Diagnosis and Screening of Velocardiofacial Syndrome by Evaluating Facial Photographs Using a Deep Learning-Based Algorithm.

BACKGROUND: Early detection of rare genetic diseases, including velocardiofacial syndrome (VCFS), is essential for patient well-being. However, their rarity and limited clinical experience of physicians make diagnosis challenging. Deep learning algorithms have emerged as promising tools for efficient and accurate diagnosis. This study investigates the use of a deep learning algorithm to develop a face recognition model for diagnosing VCFS. METHODS: The study employed publicly available labeled face datasets to train the multitask cascaded convolutional neural networks (MTCNN) model. Subsequently, we examined the binary classification performance for diagnosing VCFS using the most efficient face recognition model. A total of 98 VCFS patients (920 facial photographs) and 91 non-VCFS controls (463 facial photographs) were randomly divided into training and test sets. Additionally, we analyzed whether the classification results matched the known facial phenotype of VCFS. RESULTS: The face recognition model demonstrated high accuracy, ranging from 94% to 99%, depending on the training dataset. The accuracy of the binary classification diagnostic model varied from 81% to 88% when evaluating with photographs taken at various angles, but reached 95% evaluating with frontal photographs only. Gradient-weighted class activation mapping heatmap revealed the high importance level of perinasal and periorbital areas, exhibiting consistency with the conventional facial phenotypes of VCFS. CONCLUSION: This study shows the feasibility and effectiveness of MTCNN-based model for detecting VCFS solely from facial photographs. The high accuracy underscores the potential of deep learning in aiding early diagnosis of rare genetic diseases, facilitating timely interventions for patient care.

Feline eye-inspired artificial vision for enhanced camouflage breaking under diverse light conditions.

Biologically inspired artificial vision research has led to innovative robotic vision systems with low optical aberration, wide field of view, and compact form factor. However, challenges persist in object detection and recognition against complex backgrounds and varied lighting. Inspired by the feline eye, which features a vertically elongated pupil and tapetum lucidum, this study introduces an artificial vision system designed for superior object detection and recognition in a monocular framework. Using a slit-like elliptical aperture and a patterned metal reflector beneath a hemispherical silicon photodiode array, the system reduces excessive light and enhances photosensitivity. This design achieves clear focus under bright light and enhanced sensitivity in dim conditions. Theoretical and experimental analyses demonstrate the system's ability to filter redundant information and detect camouflaged objects in diverse lighting, representing a substantial advancement in monocular camera technology and the potential of biomimicry in optical innovations.

Global Health Competency of Nursing Personnel: A Cross-Sectional Study.

Introduction: As global health issues become more important, nursing education is undergoing change to reflect the changing global health environment and new knowledge. Nurses are required to be able to understand and interact with patients of diverse cultural backgrounds and characteristics and have relevant global health competencies. Objectives: The aims of this study were to determine the GHC status of nurses and to analyze the association between GHC and nurse characteristics. Methods: This study was a cross-sectional descriptive survey using a convenience sampling method. Data were collected from 473 nurses to collect information about participants' GHC and general characteristics, including gender, age, nursing experience (years), experience of caring for foreign patients, English communication skills, learning experience in global health, and global preparedness. Multiple regression analysis was used to determine the relationship between GHC and nurse characteristics. Results: The mean GHC score of nurses was 2.21 out of 4. "Nursing practice in globalization" was the most important global health competency, while "resource management in globalization" was the one that was most necessary. In addition, "Resource management in globalization" was the highest priority for global health competency. Global preparedness (ß = .25, p < .001) and the perceived necessity of GHC in nursing practice (ß = .28, p < .001) were statistically significant factors influencing the global health competency of nurses. Conclusion: Based on the relationship identified between GHC and the characteristics of nurses, it is essential to develop an education program for enhancing global preparedness and perception of the necessity of GHC.

Normative evidence weighting and accumulation in correlated environments.

The brain forms certain deliberative decisions following normative principles related to how sensory observations are weighed and accumulated over time. Previously we showed that these principles can account for how people adapt their decisions to the temporal dynamics of the observations (Glaze et al., 2015). Here we show that this adaptability extends to accounting for correlations in the observations, which can have a dramatic impact on the weight of evidence provided by those observations. We tested online human participants on a novel visual-discrimination task with pairwise-correlated observations. With minimal training, the participants adapted to uncued, trial-by-trial changes in the correlations and produced decisions based on an approximately normative weighting and accumulation of evidence. The results highlight the robustness of our brain's ability to process sensory observations with respect to not just their physical features but also the weight of evidence they provide for a given decision.

