Effect of manual OCTA segmentation correction to improve image quality and visibility of choroidal neovascularization in AMD.

In this retrospective case series on neovascular age-related macular degeneration (nAMD), we aimed to improve Choroidal Neovascularization (CNV) visualization in Optical Coherence Tomography Angiography (OCTA) scans by addressing segmentation errors. Out of 198 eyes, 73 OCTA scans required manual segmentation correction. We compared uncorrected scans to those with minimal (2 corrections), moderate (10 corrections), and detailed (50 corrections) efforts targeting falsely segmented Bruch's Membrane (BM). Results showed that 55% of corrected OCTAs exhibited improved quality after manual correction. Notably, minimal correction (2 scans) already led to significant improvements, with additional corrections (10 or 50) not further enhancing expert grading. Reduced background noise and improved CNV identification were observed, with the most substantial improvement after two corrections compared to baseline uncorrected images. In conclusion, our approach of correcting segmentation errors effectively enhances image quality in OCTA scans of nAMD. This study demonstrates the efficacy of the method, with 55% of resegmented OCTA images exhibiting enhanced quality, leading to a notable increase in the proportion of high-quality images from 63 to 83%.

Exposure of protected areas in Central America to extreme weather events.

Central America and the Caribbean are regularly battered by megadroughts, heavy rainfall, heat waves, and tropical cyclones. Although 21st-century climate change is expected to increase the frequency, intensity, and duration of these extreme weather events (EWEs), their incidence in regional protected areas (PAs) remains poorly explored. We examined historical and projected EWEs across the region based on 32 metrics that describe distinct dimensions (i.e., intensity, duration, and frequency) of heat waves, cyclones, droughts, and rainfall and compared trends in PAs with trends in unprotected lands. From the early 21st century onward, exposure to EWEs increased across the region, and PAs were predicted to be more exposed to climate extremes than unprotected areas (as shown by autoregressive model coefficients at p < 0.05 significance level). This was particularly true for heat waves, which were projected to have a significantly higher average (tested by Wilcoxon tests at p < 0.01) intensity and duration, and tropical cyclones, which affected PAs more severely in carbon-intensive scenarios. PAs were also predicted to be significantly less exposed to droughts and heavy rainfall than unprotected areas (tested by Wilcoxon tests at p < 0.01). However, droughts that could threaten connectivity between PAs are increasingly common in this region. We estimated that approximately 65% of the study area will experience at least one drought episode that is more intense and longer lasting than previous droughts. Collectively, our results highlight that new conservation strategies adapted to threats associated with EWEs need to be tailored and implemented promptly. Unless urgent action is taken, significant damage may be inflicted on the unique biodiversity of the region.

Ciclones, olas de calor, sequías y lluvias intensas son eventos comunes en Centroamérica y el Caribe, cuya frecuencia, intensidad y duración se espera aumente durante el siglo XXI a causa del cambio climático. Sin embargo, en la actualidad, se desconoce cuál será la incidencia de estos eventos meteorológicos extremos (EME) dentro de las áreas protegidas. En este estudio examinamos la exposición histórica y futura a los extremos climáticos y comparamos el grado de exposición dentro y fuera de las áreas protegidas de toda la región por medio de 32 métricas que describen distintas dimensiones (intensidad, duración y frecuencia) de las olas de calor, los ciclones, las sequías y las precipitaciones. Los resultados indican que a medida que aumente el número de EME, las áreas protegidas estarán más expuestas a los extremos climáticos que las áreas no protegidas. Esto es especialmente cierto en el caso de las olas de calor, que, según las proyecciones, tendrán una intensidad y una duración medias significativamente mayores, y de los ciclones tropicales, que afectarán más gravemente a las zonas protegidas en los escenarios intensivos en carbono. Nuestros resultados también indican que las zonas protegidas estarán significativamente menos expuestas a sequías o lluvias torrenciales que las zonas no protegidas. Sin embargo, las sequías que podrían amenazar la conectividad entre áreas protegidas son cada vez más frecuentes en esta región. Se estima que aproximadamente el 65% del área de estudio experimentará al menos un episodio de sequía más intenso y duradero que las sequías anteriores. En conjunto, nuestros resultados ponen de relieve la necesidad de diseñar y aplicar con prontitud nuevas estrategias de conservación adaptadas a las amenazas asociadas a los EWE. A menos que se tomen medidas urgentes, la biodiversidad única de la región podría sufrir daños considerables.

