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Distal medium vessel occlusions (DMVOs) are thought to cause as many as 25% to 40% of all acute ischemic strokes and may result in substantial disability amongst survivors. Although intravenous thrombolysis (IVT) is more effective for distal than proximal vessel occlusions, the overall efficacy of IVT remains limited in DMVO with less than 50% of patients achieving reperfusion and about 1/3 to 1/4 of the patients failing to achieve functional independence. Data regarding mechanical thrombectomy (MT) among these patients remains limited. The smaller, thinner, and more tortuous vessels involved in DMVO are presumably associated with higher procedural risks whereas a lower benefit might be expected given the smaller amount of tissue territory at risk. Recent advances in technology have shown promising results in endovascular treatment of DMVOs with room for future improvement. In this review, we discuss some of the key technical and clinical considerations in DMVO treatment including the anatomical and clinical terminology, diagnostic modalities, the role of IVT and MT, existing technology, and technical challenges as well as the contemporary evidence and future treatment directions.

The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information—AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples—Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a “garbage in, garbage out” phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth.

We present results of the coefficient of thermal expansion for the frustrated quasi-two-dimensional molecular conductor θ-(BEDT-TTF)_{2}RbZn(SCN)_{4} for temperatures 1.5≤T≤290 K. A pronounced first-order phase transition anomaly is observed at the combined charge-order/structural transition at 215 K. Furthermore, clear evidence is found for two separate glasslike transitions at T_{g}=90–100 K and T_{g}^{†}=120–130 K, similar to previous findings for θ-(BEDT-TTF)_{2}CsZn(SCN)_{4} and θ-(BEDT-TTF)_{2}CsCo(SCN)_{4} reported by Thomas et al. [Phys. Rev. B 105, L041114 (2022)2469-995010.1103/PhysRevB.105.L041114], both of which lack the charge-order/structural transition. Our findings indicate that these glasslike transitions are common features for the θ-(BEDT-TTF)_{2}MM^{′}(SCN)_{4} family, with M=(Rb, Cs) and M^{′}=(Co, Zn), irrespective of the presence or absence of charge order. These results are consistent with our model calculations on the glasslike dynamics associated with the flexible ethylene end groups of the BEDT-TTF molecules for various θ-(BEDT-TTF)_{2}MM^{′}(SCN)_{4} salts, predicting two different conformational glass transitions. Moreover, calculations of the hopping integrals show a substantial degree of dependence on the end groups' conformation, suggesting a significant coupling to the electronic degrees of freedom. Our findings support the possibility that the glassy freezing of the ethylene end groups could drive or enhance glassy charge dynamics.

Introduction The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline update showed improved functional outcomes and lower peri‐procedural mortality. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update. Methods We analyzed the National Inpatient Sample from 2012‐2019. ICD‐9 and ICD‐10 codes identified Ischemic stroke and mechanical thrombectomy patients. Similar to the previous study, discharge to home was the primary efficacy outcome measure in this study since it strongly correlates with mild degree of disability at discharge and 3 months post‐stroke. Safety outcomes include in‐hospital medical complications and mortality. We utilized multivariate logistic regression to assess outcomes. Results From 2012‐2019, 4,003,405 individuals with a diagnosis of ischemic stroke were recorded, 103,605 (2.6%) of which were treated with mechanical thrombectomy, proportionally increased from 4,910/452,905 (1.1%) in 2012 to 26,365/552,780 (4.8%) in 2019. The proportion of endovascular thrombectomy performing hospitals nearly doubled during the study period from 2012 (295/4,378; 6.7%) to 2019 (582/4,568; 12.7%). Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78). Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. The presence of septicemia, shock, and cardiac arrest were unchanged. Conclusion The number of large vessel occlusion stroke patients receiving mechanical thrombectomy treatment in the United States is increasing rapidly each year after the 2015 US guideline update. As the use of mechanical thrombectomy expands, included patients have more medical complications at baseline, but experience fewer complications, peri‐procedural mortality and overall improved outcomes.

Introduction There is growing evidence supporting endovascular treatment with middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematoma (cSDH). We aimed to compare Onyx vs. N‐Butyl cyanoacrylate (n‐BCA) as liquid embolic materials for MMAE. Methods We included all eligible patients undergoing MMAE for cSDH at University of Pittsburgh Medical Center from April 2019 to December 2022. The main outcomes included radiographic resolution of cSDH with at least 50% reduction of hematoma thickness as a surrogate for treatment success in addition to the need for rescue surgical intervention. Additional outcomes including complication rates and hematoma thickness at the last available follow up. Results A total of 195 patients underwent embolization of 234 hemispheres including 39 bilateral procedures and had available data for final analysis (168 (71.8%) in Onyx group vs. 66 (28.2%) in n‐BCA group). There were no significant differences in age, sex, co‐morbidities, prior SDH/evacuation, pre‐operative cSDH thickness, or use of antithrombotic therapy(P>0.05) while concurrent surgical intervention and midline shift showed a statistically significant difference (P

