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Diagnostic accuracy of physical examination tests for painful cervical radiculopathy: update of a systematic review and meta-analysis
No full textCervical radiculopathy (CR) is a clinical condition caused by compression of the nerve root. In clinical practice, the diagnosis of CR is based on information from the patient's history, physical examination, and diagnostic imaging. This systematic review aimed to update and summarise the evidence reported in a systematic review published in 2018 on the diagnostic performance of physical examination tests. A literature search was performed in six electronic databases. Selection, assessment of risk of bias (using the QUADAS-2) and data extraction were performed independently by two reviewers. Sensitivity and specificity were calculated, and the certainty of the evidence was assessed using the GRADE framework. For the meta-analysis, a hierarchical bivariate random-effects model was used and, in line with recommendations for sparse data, models were interpreted as bivariate fixed-effect Generalized Linear Mixed Models. In total, eight studies were included. Diagnostic value was assessed for six physical examination tests. Slightly different versions of Spurling's test were assessed in five studies, with a reported high specificity ranging from 0.84 to 1.00 (95% CI range: 0.56-1.00) and sensitivity values ranging from 0.38 to 0.98 (95%CI range: 0.22-0.99). There is low certainty evidence of pooled sensitivity of 0.70 (95%CI 0.60-0.79) and specificity of 0.71 (95%CI 0.63-0.79) for Upper Limb Neurodynamic Test (ULNT) 1. Similary there was low certainty evidence of pooled sensitivity of 0.97 (95%CI 0.88-0.99) and pooled specificity of 0.51 (95%CI 0.40-0.62) for combined ULNTs, and of pooled sensitivity of 0.49 (95%CI 0.39-0.60) and pooled specificity of 0.76 (95%CI 0.66-0.84) for the shoulder abduction relief test. All other tests were assessed in a single study only. Clinicians may use the outcome of Spurling's test and the outcome of the combination of four ULNTs to assist their clinical reasoning in diagnosing CR. However, evidence on the diagnostic accuracy of all physical tests for the diagnosis of CR is sparse, and the certainty of the evidence was very low for all outcomes of all tests, implying that new studies of high methodological value are still required to strengthen these results. Because of the small number of studies, the pooled estimates are valid only for the populations and tests studied in the specific studies included in this review. [Abstract copyright: © 2026. The Author(s).
Age differences in inhibition and episodic retrieval in task switching: a drift diffusion model analysis of N–2 repetition costs
No full textSuccessful task-switching performance is thought to rely on inhibitory mechanisms suppressing no-longer-relevant tasks, indexed by the n–2 repetition cost. Recent work has shown that episodic retrieval contributes to this cost, confounding estimates of inhibition. This study examines age-related differences in the contributions of inhibition and episodic retrieval to the n–2 repetition cost using a paradigm that controls episodic interference. We also applied the drift diffusion model (DDM) to estimate latent processes underlying these effects. Results showed robust n–2 repetition costs for younger and older adults in response times which reduced when episodic interference was controlled. However, only younger adults showed this pattern in error rates. The DDM showed n–2 repetition costs and their modulation by episodic retrieval were isolated to drift rates, reflecting changes in evidence accumulation. Only younger adults’ drift rates were affected by episodic retrieval, with n–2 repetition costs reduced under episodic match conditions. Older adults showed n–2 repetition costs in drift rate regardless of episodic match, suggesting age-related differences in episodic retrieval at the latent level. The results provide insight into age-related differences in inhibition, the importance of controlling episodic retrieval effects in task switching, and the value of computational modelling in revealing age-related differences
Cutaneous Leishmaniasis in Tigray, Ethiopia: Clinical patterns, environmental drivers and public health implications.
