Search

Abstract Background Cutibacterium acnes ( C. acnes), a Gram-positive anaerobe and a dominant bacterium species in the sebaceous follicles of the face was detected in the brain of Alzheimer’s disease (AD) patients. It has been found that C. acnes activates non-specifically the innate immune system by producing proinflammatory cytokines and can participate in brain inflammation. We hypothesise that C. acnes could influence the brain through the structural alteration in axons and dendrites of neurons. Methods In this regard, the hippocampus of rats was infected with C. acnes, and memory retention, amyloid-β (Aβ1–42) deposition, hyperphosphorylated tau protein (p-Tau) formation, and expression levels of MAP2 and β-tubulin proteins in the hippocampus tissues were investigated. Results C. acnes-infected rats displayed memory deficits and Aβ1–42 deposits were detected in their hippocampus tissue up to 7 days post-infection. C. acnes was neurotoxic and exerted detrimental effects on MAP2 and β-tubulin proteins, which are required for normal neuronal function. An elevated level of p-Tau was also identified in infected animals. Conclusion Based on these results, we propose that C. acnes infection of the brain participates in the initiation of the pathogenesis of sporadic AD through degeneration of axons and dendrites. Graphical Abstract

Design thinking is often proposed as an educative strategy to enhance growth mindset, problem solving, and creativity, but there are very few evaluations of the impact of experiential design thinking programs. The primary aim of this study was to investigate whether an online design-thinking workshop provided to outdoor education staff could improve their design-thinking traits. The pilot program was delivered over a 6-week period and comprised four, 2-hour sessions, in which teams worked together to actively engage in the steps of the design thinking process. Significant improvements were observed in participants' growth mindset and design thinking process--specifically, feedback seeking. Furthermore, design thinking was strongly correlated with growth mindset and cognitive flexibility; two constructs previously theorised to be associated with design thinking. This study provides a framework for constructing online design thinking workshops and how to effectively evaluate participant outcomes.

Background: Meaningful, varied, joyful conversation is an important therapy target for adults with language or cognitive-communication disorders following acquired brain injury (ABI). However, the complexity of daily communication is often reduced to component parts within intervention programmes, with mixed evidence of generalization to everyday conversation. Interventions targeting co-construction of communication within a dyad offer a structured way in which to retain and treat elements of everyday conversation for individuals and their communication partner (CP). Such interventions exist but they are variably labelled, target different ABI populations and have not been synthesized. Aims: To identify the nature, scope and effects of intervention studies targeting co-constructed communication in adults with ABI. Method: This systematic review was completed using PRISMA Guidelines. Six databases (MEDLINE, Embase, CINAHL, Scopus, LLBA, PsychInfo) were searched and 1210 studies were screened. Data were extracted and studies were rated for methodological quality and completeness of reporting. Outcome measures and effects of treatment were collated through descriptive synthesis. Main Contribution: This review highlights an emerging evidence base in relation to an intervention approach that targets everyday communication. Co-constructed communication interventions have been reported by 13 studies, from a total of 206 participants with post-stroke aphasia, traumatic brain injury and progressive language impairments. These interventions take a range of formats, including referential communication tasks, retell/recount therapies and communication training programmes. Methodological quality evaluation indicated mostly low-level study designs. Heterogeneity was identified in primary outcome measures, with 28 unique primary outcome measures reported across studies. Most studies demonstrated change in task-specific or broad communication outcome measures. Conclusions: Co-constructed communication interventions may offer clinicians a systematic, protocolized, replicable way to target everyday communication for adults with ABI. More high-quality, experimental designs with complete reporting and psychometrically sound outcome measures are needed to strengthen the evidence base.

The higher education sector has learnt a great deal in the online delivery shift due to COVID-19, however, student voice has been underrepresented in literature. This paper reveals 15 student perspectives, including both international and domestic students, who were studying a Master of Teaching (Secondary) at one university in Melbourne, Australia, during heightened social distancing restrictions. The inductive thematic qualitative data analysis collected through semi-structured interviews showed opportunities and challenges of learning experiences. Emergent themes found affordances of convenience and challenges of relational and structural aspects of teaching and learning. Relational aspects of learning were more challenging, including peer collaboration, seeking informal advice and feedback from academics, and participation and engagement. We recommend the inclusion of student voice to guide post COVID-19 teacher education design recommend several areas of support to guide a humanising and personal connection into the remote learning environment.