The use of smartphones has greatly increased in the last decade and has revolutionized the way that health data are being collected and shared. Mobile applications leverage the ubiquity and technological sophistication of modern smartphones to record and process a variety of metrics relevant to human health, including behavioral measures, clinical data, and disease symptoms. Information processed by mobile applications may have significant utility for increasing biomedical knowledge, both through conventional research and emerging discovery paradigms such as citizen science. However, the ways in which smartphone-collected data may be used in nontraditional modes of biomedical discovery are not well understood, such as using data to train artificially intelligent algorithms and for product development purposes. This paper argues that the use of mobile health data for algorithm training and product development is (a) likely to become a prominent fixture in medicine, (b) likely to raise significant ethical and legal challenges, and (c) warrants immediate scrutiny by policymakers and scholars. We introduce the concept of “smartphone-crowdsourced medical data,” or SCMD, and set out a broad research agenda for addressing concerns associated with this new and potentially momentous practice. We conclude that SCMD for algorithm training raises a number of ethical and legal issues which require further scholarly attention to ensure that individual interests are protected and that emerging health information sources can be used in ways that maximally, and safely, promote medical innovation.

Online resources offer a uniquely efficient way of sharing health research with scientists and the public. Using web portals to make results and study information available to diverse audiences could work to accelerate research translation and empower patients to play a more active role in their care. But using online tools to broadly share health information raises several challenging ethical and regulatory questions. Issues such as equity, privacy, and patient empowerment may create challenges for regulators, portal developers, as well as researchers. It is additionally unclear whether web portals designed to facilitate access to research results and general health information will be regulated as medical devices under emerging regimes that control software with medical purposes. This paper aims to comparatively address whether online therapeutic portals for sharing health research are likely to be regulated in Canada, the United States, the United Kingdom, and France. We find that though these jurisdictions have each taken recent steps to regulate software as medical devices, the applicable regimes will generally not capture online portals for sharing health research. Though online portals for sharing health research are probably unregulated in many (if not most) jurisdictions, agencies have nevertheless signalled their concerns regarding several important ethical considerations (such as equity, transparency, and safety), to which portal developers and researchers should be attentive and respond. We describe here one set of issues highlighted by regulators – that is, efficiency, equity, transparency, confidentiality, communication, empowerment, training, and safety & efficacy – and consider how to best guide the design of online portals in a context of regulatory uncertainty.

Abstract Background Stories can be a powerful tool to increase uptake of health information, a key goal of knowledge translation (KT). Systematic reviews demonstrate that storytelling (i.e. sharing stories) can be effective in changing health-promoting behaviours. Though an attractive KT strategy, storytelling is a complex approach requiring careful planning and consideration of multiple factors. We sought to develop a framework to assist KT researchers and practitioners in health contexts to consider and develop effective KT interventions that include stories or storytelling. Methods We conducted a broad search of the literature to identify studies that used storytelling as a KT intervention across different disciplines: health research, education, policy development, anthropology, organizational development, technology research, and media. We extracted purposes, theories, models, mechanisms, and outcomes and then mapped the theoretical and practical considerations from the literature onto the Medical Research Council guidance for complex interventions. The theoretical and practical considerations uncovered comprised the basis of the storytelling framework development. Through discussion and consensus, methodological experts refined and revised the framework for completeness, accuracy, nuance, and usability. Results We used a complex intervention lens paired with existing behaviour change techniques to guide appropriate theory-based intervention planning and practical choices. An intentional approach to the development of story-based KT interventions should involve three phases. The theory phase specifies the goal of the intervention, mechanisms of action, and behaviour change techniques that will achieve the intended effects. The modelling phase involves development and testing using an iterative approach, multiple methods and engagement of end-users. Finally, formal evaluation using multiple methods helps determine whether the intervention is having its intended effects and value added. Conclusions This framework provides practical guidance for designing story-based KT interventions. The framework was designed to make explicit the requisite considerations when determining the appropriateness and/or feasibility of storytelling KT, clarify intervention goals and audience, and subsequently, support the development and testing of storytelling interventions. The framework presents considerations as opposed to being prescriptive. The framework also offers an opportunity to further develop theory and the KT community’s understanding of effectiveness and mechanisms of action in storytelling interventions.

The low-temperature state of the quantum spin liquid candidate κ-(BEDT-TTF)_{2}Cu_{2}(CN)_{3} emerges via an anomaly at T^{*}∼6 K. Although signatures of this anomaly have been revealed in various quantities, its origin has remained unclear. Here we report inelastic neutron scattering measurements on single crystals of κ-(BEDT-TTF)_{2}Cu_{2}(CN)_{3}, aiming at studying phonon renormalization effects at T^{*}. A drastic change was observed in the phonon damping across T^{*} for a breathing mode of BEDT-TTF dimers at E=4.7 meV. The abrupt change in the phonon damping is attributed to a phase transition into a valence bond solid state based on an effective model describing the spin-charge coupling in this dimer-Mott system.

