Cotransport of nanoplastics with nZnO in saturated porous media: From brackish water to seawater.

The ocean serves as a repository for various types of artificial nanoparticles. Nanoplastics (NPs) and nano zinc oxide (nZnO), which are frequently employed in personal care products and food packaging materials, are likely simultaneously released and eventually into the ocean with surface runoff. Therefore, their mutual influence and shared destiny in marine environment cannot be ignored. This study examined how nanomaterials interacted and transported through sea sand in various salinity conditions. Results showed that NPs remained dispersed in brine, while nZnO formed homoaggregates. In seawater of 35 practical salinity units (PSU), nZnO formed heteroaggregates with NPs, inhibiting NPs mobility and decreasing the recovered mass percentage (Meff) from 24.52% to 12.65%. In 3.5 PSU brackish water, nZnO did not significantly aggregate with NPs, and thus barely affected their mobility. However, NPs greatly enhanced nZnO transport with Meff increasing from 14.20% to 25.08%, attributed to the carrier effect of higher mobility NPs. Cotransport from brackish water to seawater was simulated in salinity change experiments and revealed a critical salinity threshold of 10.4 PSU, below which the mobility of NPs was not affected by coexisting nZnO and above which nZnO strongly inhibited NP transport. This study highlights the importance of considering the mutual influence and shared destiny of artificial nanoparticles in the marine environment and how their interaction and cotransport are dependent on changes in seawater salinity.

Circular economy, economic growth, and e-waste generation in EU27 countries: Further evidence from the novel circular economy index and threshold effect.

The circular economy has been identified as a critical keyword for achieving the Sustainable Development Goals. Nevertheless, there is a lack of in-depth empirical literature on the impact mechanisms of the circular economy (CE) and economic growth (GDP) in mitigating e-waste generation (waste electrical and electronic equipment - WEEE). Given Europe's leading position in e-waste generation per capita, the study aims to scrutinize the interplay between CE, GDP, and WEEE for 2010-2020. The research applies advanced econometric methods, primarily centered around the system generalized method of moment and dynamic panel threshold. It was noteworthy that different CE indicators exhibited varying effects on WEEE through the econometric analysis. Therefore, the research uniquely utilized the entropy weight method to compute a holistic composite index for the circular economy (CEI) and gained some interesting findings. Firstly, CEI significantly reduced WEEE, while GDP drove its increase. However, an overly developed CEI of 0.7616 counteracted its beneficial effect. Secondly, the synergy of CEI*GDP engendered the circular economy rebound effect, diminishing environmental benefits. Thirdly, in the circular context, the environmental Kuznets curve was validated, showcasing an inverted U-shaped pattern. Finally, the study found CEI to have different threshold effects, with thresholds of 0.2161 to inhibit WEEE, 0.2114 to avert the circular economy rebound effect, and 0.2360 to leverage GDP in reducing WEEE. These outcomes give insights to policymakers in designing sound policies targeting circular economy development and decoupling e-waste generation from economic growth towards the United Nations' SDGs.

Laser ultrasonic detection for defects of LAM components based on variable time window intensity mapping with adaptive 2σ thresholds.

Metallurgical defects in metal laser additive manufacturing (LAM) are inevitable due to complex non-equilibrium thermodynamics. A laser ultrasonic system was designed for detecting surface/near-surface defects in the layer-by-layer LAM process. An approach was proposed for ultrasonic imaging of defects based on variable time window intensity mapping with adaptive 2σ threshold denoising. The Gaussian mixture model hypothesis and expectation-maximization algorithm can automatically differentiate between components dominated by defects and background noises, thereby providing an adaptive threshold that accommodates detection environments and surface roughness levels. Results show that the ultrasonic wave reflection at defect boundaries diminishes far-field ultrasonic intensity upon pulsed laser irradiation on surface defects, enabling defect size and location characterization. This method is applicable to LAM samples with a significant surface roughness of up to 37.5 µm. It can detect superficial and near-surface defects down to 0.5 mm in diameter and depth, making it significant for online defect detection in additive manufacturing.