PrOgnosis in Pulmonary Embolism (PoPE): 30-Day mortality risk score based on five admission parameters.

INTRODUCTION AND OBJECTIVE: Several scoring systems have been developed for risk stratification in patients with acute pulmonary embolism (PE). The Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are among the most used, however the high number of variables hinder its application. Our aim was to derive an easy-to-perform score based on simple parameters obtained at admission to predict 30-day mortality in acute PE patients. METHODS: Retrospective study in 1115 patients with acute PE from two institutions (derivation cohort n=835, validation cohort n=280). The primary endpoint was all-cause mortality at 30 days. Statistically and clinically relevant variables were selected for multivariable Cox regression analysis. We derived and validated a multivariable risk score model and compared to other established scores. RESULTS: The primary endpoint occurred in 207 patients (18.6%). Our model included five variables weighted as follows: modified shock index ≥1.1 (hazard ratio [HR] 2.57, 1.68-3.92, p<0.001), active cancer (HR 2.27, 1.45-3.56, p<0.001), altered mental state (HR 3.82, 2.50-5.83, p<0.001), serum lactate concentration ≥2.50 mmol/L (HR 5.01, 3.25-7.72, p<0.001), and age ≥80 years (HR 1.95, 1.26-3.03, p=0.003). The prognostic ability was superior to other scores (area under curve [AUC] 0.83 [0.79-0.87] vs 0.72 [0.67-0.79] in PESI and 0.70 [0.62-0.75] in sPESI, p<0.001) and its performance in the validation cohort was deemed good (73 events in 280 patients, 26.1%, AUC=0.76, 0.71-0.82, p<0.0001) and superior to other scores (p<0.05). CONCLUSIONS: The PoPE score (https://tinyurl.com/ybsnka8s) is an easy tool with superior performance to predict early mortality in patients admitted for PE with non-high-risk PE.

Data error propagation in stacked bioclimatic envelope models.

Stacking is the process of overlaying inferred species potential distributions for multiple species based on outputs of bioclimatic envelope models (BEMs). The approach can be used to investigate patterns and processes of species richness. If data limitations on individual species distributions are inevitable, but how do they affect inferences of patterns and processes of species richness? We investigate the influence of different data sources on estimated species richness gradients in China. We fitted BEMs using species distributions data for 334 bird species obtained from (1) global range maps, (2) regional checklists, (3) museum records and surveys, and (4) citizen science data using presence-only (Mahalanobis distance), presence-background (MAXENT), and presence-absence (GAM and BRT) BEMs. Individual species predictions were stacked to generate species richness gradients. Here, we show that different data sources and BEMs can generate spatially varying gradients of species richness. The environmental predictors that best explained species distributions also differed between data sources. Models using citizen-based data had the highest accuracy, whereas those using range data had the lowest accuracy. Potential richness patterns estimated by GAM and BRT models were robust to data uncertainty. When multiple data sets exist for the same region and taxa, we advise that explicit treatments of uncertainty, such as sensitivity analyses of the input data, should be conducted during the process of modeling.

Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines.

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.

Power laws in species' biotic interaction networks can be inferred from co-occurrence data.