Abstract Geometrical frustration among interacting spins combined with strong quantum fluctuations destabilize long-range magnetic order in favor of more exotic states such as spin liquids. By following this guiding principle, a number of spin liquid candidate systems were identified in quasi-two-dimensional (quasi-2D) systems. For 3D, however, the situation is less favorable as quantum fluctuations are reduced and competing states become more relevant. Here we report a comprehensive study of thermodynamic, magnetic and dielectric properties on single crystalline and pressed-powder samples of PbCuTe2O6, a candidate material for a 3D frustrated quantum spin liquid featuring a hyperkagome lattice. Whereas the low-temperature properties of the powder samples are consistent with the recently proposed quantum spin liquid state, an even more exotic behavior is revealed for the single crystals. These crystals show ferroelectric order at T FE ≈ 1 K, accompanied by strong lattice distortions, and a modified magnetic response—still consistent with a quantum spin liquid—but with clear indications for quantum critical behavior.

Background Asymmetric genitalia have repeatedly evolved in animals, yet the underlying causes for their evolution are mostly unknown. The fruit fly Drosophila pachea has asymmetric external genitalia and an asymmetric phallus with a right-sided phallotrema (opening for sperm release). The complex of female and male genitalia is asymmetrically twisted during copulation and males adopt a right-sided copulation posture on top of the female. We wished to investigate if asymmetric male genital morphology and a twisted gentitalia complex may be associated with differential allocation of sperm into female sperm storage organs. Methods We examined the internal complex of female and male reproductive organs by micro-computed tomography and synchrotron X-ray tomography before, during and after copulation. In addition, we monitored sperm aggregation states and timing of sperm transfer during copulation by premature interruption of copulation at different time-points. Results The asymmetric phallus is located at the most caudal end of the female abdomen during copulation. The female reproductive tract, in particular the oviduct, re-arranges during copulation. It is narrow in virgin females and forms a broad vesicle at 20 min after the start of copulation. Sperm transfer into female sperm storage organs (spermathecae) was only in a minority of examined copulation trials (13/64). Also, we found that sperm was mainly transferred early, at 2–4 min after the start of copulation. We did not detect a particular pattern of sperm allocation in the left or right spermathecae. Sperm adopted a granular or filamentous aggregation state in the female uterus and spermathecae, respectively. Discussion No evidence for asymmetric sperm deposition was identified that could be associated with asymmetric genital morphology or twisted complexing of genitalia. Male genital asymmetry may potentially have evolved as a consequence of a complex internal alignment of reproductive organs during copulation in order to optimize low sperm transfer rates.

Abstract Introduction Male genitalia are thought to ensure transfer of sperm through direct physical contact with female during copulation. However, little attention has been given to their pre-copulatory role with respect to sexual selection and sexual conflict. Males of the fruitfly Drosophila pachea have a pair of asymmetric external genital lobes, which are primary sexual structures and stabilize the copulatory complex of female and male genitalia. We wondered if genital lobes in D. pachea may have a role before or at the onset of copulation, before genitalia contacts are made. Results We tested this hypothesis with a D. pachea stock where males have variable lobe lengths. In 92 mate competition trials with a single female and two males, females preferentially engaged into a first copulation with males that had a longer left lobe and that displayed increased courtship vigor. In 53 additional trials with both males having partially amputated left lobes of different lengths, we observed a weaker and non-significant effect of left lobe length on copulation success. Courtship durations significantly increased with female age and when two males courted the female simultaneously, compared to trials with only one courting male. In addition, lobe length did not affect sperm transfer once copulation was established. Conclusion Left lobe length affects the chance of a male to engage into copulation. The morphology of this primary sexual trait may affect reproductive success by mediating courtship signals or by facilitating the establishment of genital contacts at the onset of copulation.

This fifth installment of the Emerging Horizons series explores Kenzie’s digital storytelling (DST) experience (please see the introductory editorial, Crafting Meaning, Cultivating Understanding, to access the documentary film on which the series is based). Kenzie's storyline revealed how culturally accepted language and metanarratives around health and wellness can create dissonance for Adolescent and Young Adult (AYA) cancer survivors as they attempt to share their experiences with others. Alternatively, the genuine conversation inherent in the Story Circle, and throughout the DST process, could promote and stimulate the re-storying of ill-fitting, “hand-me-down” cancer narratives. Specifically, the reflective intensity and co-creative nature of DST could facilitate the discovery of deeper truths, or new truths, in healthcare stories while the narrative structure and creative limitations of a digital story could empower AYAs to craft a closed ending to a perpetually open-ended cancer survivorship experience.

