in describing thermodynamic and transport properties of Al-Cu alloys. In particular, r2SCAN-based deep machine learning potential allows us to quantitatively reproduce the concentration dependence of dynamic viscosity. Our findings contribute to the development of MLIPs that provide quantum chemical accuracy, which is one of the most challenging problems in modern computational materials science.

Evaluating Treatment and Management Strategies for Diarrhea and Typhoid Fever in Uganda

Diarrhea and typhoid fever remain significant public health challenges in Uganda, contributing to high morbidity and mortality, particularly among vulnerable populations. This review evaluates current treatment and management strategies for these diseases, focusing on standard protocols, rehydration therapy, and the escalating issue of antibiotic resistance. Diarrhea, primarily caused by infectious agents, accounts for a substantial portion of childhood morbidity and mortality, while typhoid fever, caused by Salmonella enterica serotype Typhi, poses severe health risks, particularly in urban areas with poor sanitation. Effective management relies on timely interventions, including rehydration therapy, which significantly reduces the risk of dehydration-related complications. However, the emergence of antibiotic resistance complicates treatment efficacy, necessitating ongoing evaluation and adaptation of management strategies. This review highlights the importance of integrated public health approaches that combine treatment, prevention, and community education to address the interplay of these diseases in Uganda. Key recommendations include the exploration of novel treatment modalities, robust surveillance of resistance patterns, and understanding the impact of climate change on disease incidence. Keywords: Diarrhea, Typhoid fever, Uganda, Public health, Rehydration therapy, Antibiotic resistance.

Efficacy of a Standardized Regimen of Therapeutic Plasma Exchange and IVIG for Treatment of Antibody‐Mediated Rejection in Lung Transplant Recipients

ABSTRACTAntibody‐mediated rejection (AMR) in lung transplantation has been associated with poor long‐term clinical course and is a risk factor for chronic lung allograft dysfunction and graft loss. Appropriate management of AMR is necessary to improve graft survival in lung transplant recipients. There is currently no standardized approach to the treatment of lung AMR, and practices vary by institution. We sought to examine the efficacy of a standardized protocol of plasma exchange (PLEX) and IVIG in decreasing donor‐specific antibodies (DSAs) and improving AMR in lung transplant recipients. A retrospective chart review was conducted on all lung transplant recipients who completed a course of PLEX per UT Southwestern AMR protocol between January 2012 and December 2019 for diagnosis of AMR. Data were collected on the patient clinical course, treatment regimen, pre‐PLEX DSA, post‐PLEX DSA, follow‐up (> 1‐month post‐PLEX) DSA, and pre‐and post‐PLEX biopsy, when available. Of 527 patients who underwent lung transplantation during the study period, 56 (11%) received an acute course of PLEX every other day per protocol for AMR of lung transplant. Forty (71%) of 56 patients had one episode of AMR requiring PLEX; 16 patients (29%) had repeat episodes of AMR within 6 weeks to 47 months of the first episode. Most patients showed improvement in AMR on biopsy (69%) and a decline in DSA (68%). Our data suggest that treatment with combined PLEX and IVIG protocol appears effective for treating lung AMR.

The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial

BackgroundCNSLBP accounts for 85% of all LBP cases and impairs physical health, quality of life, and work productivity, posing a significant health and economic burden. Baduanjin (BDJ) exercises are traditional Chinese Qi Gong mind-body exercises that have been practiced for over 1,000 years. However, the standard BDJ protocol established by the State Sports General Administration does not stimulate core muscles, limiting the effectiveness of low back pain rehabilitation. Therefore, it is necessary to improve the original BDJ protocol.MethodsThis 24-week single-center, single-blind, parallel-group randomized control superiority trial will allocate 100 patients into two groups (control and intervention) at a 1:1 ratio. The patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The patients in the patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The intervention group will perform intervention. The primary outcomes will be Quebec back pain disability scale. Secondary outcomes will include visual analog scale pain scores, Surface electromyography. The assessments of the tests will be performed at four time points. Adverse events will be recorded faithfully during the study.DiscussionThis randomized control trial is the first to compare a standard BDJ protocol and an optimized protocol in patients with CNSLBP. This study can help guide rehabilitation programs.Trial registrationChinese Clinical Trial Registry, ChiCTR2200065618, Registered on 10 Nov. 2022. This protocol is the first version 1, which was approved on 26 Aug 2022.

