Deepfake: definitions, performance metrics and standards, datasets, and a meta-review.

Recent advancements in AI, especially deep learning, have contributed to a significant increase in the creation of new realistic-looking synthetic media (video, image, and audio) and manipulation of existing media, which has led to the creation of the new term "deepfake." Based on both the research literature and resources in English, this paper gives a comprehensive overview of deepfake, covering multiple important aspects of this emerging concept, including (1) different definitions, (2) commonly used performance metrics and standards, and (3) deepfake-related datasets. In addition, the paper also reports a meta-review of 15 selected deepfake-related survey papers published since 2020, focusing not only on the mentioned aspects but also on the analysis of key challenges and recommendations. We believe that this paper is the most comprehensive review of deepfake in terms of the aspects covered.

Definition and diagnosis of Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology.

BACKGROUND: Accurate definition and operational criteria for diagnosing Parkinson's disease (PD) are crucial for evidence-based, patient-centered care. OBJECTIVE: To offer evidence-based recommendations for defining and diagnosing PD, incorporating contemporary clinical, imaging, biomarker, and genetic insights. METHODS: The guideline development began with the steering committee establishing key PICO (patient, intervention, comparison, outcome) questions, which were refined by the coauthors. Systematic literature searches identified relevant studies, reviews, and meta-analyses. Recommendations were drafted, evaluated, optimized, and voted upon by the German Parkinson's Guideline Group. RESULTS: Parkinson's disease (PD) is now understood to encompass a broader spectrum of etiologies than previously recognized. Advances in molecular pathogenesis, neuroimaging, and early clinical phenotypes suggest that PD is not a uniform disease entity and is often not idiopathic. This necessitates an updated framework for PD definition and diagnosis. The German Society for Neurology now endorses a broader concept of PD, incorporating both idiopathic and hereditary forms, as opposed to the previously narrower concept of "idiopathic Parkinson syndrome." The revised guidelines recommend using the 2015 Movement Disorders Society diagnostic criteria, emphasize the importance of long-term clinical follow-up for improved diagnostic accuracy, and highlight the significance of non-motor symptoms in clinical diagnosis. Specific recommendations are provided for the use of imaging and fluid biomarkers and genetic testing to support the clinical diagnosis. CONCLUSION: The updated guidelines from the German Society for Neurology enhance diagnostic accuracy for PD, promoting optimized clinical care.

Effects of high-definition tDCS targeting individual motor hotspot with EMG-driven robotic hand training on upper extremity motor function: a pilot randomized controlled trial.

BACKGROUND: Delivering HD-tDCS on individual motor hotspot with optimal electric fields could overcome challenges of stroke heterogeneity, potentially facilitating neural activation and improving motor function for stroke survivors. However, the intervention effect of this personalized HD-tDCS has not been explored on post-stroke motor recovery. In this study, we aim to evaluate whether targeting individual motor hotspot with HD-tDCS followed by EMG-driven robotic hand training could further facilitate the upper extremity motor function for chronic stroke survivors. METHODS: In this pilot randomized controlled trial, eighteen chronic stroke survivors were randomly allocated into two groups. The HDtDCS-group (n = 8) received personalized HD-tDCS using task-based fMRI to guide the stimulation on individual motor hotspot. The Sham-group (n = 10) received only sham stimulation. Both groups underwent 20 sessions of training, each session began with 20 min of HD-tDCS and was then followed by 60 min of robotic hand training. Clinical scales (Fugl-meyer Upper Extremity scale, FMAUE; Modified Ashworth Scale, MAS), and neuroimaging modalities (fMRI and EEG-EMG) were conducted before, after intervention, and at 6-month follow-up. Two-way repeated measures analysis of variance was used to compare the training effect between HDtDCS- and Sham-group. RESULTS: HDtDCS-group demonstrated significantly better motor improvement than the Sham-group in terms of greater changes of FMAUE scores (F = 6.5, P = 0.004) and MASf (F = 3.6, P = 0.038) immediately and 6 months after the 20-session intervention. The task-based fMRI activation significantly shifted to the ipsilesional motor area in the HDtDCS-group, and this activation pattern increasingly concentrated on the motor hotspot being stimulated 6 months after training within the HDtDCS-group, whereas the increased activation is not sustainable in the Sham-group. The neuroimaging results indicate that neural plastic changes of the HDtDCS-group were guided specifically and sustained as an add-on effect of the stimulation. CONCLUSIONS: Stimulating the individual motor hotspot before robotic hand training could further enhance brain activation in motor-related regions that promote better motor recovery for chronic stroke. TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov (ID NCT05638464).