Background: Subarachnoid hemorrhage (SAH) can lead to elevated intracranial pressure (ICP), which poses significant risks of morbidity and mortality. Monitoring ICP is crucial for the early detection and management of these complications in patients with aneurysmal SAH (aSAH). Traditional invasive ICP monitoring techniques, while effective, carry risks associated with infection and other complications. The Schmidt method, a noninvasive ICP monitoring technique, has emerged as a potential alternative to provide reliable measurements without the inherent risks of invasive methods. Methods: From January 2018 to December 2023, the authors performed both invasive (intraventricular catheters) and noninvasive (Schmidt method) ICP monitoring in patients with aSAH and Hunt and Hess (H and H) scores of 3–5. Patients requiring emergent craniotomy, with serious medical comorbidities or coagulopathies, or with noncompliance were excluded from the study. The accuracy and efficacy of the Schmidt method were evaluated by comparing the results of noninvasive monitoring with the results of invasive ICP monitoring. Results: Out of 238 cases with aSAH referred to our neurosurgical center, 105 had H and H scores of 3–5. Noninvasive ICP monitoring using the Schmidt method was performed in 86 cases (48 females, 38 males; mean age 68 ± 8 years). The mean ICP measured by the invasive method was 15.2 ± 6.2 mmHg, whereas the mean ICP measured by the noninvasive method was 16.6 ± 5.4 mmHg. The calculated root mean square error was 3.6 mmHg, and the average Pearson correlation between the estimated and real waveforms was 0.96. Conclusion: The findings of this study suggest that the application of the Schmidt method is a reliable and accurate approach for the assessment of ICP in patients with SAH, potentially eliminating the need for invasive ICP monitoring and reducing the associated risks.

Background: Tuberculosis (TB) remains a significant global health concern, with extrapulmonary manifestations, including central nervous system involvement, posing substantial morbidity and mortality. While medical treatment with anti-TB drugs is the mainstay of therapy, certain TB-related cerebral complications, such as hydrocephalus, abscesses, and large symptomatic tuberculomas, may require surgical intervention. This study aimed to evaluate the outcomes of surgical management in patients with TB-related cerebral disorders. Methods: A retrospective analysis was conducted on 24 patients who underwent surgical intervention for TB-related cerebral disorders, including tuberculomas, hydrocephalus, and abscesses, at a tertiary care center between 2005 and December 2020. Demographic data, clinical presentations, radiological findings, surgical techniques, and treatment outcomes were analyzed. Results: The study cohort had a mean age of 35.8 ± 13.6 years, and the majority (62.5%) were male. Underlying immunodeficiency, primarily HIV infection, was present in 75% of the patients. The most common presenting symptoms were headache (83.3%), focal neurological deficits (75%), and altered mental status (54.2%). Radiological findings revealed 13 (54.2%) tuberculomas, 8 (33.3%) instances of hydrocephalus, and 3 (12.5%) abscesses. VP shunt inserted in 8 (33.3%) cases. Microscopic craniotomy performed in 7 (29.16%) cases. Aspiration through burr hole was done in 3 (12.5%) cases and stereotactic biopsy was performed in 6 (25%) cases. After 12 months of follow-up, favorable outcome achieved in 18 cases (75%) and the mortality occurred in 2 patients (8.3%). Surgical interventions included lesion resection (n = 10), stereotactic biopsy (n = 7), and ventriculoperitoneal (VP) shunt placement (n = 7). At 12-month follow-up, 18 (75%) patients had a favorable outcome, defined as clinical improvement or stabilization. Unfavorable outcomes were observed in 6 (25%) patients, including 2 deaths. Conclusion: Surgical management, in conjunction with appropriate anti-TB medical therapy, may be a valuable component of the comprehensive treatment approach for select patients with TB-related cerebral disorders. The favorable outcome rate observed in this study suggests that timely and tailored surgical intervention can contribute to improved patient outcomes. However, larger, prospective, multicenter studies are needed to further elucidate the role and long-term efficacy of surgical management in this patient population.

Abstract Objective Neurological and functional impairments are commonly observed in individuals with spinal cord injury (SCI) due to insufficient regeneration of damaged axons. Exosomes play a crucial role in the paracrine effects of mesenchymal stem cells (MSCs) and have emerged as a promising therapeutic approach for SCI. Thus, this study aimed to evaluate the safety and potential effects of intrathecal administration of allogeneic exosomes derived from human umbilical cord MSCs (HUC-MSCs) in patients with complete subacute SCI. Methods This study was a single-arm, open-label, phase I clinical trial with a 12-month follow-up period. HUC-MSCs were extracted from human umbilical cord tissue, and exosomes were isolated via ultracentrifugation. After intrathecal injection, each participant a underwent complete evaluation, including neurological assessment using the American Spinal Injury Association (ASIA) scale, functional assessment using the Spinal Cord Independence Measure (SCIM-III), neurogenic bowel dysfunction (NBD) assessment using the NBD score, modified Ashworth scale (MAS), and lower urinary tract function questionnaire. Results Nine patients with complete subacute SCI were recruited. The intrathecal injection of allogeneic HUC-MSCs-exosomes was safe and well tolerated. No early or late adverse event (AE) attributable to the study intervention was observed. Significant improvements in ASIA pinprick (P-value = 0.039) and light touch (P-value = 0.038) scores, SCIM III total score (P-value = 0.027), and NBD score (P-value = 0.042) were also observed at 12-month after the injection compared with baseline. Conclusions This study demonstrated that intrathecal administration of allogeneic HUC-MSCs-exosomes is safe in patients with subacute SCI. Moreover, it seems that this therapy might be associated with potential clinical and functional improvements in these patients. In this regard, future larger phase II/III clinical trials with adequate power are highly required. Trial registration Iranian Registry of Clinical Trials, IRCT20200502047277N1. Registered 2 October 2020, https://en.irct.ir/trial/48765 .