ChatGPT-4 Omni Performance in USMLE Disciplines and Clinical Skills: Comparative Analysis.

Recent studies, including those by the National Board of Medical Examiners, have highlighted the remarkable capabilities of recent large language models (LLMs) such as ChatGPT in passing the United States Medical Licensing Examination (USMLE). However, there is a gap in detailed analysis of LLM performance in specific medical content areas, thus limiting an assessment of their potential utility in medical education. This study aimed to assess and compare the accuracy of successive ChatGPT versions (GPT-3.5, GPT-4, and GPT-4 Omni) in USMLE disciplines, clinical clerkships, and the clinical skills of diagnostics and management. This study used 750 clinical vignette-based multiple-choice questions to characterize the performance of successive ChatGPT versions (ChatGPT 3.5 [GPT-3.5], ChatGPT 4 [GPT-4], and ChatGPT 4 Omni [GPT-4o]) across USMLE disciplines, clinical clerkships, and in clinical skills (diagnostics and management). Accuracy was assessed using a standardized protocol, with statistical analyses conducted to compare the models' performances. GPT-4o achieved the highest accuracy across 750 multiple-choice questions at 90.4%, outperforming GPT-4 and GPT-3.5, which scored 81.1% and 60.0%, respectively. GPT-4o's highest performances were in social sciences (95.5%), behavioral and neuroscience (94.2%), and pharmacology (93.2%). In clinical skills, GPT-4o's diagnostic accuracy was 92.7% and management accuracy was 88.8%, significantly higher than its predecessors. Notably, both GPT-4o and GPT-4 significantly outperformed the medical student average accuracy of 59.3% (95% CI 58.3-60.3). GPT-4o's performance in USMLE disciplines, clinical clerkships, and clinical skills indicates substantial improvements over its predecessors, suggesting significant potential for the use of this technology as an educational aid for medical students. These findings underscore the need for careful consideration when integrating LLMs into medical education, emphasizing the importance of structured curricula to guide their appropriate use and the need for ongoing critical analyses to ensure their reliability and effectiveness.

Novel MRI Signs in Atlantodental Space Predict Reduction Degree of Atlantoaxial Dislocation.

The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. This study aimed to summarize cases of AAD, classified based on the atlantodental space using magnetic resonance imaging (MRI), and preliminarily explore its impact on the degree of reduction. Preoperative T2-weighted MRIs and dynamic digital radiographs of patients who underwent posterior reduction and fixation surgery for congenital AAD between September 2012 and February 2023 were collected. The patients were classified into flexible and inflexible tissue sign groups based on T2-weighted imaging. Patients with an atlantodental interval < 3 mm on extension digital radiography were considered radiographically reducible. Three radiologists read and recorded the MRI results using standard protocols. Kappa and Fleiss kappa values were used to evaluate intra- and inter-observer agreements for MRI signs and dynamic digital radiography findings. Multivariate logistic regression and receiver operating characteristic curves were used to analyze the relationships between imaging parameters and the reduction degree. In total, 118 patients with AAD were included in the analysis. Inter-observer agreement among the three readers was higher for MRI than for dynamic digital radiography (0.816 vs. 0.668). The intra-observer consistency for MRI signs was also better than that of dynamic digital radiography. Both the flexible tissue sign and radiographically reducible groups showed a higher rate of satisfactory reduction. However, only the flexible tissue sign showed positive results in the multivariate regression. The receiver operating characteristic curve for MRI signs as a predictor of satisfactory reduction yielded an area under the curve of 0.776 (95% confidence interval, 0.667-0.875, p < 0.0001). Novel MRI signs of the atlantodental space exhibited high inter- and intra-observer agreement. Patients with flexible tissue signs were more likely to achieve satisfactory reduction after direct posterior surgery.