Inferring biotic interactions from species co-occurrence patterns has long intrigued ecologists. Yet recent research revealed that co-occurrences may not reliably represent pairwise biotic interactions. We propose that examining network-level co-occurrence patterns can provide valuable insights into community structure and assembly. Analysing ten bipartite networks of empirically sampled biotic interactions and associated species spatial distribution, we find that approximately 20% of co-occurrences correspond to actual interactions. Moreover, the degree distribution shifts from exponential in co-occurrence networks to power laws in networks of biotic interactions. This shift results from a strong interplay between species' biotic (their interacting partners) and abiotic (their environmental requirements) niches, and is accurately predicted by considering co-occurrence frequencies. Our work offers a mechanistic understanding of the assembly of ecological communities and suggests simple ways to infer fundamental biotic interaction network characteristics from co-occurrence data.

ARTIFICIAL INTELLIGENCE FOR OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-BASED DISEASE ACTIVITY PREDICTION IN AGE-RELATED MACULAR DEGENERATION.

PURPOSE: The authors hypothesize that optical coherence tomography angiography (OCTA)-visualized vascular morphology may be a predictor of choroidal neovascularization status in age-related macular degeneration (AMD). The authors thus evaluated the use of artificial intelligence (AI) to predict different stages of AMD disease based on OCTA en face 2D projections scans. METHODS: Retrospective cross-sectional study based on collected 2D OCTA data from 310 high-resolution scans. Based on OCT B-scan fluid and clinical status, OCTA was classified as normal, dry AMD, wet AMD active, and wet AMD in remission with no signs of activity. Two human experts graded the same test set, and a consensus grading between two experts was used for the prediction of four categories. RESULTS: The AI can achieve 80.36% accuracy on a four-category grading task with 2D OCTA projections. The sensitivity of prediction by AI was 0.7857 (active), 0.7142 (remission), 0.9286 (dry AMD), and 0.9286 (normal) and the specificity was 0.9524, 0.9524, 0.9286, and 0.9524, respectively. The sensitivity of prediction by human experts was 0.4286 active choroidal neovascularization, 0.2143 remission, 0.8571 dry AMD, and 0.8571 normal with specificity of 0.7619, 0.9286, 0.7857, and 0.9762, respectively. The overall AI classification prediction was significantly better than the human (odds ratio = 1.95, P = 0.0021). CONCLUSION: These data show that choroidal neovascularization morphology can be used to predict disease activity by AI; longitudinal studies are needed to better understand the evolution of choroidal neovascularization and features that predict reactivation. Future studies will be able to evaluate the additional predicative value of OCTA on top of other imaging characteristics (i.e., fluid location on OCT B scans) to help predict response to treatment.

Neuro-cranio-vertebral syndrome related to coccygeal dislocation: A preliminary study.

Background: Neuro-cranio-vertebral syndrome (NCVS) includes a set of idiopathic diseases: Arnold-Chiari syndrome type 0,1 and 1.5, idiopathic scoliosis, and idiopathic syringomyelia. It is caused by the pathological traction transmitted by the filum terminale on the neuraxis. Considering that the filum terminale is inserted at sacrococcygeal level, it is logical to think that an alteration of this segment's anatomy, such as an anterior coccyx dislocation, can increase the tension exerted by the filum terminale on the neuraxis, which in turn triggers NCVS. Methods: We collected data from 372 patients with NCVS and 15 patients with coccygeal dislocation and NCVS from our database. We analyzed the relationship between the sacrococcygeal and intercoccygeal angles with signs, symptoms and associated diagnoses. T-tests for independent samples and linear regression were used for analysis (p <0.05). We describe the MRI findings and clinical features of NCVS caused by coccygeal dislocation and compare its prevalence with that of a sample without coccygeal dislocation. Results: 65% of the signs, symptoms, and imaging features were present in similar proportions in both samples. There was a similar prevalence of cerebellar tonsillar descent and scoliosis in both groups, whereas the incidence of syringomyelia differed. A sacrococcygeal angle between 89-110° prevails in cases of syringomyelia while an intercoccygeal angle between 90-140° prevails in cases with cerebellar tonsillar descent. Conclusions: The high clinical and radiological prevalence of coccygeal dislocation in patients with Neuro-cranio-vertebral syndrome suggests an association between them. The mechanism involved in coccygeal dislocation can directly influence the development of Neuro-cranio-vertebral syndrome.

