Evaluation of the Accuracy of the Smart Work Injury Management (SWIM) System to Assist Case Managers in Predicting the Work Disability of Injured Workers.

PURPOSE: Many countries have developed clinical decision-making support tools, such as the smart work injury management (SWIM) system in Hong Kong, to predict rehabilitation paths and address global issues related to work injury disability. This study aims to evaluate the accuracy of SWIM by comparing its predictions on real work injury cases to those made by human case managers, specifically with regard to the duration of sick leave and the percentage of permanent disability. METHODS: The study analyzed a total of 442 work injury cases covering the period from 2012 to 2020, dividing them into non-litigated and litigated cases. The Kruskal-Wallis post hoc test with Bonferroni adjustment was used to evaluate the differences between the actual data, the SWIM predictions, and the estimations made by three case managers. The intra-class correlation coefficient was used to assess the inter-rater reliability of the case managers. RESULTS: The study discovered that the predictions made by the SWIM model and a case manager possessing approximately 4 years of experience in case management exhibited moderate reliability in non-litigated cases. Nevertheless, there was no resemblance between SWIM's predictions regarding the percentage of permanent disability and those made by case managers. CONCLUSION: The findings indicate that SWIM is capable of replicating the sick leave estimations made by a case manager with an estimated 4 years of case management experience, albeit with limitations in generalizability owing to the small sample size of case managers involved in the study. IMPLICATIONS: These findings represent a significant advancement in enhancing the accuracy of CDMS for work injury cases in Hong Kong, signaling progress in the field.

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol.

INTRODUCTION: Early sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs. METHODS AND ANALYSIS: We will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics. ETHICS AND DISSEMINATION: The institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. TRIAL REGISTRATION NUMBER: NCT05731349.

Lepidothelphusa menneri n. sp. (Crustacea: Brachyura: Gecarcinucidae), first record of the genus from Kalimantan, Indonesia.

The gecarcinucid freshwater crab genus, Lepidothelphusa Colosi, 1920, is known only from Sarawak in northern Borneo, with six recognised species i.e. Lepidothelphusa cognettii (Nobili, 1903); L. flavochela Grinang & Ng, 2015; L. limau Grinang & Ng, 2015; L. loi Grinang & Ng, 2015; L. padawan Grinang & Ng, 2015; and L. sangon Grinang & Ng, 2015. The genus is now reported from Indonesian Borneo for the first time, from specimens recently collected from Gunung Kelam in Sintang Regency, Kalimantan Barat Province. Lepidothelphusa menneri n. sp. has a very distinctive tri-coloured pattern in life, unique among congeners. It can also easily be separated from congeners by carapace, epistome, male pleonal and male first gonopod characters.

The Influence of Advanced Hyperbaric Medical Training on Arterial Gas Embolism Treatment.

3d Reconnaissance Battalion, a forward-deployed Marine Corps unit in Okinawa, Japan, frequently performs diving operations. Often throughout the year, several reconnaissance teams are diving simultaneously in different locations for training. We present a case of an otherwise healthy 30-year-old-male Reconnaissance Marine who surfaced from a dive with abnormal symptoms and received prompt care from exercise participants who were nonmedical personnel. Studies have demonstrated improved morbidity outcomes in decompression illness patients with shorter times to hyperbaric treatment following the onset of symptoms. High-risk military exercises with diving components have a mandatory safety structure that includes recompression chamber support. All United States Marine Corps Reconnaissance, Marine Corps Special Operations Command, and U.S. Navy dive operations are required to have at least one diving supervisor. To expand the diving capabilities of the unit, Marines are encouraged to attend training and qualify as diving supervisors. This case study demonstrates the efficacy and importance of training Recon Marines to recognize decompression illness as diving supervisors.

Diversification of freshwater crabs on the sky islands in the Hengduan Mountains Region, China.

The numerous naturally-fragmented sky islands (SIs) in the Hengduan Mountains Region (HMR) of southwestern China constitute discontinuous landscapes where montane habitats are isolated by dry-hot valleys which have fostered exceptional species diversification and endemicity. However, studies documenting the crucial role of SI on the speciation dynamics of native freshwater organisms are scarce. Here we used a novel set of comprehensive genetic markers (24 nuclear DNA sequences and complete mitogenomes), morphological characters, and biogeographical information to reveal the evolutionary history and speciation mechanisms of a group of small-bodied montane potamids in the genus Tenuipotamon. Our results provide a robustly supported phylogeny, and suggest that the vicariance events of these montane crabs correlate well with the emergence of SIs due to the uplift of the HMR during the Late Oligocene. Furthermore, ancestrally, mountain ridges provided corridors for the dispersal of these montane crabs that led to the colonization of moist montane-specific habitats, aided by past climatic conditions that were the crucial determinants of their evolutionary history. The present results illustrated that the mechanisms isolating SIs are reinforced by the harsh-dry isolating climatic features of dry-hot valleys separating SIs and continue to affect local diversification. This offers insights into the causes of the high biodiversity and endemism shown by the freshwater crabs of the HMR-SIs in southwestern China.

Two centuries of biodiversity discovery and loss in Singapore.

There is an urgent need for reliable data on the impacts of deforestation on tropical biodiversity. The city-state of Singapore has one of the most detailed biodiversity records in the tropics, dating back to the turn of the 19th century. In 1819, Singapore was almost entirely covered in primary forest, but this has since been largely cleared. We compiled more than 200 y of records for 10 major taxonomic groups in Singapore (>50,000 individual records; >3,000 species), and we estimated extinction rates using recently developed and novel statistical models that account for "dark extinctions," i.e., extinctions of undiscovered species. The estimated overall extinction rate was 37% (95% CI [31 to 42%]). Extrapolating our Singapore observations to a future business-as-usual deforestation scenario for Southeast Asia suggests that 18% (95% CI [16 to 22%]) of species will be lost regionally by 2100. Our extinction estimates for Singapore and Southeast Asia are a factor of two lower than previous estimates that also attempted to account for dark extinctions. However, we caution that particular groups such as large mammals, forest-dependent birds, orchids, and butterflies are disproportionately vulnerable.

Convergent adaptation of true crabs (Decapoda: Brachyura) to a gradient of terrestrial environments.

For much of terrestrial biodiversity, the evolutionary pathways of adaptation from marine ancestors are poorly understood, and have usually been viewed as a binary trait. True crabs, the decapod crustacean infraorder Brachyura, comprise over 7,600 species representing a striking diversity of morphology and ecology, including repeated adaptation to non-marine habitats. Here, we reconstruct the evolutionary history of Brachyura using new and published sequences of 10 genes for 344 tips spanning 88 of 109 brachyuran families. Using 36 newly vetted fossil calibrations, we infer that brachyurans most likely diverged in the Triassic, with family-level splits in the late Cretaceous and early Paleogene. By contrast, the root age is underestimated with automated sampling of 328 fossil occurrences explicitly incorporated into the tree prior, suggesting such models are a poor fit under heterogeneous fossil preservation. We apply recently defined trait-by-environment associations to classify a gradient of transitions from marine to terrestrial lifestyles. We estimate that crabs left the marine environment at least seven and up to 17 times convergently, and returned to the sea from non-marine environments at least twice. Although the most highly terrestrial- and many freshwater-adapted crabs are concentrated in Thoracotremata, Bayesian threshold models of ancestral state reconstruction fail to identify shifts to higher terrestrial grades due to the degree of underlying change required. Lineages throughout our tree inhabit intertidal and marginal marine environments, corroborating the inference that the early stages of terrestrial adaptation have a lower threshold to evolve. Our framework and extensive new fossil and natural history datasets will enable future comparisons of non-marine adaptation at the morphological and molecular level. Crabs provide an important window into the early processes of adaptation to novel environments, and different degrees of evolutionary constraint that might help predict these pathways.

Remission of Type II Diabetes Mellitus after Duodenal Switch: the Contribution of Common Channel Length.

INTRODUCTION: The role of the common channel length in duodenal switch (DS) on remission of type II diabetes mellitus (DM), when stratifying patients based on diabetes severity, is not well understood. METHODS: We retrospectively reviewed 341 consecutive patients with DM undergoing DS with one of three different common channel (CC) lengths (100 cm, 150 cm, and 200 cm), each with a fixed 300 cm alimentary limb (AL). Patients were stratified by insulin dependence (IDDM) versus non-insulin dependent diabetes (NIDDM). Data was collected at one year and at the last available follow-up. RESULTS: The NIDDM group had a similar average HbA1c at last follow-up for each of the CC lengths. However, the IDDM group had lower average HbA1c with shorter CC lengths (100 cm = 5.4%, 150 cm = 6%, 200 cm = 6.4%, p < 0.05). Shorter CC lengths resulted in a greater proportion of patients achieving remission in the IDDM group (66%, 50%, 32% in the 100 cm, 150 cm, and 200 cm CC, respectively, p < 0.01). Improvements in HbA1c were independent of weight loss and average DiaRem scores were similar between CC lengths. Rates of nutritional deficiencies were higher in shorter common channel lengths. Revision for malnutrition was similar between common channel lengths (100 cm group: 3.7%; 150 cm group: 1.8%; 200 cm group: 0%, p = NS). CONCLUSIONS: When the AL is fixed, shortening CC lengths results in improved glycemic control and remission of DM in patients with the need for insulin preoperatively. Milder forms of DM are treated well with any of the CC lengths.

Shift in symbiotic lifestyle as the major process shaping the evolution of pea crabs (Decapoda: Brachyura: Pinnotheroidea).

The pea crabs, superfamily Pinnotheroidea, are exceptional among brachyuran crabs in their diverse symbiotic associations involving both inquilinism and protective symbiosis. While this group presents a rare opportunity for evolutionary comparative study of host switching and morphological evolution in marine macroinvertebrates, previous phylogenetic studies have been focused on systematics. Here, we reconstructed the most extensive phylogeny of Pinnotheroidea based on two mitochondrial and six nuclear markers, with the aim of elucidating the host switching pathways and the correlation between symbiotic lifestyles and selected morphological adaptations. Ancestral state reconstruction of host association revealed a monophyletic origin of symbiosis in the form of inquilinism. Subsequent shifts in microhabitat preference for burrows or worm tubes, and the move to protective symbiosis, primarily in the switch to mollusc endosymbiosis, contributed to radiation in Pinnotheridae. Further parallel colonisations of echinoderms and tunicates occurred but did not lead to extensive diversification, except in the Clypeasterophilus + Dissodactylus lineage, which experienced a unique switch to echinoderm ectosymbiosis. The evolution of the third maxillipeds, carapace shape and ambulatory pereiopods suggests a rather strong coupling with the symbiotic lifestyle (whether inquilinism or protective symbiosis). Phenotypic diversity of these characters was higher among species engaged in protective symbiosis, with convergence in form (or function) among those sharing the same host affiliation. Species having different host affiliations or symbiotic lifestyles might also exhibit convergence in the form of the three morphological traits, suggesting a common adaptive value of the specialisations. Pinnotherid crabs overall exhibited a lower trait diversity than the also symbiotic palaemonid shrimps with comparable species diversity. This may plausibly be attributed to differences in potential for morphological modification to serve additional functions among the traits analysed in the two groups, the less frequent host switching and the less diverse host affiliations, and thus a less complicated evolutionary history in pinnotherids.

On the identities of the sesarmid crabs, Sesarma villosum A. Milne-Edwards, 1869, and Clistocoeloma suvaense Edmondson, 1951, with the description of a new species from the West Pacific (Decapoda, Brachyura, Thoracotremata).

The identities of two sesarmid crabs, Clistocoeloma villosum (A. Milne-Edwards, 1869), and C. suvaense Edmondson, 1951, both currently in Clistocoeloma A. Milne-Edwards, 1873, are poorly known and the types have not been studied in detail since their description. Clistocoeloma villosum, supposedly widespread, has been recorded from Madagascar and East Africa to Singapore, Japan, Korea, and Samoa. Clistocoeloma suvaense is only known for certain from one male collected from its type locality, Fiji. The taxonomy of C. villosum, and C. suvaense is clarified on the basis of the type specimens from Samoa and Fiji, respectively. A new species, which has long been confused with C. villosum, is described from Southeast Asia and Western Pacific.

New and rare deep-sea majoid crabs (Crustacea: Brachyura) from Papua New Guinea.

