Search Results (1,721)

Background: Arising in the late 1990s, when a promising role in prenatal diagnostics was first delineated for circulating fetal DNA, non-invasive prenatal tests (NIPTs) have been increasingly used with more frequency and popularity. These exams have been used as a prenatal screening tests for genetic diseases. Initially, they were developed for the investigation of the main fetal chromosomal aneuploidies, but lately they have also been used to rule out genomic microrearrangements and monogenic conditions. However, along with great opportunities and potential, the tests can show inconclusive or unexpected results. Several studies have shown that the current pre-test counseling is often insufficient, and more oriented at providing pieces of information about the identifiable diseases rather than providing extensive information on all possible scenarios which may affect both the fetus and the pregnant mother, especially in the case of an invasive test for the pregnant mother. Methods and Results: We have gathered from the literature on NIPT the main pitfalls, imperfections, and particular cases associated with this innovative diagnostic procedure. Conclusions: In view of further improvements in the methods that can limit the inconclusive or unexpected results, this paper aims to reinforce the importance of more accurate pre-test counseling with comprehensive information about the above-mentioned questions, as well as ultrasound use and also the creation of an international consensus statement concerning these topics. Full article

Background/Objectives: Transforaminal endoscopic lumbar discectomy (TELD) under local anesthesia is a promising minimally invasive surgical option for intractable lumbar disc herniation (LDH). However, our understanding of access pain prediction during foraminal pathological procedures is limited. To our knowledge, no predictive rules for access pain have been established during TELD for foraminal or extraforaminal LDH. This study, with its potential for predicting access pain during TELD and discussing strategies for pain prevention and management, could significantly benefit the field of endoscopic spine surgery. Methods: This observational study included 73 consecutive patients who underwent TELD for foraminal or extraforaminal LDH between January 2017 and December 2022. Preoperative clinical and radiographic factors affecting significant access pain and the impact of access pain on clinical outcomes were evaluated. Results: The rate of significant access pain was 13.70% (10 of 73 patients). Extraforaminal LDH tended to cause more severe pain than did foraminal LDH during TELD under local anesthesia (p < 0.05). Although the degree of access pain was not related to global clinical outcomes, increased pain was strongly associated with prolonged operative time and length of hospital stay (p < 0.05). Conclusions: TELD could be an effective surgical option for foraminal or extraforaminal LDH under local anesthesia. More access pain might develop during TELD for extraforaminal LDH. The extraforaminal component of LDH could narrow the safe working zone. Significant access pain might prolong the duration of surgery and hospitalization. Thus, a specialized technique is required for the clinical success of TELD. Full article

This study aimed to predict residential apartment prices in Latvia and Brazil using algorithms from machine learning, fuzzy logic, and civil engineering principles, with a focus on overcoming multicollinearity challenges. To explore the market dynamics, we conducted four initial experiments in the central regions of Riga and Jelgava (Latvia), as well as São Paulo and Niterói (Brazil). Data were collected from real estate advertisements, supplemented by civil engineering inspections, and analyzed following international valuation standards. The research integrated human decision-making behavior with machine learning and the Apriori algorithm. Our methodology followed five key stages: data collection, data preparation for association rule mining, the generation of association rules, fuzzy logic analysis, and the interpretation of model accuracy. The proposed method achieved a mean absolute percentage error (MAPE) that ranged from 5% to 7%, indicating strong alignment with market trends. These findings offer valuable insights for decision making in urban development, particularly in optimizing renovation priorities and promoting sustainable growth. Full article

In the field of education, the accurate prediction of students’ future performance is essential for personalized instruction and efficient allocation of resources. Such predictions not only help education professionals develop targeted educational strategies but also identify students’ learning needs at an early stage so that timely interventions and support can be provided. To gain the trust of educational experts and ensure the practical application value of the prediction results, the prediction methods used must be highly interpretable. However, there are two problems with the current belief rule base (BRB) applied to student performance prediction. First, there is a current lack of effective strategies for enhancing the interpretability of the optimization process. Second, BRB models that overemphasize accuracy tend to exhibit characteristics of black-box models. To overcome these challenges, this paper proposes a new method based on BRB with balanced accuracy and interpretability (BRB-Bai) for student achievement prediction. First, an attribute selection method is proposed to filter out important features associated with student performance. Then, expert knowledge credibility is calculated, and four interpretability strategies are proposed to ensure the interpretability of the model and to achieve a balance between interpretability and accuracy on the basis of expert knowledge credibility. The effectiveness of the proposed model is demonstrated by conducting experiments on the student achievement dataset. Full article

