Neural interface-based motor neuroprosthesis in post-stroke upper limb neurorehabilitation: An individual patient data meta-analysis.

OBJECTIVE: To determine the efficacy of neural interface-, including brain-computer interface (BCI), based neurorehabilitation through conventional and individual patient data (IPD) meta-analysis, and to assess clinical parameters associated with positive response to neural interface-based neurorehabilitation. DATA SOURCES: PubMed, EMBASE, and Cochrane Library databases up to February 2022 were reviewed. STUDY SELECTION: Studies using neural interface-controlled physical effectors (FES and/or powered exoskeletons) and reported Fugl-Meyer Assessment-upper extremity (FMA-UE) scores were identified. This meta-analysis was prospectively registered on PROSPERO (#CRD42022312428). PRISMA guidelines were followed. DATA EXTRACTION: Change in FMA-UE scores were pooled to estimate the mean effect size. Subgroup analyses were performed on clinical parameters and neural interface parameters with both study-level variables and IPD. DATA SYNTHESIS: Forty-six studies containing 617 patients were included. Twenty-nine studies involving 214 patients reported IPD. FMA-UE score increased by a mean of 5.23 (95% CI: 3.85 to 6.61). Systems that used motor attempt resulted in greater FMA-UE gain than motor imagery, as did training lasting >4 versus ≤4 weeks. On IPD analysis, the mean time-to-improvement above MCID was 12 weeks (95% CI: 7 to not reached). At 6 months, 58% improved above MCID (95% CI: 41 to 70%). Patients with severe impairment (p=0.042) and age >50 years (p=0.0022) correlated with the failure to improve above the MCID on univariate log-rank tests. However, these factors were only borderline significant on multivariate Cox analysis (HR 0.15, p = 0.08 and HR 0.47, p = 0.06, respectively). CONCLUSION: Neural interface-based motor rehabilitation resulted in significant though modest reductions in post-stroke impairment and should be considered for wider applications in stroke neurorehabilitation.

Character Traits Predict Health and Well-Being beyond Personality.

We examined the incremental validity of character in predicting health outcomes and well-being beyond personality traits and investigated the extent to which health-related behaviors mediate the relationship between character and well-being. Findings indicate that several character cores (e.g., transcendence, fortitude) predict well-being, health behaviors, and health outcomes beyond different measures of personality traits, indicating that character is discriminable from personality as indicated by incremental prediction. In particular, fortitude, temperance, transcendence, and sincerity appear to be key players. Implications for character research are discussed.

Kerr microresonator dual-comb source with adjustable line-spacing.

Optical microresonators offer a highly-attractive new platform for the generation of optical frequency combs. Recently, several groups have been able to demonstrate the generation of dual-frequency combs in a single microresonator driven by two optical pumps. This opens the possibility for microresonator-based dual-comb systems suitable for measurement applications such as spectroscopy, ranging and imaging. Key to the performance of these systems are the parameters of the radio-frequency comb spectrum that arises from the interference of the two optical combs. In this work, we present a simple mechanism to enable the discrete fine-tuning of these parameters by driving the two optical combs with optical pumps with different azimuthal mode numbers. The mechanism consists of tuning the difference in azimuthal mode number between the two pumps by selection of the pumps' frequencies. We are able to implement this technique when the two counter-propagating pumps are set to drive resonances of the same spatial mode family, as well as different mode families. In each case, we experimentally observe ∼1 MHz of discrete tunability in the line-spacing of the radio-frequency comb as the frequency offset between the two pumps is scanned between 0 to 80 free-spectral-ranges.

A Health App for Post-Pandemic Years (HAPPY) for people with physiological and psychosocial distress during the post-pandemic era: Protocol for a randomized controlled trial.

Objective: This article describes a protocol for a randomized controlled trial to evaluate the effects of a three-level Health App for Post-Pandemic Years (HAPPY) on alleviating post-pandemic physiological and psychosocial distress. Methods: Convenience and snowball sampling methods will be used to recruit 814 people aged 18+ with physiological and/or psychosocial distress. The experimental group will receive a 24-week intervention consisting of an 8-week regular supervision phase and a 16-week self-help phase. Based on their assessment results, they will be assigned to receive interventions on mindfulness, energy conservation techniques, or physical activity training. The waitlist control group will receive the same intervention in Week 25. The primary outcome will be changes in psychosocial distress, measured using the Kessler Psychological Distress Scale (K10). Secondary outcomes will include changes in levels of fatigue (Chinese version of the Brief Fatigue Inventory), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index), pain intensity (Numeric Rating Scale), positive appraisal (Short version of the 18-item Cognitive Emotion Regulation Questionnaire), self-efficacy (Chinese version of the General Self-efficacy Scale), depression and anxiety (Chinese version of the 21-item Depression Anxiety Stress Scale), and event impact (Chinese version of the 22-item Impact of Event Scale-Revised). All measures will be administered at baseline (T0), Week 8 after the supervision phase (T1), and 24 weeks post-intervention (T2). A generalized estimating equations model will be used to examine the group, time, and interaction (Time × Group) effect of the interventions on the outcome assessments (intention-to-treat analysis) across the three time points, and to compute a within-group comparison of objective physiological parameters and adherence to the assigned interventions in the experimental group. Conclusions: The innovative, three-level mobile HAPPY app will promote beneficial behavioral strategies to alleviate post-pandemic physiological and psychosocial distress. Trial registration: ClinicalTrials.gov, NCT05459896. Registered on 15 July 2022.

Comparing the Pretrained Models of Source Code by Re-pretraining Under a Unified Setup.

Recent years have seen the successful application of large pretrained models of source code (CodePTMs) to code representation learning, which have taken the field of software engineering (SE) from task-specific solutions to task-agnostic generic models. By the remarkable results, CodePTMs are seen as a promising direction in both academia and industry. While a number of CodePTMs have been proposed, they are often not directly comparable because they differ in experimental setups such as pretraining dataset, model size, evaluation tasks, and datasets. In this article, we first review the experimental setup used in previous work and propose a standardized setup to facilitate fair comparisons among CodePTMs to explore the impacts of their pretraining tasks. Then, under the standardized setup, we re-pretrain CodePTMs using the same model architecture, input modalities, and pretraining tasks, as they declared and fine-tune each model on each evaluation SE task for evaluating. Finally, we present the experimental results and make a comprehensive discussion on the relative strength and weakness of different pretraining tasks with respect to each SE task. We hope our view can inspire and advance the future study of more powerful CodePTMs.

Exploring the Educational Value of Popular Culture in Web-Based Medical Education: Pre-Post Study on Teaching Jaundice Using "The Simpsons".

BACKGROUND: The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary. OBJECTIVE: This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session. METHODS: We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from "The Simpsons" television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants. RESULTS: A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of "The Simpsons" characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7). CONCLUSIONS: When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. "The Simpsons" characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice.

Conceptualizing "positive attributes" across psychological perspectives.

BACKGROUND: The growth of positive psychology has birthed debate on the nature of what "positive" really means. Conceptualizations of positive attributes vary across psychological perspectives, and it appears these definitional differences stem from standards for "positive" espoused by three normative ethical frameworks: consequentialism, deontology, and virtue ethics. When definitions of "positive" do not align with one of these ethical schools, it appears researchers rely on preference to distinguish positive attributes. In either case, issues arise when researchers do not make their theoretical alignment explicit, leading to value-laden, often subjective criteria being smuggled into science as a description of what is positive. OBJECTIVE: To foster a deeper critical understanding of the different approaches, we examine how these conceptual definitions of positive attributes (mis)align with their ethical traditions or fail to align with an ethical school. METHOD: We review several positive attribute theories across psychological disciplines that serve as examples of the ethical and non-ethical sources of "positivity." Through this, we assess the conceptual criteria for what each approach considers "positive," note the degree of alignment between definition and ethical school, and draw attention to potential issues. CONCLUSION: We advance the conceptual assessment of positive attributes by considering the implications of failing to explicitly address the theoretical foundation from which a construct is defined.

Wideband multimode optical parametric oscillation in a Kerr microresonator.

