Search Results (228)

Background: The education process for newly diagnosed Type 1 diabetes mellitus (T1D) patients and their families, primarily led by diabetes specialist nurses, is essential for gaining knowledge about the disease and its management. However, few assessment tools have been employed to evaluate long-term knowledge retention among T1D patients years after diagnosis. Methods: We developed a 20-question test to assess the knowledge of patients and their families at the conclusion of the initial education process and again 6–12 months later. Demographic and clinical data were also collected. Statistical analyses included comparisons between the first and second test results, as well as evaluation of potential contributing factors. The internal consistency and construct validity of the questionnaire were evaluated. Results: Forty-four patients completed both assessments, with a median interval of 11.5 months between them. The average score on the first test was 88.6, which declined to 82.7 on the second assessment (p < 0.001). In univariate analysis, factors positively associated with higher scores included Jewish ethnicity, lower HbA1c levels, and shorter hospitalization duration. Multivariate analysis revealed that parents had lower odds of experiencing a significant score decline compared to patients. Cronbach’s alpha was 0.69, and Principal Component Analysis (PCA) identified eight components accounting for 67.1% of the total variance. Conclusions: Healthcare providers should consider offering re-education to patients and their families approximately one year after diagnosis, with particular attention to high-risk populations during the initial education phase. Further studies are needed to examine this tool’s performance in larger cohorts. Full article

This paper examines a previously unknown anonymous Hebrew letter inserted into a postwar edition of Shem HaGedolim, found in the library of the Jewish University in Budapest. The letter, composed in Győr in 1947, consists almost entirely of passages copied from Tiferet Chayim, a hagiographic genealogy of the Sanz Hasidic dynasty. Although derivative in content, the letter’s form and placement suggest it was not meant for transmission but instead served as a private act of mourning and historiographical preservation. By situating the letter within the broader context of post-Holocaust Jewish and Hasidic memory practices, including yizkor books, rabbinic memoirs, and grassroots commemorative writing, this study proposes that the document constitutes a “micro-yizkor”: a bibliographic ritual that aimed to re-inscribe lost tzaddikim into sacred memory. Drawing on theories of trauma, religious coping, and bereavement psychology, particularly the Two-Track Model of Bereavement, the paper examines the letter as both a therapeutic and historiographical gesture. The author’s meticulous copying, selective omissions, and personalized touches (such as modified honorifics and emotive phrases) reflect an attempt to maintain spiritual continuity in the wake of communal devastation. Engaging scholarship by Michal Shaul, Lior Becker, Gershon Greenberg, and others, the analysis demonstrates how citation, far from being a passive act, functions here as an instrument of resistance, memory, and redemptive reconstruction. The existence of such a document can also be examined through the lens of Maurice Rickards’ insights, particularly his characterization of the “compulsive note” as a salient form of ephemera, materials often inserted between the pages of books, which pose unique challenges for interpreting the time capsule their authors sought to construct. Ultimately, the paper argues that this modest and anonymous document offers a rare window into postwar Ultra-orthodox religious subjectivity. It challenges prevailing assumptions about Hasidic silence after the Holocaust and demonstarates how even derivative texts can serve as potent sites of historical testimony, spiritual resilience, and bibliographic mourning. The letter thus sheds light on a neglected form of Hasidic historiography, one authored not by professional historians, but by the broken-hearted, writing in the margins of sacred books. Full article

Despite the transformative potential of AI, the concept of neural networks that can produce other neural networks by generating model weights (hypernetworks) has been largely understudied. One of the possible reasons is the lack of available research resources that can be used for the purpose of hypernetwork research. Here we describe a dataset of neural networks, designed for the purpose of hypernetwork research. The dataset includes ${10}^4$ LeNet-5 neural networks trained for binary image classification separated into 10 classes, such that each class contains 1000 different neural networks that can identify a certain ImageNette V2 class from all other classes. A computing cluster of over ${10}^4$ cores was used to generate the dataset. Basic classification results show that the neural networks can be classified with accuracy of 72.0%, indicating that the differences between the neural networks can be identified by supervised machine learning algorithms. The ultimate purpose of the dataset is to enable hypernetwork research. The dataset and the code that generates it are open and accessible to the public. Full article

Power transformers are the most vital component in the electric grid. Their loss calculation is critical to transformer asset management and reflects on both operation and techno-economic assessment. Acknowledging the above, this paper presents an application of a novel loss calculation method to oil-type transformers supplying nonlinear loads. Unlike the methodology presented in std. C57.110-2018, the applied approach evaluates transformer loss components relying solely on readily available technical data. The method was experimentally validated using a full-scale 250kVA oil-type distribution transformer. Experimental results show close agreement with the theoretical model and feature errors smaller than 3%. Full article