No full textBackgroundCutaneous leishmaniasis (CL) is a vector-borne skin disease caused by the bite of female sandflies infected with the Leishmania parasite and is widely distributed in the highlands of Tigray, Northern Ethiopia. However, despite its widespread distribution, little is known about the actual epidemiology of the disease in Tigray and Ethiopia as a whole. Therefore, this study aimed to document the epidemiology, risk factors and public health implications of CL in Tigray, Ethiopia.MethodsBetween March and May 2022, a cross-sectional household survey was conducted in seven districts of Tigray, Northern Ethiopia, using multistage sampling technique. Participants were clinically examined for scars and/or active lesions and samples taken from active lesions were investigated for parasite amastigotes by microscopy. Data on socio-demographic characteristics and environmental determinants were documented using semi-structured questionnaires. Bivariate and multivariate logistic regressions were used to identify risk factors associated with CL infections.ResultsA total of 3,817 individuals (48.2% males and 51.8% females) residing in 927 households were screened and included in the study. A total of 484 individuals showed clinical evidence of CL infection (13.7% of all males, 11.5% of all females). The overall prevalence was found to be 12.7% (4.5% active lesions, 8.2% scars). Active cases were predominantly localized cutaneous leishmaniasis (LCL) (85%) but a substantial number of mucocutaneous (MCL) cases (11%) and diffused (DCL) (4%) types were also identified. The highest rates of active lesions (5.2%) were found in children aged 1-14 years. Most lesions (69%) occurred on the face, and 51.4% of cases had ≥ 2 lesions. Of the study sites screened, Emba Alaje district had the highest prevalence (15.7%). Cases clustered in highland zones (70.2% at 2,300-3,200 m altitude; 93% at 2,000-3,000 m). Significant host risk factors included age, outdoor sleeping and poor housing (cracked walls). Moreover, proximity to hyraxes, bats, caves, or animal burrows were identified among the significant environmental risk factors (p < 0.05).ConclusionsCutaneous leishmaniasis is an underprioritized yet serious public health challenge in Tigray, driven by environmental and behavioral factors. Several forms of the disease (LCL, MCL and DCL) are prevalent in the region, with children and young adults being the most affected. Advocacy for regional recognition of CL, integration of CL control into existing NTD programmes is recommended. Targeted interventions for high-risk groups, enhanced surveillance and mapping, vector and reservoir control measures, community awareness and healthcare capacity and a One Health approach are highly recommended-for sustainable control of CL in Tigray, Ethiopia
Impact of tissue staining and scanner variation on the performance of pathology foundation models: a study of sarcomas and their mimics
No full textHistopathological analysis is considered the gold standard for the diagnosis and prognostication of cancer. Recent advances in AI, driven by large‐scale digitisation and pan‐cancer foundation models, are opening new opportunities for clinical integration. However, it remains unclear how robust these foundation models are to real‐world sources of variability, particularly in H&E staining and scanners produced by different manufacturers. In this study, we use soft tissue tumours, a rare and morphologically diverse tumour type, as a challenging test case to systematically investigate the colour‐related robustness and generalisability of seven AI models. Controlled staining and scanning experiments were utilised to assess model performance across diverse real‐world data sources. Foundation models, particularly UNI‐v2, Virchow and TITAN, demonstrated encouraging robustness to staining and scanning variation, particularly when a small number of stain‐varied slides were included in the training loop, highlighting their potential as adaptable and data‐efficient tools for real‐world digital pathology workflows
Adaptive Bandelet Transform and Transfer Learning for Geometry-Aware Thyroid Cancer Ultrasound Classification
No full textBackground and Objectives: Classification of thyroid nodules (TN) in ultrasound remains challenging due to limited labelled data and the limited capacity of conventional feature representations to capture complex, multi-directional textures. This work aims to improve data-efficient TN classification by integrating a geometry-adaptive Bandelet Transform (BT) with transfer learning (TL) to enhance feature representation and generalisation. Methods: The proposed pipeline first applies BT to strengthen directional and structural encoding in ultrasound images via quadtree-driven geometric adaptation. It then mitigates class imbalance using SMOTE and increases data diversity through targeted data augmentation. The resulting representations are classified using multiple ImageNet-pretrained architectures, where VGG19 yields the most consistent performance. Results: Experiments on the publicly available DDTI dataset show that BT-based preprocessing consistently improves performance over classical wavelet representations across multiple quadtree thresholds, with the best results obtained at T=30. Under this setting, the proposed BT+TL (VGG19) model achieves 98.91% accuracy, 98.11% sensitivity, 97.31% specificity, and a 98.89% F1-score, outperforming comparable approaches reported in the literature. Conclusions: Coupling geometry-adaptive transforms with modern TL backbones provides a robust and data-efficient strategy for ultrasound TN classification, particularly under limited annotation and challenging texture variability. The complete project is publicly available
Evidence for the Merger Hypothesis in V4332 Sgr: A Low 12 C/ 13 C Ratio and Multiple Outbursts
No full textFollowing the detections of the first extragalactic “luminous red nova” (LRN) M31RV in 1989, and its first Galactic counterpart V4332 Sgr in 1994, there have been many discoveries of similar, or closely related, objects. They are important because they bridge the luminosity gap between the brightest novae and supernovae, a largely unexplored parameter space. The cause of eruptions in LRNe is still unclear, a stellar merger being the most favored mechanism. However, barring V1309 Sco, there has been no direct evidence for a merger in the other objects. Here we present strong evidence that V4332 Sgr was a merger event. High-resolution infrared observations of the CO fundamental band show an unusually small 12C/13C ratio of 3.5 ± 1. This indicates that a violent event had occurred, whose effects penetrated deep enough to allow the CNO cycle processed 13C in the inner H burning shell to be brought to the surface. We rule out planetary ingestion and propose that the eruption was due to a merger between V4332 Sgr and a companion star. It is shown that V4332 Sgr was likely surrounded by an edge-on disk before its eruption. If this disk was a flattened common envelope containing V4332 Sgr and a companion star, then a merger scenario would not be inconsistent. Furthermore, it is also shown that V4332 Sgr had multiple outbursts, previously unreported but an important piece of information, since multiple outbursts are a trait shared by many LRNe
The use of guidelines in multimorbidity related practice: An exploratory questionnaire survey
Full text linkIntroduction The use of guidelines in multimorbidity-related practice has not yet been extensively investigated. We aimed to explore how healthcare professionals use guidelines when managing individuals with multimorbidity. Method We conducted an exploratory survey among a convenience sample of medical professionals with clinical experience. The questionnaire addressed whether and how different types of guidelines are used in multimorbidity-related practice, the reasons for not using specific types of guidelines, and other approaches to inform multimorbidity practice. It was distributed through the investigators’ contact networks. The results were presented descriptively. Result We received 311 valid responses: 136 from the WHO European Region, 137 from the Western Pacific Region, and 38 from other regions. Most participants were familiar with the concept of multimorbidity (n=245, 79%). Among the 269 respondents who reported using guidelines in multimorbidity practice, 124 (46%) used guidelines specifically focusing on combinations of diseases, and 148 (55%) multiple single-disease guidelines together. Lack of availability was the main reason for not using guidelines that address multimorbidity itself; and the high number of guidelines (n=76, 40%) and possible interactions between conditions or treatments (n=62, 38%) for not using single-disease guidelines. Respondents frequently consult experts or refer to systematic reviews and primary studies when existing guidelines do not meet their needs. The development of a tool or method to guide the use of multiple guidelines ranked highest among possible actions to improve multimorbidity practice. Conclusion Although the medical professionals in our sample were generally familiar with use of guidelines, there are many unmet needs and tool gaps related to guideline-informed multimorbidity-related practice
Investigating the crosslinking of an aligned, all-natural chitosan-gelatine-cellulose based polymeric scaffold for tendon tissue engineering.