Hierarchical Surface Pattern on Ni-Free Ti-Based Bulk Metallic Glass to Control Cell Interactions.

Ni-free Ti-based bulk metallic glasses (BMGs) are exciting materials for biomedical applications because of their outstanding biocompatibility and advantageous mechanical properties. The glassy nature of BMGs allows them to be shaped and patterned via thermoplastic forming (TPF). This work demonstrates the versatility of the TPF technique to create micro- and nano-patterns and hierarchical structures on Ti40Zr10Cu34Pd14Sn2 BMG. Particularly, a hierarchical structure fabricated by a two-step TPF process integrates 400 nm hexagonal close-packed protrusions on 2.5 µm square protuberances while preserving the advantageous mechanical properties from the as-cast material state. The correlations between thermal history, structure, and mechanical properties are explored. Regarding biocompatibility, Ti40Zr10Cu34Pd14Sn2 BMGs with four surface topographies (flat, micro-patterned, nano-patterned, and hierarchical-structured surfaces) are investigated using Saos-2 cell lines. Alamar Blue assay and live/dead analysis show that all tested surfaces have good cell proliferation and viability. Patterned surfaces are observed to promote the formation of longer filopodia on the edge of the cytoskeleton, leading to star-shaped and dendritic cell morphologies compared with the flat surface. In addition to potential implant applications, TPF-patterned Ti-BMGs enable a high level of order and design flexibility on the surface topography, expanding the available toolbox for studying cell behavior on rigid and ordered surfaces.

Temperate species underfill their tropical thermal potentials on land.

Understanding how temperature determines the distribution of life is necessary to assess species' sensitivities to contemporary climate change. Here, we test the importance of temperature in limiting the geographic ranges of ectotherms by comparing the temperatures and areas that species occupy to the temperatures and areas species could potentially occupy on the basis of their physiological thermal tolerances. We find that marine species across all latitudes and terrestrial species from the tropics occupy temperatures that closely match their thermal tolerances. However, terrestrial species from temperate and polar latitudes are absent from warm, thermally tolerable areas that they could potentially occupy beyond their equatorward range limits, indicating that extreme temperature is often not the factor limiting their distributions at lower latitudes. This matches predictions from the hypothesis that adaptation to cold environments that facilitates survival in temperate and polar regions is associated with a performance trade-off that reduces species' abilities to contend in the tropics, possibly due to biotic exclusion. Our findings predict more direct responses to climate warming of marine ranges and cool range edges of terrestrial species.

Detection of skin wrinkles and quantification of roughness using a novel image processing technique from a dermatoscope device.

OBJECTIVE: Cutaneous relief analysis is crucial in the development of new skincare products, as well as in the evaluation of dermatological treatments. The analysis can be performed by qualitative or quantitative methods. We propose a new algorithm to detect wrinkles and quantify skin roughness by image processing from a dermatoscope. METHODS: A clinical study was carried out with 33 research participants, and images were collected with the dermatoscope and PRIMOS equipment for wrinkle evaluation at two different times: Day 0 (D0) and 45 days (D45) after the use of a dermocosmetic product. Later, a new algorithm was developed to detect wrinkles in the acquired images by applying filters and image transformations that generate a segmented image highlighting the wrinkles. A roughness calculation method is proposed from the pixels belonging to wrinkles. RESULTS: Correlation between the values obtained by the PRIMOS equipment and the proposed system was verified. No correlation was found for data obtained at D0; however, there was correlation at time D45 by Spearman's similarity coefficient. By comparing roughness between times D0 and D45, the treatment was statistically significant for both PRIMOS and the proposed methodology data. CONCLUSION: The wrinkle detection algorithm, in addition to the roughness calculation, demonstrated a sensitivity comparable to the PRIMOS system in evaluating the effectiveness of the dermocosmetic treatment. SIGNIFICANCE: Considering the simplicity of the dermatoscope design compared to other established devices such as PRIMOS, the proposed system is promising as an alternative for dermatological evaluations.