When sensory input meets spontaneous brain activity.

A recent study by Wu, Podvalny, and colleagues investigated how ongoing spontaneous brain activity interacts with sensory input and shapes conscious perception. It reports diverse effects of prestimulus activity in several key networks, revealing new roles of the prefrontal cortex and the default mode network in perception and consciousness.

Radiation Dose Units: How We Got Here, Do They Serve the Purposes They are Intended to?

The current radiation dose estimates used in medical imaging, radiation oncology or environmental assessments are not entirely accurate from a fundamental physics perspective, let alone for biological consequences. The "one cloth fits all" approach of radiation-matter interactions cannot assess the effects of interactions of the same species of radiation of different energies on the same isotope of an element. Preliminary steps to set the radiation dosimetry in the right direction are suggested.

Threshold effect of physical exercise on its association to diabetes mellitus in short sleep population: evidence from a nationwide study.

Background: The prevalence of diabetes mellitus (DM) is a significant public health concern, especially among individuals with short sleep duration. Understanding the relationship between physical exercise and DM in this population is crucial for developing effective prevention strategies. However, the presence of a potential threshold effect of exercise on DM risk remains unclear. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018, this population-based study investigated the association between physical exercise and DM in individuals with short sleep duration (no more than 7 hours per night). Weighted logistic regression analyses were conducted, adjusting for demographic and lifestyle factors. Additionally, a two-piecewise linear regression model was employed to identify any threshold effect of exercise on DM risk. Results: This study included 15,092 participants identified with short sleep duration. Demographic characteristics stratified by DM status indicate higher prevalence among certain groups, such as middle-aged and older adults, males, and non-Hispanic Whites. The analysis revealed an inverse association between exercise levels and DM prevalence among the short sleep population. In the fully adjusted model, individuals engaging in sufficient exercise (> 600 MET-minutes/week) exhibited significantly reduced odds of developing DM [OR (95% CI): 0.624(0.527,0.738), p < 0.001]. Furthermore, the segmented regression model identified an inflection point at 2000 MET-minutes/week, below which a significant correlation between exercise and DM was observed. Conclusions: This study provides evidence of a threshold effect of physical exercise on its association with DM in individuals with short sleep duration. Tailored exercise interventions targeting this population may help mitigate DM risk and improve overall health outcomes. Further research is warranted to validate these findings and explore optimal exercise thresholds for DM prevention strategies.

A study on the relationship between high-quality development of the logistics industry and rural revitalization across different levels of industrial structure.

Due to regional differences in industrial structure levels, the development of the logistics industry in rural areas faces various challenges and opportunities. The objective is to explore how the high-quality development of the logistics industry influences rural revitalization at various tiers of industrial structure. It employs a benchmark regression model to dissect the influence that the logistics industry's high-quality development exerts on fostering rural revitalization. Moreover, a panel threshold model is employed to examines this impact across different levels of industrial structure. It demonstrates that enhancing the logistics industry significantly supports rural revitalization, with its impact varying across different levels of industrial structure. Hence, it is imperative to develop customized strategies for the logistics industry that account for the varying industrial structure in rural areas. It emphasizes the logistics industry's role in facilitating rural growth and recommends adopting tailored development strategies corresponding to the industrial structure's evolution to boost rural revitalization. Despite valuable insights, this study has limitations in reflecting regional trends and exploring other factors beyond the direct impact of logistics on rural revitalization, pointing to potential avenues for future research.

ANKLE TORQUE VARIANCE IS A BETTER INDICATOR OF BALANCE CONTROL PERFORMANCE THAN PLANTAR PERCEPTUAL SENSITIVITY THRESHOLD.

