bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation and performance analysis of polycarboxylate superplasticizer modified with fluorine-containing monomer and silicon dioxide nanoparticles
Authors: Cao Yang , Wu Hongte
Published: February 2024

With the development of technology, the performance requirements for building materials in the modern construction industry are increasing. Nanomaterials and polycarboxylate superplasticizers (PCE) have good applicability in this field. Therefore, we develop a composite material by
incorporating a fluorocarbon surfactant (FS) as a shrinkage-reducing agent into the PCE and modifying it with silicon dioxide nanoparticles (nano-SiO2) (SiO2-FS-PCE). Moreover, we investigate the preparation, dispersity, flowability, rheological properties, adsorption
performance, and microstructure of the SiO2-FS-PCE composite. We observe that introducing an appropriate concentration of fluorine-containing monomer can effectively reduce surface tension in the solution and inhibit the shrinkage of the slurry. The rheological properties of the
SiO2-FS-PCE1 slurry decrease significantly with time. When the dosage of nano-SiO2 exceeds 20%, the silicon hydroxyl groups on the material’s surface tend to polymerize, which affects the adsorption and dispersion of the superplasticizer, thereby reducing its fluidity.
As the dosage of nano-SiO2 increases, there is a trend of increasing friction of SiO2-FS-PCE, followed by a decrease. This change is closely related to changes in the adsorption and morphology of SiO2-FS-PCE, providing higher adsorption sites than other materials.
In conclusion, these findings provide insights for a deeper understanding of the synthesis and properties of nanocomposite materials, thereby offering a theoretical basis for further optimization of their preparation and performance.
Flavopiridol-loaded lubricative microspheres for osteoarthritis treatment in rabbit
Authors: Chen Zhi , Wen Di
Published: February 2024

Osteoarthritis considerably affects the daily activities of humans and pets. Medication is an effective treatment option for osteoarthritis. However, commonly used medications require frequent injections or oral administration, which may cause side effects such as gastrointestinal reactions,
drug overdose, and missed doses. In this study, we developed lubricative drug-releasing microspheres based on poly(lactic-co-glycolic acid) (PLGA), for the treatment of osteoarthritis. PLGA microspheres formed using microfluidic electronic technology have uniform spherical morphology, sufficient
biocompatibility, and excellent drug-release performance. Animal experiments in rabbits have shown that flavopiridol-loaded PLGA is an effective drug carrier for osteoarthritis treatment, since it promotes glycosaminoglycan deposition. Therefore, our flavopiridol-loaded lubricating microspheres
is anticipated to exhibit considerable potential for osteoarthritis treatment in humans and pets.
Ultrasound-assisted facile and green preparation of Ag nanoparticle conductive ink for printing electronics
Authors: Feng Junyan , Xing Bo , Li Kaifeng
Published: February 2024

The development of low-cost, high-efficiency, and environment-friendly methods for the preparation of Ag nanoparticle (NP) conductive inks is key to promoting the application of such inks for printing flexible electronic components. This article presents an effective method for preparing
a AgNP ink by reducing silver compounds in a polyol solution with ultrasonication. When the silver solution was ultrasonicated at 640 W, 21-nm AgNPs were readily produced within 5 min, and the particles grew considerably to 53 nm as the reaction was continued for 15 min. Thereafter, the NP
size increased marginally with further increase in reaction time. When the reaction was conducted for a fixed duration of 15 min and the ultrasonic power was increased from 480 to 760 W, the AgNP size decreased from 63 to 48 nm. During ultrasonication, the bubble eruption in the solution generates
large temperature and pressure gradients, inducing the rapid reduction of the Ag(I) to Ag(0). Printing experiments revealed that the synthesized AgNP ink has good inkjet printability. During the sintering of the printed film, the bridge connections between large particles increased and the
interparticle voids decreased gradually, resulting in a decrease in film resistivity. A relatively low resistivity of 40×10−5 Ωcm was obtained when the flexible AgNP pattern was heated at 250 °C for 80 min. The facile synthesis process and the favorable conductive
properties of the obtained ink render this preparation method promising for the low-cost production of flexible electronics.
Examining the pancreatic regenerative potential of Nigella sativa in diabetic rats: Evaluation of histological changes and transcription factors pdx-1 and neurog-3 levels
Authors: Alaryani Fatima S.
Published: February 2024