This third installment of the Emerging Horizons series explores Kelsey’s digital storytelling (DST) experience (please see the introductory editorial, Crafting Meaning, Cultivating Understanding, to access the documentary film on which the series is based). In addition to providing a compelling exploration of a relatively common occurrence of Adolescent and Young Adult (AYA) cancer survivors, delayed diagnosis, Kelsey’s involvement in the film illustrated the potential for DST to help participants explore, name, and represent their inner emotional experience. Her storyline illuminated how difficult it can be for AYAs to both understand their “true feelings” and share them with others in a way that moves beyond a surface level, “hashtag” description of emotion (e.g. #sad). I (Lang) conclude by discussing how the three primary modes of narrative engagement in the DST process (external, internal, and reflexive) could help AYAs cultivate a deeper understanding of their emotional cancer experiences, and in doing so, break cancer’s grasp on their life, by grasping it instead.

This fourth installment of the Emerging Horizons series explores Derek’s digital storytelling (DST) experience (please see the introductory editorial, Crafting Meaning, Cultivating Understanding, to access the documentary film on which the series is based). In contrast to other workshop participants, Derek’s primary goal for his digital story was to convey a specific, pre-determined meaningful moment from his cancer experience in a more compelling manner. Building from the image system Derek utilized in his digital story, and further contextualizing the events he describes, this interpretive article depicts the unique cancer survivorship experiences of Adolescent and Young Adult (AYA) cancer survivors and demonstrates the possibilities of DST to help AYAs release “bottled up” emotions before they become rancid (i.e., release suppressed or repressed emotions before they transform into diagnosed psychosocial co-morbidity). Finally, Derek’s experience demonstrates how the multi-modal nature of DST can enable AYAs to incite an emotional response from their audience that can in turn confirm and affirm the life lessons embedded in their cancer experience.

The goal of this paper is to evaluate the current academic approaches in the field of business model innovation. By conducting a systematic literature review, 31 academic approaches are identified and compared using the dimensions of business model and process model. In addition, the research concentrates on organizational mindset and to what extend it is considered in current approaches. Among other findings, the research proves that all analyzed studies vary in terms of focus, level of detail and content in the perspectives of business and process model. In particular, organizational mindset is mentioned in four out of the 31 studies as an important success factor of business model innovation, whereas only one approach is dealing with organizational mindset in its process model. This indicates that overcoming the organizational mindset as a main barrier in business model innovation is not systematically integrated in any of the selected studies. In summary, the findings of this paper highlight that the current research in the field of business model innovation is not sufficient and further research has to follow. Thus, three research gaps are identified. First, the lack of level of detail concerning business and process model. Secondly, the lack of business innovation approaches for specific industries. Finally, the lack of systematic integration of organizational mindset in business model innovation approaches.

Introduction: The approach-related morbidity rate in the care of pelvic fractures is still high. Endoscopic procedures are known to significantly reduce access-related complications. Recently, a new endoscopically assisted implantation technique for plate osteosynthesis on the anterior pelvic ring has been described as the “Endoscopic Approach to the Symphysis”. Case report: We present a case of a 29-year old male with a pelvic injury (AO type 61B2.3a) initially treated with a supraacetabular external fixator. After one week the definitive stabilization was performed by an endoscopically assisted symphyseal plating as well as a percutaneous iliosacral screw on the right side. One year after primary surgery, we performed an endoscopically assisted removal of the symphyseal plate using standard laparoscopic instruments. Results: We demonstrate the feasibility of an endoscopically assisted implant removal at the anterior pelvic ring. No complications occurred during the procedure. The patient was discharged after a regular time of surveillance and with an adequate decline of pain. Discussion: While we were able to show that the endoscopically assisted implantation as well as the removal of a plate osteosynthesis on the anterior pelvic ring is possible, there is still further research necessary, especially regarding the development of specific endoscopic instruments. This should enable operating times similar to the standard open procedures.

BackgroundThis study aims to identify a novel potential use for web portals in health care and health research: their adoption for the purposes of rapidly sharing health research findings with clinicians, scientists, and patients. In the era of precision medicine and learning health systems, the translation of research findings into targeted therapies depends on the availability of big data and emerging research results. Web portals may work to promote the availability of novel research, working in tandem with traditional scientific publications and conference proceedings. ObjectiveThis study aims to assess the potential use of web portals, which facilitate the sharing of health research findings among researchers, clinicians, patients, and the public. It also summarizes the potential legal, ethical, and policy implications associated with such tools for public use and in the management of patient care for complex diseases. MethodsThis study broadly adopts the methods for scoping literature reviews outlined by Arskey and O’Malley in 2005. Raised by the integration of web portals into patient care for complex diseases, we systematically searched 3 databases, PubMed, Scopus, and WestLaw Next, for sources describing web portals for sharing health research findings among clinicians, researchers, and patients and their associated legal, ethical, and policy challenges. Of the 719 candidate source citations, 22 were retained for the review. ResultsWe found varied and inconsistent treatment of web portals for sharing health research findings among clinicians, researchers, and patients. Although the literature supports the view that portals of this kind are potentially highly promising, they remain novel and are not yet widely adopted. We also found a wide range of discussions on the legal, ethical, and policy issues related to the use of web portals to share research data. ConclusionsWe identified 5 important legal and ethical challenges: privacy and confidentiality, patient health literacy, equity, training, and decision-making. We contend that each of these has meaningful implications for the increased integration of web portals into clinical care.