Traditionally, systems thinking support has relied on an ever-increasing plethora of systems tools, methods, and approaches. Arguably though, such support requires something different from, and more accessible than, detailed instruction on somewhat abstract laws and detailed principles and/or constitutive rules associated with conventional systems approaches or systems ‘tools of the trade’. For busy managers and decision makers working in often-stressful conditions, what is perhaps more valued are simple principles for enabling systems thinking in practice. Such principles should acknowledge and build on existing (multi)disciplinary skill sets and expertise, allowing for more meaningful interdisciplinary support amongst professions, as part of a nested transdisciplinary support for addressing wider social challenges. This monograph offers three principles of systems thinking in practice (STiP): relational STiP, perspective STiP, and adaptive STiP. They each have two sets of operational principles applicable to first-order and second-order practice, respectively. The three general principles are nested in an overriding principle of STiP as praxis (theory-informed action or thinking in practice) manifest in the need for being both systemic and systematic. The three principles represent a distilled expression of a systematic literacy of systems thinking, a literacy that speaks to the systemic sensibilities of Inter-relationships, Perspectives, and Boundaries (sometimes referred collectively as IPB), associated with any area of intervention. Drawing on metaphors of bricolage, conversation, and performance, and building on philosophical foundations of boundary critique, the three principles provide for a requisite systems literacy (as an emergent property of systemic sensibilities and systems thinking literacy) for enabling appropriate STiP capabilities to flourish when making a meaningful change. Full article

Background: Bacterial/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted a secondary analysis of two prospective multicenter cohort studies with confirmed influenza A (H1N1)pdm09 and COVID-19. Multiple logistic regression (MLR) and random forest (RF) were used to identify factors associated with BFC in the overall population and in each subgroup (influenza and COVID-19). The performance of these models was assessed by the area under the ROC curve (AUC) and out-of-bag (OOB) methods for MLR and RF, respectively. Results: Of the 8902 patients, 41.6% had influenza and 58.4% had SARS-CoV-2 infection. The median age was 60 years, 66% were male, and the crude ICU mortality was 25%. BFC was observed in 14.2% of patients. Overall, the predictive models showed modest performances, with an AUC of 0.68 (MLR) and OOB 36.9% (RF). Specific models did not show improved performance. However, age, procalcitonin, CRP, APACHE II, SOFA, and shock were factors associated with BFC in most models. Conclusions: Machine learning models do not adequately predict the presence of co-infection in critically ill patients with pandemic virus infection. However, the presence of factors such as advanced age, elevated procalcitonin or CPR, and high severity of illness should alert clinicians to the need to rule out this complication on admission to the ICU. Full article

As the popularity of fresh air systems (FAS) in residential buildings increases, exploring the behavioral characteristics of their use can help to provide a comprehensive understanding of the potential for demand flexibility in residential buildings. However, few studies in the past have focused on the personalized usage behavior of FAS. To fill this gap, this study proposes a method based on data mining techniques to reveal the behavioral patterns of FAS usage and the motivations behind them, including motivational patterns, operation duration patterns, and human–machine interaction patterns, for 13 households in Beijing. The simultaneously obtained behavioral patterns, in turn, form the basis of association rules, which can classify FAS usage behavior into two typical residential user profiles containing user behavioral characteristics. This study can not only provide more accurate assumptions and inputs for behavioral stochastic models but also provide data support for the development and optimization of demand response strategies. Full article

High-sensitivity cardiac troponin (hs-cTn) assays have significantly refined the resolution of biomarker-level detection and have emerged as the gold standard cardiac biomarker in evaluating myocardial injury. Since its introduction, hs-cTn has been integrated into the Fourth Universal Definition of Myocardial Infarction and various European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the evaluation and diagnosis of chest pain syndromes. However, despite its integral role in caring for patients with chest pain, there are still substantive gaps in our knowledge of the clinical interpretation of dynamic changes in hs-cTn values. Whether a relative or absolute hs-cTn delta should be used to detect acute myocardial injury remains debatable. There are also emerging considerations of possible sex and racial/ethnic differences in clinically significant troponin deltas. In the emergency department, there is debate about the optimal time frame to recheck hs-cTn after symptom onset for myocardial infarction rule-out and whether hs-cTn deltas should be integrated into clinical risk scores. In this review, we will provide an overview of the history of clinical utilization of cardiac biomarkers, the development of hs-cTn assays, and the ongoing search for a meaningful delta that can be clinically applicable. Full article