Pancreatic β cell neogenesis and proliferation represent promising avenues for diabetes management. Nigella sativa, known for its potent anti-inflammatory and antioxidant properties, has demonstrated efficacy in promoting regeneration across various organ systems.
This study investigates the potential of Nigella sativa in pancreatic regeneration by examining pancreatic histology in addition, the expression levels of the key transcription factors, comprising NEUROG-3, PDX-1, INS-1, and INS-2. Twenty-four rats were categorized in 4sets that is
negative control, positive control, normal, and treatment. Diabetes was prompted through intraperitoneal administration of alloxan hydrate. After 21 days of diabetes induction, the treatment set was applied with N. sativa extract, the positive control set was administered Glibenclamide,
while the negative control group received no treatment. Parameters such as biochemical markers, oxidative stress markers, pancreatic islet architecture changes, and the expression levels of the NEUROG-3, PDX-1, INS-1, and INS-2 were assessed. Data analysis, conducted through DMR Test and ANOVA
with a 5% threshold of significance, revealed significant insights into the consequence of N. sativa on the parameters under investigation. The results propose a possible part for N. sativa in promoting pancreatic regeneration and warrant further exploration for its application
in diabetes management.
The bacteriostatic effect of a new controlled-release carotenoids-silver nanoparticle
Authors: Yan Wei , Zhang Hui
Published: February 2024

Discuss the bacteriostatic effect of a novel controlled release silver nanoparticles carotenoids-silver nanoparticle. Detect the optimal extraction conditions for carotenoids through material liquid ratio, different ultrasonic temperatures and times; Detect the optimal synthesis conditions
of carotenoids-silver nanoparticle through different volume ratios, UV irradiation times, and temperatures; Detect the bacteriostatic effects on Escherichia coli and Staphylococcus albus using the minimum inhibitory concentration (MIC) and Oxford cup agar plate diffusion method.
The experiment proved that the best extraction effect of carotenoids was achieved when the volume ratio of orange peel powder to ethanol was 1:25, the ultrasound time was 40 min, and the temperature was 50 °C; When the amount of carotenoid extract added is 12 mL, the concentration of silver
nitrate is 8 mmol/l, the UV irradiation time is 40 min, and the ultrasound temperature is 60 °C, the synthesized carotenoids-silver nanoparticle has the highest absorbance value; carotenoids-silver nanoparticle have strong inhibitory effects on the growth of both Escherichia coli
and Staphylococcus albus. As the concentration increases, the bacteriostatic effect also becomes stronger, especially the strongest inhibitory effect on Staphylococcus albus. It was shown that carotenoids-silver nanoparticle has significant bacteriostatic effects, providing new
ideas for the development of bacteriostatic agents in plant resources.
The mechanism of intravenous immunoglobulin (IVIG) in vascular endothelial injury in kawasaki disease based on neutrophil extracellular traps
Authors: Wu Fengzhi , Zhang Wei , Duan Gaoyang , Guo Yao , Tang Mingsheng , Jiang Fengzhi , Zhang Haiqiao
Published: February 2024

This study explores the role of Neutrophil extracellular traps (NETs) in kawasaki disease (KD)-induced vascular inflammatory injury and the protective effect and mechanism of IVIG on vascular endothelial damage. A total of 37 children diagnosed with KD and admitted to Dongguan maternal
and Child Health Care Hospital between March 2020 and June 2022 were included in the study. The children were divided into different groups based on their treatment and the presence or absence of coronary artery damage: IVIG treatment group (KDIVIG group), subgroup with coronary
artery damage (KDCAL group), and subgroup without coronary artery damage (KDNCAL group), and a Control group consisting of 9 children who underwent surgical treatment. Flow cytometry was used to detect the proportion of neutrophils and the number of NETs in peripheral
blood. It was found that the proportion of neutrophils in the peripheral blood of the acute KD group significantly increased with the presence of NETs. RT-PCR and ELISA detection showed that the levels of inflammatory factors TNF-α, IL-6 and CitH3 were abnormally elevated in this
acute KD group, and the CAL group exhibited higher proportions of neutrophils and NETs-related markers compared to the NCAL group, while the IVIG group had significantly decreased proportions of neutrophils. PMA culture of neutrophils induced an increase expression of NETs marker protein,
the content of NETs cfDNA increased. NETs culture could promote the secretion of TNF-α, whereas IVIG cultured cells inhibited the secretion of TNF-α. Finally, HCAEC cells were cultured with different levels of TNF-α, and the function of HCAEC cells was
assessed using CCK8, scratch assay and flow cytometry. The high expression of TNF-α in the NETs group inhibited the proliferation and migration of HUVEC cells and enhanced their apoptosis. In contrast, the IVIG culture group exhibited similar effects to the TNF-α
monoclonal antibody, as it inhibited HUVEC cell apoptosis and improved their viability by reducing TNF-α expression. Total protein was extracted from the cells using nano-magnetic beads, and RT-PCR and western blot detection indicated that the increase of TNF-α expression
could increase the phosphorylation of NF-κB and and the expression of MMP-9. However, when TNF-α was inhibited by IVIG and TNF-α monoclonal antibody culture, the activity of NF-κB/MMP-9 athway was decreased. Therefore, IVIG may inhibit the
production of NETs in KD children, thereby reducing TNF-α/NF-NF-κB/MMP-9 mediated inflammatory response process and protecting the function of vascular endothelial cells.
Streamlined Multi-Attribute Assessment of an Array of Clinical-Stage Antibodies: Relationship Between Degradation and Stability
Authors: Pastrana Belinda , Culyba Elizabeth , Nieves Sherly , Sazinsky Stephen L. , Canto Eduardo I. , Noda Isao
Published: February 2024