Additional spider crab (superfamily Majoidea) material from four major French-led expeditions to the Papua New Guinea region were examined in this study. One new genus and four new species from the families Inachidae and Oregoniidae are described. Dorhynchus profundus n. sp. is close to D. rostratus (Sakai, 1932) but can easily be separated by the shape of the ambulatory dactylus and the proportionately lower protogastric spines. Achaeus pholcus n. sp. is unusual in that it occurs in deeper waters (beyond 500 m), and can be separated from A. lacertosus Stimpson, 1857, A. villosus Rathbun, 1916, and A. brevidactylus Sakai, 1938, by its distinctive carapace shape, structure of the frontal margin, regions of the carapace, antennular fossa, ambulatory dactylus, male pleon, and proportions of the chela. Parapleisticantha aie n. sp. is closest to P. japonica Yokoya, 1933, but differs in its proportionately longer carapace, more elongated basal antennal article, longer third maxilliped ischium and the relatively less curved male first gonopod with the distal part differently structured. A new genus (Orbicantha n. gen.) with one new species (Orbicantha sacrebleu n. gen., n. sp.) is also described; it is allied to Pleistacantha Miers, 1879, Parapleisticantha Yokoya 1933, and Pleisticanthoides Yokoya, 1933, but is distinctive in its subcircular carapace, shorter regions, short pseudorostral spines, possession of spines on the gastric, cardiac and branchial regions, some of which have rounded tips, a short ocular peduncle, a very short third antennal article, a quadrate epistome, and the more reduced P4 and P5. New records from the family Epialtidae are also reported: Griffinia gilloloensis (Rathbun, 1916), Hyastenus borradailei (Rathbun, 1907), and Oxypleurodon luzonicum (Rathbun, 1916). The taxonomy of Grypachaeus tenuicollis Takeda, 1978 (Oregoniidae) and Griffinia lappacea (Rathbun, 1918) (Epialtidae) is also discussed.

On the identity of Pronotonyx laevis (Miers, 1884) (Crustacea: Brachyura: Pilumnidae).

The poorly known brachyuran crab, Pronotonyx laevis Ward, 1936, from northern Australia, is redescribed based on type and other material. We document adults of both sexes and confirm the taxonomic placement of the Pronotonyx in the Pilumnidae. Pronotonyx is most similar to the Australian Pseudocryptocoeloma parvum Ward, 1936, differing in features of the carapace and pereopods.

Two new species of semiaquatic freshwater crabs of the genera Tortomon and Aiyunamon from karst forests in northern Vietnam (Crustacea: Brachyura: Potamidae).

Two new genera of freshwater crabs (Potamidae) are recorded from northern Vietnam, Tortomon Huang, Wang & Shih, 2020, and Aiyunamon Pan, Ng & Sun, 2022. These genera had previously only been reported from southern China and eastern Myanmar. Each genus is represented by a new species. Tortomon distinctum n. sp. is markedly different from its two Chinese congeners in its proportionately wider carapace, more elongate third maxilliped, the carpus of the cheliped being armed only with a low tubercle, possessing relatively more slender and longer ambulatory legs, a gently curved male first gonopod and a more elongate male second gonopod. Aiyunamon vietnamicum n. sp. is distinct from its five congeners in its proportionately less convex dorsal surface of the carapace, relatively lower epigastric cristae, lower rugosities of the postorbital cristae, wider median lobe of the posterior margin of the epistome, relatively narrower male pleon, and a male first gonopod that has the terminal segment more distinctly curved with a wider concavity on the outer margin of the subterminal segment.

Two new species of hairy crabs (Pilumnidae) and the first record of Crinitocinus alcocki (Borradaile, 1900) (Acidopsidae) (Crustacea: Brachyura) from Taiwan.

Two new species of pilumnid crabs, Heteropilumnus planus n. sp. and Pseudolitochira taiwang n. sp., are described from reefs in Taiwan. Heteropilumnus planus n. sp. is most similar to H. hirsutior (Lanchester, 1900) from Singapore and Japan, but can easily be distinguished by its distinctly flatter carapace, different anterolateral carapace armature, longer ambulatory legs, and male first gonopod structure. Pseudolitochira taiwang n. sp. is most similar to P. crinita Ng & Clark, 2022, from Papua New Guinea but can easily be separated by its carapace physiognomy, armature of the anterolateral carapace margin and proportionately shorter ambulatory legs. Heteropilumnus setosus (A. Milne-Edwards, 1873) is also transferred to Pseudolitochira; and compared with P. taiwang n. sp. The rarely reported acidopsid, Crinitocinus alcocki (Borradaile, 1900) is also recorded from Taiwan for the first time, substantially extending its known range northwards.

Revision of the Genus Lacunipotamon Dai, Song, He, Cao, Xu & Zhong, 1975 (Crustacea: Decapoda: Brachyura: Potamidae), with Descriptions of Eight New Species from Vietnam.

