Source-free domain adaptation for semantic image segmentation using internal representations.

Semantic segmentation models trained on annotated data fail to generalize well when the input data distribution changes over extended time period, leading to requiring re-training to maintain performance. Classic unsupervised domain adaptation (UDA) attempts to address a similar problem when there is target domain with no annotated data points through transferring knowledge from a source domain with annotated data. We develop an online UDA algorithm for semantic segmentation of images that improves model generalization on unannotated domains in scenarios where source data access is restricted during adaptation. We perform model adaptation by minimizing the distributional distance between the source latent features and the target features in a shared embedding space. Our solution promotes a shared domain-agnostic latent feature space between the two domains, which allows for classifier generalization on the target dataset. To alleviate the need of access to source samples during adaptation, we approximate the source latent feature distribution via an appropriate surrogate distribution, in this case a Gaussian mixture model (GMM).

Multi-Source Data Integration for Segmentation of Unannotated MRI Images.

Automatic semantic segmentation of magnetic resonance imaging (MRI) images using deep neural networks greatly assists in evaluating and planning treatments for various clinical applications. However, training these models is conditioned on the availability of abundant annotated data. Even if we annotate enough data, MRI images display considerable variability due to factors such as differences among patients, MRI scanners, and imaging protocols. This variability necessitates retraining neural networks for each specific application domain, which, in turn requires manual annotation by expert radiologists for all new domains. To relax the need for persistent data annotation, we develop a method for unsupervised federated domain adaptation using multiple annotated source domains. Our approach enables the transfer of knowledge from several annotated source domains for use in an unannotated target domain. Initially, we ensure that the target domain data shares similar representations with each source domain in a latent embedding space by minimizing the pair-wise distances between the distributions for the target and the source domains. We then employ an ensemble approach to leverage the knowledge obtained from all domains to build an integrated outcome. We perform experiments on two datasets to demonstrate our method is effective. Our implementation code is publicly available: https://github.com/navapatn/Unsupervised -Federated-Domain-Adaptation-for-Image-Segmentation new.

Preparation and characterization of CS/PAT/ MWCNT@MgAl-LDHs nanocomposite for Cd2+ removal and 4-nitrophenol reduction.

The present study evaluated the performance of multiwalled carbon nanotube (MWCNT)@MgAl-layered double hydroxide (LDH) nanoparticles loaded on poly-2 aminothiazole (PAT)/chitosan (CS) matrix (CPML) to remove Cd2+ ions from aqueous solution. The removal efficiency of modified CS/PAT with MWCNT@MgAl-LDHs was increased significantly compared to pure CS/PAT. The influence of heavy metal ion concentration, pH, temperature, adsorbent dosage, and contact time on the adsorption was examined. The optimum conditions for the adsorption of Cd2+ ions were 25 0C with the adsorbent dosage of 0.06 g and initial concentration for adsorption of the Cd2+ 100 mg/L at pH = 8. The maximum adsorption capacity was measured to be 1106.19 mg/g. The values of thermodynamic parameters namely Gibbs free energy (ΔG°), entropy change (ΔS°), and enthalpy change (ΔH°) indicated the feasibility, spontaneity and the endothermic nature of the adsorption process, respectively. The pseudo-second-order kinetics and the Langmuir model were selected as the best models for the adsorption process. Also, CPML nanocomposite (NC) was successfully tested for p-nitrophenol (p-NP) reduction in the presence of NaBH4. The reaction was nearly completed in 6 min. The fabricated CPML-NC could be reused for three consecutive cycles.

Surface modified of chitosan by TiO2@MWCNT nanohybrid for the efficient removal of organic dyes and antibiotics.