We explored whether ankle torque variability or plantar perceptual threshold explains human balance control more effectively. We hypothesized that ankle torque variance is a better indicator of center of pressure (COP) velocity variance than plantar perceptual sensitivity. Two conditions were tested: loaded (23 kg vest added) and unloaded, as loading should diminish plantar sensitivity and increase COP velocity variability. We created a linear feedback model to assess the noise change in the sensorimotor loop induced by loading. Plantar sensitivity was quantified using a psychophysical approach while participants stood barefoot. A linear motor applied a force impulse on the participant's heel. A 'yes-no' method of limits was selected to identify plantar sole sensory thresholds in both conditions. We observed reduced plantar sensitivity in loaded compared to unloaded conditions. In the loaded condition, participants exhibited greater COP velocity variance, with significant positive Pearson's correlations confirming a substantial association between ankle torque and COP velocity variances for both loaded (variance accounted for (VAR): r2 = 44.56%, p = 0.018) and unloaded conditions (VAF: r2 = 58.83 %, p = 0.004). No significant correlation existed between COP velocity variance and plantar sensitivity threshold for both loaded (VAF: r2 = 0.002 %, p = 0.99) and unloaded conditions (VAF: r2 = 21.81%, p = 0.35). The model confirmed a ~88% rise in sensorimotor loop noise in the loaded condition. Ankle torque variance assesses the precision of non-perceptual and perceptual detection mechanisms in evaluating whole-body motions and the accuracy in converting sensory cues into ankle torque.

The impact of cut-off values on the prevalence of short cervical length in pregnancy.

BACKGROUND: A prior study suggested that implementing a cut-off value of ≤30 mm for a short cervical length (CL) could potentially introduce selection bias and alter the distribution of CL measurements. As such, the objective of this study is to evaluate how CL distribution and incidence of short CL are affected when using different cut-off values for a short CL. STUDY DESIGN: This is a secondary analysis of the Quadruple P (QP) Screening study; a prospective cohort study that included low-risk patients with singleton pregnancies undergoing fetal anomaly scan at 18-22 weeks of gestation, including a CL measurement. Patients with a short cervix, defined as ≤35 mm, were subsequently counseled for the QP trial; a randomized controlled trial (RCT) comparing progesterone to cervical pessary for the prevention of preterm birth. If participation to the RCT was refused, patients with a CL ≤25 mm were advised to use progestogen. The primary objective of this current study was to assess the normal distribution of CL across the entire cohort and to assess the incidence of short CL when using the cut-off values of ≤35 and ≤25 mm. Normal distributions for CL were simulated based on mean and standard deviation(SD) of the original data. The Kolmogorov-Smirnov test was used to evaluate the distribution of the CL measurements. Moreover, to evaluate the motives behind ultrasound measurements around the cut-off value, sonographers were asked to fill out a qualitative questionnaire. RESULTS: The total cohort included 19.171 eligible participants who underwent CL measurement, with a mean CL of 43.9 mm (±8.1 SD). The distribution of all CL observed measurements deviated significantly from the normal distribution (p < 0.001). A total of 1.852 (9.7%) patients had short CL ≤35 mm, which was significantly lower than expected when compared to the simulated normal distribution (n = 2.661, 13.9%; p < 0.001). The incidence of short CL ≤25 mm in our cohort statistically differed from the simulated normal distribution (238, 1.2% vs 177, 0.9%; p=0.003). When comparing our data to the simulated normal distribution, the difference in distributions is most pronounced when examining the difference between 35 and 36 mm. Results of the questionnaire reveal sonographers claimed not to be influenced by a cut-off value for study participation or progesterone treatment. CONCLUSION: This study demonstrates that using any cut-off value for a short CL influences the incidence and distribution of CL. When using a cut-off value of ≤35 mm for study inclusion, the incidence of measurements of a short CL is lower than the anticipated incidence compared to a normal distribution. However, when using a cut-off value of ≤25 mm for progesterone treatment, the frequency of CL measurements is higher than expected below this threshold compared to a normal distribution. This study highlights the risk of introducing selection bias, most likely unintentionally, when cut-off values for short CL are used, regardless of the specific value chosen. Therefore healthcare providers should measure the CL with caution if essential decisions depend on a specific cut-off value.