Parametric oscillation in Kerr microresonators provides an attractive pathway for the generation of new optical frequencies in a low-power, small-footprint device. The frequency shift of the newly generated parametric sidebands is set by the phasematching of the underlying four-wave-mixing process, with the generation of large frequency shift sidebands typically placing exacting requirements on a resonator's dispersion profile. In practice, this limits the range of viable pump wavelengths, and ultimately the range of output frequencies. In this paper, we consider a multimode four-wave-mixing process in which the pump and sidebands propagate in different mode families of the resonator. We show that this multimode configuration yields a considerable relaxation in the phasematching requirements needed to generate large frequency shift parametric sidebands, allowing their formation even in resonators with strong second-order dispersion. Experimentally we use a magnesium-fluoride micro-disk resonator to demonstrate this multimode phasematching. By accessing different pump and sideband modes, four distinct multimode parametric processes generating frequency shifts between 118 and 216 THz are reported. The resulting separation between the two sidebands is almost three octaves.

Malignant Transformation in Ollier's Disease: A Novel Stem for a Tibial Megaprosthesis.

Ollier's disease is a rare syndrome characterized by multiple enchondromas with the potential for malignant transformation. The treatment for secondary chondrosarcoma is surgical resection, which can be a morbid procedure depending on the location and size of the tumor. We present a successful limb salvage in which the majority of the tibia was removed and replaced with a megaprosthesis. The complex reconstruction in this case required the use of a novel uncemented stem.

Enhancing medical students` confidence and performance in integrated structured clinical examinations (ISCE) through a novel near-peer, mixed model approach during the COVID-19 pandemic.

BACKGROUND: Near-peer medical education serves as an important method of delivering education to junior students by senior students. Due to the reduced clinical exposure because of the COVID-19 pandemic, we developed a mentorship scheme to help medical students with their Integrated Structured Clinical Examinations (ISCEs) by providing a combination of near-peer mentorship together with lecture-based teaching on a weekly basis for a 12-week period. Students attended a specialty-focused lecture every Tuesday followed by a small group teaching session organised by their tutor. METHODS: A longitudinal evaluative interventional study was undertaken by the international student led medical education organisation, OSCEazy. The teaching programme was organised and conducted by third year medical students to a recruited cohort of second year medical students. Students' perceptions of ISCEs (confidence, anxiety, and overall performance) were evaluated using 5-point Likert scales while their knowledge of the specialty was assessed using 10 single best answer questions which were distributed via Google® forms at the start and end of each week. In addition, we assessed tutor perceptions of their teaching and learning experience. RESULTS: Seventy-two tutees were enrolled in the programme (mean age: 24.4, female: 77.8%). 88.9% of the participants had not attended any online ISCE teaching prior to this. They preferred in-person ISCE teaching as compared to virtual sessions [median 4.5 (IQR 4-5) vs 3 (IQR 3-4), p <  0.0001), respectively]. There was a significant overall increase in knowledge when comparing pre-session and post-session performance [mean 53.7% vs 70.7%, p <  0.0001)]. There was a significant increase in student confidence [Confidence: median 3 (IQR:3-4) vs 4 (IQR 3-4), p <  0.0001] while no change was seen in the anxiety and perception of their overall performance in an ISCE. [Anxiety: median 3 (IQR 2-4) vs 3 (IQR 3-4), p = 0.37, Performance: median 3 (IQR 3-4) vs median 3 (IQR 3-4), p <  0.0001]. The tutors reported an increase in their confidence in teaching ISCEs online [median 3 (IQR 2-3.25) vs median 4 (IQR 4-5), p <  0.0001)]. CONCLUSION: Online near-peer teaching increases the confidence of both tutees and tutors involved while enhancing the tutees' knowledge of the specialty. Thus, medical schools should incorporate near-peer teaching in their curriculum to enhance the student learning experience.

Experience Using Adjuvant Bacteriophage Therapy for the Treatment of 10 Recalcitrant Periprosthetic Joint Infections: A Case Series.

Periprosthetic joint infections are a devastating complication of joint replacement surgery. One novel therapeutic that has potential to change the current treatment paradigm is bacteriophage therapy. Herein, we discuss our experiences with bacteriophage therapy for 10 recalcitrant periprosthetic joint infections and review the treatment protocols utilized to achieve successful outcomes.

Salphage: Salvage Bacteriophage Therapy for Recalcitrant MRSA Prosthetic Joint Infection.