Clinical and laboratory characteristics during a 1-year follow-up in European Lyme neuroborreliosis: A prospective cohort study.

BACKGROUND AND PURPOSE: We need more knowledge on clinical presentations, time course, biomarkers, and prognosis in European Lyme neuroborreliosis (LNB). METHODS: A prospective 12-month follow-up of predetermined clinical and laboratory parameters was undertaken in 105 patients with LNB. RESULTS: At presentation, 79% had radiculopathy, 49% had facial palsy, and 13% had solely subjective symptoms (predominately pain). Intrathecally produced Borrelia burgdorferi (Bb) antibodies were demonstrated and cerebrospinal fluid (CSF) CXCL13 was positive in 85% and 82% pretreatment, in 73% and 10% at 6 months, and in 58% and 14% at 12 months, respectively. CSF Bb polymerase chain reaction (PCR) was positive in 40% pretreatment. In four patients who tested negative for Bb antibodies in both serum and CSF, the diagnosis was supported by typical clinical features, pleocytosis, CSF Bb-PCR (n = 1), or CSF CXCL13 (n = 2). The proportion with symptoms influencing daily life was 91% pretreatment, 25% at 10 weeks, 20% at 6 months, and 15% at 12 months. Fatigue was the most common complaint at 12 months. A high burden of symptoms before and after treatment was associated with residual complaints at 12 months, whereas background data, other clinical features, and laboratory features were not. CONCLUSIONS: LNB can present with solely subjective symptoms, especially pain. Many LNB patients have persistent Bb antibodies in serum and CSF. In seronegative LNB, CSF Bb-PCR and CXCL13 may give diagnostic support. CXCL13 may be persistently positive after treatment in some patients. Most of the clinical improvement occurs during the first 10 weeks. High initial clinical score is associated with poorer outcome.

The challenge of identifying dust events in a highly polluted Eastern Mediterranean region.

Dust pollution largely impacts our environment, health and well-being. However, there is no agreement on how dust-contaminated days are identified to study exposures, as methods differ across disciplines. Different quantitative thresholds, which rely on ground measurements, are generally used to define these events. In this study, we used ground-based lidar measurements to detect dust layers. The dataset was then compared to methods that are widely used to define the presence of dust on the ground. Our results show that dust layers extend to a height of up to 10 km and a depth of up to 6.3 km. We show that at least 50 % of days that include dust components according to the lidar were not included by any of the methods that we investigated. As a result, these days are not considered in many health-related studies and climate models. Many dust events exhibit a high anthropogenic component and can be misinterpreted: (Ångström exponent>1.2), high-altitude (on average above 1.7 km) and relatively shallow (average depth 1.4 km) dust layers, and low PM10 on the ground. Mixed pollution (0.8 < Ångström exponent < 1.2) accounts for 45 % of these events. The most accurate dust-detection method considered the aerosol optical depth and Ångström exponent parameters, and provided 60 % of the dust days as determined by lidar. It does not seem to be possible to differentiate between anthropogenic and dust events because most measurements contained dust, resulting in further biased estimations. Our results indicate that there is a need to change our perception of what constitutes a dust day, when studying the impact of dust exposure. We suggest that in arid and semiarid, and in particular Eastern Mediterranean climates, where dust is a frequent and strong meteorological component, a greater number of days need to be included in the analyses or critically evaluated.

What is safety leadership? A systematic review of definitions.