Clinical antibodies are an important class of drugs for the treatment of both chronic and acute diseases. Their manufacturability is subject to evaluation to ensure product quality and efficacy. One critical quality attribute is deamidation, a non-enzymatic process that is observed to occur during thermal stress, at low or high pH, or a combination thereof. Deamidation may induce antibody instability and lead to aggregation, which may pose immunogenicity concerns. The introduction of a negative charge via deamidation may impact the desired therapeutic function (i) within the complementarity-determining region, potentially causing loss of efficacy; or (ii) within the fragment crystallizable region, limiting the effector function involving antibody-dependent cellular cytotoxicity. Here we describe a transformative solution that allows for a comparative assessment of deamidation and its impact on stability and aggregation. The innovative streamlined method evaluates the intact protein in its formulation conditions. This breakthrough platform technology is comprised of a quantum cascade laser microscope, a slide cell array that allows for flexibility in the design of experiments, and dedicated software. The enhanced spectral resolution is achieved using two-dimensional correlation, co-distribution, and two-trace two-dimensional correlation spectroscopies that reveal the molecular impact of deamidation. Eight re-engineered immunoglobulin G4 scaffold clinical antibodies under control and forced degradation conditions were evaluated for deamidation and aggregation. We determined the site of deamidation, the overall extent of deamidation, and where applicable, whether the deamidation event led to self-association or aggregation of the clinical antibody and the molecular events that led to the instability. The results were confirmed using orthogonal techniques for four of the samples.
School Effectiveness Factors and Student Achievement: A Longitudinal Study in an Urban School District
Authors: Zheng Yunzheng , Shen Jianping , Johnson Megan Russell , Krenn Huilan Y. , Carter Kimberly
Published: February 2024

In this study we explore the longitudinal impact of effective school factors on student achievement over a five-year period in an urban school district. By collecting teacher survey data from urban schools in a Midwest school district and analyzing the survey data alongside student achievement, we identified several factors associated with student achievement growth. Our findings reveal that Shared Vision and Goals is positively associated with student achievement growth in math and reading. Furthermore, Student Behavior Expectations and Behavior Management Practices are positively associated with growth in reading achievement. Our research contributes to the understanding of effective school factors from a longitudinal perspective, particularly in an urban school setting.
Substance use and its association with mental health among Swiss medical students: A cross-sectional study
Authors: Gaume Jacques , Carrard Valérie , Berney Sylvie , Bourquin Céline , Berney Alexandre
Published: February 2024

Background:

Studies on mental health and substance use among medical students indicated worrying prevalence but have been mainly descriptive.

Aim:

To evaluate the prevalence of substance use in a sample of medical students and investigate whether mental health variables have an influence on substance use.

Methods:

The data were collected as part of the first wave of the ETMED-L, an ongoing longitudinal open cohort study surveying medical students at the University of Lausanne (Switzerland). N = 886 students were included and completed an online survey including measures of mental health (depression, suicidal ideation, anxiety, stress, and burnout) and use of and risk related with several substances (tobacco, alcohol, cannabis, cocaine, stimulants, sedatives, hallucinogens, opioids, nonmedical prescription drugs, and neuroenhancement drugs). We evaluated the prevalence of use of each substance and then tested the association between mental health and substance use in an Exploratory Structural Equation Modeling framework.

Results:

Statistical indices indicated a four-factor solution for mental health and a three-factor solution for substance use. A factor comprising risk level for alcohol, tobacco, and cannabis use – which were the most prevalent substances – was significantly associated with a burnout factor and a factor related to financial situation and side job stress. There was a significant association between a factor comprising depression, anxiety, and suicidal ideation and a factor related to the use of sedatives, nonmedical prescription drugs and neuroenhancement drugs. Although their use was less prevalent, a factor comprising the risk level of stimulants and cocaine use was significantly but more mildly related to the burnout factor. A factor comprising stress related to studies and work/life balance as well as emotional exhaustion was not related to substance use factors.

Conclusion:

In this sample of medical students, the prevalence of substance use was substantial and poorer mental health status was related with higher substance use risk levels.
Knuckle hyperpigmentation in a young male: A clinical sign of B12 deficiency not to be missed
Authors: Singh Harpreet , Subramanian Arvind , Dibhar Deba P , Suri Vikas , Bhalla Ashish
Published: February 2024

Vitamin B12 and folate deficiency are reversible causes of megaloblastic anemia. Strict vegetarians are at risk of megaloblastic anemia due to low cobalamin in their diet. Knuckle hyperpigmentation in patients with megaloblastic anemia is due to excess melanin synthesis in skin. Here we present a case of a young vegetarian male with megaloblastic anemia with knuckle hyperpigmentation managed successfully with intravenous followed by oral vitamin b12 and folate supplementation.
Peer Response to Regulatory Enforcement: Lobbying by Non-Sanctioned Firms
Authors: Kolomeitsev Sergei , Moergen Kristie J. N. , Ridge Jason W. , Worrell Dan L. , Kuban Scott
Published: February 2024