Prosthetic joint infections are a devastating complication of joint replacement surgery. Consequently, novel therapeutics are needed to thwart the significant morbidity and enormous financial ramifications that are associated with conventional treatments. One such promising adjuvant therapeutic is bacteriophage therapy given its antibiofilm activity and its ability to self-replicate. Herein we discuss the case of a 70-year-old female who had a recalcitrant MRSA prosthetic knee and femoral lateral plate infection who was successfully treated with adjuvant bacteriophage therapy. Moreover, this case discusses the importance of propagating bacteriophage therapeutics on bacteria that are devoid of toxins and the need to ensure bacteriophage activity to all bacterial morphologies. Overall, this case reinforces the potential benefit of using personalized bacteriophage therapy for recalcitrant prosthetic joint infections, but more translational research is needed to thereby devise effective, reproducible clinical trials.

Relevance of presenting risks of frailty, sarcopaenia and osteopaenia to outcomes from aneurysmal subarachnoid haemorrhage.

INTRODUCTION: Aneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. Traditional markers of aSAH have established their utility in the prediction of aSAH outcomes while frailty markers have been validated in other surgical specialties. We aimed to compare the predictive value of frailty indices and markers of sarcopaenia and osteopaenia, against the traditional markers for aSAH outcomes. METHODS: An observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. The best performing marker in predicting the modified Rankin scale (mRS) on discharge was selected and an appropriate threshold for the definition of frail and non-frail was derived. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]) and markers of sarcopaenia and osteopaenia (temporalis [TMT] and zygoma thickness), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. Univariable and multivariable analysis was then performed for various inpatient and long-term outcomes. RESULTS: TMT was the best performing marker in our cohort with an AUC of 0.82, Somers' D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68). The threshold of 5.5 mm in TMT thickness was found to have a specificity of 0.93, sensitivity of 0.51, positive predictive value of 0.95 and negative predictive value of 0.42. After multivariate analysis, patients with TMT ≥ 5.5 mm (defined as non-frail), were less likely to experience delayed cerebral ischaemia (OR 0.11 [0.01 - 0.93], p = 0.042), any complications (OR 0.20 [0.06 - 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. CONCLUSION: TMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes.

Experiences and challenges faced by community mental health workers when providing care to people with mental health conditions: A qualitative descriptive study.

The global prevalence of mental health conditions and the associated wide treatment gaps have led to increased demand for quality mental healthcare services. In Singapore, despite a shift towards a joint provision of mental healthcare in hospitals and the community, experiences of mental healthcare teams in such hospital-community partnerships have remained unclear. Through a qualitative descriptive approach, this study explored community mental health workers' experiences and perceptions of working with partners from tertiary hospitals and other community organisations. Eighteen participants were individually interviewed with a semi-structured question guide through video conferencing. This study was guided by the 32-item checklist from the Consolidated Criteria for Reporting Qualitative Research. Data were subjected to Braun and Clark's six-step thematic analysis. Three themes emerged: (i) the need for supportive partners, due to institutional and legal challenges faced in the participants' liaison with hospital partners and other community organisations; (ii) the need for a supportive organisation, whose presence and importance were revealed by the interviews; and (iii) the necessity of advanced training, identified by the participants as a contributor to their professional growth. The findings highlighted the importance of inter-sectoral communication and positive effects of a robust organisational support system. Accordingly, hospitals and community mental healthcare organisations should consider strengthening networking and boosting case discussions through regular inter-sectoral meetings that would prioritise the clients' continuity of care. Furthermore, opportunities for advanced trainings should be created for community-based mental healthcare workers.

Automated video interview personality assessments: Reliability, validity, and generalizability investigations.

Organizations are increasingly adopting automated video interviews (AVIs) to screen job applicants despite a paucity of research on their reliability, validity, and generalizability. In this study, we address this gap by developing AVIs that use verbal, paraverbal, and nonverbal behaviors extracted from video interviews to assess Big Five personality traits. We developed and validated machine learning models within (using nested cross-validation) and across three separate samples of mock video interviews (total N = 1,073). Also, we examined their test-retest reliability in a fourth sample (N = 99). In general, we found that the AVI personality assessments exhibited stronger evidence of validity when they were trained on interviewer-reports rather than self-reports. When cross-validated in the other samples, AVI personality assessments trained on interviewer-reports had mixed evidence of reliability, exhibited consistent convergent and discriminant relations, used predictors that appear to be conceptually relevant to the focal traits, and predicted academic outcomes. On the other hand, there was little evidence of reliability or validity for the AVIs trained on self-reports. We discuss the implications for future work on AVIs and personality theory, and provide practical recommendations for the vendors marketing such approaches and organizations considering adopting them. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Osteochondroma Pathogenesis: Mouse Models and Mechanistic Insights into Interactions with Retinoid Signaling.