Physiological and perceptual response to critical power anchored HIIT: a sex comparison study.

PURPOSE: The aim of this study was to test the hypothesis that using threshold-based high intensity interval training (HIITTHR) prescribed at an intensity above critical power (CP) in males and females matched for maximal oxygen uptake ( V ˙ O2max) (mL/kg lean mass/min) will yield no sex differences in time to fatigue. METHODS: Thirteen males (mean ± SD: 22.0 ± 2.48 years, 181 ± 8.36 cm, 78.8 ± 11.4 kg) and eleven females (mean ± SD: 22.4 ± 2.69 years, 170 ± 5.73 cm, 65.2 ± 7.66 kg) initially undertook an incremental test to exhaustion to determine V ˙ O2max, and a CP test. Then, one HIIT session (4 min on, 2 min off) was performed to exhaustion at the work rate associated with 105%CP. Acute physiological and cardiovascular responses were recorded. RESULTS: No sex differences were recorded in time to fatigue [Female vs. Male (min): 36.0 ± 18.5 vs. 39.3 ± 16.3], heart rate, rate of perceived exertion, or %oxygenated [haem]. Females displayed lower %deoxygenated [haem] at the end of interval 1, 2, 3, and 4 [Female vs. Male (%): 89.4 ± 21.2 vs. 110 ± 27.3, 92.0 ± 21.5 vs. 115 ± 27.6, 87.1 ± 23.7 vs. 112 ± 22.8, 88.9 ± 26.3 vs. 113 ± 23.5]. Large interindividual variability in performance, and physiological and perceptual response were present despite the use of threshold-based prescription. CONCLUSION: The present study suggests that threshold-based prescription may help standardize the mean response exercise across sexes but does not eliminate physiological or perceptual variability. Furthermore, the lack of sex differences in TTF was accompanied by greater %deoxy[haem] in males, indicating tissue oxygenation is an unlikely determinant of HIIT performance. This study has been retrospectively registered at Trial Registration https://doi.org/10.17605/OSF.IO/KZVGC January 17th, 2023, following data collection but prior to data analyses.

Predictive and classification capabilities of the timed up and go as a physical performance measure in hip osteoarthritis: a retrospective study of 606 patients.

INTRODUCTION: Hip osteoarthritis (OA) is a common joint pathology that significantly constrains functional capacity. Assessing the impact of hip OA on functionality is crucial for research and clinical practices. The study aimed to assess hip OA patients' functionality using the Timed Up and Go (TUG) test and to evaluate its diagnostic ability to differentiate between different grades of hip OA. We hypothesized that the severity of hip OA would impact the time required to complete the TUG test. MATERIALS AND METHODS: Patients (Ν = 606) with unilateral, primary hip OA were selected from de-identified data and divided according to the radiographic Kellgren-Lawrence classification system (groups: Grade 2, Grade 3, and Grade 4). Groups' differences were assessed using the X2 test of independence and the one-way ANOVA model. Correlations between dependent and independent variables were assessed using Pearson's correlation coefficient (r). A receiver operating characteristic (ROC) analysis was conducted to assess the TUG test's ability to differentiate between the hip OA grades. RESULTS: Statistically significant differences were found among the three groups in age, gender distribution, TUG test, and occasional cane use (all p-values < 0.001). The correlation analysis shows a significant and strong positive correlation between TUG performance time and hip OA grades (r = .78, p < .001). The adjusted odds ratios (OR) were: Grade2-3=(2.29[95%CI: 1.89, 2.77], p < .001) and Grade3-4=(1.47[95%CI: 1.34, 1.62], p < .001). The TUG cut-off points from the ROC analysis were: Grades 2-3 = 10.25 s, Grades 2-4 = 11.35 s, and Grades 3-4 = 12.8 s. CONCLUSIONS: This study provides evidence that the duration of the TUG test significantly increased with the severity of the disease. TUG can offer real-time data on the management and progression of hip OA. Future studies should explore the correlation between hip OA and the TUG test, as understanding the relationship can influence treatment and patient outcomes.