Unexpected postoperative atlantoaxial rotatory subluxation after excision of melanocytic nevi of the head and neck in older children: two case reports and literature review.

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

Transcriptome and functional analyses of phenotypic plasticity in sea grape Caulerpa okamurae.

Caulerpa is a marine green macroalga distinguished by a large single cell with multiple nuclei. It also exhibits remarkable morphological intraspecies variations, in response to diverse environmental types. However, the molecular mechanisms underlying this phenotypic plasticity remain poorly understood. In this work, we compare the transcriptomes of Caulerpa okamurae Weber Bosse, 1897 displaying altered phenotypes of cultivation and natural phenotypes and investigate significantly regulated genes and their biological functions using differential expression analyses. We observe light-harvesting complex upregulation and cellular framework stability downregulation in altered phenotypes compared to the natural phenotypes. Intertidal macrophytes reduce light capture to avoid photodamage and regulate their morphology to protect against wave damage. In contrast, the lower light conditions and the cultivation environment augment light capture and increase a morphology prioritizing light trapping. Moreover, the addition of simulated wave-sweeping stimuli induces a return to the natural morphology under high-light conditions, showing how mechanical stress affects morphological organization in C. okamurae. We provide detailed gene expression patterns in C. okamurae under varying light intensities and water conditions, suggesting a distinct influence on its morphological traits.

Clinical nurses' work-life balance prediction due to patient safety incidents using classification and regression tree analysis: a secondary data analysis.

BACKGROUND: Patient safety incidents lead to performance difficulties for nurses when providing nursing practice. This affects work-life balance and causes second and third-victimization. This study predicts factors affecting clinical nurses' work-life balance due to patient safety incidents using classification and regression tree analysis techniques. METHODS: This study was a secondary analysis of data from a cohort research project, which used a descriptive survey for data collection. Participants comprised 372 nurses. Data were collected using SurveyMonkey, a mobile-based survey software solution, from January to September 2021. Data included the general characteristics of clinical nurses, second damage, second damage support, third damage, and work-life balance. The specific variables included in the analysis chosen through rigorous Lasso analysis form the foundation for predicting work-life balance. Variables with low explanatory power were excluded, thereafter, the variables selected by Lasso were analyzed with a classification and regression tree model to predict work-life balance. RESULTS: A regression tree was applied to predict work-life balance using seven variables-education level, marital status, position, physical distress, second-victim support, turnover intentions, and absenteeism (selected through Lasso analysis). After pruning, at tree size four, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support < 2.345, the predicted work-life balance was 3.972. However, when turnover intentions were < 4.250, physical distress < 2.875, and second-victim support ≥ 2.345, then the predicted work-life balance was 2.760. CONCLUSIONS: This study's insights offer crucial groundwork for crafting targeted workforce risk management strategies and fostering a conducive organizational culture to mitigate nursing occupational stress, potentially curbing the recurrence of patient safety incidents and improving nursing practice while enhancing patient outcomes. Future research should explore second and third victim experiences across various healthcare settings globally to understand their impact on WLB and patient safety outcomes.

Stability of Zr-Based UiO-66 Metal-Organic Frameworks in Basic Solutions.

Although Zr-based metal-organic frameworks (MOFs) exhibit robust chemical and physical stability in the presence of moisture and acidic conditions, their susceptibility to nucleophilic attacks from bases poses a critical challenge to their overall stability. Herein, we systematically investigate the stability of Zr-based UiO-66 (UiO = University of Oslo) MOFs in basic solutions. The impact of 11 standard bases, including inorganic salts and organic bases, on the stability of these MOFs is examined. The destruction of the framework is confirmed through powder X-ray diffraction (PXRD) patterns, and the monitored dissolution of ligands from the framework is assessed using nuclear magnetic resonance (NMR) spectroscopy. Our key findings reveal a direct correlation between the strength and concentration of the base and the destruction of the MOFs. The summarized data provide valuable insights that can guide the practical application of Zr-based UiO-66 MOFs under basic conditions, offering essential information for their optimal utilization in various settings.

Various soft tissue defect reconstructions using anterolateral thigh and vascularized fascia lata composite free flap.

The anterolateral thigh flap (ALT) is versatile for soft-tissue reconstruction of various body defects because of its thick and vascularized fascia component. We present our clinical experience with the functional one-stage reconstruction of complicated soft-tissue defects using ALTs with vascularized fascia lata (FL). Between April 2018 and February 2022, we transferred ALTs with FL components for various soft-tissue defects in 15 patients. The FL component was used for reconstruction of hand & forearm tendon, medial and lateral patellar synovial membrane, plantar aponeurosis, abdominal wall, dura and Achilles tendon. Functional outcomes were evaluated in each patient. Partial flap necrosis occurred in 2 patients and were treated successfully with minimal surgical debridement and dressing. The vascularized fascia could replace a tendon and fascial component and all the patients achieved satisfactory results without major postoperative complications. Anterolateral thigh flaps with vascularized FL provide reliable fascial and tendon components for single-stage reconstruction of complex soft tissue defects.