Oceanographic connectivity explains the intra-specific diversity of mangrove forests at global scales.

The distribution of mangrove intra-specific biodiversity can be structured by historical demographic processes that enhance or limit effective population sizes. Oceanographic connectivity (OC) may further structure intra-specific biodiversity by preserving or diluting the genetic signatures of historical changes. Despite its relevance for biogeography and evolution, the role of oceanographic connectivity in structuring the distribution of mangrove's genetic diversity has not been addressed at global scale. Here we ask whether connectivity mediated by ocean currents explains the intra-specific diversity of mangroves. A comprehensive dataset of population genetic differentiation was compiled from the literature. Multigenerational connectivity and population centrality indices were estimated with biophysical modeling coupled with network analyses. The variability explained in genetic differentiation was tested with competitive regression models built upon classical isolation-by-distance (IBD) models considering geographic distance. We show that oceanographic connectivity can explain the genetic differentiation of mangrove populations regardless of the species, region, and genetic marker (significant regression models in 95% of cases, with an average R-square of 0.44 ± 0.23 and Person's correlation of 0.65 ± 0.17), systematically improving IBD models. Centrality indices, providing information on important stepping-stone sites between biogeographic regions, were also important in explaining differentiation (R-square improvement of 0.06 ± 0.07, up to 0.42). We further show that ocean currents produce skewed dispersal kernels for mangroves, highlighting the role of rare long-distance dispersal events responsible for historical settlements. Overall, we demonstrate the role of oceanographic connectivity in structuring mangrove intra-specific diversity. Our findings are critical for mangroves' biogeography and evolution, but also for management strategies considering climate change and genetic biodiversity conservation.

Exposure to family planning messages and teenage pregnancy: results from the 2017 Philippine National Demographic and Health Survey.

BACKGROUND: Teenage pregnancy is known to have physical, emotional, and psychosocial effects. Because of these risks, family planning and contraception messages have been disseminated in various forms of media, but their association with teenage pregnancy has not been studied previously in the Philippines. This study aims to examine the association between exposure to various family planning and contraception messages disseminated in various media channels and pregnancy among Filipino women aged 15-19. The study also intended to examine interactions between the different media channels where these family planning and contraception messages are being disseminated on their effect on teenage pregnancy. METHODS: We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to  study the association between exposure to family planning and contraception messages and teenage pregnancy. RESULTS: Out of 5120 respondents, 44% of respondents have accessed information on contraception from the internet, 25% have heard information about contraception through the radio, 55% of respondents have heard about contraception via television, 15% have read about contraception in the newspapers and magazines, and only 6% have received information on contraception via short messaging service (SMS). There were 420 (8.56%) who have ever been pregnant. After adjusting for confounding variables, those who were exposed to family planning/contraceptive messages via the internet (aOR: 0.90; 95% CI: 0.59, 1.35) and newspapers/magazines (aOR: 0.78; 95% CI: 0.44, 1.41) have lower odds of teenage pregnancy, but no strong evidence of their effectiveness. On the other hand, exposure to family planning messages through the radio (aOR: 1.06; 95% CI: 0.71, 1.59), television (aOR: 1.09; 95% CI: 0.72, 1.65), and short messaging service (aOR: 1.29; 95% CI: 0.51, 3.22) marginally increase the risk of teenage pregnancy. We did not find any pairwise interactions between the different exposure variables. CONCLUSIONS: Our results highlight the need to improve the content and key messages of contraceptive and family planning messages in the Philippines, especially those that are broadcasted online and in print media. There is also a need to increase the reach of these different family planning and contraception messages, especially by utilizing social media and other print and online media platforms commonly used by the youth.