Considering the increase in the discharge of industrial effluents containing dyes and antibiotic resistance as a consequence of increasing the prescription and easy distribution of antibiotic drugs at the global level, designing efficient, biodegradable and non-toxic absorbents is necessary to reduce environmental harm effects. Herein, we present a series of novel eco-friendly ternary hybrid nanocomposite hydrogels CS/TiO2@MWCNT (CTM) composed of chitosan (CS), TiO2, and multiwalled carbon nanotube (MWCNT) for removal of methylene blue (MB) and methyl orange (MO) and common antibiotic ciprofloxacin (CIP) in aqueous medium. The combination of MWCNT and TiO2 improves the physicochemical properties of CS hydrogel and increases the adsorption capacity toward pollutants in the presence of different loadings. CTM hydrogel showed a specific surface area of 236.45 m2 g-1 with a pore diameter of 7.89 nm. Adsorption mechanisms were investigated in detail using kinetic, isotherm, and thermodynamic studies of adsorption as well as various spectroscopic techniques. Adsorption of these pollutants by CTM nanocomposite hydrogel occurred using various interactions at different pHs, which showed the obvious dependence of CTM adsorption capacity on pH. Electrostatic attractions, complex formation, π-π stacking and hydrogen bonds played a key role in the adsorption process. The adsorption of MB, MO, and CIP was fitted with the Langmuir isotherm with maximum adsorption capacities of 531.91, 1763.6, and 1510.5 mg g-1, respectively. CTM had a minor decrease in adsorption strength and showed good structural stability even after 8 adsorptions-desorption cycles. The total cost of producing a 1 kg adsorbent was calculated to be $ 450, which helped us determine the economic feasibility of the adsorbent in large-scale applications.

Recent advances in chitosan-based nanocomposites for adsorption and removal of heavy metal ions.

Due to the high concentration of various toxic and dangerous pollutants, industrial effluents have imposed increasing threats. Among the various processes for wastewater treatment, adsorption is widely used due to its simplicity, good treatment efficiency, availability of a wide range of adsorbents, and cost-effectiveness. Chitosan (CS) has received great attention as a pollutant adsorbent due to its low cost and many -OH and -NH2 functional groups that can bind heavy metal ions. However, weaknesses such as sensitivity to pH, low thermal stability and low mechanical strength, limit the application of CS in wastewater treatment. The modification of these functional groups can improve its performance via cross-linking and grafting agents. The porosity and specific surface area of CS in powder form are not ideal, so physical modification of CS via integration with other materials (e.g., metal oxide, zeolite, clay, etc.) leads to the creation of composite materials with improved absorption performance. This review provides reports on the application of CS and its nanocomposites (NCs) for the removal of various heavy metal ions. Synthesis strategy, adsorption mechanism and influencing factors on sorbents for heavy metals are discussed in detail.

Hematopoietic Stem Cell Transplantation in Sickle Cell Disease: A Multidimentional Review.

While exagamglogene autotemcel (Casgevy) and lovotibeglogene autotemcel (Lyfgenia) have been approved by the US Food and Drug Administration (FDA) as the first cell-based gene therapies for the treatment of patients 12 years of age and older with sickle cell disease (SCD), this treatment is not universally accessible. Allogeneic hematopoietic stem cell transplant (HSCT) has the potential to eradicate the symptoms of patients with SCD, but a significant obstacle in HSCT for SCD is the availability of suitable donors, particularly human leukocyte antigen (HLA)-matched related donors. Furthermore, individuals with SCD face an elevated risk of complications during stem cell transplantation due to SCD-related tissue damage, endothelial activation, and inflammation. Therefore, it is imperative to consider optimal conditioning regimens and investigate HSCT from alternative donors. This review encompasses information on the use of HSCT in patients with SCD, including the indications for HSCT, conditioning regimens, alternative donors, and posttransplant outcomes.

Unsupervised model adaptation for source-free segmentation of medical images.

The recent prevalence of deep neural networks has led semantic segmentation networks to achieve human-level performance in the medical field, provided they are given sufficient training data. However, these networks often fail to generalize when tasked with creating semantic maps for out-of-distribution images, necessitating re-training on new distributions. This labor-intensive process requires expert knowledge for generating training labels. In the medical field, distribution shifts can naturally occur due to the choice of imaging devices, such as MRI or CT scanners. To mitigate the need for labeling images in a target domain after successful model training in a fully annotated source domain with a different data distribution, unsupervised domain adaptation (UDA) can be employed. Most UDA approaches ensure target generalization by generating a shared source/target latent feature space, allowing a source-trained classifier to maintain performance in the target domain. However, such approaches necessitate joint source and target data access, potentially leading to privacy leaks with respect to patient information. We propose a UDA algorithm for medical image segmentation that does not require access to source data during adaptation, thereby preserving patient data privacy. Our method relies on approximating the source latent features at the time of adaptation and creates a joint source/target embedding space by minimizing a distributional distance metric based on optimal transport. We demonstrate that our approach is competitive with recent UDA medical segmentation works, even with the added requirement of privacy. 1.

Graft failure after allogeneic hematopoietic stem cell transplantation in pediatric patients with acute leukemia: autologous reconstitution or second transplant?