Inflammatory cytokine signalling in vulvovaginal candidiasis: a hot mess driving immunopathology.

Protective immunity to opportunistic fungal infections consists of tightly regulated innate and adaptive immune responses that clear the infection. Immune responses to infections of the vaginal mucosa by Candida species are, however, an exception. In the case of vulvovaginal candidiasis (VVC), the inflammatory response is associated with symptomatic disease, rather than that it results in pathogen clearance. As such VVC can be considered an inflammatory disease, which is a significant public health problem due to its predominance as a female-specific fungal infection. Particularly, women with recurrent VVC (RVVC) suffer from a significant negative impact on their quality of life and mental health. Knowledge of the inflammatory pathogenesis of (R)VVC may guide more effective diagnostic and therapeutic options to improve the quality of life of women with (R)VVC. Here, we review the immunopathogenesis of (R)VVC describing several elements that induce an inflammatory arson, starting with the activation threshold established by vaginal epithelial cells that prevent unnecessary ignition of inflammatory responses, epithelial and inflammasome-dependent immune responses. These inflammatory responses will drive neutrophil recruitment and dysfunctional neutrophil-mediated inflammation. We also review the, sometimes controversial, findings on the involvement of adaptive and systemic responses. Finally, we provide future perspectives on the potential of some unexplored cytokine axes and discuss whether VVC needs to be subdivided into subgroups to improve diagnosis and treatment.

Intra-rater and Inter-rater Reliability of the Commander Pressure Algometer in Greek Patients With Chronic Neck Pain.

Introduction Non-specific chronic neck pain (NSCNP) is a musculoskeletal disorder that affects 45%-54% of the general population. There is a strong correlation between patient-reported pain and mechanical pain pressure threshold (PPT) measured with an algometer. Purpose This study aims to investigate the intra- and inter-rater reliability of the Commander algometer in Greek NSCNP patients, in an urban primary care setting. Methods Thirty-three patients (22 women and 11 men) suffering from NSCNP (>3 months), the majority (42.4%) between the ages of 50 years and 59 years and overweight, were measured bilaterally both at the neck (mastoid, trapezius head-insertion and mid-portion, C5-C6 facet, insertion of levator scapula) and at the control areas (mid-deltoid and tibialis anterior) using the Commander algometer. Measurements were taken twice over a span of six days, by two raters, in a primary care setting. Intraclass correlation coefficient (ICC) statistics were used as measures of reliability (p = 0.05). Results Intra-rater reliability was "moderate to good" for both raters. ICC values for PPT at the seven bilaterally measured sites varied between 0.67 and 0.86 for the first rater (p ≤ 0.001) and 0.64 and 0.82 for the second rater (p ≤ 0.003). The inter-rater reliability was "moderate to excellent" (ICC = 0.68-0.92) in the first measurement (T1) and "moderate to good" (ICC = 0.68 to 0.89) in the second measurement (T2). Conclusion This study supports the intra- and inter-rater reliability of the Commander algometer in detecting reliably the mechanical PPT, in Greek NSCNP patients, as measured according to the procedures and methodology followed throughout this study.

Ecological compensation mechanism controlled by both river ecological water demand and regional water rights.