APPLICATION OF SIZE SPECIFIC DOSE ESTIMATE (SSDE) AS A LOCAL DIAGNOSTIC REFERENCE LEVEL IN HEAD CT SCAN EXAMINATION AT INDRIATI HOSPITAL SOLOBARU, DR. MOEWARDI HOSPITAL SURAKARTA, SLEMAN HOSPITAL, AND NATIONAL BRAIN CENTER HOSPITAL JAKARTA

CT scan is a modality that produces a higher radiation dose compared to other modalities in radiodiagnostic installations. The radiation dose received by patients from examinations with this CT scan device is expressed in the volume CT Dose Index (CTDIvol) and Dose Length Product (DLP), which are dose indicators from the Indonesian Diagnostic Reference Level (DRL) value regulated in the Decree of the Head of the Nuclear Energy Regulatory Agency (BAPETEN) nationally. However, the CTDIvol value is only an indicator of the output dose from the CT scan, and the DLP value is an indicator of the total dose during the examination, which is influenced by the length of the scan. Both do not represent the specific dose received by the patient because the patient's dose depends not only on the output dose but also on the patient's characteristics. The patient's dose, which includes the output dose and patient characteristics, is called the Size-Specific Dose Estimate (SSDE), which is used to estimate the dose received by the patient by including a correction factor depending on the patient's dimensions. This study aims to calculate the SSDE value in a CT Head examination with a standard protocol using the same type of device, namely a 128-slice CT scan in several hospitals. The values of CTDIvol and DLP patients are obtained from the dose report displayed on the CT scan monitor screen in the IndoseCT software. The patient samples studied were patients undergoing CT Head examinations from March 2023 to February 2024, with 100 patients in each hospital. The results of this study obtained local DRL values based on SSDE calculated at Indriati Hospital, Moewardi Hospital, Sleman Hospital, and the National Brain Center Hospital and then compared them with the national TPD values. Based on the SSDE value from Indriati Hospital, the TPD value was 30.26 mGy, Sleman Hospital was 39.5 mGy, Dr. Moewardi Hospital was 49.3 mGy, and RSPON was 51.7 mGy. The TPD value of CT Head examinations without contrast from each hospital was still below the national TPD value of 60 mGy. Keywords: CT scan, diagnostic reference level (DRL), local DRL, national DRL, Size-Specific Dose Estimate (SSDE), IndoseCT.

Unravelling the Nexus of Beach Litter and Plant Species and Communities Along the Mediterranean Coasts: A Critical Literature Review

Beach litter, an anthropogenic and hazardous component, can interact with psammophilous plant species and communities. These are particularly prominent in the Mediterranean Basin, renowned for its highly specialized and unique flora but recognized as one of the areas that is globally most severely affected by marine litter. To provide a comprehensive picture and outline possible future directions, data on beach litter in the Mediterranean coastal ecosystems were collected through a bibliographic research. Overall, 103 studies investigated the presence of beach litter on the Mediterranean coasts, of which only 18 considered its relationship with psammophilous plant species and communities. Our research highlights that this topic is rather underexplored in the Mediterranean Basin and the need to develop a standardized protocol for the assessment of beach litter that can be applied consistently across different beaches and countries. Information collected through a standardized protocol might improve the management and conservation strategies for these fragile ecosystems.

Design characteristics of integrated surveillance of antimicrobial resistance at the human, animal, and environment interfaces

Abstract Efforts have been made to strengthen national and global antimicrobial resistance (AMR) surveillance programs by integrating data collection across the human, animal, and environmental sectors. We searched the literature to review published studies reporting the implementation of integrated AMR surveillance approaches, and we identified a total of 96 articles from 36 countries published from 2000 to 2022, which met our inclusion criteria. Standard review protocols were applied in our study. Out of 96 studies, 47 (49%) articles integrated AMR analysis from human and animal (HA) populations, 24 (25%) considered human, animal, and environmental (HAE) samples together, 11 (12%) studies included animal and environment (AE) samples, and 12 (13%) integrated human and environmental (HE) surveillance. Human isolate-based and animal isolate-based surveillance were the most common study designs (38, 52.8%), with the remainder applying human case-based and isolate-based for animal populations (32, 44.4%). Finally, our results demonstrate that AMR studies on E. coli revealed a lower correlation between human and animal AMR prevalence compared to Salmonella spp. and Campylobacter spp. studies. Different aspects of surveillance design were associated with the level of correlation of AMR prevalence between sectors. Our study found that while global efforts for integrated AMR surveillance have increased in the past 10 years, significant variation exists between studies with regard to the epidemiological and laboratory aspects of their surveillance designs. Our findings indicate that to enable the generation of comparable epidemiological data across countries and sectors, there is a need for the development of a global protocol to support the design of surveillance programs that aim to conduct integrated surveillance of AMR.

Photobiomodulation Therapy in the Prevention of Chemotherapy Induced Oral Mucositis in Children with Acute Myeloid Leukemia: A Randomized, Double-blind, Clinical trial.

Many preventive modalities have been advocated to reduce the incidence and severity of chemotherapy-induced Oral Mucositis (OM). Photobiomodulation, also known as Low-Level laser. Therapy, has shown promising results. This clinical trial was performed to evaluate the effectiveness of Photobiomodulation (PBM) for the prevention of chemotherapy-induced oral mucositis (OM) in children with Acute Myeloid Leukemia (AML). A double-blinded randomized clinical trial was performed, including forty-two children diagnosed with Acute Myeloid Leukemia (AML) admitted to receiving chemotherapy (CT) at Children's Cancer Hospital 57357, Cairo, Egypt. Patients were randomly assigned to either the control or test group. Both groups followed the standard preventive protocol for oral mucositis. In the control group I sham therapy, while in the Laser group I had Photobiomodulation sessions for five consecutive days once a day performed by Diode laser (Sirrolaser Blue ™, USA) 660nm, 15watt, 10 s. Laser sessions began on day 1 of chemotherapy and were repeated on days 2,3, 4, and 5. The response to both groups was evaluated according to the development of oral mucositis; graded using the classification criteria of the World Health Organization (WHO) and the National Cancer Institute scale (NCI - Common Terminology Criteria for Adverse Events, version 4.0). Incidence of oral mucositis was evaluated from baseline to 5, 12, 19, and 30 days after treatment. A clinical significant difference between the laser and control group was observed. The laser group showed a higher prevalence of no oral mucositis with decreased incidence of OM, while on day 12, the control group showed a higher prevalence of grades I and II (P-value <0.001, effect size = 0.796). However, the laser group showed higher prevalence of mucosa free of OM; on day 19, the control group showed higher rates of grades II and III, (P-value <0.001, effect size = 0.670). while on day 30 there was higher rates of grades I and II (P-value <0.001, effect size = 0.576) with higher rates of healthy oral mucosa in the laser group. Photobiomodulation effectively reduces the incidence and severity of chemotherapy-induced oral mucositis in pediatric patients diagnosed with AML.

Somatosensory integration in robot-assisted motor restoration post-stroke

Disruption of somatosensorimotor integration (SMI) after stroke is a significant obstacle to achieving precise motor restoration. Integrating somatosensory input into motor relearning to reconstruct SMI is critical during stroke rehabilitation. However, current robotic approaches focus primarily on precise control of repetitive movements and rarely effectively engage and modulate somatosensory responses, which impedes motor rehabilitation that relies on SMI. This article discusses how to effectively regulate somatosensory feedback from target muscles through peripheral and central neuromodulatory stimulations based on quantitatively measured somatosensory responses in real time during robot-assisted rehabilitation after stroke. Further development of standardized recording protocols and diagnostic databases of quantitative neuroimaging features in response to post-stroke somatosensory stimulations for real-time precise detection, and optimized combinations of peripheral somatosensory stimulations with robot assistance and central nervous neuromodulation are needed to enhance the recruitment of targeted ascending neuromuscular pathways in robot-assisted training, aiming to achieve precise muscle control and integrated somatosensorimotor functions, thereby improving long-term neurorehabilitation after stroke.