BACKGROUND: Graft failure (GF) is a rare but serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Prevention of graft failure remains the most advisable approach as there is no clear recommendation for the best strategies for reversing this complication. Administration of growth factor, additional hematopoietic progenitor boost, or a salvage HSCT are current modalities recommended for the treatment of GF. Autologous recovery without evidence of disease relapse occurs rarely in patients with GF, and in the absence of autologous recovery, further salvage transplantation following a second conditioning regimen is a potential treatment option that offers the best chances of long-term disease-free survival. The preconditioning regimens of second HSCT have a significant impact on engraftment and outcome, however, currently there is no consensus on optimal conditioning regimen for second HSCT in patients who have developed GF. Furthermore, a second transplant from a different donor or the same donor is still a matter of debate. OBSERVATIONS: We present our experience in managing pediatric patients with acute leukemia who encountered graft failure following stem cell transplantation. CONCLUSIONS AND RELEVANCE: Although a second transplantation is almost the only salvage method, we illustrate that some pediatric patients with acute leukemia who experience graft failure after an allogeneic stem cell transplant using Myeloablative conditioning (MAC) regimen may achieve long-term disease-free survival through autologous hematopoiesis recovery.

Artificial Intelligence to Differentiate Pediatric Pseudopapilledema and True Papilledema on Fundus Photographs.

Purpose: To develop and test an artificial intelligence (AI) model to aid in differentiating pediatric pseudopapilledema from true papilledema on fundus photographs. Design: Multicenter retrospective study. Subjects: A total of 851 fundus photographs from 235 children (age < 18 years) with pseudopapilledema and true papilledema. Methods: Four pediatric neuro-ophthalmologists at 4 different institutions contributed fundus photographs of children with confirmed diagnoses of papilledema or pseudopapilledema. An AI model to classify fundus photographs as papilledema or pseudopapilledema was developed using a DenseNet backbone and a tribranch convolutional neural network. We performed 10-fold cross-validation and separately analyzed an external test set. The AI model's performance was compared with 2 masked human expert pediatric neuro-ophthalmologists, who performed the same classification task. Main Outcome Measures: Accuracy, sensitivity, and specificity of the AI model compared with human experts. Results: The area under receiver operating curve of the AI model was 0.77 for the cross-validation set and 0.81 for the external test set. The accuracy of the AI model was 70.0% for the cross-validation set and 73.9% for the external test set. The sensitivity of the AI model was 73.4% for the cross-validation set and 90.4% for the external test set. The AI model's accuracy was significantly higher than human experts on the cross validation set (P < 0.002), and the model's sensitivity was significantly higher on the external test set (P = 0.0002). The specificity of the AI model and human experts was similar (56.4%-67.3%). Moreover, the AI model was significantly more sensitive at detecting mild papilledema than human experts, whereas AI and humans performed similarly on photographs of moderate-to-severe papilledema. On review of the external test set, only 1 child (with nearly resolved pseudotumor cerebri) had both eyes with papilledema incorrectly classified as pseudopapilledema. Conclusions: When classifying fundus photographs of pediatric papilledema and pseudopapilledema, our AI model achieved > 90% sensitivity at detecting papilledema, superior to human experts. Due to the high sensitivity and low false negative rate, AI may be useful to triage children with suspected papilledema requiring work-up to evaluate for serious underlying neurologic conditions. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Experiences of operating room nurses in disaster preparedness of a great disaster in Iran: a qualitative study.

BACKGROUND: In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran. METHODS: The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed. RESULTS: The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations. CONCLUSION: The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams.

Clinical Features and Risk Factors of Relapse and Mortality in Thrombotic Thrombocytopenic Purpura Patients: A Seven-Year Experience.

Background: Thrombotic thrombocytopenic purpura (TTP) is associated with microangiopathic hemolytic anemia, thrombocytopenia, and microvascular thrombosis. No comprehensive report exists on clinical characteristics and risk factors of relapse and mortality in Iranian TTP patients. In this study, we aimed to report clinical features of Iranian TTP patients, to evaluate disease relapse and mortality rate and their associated risk factors. Materials and Methods: This study was a cohort study of patients diagnosed with microangiopathic hemolytic anemia admitted to the Shariati Hospital, Tehran, a referral center for TTP patients, from 2010 to 2017. Demographic, clinical, and laboratory data were recorded and patients were followed for 3 years regarding disease relapse and mortality. Results:  114 patients (80 females, 34 males) with a mean age of 39.3 ± 14.99 years were included.  Hematologic and neurologic symptoms were the most common manifestations. Abnormal laboratory findings at the presentation included thrombocytopenia, anemia, and elevated LDH. All patients were treated with plasma exchange, and 75.5% of them had a response to treatment, while the 3-year relapse and mortality rate was 23.6 and 26.3%.  Lower platelet count was a predictor of disease relapse. Age, hematological, or neurological initial presentation were associated with TTP mortality. Conclusion: Based on the largest study of TTP patients ever in Iran, the demographic and clinical characteristics of Iranian TTP patients are similar to other existing reports. Knowledge of the risk factors for TTP relapse and mortality could be useful to alert hematologists for prompt therapeutic actions when necessary.