Osteochondromas are cartilage-capped tumors that arise near growing physes and are the most common benign bone tumor in children. Osteochondromas can lead to skeletal deformity, pain, loss of motion, and neurovascular compression. Currently, surgery is the only available treatment for symptomatic osteochondromas. Osteochondroma mouse models have been developed to understand the pathology and the origin of osteochondromas and develop therapeutic drugs. Several cartilage regulatory pathways have been implicated in the development of osteochondromas, such as bone morphogenetic protein, hedgehog, and WNT/ß-catenin signaling. Retinoic acid receptor-γ is an important regulator of endochondral bone formation. Selective agonists for retinoic acid receptor-γ, such as palovarotene, have been investigated as drugs for inhibition of ectopic endochondral ossification, including osteochondromas. This review discusses the signaling pathways involved in osteochondroma pathogenesis and their possible interactions with the retinoid pathway.

Outcomes of a National, Cross-Sector Antimicrobial Stewardship Training Initiative for Pharmacists in England.

(1) Background: Pharmacists play a pivotal role in tackling Antimicrobial resistance through antimicrobial stewardship (AMS) and are well placed to lead behaviour change interventions across the healthcare system; (2) Methods: A cross-sector AMS training initiative for pharmacists was implemented across England, with three cohorts between 2019-2021. Each cohort took part in an introductory workshop, followed- by a workplace-based quality improvement project supported by peer-assisted learning sessions. Completion of training was determined by an end of training assessment after three to four months. Outcome data and learner survey results were collated, anonymised, and analysed by the training provider. (3) Results: In total, 118 pharmacists participated in the introductory workshop, 70% of these subsequently undertook an improvement project, and 48% engaged workplace stakeholders in the process. Interventions were designed by 57% of learners and 18% completed a at least one Plan-Do-Study-Act cycle. Approximately a quarter of learners met the requirements for a Certificate of Completion. Knowledge quiz scores were obtained from 115 learners pre-training and 28 learners post-training. Paired t-tests conducted for 28 learners showed a statistically significant improvement in mean score from 67.7% to 81.1% (p < 0.0001). Sixty-two learner survey responses were received during the training and 21 follow-up survey responses 6 to 12 months post training. Of the 21 responses to the follow-up survey, ongoing quality improvement work and improvement outcomes were reported by nine and six learners, respectively. (4) Conclusions: The delivery of workplace-based training at scale can be challenging, however this study demonstrates that coupling learning with workplace implementation and peer support can promote behaviour change in learners. Further study into the impact of providing pharmacists across sectors and geographies with access to this type of training will help inform ongoing workforce development interventions.

Cerebral Arteriovenous Malformation Recurrence After Complete Surgical Excision in an Adult: Case Report and Review of the Literature.

Angiographically confirmed complete surgical excision of brain arteriovenous malformations (bAVMs) is conventionally considered curative. Recurrence in adults is rarely encountered; only 18 cases have been reported in the English literature over the past 30 years. The potential for recurrence and consequent need for routine long-term follow-up are important considerations in the management of these lesions. We report a case of a 23-year-old female with a recurrent bAVM discovered incidentally on routine imaging three years after complete surgical excision. We review the existing literature and discuss the options for surveillance and management.

Potential Use of Adjuvant Bacteriophage Therapy With Debridement, Antibiotics, and Implant Retention Surgery to Treat Chronic Prosthetic Joint Infections.

The number of arthroplasties conducted annually continues to increase; however, approximately 1%-2% of all knee and hip arthroplasties will become infected. These prosthetic joint infections are costly, difficult to treat, and cause significant morbidity and mortality as a direct result of conventional surgical and medical managements. In this perspective, we discuss factors that make these infections arduous to treat as well as the potential use of adjuvant bacteriophage therapy with debridement, antibiotics, and implant retention surgery to cure these infections without removing the infected prosthesis. We also provide rationale as to why future clinical trials evaluating this novel therapeutic will need to be designed as noninferiority trials, and we compare this approach to 2-stage revision surgery. If bacteriophage therapy continues to show effectiveness, this could revolutionize the treatment of prosthetic joint infections and pioneer new treatments for similar infections.