Government agencies rely on general deterrence to protect the public. Firms utilize lobbying for influence and information purposes. This paper explores the intersection of general deterrence and lobbying by firms while investigating whether general deterrence efforts of regulators are met with a lobbying response. Specifically, we propose that following a competitor firm being sanctioned, the non-sanctioned peer firms will increase their amount of lobbying targeted at the sanctioning agency, and the key drivers of these increases in targeted lobbying will be penalty severity, concerns over likely reputational damage, and value alignment. We test our hypotheses using U.S. Environmental Protection Agency violations as a context, and they largely receive support.
‘If he thought that I was going to go and hurt myself, he had another thing coming’: Treatment experiences of those with large to massive rotator cuff tears and the perspectives of healthcare practitioners
Authors: Fahy Kathryn , Galvin Rose , Lewis Jeremy , McCreesh Karen
Published: February 2024

Objective

To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care.

Design

A qualitative descriptive study using reflexive thematic analysis.

Setting

In-person focus groups were undertaken in a clinical setting (private practice [ n = 1]; public outpatient [ n = 2]). Semi-structured interviews were conducted online via Microsoft Teams.

Participants

Patients diagnosed with these tears ( n = 12) and healthcare practitioners ( n = 11).

Results

Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears: 1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient–clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress. 2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient–clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty.

Conclusions

The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners.
Spreading Relations Rather Than Chemicals in Melanesian Gardens
Authors: Iteanu André
Published: February 2024

The strand of environmentalism that focuses on biodiversity as produced by the ecosystem places natural agency beyond human control. In Melanesia, where plants, animals, and men cannot radically be distinguished from one another, this standpoint seems too radical. Agronomic studies have shown that Melanesian gardens possess a profusion of biodiversity superior to the so-called natural one. This article therefore attempts to show that Melanesian commonality between people and plants and the correlative association of plants with humans are at the root of this profusion. In sum, rather than placing nature outside the reach of humans, the Melanesian case suggests that biodiversity is best served by human ritual actions during which vegetal materialize the social relations which link the different people.
EFT for Three: Working with Polyamorous Relationships
Authors: Hayes Lindsay , Allan Robert
Published: February 2024

This article proposes an adaptation of Emotionally Focused Therapy (EFT) for couples to serve nonmonogamous clients. This article also discusses the risks of failing to adapt therapeutic models to consider individuals who practice polyamory and research to date on attachment styles and polyamory. The authors suggest EFT as an efficacious approach to working with polyamorous individuals seeking therapy and provide a case illustration of a three-person polyamorous group, or triad.
Counselors’ Knowledge of Serving the Birth to Six Population
Authors: Woodliff Tricia A. , Jacoby Rachel , Danielson Rachael
Published: February 2024

Infant and Early Childhood Mental Health (IECMH) is a culturally informed, relationally focused area of clinical expertise which addresses the social–emotional needs of very young children and their families. IECMH addresses a critical need and, because of the nuances of the population, requires specific knowledge and skills. Although counselors are often providers of this type of clinical work, very little training exists in counselor education programs, leaving counselors to possibly work outside of scope of competence. This article explores the knowledge and experiences of counselors’ with IECMH. The results of a quantitative survey will be addressed, along with implications and recommendations for counselor education programs and professional counselors to further their knowledge on IECMH.
Performance evaluation of machine learning algorithms and impact of activation functions in artificial neural network classifier for bearing fault diagnosis
Authors: Rayjade Ganesh , Bhagure Amit , Kushare Prashant B , Bhandare Ramesh , Matsagar Vilas , Chaudhari Ashutosh
Published: February 2024

Machine learning algorithms are used to identify the bearing condition. In this work, different machine learning techniques such as decision tree, logistic regression, support vector machine (SVM), and artificial neural network (ANN) are used and compared to find healthy and faulty conditions of the bearing. The identification of the condition of the bearing is based on vibrations recorded using Fast Fourier Transform Analyzer. The vibration data recorded for the bearings have been used to categorize the condition of the bearing as healthy or faulty by applying machine learning techniques. The dataset of healthy and faulty bearings is collected using a four-channel Fast Fourier Transform Analyzer (FFT) analyzer. However, the statistical feature extraction technique has been used to evaluate the accuracy and performance of artificial neural network, support vector machine, logistic regression, and decision tree algorithms based on their classification accuracy and total costs. The result of the work reveals that the performance of the activation function based artificial neural network (ANN-AF) and SVM algorithm is better than logistic regression and decision tree models. However, it is observed that the use of appropriate activation functions within the ANN-AF technique improves the accuracy of the machine learning model.
Effect of Virtual Reality Glasses Application on Pain, Anxiety, and Patient Satisfaction During a Transrectal Prostate Biopsy: A Randomized Controlled Trial
Authors: Toraman Rumeysa Lale , Eskici Ilgin Vesile
Published: February 2024

Background

This study aims to determine the effect of virtual reality glasses application on pain, anxiety, and patient satisfaction during a transrectal prostate biopsy.