We report a case of SYNE1-associated autosomal recessive spinocerebellar ataxia (SCAR8) presenting with a complex multisystemic phenotype, including highly elevated creatine kinase levels and lower-leg muscle atrophy. In addition to identifying two novel pathogenic variants in the SYNE1 gene, whole-exome sequencing revealed three variants of uncertain significance in the DYSF gene. Electromyography and muscle magnetic resonance imaging indicated a neurogenic pattern of muscle involvement. These findings, along with the segregation analysis of the variants, allowed us to exclude DYSF-associated muscular dystrophy; however, we cannot entirely rule out the possibility that the DYSF gene variants may act as modifiers of the patient’s phenotype. Full article

Asbestos research, identification, and quantification have been performed over the years, and the relationship between fiber inhalation and lung disease development is well defined. The same cannot be said for the gastroenteric system: the International Agency for Research on Cancer (IARC) believes that colorectal cancer (CRC) could be associated with asbestos exposure, but research has not demonstrated a casual nexus between exposure and CRC, despite highlighting an association tendency. The combination of scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) is the most applied technique in asbestos fiber identification in tissues and intestinal mucosa. In this study, SEM/EDS was applied to evaluate the presence of asbestos fibers and bodies (ABs) inside the tissue of eleven patients affected by CRC who had undergone environmental exposure due to living in an asbestos-polluted area where an Eternit plant had been active in the past. This technique was coupled with optical microscopy (OM) to verify whether the latter could be applied to evaluate the presence of these mineral phases, with the goal of understanding its suitability for identifying fibers and ABs in colon tissues. In addition to verifying the presence of fibers, this study allowed us to identify the deposition site of said fibers within the sample and possibly detect associated tissue reactions using OM, over a shorter time and at lower costs. Despite being a preliminary and descriptive work, the obtained results allowed us to propose a method involving first-sample OM observation to identify regulated (fibers with a length ≥ 5 μm, a thickness ≤ 3 μm, and a length/thickness ratio > 3) asbestos phases and ABs in the extra-respiratory system. In fact, OM and SEM/EDS provided similar information: no asbestiform morphology or ABs were found, but phyllosilicates and other inorganic materials were identified. This research needs to be continued using higher-resolution techniques to definitively rule out the presence of these fibers inside tissues whilst also increasing the number of patients involved. Full article

Background: The utilities of anterior segment optical coherence tomography (AS-OCT) for characterization, differential diagnosis, postoperative monitoring, and evaluation/comparison of surgical techniques in pterygium are described. Through AS-OCT, it is also possible to study the corneal astigmatic effect of pterygium. Our purpose is to study the associations between the anatomical characteristics of pterygium and the corneal topography through AS-OCT. Methods: Fifty eyes with primary pterygium in a tertiary hospital were evaluated before surgery by measuring 10 anatomical variables of pterygium and 13 topographic variables using AS-OCT (Casia 2; Tomey Corp., Nagoya, Japan). Statistical analysis was used to study the association between them. Results: Pterygium classified as flat pattern exhibited lower preoperative values of flat keratometry (K1), real flat keratometry (K1r), average keratometry (AvgK), and real average keratometry (AvgKr) compared to nodular ones. The flat pattern showed greater cylinder (CYL) and real cylinder (CLYr) values. The horizontal corneal invasion proportionally increased CYL and CYLr. Overall, larger anatomical pterygium measurements (limbus thickness (LimbusT), central pterygium thickness (CentreT), head pterygium thickness (HeadT), epithelial thickness at 1 mm (EpitT1mm), stromal thickness at 1 mm (stromT1mm), total thickness at 1 mm (TotalT1mm), total thickness at 2 mm (TotalT2mm), and total thickness at 3 mm (TotalT3mm)) resulted in lower anterior K1, K1r, AvgK, and AvgKr, and posterior K1 and AvgK values. CentreT was greater in astigmatisms against the rule than in oblique ones. Conclusions: This study demonstrates associations between preoperative topography and the NF (nodular or flat) classification of pterygium and its anatomical measurements assessed by AS-OCT. Full article