The taxonomy of the potamid genus Lacunipotamon Dai, Song, He, Cao, Xu & Zhong, 1975, is revised. Three species are known from southern China: L. albusorbitum Dai, Song, He, Cao, Xu & Zhong, 1975 (type species); L. yuanshi Huang, Shih & Ahyong, 2020; and L. cymatile Huang, Shih & Ahyong, 2020. Eight new species are here described from northern Vietnam: L. globus, L. panda, L. contrastum, L. sublividum, L. mimicum, L. thuanchau, L. pectum and L. purpureum. This is the first record of the genus in Vietnam, with all the new species obtained from karst formations. The species are differentiated by the characters of carapace shape, anterolateral armature, posterior margin of the epistome, male sternopleonal cavity, chelipeds, ambulatory legs, male thoracic sternum, male pleon, and structures of the male first gonopods and vulvae.

Tuerkayana latens, a New Species of Land Crab from French Polynesia, with a Discussion on the Phylogeny of the Genus (Crustacea: Decapoda: Brachyura: Gecarcinidae).

The taxonomy of the gecarcinid land crab Tuerkayana rotundum (Quoy & Gaimard, 1824) is revised. The taxon, the type species of the genus, occurs from the western Indian Ocean to the western Pacific, and varies substantially in colour and various morphological features, but the male first gonopod structure is constant and the extensive genetic data from mitochondrial 16S rDNA, cytochrome c oxidase subunit 1 and control region markers confirms the recognition of one wide-ranging species. Specimens from Tuamotu in French Polynesia and Pitcairn Island, however, differ in having a smoother and slightly more swollen carapace, and significantly, the male first gonopod structure is distinctly different. The genetic data also supports their differentiation. As such, this material is here recognised as a new species, Tuerkayana latens n. sp.

Review of the pilumnid crab genus Lophoplax Tesch, 1918 from the western Pacific, with descriptions of two new species, and the clarification of the identity of Pseudocryptocoeloma parvus Ward, 1936 (Crustacea: Brachyura).

The taxonomy of the pilumnid crab genus Lophoplax Tesch, 1918, is discussed. Lophoplax sculpta Stimpson, 1858) is redescribed and a neotype is selected in the interests of nomenclatural stability. Two new species allied to L. sculpta are described: L. sordida n. sp. from Indonesia, and L. pannosa n. sp. from Vanuatu. Pilumnus vermiculatus A. Milne-Edwards, 1873, is here transferred to Lophoplax. The poorly known Pseudocryptocoeloma parvus Ward, 1936 (type species of Pseudocryptocoeloma Ward, 1936), known only from Australia thus far, is redescribed and figured; and Pseudocryptocoeloma symmetrinudum Edmondson, 1951 (from Samoa and Japan), is transferred to Lophoplax.

Smart Work Injury Management (SWIM) System: A Machine Learning Approach for the Prediction of Sick Leave and Rehabilitation Plan.

As occupational rehabilitation services are part of the public medical and health services in Hong Kong, work-injured workers are treated along with other patients and are not considered a high priority for occupational rehabilitation services. The idea of a work trial arrangement in the private market occurred to meet the need for a more coordinated occupational rehabilitation practice. However, there is no clear service standard in private occupational rehabilitation services nor concrete suggestions on how to offer rehabilitation plans to injured workers. Electronic Health Records (EHRs) data can provide a foundation for developing a model to improve this situation. This project aims at using a machine-learning-based approach to enhance the traditional prediction of disability duration and rehabilitation plans for work-related injury and illness. To help patients and therapists to understand the machine learning result, we also developed an interactive dashboard to visualize machine learning results. The outcome is promising. Using the variational autoencoder, our system performed better in predicting disability duration. We have around 30% improvement compared with the human prediction error. We also proposed further development to construct a better system to manage the work injury case.

Allopatric mosaics in the Indo-West Pacific crab subfamily Chlorodiellinae reveal correlated patterns of sympatry, genetic divergence, and genitalic disparity.

Molecular studies have revealed that many species once thought to be wide-ranging in the Indo-West Pacific contain allopatric mosaics of endemic lineages. These lineages provide compelling evidence that substantial time is needed to evolve isolating mechanisms sufficient to permit successful secondary sympatry, and that divergence is initiated in allopatry. In this context, questions arise regarding the nature, timing, and origin of isolating mechanisms that permit secondary sympatry. We present a phylogeny of the crab subfamily Chlorodiellinae which displays allopatric mosaics within species. These allopatric lineages typically do not have divergent male genitalia, while older sympatric lineages do. We tested the relationship between genetic distance (proxy for time), sympatry, and the divergence of male genitalic morphology. Our results suggest that male genitalic divergence is not involved in the initiation of speciation in chlorodielline crabs, having likely occurred only after isolation began in allopatry. However, morphological evolution of genitalia seemingly does play an important role in completing the process of speciation in these crabs.