Materials and Methods

The study was conducted with pre-tests, post-tests, and a control group, using a randomized controlled experimental research design. A total of 70 patients (35 in the intervention group and 35 in the control group) were included in the study. The intervention group watched a video with virtual reality glasses during the biopsy process. A Descriptive Information Form, State-Trait Anxiety Inventory (STAI-I, STAI-II), Scale of Patient Perception of Hospital Experience with Nursing Care (PPHEN), and Visual Analog Scale for Pain (VAS) were used for data collection. To evaluate the data, numbers, percentages, mean, standard deviation, chi-square, paired sample t test, independent samples t test, regression analysis, and Cronbach’s alpha Reliability Coefficient were used.

Results

There was no significant difference between the groups in terms of descriptive and clinical characteristics ( p > .05). The mean VAS and STAI post-test scores of the patients in the intervention group were lower than the control group, and the difference between them was statistically significant ( p < .05). The mean PPHEN post-test scores of the patients in the intervention group were significantly higher than those in the control group ( p < .05).

Conclusion

The application of virtual reality glasses during a transrectal prostate biopsy significantly reduced the level of pain and anxiety and increased patient satisfaction.
CancerSupportSource-Spanish: Development of a Distress Screening Measure for Spanish-Speaking Hispanic and Latino Individuals with Cancer
Authors: Fortune Erica E. , Olson Julie S. , Hendershot Kelly , Zaleta Alexandra K.
Published: February 2024

Introduction: CancerSupportSource (CSS), a distress screening and referral program, identifies unmet needs of people with cancer and links them to resources and support. We developed and validated a Spanish-language version (CSS-Spanish) to better serve Hispanic and Latino communities and promote health equity. Methods: The 25-item CSS-Spanish was created leveraging rigorous translation methods and cognitive interviews to ensure cultural relevance and topical breadth. A total of 210 Spanish-speaking Hispanic and Latino individuals completed CSS-Spanish and comparison measures. Psychometric analyses examined dimensionality and statistical validation, and determined scoring thresholds for depression and anxiety risk subscales. Results: CSS-Spanish represented key concerns across five factors and exhibited strong internal consistency and test–retest reliability, convergent validity, and known-groups validity. Risk subscales demonstrated adequate sensitivity. Conclusion: CSS-Spanish is a reliable, valid multidimensional distress screener that rapidly assesses needs of Hispanic and Latino individuals. Embedded depression and anxiety risk flags can support staff in identifying those with high-acuity needs.
Using System of Least Prompts to Teach Self-Help Skills to Students Who Are Deafblind
Authors: Grattan Jill , Demchak MaryAnn
Published: February 2024

To date, no evidence-based practices are identified for working with students who are deafblind (DB). No evidence-based practices have been identified for teaching basic self-help skills such as dressing. The present study examined the efficacy of an intervention package including the system of least prompts (SLP; i.e., SLP and least-to-most prompting), visual cues, and reinforcement to teach three self-help skills (i.e., wash hands, dry hands, entry routine) to four participants, ages 3-5 years, with vision and hearing impairments and multiple disabilities. A multiple probe across behaviors design, replicated across participants, was used to evaluate the effectiveness of an intervention package including SLP to teach self-help skills. Three of four participants increased their independence for all targeted self-help skills. A functional relation is indicated for three of four participants and provides promising evidence for use of SLP in teaching individuals with multiple disabilities that include DB.
Patients With and Without Double Crush Syndrome Achieve Similar Rates of Clinical Improvement Following Carpal Tunnel Release
Authors: Hansen Logan M. , Jiang Eric X. , Hodson Noah M. , Livingston Nicholas , Kazanjian Ani , Wu Mitchell , Day Charles S.
Published: February 2024

Background:

The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies.

Methods:

Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: “Since your treatment, how would you rate your overall function?” (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID).

Results:

Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group.

Conclusions:

At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.
Assessment and evaluation of nutrition education among physicians in a tertiary paediatric specialist hospital: The need for improved clinical nutrition teaching
Authors: Roy Chowdhury Sudipta , Chia Moira Suyin , Ho Wen Wei Christopher
Published: February 2024

Background

Nutrition education is one the essential components of any paediatric residency training. However, many paediatricians world-wide have suboptimal knowledge in core clinical nutritional topics. The purpose of our study is to assess the perceived effectiveness of nutrition training among physicians, including paediatric residents, paediatric trainees and paediatricians; identify areas of need for additional education resources and the preferred method of teaching for nutritional topics for medical education.