River ecological protection and rational utilization of water resources provide an important support for the sustainable development for human beings and nature. In view of the lack of ecological compensation research on river ecological water demand and socio-economic water demand, a mechanism and methodology for ecological compensation based on the synergistic control of river ecological water demand and river water rights allocation is proposed. The variable monthly flow method and the improved dynamic calculation method are applied to obtain the river basic and suitable ecological water demands as the river protection threshold. A two-layer decision model for water rights allocation is established, which realizes the cascading allocation of initial water rights from city to counties to sectors, and the socio-economic water usage threshold for each level is obtained based on the model. Developing compensation discrimination guidelines under the dual-threshold synergistic control and using the unilateral water resources value by sub-sector as the compensation standard, realize the quantification and sharing of compensation funds. The Nanyang section of the Bai River basin in China is used as an example. The ecological compensation value for wet year (2011), normal year (2012), and dry years (2014-2013) are 0, 15.09 × 108 and 12.04 × 108 (average value for dry years) RMB. The adoption of suitable ecological water demand thresholds in 2012 increases the ecological protection requirements thus leading to an internal compensation situation between Nanyang County and Xinye County. From 2014 to 2016, river runoff continued to be low, and excessive water intake from upstream lead to a chain of compensation situations in the midstream and downstream. It is essential to establish a basin and regionally nested ecological compensation mechanism. The research results are conducive to improving the eco-compensation theory and provide scientific references for water resources management and high-quality development in the basin.

Fluctuations in resting motor threshold during electroconvulsive and magnetic seizure therapy.

OBJECTIVES: Magnetic seizure therapy (MST) is more benign than electroconvulsive therapy (ECT) in terms of cognitive impairment. However, whether these two 'artificial seizures' facilitate the central motor neural pathway and the motor cortical effects have not been investigated. The study aimed to compare the effects of ECT and MST on motor-evoked potential (MEP) in patients with mental disorders. METHODS: Forty-nine patients with mental disorders (major depressive disorder, bipolar disorder type II and schizophrenia [SCZ]) received 6 treatment sessions of vertex MST versus 6 bifrontal ECT treatments in a nonrandomized comparative clinical design. Data on the duration of motor seizures were collected for each treatment. MEP latency and the resting motor threshold (rMT) were measured at baseline and after every two treatments. Comparisons were performed between or within the groups. RESULTS: Seizure durations were significantly longer in the ECT group compared to the MST group across multiple sessions. Both MST and ECT demonstrated a significant reduction in rMT in the left and right hemispheres after the fourth (T3) and sixth treatments (T4) compared to baseline (T1). However, there were no significant changes in MEP latency within or between the groups throughout the treatment sessions. The only difference was that the rMT in the left cerebral hemisphere was significantly lower after T4 than after the second treatment (T2). There was no difference in rMT between the ECT and MST groups. CONCLUSIONS: Both ECT and MST facilitate the central motor pathway, with a shared mechanism of increased motor cortex excitability.

Complex-valued soft-log threshold reweighting for sparsity of complex-valued convolutional neural networks.

Complex-valued convolutional neural networks (CVCNNs) have been demonstrated effectiveness in classifying complex signals and synthetic aperture radar (SAR) images. However, due to the introduction of complex-valued parameters, CVCNNs tend to become redundant with heavy floating-point operations. Model sparsity is emerged as an efficient method of removing the redundancy without much loss of performance. Currently, there are few studies on the sparsity problem of CVCNNs. Therefore, a complex-valued soft-log threshold reweighting (CV-SLTR) algorithm is proposed for the design of sparse CVCNN to reduce the number of weight parameters and simplify the structure of CVCNN. On one hand, considering the difference between complex and real numbers, we redefine and derive the complex-valued log-sum threshold method. On the other hand, by considering the distinctive characteristics of complex-valued convolutional (CConv) layers and complex-valued fully connected (CFC) layers of CVCNNs, the complex-valued soft and log-sum threshold methods are respectively developed to prune the weights of different layers during the forward propagation, and the sparsity thresholds are optimized during the backward propagation by inducing a sparsity budget. Furthermore, different optimizers can be integrated with CV-SLTR. When stochastic gradient descent (SGD) is used, the convergence of CV-SLTR is proved if Lipschitzian continuity is satisfied. Experiments on the RadioML 2016.10A and S1SLC-CVDL datasets show that the proposed algorithm is efficient for the sparsity of CVCNNs. It is worth noting that the proposed algorithm has fast sparsity speed while maintaining high classification accuracy. These demonstrate the feasibility and potential of the CV-SLTR algorithm.