Adolescent pregnancy is associated with adverse health, psychosocial, and economic outcomes. As of 2017, the proportion of women aged 15­19 who have begun childbearing in the Philippines is 9%. To counter this, the Philippine government and its partners in the private sector disseminate family planning and contraception information to the general population. Thus, we studied the effect of being exposed to these family planning and contraception information in different forms of media and their effect of teenage pregnancy. We analysed the 2017 Philippine National Demographic and Health Survey. After controlling for the effect of other variables, we found that these family planning and contraception information had little effect on teenage pregnancy in the country. These findings highlight the need to improve the content and key messages of contraceptive and family planning messages, and improve their coverage in the general population.

Genome Sequences of Arthrobacter globiformis B-2979 Phages GlobiWarming and TaylorSipht.

Phages GlobiWarming and TaylorSipht are siphoviruses isolated on Arthrobacter globiformis B-2979. GlobiWarming has a 42,691 bp long genome that encodes 74 genes, whereas TaylorSipht has a 39,051 bp genome that encodes 65 genes. Both phages encode functions typical of temperate phages, with each including an immunity repressor, integrase, and excise.

Human disturbances affect the topology of food webs.

Networks describe nodes connected by links, with numbers of links per node, the degree, forming a range of distributions including random and scale-free. How network topologies emerge in natural systems still puzzles scientists. Based on previous theoretical simulations, we predict that scale-free food webs are favourably selected by random disturbances while random food webs are selected by targeted disturbances. We assume that lower human pressures are more likely associated with random disturbances, whereas higher pressures are associated with targeted ones. We examine these predictions using 351 empirical food webs, generally confirming our predictions. Should the topology of food webs respond to changes in the magnitude of disturbances in a predictable fashion, consistently across ecosystems and scales of organisation, it would provide a baseline expectation to understand and predict the consequences of human pressures on ecosystem dynamics.

Determinants of consistent condom use among Filipino women: Results from the 2017 Philippine National Demographic and Health Survey.

BACKGROUND: Consistent condom use in women, defined as the self-reported usage of male condom in every sexual encounter of the respondent with her most recent partner in the last 12 months, had been perennially low in the Philippines. This is despite consistent condom use being a tested and proven public health intervention to prevent unwanted pregnancy and sexually transmitted infections. Considering the high fertility rate, teenage pregnancy rate, and the rapidly increasing incidence of HIV in the country, we identified the determinants of consistent condom use in the Philippines. METHODS: We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to identify factors associated with consistent condom use. RESULTS: Out of 25,074 respondents, only 261 (1.13%) have used condoms consistently with their most recent partner. Reach of information and education campaigns on contraceptive use via different media ranged from 62% via television to 7% via short messaging service. After adjusting for confounders, those who were able to ask their partners to use condoms during sexual intercourse have 6.18 times (adjusted odds ratio (aOR): 6.18; 95% Confidence Interval (95% CI): 2.02. 18.94) greater odds of consistent condom use than those who were unable to ask their partners to use condoms during sexual intercourse. Meanwhile, HIV knowledge (aOR: 1.16; 95% CI: 0.98, 1.38) and hearing about contraception in television (aOR: 1.54; 95% CI: 1.00, 2.38) have weaker associations with consistent condom use. CONCLUSIONS: The low percentage of those who use condoms consistently, together with the low reach of information and education campaigns, highlight the need to implement multi-faceted and context-specific interventions to promote sexual agency and/or consistent condom use to address the burden of unwanted pregnancies and HIV in the Philippines.

Access to Surgical Treatment for Breast Cancer in the Philippines.

Female breast cancer is the most commonly diagnosed cancer worldwide; however, while high-income countries have the highest incidence rates, lower-middle income countries have the highest mortality rates. In this article, we describe the landscape of disparities in access to surgical care for patients with breast cancer in the Philippines, a lower-middle income country in Southeast Asia. We describe the payment landscape that allows access to care for patients with non-metastatic disease, and draw attention to the fact that despite some degree of insurance for most Filipinos, great barriers to access remain in the form of a low number of surgical providers, geographic disparities, and persistent socioeconomic barriers. Lastly, we suggest steps forward to improve equity in access to surgical care for Filipino patients with breast cancer.