Material and Methods

A survey-questionnaire was sent to our physicians in our centre to assess general nutrition education via self-assessment of current nutritional knowledge across 12 distinct topics; importance of teaching amongst these topics and the preferred method of teaching.

Results

A total of 64 physicians completed the survey with an overall response rate of 88%. Most responders reported having average or above-average knowledge base in all nutritional topics except for nutritional aspects of special diets. Poorest knowledge base (either below average or poor) was reported in special diet ( n = 38, 59.4%), inflammatory bowel disease ( n = 17, 26.6%) and gastrointestinal allergy ( n = 16, 25.0%). There was strong interest in additional teaching needs for the topics of failure to thrive ( n = 38, 59.4%), nutritional assessment ( n = 34, 53.1%) and infant feeding ( n = 31, 48.4%). Most popular teaching methods were clinical case review (31.7%) followed by didactic lectures (29.8%) for overall clinical nutritional education.

Conclusions

Physicians identified gaps in their nutrition knowledge base and multiple topics were identified for additional nutrition education. Preferred methods of teaching for nutritional education were clinical case reviews and didactic lectures.
At the Heart of the Community: Implementation of Echocardiographic Screening for Rheumatic Heart Disease in Primary Care Facilities of Northern Borneo Island
Authors: Jiee Sam Froze , Joo Lim Kai , Eng Pee Nai , Simon Sumeh Aini , Jantim Anisah , Shanmuganathan Selvanaayagam , Muniandy Siva Rao
Published: February 2024

Background:

Rheumatic heart disease (RHD) is a potentially life-threatening condition that causes long-standing public health concerns. Echocardiography is a reliable diagnostic and screening technique for many cardiovascular conditions, including RHD. It is commonly used in tertiary care facilities worldwide but less so in the community setting. The primary aim of this study was to introduce and elaborate on the echocardiographic screening for RHD that was implemented by a Malaysian primary care clinic in Penampang district, Sabah. We also set out to present the uptake of the service in its initial years of establishment, as well as the challenges faced.

Methods:

In the first part of this study, document reviews were conducted to compile relevant information about the conceptualization and implementation of this service. Following that, we also obtained secondary data on the echocardiographic screening service from its first implementation in April 2020 until May 2021 to examine the uptake and the patient profile.

Results:

From April 2020 to May 2021, a total of 189 echocardiographic screening was conducted by primary care doctors using handheld ultrasound. Of the 189 children screened, 19 (10.1%) were found to have cardiac anomalies and were referred for a formal echocardiogram. Upon follow-up, 8 were detected with mild mitral regurgitation and referred to the nearest tertiary hospital for further management.

Conclusion:

Based on our review, the echocardiographic screening for RHD among children conducted by the Penampang Health Clinic was deemed successful. Echocardiogram service provided by primary care centers located in suburban and rural areas is highly beneficial for patients with poor access to specialized health care services because they stay far away from tertiary care facilities. Tapping into family medicine physicians located closer to communities to conduct echocardiographic screening and review the results can improve the detection of cardiac anomalies requiring further investigation. With the success of this project, echocardiographic services in the primary healthcare setting can be expanded by garnering the necessary collaborative efforts and consistent support from various stakeholders.
Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment
Authors: Richards John T. , O’Hara Nathan N. , Healy Kathleen , Zingas Nicolas , McKibben Natasha , Benzel Caroline , Slobogean Gerard P. , O’Toole Robert V. , Sciadini Marcus F.
Published: February 2024

Introduction

When considering treatment options for geriatric patients with lower extremity fractures, little is known about which outcomes are prioritized by patients. This study aimed to determine the patient preferences for outcomes after a geriatric lower extremity fracture.

Materials and Methods

We administered a discrete choice experiment survey to 150 patients who were at least 60 years of age and treated for a lower extremity fracture at a Level I trauma center. The discrete choice experiment presented study participants with 8 sets of hypothetical outcome comparisons, including joint preservation (yes or no), risk of reoperation at 6 months and 24 months, postoperative weightbearing status, disposition, and function as measured by return to baseline walking distance. We estimated the relative importance of these potential outcomes using multinomial logit modeling.

Results

The strongest patient preference was for maintained function after treatment (59%, P < .001), followed by reoperation within 6 months (12%, P < .001). Although patients generally favored joint preservation, patients were willing to change their preference in favor of joint replacement if it increased function (walking distance) by 13% (SE, 66%). Reducing the short-term reoperation risk (12%, P < .001) was more important to patients than reducing long-term reoperation risk (4%, P = .33). Disposition and weightbearing status were lesser priorities to patients (9%, P < .001 and 7%, P < .001, respectively).

Discussion

After a lower extremity fracture, geriatric patients prioritized maintained walking function. Avoiding short-term reoperation was more important than avoiding long-term reoperation. Joint preservation through fracture fixation was the preferred treatment of geriatric patients unless arthroplasty or arthrodesis provides a meaningful functional benefit. Hospital disposition and postoperative weightbearing status were less important to patients than the other included outcomes.