INTRODUCTION: To the authors' knowledge, no systematic review has examined the definition of safety leadership in the academic literature to date. A review was therefore carried out to determine how safety leadership was defined in the peer reviewed empirical literature and thematic analysis was employed to identify patterned meanings across the data. METHOD: Thirty-seven primary definitions, or definitions that were not borrowed from other studies, were identified. Of these 37, seven conceptual definitions were found to be evidence-based, six of which were endorsed by their operational counterpart definitions and one which was derived using exploratory research. RESULTS: These seven definitions showed strong alignment with the three themes that emerged from the thematic analysis that capture the why, how, and who of safety leadership. Transformational leadership theory formed the foundation for many of the definitions in the academic literature, despite recent evidence suggesting that adopting multiple forms of leadership styles would be more effective for improving workplace safety. PRACTICAL APPLICATIONS: Gaps in the current evidence base are explored and suggestions for future research are discussed.

When we talk about Big Data, What do we really mean? Toward a more precise definition of Big Data.

Despite the lack of consensus on an official definition of Big Data, research and studies have continued to progress based on this "no consensus" stance over the years. However, the lack of a clear definition and scope for Big Data results in scientific research and communication lacking a common ground. Even with the popular "V" characteristics, Big Data remains elusive. The term is broad and is used differently in research, often referring to entirely different concepts, which is rarely stated explicitly in papers. While many studies and reviews attempt to draw a comprehensive understanding of Big Data, there has been little systematic research on the position and practical implications of the term Big Data in research environments. To address this gap, this paper presents a Systematic Literature Review (SLR) on secondary studies to provide a comprehensive overview of how Big Data is used and understood across different scientific domains. Our objective was to monitor the application of the Big Data concept in science, identify which technologies are prevalent in which fields, and investigate the discrepancies between the theoretical understanding and practical usage of the term. Our study found that various Big Data technologies are being used in different scientific fields, including machine learning algorithms, distributed computing frameworks, and other tools. These manifestations of Big Data can be classified into four major categories: abstract concepts, large datasets, machine learning techniques, and the Big Data ecosystem. This study revealed that despite the general agreement on the "V" characteristics, researchers in different scientific fields have varied implicit understandings of Big Data. These implicit understandings significantly influence the content and discussions of studies involving Big Data, although they are often not explicitly stated. We call for a clearer articulation of the meaning of Big Data in research to facilitate smoother scientific communication.

Social isolation in people with type 2 diabetes: A concept analysis.

Objective: To identify the defining attributes, antecedents, consequences and empirical referents to form an operational definition of social isolation in people with type 2 diabetes. Design: The Walker and Avant approach. Data source: An electronic search of the literature using China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Web of Science, CINAHL, and PsycINFO informed the analysis. The search included both quantitative and qualitative studies related to social isolation in people with type 2 diabetes published in Chinese and English. Results: Of the 2918 articles identified, 21 ultimately met the inclusion criteria. The analysis identified the defining attributes of social isolation in people with type 2 diabetes as objective and subjective. Antecedents included five aspects: personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors. Consequences were identified as physiological, psychological, behavioral aspects and quality of life. Conclusions: The operational definition of social isolation in people with type 2 diabetes is that due to personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors, people with type 2 diabetes will have limited social networks and social support, reduced social contact and social involvement, and/or negative feelings of disconnection from the outside world, which lead to adverse physiological, psychological, and behavioral outcomes and poor quality of life. Clinicians can further develop tools to measure social isolation in people with type 2 diabetes and analyze the path of the antecedents to social isolation to investigate the interplay between them in order to develop target interventions.

Good mental health in people with intellectual disabilities: a systematic review.

While mental disorders have been broadly researched in people with intellectual disabilities (ID), comparatively less attention has been given to the conceptualisation of good mental health for this population. To capture existing concepts, definitions and measurement approaches of good mental health a systematic literature review was conducted following PRISMA guidelines. The search was carried out in eleven databases, using various synonyms of (i) intellectual disability, (ii) mental health, (iii) wellbeing, (iv) definition, and (v) assessment. A total of 2,046 datasets were identified, of which 37 met the inclusion criteria and were analysed using reflexive thematic analysis and content analysis. Results show four main themes: (1) environment, (2) absence of mental illness, (3) physical health, and (4) psychosocial functioning. The fourth was the most dominant theme and was further divided into five sub-themes: (1) emotionality, (2) interpersonal relations, (3) realise own potential, (4) personal resources, and (5) overall appraisal of life. Our findings reveal different conceptualisations of wellbeing, which is a vital part of good mental health, but highlight a notable research gap in the actual definition and conceptualisation of good mental health for people with ID.

Exoscopic Transoral Supraglottic Laryngectomy.

This article, accompanied by technical notes and video, presents a case of an 85-year-old patient with a cT2N0 laryngeal squamous cell carcinoma treated using CO2 transoral laser exoscopic surgery (TOLES). The procedure achieved en bloc tumor removal with negative margins, preserving laryngeal and swallowing functions, demonstrating TOLES as a viable alternative to traditional microsurgery with enhanced visualization and ergonomics. Laryngoscope, 2024.

Diagnosis of sarcopenic obesity in Japan: Consensus statement of the Japanese Working Group on Sarcopenic Obesity.

Sarcopenic obesity is the co-existence of obesity and sarcopenia in individuals aged 40-75 years. The Japanese Working Group on Sarcopenic Obesity has developed diagnostic criteria tailored for the Japanese population, considering their unique characteristics compared with European populations. Our algorithm consists of two steps: screening and diagnosis. The screening of obesity mandates using waist circumference and/or body mass index (BMI) based on national standards, while screening for sarcopenia involves the "finger ring test" in addition to the Asian Working Group for Sarcopenia 2019 criteria. The final diagnosis of sarcopenia involves handgrip strength for low muscle strength, the five-times chair stand test for low physical function, and limb skeletal muscle mass (corrected for BMI) for low muscle mass. Obesity is assessed by visceral fat area or body fat percentage. Sarcopenic obesity is then categorized into Stage I, with muscle weakness/loss of function, loss of muscle mass, and obesity; or Stage II, which includes complications. Further clinical validation is needed to refine the consensus and age range. Geriatr Gerontol Int 2024; ••: ••-••.

Operational description of rare diseases: a reference to improve the recognition and visibility of rare diseases.

Improving health and social equity for persons living with a rare disease (PLWRD) is increasingly recognized as a global policy priority. However, there is currently no international alignment on how to define and describe rare diseases. A global reference is needed to establish a mutual understanding to inform a wide range of stakeholders for actions. A multi-stakeholder, global panel of rare disease experts, came together and developed an Operational Description of Rare Diseases. This reference describes which diseases are considered rare, how many persons are affected and why the rare disease population demands specific attention. The operational description of rare diseases is framed in two parts: a core definition of rare diseases, complemented by a descriptive framework of rare diseases. The core definition includes parameters that permit the identification of which diseases are considered rare, and how many persons are affected. The descriptive framework elaborates on the impact and burden of rare diseases on patients, their caregivers and families, healthcare systems, and society overall. The Operational Description of Rare Diseases establishes a common point of reference for decision-makers across the world who strive to understand and address the unmet needs of persons living with a rare disease. Adoption of this reference is essential to improving the visibility of rare conditions in health systems across the world. Greater recognition of the burden of rare diseases will motivate new actions and policies to address the unmet needs of the rare disease community.

Type of fixation is not associated with range of motion after operative treatment of proximal radius fractures- a systematic review of 519 patients.

Background: The aims of this study are 1) to assess whether open reduction internal fixation (ORIF) techniques for fractures of the proximal radius are associated with the range of motion (ROM), 2) to determine the incidence of hardware-related complications and removal following plate and screw fixation of the proximal radius, and 3) to evaluate whether the safe-zone definition is described in the literature and its relation to the ROM. Methods: A literature search was performed in the PubMed, Embase, and Cochrane databases. Studies reporting ROM in patients undergoing ORIF for radial head or neck fractures were included. Two treatment groups were defined based on ORIF technique: screws only or plates with and without additional screw placement. Results: A total of 13 articles were included with 519 patients, of which 271 belonged to the screw group and 248 to the plate group. At final follow-up, the screw group reported a mean supination of 79 (95% CI: 74-83), pronation of 76 (95% CI: 69-84), flexion of 131 (95% CI: 124-138), and loss of extension of 4 (95% CI: 1-7). The plate group reported a mean supination of 72 (95% CI: 65-80), pronation of 697 (95% CI: 60-75), flexion of 126 (95% CI: 118-133), and loss of extension of 7 (95% CI: 1-14). Conclusion: Predominantly retrospective studies show that the ROM seems similar for screw and plate osteosynthesis of proximal radius fractures. Complication rates are similar as well. The safe-zone definition is rarely reported.