Investigation of the influencing factors with the uptake of the COVID-19 vaccine booster dose among the general population of Ardabil, Iran: A cross-sectional study.

Background and Aims: Vaccination is one of the most efficient approaches to combating COVID-19 if it is adequately embraced by the general population. Numerous factors influence the uptake or refusal of the booster dose. The goal of this study was to look at the different factors that affect how the general population in Ardabil feels about getting vaccine boosters (annual boosters) for COVID-19 and to evaluate those feelings. Methods and Materials: In the city of Ardabil, general population, perceptions towards the COVID-19 vaccine booster (annual boosters) dose were evaluated using a cross-sectional survey design between January 2 and March 25, 2022. A questionnaire was developed and filled out by 662 subjects via phone calls from healthcare providers. Descriptive statistics, the Chi-square test, the correlation coefficient, and regression analysis were run for the analysis of quantitative data. Results: The findings of the research revealed that 238 participants, or 35.9%, had previously gotten the booster dose of the COVID-19 vaccination, while 198 participants, or 29.2%, expressed a desire to do so as soon as feasible. A total of 187 (28.2%) respondents reported not wanting to get a booster dose, and 39 (5.7%) could not decide. In the factors found to affect decisions not to accept regular doses, adverse effects (45.4%) and the presence of misinformation (30%) were the most important. Regression in educational achievement, and following the COVID-19 news showed to be the major predictors of the subjects' attitudes toward the regular COVID-19 vaccine. Conclusion: The present findings revealed that low confidence in the efficiency of the booster shot and misinformation are two critical factors to consider in educational planning and interventions.

Seroepidemiological and Molecular Survey for the Detection of SARS-CoV-2 Infection among Children in Iran, September 2020 to June 2021: 1-Year Cross-Sectional Study.

A population-based seroepidemiological and molecular survey on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed to detect induced antibodies to prior exposure and active infection of children aged 14 years or less in Tehran between 19 September 2020 and 21 June 2021. Moreover, correlations between the children's demographic data and coronavirus disease 2019 (COVID-19) symptoms with the infection status were investigated. Out of 1517 participants, cardinal symptoms of COVID-19 (fever > 38 °C and/or cough and/or diarrhea) were detected in 18%, and serological history of SARS-CoV-2 infection and polymerase chain reaction (PCR) positivity were confirmed in 33.2% and 10.7% of the weighted population, respectively. The prevalence of SARS-CoV-2 infection was significantly higher among 10-14-year-old children. Active infection was significantly higher in symptomatic children and during autumn 2020 and spring 2021. The quantitative reverse transcription real-time PCR (RT-qPCR) positivity was significantly higher among families with a lower socioeconomic status, whereas no association between RT-qPCR or seropositivity was determined with household size, underlying diseases, or gender. In conclusion, high SARS-CoV-2 infection prevalence and seroprevalence were detected in children in Tehran in different seasons. Infection prevalence was significantly higher in older children and in those with a positive history of close contact with infected cases and/or lower socioeconomic status.

Cognitive deficits in multiple sclerosis: Auditory and visual attention and inhibitory control.

BACKGROUND: A growing body of evidence has been paid to the cognitive impairment in patients with multiple sclerosis (MS). However, studies concerning cognitive functions in MS have also yielded conflicting results. This study investigates the attention and inhibitory control functions in patients with MS and their relationship with other clinical features, such as depression and fatigue in these patients. METHODS: Participants included 80 patients with MS and 60 healthy controls. The attention and inhibitory control, fatigue, and psychiatric screening in all subjects were studied, respectively with the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Patients with MS performed the IVA-CPT task more poorly than the healthy control group (p < 0.001). However, multiple regression analysis did not show any significant relationship between disease duration, FSS, and HADS on attention and inhibitory control. CONCLUSION: Inhibitory control and attention are significantly impaired in patients with MS. Finding the basics of cognitive deficits in MS have potentially important clinical implications for developing better cognitive rehabilitation strategies.