Abstract Background Male genitals have repeatedly evolved left-right asymmetries, and the causes of such evolution remain unclear. The Drosophila nannoptera group contains four species, among which three exhibit left-right asymmetries of distinct genital organs. In the most studied species, Drosophila pachea, males display asymmetric genital lobes and they mate right-sided on top of the female. Copulation position of the other species is unknown. Results To assess whether the evolution of genital asymmetry could be linked to the evolution of one-sided mating, we examined phallus morphology and copulation position in D. pachea and closely related species. The phallus was found to be symmetric in all investigated species except D. pachea, which displays an asymmetric phallus with a right-sided gonopore, and D. acanthoptera, which harbors an asymmetrically bent phallus. In all examined species, males were found to position themselves symmetrically on top of the female, except in D. pachea and D. nannoptera, where males mated right-sided, in distinctive, species-specific positions. In addition, the copulation duration was found to be increased in the nannoptera group species compared to closely related outgroup species. Conclusion Our study shows that gains, and possibly losses, of asymmetry in genital morphology and mating position have evolved repeatedly in the nannoptera group. Current data does not allow us to conclude whether genital asymmetry has evolved in response to changes in mating position, or vice versa.

Abstract Background Medical assistance in dying (MAID) was legalized in Canada in 2016. As of July 2017, approximately 2149 patients have accessed MAID. There remains no national-level data on the perspectives of future physicians about MAID or its changing legal status. We provide evidence from a national survey of Canadian medical students about their opinions, intentions, and concerns about MAID. Methods From October 2016 to July 2017, we distributed an anonymous online survey to all students at 15 of Canada’s 17 medical schools. The survey collected data on respondent socio-demographic characteristics, features of their medical education, intentions for medical practice, and perspectives on MAID. We analyzed responses using univariate descriptive and stepwise multivariate logistic regression. Results In 1210 completed surveys, 71% of respondents reported being willing to provide MAID under a legal framework that permits it. Non-religious respondents reported greater willingness to participate in MAID than respondents of any religious affiliation (p

Abstract Introduction In addition to a wide range of disease-related burdens, patients with multiple sclerosis (MS) are challenged by long-term medication and complex disease management plans, often leading to decreased adherence. Earlier studies have indicated that patient support through intensified communication can positively impact adherence. During recent years, the use of mobile health applications has gained importance in patient communication and disease management. Objective Our objective was to describe a novel software application providing innovative features that engage patient–physician contact and to evaluate users’ acceptance. Methods A novel software application ensuring data security was developed. Various innovative modules have been implemented, enabling bidirectional communication between treating physicians and patients, supporting therapy monitoring and management, and allowing the collection of large sets of anonymous patient data. The currently conducted FASTER study will analyze the acceptance of patients and physicians using this novel application. Results PatientConcept is a free app available for download since 2016. Meanwhile, it has been successfully implemented. First preliminary results indicate high acceptance among users. The clinical benefit will have to be tested in larger patient populations. Conclusion This ID-associated application may provide a secure, feasible, and cost-optimized possibility to intensify and simplify the communication between patients and their treating physicians, thus promising an exceptional benefit to both.

Background: Fingolimod (Gilenya®) is approved for adult and pediatric patients with highly active relapsing–remitting multiple sclerosis (RRMS).Objectives: The objective was to describe the effectiveness of fingolimod in young adults compared to older patients in clinical practice.Methods: PANGAEA is the largest prospective, multi-center, non-interventional, long-term study evaluating fingolimod in RRMS. We descriptively analyzed demographics, MS characteristics, and severity in two subgroups of young adults (≤20 and >20 to ≤30 years) and older patients (>30 years).Results: Young adults had lower Expanded Disability Status Scale (EDSS) scores compared to older patients (1.8 and 2.3 vs. 3.2) at baseline. The mean EDSS scores remained stable over 5 years in all subgroups. Young adults had higher annual relapse rates (2.0 and 1.7 vs. 1.4) at study entry, which were reduced by approximately 80% in all subgroups over 5 years. The proportion of patients with no clinical disease activity in year 4 was 52.6 and 73.4 vs. 66.9% in patients ≤20, >20 to ≤30 years and >30 years, respectively. The symbol digit modalities test score increased by 15.25 ± 8.3 and 8.3 ± 11.3 (mean ± SD) from baseline in patients >20 to ≤30 and >30 years.Conclusions: Real-world evidence suggests a long-term treatment benefit of fingolimod in young RRMS patients.