Development of a web-based care networking system to support visiting healthcare professionals in the community.

BACKGROUND: The role of visiting health services has been proven to be effective in promoting the health of older populations. Hence, developing a web system for nurses may help improve the quality of visiting health services for community-dwelling frail older adults. This study was conducted to develop a web application that reflects the needs of visiting nurses. METHODS: Visiting nurses of public health centers and community centers in South Korea participated in the design and evaluation process. Six nurses took part in the focus group interviews, and 21 visiting nurses and community center managers participated in the satisfaction evaluation. Focus group interviews were conducted to identify the needs of visiting nurses with respect to system function. Based on the findings, a web application that can support the effective delivery of home visiting services in the community was developed. An artificial intelligence (AI) algorithm was also developed to recommend health and welfare services according to each patient's health status. After development, a structured survey was conducted to evaluate user satisfaction with system features using Kano's model. RESULTS: The new system can be used with mobile devices to increase the mobility of visiting nurses. The system includes 13 features that support the management of patient data and enhance the efficiency of visiting services (e.g., map, navigation, scheduler, protocol archives, professional advice, and online case conferencing). The user satisfaction survey revealed that nurses showed high satisfaction with the system. Among all features, the nurses were most satisfied with the care plan, which included AI-based recommendations for community referral. CONCLUSIONS: The system developed from the study has attractive features for visiting nurses and supports their essential tasks. The system can help with effective case management for older adults requiring in-home care and reduce nurses' workload. It can also improve communication and networking between healthcare and long-term care institutions.

Integrated genomics and phenotype microarray analysis of Saccharomyces cerevisiae industrial strains for rice wine fermentation and recombinant protein production.

The industrial potential of Saccharomyces cerevisiae has extended beyond its traditional use in fermentation to various applications, including recombinant protein production. Herein, comparative genomics was performed with three industrial S. cerevisiae strains and revealed a heterozygous diploid genome for the 98-5 and KSD-YC strains (exploited for rice wine fermentation) and a haploid genome for strain Y2805 (used for recombinant protein production). Phylogenomic analysis indicated that Y2805 was closely associated with the reference strain S288C, whereas KSD-YC and 98-5 were grouped with Asian and European wine strains, respectively. Particularly, a single nucleotide polymorphism (SNP) in FDC1, involved in the biosynthesis of 4-vinylguaiacol (4-VG, a phenolic compound with a clove-like aroma), was found in KSD-YC, consistent with its lack of 4-VG production. Phenotype microarray (PM) analysis showed that KSD-YC and 98-5 displayed broader substrate utilization than S288C and Y2805. The SNPs detected by genome comparison were mapped to the genes responsible for the observed phenotypic differences. In addition, detailed information on the structural organization of Y2805 selection markers was validated by Sanger sequencing. Integrated genomics and PM analysis elucidated the evolutionary history and genetic diversity of industrial S. cerevisiae strains, providing a platform to improve fermentation processes and genetic manipulation.

Full-Control and Switching of Optical Fano Resonance by Continuum State Engineering.

Fano resonance, known for its unique asymmetric line shape, has gained significant attention in photonics, particularly in sensing applications. However, it remains difficult to achieve controllable Fano parameters with a simple geometric structure. Here, a novel approach of using a thin-film optical Fano resonator with a porous layer to generate entire spectral shapes from quasi-Lorentzian to Lorentzian to Fano is proposed and experimentally demonstrated. The glancing angle deposition technique is utilized to create a polarization-dependent Fano resonator. By altering the linear polarization between s- and p-polarization, a switchable Fano device between quasi-Lorentz state and negative Fano state is demonstrated. This change in spectral shape is advantageous for detecting materials with a low-refractive index. A bio-particle sensing experiment is conducted that demonstrates an enhanced signal-to-noise ratio and prediction accuracy. Finally, the challenge of optimizing the film-based Fano resonator due to intricate interplay among numerous parameters, including layer thicknesses, porosity, and materials selection, is addressed. The inverse design tool is developed based on a multilayer perceptron model that allows fast computation for all ranges of Fano parameters. The method provides improved accuracy of the mean validation factor (MVF = 0.07, q-q') compared to the conventional exhaustive enumeration method (MVF = 0.37).

