The importance of the weak: Interaction modifiers in artificial spin ices

The modification of geometry and interactions in two-dimensional magnetic nanosystems has enabled a range of studies addressing the magnetic order, collective low-energy dynamics, and emergent magnetic properties, in e.g. artificial spin ice structures. The common denominator of all these investigations is the use of Ising-like mesospins as building blocks, in the form of elongated magnetic islands. Here we introduce a new approach: single interaction modifiers, using slave-mesospins in the form of discs, within which the mesospin is free to rotate in the disc plane. We show that by placing these on the vertices of square artificial spin ice arrays and varying their diameter, it is possible to tailor the strength and the ratio of the interaction energies. We demonstrate the existence of degenerate ice-rule obeying states in square artificial spin ice structures, enabling the exploration of thermal dynamics in a spin liquid manifold. Furthermore, we even observe the emergence of flux lattices on larger length-scales, when the energy landscape of the vertices is reversed. The work highlights the potential of a design strategy for two-dimensional magnetic nano-architectures, through which mixed dimensionality of mesospins can be used to promote thermally emergent mesoscale magnetic states.Comment: 17 pages, including methods, 4 figures. Supplementary information contains 16 pages and 15 figure

A multimodal deep learning framework using local feature representations for face recognition

YesThe most recent face recognition systems are mainly dependent on feature representations obtained using either local handcrafted-descriptors, such as local binary patterns (LBP), or use a deep learning approach, such as deep belief network (DBN). However, the former usually suffers from the wide variations in face images, while the latter usually discards the local facial features, which are proven to be important for face recognition. In this paper, a novel framework based on merging the advantages of the local handcrafted feature descriptors with the DBN is proposed to address the face recognition problem in unconstrained conditions. Firstly, a novel multimodal local feature extraction approach based on merging the advantages of the Curvelet transform with Fractal dimension is proposed and termed the Curvelet–Fractal approach. The main motivation of this approach is that theCurvelet transform, a newanisotropic and multidirectional transform, can efficiently represent themain structure of the face (e.g., edges and curves), while the Fractal dimension is one of the most powerful texture descriptors for face images. Secondly, a novel framework is proposed, termed the multimodal deep face recognition (MDFR)framework, to add feature representations by training aDBNon top of the local feature representations instead of the pixel intensity representations. We demonstrate that representations acquired by the proposed MDFR framework are complementary to those acquired by the Curvelet–Fractal approach. Finally, the performance of the proposed approaches has been evaluated by conducting a number of extensive experiments on four large-scale face datasets: the SDUMLA-HMT, FERET, CAS-PEAL-R1, and LFW databases. The results obtained from the proposed approaches outperform other state-of-the-art of approaches (e.g., LBP, DBN, WPCA) by achieving new state-of-the-art results on all the employed datasets

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Digital mental health and covid-19: mental health literacy among general population in Selangor

Introduction: Mental health increased in prevalence during the COVID-19 pandemic, which caused changes in health-seeking behaviour among the general population. Having adequate knowledge helps to improve community attitudes on mental health. Thus, measuring mental health literacy is essential in developing policies, prevention strategies and formulating interventions. Therefore, this study aims to measure mental health literacy among the general population during the COVID-19 pandemic in Selangor. Methods: A validated Malay version of the self-administered Mental Health Literacy Scale (MHLS) was used in this cross-sectional study among all Selangor citizens through SELANGKAH Apps from 13th September 2021 until 7th March 2022. This app was initially used as a contact tracing during the pandemic. Later features of the mental health module (SEHAT) were added, consisting of screening questionnaires, literacy questionnaires, and psychoeducation videos. This app was promoted to all Selangor citizens and can be downloaded for free. Data was analysed using IBM SPSS version 26. Result: There are a total of 42072 SEHAT app users, while 1222 users completed the MHLS questionnaires. Most respondents were female (52.8%), Muslims (79.3%), had formal education up to secondary level (51.1%), had a monthly income below RM 5000 (90.5%), and age group of 21-40 years old (58.5%), and lived in the district of Petaling, Selangor (29.5%). The overall mean (sd) MHLS was low, which is 101.3 (17.03) and was significantly associated with all determinants (p<0.05). Those with higher mean MHLS include females, Muslims, aged 21-40 years old, university graduates, had a monthly income of RM 5001 to RM 10000 and living in the district of Petaling, which is an urban centre in Selangor. Discussion: This is one of the most extensive state-wide level studies during the pandemic. Higher mean MHLS among females could be due to more sensitive recognition and perception of symptoms in females than males. Access to mental health information is now at one 's fingertip with the luxury of the internet and devices. A surge in internet usage among Malaysians was seen during the pandemic, mainly during the Movement Control Order (MCO) period. Subsequently, those in the younger age group, with higher monthly income, and living in urban areas have greater access to the mental health information on media, hence having higher MHLS. Furthermore, the higher the formal education level, the higher the mental health literacy as more information is known via greater exposure in higher institutions. Conclusion: The mental health literacy scores were low among the general population in Selangor during the pandemic. Hence, more mental health advocacy and awareness programs should be carried out