Stakeholder-informed positivity thresholds for disease markers and risk scores: a methodological framework and an application in obstructive lung disease.

OBJECTIVE: A positivity threshold is often applied to markers or predicted risks to guide disease management. These rules are often decided exclusively by clinical experts despite being sensitive to the preferences of patients and general public as ultimate stakeholders. STUDY DESIGN AND SETTING: We propose an analytical framework for quantifying the net benefit of an evidence-based positivity threshold based on combining preference-sensitive (e.g., how individuals weight benefits and harms of treatment) and preference-agnostic (e.g., the magnitude of benefit and the risk of harm) parameters. We propose parsimonious choice experiments to elicit preference-sensitive parameters from stakeholders, and evidence synthesis to quantify the value of preference-agnostic parameters. We apply this framework to maintenance azithromycin therapy for chronic obstructive pulmonary disease (COPD) using a discrete choice experiment (DCE) to estimate preference weights for attribute level associated with treatment. We identify the positivity threshold on 12-month moderate or severe exacerbation risk that would maximize the net benefit of treatment in terms of severe exacerbations avoided. RESULTS: In the case study, the prevention of moderate and severe exacerbations (benefits) and the risk of hearing loss and gastrointestinal symptoms (harms) emerged as important attributes. 477 respondents completed the DCE survey. Relative to each percent risk of severe exacerbation, preference weights for each percent risk of moderate exacerbation, hearing loss, and gastrointestinal symptoms were 0.395 (95%CI 0.338-0.456), 1.180 (95%CI 1.071-1.201) and 0.253 (95%CI 0.207-0.299), respectively. The optimal threshold that maximized net benefit was to treat patients with a 12-month risk of moderate or severe exacerbations ≥12%. CONCLUSION: The proposed methodology can be applied to many contexts where the objective is to devise positivity thresholds that need to incorporate stakeholder preferences. Applying this framework to COPD pharmacotherapy resulted in a stakeholder-informed treatment threshold that was substantially lower than the implicit thresholds in contemporary guidelines.

Racial inequities in cesarean use among high- and low-risk deliveries: An analysis of childbirth hospitalizations in New Jersey from 2000 to 2015.

OBJECTIVE: To examine racial inequities in low-risk and high-risk (or "medically appropriate") cesarean delivery rates in New Jersey during the era surrounding the United States cesarean surge and peak. STUDY SETTING AND DESIGN: This retrospective repeated cross-sectional study examined the universe of childbirth hospitalizations in New Jersey from January 1, 2000 through September 30, 2015. We estimate the likelihood of cesarean delivery by maternal race and ethnicity, with mixed-level logistic regression models, stratified by cesarean risk level designated by the Society of Maternal Fetal Medicine (SMFM). DATA SOURCES AND ANALYTIC SAMPLE: We used all-payer hospital discharge data from the Healthcare Cost and Utilization Project's State Inpatient Discharge Database and linked this data to the American Hospital Association Annual Survey. ZIP-code Tabulation Area (ZCTA)-level racialized economic segregation index data were from the 2007-2011 American Community Survey. We identified 1,604,976 statewide childbirth hospitalizations using International Classification of Diseases-9-CM (ICD-9) diagnosis and procedure codes and Diagnosis-Related Group codes, and created an indicator of cesarean delivery using ICD-9 codes. PRINCIPAL FINDINGS: Among low-risk deliveries, Black patients, particularly those in the age group of 35-39 years, had higher predicted probabilities of giving birth via cesarean than White people in the same age categories (Black-adjusted predicted probability = 24.0%; vs. White-adjusted predicted probability = 17.3%). Among high-risk deliveries, Black patients aged 35 to 39 years had a lower predicted probability (by 2.7 percentage points) of giving birth via cesarean compared with their White counterparts. CONCLUSIONS: This study uncovered a lack of medically appropriate cesarean delivery for Black patients, with low-risk Black patients at higher odds of cesarean delivery and high-risk Black patients at lower odds of cesarean than their White counterparts. The significant Black-White inequities highlight the need to address misalignment of evidence-based cesarean delivery practice in the efforts to improve maternal health equity. Quality metrics that track whether cesareans are provided when medically needed may contribute to clinical and policy efforts to prevent disproportionate maternal morbidity and mortality among Black patients.