Objective (s): In a situation where the vaccine was not completely accurate and up-to-date against different strains of the virus in all people of the world, compliance with health guidelines was the main key to prevent transmission. But what is clear is that compliance with health protocols is not the same among all communities and depends on factors. This article examines the effects and attitudes of health protocols. Methods: This research was a descriptive-quantitative cross-sectional study, which was conducted among 385 students of Shahid Beheshti University of Medical Sciences, Iran in the last week of May 2022. Factors affecting the adherence to water hygiene behaviors due to covid-19 were investigated using a questionnaire and the results were analyzed and reported in ordinal regression with SPSS 25 software. Results: The ratio of the average score of compliance (19.08) from the total of eight health behaviors to the maximum score (25) was reported as 76%. It was reported that the score of awareness was very high, 94%, and the average score of attitude was about 75%. In the ordinal regression, it was found that having knowledge was not effective in following all health protocols and only two behaviors of avoiding attending gatherings and avoiding losing when meeting acquaintances showed a statistically significant relationship. In other words, with the increase of each score of awareness, the chance of having higher compliance scores in these two behaviors increased by about 1.5 times. On the other hand, the attitude score had a statistically significant relationship with most of the behaviors, except the compliance of coughing and sneezing into a handkerchief or the corner of the arm, and it had a positive simultaneous effect on the compliance of the behaviors. Conclusion: The high level of awareness among the studied community can partially indicate the effectiveness of interventions in increasing awareness, but the gap between awareness, attitude and behavior indicates the need to pay attention to other factors affecting attitude and behavior.

Abstract This paper presents a new methodology for addressing imbalanced class data for failure prediction in Water Distribution Networks (WDNs). The proposed methodology relies on existing approaches including under-sampling, over-sampling, and class weighting as primary strategies. These techniques aim to treat the imbalanced datasets by adjusting the representation of minority and majority classes. Under-sampling reduces data in the majority class, over-sampling adds data to the minority class, and class weighting assigns unequal weights based on class counts to balance the influence of each class during machine learning (ML) model training. In this paper, the mentioned approaches were used at levels other than “balance point” to construct pipe failure prediction models for a WDN with highly imbalanced data. F1-score, and AUC–ROC, were selected to evaluate model performance. Results revealed that under-sampling above the balance point yields the highest F1-score, while over-sampling below the balance point achieves optimal results. Employing class weights during training and prediction emphasises the efficacy of lower weights than the balance. Combining under-sampling and over-sampling to the same ratio for both majority and minority classes showed limited improvement. However, a more effective predictive model emerged when over-sampling the minority class and under-sampling the majority class to different ratios, followed by applying class weights to balance data.

Abstract In the context of early disease detection, machine learning (ML) has emerged as a vital tool. Feature selection (FS) algorithms play a crucial role in ensuring the accuracy of predictive models by identifying the most influential variables. This study, focusing on a retrospective cohort of 4778 COVID-19 patients from Iran, explores the performance of various FS methods, including filter, embedded, and hybrid approaches, in predicting mortality outcomes. The researchers leveraged 115 routine clinical, laboratory, and demographic features and employed 13 ML models to assess the effectiveness of these FS methods based on classification accuracy, predictive accuracy, and statistical tests. The results indicate that a Hybrid Boruta-VI model combined with the Random Forest algorithm demonstrated superior performance, achieving an accuracy of 0.89, an F1 score of 0.76, and an AUC value of 0.95 on test data. Key variables identified as important predictors of adverse outcomes include age, oxygen saturation levels, albumin levels, neutrophil counts, platelet levels, and markers of kidney function. These findings highlight the potential of advanced FS techniques and ML models in enhancing early disease detection and informing clinical decision-making.

ABSTRACT Background Despite remarkable progress in contemporary medical technology and enhanced survival outcomes for various cancer types, pancreatic cancer (PC) continues to stand out as a particularly deadly gastrointestinal malignancy. Given a persistent rise in both incidence and the corresponding mortality rates of PC globally, evaluations of PC burden by sex are of great importance. Here, we used the illness‐death multi‐state model (IDM) to forecast the prevalence of PC through the year 2040. Methods IDM was established based on obtainable data to predict the future prevalence of PC on global, regional, and national scales from 2019 to 2040. Analyses were also performed regarding sex and 95% confidence intervals (CIs) are presented for all estimates. Results The projected prevalence rate for 2040 is anticipated to be 6.093 ([95% CI 5.47–6.786] per 100,000) worldwide, indicating a significant increase of 31.45% since 1990, and a 12.29% increase since 2019. The estimated average annual increase since 2020 was 0.5%. Considering sex differences, females are expected to have a steeper slope in prevalence rate than males. Intriguingly, when considering the percentage changes between the periods of 2019–2040 and 1990–2019 for both sexes, females exhibited 29% and 11% increase relative to males (2.6‐fold greater increase). Conclusions By 2040, it is predicted that the prevalence of PC will increase globally, with women being at higher risk of developing the disease. Considering the percentage changes, regions with lower socioeconomic status are anticipated to face a greater risk of experiencing PC compared to other geographical areas.