Background: Evening chronotypes are increasingly recognized as being at elevated risk of psychological vulnerabilities, including sleep disturbances, mood disorders, and disordered eating. Body image, a central self-related construct, has been identified as a key factor influencing eating disorder (ED) risk. This study aimed to explore whether body image moderates the relationship between chronotype and the risk of developing an ED. Methods: A total of 165 adults (139 women; mean age = 35.45) completed validated self-report questionnaires assessing chronotype (Morningness–Eveningness Questionnaire), body image (Body Shape Questionnaire), and ED risk (EAT-26). Pearson correlations and moderation analyses (PROCESS macro and Model 1) were conducted with body image as a moderator of the association between chronotype and ED risk. Results: Eveningness was significantly associated with greater ED risk (r = −0.53, p < 0.001) and a more negative body image (r = −0.48, p < 0.001). Body image was a strong predictor of ED risk (r = 0.85, p < 0.001). Moderation analysis revealed a significant interaction between chronotype and body image (b = −0.006, SE = 0.0009, p < 0.001), indicating that the relationship between chronotype and ED risk was stronger among individuals with a more negative body image. Conclusions: These findings highlight the role of body image as a moderating factor in the link between chronotype and eating disorder vulnerability. Interventions aimed at improving body image, especially among evening chronotypes, may help mitigate ED risk. These results underscore the importance of integrating circadian and psychosocial factors in ED prevention and early intervention strategies. Full article

Background: Pathological complete response (pCR) following neoadjuvant therapy and surgery for locally advanced rectal cancer is associated with improved prognosis. Accurately predicting who will achieve pCR could theoretically eliminate the need for surgery for these patients. We aimed to compare pCR and non-pCR rectal cancer patients following neoadjuvant therapy, searching for clinical predictors for pCR and comparing oncological outcomes between these groups. Methods: This is a single-center retrospective analysis of all patients who underwent a curative-intent rectal resection between 2010 and 2020 for primary non-metastatic rectal cancer following neoadjuvant therapy. The cohort (263 patients) was divided into two groups according to the pathological results from surgery: the pCR group (53 patients) and the non-pCR group (210 patients). Results: The groups were similar in terms of baseline characteristics, clinical presentation, and staging, but tumors of the pCR group were significantly higher in the rectum (mean distance from the anal verge 7.92 cm versus 6.9 cm respectively, p = 0.04), and more of them were located at the posterior rectal wall (37.7% versus 24.3%, p = 0.049). Multivariate analysis found posterior location and tumor height to be significantly associated with pCR (OR 2.23, 95% CI 1.11–4.45, p = 0.023), (OR 1.14, 95% CI 1.03–1.27, p = 0.015). The 5-year overall survival was 95.6% in the pCR group compared with 87.5% in the non-pCR group (p = 0.09), and the 5-year disease-free survival was 92.7% versus 64.5%, respectively (p < 0.001). Conclusions: Tumor location at the posterior wall of the rectum and higher tumor location were found to be associated with pCR. Patients achieving pCR demonstrate improved prognosis compared with non-pCR patients. Full article

Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged > 18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < 0.001), respiratory complications (OR 2.17, p < 0.001), surgical site infections (OR 3.94, p = 0.001), and cardiac complications (OR 1.53, p = 0.002). They also had higher hospital charges (mean difference USD 17,739.2, p < 0.001) and prolonged LOS (mean difference 0.83 days, p < 0.001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusions: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes. Full article

As acne scars remain challenging to treat, this study compared the safety and efficacy of two laser modalities for acne scar treatment. Between 2022 and 2024, 88 patients were treated for acne scars using either the Hybrid platform with the ProScan applicator, which delivers fractional ablative carbon dioxide (CO₂) 10,600 nm and non-ablative 1570 nm wavelengths in a dual mode, or the Pixel CO₂ laser with the LiteScan applicator, which delivers a fractional ablative CO₂ 10,600 nm wavelength alone. Clinical efficacy was assessed using the Echelle d’Evaluation Clinique des Cicatrices D’Acne (ECCA) scale. Both groups showed significant improvements in ECCA scores post-treatment (p < 0.001, Wilcoxon signed-rank test). However, the percentage change in scores from baseline to post-treatment did not differ significantly between the groups (p > 0.05, Wilcoxon rank-sum test). Adverse effects were mild and transient, resolving within a few days, with no significant differences between the groups (p > 0.05, chi-squared test). Both laser modalities demonstrated high efficacy and safety in treating acne scars, with significant post-treatment improvement in scar severity. Full article

Young vegetative quinoa (YVQ) has gained attention as a high-protein leafy crop for human consumption with potential for cultivation in Mediterranean and semiarid regions. We investigated the effects of inter-row spacing and genotype on YVQ fresh and dry matter (DM) yield, protein content (PC), and protein yield during summer cultivation in northern Israel in two separate, independent, randomized field experiments over two consecutive years (2020–2021). We hypothesized that row spacing and genotypic differences would significantly impact yield and PC. Inter-row spacing significantly affected plant density, ranging from 55 to 366 plants m⁻². Fresh and DM yields ranged from 4957 to 28,469 kg ha⁻¹ and 661 to 3737 kg DM ha⁻¹, respectively. PC ranged from 20.5 to 26.6% and was not significantly influenced by row spacing. Total protein yield ranged from 147 to 884 kg ha⁻¹. Among the five tested genotypes, no significant differences were observed in fresh (7477–17,776 kg ha⁻¹) or dry (1122–2199 kg DM ha⁻¹) biomass, PC (21.2–26.5%), or protein yield (260–579 kg ha⁻¹), suggesting limited genetic differentiation under the specific environmental and agronomic conditions tested. Amino acid analysis confirmed the presence of all nine essential amino acids, fulfilling over 30% of the recommended daily intake per 100 g DM. These findings highlight YVQ as a promising, sustainable, and protein-rich leafy crop for Mediterranean agriculture. Further research should explore multi-harvest potential, mechanical weeding, and optimized agronomic practices for commercial-scale production. Full article

Background/Objectives: This study aims to evaluate and compare the diagnostic accuracy of skin lesion classification among three different classifiers: AI-based image classification, an expert dermatologist, and a non-expert. Given the rising interest in artificial intelligence (AI) within dermatology, it is crucial to assess its performance against human expertise to determine its viability as a reliable diagnostic tool. Methods: This reader study utilized a set of pre-labeled skin lesion images, which were assessed by an AI-based image classification system, an expert dermatologist, and a non-expert. The accuracy of each classifier was measured and compared against the ground truth labels. Statistical analysis was conducted to compare the diagnostic accuracy of the three classifiers. Results: The AI-based image classification system exhibited high sensitivity (93.59%) and specificity (70.42%) in identifying malignant lesions. The AI model demonstrated similar sensitivity and notably higher specificity compared to the expert dermatologist and non-expert. However, both the expert and non-expert provided valuable diagnostic insights, especially in classifying specific cases like melanoma. The results indicate that AI has the potential to assist dermatologists by providing a second opinion and enhancing diagnostic accuracy. Conclusions: This study concludes that AI-based image classification systems may serve as a valuable tool in dermatological diagnostics, potentially augmenting the capabilities of dermatologists. However, it is not yet a replacement for expert clinical judgment. Continued improvements and validation in diverse clinical settings are necessary before widespread implementation. Full article

Background: End-stage ankle osteoarthritis (OA) severely limits function and quality of life. Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are key surgical interventions when conservative treatment fails. This study compares TAA and AA outcomes using a national dataset to inform patient-centered care. Methods: A retrospective analysis of 27,595 patients undergoing TAA or AA from 2016–2019 was conducted using the National Inpatient Sample. Propensity score matching addressed baseline differences. Results: Primary OA was more prevalent in TAA (85.9%) than in AA (55.4%). TAA utilization rose from 73% to 78% (p < 0.0001), while AA declined. TAA patients were older (65.6 vs. 59.7 years), more often Medicare-insured, and predominantly Caucasian. AA patients had higher rates of comorbidities, including diabetes, obesity, lung disease, and mental disorders (all p < 0.0001). Conclusions: TAA and AA cater to distinct patient profiles. TAA is increasingly favored and associated with lower immediate risks, though procedure choice should be individualized based on comorbidities and risk profiles. These insights support evidence-based decision-making in end-stage ankle OA management. Full article

Background: Reusable, machine-processable clinical decision support system (CDSS) rules have not been widely achieved in the medical informatics field. This study introduces the process, results, challenges faced, and lessons learned while converting the United States of America Centers for Disease Control and Prevention (CDC)-recommended immunization schedules (2022) to machine-processable CDSS rules. Methods: We converted the vaccination schedules into tabular, charts, MS Excel, and clinical quality language (CQL) formats. The CQL format can be automatically converted to a machine-processable format using existing tools. Therefore, it was regarded as a machine-processable format. The results were reviewed, verified, and tested. Results: We have developed 465 rules for 19 vaccines in 13 categories, and we have shared the rules via GitHub to make them publicly available. We used cross-review and cross-checking to validate the CDSS rules in tabular and chart formats. The CQL files were tested for syntax and logic with hypothetical patient HL7 FHIR resources. Our rules can be reused and shared by the health IT industry, CDSS developers, medical informatics educators, or clinical care institutions. The unique contributions of our work are twofold: (1) we created ontology-based, machine-processable, and reusable immunization recommendation rules, and (2) we created and shared multiple formats of immunization recommendation rules publicly which can be a valuable resource for medical and medical informatics communities. Conclusions: These CDSS rules can be important contributions to informatics communities, reducing redundant efforts, which is particularly significant in resource-limited settings. Despite the maturity and concise presentation of the CDC recommendations, careful attention and multiple layers of verification and review are necessary to ensure accurate conversion. The publicly shared CDSS rules can also be used for health and biomedical informatics education and training purposes. Full article

Background: Next-generation sequencing (NGS) has emerged as a transformative tool in precision medicine, offering insights into actionable genomic alterations and informing clinical decision-making in childhood and adolescent/young adult (AYA) solid tumors. Methods: We conducted a systematic review and meta-analysis to assess the utility of NGS in identifying actionable genomic alterations and its impact on clinical decision-making. Studies involving patients aged 0–40 years with solid tumors were included. Data were extracted using Covidence, and pooled estimates were calculated using a random-effects model. Bias was assessed using Begg–Mazumdar, Egger, and Harbord tests. Results: Out of 13,624 references screened, 24 studies met eligibility criteria, comprising 5278 patients and 5359 samples, of which 5207 provided usable data. The pooled proportion of actionable alterations was 57.9% (95% CI: 49.0–66.5%), with minimal evidence of publication bias. Clinical decision-making outcomes were reported in 21 studies, with a pooled proportion of 22.8% (95% CI: 16.4–29.9%). Germline mutation rates, reported in 11 studies, yielded a pooled proportion of 11.2% (95% CI: 8.4–14.3%), consistent with rates typically observed in childhood cancers. Significant heterogeneity was observed across studies due to differences in sequencing methodologies, tumor types, and sampling strategies. Conclusions: NGS demonstrates considerable potential in identifying actionable genomic targets and guiding clinical decision-making in childhood and AYA solid tumors. However, the variability in methodologies underscores the need for standardized protocols and reporting practices to enhance comparability and generalizability. This meta-analysis highlights the promise of genomic medicine while acknowledging challenges posed by heterogeneity in study designs. Full article

Background/Objectives: Modified messenger RNA (modRNA) is a promising gene delivery method used to upregulate genes in cardiac tissue, with applications in both clinical and preclinical settings to prevent cardiac remodeling after ischemic injury. The 5′ untranslated region (5′UTR) plays a crucial role in regulating the translation efficiency of mRNA into functional proteins. Due to the high production cost and short half-life of modRNA, it is essential to identify novel 5′UTR designs that enhance modRNA translation in the heart. Methods: Here, we present an artificial 5′UTR, termed “Top Heart 5′UTR”, designed based on ribonucleotide frequency analyses of 1000 genes highly expressed in the heart. This novel artificial 5′UTR contains a unique 20-nucleotide sequence, consisting of 11 previously uncharacterized nucleotides (CCCCCGCCCCC) and 9 well-described nucleotides from the Kozak sequence upstream of the start codon (ATG). Results: This design significantly improves modRNA translation efficiency in cardiomyocytes (CMs) and heart cells both in vitro and in vivo. Specifically, the Top Heart 5′UTR increases translation efficiency by approximately 30–60% in both mouse and human CMs compared to a standard 5′UTR control. Moreover, the artificial 5′UTR induces a 2–2.5 times higher translation of modRNA in the mouse heart 24 and 48 h post-delivery. Conclusions: Our findings may contribute to the development of a superior modRNA platform for use in preclinical and clinical studies, potentially allowing reduced dosages or increased gene expression at the same dosage level. This approach can be extended to identify optimized 5′UTRs for various cell types or organs, including applications in cancer therapies. Full article