Chitosan-based composite films to remove cationic and anionic dyes simultaneously from aqueous solutions: Modeling and optimization using RSM.

Regarding the existence of cationic and anionic dyes in the water environment developing new and effective techniques to remove them simultaneously is essential. Herein, a chitosan/poly-2-aminothiazole composite film reinforced with multi-walled carbon nanotube-Mg Al-layered double hydroxide (CPML) was created, characterized, and used as an effective adsorbent for methylene blue (MB) and methyl orange (MO) dyes removal from the aquatic medium. The SEM, TGA, FTIR, XRD, and BET methods were used to characterize the synthesized CPML. Response surface methodology (RSM) was utilized to evaluate dye removal based on the initial concentration, dosage, and pH factors. The highest adsorption capacities were measured at 471.12 and 230.87 mg g-1 for MB and MO, respectively. The study of different isotherm and kinetic models revealed that the adsorption of the dyes onto CPML nanocomposite (NC) was correlated with the Langmuir and pseudo-second-order kinetic model, which indicated a monolayer adsorption manner on the homogeneous surface of NCs. The reusability experiment clarified that the CPML NC could be applied multiple times. Experimental results show that the CPML NC has sufficient potential for treating cationic and anionic dye-contaminated water.

Epidemiology and Histopathology of Nasopharyngeal Neoplasms in Iran.

Introduction: This study aimed to study the trend, histologic pattern, geographical distribution, and characteristics of nasopharyngeal carcinoma (NPC) and nasopharyngeal neoplasms (NPN) from 2003 to 2017 in Iran. Materials and Methods: The Ministry of Health and Medical Education collected NPN cases from the corresponding university in each province and stored them in Iran National Cancer Registry (INCR) database. The Joinpoint program calculated the average annual percent change (AAPC) and its 95% confidence interval (CI). The jump model minimized the interfering effect of INCR transformation. Results: 3653 NPN cases were reported between 2003-2010 and 2014-2017, with a mean age of 49.04 ± 18.31 years and a male-to-female ratio of 2.15. The age-standardized incidence rate (ASIR) per 100,000 person-years was 0.30 for females and 0.68 for males in 2017. Although the ASIR/100,000 of NPN raised from 0.35 to 0.49 during 2003-2017, the trend was constant with an AAPC of -2% (95% CI: -4.8% to 0.9%). The age-specific incidence rate was highest in the older than 70 population (1.56/100,000). NPC formed 77.1% of NPNs and showed a constant pattern (AAPC CI: -5.7% to 0.2%), in contrast to the significant increase of non-keratinizing squamous cell carcinoma (AAPC CI: 2.3%to 24.5%). Conclusions: Nasopharynx cancer is rare in Iran, and NPC incidence remained constant from 2003 to 2017, unlike previously reported rising trend. However, non-keratinizing squamous cell carcinoma exhibited a significant increase, and future studies are needed to examine the role of the Epstein-Barr virus on this growth rate.

Incidence of hemorrhagic cystitis following unmanipulated peripheral blood stem cell transplantation in acute Leukemia: A retrospective single-center risk factor analysis.

BACKGROUND: Hemorrhagic cystitis (HC) is an important adverse event experienced after hematopoietic stem cell transplantation (HSCT). Severe HC could lead to significant morbidity, prolonged hospitalization with increased health-care costs, and may cause considerable mortality. OBJECTIVES: In order to investigate the influence of different contributing factors other than BK viruria on HC occurrence in a homogenous population, we retrospectively analyzed the potential risk factors. STUDY DESIGN: We conducted a retrospective study among 200 patients (median age 12.4 years, IQR: 7.9-16.1) with acute leukemia who received peripheral blood allogenic HSCT after radiation-free myeloablative conditioning regimen, in pediatric cell therapy department of Research Institute for Oncology, Hematology and Cell Therapy (RIOHCT), Tehran, Iran, between December 2014 and December 2021. Associations between risk factors and outcomes were examined by univariable and multivariable logistic regression models. RESULTS: A total of 46 patients (23%) had developed HC during the study period. The median onset of HC was 29 (IQR: 24-37) days post-transplant, and it persisted for a median of 33 (7-270) days. The incidence of HC in our patients was estimated to be 3 in 1000 cases (95% CI: 2-4). The results of multivariable logistic model shows that the chance of HC in T-cell acute lymphoblastic leukemia (ALL) compared to B-cell All is nearly five times more (OR = 4.88; 95%CI: (1.51-15.78), P = 0.008). The incidence of HC in patients who underwent HSCT from haploidentical donors was significantly higher than full matched donors (P < 0.001). Undergoing transplant from a matched unrelated and haploidentical donor both augment the chance of HC in about six times more than matched related donors (OR = 6.36; 95%CI: (1.58-25.49), P = 0.009 and OR = 5.7; 95%CI: (1.83-17.75), P = 0.003, respectively). In patients who developed HC compared to non-HC group, overall survival was much worse (P < 0.001). DISCUSSION: Most studies have failed to demonstrate any relationship between late-onset HC and the dose of cyclophosphamide. In our study, although the dose of cyclophosphamide was similar in HSCT from MRD and MUD, the hazard of HC incidence was significantly higher in the latter group. This could be accredited to ATG, as in patients in the MRD group who had not received any ATG, the incidence of HC was much lower than the patients who had underwent HSCT from MUD or haploidentical donor group. CONCLUSIONS: Patients with T-cell ALL and those who under haploidentical HSCT had the highest incidence of HC.

Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia.

OBJECTIVE: To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia's immigration policy of indefinite mandatory detention on Nauru. DESIGN: Cross-sectional analysis of a cohort of CYP seeking asylum. SETTING: Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. PARTICIPANTS: Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. MAIN MEASURES: Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. RESULTS: Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%). CONCLUSIONS: This study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia's offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.

The Relationship of Mobile-Based Social Network Addiction and Family Communication Patterns, with Behavioral Problems in Secondary School Students: The Mediating Role of Emotional Self-Regulation.

Background: New technologies offer endless possibilities for students and schools, but as the use of smartphones increases, psychological and behavioral problems may also increase. Objective: To investigate the relationship of mobile-based social network addiction and family communication patterns on the one hand, and behavioral problems in students on the other, with a focus on the mediating role of emotional self-regulation. Design: This study used a quantitative approach and a cross-sectional design. The participants were 384 students (female/male: 226/168; mean age: 16 ± 1.98) in secondary high schools in Tehran in the academic year 2022-2023. The students were selected using convenience sampling. The data were collected online using the Revised Family Communication Pattern Scale (1994), Mobile-Based Social Network Addiction Questionnaire (2016), Child Behavior Checklist - Adolescent Version (2001), and the Affective Style Questionnaire (2010). The data were analyzed using structural equation modeling with SPSS-25 and AMOS-24 statistical software. Results: The study showed that emotional self-regulation plays a mediating role in the relationship between mobile-based social network addiction and internalized and externalized behavioral problems (P ≤ .05). The indirect effect of conversation orientation on internalized and externalized behavioral problems mediated by emotional self-regulation was not significant, but the indirect effect of conformity orientation on internalized and externalized behavioral problems with the mediation of emotional self-regulation was significant (P ≤ .05). Conclusion: Based on the findings, it is suggested that school officials and parents should develop emotional self-regulation and communication skills in students and parenting skills in their parents to prevent and reduce potential harm such as internet addiction and behavioral problems in students.

Regional cerebral blood flow and brain atrophy in mild cognitive impairment and Alzheimer's disease.

Objectives: A decline in the regional cerebral blood flow (CBF) is proposed to be one of the initial changes in the Alzheimer's disease process. To date, there are limited data on the correlation between CBF decline and gray matter atrophy in mild cognitive impairment (MCI) and AD patients. to investigate the association between CBF with the gray matter structural parameters such as cortical volume, surface area, and thickness in AD, MCI, and healthy controls (HC). Methods: Data from three groups of participants including 39 HC, 82 MCI, and 28 AD subjects were obtained from the Alzheimer's disease Neuroimaging Initiative (ADNI). One-way ANOVA and linear regression were used to compare data and find a correlation between structural parameters such as cortical volume, surface area, and thickness and CBF which measured by arterial spin labeling (ASL)-MRI. Results: Our findings revealed a widespread significant correlation between the CBF and structural parameters in temporal, frontal, parietal, occipital, precentral gyrus, pericalcarine cortex, entorhinal cortex, supramarginal gyrus, fusiform, precuneus, and pallidum. Conclusion: CBF decline may be a useful biomarker for MCI and AD and accurately reflect the structural changes related to AD. According to the present results, CBF decline, as measured by ASL-MRI, is correlated with lower measures of structural parameters in AD responsible regions. It means that CBF decline may reflect AD-associated atrophy across disease progression and is also used as an early biomarker for AD and MCI diagnosis.