Conclusions

Geriatric patients strongly prioritize function over other outcomes after a lower extremity fracture.
The Role of Osteobiologics in Augmenting Spine Fusion in Unplated Anterior Cervical Discectomy and Fusion Compared to Plated Constructs: A Systematic Review and Meta-analysis
Authors: Vadalà Gianluca , Ambrosio Luca , De Salvatore Sergio , Riew Daniel K. , Yoon S. Tim , Wang Jeffrey C. , Meisel Hans Jörg , Buser Zorica , Denaro Vincenzo ,   AO Spine Knowledge Forum Degenerative
Published: February 2024

Study Design

Systematic review and meta-analysis.

Objective

To compare clinical and radiographic outcomes as well as complications of unplated vs plated anterior cervical discectomy and fusion (ACDF) surgery considering the role of osteobiologics in single- and multi-level procedures.

Methods

A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL, Cochrane and ClinicalTrials.gov databases was performed. Briefly, we sought to identify studies comparing unplated vs. plated ACDF for cervical degenerative disc disease reporting the use of osteobiologics in terms of clinical outcomes, radiographic fusion, and complications. Data on study population, follow-up time, type of cage and plate used, type of osteobiologic employed, number of levels treated, patient-reported outcomes (PROs), radiographic outcomes and complications were collected and compared. Relevant information was pooled for meta-analyses.

Results

Thirty-eight studies met the inclusion criteria. No significant difference was found in terms of clinical outcomes between groups. Unplated ACDF was characterized by reduced blood loss, operation time and length of hospital stay. Fusion was achieved by the majority of patients in both groups, with no evidence of any specific contribution depending on the osteobiologics used. Dysphagia was more commonly associated with anterior plating, while cage subsidence prevailed in the unplated group.

Conclusion

Unplated and plated ACDF seem to provide similar outcomes irrespective of the osteobiologic used, with minor differences with doubtful clinical significance. However, the heterogeneity and high risk of bias affecting included studies markedly prevent significant conclusions.
Comparison of Different Osteobiologics in Terms of Imaging Modalities and Time Frames for Fusion Assessment in Anterior Cervical Discectomy and Fusion: A Systematic Review
Authors: Chung Andrew S. , Ravinsky Robert , Kulkarni Ronit , Hsieh Patrick C. , Arts Jacobus J. , Rodrigues-Pinto Ricardo , Wang Jeffrey C. , Meisel Hans Jörg , Buser Zorica ,   AO Spine Knowledge Forum Degenerative
Published: February 2024

Study Design

Systematic review.

Objectives

The study’s primary objective was to determine how osteobiologic choice affects fusion rates in patients undergoing anterior cervical discectomy and fusion (ACDF). The study’s secondary objectives were to 1) determine the optimal timing of fusion assessment following ACDF and 2) determine if osteobiologic type affects the timing and optimal modality of fusion assessment.

Methods

A systematic search of PubMed/MEDLINE was conducted for literature published from 2000 through October 2020 comparing anterior fusion in the cervical spine with various osteobiologics. Both comparative studies and case series of ≥10 patients were included.

Results

A total of 74 studies met the inclusion criteria. Seventeen studies evaluated the efficacy of autograft on fusion outcomes, and 23 studies assessed the efficacy of allograft on fusion outcomes. 3 studies evaluated the efficacy of demineralized bone matrix, and seven assessed the efficacy of rhBMP-2 on fusion outcomes. Other limited studies evaluated the efficacy of ceramics and bioactive glasses on fusion outcomes, and 4 assessed the efficacy of stem cell products. Most studies utilized dynamic radiographs for the assessment of fusion. Overall, there was a general lack of supportive data to determine the optimal timing of fusion assessment meaningfully or if osteobiologic type influenced fusion timing.

Conclusions

Achieving fusion following ACDF appears to remain an intricate interplay between host biology and various surgical factors, including the selection of osteobiologics. While alternative osteobiologics to autograft exist and may produce acceptable fusion rates, limitations in study methodology prevent any definitive conclusions from existing literature.
Complications of the Use Allograft in 1- or 2-Level Anterior Cervical Discectomy and Fusion: A Systematic Review
Authors: Rodrigues-Pinto Ricardo , Muthu Sathish , Diniz Sara E. , Cabrera Juan Pablo , Martin Christopher T. , Agarwal Neha , Meisel Hans Jörg , Wang Jeffrey C. , Buser Zorica ,   AO Spine Knowledge Forum Degenerative
Published: February 2024

Study Design: Systematic literature review

Objective: To critically analyze the literature and describe the complications associated with the use of allograft in 1- or 2- level anterior cervical discectomy and fusion (ACDF)

Methods: A systematic search of PubMed/MEDLINE, EMBASE, and ClinicalTrials.gov databases was conducted for literature published between January 2000 and August 2020 reporting complications associated with the use of allograft in 1- or 2- level ACDF.