Pressure Control Surrogate Formula for Estimating Mechanical Power in ARDS is Associated with Mortality.

BACKGROUND: Mechanical power applied to the respiratory system (MPRS) is associated with ventilator-induced lung injury (VILI) and ARDS mortality. Absent automated ventilator MPRS measurements, the alternative is clinically unwieldy equations. However, simplified surrogate formulas are now available and accurately reflect values produced by airway pressure-volume curves. This retrospective, observational study examined whether the surrogate pressure-control equation alone could accurately assess mortality risk in ARDS subjects managed almost exclusively with volume-control ventilation.METHODS: 948 subjects were studied in whom invasive mechanical ventilation and implementation of ARDSNet ventilator protocols commenced ≤ 24hr after ARDS onset, and who survived > 24hr. MPRS was calculated as 0.098 x respiratory frequency x VT x (PEEP + driving pressure [PDR]). MPRS was assessed as a risk factor for hospital mortality, and compared between non-survivors and survivors across Berlin Definition classifications. In addition, mortality was compared across 4 MPRS thresholds associated with VILI or mortality (ie. 15, 20, 25 and 30 J/m).RESULTS: MPRS was associated with increased mortality risk: Odds Ratio (95% CI) of 1.06 (1.04-1.07) per J/m, P<0.001). Median MPRS differentiated non-survivors from survivors in Mild (24.7 vs. 18.5 J/m, respectively, P==0.034); Moderate (25.7 vs. 21.3 J/m, P<0.001); and Severe ARDS (28.7 vs. 23.5 J/m, P<0.001). Across 4 MPRS thresholds mortality increased from 23-29% when MPRS was < threshold vs. 38-51% when MPRS was > threshold (P<0.001). In the > cohort the Odds Ratio (95%CI) increased from 2.03 (1.34-3.12) to 2.51 (1.87-3.33).CONCLUSION: The pressure control surrogate formula is sufficiently accurate to assess mortality in ARDS, even when using volume control ventilation. In our subjects when MPRS exceeds established cut-off values for VILI or mortality risk, we found mortality risk consistently increased by a factor of > 2.0.

Host population structure and species resolution reveal prophage transmission dynamics.

Much knowledge about bacteriophages has been obtained via genomics and metagenomics over the last decades. However, most studies dealing with prophage diversity have rarely conducted phage species delimitation (aspect 1) and have hardly integrated the population structure of the host (aspect 2). Yet, these two aspects are essential in assessing phage diversity. Here, we implemented an operational definition of phage species (clustering at 95% identity, 90% coverage) and integrated the host's population structure to understand prophage diversity better. Gathering the most extensive data set of Acinetobacter baumannii phages (4,152 prophages + 122 virulent phages, distributed in 46 countries in the world), we show that 91% (875 out of 963) of the prophage species have four or fewer prophages per species, and just five prophage species have more than 100 prophages. Most prophage species have a narrow host range and are geographically restricted; yet, very few have a broad host range being well spread in distant lineages of A. baumannii. These few broad host range prophage species are not only cosmopolitan but also the most abundant species. We also noted that polylysogens had very divergent prophages, belonging to different prophage species, and prophages can easily be gained and lost within the bacterial lineages. Finally, even with this extensive data set, the prophage diversity has not been fully grasped. Our study highlights how integrating the host population structure and a solid operational definition of phage species allows us to better appreciate phage diversity and its transmission dynamics. IMPORTANCE: Much knowledge about bacteriophages has been obtained via genomics and metagenomics over the last decades. However, most studies dealing with prophage diversity have rarely conducted phage species delimitation (aspect 1) and have hardly integrated the population structure of the host (aspect 2). Yet, these two aspects are essential in assessing phage diversity. Here, we implemented an operational definition of phage species (clustering at 95% identity, 90% coverage) and integrated the host's population structure to understand prophage diversity better. Gathering the most extensive data set of Acinetobacter baumannii phages, we show that most prophage species have four or fewer prophages per species, and just five prophage species have more than 100 prophages. Most prophage species have a narrow host range and are geographically restricted; yet, very few have a broad host range being well spread in distant lineages of A. baumannii. These few broad host range prophage species are cosmopolitan and the most abundant species. Prophages in the same bacterial genome are very divergent, and prophages can easily be gained and lost within the bacterial lineages. Finally, even with this extensive data set, the prophage diversity has not been fully grasped. This study shows how integrating the host population structure and clustering at the species level allows us to better appreciate phage diversity and its transmission dynamics.