Fighting Fire or Fighting War: Examining the Framing Effects of COVID-19 Metaphors.

Metaphorical language describing the COVID-19 pandemic as a war has been pervasive in public discourse (e.g. "the pandemic is a war," "the virus is an enemy," and "the vaccine is a weapon"). This study employs an online survey experiment (N = 551 U.S. adults) to examine the impact of war metaphors compared to non-metaphorical literal frames and fire metaphors (e.g. "the pandemic is a wildfire"). War metaphors exhibited little advantage over literal frames across a variety of desirable outcomes (i.e. the adoption of pro-health behaviors against COVID-19, perceived solidarity and collective responsibility to curb the pandemic, and intentions to discuss and share the health news with others). However, this study revealed some benefits of war metaphors over fire metaphors. Compared with fire metaphors, health news featuring war metaphors increased both positive emotions and perceived threats of COVID-19, which in turn promoted pro-health behaviors against COVID-19 and perceived solidarity to cope with the public health crisis. Moreover, positive emotions in response to war metaphors also indirectly encouraged the retransmission of science-based COVID-19 health news. This study thus showcased the benefits and limitations of war metaphors and revealed the mediating roles of perceived threats and positive emotions in explaining war metaphorical framing effects. Implications of using war and fire metaphors for communicating about public health crises are also discussed.

Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country.

BACKGROUND: The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers' experiences in Ethiopia in building relationships with local healthcare providers. METHODS: Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi's phenomenological method. RESULTS: Ten subthemes emerged from five themes: "facing new situations", "accepting myself as an outsider in Ethiopia", "impact on the wall of prejudice", "adapting to a new culture", and "positive outlook". CONCLUSIONS: This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.

Dancing on the inside: A qualitative study on online dance learning with teacher-AI cooperation.

Recent technologies have extended opportunities for online dance learning by overcoming the limitations of space and time. However, dance teachers report that student-teacher interaction is more likely to be challenging in a distant and asynchronous learning environment than in a conventional dance class, such as a dance studio. To address this issue, we introduce DancingInside, an online dance learning system that encourages a beginner to learn dance by providing timely and sufficient feedback based on Teacher-AI cooperation. The proposed system incorporates an AI-based tutor agent (AI tutor, in short) that uses a 2D pose estimation approach to quantitatively estimate the similarity between a learner's and teacher's performance. We conducted a two-week user study with 11 students and 4 teachers. Our qualitative study results highlight that the AI tutor in DancingInside could support the reflection on a learner's practice and help the performance improvement with multimodal feedback resources. The interview results also reveal that the human teacher's role is essential in complementing the AI feedback. We discuss our design and suggest potential implications for future AI-supported cooperative dance learning systems.

Increased suicide risk of psychiatric patients following the recent utilization of health care services: results from a nationwide cohort study in South Korea.

Purpose: This study aimed to examine whether and to what degree the suicide risk of psychiatric patients is associated with psychiatric and non-psychiatric health service utilization. Methods: We selected incident psychiatric patients, including schizophrenia, bipolar disorders, borderline personality disorder, depressive disorders, other affective disorders, and post-traumatic stress disorder patients, in 2007-2010 and followed them up until 2017 based on the data linkage between the Korean National Health Insurance and National Death Registry. We analyzed the time-dependent association between suicide and four types of health service (psychiatric vs. non-psychiatric and outpatient vs. inpatient) utilization using a time-dependent Cox regression. Results: The suicide risk of psychiatric patients was significantly increased with recent psychiatric and non-psychiatric admission and psychiatric outpatient visits. The adjusted suicide hazard ratios for recent outpatient visits were similar to or even higher than those for recent psychiatric admission. The adjusted suicide hazard ratios of schizophrenia patients for psychiatric admission, psychiatric outpatient visits, and non-psychiatric admission within the recent 6 months were 2.34 (95% confidence interval [CI]: 2.12-2.58, p < 0.001), 2.96 (95% CI: 2.65-3.30, p < 0.001), and 1.55 (95% CI: 1.39-1.74, p < 0.001), respectively. Suicide risk was not associated with recent non-psychiatric outpatient visits in patients, except for the depressive disorders group showing a negative association. Conclusion: Our results highlight the priority of suicide prevention for psychiatric patients in the clinical setting. Additionally, our results warrant the precaution against increased suicide risk of psychiatric patients after psychiatric and non-psychiatric discharge.

Food Allocation under Asynchronous Hatching Conditions of Great Tits (Parus major).