ABSTRACT The purpose of this paper is to present the LITTERA corpus, an English-Spanish literary parallel speech corpus created for the purpose of language learning, and to sketch out a few pedagogical applications for the study of English phonology by Spanish-speaking language learners. It is composed of 25 literary texts that have been aligned with the Spanish translation and are accompanied by audio from the corresponding audiobooks. In this article, we will detail its conception, composition and features at length, as well as provide a few examples of how LITTERA can be applied in language learning, particularly within the realm of oral comprehension and speech production.

Background Digital storytelling (DST) is a participatory, arts-based methodology that facilitates the creation of short films called digital stories. Both the DST process and resulting digital stories can be used for education, research, advocacy, and therapeutic purposes in public health. DST is widely used in Europe and North America, and becoming increasingly common in Africa. In East Africa, there is currently limited in-country DST facilitation capacity, which restricts the scope of use. Through a Ugandan-Canadian partnership, six Ugandan faculty and staff from Mbarara University of Science and Technology participated in a pilot DST facilitation training workshop to enhance Ugandan DST capacity. Objective This Participatory Action Research (PAR) study assessed the modification of DST methodology, and identified the future potential of DST in Uganda and other East African settings. Methods In the two-week DST Facilitator Training, trainees created their own stories, learned DST technique and theory, facilitated DST with community health workers, and led a community screening. All trainees were invited to contribute to this study. Data was collected through daily reflection and journaling which informed a final, post-workshop focus group where participants and researchers collaboratively analyzed observations and generated themes. Results In total, twelve stories were created, six by trainees and six by community health workers. Three key themes emerged from PAR analysis: DST was a culturally appropriate way to modernize oral storytelling traditions and had potential for broad use in Uganda; DST could be modified to address ethical and logistical challenges of working with vulnerable groups in-country; training in-country facilitators was perceived as advantageous in addressing community priorities. Conclusion This pilot study suggests DST is a promising methodology that can potentially be used for many purposes in an East African setting. Building in-country DST facilitation capacity will accelerate opportunities for addressing community health priorities through amplifying local voices.

Many research methods emphasize procedures to minimize potential bias introduced by measurement tools, environmental factors, and researchers themselves. Using the example of digital storytelling, in which short films are cocreated between a researcher and participant, we examine the possibility of cocreated stories as data in philosophical hermeneutic (PH) health research. The etymological explication of the words “data” and “story” brings the meaning of these words closer together while an exploration of the ontological and epistemological assumptions of PH indicate that cocreated digital stories can be viewed as data in a similar way to traditional verbatim interview transcripts used in other types of qualitative health research. Using digital storytelling as a data generation tool in PH health research may help provide a deeper understanding of health-related phenomena by cultivating understanding through genuine conversation, addressing the challenges of language, and apprehending the immediacy of understanding.

Stroke patients are at increased risk for recurrent stroke and development of post-stroke dementia. In this study, we investigated the effects of recurrent stroke on adult brain neurogenesis using a novel rat model of recurrent middle cerebral artery occlusion (MCAO) developed in our laboratory. Using BrdU incorporation, activation and depletion of stem cells in the subgranular zone (SGZ) and subventricular zone (SVZ) were assessed in control rats and rats after one or two strokes. In vitro neurosphere assay was used to assess the effects of plasma from normal and stroke rats. Also, EM and permeability studies were used to evaluate changes in the blood-brain-barrier (BBB) of the SGZ after recurrent stroke. We found that proliferation and neurogenesis was activated 14 days after MCAO. This was correlated with increased permeability in the BBB to factors which increase proliferation in a neurosphere assay. However, with each stroke, there was a stepwise decrease of proliferating stem cells and impaired neurogenesis on the ipsilateral side. On the contralateral side, this process stabilized after a first stroke. These studies indicate that stem cells are activated after MCAO, possibly after increased access to systemic stroke-related factors through a leaky BBB. However, the recruitment of stem cells for neurogenesis after stroke results in a stepwise ipsilateral decline with each ischemic event, which could contribute to post-stroke dementia.

Despite improvements in diagnosis and treatment, multiple sclerosis (MS) is the leading neurological cause of disability in young adults. As a chronic disease, MS requires complex and challenging management. In this context, eHealth has gained an increasing relevance. Here, we aim to summarize beneficial features of a mobile app recently implemented in clinical MS routine as well as beyond MS. PatientConcept is a CE-certified, ID-associated multilingual software application allowing patients to record relevant health data without disclosing any identifying data. Patients can voluntarily share their health data with selected physicians. Since its implementation in 2018, about 3000 MS patients have used PatientConcept. Initially developed as a physician–patient communication platform, the app maps risk management plans of all current disease modifying therapies and thereby facilitates adherence to specified monitoring appointments. It also allows continuous monitoring of various PROs (Patient Reported Outcomes), enabling a broad overview of the disease course. In addition, various studies/projects currently assess monitoring, follow-up, diagnostics and telemetric evaluations of patients with other diseases beyond MS. Altogether, PatientConcept offers a broad range of possibilities to support physician–patient communication, implementation of risk management plans and assessment of PROs. It is a promising tool to facilitate patient-tailored management of MS and other chronic diseases.

Abstract Background Maintaining patient adherence to disease modifying drugs in multiple sclerosis is a challenge, which can be improved by autoinjectors. The BETACONNECT® is a fully electronic autoinjector for the injection of interferon beta-1b (IFN beta-1b) automatically recording injections. Methods The BETAEVAL study was a prospective, observational, cohort study over 24 weeks among patients with relapsing remitting multiple sclerosis or clinically isolated syndrome treated with IFN beta-1b in Germany using the BETACONNECT®. The primary aim was to investigate treatment adherence, secondary aims included assessing satisfaction and functional health status. Adherence was evaluated from injection data recorded by the device. Patient-related data were obtained from clinical examinations and patient questionnaires. Results Of the 151 patients enrolled, 143 were available for analysis. Thirty-four patients discontinued the study prematurely. 107/143 (74.8%) patients still used the BETACONNECT® at the end of the study. Injection data from the device at any visit was available for 107 patients. Among those, the percentage of adherent patients injecting ≥80% of doses and still participating in the study was 57.9% at week 24. 29% of patients prematurely stopped the study, 13.1% injected

In this technological age, storytelling is moving from oral and written to digital formats, creating many methodological opportunities for researchers and practitioners. This article explores a specific genre of participatory media production, digital storytelling (DST), which could be a valuable research tool to describe, analyze, and understand the experiences of research participants. Digital stories (DS) are short movies that use images, videos, a voice-over, and various video editing techniques to share an important story from the participant’s life. In a health care setting, DS can be used as knowledge translation tools for education and advocacy, as data to be analyzed in the research process, or as a therapeutic intervention, in any combination, depending on the intent of the project. Although an increasing number of health-related research studies indicate using DST, or some variation of it, there is a glaring paucity of methodologically focused manuscripts in the health care literature. This article delineates and describes four primary phases of DST in a health care context as finding the story, telling the story, crafting the story, and sharing the story. Both the creative and technical considerations of DST facilitation are elucidated through specific examples and practical concepts. By drawing from diverse literature such as narratology, film, and psychotherapy, and exploring new creative tools and ideas to help research participants convey meaning, this article provides a starting point for qualitative researchers to explore the use of DST in their own contexts.

Article first published in: LANG MICHAEL. 2020. Business Model Innovation Approaches: A Systematic Literature Review. Acta Universitatis Agriculturae et Silviculturae Mendelianae Brunensis, 68(2): 435–449. https://doi.org/10.11118/actaun202068020435.

Since their introduction in 1954, cumulative sum (CUSUM) control charts have seen a widespread use beyond the conventional realm of statistical process control (SPC). While off-the-shelf implementations aimed at practitioners are available, their successful use is often hampered by inherent limitations which make them not easily reconcilable with real-world scenarios. Challenges commonly arise regarding a lack of robustness due to underlying parametric assumptions or requiring the availability of large representative training datasets. We evaluate an adaptive distribution-free CUSUM based on sequential ranks which is self-starting and provide detailed pseudo-code of a simple, yet effective calibration algorithm. The main contribution of this paper is in providing a set of ready-to-use tables of control limits suitable to a wide variety of applications where a departure from the underlying sampling distribution to a stochastically larger distribution is of interest. Performance of the proposed tabularized control limits is assessed and compared to competing approaches through extensive simulation experiments. The proposed control limits are shown to yield significantly increased agility (reduced detection delay) while maintaining good overall robustness.

IntroductionOsteoporotic vertebral fractures are a major cause of morbidity, disability, and mortality among the elderly. Traditional methods for fracture risk assessment, such as dual-energy X-ray absorptiometry (DXA), may not fully capture the complex factors contributing to fracture risk. This study aims to enhance vertebral fracture risk prediction by integrating radiomics features extracted from computed tomography (CT) scans with clinical data, utilizing advanced machine learning techniques.MethodsWe analyzed CT imaging data and clinical records from 124 patients, extracting a comprehensive set of radiomics features. The dataset included shape, texture, and intensity metrics from segmented vertebrae, alongside clinical variables such as age and DXA T-values. Feature selection was conducted using a Random Forest model, and the predictive performance of multiple machine learning models—Random Forest, Gradient Boosting, Support Vector Machines, and XGBoost—was evaluated. Outcomes included the number of fractures (N_Fx), mean fracture grade, and mean fracture shape. Incorporating radiomics features with clinical data significantly improved predictive accuracy across all outcomes. The XGBoost model demonstrated superior performance, achieving an R2 of 0.7620 for N_Fx prediction in the training set and 0.7291 in the validation set. Key radiomics features such as Dependence Entropy, Total Energy, and Surface Volume Ratio showed strong correlations with fracture outcomes. Notably, Dependence Entropy, which reflects the complexity of voxel intensity arrangements, was a critical predictor of fracture severity and number.DiscussionThis study underscores the potential of radiomics as a valuable tool for enhancing fracture risk assessment beyond traditional clinical methods. The integration of radiomics features with clinical data provides a more nuanced understanding of vertebral bone health, facilitating more accurate risk stratification and personalized management in osteoporosis care. Future research should focus on standardizing radiomics methodologies and validating these findings across diverse populations.