Semi-automated reproducible target transfer for cardiac radioablation - A multi-center cross-validation study within the RAVENTA trial.

BACKGROUND: Stereotactic arrhythmia radioablation (STAR) is a therapeutic option for ventricular tachycardia (VT) where catheter-based ablation is not feasible or has previously failed. Target definition and its transfer from electro-anatomic maps (EAM) to radiotherapy treatment planning systems (TPS) is challenging and operator-dependent. Software solutions have been developed to register EAM with cardiac CT and semi-automatically transfer 2D target surface data into 3D CT volume coordinates. Results of a cross-validation study of two conceptually different software solutions using data from the RAVENTA trial (NCT03867747) are reported. METHODS: Clinical Target Volumes (CTVs) were created from target regions delineated on EAM using two conceptually different approaches by separate investigators on data of 10 patients, blinded to each other's results. Targets were transferred using 3D-3D registration and 2D-3D registration, respectively. The resulting CTVs were compared in a core-lab using two complementary analysis software packages for structure similarity and geometric characteristics. RESULTS: Volumes and surface areas of the CTVs created by both methods were comparable: 14.88 ± 11.72 ml versus 15.15 ± 11.35 ml and 44.29 ± 33.63 cm2 versus 46.43 ± 35.13 cm2. The Dice-coefficient was 0.84 ± 0.04; median surface-distance and Hausdorff-distance were 0.53 ± 0.37 mm and 6.91 ± 2.26 mm, respectively. The 3D-center-of-mass difference was 3.62 ± 0.99 mm. Geometrical volume similarity was 0.94 ± 0.05 %. CONCLUSION: The STAR targets transferred from EAM to TPS using both software solutions resulted in nearly identical 3D structures. Both solutions can be used for QA (quality assurance) and EAM-to-TPS transfer of STAR-targets. Semi-automated methods could potentially help to avoid mistargeting in STAR and offer standardized workflows for methodically harmonized treatments.

Application of a new definition of sarcopenic obesity in middle-aged and older adults and association with cognitive function: Findings from the National Health and Nutrition Examination Survey 1999-2002.

BACKGROUND & AIMS: The role of sarcopenic obesity (SO) in impaired cognitive function has been investigated in several observational studies, but results have been mixed. This study applied the proposed European Society for Clinical Nutrition and Metabolism (ESPEN)-European Association for the Study of Obesity (EASO) definition of SO to a representative population aged ≥50 years to identify the association between SO and cognitive function. METHODS: Data from the National Health and Nutrition Examination Survey 1999-2002 waves were used. At the screening phase, body mass index or waist circumference were used to evaluate obesity; sarcopenia was identified using the SARC-F questionnaire. At the diagnostic phase I and II, sarcopenia was assessed using knee extensor isometric strength and appendicular lean mass, and fat mass percent was used to assess obesity. Cognitive function in older participants (60-85 years) was assessed using the Digit Symbol Substitution Test. A self-reported memory question was used in middle-aged individuals (50-59 years). RESULTS: The sample included 2356 participants (men, 44.7%). The prevalence of SO was 32.3%, 21.2% and 15.0% at the screening, diagnosis I, and diagnosis II, respectively. Significant associations between SO and cognitive impairment were observed in individuals aged 60-85 at diagnosis I (OR: 2.3, 95%CI 1.4-3.8, P = 0.007) and diagnosis II (OR: 2.7, 95%CI 1.5-4.9, P = 0.004). CONCLUSION: The new ESPEN-EASO definition of SO identified a high prevalence of SO cases. A significant association between SO and poor cognitive function in older individuals was observed.