The Audible Contrast Threshold (ACT) test: A clinical spectro-temporal modulation detection test.

Over the last decade, multiple studies have shown that hearing-impaired listeners' speech-in-noise reception ability, measured with audibility compensation, is closely associated with performance in spectro-temporal modulation (STM) detection tests. STM tests thus have the potential to provide highly relevant beyond-the-audiogram information in the clinic, but the available STM tests have not been optimized for clinical use in terms of test duration, required equipment, and procedural standardization. The present study introduces a quick-and-simple clinically viable STM test, named the Audible Contrast Threshold (ACT™) test. First, an experimenter-controlled STM measurement paradigm was developed, in which the patient is presented bilaterally with a continuous audibility-corrected noise via headphones and asked to press a pushbutton whenever they hear an STM target sound in the noise. The patient's threshold is established using a Hughson-Westlake tracking procedure with a three-out-of-five criterion and then refined by post-processing the collected data using a logistic function. Different stimulation paradigms were tested in 28 hearing-impaired participants and compared to data previously measured in the same participants with an established STM test paradigm. The best stimulation paradigm showed excellent test-retest reliability and good agreement with the established laboratory version. Second, the best stimulation paradigm with 1-second noise "waves" (windowed noise) was chosen, further optimized with respect to step size and logistic-function fitting, and tested in a population of 25 young normal-hearing participants using various types of transducers to obtain normative data. Based on these normative data, the "normalized Contrast Level" (in dB nCL) scale was defined, where 0 ± 4 dB nCL corresponds to normal performance and elevated dB nCL values indicate the degree of audible contrast loss. Overall, the results of the present study suggest that the ACT test may be considered a reliable, quick-and-simple (and thus clinically viable) test of STM sensitivity. The ACT can be measured directly after the audiogram using the same set up, adding only a few minutes to the process.

Optoelectronic neuron based on transistor combined with volatile threshold switching memristors for neuromorphic computing.

The human perception and learning heavily rely on the visual system, where the retina plays a vital role in preprocessing visual information. Developing neuromorphic vision hardware is based on imitating the neurobiological functions of the retina. In this work, an optoelectronic neuron is developed by combining a gate-modulated PDVT-10 channel with a volatile threshold switching memristor, enabling the achievement of optoelectronic performance through a resistance-matching mechanism. The optoelectronic spiking neuron exhibits the ability to alter its spiking behavior in a manner resembling that of a retina. Incorporating electrical and optical modulation, the artificial neuron accurately replicates neuronal signal transmission in a biologically manner. Moreover, it demonstrates inhibition of neuronal firing during darkness and activation upon exposure to light. Finally, the evaluation of a perceptron spiking neural network utilizing these leaky integrate-and-fire neurons is conducted through simulation to assess its capability in classifying image recognition algorithms. This research offers a hopeful direction for the development of easily expandable and hierarchically structured spiking electronics, broadening the range of potential applications in biomimetic vision within the emerging field of neuromorphic hardware.