While the importance of continuous monitoring of electrocardiographic (ECG) or photoplethysmographic (PPG) signals to detect cardiac anomalies is generally accepted in preventative medicine, there remain numerous challenges to its widespread adoption. Most notably, difficulties arise regarding crucial characteristics such as real-time capability, computational complexity, the amount of required training data, and the avoidance of too-restrictive modeling assumptions. We propose a lightweight and model-free approach for the online detection of cardiac anomalies such as ectopic beats in ECG or PPG signals on the basis of the change detection capabilities of singular spectrum analysis (SSA) and nonparametric rank-based cumulative sum (CUSUM) control charts. The procedure is able to quickly detect anomalies without requiring the identification of fiducial points such as R-peaks, and it is computationally significantly less demanding than previously proposed SSA-based approaches. Therefore, the proposed procedure is equally well suited for standalone use and as an add-on to complement existing (e.g., heart rate (HR) estimation) procedures.

The quasi-two-dimensional organic charge-transfer salt κ -(BEDT-TTF) 2 Cu 2 (CN) 3 is one of the prime candidates for a quantum spin-liquid due the strong spin frustration of its anisotropic triangular lattice in combination with its proximity to the Mott transition. Despite intensive investigations of the material’s low-temperature properties, several important questions remain to be answered. Particularly puzzling are the 6 K anomaly and the enigmatic effects observed in magnetic fields. Here we report on low-temperature measurements of lattice effects which were shown to be particularly strongly pronounced in this material (R. S. Manna et al., Phys. Rev. Lett. 2010, 104, 016403)). A special focus of our study lies on sample-to-sample variations of these effects and their implications on the interpretation of experimental data. By investigating overall nine single crystals from two different batches, we can state that there are considerable differences in the size of the second-order phase transition anomaly around 6 K, varying within a factor of 3. In addition, we find field-induced anomalies giving rise to pronounced features in the sample length for two out of these nine crystals for temperatures T < 9 K. We tentatively assign the latter effects to B-induced magnetic clusters suspected to nucleate around crystal imperfections. These B-induced effects are absent for the crystals where the 6 K anomaly is most strongly pronounced. The large lattice effects observed at 6 K are consistent with proposed pairing instabilities of fermionic excitations breaking the lattice symmetry. The strong sample-to-sample variation in the size of the phase transition anomaly suggests that the conversion of the fermions to bosons at the instability is only partial and to some extent influenced by not yet identified sample-specific parameters.

We present a study of the influence of disorder on the Mott metal-insulator transition for the organic charge-transfer salt κ -(BEDT-TTF) 2 Cu[N(CN) 2 ]Cl. To this end, disorder was introduced into the system in a controlled way by exposing the single crystals to X-ray irradiation. The crystals were then fine-tuned across the Mott transition by the application of continuously controllable He-gas pressure at low temperatures. Measurements of the thermal expansion and resistance show that the first-order character of the Mott transition prevails for low irradiation doses achieved by irradiation times up to 100 h. For these crystals with a moderate degree of disorder, we find a first-order transition line which ends in a second-order critical endpoint, akin to the pristine crystals. Compared to the latter, however, we observe a significant reduction of both, the critical pressure p c and the critical temperature T c . This result is consistent with the theoretically-predicted formation of a soft Coulomb gap in the presence of strong correlations and small disorder. Furthermore, we demonstrate, similar to the observation for the pristine sample, that the Mott transition after 50 h of irradiation is accompanied by sizable lattice effects, the critical behavior of which can be well described by mean-field theory. Our results demonstrate that the character of the Mott transition remains essentially unchanged at a low disorder level. However, after an irradiation time of 150 h, no clear signatures of a discontinuous metal-insulator transition could be revealed anymore. These results suggest that, above a certain disorder level, the metal-insulator transition becomes a smeared first-order transition with some residual hysteresis.

Web development teams are multidisciplinary, bringing together designers from a variety of backgrounds. A Web designer’s professional training and education can shape his problem-solving orientation and world view by indoctrinating certain values and conditioning him to think and behave in certain ways. This paper presents an analysis of data gathered across 14 interviews, wherein four distinct orientations were identified: (1) Web development as the design of a functional software application (emphasis on back-end functionality); (2) as the design of an interactive tool (emphasis on ergonomics); (3) as the design of a communicational dialogue (emphasis on audience engagement); and (4) as an extension of branded graphic design (emphasis on visual presentation).