Results: From 584 potentially relevant citations, 21 met the inclusion criteria (4 randomized controlled trials (RCT), 4 prospective, and 13 retrospective studies). The patient number varied between 26 and 463 in comparative studies (RCT and non-RCT) and between 29 and 345 in non-comparative studies. Fusion rate was reported in 14 studies and ranged between 68.5-100%. The most frequently reported complication was post-operative dysphagia or dysphonia, with incidences ranging between .5% and 14.4%. Revision surgery was the second most reported complication (14 studies) and ranged between 0% and 10.3%. Wound-related complications were reported in 6 studies and ranged between 0% and 22.8%.

Conclusion: The overall reporting of complications was low with very few comparative studies. Reported complications with allografts are within the range of other osteobiologics and autografts and in most cases may not attributable to the use of osteobiologics and may be complications of the procedure itself. Comparative studies with a more robust methodology analyzing complications with allograft and other osteobiologics are needed to inform current practice with strong recommendations.
Dosing Strategy for Osteobiologics Used in ACDF Surgery: Influence on Fusion Rates and Associated Complications. A Systematic Literature Review
Authors: Hamouda Waeel O. , Veranis Sotiris , Krol Oscar , Sagoo Navraj S. , Passias Peter G. , Buser Zorica , Meisel Hans Jörg , Yoon Tim ,   AO Spine Knowledge Forum Degenerative
Published: February 2024

Study Design

Systematic review.

Objective

To assess the available evidence related to dose-dependent effectiveness (i.e., bone fusion) and morbidity of osteobiologics used in anterior cervical discectomy and fusion (ACDF).

Methods

Studies with more than 9 adult patients with degenerated/herniated cervical discs operated for one-to four-levels ACDF reporting used osteobiologics doses, fusion rates at six months or later, and related comorbidities were included. PubMed, EMBASE, ClinicalTrials, and Cochrane were searched through September 2021. Data extracted in spread sheet and risk of bias assessed using MINORS and Rob-2.

Results

Sixteen studies were selected and sub-grouped into BMP and non-BMP osteobiologics. For the 10 BMP studies, doses varied from 0.26 to 2.1 mg in 649 patients with fusion rates of 95.3 to 100% at 12 months. For other osteobiologics, each of six studies reported one type of osteobiologic in certain dose/concentration/volume in a total of 580 patients with fusion rates of 6.8 to 96.9% at 12 months. Risk of bias was low in three of the 13 non-randomized (18.75%) and in all the three randomized studies (100%).

Conclusions

Taking into account the inconsistent reporting within available literature, for BMP usage in ACDF, doses lower than 0.7 mg per level can achieve equal successful fusion rates as higher doses, and there is no complication-free dose proved yet. It seems that the lower the dose the lower the incidence of serious complications. As for non-BMP osteobiologics the studies are very limited for each osteobiologic and thus conclusions must be drawn individually and with caution.
Development of an International AO Spine Guideline for the Use of Osteobiologics in Anterior Cervical Fusion and Decompression (AO-GO)
Authors: Buser Zorica , Meisel Hans Jörg , Agarwal Neha , Wu Yabin , Jain Amit , van Hooff Miranda , Alini Mauro , Yoon Sangwook Tim , Wang Jeffrey C. , Santesso Nancy ,   AO Spine Knowledge Forum Degenerative
Published: February 2024

Study Design

Methodological study for guideline development.

Objective

AO Spine Guideline for Using Osteobiologics (AO-GO) project for spine degenerative pathologies was an international, multidisciplinary collaborative initiative to identify and evaluate evidence on existing use of osteobiologics in Anterior Cervical Fusion and Decompression (ACDF). The aim was to formulate precisely defined, clinically relevant and internationally applicable guidelines ensuring evidence-based, safe and effective use of osteobiologics, considering regional preferences and cost-effectiveness.

Methods

Guideline was completed in two phases: Phase 1- evidence synthesis; Phase 2- recommendation development based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In Phase 1, key questions identified by a panel of experts were addressed in a series of systematic reviews of randomized and non-randomized studies. In Phase 2, the GRADE approach was used to formulate a series of recommendations, including expert panel discussions via web calls and face-to-face meetings.

Discussion

AO-GO aims to bridge an important gap between evidence and use of osteobiologics in spine fusion surgeries. Owing to differences in osteobiologics preparation and functional characteristics, regulatory requirements for approval may vary, therefore it is highly likely that these products enter market without quality clinical trials. With a holistic approach the guideline aims to facilitate evidence-based, patient-oriented decision-making processes in clinical practice, thus stimulating further evidence-based studies regarding osteobiologics usage in spine surgeries. In Phase 3, the guideline will be disseminated and validated using prospectively collected clinical data in a separate effort of the AO Spine Knowledge Forum Degenerative in a global multicenter clinical study.