No full textCrosslinking is a key step in the production of stable all-natural polymeric scaffolds for tissue engineering, as it slows the degradation and increases the mechanical properties of the material. In this study, we investigate the crosslinking parameters of a natural, anisotropic scaffold produced from gelatine, chitosan and cellulose through a modified freeze drying protocol, with the goal of maintaining the porous architecture of the scaffold while improving its degradation and mechanical strength. Genipin and EDC were selected as the two crosslinking alternatives, while crosslinker concentration and solvent system (ethanol-to-water ratio) were the optimized parameters. The degree of crosslinking was quantified through a 2,4,6-Trinitrobenzene Sulfonic Acid assay, and the scaffolds were further tested for hydrolytic and enzymatic degradation, swelling and mechanical properties. Scaffolds achieve ultimate tensile strength values of up to 4 MPa, in the relevant physiological range for tendon applications, and crosslinking degrees in the range of 70% - 90%. While scaffolds processed with both crosslinkers maintain the desired pore alignment, genipin was the most successful at delaying the degradation of the material, with 85% of the initial mass of the scaffold remaining after 21 days of immersion in PBS. The solvent system of the crosslinking solution was investigated, with varying ratios of ethanol to water, finding that adding water is necessary for optimal swelling, homogeneous crosslinking and low cytotoxicity of the scaffolds, highlighting the importance of this parameter in the genipin crosslinking process. Genipin crosslinked scaffolds were found to be capable of sustaining the attachment and proliferation of tendon derived stem cells up to 21 days in both 21% and 2% oxygen environments, yielding a strong stable scaffold suitable for supporting tendon regeneration in-vitro. [Abstract copyright: Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.
Governing Through Participation: On Permacrises and the Making of the Argentine Juror
No full textThis article relies on the analysis of interviews with legislators and reformers and documentary sources like parliamentary bills to discuss the governance of (perma)crises in context of the recent introduction of lay decision-makers to criminal justice systems in Argentina. The paper proposes a critique of the perennial trust in law as a tool to deal with crises—even in the case of lay people participation in judicial adjudication, which could be thought of as a legal technology that represents a disinvestment in law in as much as it is an investment in ‘common sense’, touted as belonging in the opposite extreme of a continuum of knowledges (especially in the context of a codified civil law system). The paper has a twofold aim: first, it discusses the use of one governmental technology (participation) imagined as a solution to a series of crises. Second, it looks at these reformers as their programmatic work moves from the broader political effects of lay participation to the ethical dimensions of their transformative endeavour, tracing their attempts to devise the proper participant citizen and its conducts, within and beyond the courthouse
A High-resolution Study of the Cold Neutral Medium in and around 30 Doradus
No full textWith the aim of evaluating the roles of the cold neutral medium (CNM) in the cloud-scale baryon cycle, we perform a high-resolution study of the CNM in and around the extreme star-forming region 30 Doradus (30 Dor). For our study, we use Galactic Australian Square Kilometre Array Pathfinder H i Survey data and produce H i emission and absorption cubes on 7 pc scales. To examine the CNM structures toward 30 Dor, we decompose the H i absorption cube into 862 Gaussian components and find that these components are distributed at four velocity ranges (B1, B2, B3, and B4, respectively): 200–230 km s−1, 230–260 km s−1, 260–277 km s−1, and 277–300 km s−1. We derive line-of-sight average spin temperatures and opacity-corrected total H i column densities and show that the B1–B4 structures have systematically different properties, indicating that they are physically distinct. As for the nature of the observed CNM structures, we find that B2 is associated with the main dense structure where ionized, atomic, and molecular gases are concentrated. B3 and B4 trace inflows whose combined mass flux rate of 0.14 M⊙ yr−1 is comparable to the current star formation rate, while B1 probes outflows with a much lower mass flux rate of 0.007 M⊙ yr−1. Interestingly, the H i column densities in B1–B4 are nearly uniform with a factor of 2 spatial variations, implying the presence of H i shielding layers for H2 formation