The brood reduction hypothesis, which explains asynchronous hatching in birds, as an adaptation that enables selective survival of older nestlings when availability of food is unpredictable. This study was conducted in order to determine whether the brood reduction hypothesis can explain asynchronous hatching in passerines. Infrared cameras were installed inside nest boxes where great tits (Parus major) were attempting to reproduce in order to determine whether the parents practiced selective feeding of older nestlings. According to the results of the study, no significant difference was observed between the hatching order and the average number of feedings per nestling. In addition, when examining the distribution of food according to hatching order over time, every 30 min, beginning at 9 a.m., selective distribution of food to older nestlings was not observed. In conclusion, use of the brood reduction hypothesis, which supports selective provision of beneficial feeding of older and larger nestlings, to explain the asynchronous hatching of passerines is problematic, thus conduct of future studies focusing on other hypotheses in order to explain the asynchronous hatching of this passerine bird will be necessary.

Nipple Projection Change in Immediate Breast Reconstruction and Use of an Acellular Dermal Matrix Strut for Maintaining Nipple Projection.

BACKGROUND: Nipple-sparing mastectomy (NSM) has gained popularity as more studies have supported its oncologic safety. Although there have been some studies reporting complications including mastectomy flap and nipple necrosis, there have been few reports discussing the change in nipple projection following NSM. This study aimed to analyze the change in nipple projection after NSM and identify risk factors for nipple depression. In addition, the authors present a new method for maintaining nipple projection. METHODS: Patients who underwent NSM between March of 2017 and December of 2020 at the authors' institute were included in this study. The authors measured the preoperative and postoperative nipple projection height and used a nipple projection ratio (NPR) to compare the change in height. Univariate and multivariate analyses were performed to examine the correlation of variables with the NPR. RESULTS: A total of 307 patients and 330 breasts were included in this study. There were 13 cases of nipple necrosis. The postoperative nipple height was decreased by 32.8%, which was statistically significant. In multiple linear regression analysis, the use of an acellular dermal matrix strut was positively correlated with the NPR and implant-based reconstruction and postmastectomy radiation therapy were negatively correlated with the NPR. CONCLUSIONS: The results of this study demonstrated that the reduction in nipple height after NSM was statistically significant. Surgeons need to be aware of these changes following NSM and explain this possibility to patients who have risk factors. The application of an acellular dermal matrix strut should be considered for the prevention of nipple reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Nurse Information Security Policy Compliance, Information Competence, and Information Security Attitudes Predict Information Security Behavior.

Nurses' attitudes toward information security can influence the hospital's information resources management and development. This study investigated the relationships between nurses' information security policy compliance, information competence, and information security attitudes, which are factors that influence information security behavior. Data were collected during September 2020. The participants were 200 clinical nurses from a general hospital in Korea. The self-reported questionnaire included questions on nurses' general characteristics, information security policy compliance, information competence, and information security attitudes. Information security policy compliance ( r = 0.554, P < .001) and information competence ( r = 0.614, P < .001) were positively associated with information security attitudes. Predictors of nurses' information security attitudes were information competence ( ß = .439), information security policy compliance ( ß = .343), prior information security-related education ( ß = .113), and job position (nurse manager; ß = .101). Implications for practice include the need for strategies to develop information security policy compliance and information competence to improve information security behavior, including different approaches tailored to nurses' job positions and previous information security education.

Psammomatoid Juvenile Ossifying Fibroma of the Maxilla Misdiagnosed as Fibrous Dysplasia: A Clinicopathologic Case Report.

Juvenile ossifying fibroma (JOF) is a variant of the ossifying fibroma and includes two histopathological subtypes: trabecular and psammomatoid. Psammomatoid JOF (PJOF) in craniofacial structures should be distinguished from other fibro-osseous lesions, such as fibrous dysplasia (FD), considering the difference in the treatment protocols. Here, we present a rare case of PJOF that was initially misdiagnosed as a case of FD and emphasize the importance of considering JOF in the differential diagnosis of patients with craniofacial fibro-osseous lesions. A 4-year-old boy demonstrated progressive enlargement of the zygomaticomaxillary area on his left side for the last 6 months. The patient was diagnosed as a case of FD based on the clinical features and radiographic findings, and was operated considering the rapid progression. To achieve facial symmetry, contouring of the zygomatic bone and arch was performed. However, the patient demonstrated rapid enlargement at the 3-month postoperative follow-up. The decision was made to surgically remove the tumor due to visual field impairment. Intraoperatively, a rubbery mass, which was separated from the surrounding cortical bone, was identified and excised. The lesion was confirmed as PJOF by histopathological examination. The possibility of PJOF should not be ruled out in the differential diagnosis of patients with fibrous-osseous lesions. In the event of suspected PJOF, accurate diagnosis should be made through definitive biopsy.