Risk management exerts a significant influence on the competitiveness of an organization and its operational processes. It presents opportunities for expansion, foresight, and the need to promote sustainability. Many organizations have executed comprehensive risk management processes. Moreover, internal audit has increasingly attracted managers’ attention, forming the basis of modern governance methods. The aim of this study is to examine, from the viewpoint of the agency, the impact of the role of internal auditors, training in risk management, and management support on risk management. Following this, the work examines risk management in terms of the risk-based auditing implementation that is performed by Saudi public organizations. This study encompassed 234 completed and therefore valid questionnaires from the manager and assistance of the internal audit department, internal auditors, accountants, and managers employed in Saudi public organizations. The data collected have been analyzed utilizing Smart Partial Least Squares (SmartPLS). This study’s findings confirmed that there is a significant association between the role of internal auditors in risk management, training in risk management, and between management support and risk management. There is also a significant association between risk management and the implementation of risk-based internal auditing. This study’s findings have significant ramifications for those in charge of public-sector organizations, and sustainability, aiming to enhance the dependability and trustworthiness of the internal audit process and other aspects of financial reports and audits in general. Currently, there is a dearth of published research on the factors that influence risk management and also on risk-based internal auditing. This study contributes to the emerging literature on this subject by examining Saudi public organizations; it also establishes empirical variables through a thorough review of relevant research. Conducted here is an empirical investigation that identifies the factors that affect risk management and then its influence on risk-based internal auditing implementation in the economic system of Saudi Arabia. By focusing on Saudi public organizations, this article highlights other countries that have similar systems of governance rules and procedures in their government-operated entities. Full article

This article explores the finite-time control problem associated with a specific category of non-homogeneous hidden semi-Markov jump systems. Firstly, a hidden semi-Markov model is designed to characterize the asynchronous interactions that occur between the true system mode and the controller mode, and emission probabilities are used to establish relationships between system models and controller modes. Secondly, a novel piecewise homogeneous method is introduced to tackle the non-homogeneous issue by taking into account the time-dependent transition rates for the jump rules between different modes of the system. Thirdly, an asynchronous controller is developed by applying Lyapunov theory along with criteria for stochastic finite-time boundedness, ensuring the specified $H_{\infty }$ performance level is maintained. Finally, the effectiveness of this method is verified through two simulation examples. Full article

Studies exploring not only whether, but also to what extent, telework can improve employees’ ability to coordinate private and work-related demands are largely absent. Using a probability-based large-scale survey of employees in Germany (N = 14,999), this study provides evidence of an inverted U-shaped relationship between the extent of telework and employees’ temporal alignment of work and private life, i.e., their success in considering personal and family matters when scheduling work. When telework comprised up to 40 percent of the total working time, employees were observed to temporally align their work and private life better than those who only worked on-site. Additional analyses indicated that particularly men, and even more so fathers, experience improved work and private life alignment with frequent teleworking. For women with and without children, however, highly extensive teleworking not only loses its positive effect, but is associated with less success in aligning work and private life compared to non-teleworking. To be able to benefit from telework, even when it is used extensively, clear rules are needed, for example, regarding expectations of accessibility for paid work as well as for home and care work. Full article

The goal of this research is to investigate whether taxation affects the leverage decisions of banks and if the response of leverage to tax increases depends on profit-shifting opportunities available to individual banks. This topic remains controversial since it is often believed that banking regulation is such an essential driver of leverage choices that little room is left for other considerations studied in the corporate finance literature. Using a difference-in-differences setup encompassing the period from 2006 to 2017, we exploit two exogenous income tax rate increases applicable to 225 Brazilian banks, employing novel identification strategies based on the intricacies of local taxation rules and on the distinctions between individual banks and financial conglomerates. We find stark differences in the behavior of banks around the two events, with a substantial increase in leverage following the first tax hike but no leverage response following the second. In addition, we find no evidence of heterogeneous effects based on the amount of profit-shifting opportunities available to individual banks. Regulatory concerns possibly became more relevant for leverage decisions during the period around the second tax hike because it coincided with the implementation of stricter capital requirements associated with the Basel III framework. Taken together, our results suggest that financial institutions balance considerations regarding the tax-shield benefits of debt against regulatory concerns specific to the banking industry when making capital structure choices. Full article