Nutritional intervention and its impact on the height of children among the B40 group in Selangor

Introduction: A number of children suffer from malnutrition with visible stunting due various factors such as food insecurity and household income. The address of nutritional intervention promotes healthier outcomes especially engagement through population with greater risks, those with low income of B40 groups in Selangor being the most populous state, thus accelerating health policy makers in making differences in public health strategies. Nutritional status is a significant measure for the anthropometric development of the children population. Therefore, this study aims to measure the impact of nutritional intervention on the height of children aged 1 to 6 years old among the population. Methods: A cross-sectional study was done in Selangor State involving 500 children aged 1 to 6 years old randomly selected among the B40 group. A nutritional intervention that involved the supply of specialized formula milk totalling 2kg and 30 tablets of multivitamin with lysin were given for each month. Nutritional counseling was also given. Anthropometric measurements were taken using (barang) and were monitored using WHO AthroPlus software. The height is categorized into moderately stunted and severely stunted defined by WHO height-for age Z score. Descriptive data was analyzed using IBM SPSS version 25. Results: 500 total respondents participated in the 5-month course. There were equal numbers of gender 50% and the majority of the respondents were aged 3 years old. For all ages, the baseline height results showed 15.0% were moderately stunted and 3.3% were severely stunted. For each month, there was an increase in mean of height, where the highest in the second month follow up, increase in mean of 1.89m, followed by 0.63m, 0.53m and 0.48m increase in height on the third, fourth and fifth month respectively. The fifth month has the lowest percentage of moderately stunted children 5.0% compared to the first month with 15%. Discussion: Here, by giving nutrient supplementation, it helps to improve the height of these children. Initially, children may develop stunting not as easily as being underweight. Stunting is needed more attention compared to other undernutrition anthropometric; underweight and wasting as each varies in severity, speed and onset of its retardation. Conclusion: Access to nutrition security throughout the 5-months-programme improves the stunting problems, thus the growth and health outcomes in up to aged 5 children. Therefore, other efforts of environmental sanitation, primary health care and control infections for the children are also recommended

A Low Concentration of Ethanol Impairs Learning but Not Motor and Sensory Behavior in Drosophila Larvae

Drosophila melanogaster has proven to be a useful model system for the genetic analysis of ethanol-associated behaviors. However, past studies have focused on the response of the adult fly to large, and often sedating, doses of ethanol. The pharmacological effects of low and moderate quantities of ethanol have remained understudied. In this study, we tested the acute effects of low doses of ethanol (∼7 mM internal concentration) on Drosophila larvae. While ethanol did not affect locomotion or the response to an odorant, we observed that ethanol impaired associative olfactory learning when the heat shock unconditioned stimulus (US) intensity was low but not when the heat shock US intensity was high. We determined that the reduction in learning at low US intensity was not a result of ethanol anesthesia since ethanol-treated larvae responded to the heat shock in the same manner as untreated animals. Instead, low doses of ethanol likely impair the neuronal plasticity that underlies olfactory associative learning. This impairment in learning was reversible indicating that exposure to low doses of ethanol does not leave any long lasting behavioral or physiological effects

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified