bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring European decarbonisation pathways in the Power Decisions Game
Authors: Henke Hauke T. J. , Gardumi Francesco , Ellefsen Ólavur , Lítlá Marita , Lærke Bo , Karlsson Kenneth
Published: July 2024

Background

Article 12 of the Paris Agreement summons the signing parties to co-operate in improving the education of their citizens on climate change and related matters. The article thereby acknowledges the importance of citizens’ support and understanding of climate change and needed measures to fight climate change. This work aims to inform European citizens on how climate change-related policies affect the power sector in Europe. For this purpose, a serious game, based on sound principles of energy systems analysis, has been developed to allow players to explore how key policy decisions affect capacity mix, investment needs, and electricity costs.

Results

The game is based on more than 1700 scenarios run through an open-source and accessible, yet technologically detailed, myopic energy system optimisation model for the electricity supply in the EU27 + 3. The game allows the user to take the role of a decision-maker and make decisions in 2020, 2030, and 2040 regarding the usage of CCS, biomass imports, cross-border electricity transmission and the pace of emission reductions. The user is then presented with economic, social, and environmental impacts of these choices. These impacts are, for example, measured and illustrated in the development of accumulated CO2 emissions per capita, levelised cost of electricity, and investment need per citizen.

Conclusion

The Power Decisions Game provides a first-of-its-kind open-source infrastructure that allows non-modellers to explore the impact of key decisions and preferences on the design of the future European power system. Furthermore, it provides insights on the consequences of short-sighted decision making. The game can be used to facilitate policy-science discussions.
Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study
Authors: Portais Antoine , Gallouche Meghann , Pavese Patricia , Caspar Yvan , Bosson Jean-Luc , Astagneau Pascal , Pailhé Regis , Tonetti Jérôme , Duval Brice Rubens , Landelle Caroline
Published: July 2024

Background

Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI.

Methods

A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression.

Results

A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0–1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00–1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08–0.73).

Conclusions

Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
Effects of different energy levels in low-protein diet on liver lipid metabolism in the late-phase laying hens through the gut-liver axis
Authors: Hu Hong , Huang Ying , Li Anjian , Mi Qianhui , Wang Kunping , Chen Liang , Zhao Zelong , Zhang Qiang , Bai Xi , Pan Hongbin
Published: July 2024

Background

The energy/protein imbalance in a low-protein diet induces lipid metabolism disorders in late-phase laying hens. Reducing energy levels in the low-protein diet to adjust the energy-to-protein ratio may improve fat deposition, but this also decreases the laying performance of hens. This study investigated the mechanism by which different energy levels in the low-protein diet influences liver lipid metabolism in late-phase laying hens through the enterohepatic axis to guide feed optimization and nutrition strategies. A total of 288 laying hens were randomly allocated to the normal-energy and normal-protein diet group (positive control: CK) or 1 of 3 groups: low-energy and low-protein diet (LL), normal-energy and low-protein diet (NL), and high-energy and low-protein diet (HL) groups. The energy-to-protein ratios of the CK, LL, NL, and HL diets were 0.67, 0.74, 0.77, and 0.80, respectively.

Results

Compared with the CK group, egg quality deteriorated with increasing energy intake in late-phase laying hens fed low-protein diet. Hens fed LL, NL, and HL diets had significantly higher triglyceride, total cholesterol, acetyl-CoA carboxylase, and fatty acid synthase levels, but significantly lower hepatic lipase levels compared with the CK group. Liver transcriptome sequencing revealed that genes involved in fatty acid beta-oxidation (ACOX1, HADHA, EHHADH, and ACAA1) were downregulated, whereas genes related to fatty acid synthesis (SCD, FASN, and ACACA) were upregulated in LL group compared with the CK group. Comparison of the cecal microbiome showed that in hens fed an LL diet, Lactobacillus and Desulfovibrio were enriched, whereas riboflavin metabolism was suppressed. Cecal metabolites that were most significantly affected by the LL diet included several vitamins, such as riboflavin (vitamin B2), pantethine (vitamin B5 derivative), pyridoxine (vitamin B6), and 4-pyridoxic acid.

Conclusion

A lipid metabolism disorder due to deficiencies of vitamin B2 and pantethine originating from the metabolism of the cecal microbiome may be the underlying reason for fat accumulation in the liver of late-phase laying hens fed an LL diet. Based on the present study, we propose that targeting vitamin B2 and pantethine (vitamin B5 derivative) might be an effective strategy for improving lipid metabolism in late-phase laying hens fed a low-protein diet.
Anti-TIM3 chimeric antigen receptor-natural killer cells preferentially target primitive acute myeloid leukemia cells with minimal fratricide and exhaustion
Authors: Klaihmon Phatchanat , Samart Parinya , Rojanasakul Yon , Issaragrisil Surapol , Luanpitpong Sudjit
Published: July 2024

Acute myeloid leukemia (AML) is an aggressive and genetically heterogeneous disease with poor clinical outcomes. Refractory AML is common, and relapse remains a major challenge, attributable to the presence of therapy-resistant leukemic stem cells (LSCs), which possess self-renewal and repopulating capability. Targeting LSCs is currently the most promising avenue for long-term management of AML. Likewise, chimeric antigen receptor (CAR)-natural killer (NK) cells have emerged as a promising alternative to CAR-T cells due to their intrinsic potential as off-the-shelf products and safer clinical profiles. Here, we introduced a third-generation CAR harboring TIM3 scFv, CD28, 4-1BB, and CD3ζ (CAR-TIM3) into human NK-92 cells, the only FDA-approved NK cell line for clinical trials. TIM3 was chosen as a target antigen owing to its differential expression in LSCs and normal hematopoietic stem/progenitor cells (HSPCs). The established CAR-TIM3 NK-92 cells effectively targeted TIM3 and displayed potent anti-tumor activity against various primitive AML cells, subsequently causing a reduction in leukemic clonogenic growth in vitro, while having minimal effects on HSPCs. CAR-TIM3 NK-92 cells significantly reduced leukemic burden in vivo and interestingly suppressed the engraftment of AML cells into the mouse liver and bone marrow. Surprisingly, we found that CAR-TIM3 NK-92 cells expressed relatively low surface TIM3, leading to a low fratricidal effect. As TIM3 and PD-1 are immune checkpoints involved in NK cell dysfunction, we further tested and found that CAR-TIM3 NK-92 cells are beneficial for alleviating NK cell exhaustion. Our findings highlight the potential application of CAR-TIM3 NK cells for cellular immunotherapy for TIM3+ AML.
Does using artificial intelligence assistance accelerate skill decay and hinder skill development without performers’ awareness?
Authors: Macnamara Brooke N. , Berber Ibrahim , Çavuşoğlu M. Cenk , Krupinski Elizabeth A. , Nallapareddy Naren , Nelson Noelle E. , Smith Philip J. , Wilson-Delfosse Amy L. , Ray Soumya
Published: July 2024

Artificial intelligence in the workplace is becoming increasingly common. These tools are sometimes used to aid users in performing their task, for example, when an artificial intelligence tool assists a radiologist in their search for abnormalities in radiographic images. The use of artificial intelligence brings a wealth of benefits, such as increasing the efficiency and efficacy of performance. However, little research has been conducted to determine how the use of artificial intelligence assistants might affect the user’s cognitive skills. In this theoretical perspective, we discuss how artificial intelligence assistants might accelerate skill decay among experts and hinder skill acquisition among learners. Further, we discuss how AI assistants might also prevent experts and learners from recognizing these deleterious effects. We then discuss the types of questions: use-inspired basic cognitive researchers, applied researchers, and computer science researchers should seek to answer. We conclude that multidisciplinary research from use-inspired basic cognitive research, domain-specific applied research, and technical research (e.g., human factors research, computer science research) is needed to (a) understand these potential consequences, (b) design artificial intelligence systems to mitigate these impacts, and (c) develop training and use protocols to prevent negative impacts on users’ cognitive skills. Only by answering these questions from multidisciplinary perspectives can we harness the benefits of artificial intelligence in the workplace while preventing negative impacts on users’ cognitive skills.
Using learning analytics to explore peer learning patterns in asynchronous gamified environments
Authors: Moon Jewoong , McNeill Laura , Edmonds Christopher Thomas , Banihashem Seyyed Kazem , Noroozi Omid
Published: July 2024

This study explored the dynamics of students' knowledge co-construction in an asynchronous gamified environment in higher education, focusing on peer discussions in college business courses. Utilizing epistemic network analysis, sequence pattern mining, and automated coding, we analyzed the interactions of 1,319 business students. Our findings revealed that externalization and epistemic activity were prevalent, demonstrating a strong link between problem-solving and conceptual understanding. Three primary discussion types were observed: argumentative, epistemic, and social, each with unique patterns of engagement and idea integration. Effective knowledge co-construction patterns included open-ended questions with an epistemic focus, debates serving as intense knowledge co-construction arenas, and social interactions fostering a supportive and collaborative learning environment. The introduction of gamification elements led to increased student engagement and participation. Our findings emphasize the significance of structured analysis, collaboration, and argumentation in promoting effective knowledge co-construction in peer learning settings. This study offers insights into the temporal interplay of discourse dimensions and their potential for collaborative learning, enhancing our understanding of how learning analytics can be employed to discover ways in which students co-construct knowledge in asynchronous gamified environments.
Effects of normal saline versus isotonic balanced crystalloid on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries
Authors: Bala Renu , Akanksha  , Arora Vandna , Yadav Divyansh , Singh Ankur
Published: July 2024

Background

Normal saline (NS) infusion in large volumes may result in hyperchloremic metabolic acidosis and renal compromise. Balanced crystalloid (BC) with physiochemical composition akin to that of plasma may avoid these problems associated with NS. The present study aimed to evaluate effects of NS versus BC on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries.

Methods

Fifty adult patients scheduled to undergo elective neurosurgery for intracranial tumor resection were randomized to receive either NS or BC as intraoperative or maintenance fluid. Metabolic and renal parameters were estimated prior to induction (baseline), at 1 h and 2 h after induction, at the end of surgery and 4 h after extubation. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured postoperatively. Brain relaxation score was assessed by the operating surgeon.

Results

Baseline values of variables were similar between the groups. At rest of the observed time-points, pH was significantly lower, while blood urea, serum creatinine, sodium, chloride, NGAL and plasma osmolality were significantly higher in the NS group as compared to the BC group. Brain relaxation score, serum bicarbonate and base excess were comparable between the two groups.

Conclusion

Use of balanced crystalloid (plasmalyte) resulted in better metabolic and renal profile as compared to normal saline in neurosurgical patients.
Introduction of novel intravascular ultrasound preceding with angled guiding catheter (I-PAD) technique to treat chronic total occlusions in peripheral artery disease
Authors: Sobajima Mitsuo , Imamura Teruhiko , Ueno Yohei , Onoda Hiroshi , Ushijima Ryuichi , Ueno Hiroshi , Kinugawa Koichiro
Published: July 2024

Background

The optimal endovascular treatment (EVT) for chronic total occlusion (CTO) lesions in patients with peripheral artery disease (PAD) has remained unestablished. We encountered a patient with PAD in whom CTO was successfully treated using a novel technique that involved intravascular ultrasound (IVUS) and angled guiding catheter: IVUS Preceding with Angled guiDing catheter (I-PAD) technique.

Case presentation

A 74-year-old male presented with intermittent claudication attributed to CTO of the right external iliac artery. EVT was performed via the right common femoral artery. We retrogradely advanced the I-PAD system (i.e. partially extending the IVUS transducer portion from the tip of the angled guiding catheter) in the CTO lesion under the real-time guidance of IVUS imaging. We successfully traversed the CTO lesion without the use of a guidewire in approximately three minutes. The procedure concluded successfully without any procedure-related complications, following optimal stenting.

Conclusions

The I-PAD might be an effective technique to accurately, quickly, and safely pass through CTO lesions.
Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty
Authors: Abdelmeguid Yasmine , Abdelkarem Omneya , Raafat Shaymaa
Published: July 2024

Background

Alarming trends show an increase in referrals of girls with suspected early puberty. However, variations in defining precocious puberty exist. GnRH stimulation test is the gold standard diagnostic test, which is expensive and challenging to interpret. Moreover, intravenous GnRH might not be available. Therefore, we sought to evaluate the diagnostic performance of basal serum Luteinizing Hormone and Anti-Mullerian hormone in girls with central precocious puberty, as an easier alternative to GnRH stimulation test. The study was conducted on 26 Egyptian girls presenting with early puberty at age < 8 years. Several evaluations including Tanner staging and GnRH stimulation test were performed. Basal serum luteinizing hormone, follicle stimulating hormone, and anti-Mullerian hormone were analyzed, and ROC curve was performed.

Results

The mean age of the patients at diagnosis was 5 ± 2.8 years. Most patients had breast Tanner 3 (76.9%). Bone age was advanced in 65.4% of patients. Basal luteinizing hormone level significantly differed between central precocious puberty and controls (p < 0.001), with an area under the curve of 0.840. A cut-off of 0.29 IU/L provided 84.62% sensitivity and 76.92% specificity.

Conclusions

Basal luteinizing hormone out-performs follicle-stimulating hormone and anti-Mullerian hormone as a screening tool and valuable indicator of central precocious puberty, potentially reducing the necessity of GnRH stimulation test.
Study on the spatial relationship between road network and the diversity of urban public facilities: the case of the central area of Changsha City
Authors: Hu Yiwen , Liang Chao
Published: July 2024

In the context of contemporary urbanization, the significance of diversifying urban public facilities has attracted significant attention. This study examines the relationship between road network and the diversity of urban public facilities in Changsha City. These factors are measured through the Shannon-Weiner Index and Space Syntax method. To provide greater specificity, the study employs Random Forest and Geographically Weighted Regression models to analyze the relationship between road networks and the diversity of urban public facilities. The results identify a nonlinear relationship between these variables. In addition, high accessibility exhibits a stronger association with diversity than accessibility alone, and this correlation is reflected in varying degrees of inconsistency across different study areas. Finally, the cartographic depiction of diversity clusters is overlaid on the road network, demonstrating a significant relationship between the configuration of the road network and diversity patterns. In conclusion, this research emphasizes the robust correlation between the roadway network and the diversity of urban public facilities. It prompts local governments to focus beyond mere equality, with a greater commitment to enhancing the quality of life for residents through diversity.
Exploration of microRNA biomarker panel as a predictor of evolution of pancreatitis to pancreatic ductal adenocarcinoma.
Authors: Nuthakki Mira
Published: July 2024

e16343

Background: PDAC (pancreatic ductal adenocarcinoma) is 3rd most common cause of cancer deaths, and is projected to become the 2nd leading cause of cancer death by 2030 even as it comprises only 3.2% of all cancer cases. The most important predictor of survival is resection of early stage cancer. Currently, screening for early detection of PDAC via annual MRI or endoscopic ultrasound (EUS) is recommended only in the 10% of total cases, that have hereditary/ genetic associations. PDAC risk is doubled even 5 years after acute pancreatitis and is 15-16 fold for chronic pancreatitis. Biomarkers such as CA19-9, peptide panels, tumor-associated autoantibodies and microRNAs have been studied for early diagnosis of PDAC. However, biomarkers that can predict risk of PDAC following pancreatitis have not been well studied. This study aims to identify, compare, and extract a differentially expressed microRNA (DEM) panel in serum, that could predict risk of progression to PDAC from pancreatitis. Methods: Two microarray Genomic Spatial Event (GSE) datasets containing pancreatitis (n = 75), PDAC (90), and control samples (164) were used to extract DEM (n = 22), common to both pancreatitis and PDAC. 8 smaller subgroups of DEM (for cost benefit) were derived from bioinformatics methods such as ROC/AUC of expression values, up and downregulated clustering, correlation analysis, miRNA interaction networks, target gene prediction tools, target gene interaction and functional enrichment analysis for all target genes and top modules, as well as decision tree/cross-validated random forest machine learning models. Results: The DEM main group (n = 22) and the smaller subgroups were trained on the original datasets, and were used to predict the risk of pancreatic cancer vs control in a validation set consisting of six other GSE datasets. The main 22miRNA panel had the highest accuracy (0.928), F1(0.976), precision and recall, followed by subgroup 6 (accuracy 0.910, F1 0.968) derived from the target hub genes with the highest interaction (hsa-miR-28-3p, 320b, 320c, 320d, 532-5p, and 423-5p). The associated main pathways were ubi-conjugation and ubiquitin pathway, mRNA splicing/processing/binding, and endocytosis. Conclusions: A new serum 22 microRNA biomarker panel predicting evolution of pancreatitis to pancreatic ductal adenocarcinoma, and it’s associated pathways, has been identified, that also performed very well in distinguishing pancreatic cancer (with or without pancreatitis risk factor) from control. A smaller subpanel of 6 microRNA may have a cost benefit. Further studies with larger samples, specifically differentiating PDAC vs all pancreatic cancer, and acute vs chronic pancreatitis among the samples are needed.
Pancreatoblastoma: A study of demographic and socioeconomic factors.
Authors: Bitar Gabriel Anthony , Tade Yanick , Tandon Nikhita , Sadighian Assal , Silberstein Peter T. , Heise Craig , Hsia Beau
Published: July 2024

e16345

Background: Pancreatoblastoma (PB) is a rare tumor originating from pancreatic epithelial exocrine cells with a very poor prognosis. At diagnosis, it often presents with large lesions encompassing overlapping regions and may involve the entire pancreas. PB is frequently associated with distant metastasis and often occurs in children under the age of 10. An optimal treatment strategy has yet to be established. Analyzing trends in diagnoses may yield valuable information about its epidemiology. The National Cancer Database (NCDB) was utilized to uncover the demographic factors in patients diagnosed with PB. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 82 patients were found with a histologically confirmed diagnosis of PB (ICD-8971-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics. Trends in incidence were interpreted using regression analysis. Results: A total of 82 individuals in the NCDB were confirmed to be diagnosed with pancreatoblastoma between 2004-2020. The incidence rate of patients diagnosed per year is steady (R² =0.0). The average age of diagnosis was 55.3 years (SD = 15.4, range = 19-90) with women (89%) being more likely to be diagnosed compared to men (11%). None of the observed patients utilized palliative care, and from this population, 87% received surgery, and 28% received chemotherapy as their primary treatment. The majority of the patients were non-Hispanic (89%) and White (87%). Most patients were privately insured (52%) and lived in metropolitan areas with a population greater than 1 million (51%). More patients were in the highest quartile of income earners (33%), compared to those in the second, third, or fourth quartiles. Fewer patients were treated at a comprehensive community cancer program (28%) than in an academic/research program (37%). Most patients (79%) had a Charlson/Deyo comorbidity scores of 0 and were applicable to Stage I group (49%). Conclusions: This represents the first analysis of pancreatoblastoma within the NCDB to our knowledge, addressing a notable knowledge gap. Pancreatoblastoma is predominantly treated by surgery, consistent with previous case reports. Notably, our study pioneers the exploration of socioeconomic aspects among pancreatoblastoma patients. Findings reveal a higher likelihood of these patients belonging to the highest income quartile, residing in densely populated metropolitan areas, and receiving treatment within academic/research programs. Further investigation is warranted to comprehend the influence of demographic and socioeconomic variables on the diagnosis, treatment approaches, and overall survival of individuals with pancreatoblastoma.
Phase 1 dose-finding study to evaluate safety and tolerability of CVGBM in patients with newly diagnosed and surgically resected MGMT-unmethylated glioblastoma.
Authors: Tabatabai Ghazaleh , Von Baumgarten Louisa , Van Den Bent Martin J. , Burger Michael C , Freres Pierre , Glas Martin , Hau Peter , Herrlinger Ulrich , Mildenberger Iris , Neyns Bart , Schafer Henning Sebastian , Seidel Clemens , Galot Rachel , Wick Antje , Falk Martin H. , de Freitas Chama Laura Leticia , Kelemen Peter , Koch Sven D , Romer Roche Paula , Gnad-Vogt Senta Ulrike ,   CV-GBLM-001 Study Group
Published: July 2024

TPS2095

Background: Glioblastoma (GBM) is characterized by a low mutational burden limiting the number of neoantigen targets for cancer vaccines. Vaccination against tumor-associated antigens over-presented via MHC class I and II in GBM is an alternative that has shown promise in previous trials. A previous cancer vaccine containing peptides presented by HLA-A*02:01 (class I) and some DR alleles (class II), showed evidence of peripheral and intratumoral vaccine-induced immune response against these peptides in patients with GBM. Our study will assess the safety and immunogenicity of the messenger ribonucleic acid (mRNA)-based multiepitope vaccine CVGBM, an investigational therapeutic mRNA vaccine, encoding eight of these peptides that have demonstrated immunogenicity as peptide vaccines. CVGBM consists of a mRNA with unmodified nucleotides formulated with lipid nanoparticles. Methods: CV-GBLM-001 (NCT05938387) is a first-in-human, open-label, international, dose-escalation phase 1 trial. HLA-A*02:01-positive patients with newly diagnosed MGMT-unmethylated GBM (CNS WHO Grade 4), including IDH-wildtype astrocytoma with a molecular signature of unmethylated glioblastoma who have had a gross total or partial resection and who completed post-surgery radiotherapy with or without chemotherapy, are eligible to receive CVGBM. The trial comprises a dose-escalation part (Part A) followed by a dose-expansion part (Part B). In Part A, mRNA dose levels between 12 and 100 µg are being investigated and dose escalation is guided by a Bayesian logistic regression model. Patients will receive 7 doses of CVGBM by intramuscular injection on Days 1, 8, 15, 29, 43, 57, and 71, followed by 6 optional doses at 6-week intervals, up to 1 year after the first dose or until disease progression or intolerable toxicity. An independent Data and Safety Monitoring Board will recommend the dose for expansion in Part B and about 20 patients will be enrolled. Biomarkers and vaccine-induced innate and adaptive immunogenicity, including, but not limited to, systemically induced cytokines and chemokines and antigen-specific CD4+ and CD8+ T cells, will be monitored in the blood, and optionally in vaccine-draining lymph nodes and progressive tumors. In addition to the primary safety objectives, secondary objectives of efficacy (progression-free survival, overall survival) and patient-reported quality of life outcomes will be assessed. Trial sponsor: CureVac SE, Germany. Clinical trial information: NCT05938387 .
Predictive Validity of Anesthesiologists’ Quality of Clinical Supervision and Nurse Anesthetists’ Work Habits Assessed by Their Associations With Operating Room Times
Authors: Dexter Franklin , Epstein Richard H. , Dillman Dawn , Hindman Bradley J. , Mueller Rashmi N.
Published: July 2024

BACKGROUND:

At all Joint Commission-accredited hospitals, the anesthesia department chair must report quantitative assessments of anesthesiologists’ and nurse anesthetists’ (CRNAs’) clinical performance at least annually. Most metrics lack evidence of usefulness, cost-effectiveness, reliability, or validity. Earlier studies showed that anesthesiologists’ clinical supervision quality and CRNAs’ work habits have content, convergent, discriminant, and construct validity. We evaluated predictive validity by testing for (expected) small but statistically significant associations between higher quality of supervision (work habits) and reduced probabilities of cases taking longer than estimated.

METHODS:

Supervision quality of each anesthesiologist was evaluated daily by assigned trainees using the 9-item de Oliveira Filho scale. The work habits of each CRNA were evaluated daily by assigned anesthesiologists using a 6-item scale. Both are scored binary, 1 if all items are rated the maximum, 0 otherwise. From 40,718 supervision evaluations and 53,722 work habit evaluations over 8 fiscal years, 16 mixed-effects logistic regression models were estimated, with raters as fixed effects and ratees (anesthesiologists or CRNAs) as random effects. Empirical Bayes means in the logit scale were obtained for 561 anesthesiologist-years and 605 CRNA-years. The binary-dependent variable was whether the case took longer than estimated from the historical mean time for combinations of scheduled procedures and surgeons. From 264,060 cases, 8 mixed-effects logistic regression models were fitted, 1 per fiscal year, using ratees as random effects. Predictive validity was tested by pairing the 8 one-year analyses of clinical supervision, and the 8 one-year analyses of work habits, by ratee, with the 8 one-year analyses of whether OR time was longer than estimated. Bivariate errors in variable linear least squares linear regressions minimized total variances.

RESULTS:

Among anesthesiologists, 8.2% (46/561) had below-average supervision quality, and 17.7% (99/561), above-average. Among CRNAs, 6.3% (38/605) had below-average work habits, and 10.9% (66/605) above-average. Increases in the logits of the quality of clinical supervision were associated with decreases in the logits of the probabilities of cases taking longer than estimated, unitless slope = −0.0361 (SE, 0.0053), P < .00001. Increases in the logits of CRNAs’ work habits were associated with decreases in the logits of probabilities of cases taking longer than estimated, slope = −0.0238 (SE, 0.0054), P < .00001.

CONCLUSIONS:

Predictive validity was confirmed, providing further evidence for using supervision and work habits scales for ongoing professional practice evaluations. Specifically, OR times were briefer when anesthesiologists supervised residents more closely, and when CRNAs had better work habits.
Diverse stimuli induce piloerection and yield varied autonomic responses in humans
Authors: McPhetres Jonathon
Published: July 2024

This research provides an in-depth exploration into the triggers and corresponding autonomic responses of piloerection, a phenomenon prevalent across various species. In non-human species, piloerection occurs in reaction to a variety of environmental changes, including social interactions and temperature shifts. However, its understanding in humans has been confined to emotional contexts. This is problematic because it reflects solely upon subjective experience rather than an objective response to the environment. Further, given our shared evolutionary paths, piloerection should function similarly in humans and other animals. I observed 1198 piloerection episodes from eight participants while simultaneously recording multiple autonomic and body temperature indices, finding that piloerection in humans can be elicited by thermal, tactile, and audio-visual stimuli with equal effectiveness. The data also revealed variations in cardiac reactivity measures: audio-visual piloerection was associated with greater sympathetic arousal, while tactile piloerection was linked to greater parasympathetic arousal. Despite prevailing notions of piloerection as a vestigial response in humans, it does respond to decreases in skin temperature and is associated with a rise in skin temperature during episodes. This research underscores that piloerection in humans is not purely vestigial, nor is it solely an affective response to emotional stimuli. Rather, it is best understood as a reflexive response to environmental changes, suggesting a shared functional similarity with other species.
Physical Activity Patterns in Adolescents and Adults with Intellectual and Developmental Disabilities
Authors: Helsel Brian C. , Bodde Amy E. , Ptomey Lauren T. , Sherman Joseph R. , Rice Anna , Donnelly Joseph E. , Washburn Richard A.
Published: July 2024

Introduction

Limited information exists on the descriptive epidemiology of physical activity (PA) in individuals with intellectual disabilities (ID). The purpose of this study was to report device-measured PA and sedentary time for individuals with ID (age 10–70 yr) eligible to participate in PA promotion (i.e., self-reported PA <60–90 min·wk−1) and weight loss (i.e., body mass index ≥25 kg·m−2) clinical trials. We aimed to examine patterns of PA by diagnosis within a day and across days and US meteorological seasons.

Methods

This cross-sectional study used baseline accelerometer data from individuals with ID participating in clinical trials. The Troiano adult and Freedson child cut-points were used to classify sedentary time and PA, and Wilcoxon rank sum or Kruskal–Wallis tests assessed differences by age, diagnosis, weekday versus weekend, time of day, and season. Mixed effects linear regressions explored the effect of time of day, weekend, and season on PA and sedentary time.

Results

There were 330 individuals (57% female) who had valid wear time with an average of 14 ± 18 min·d−1 of moderate-to-vigorous PA (age 10–17 yr: 13 ± 16 min·d−1; age 18–24 yr: 18 ± 23 min·d−1; age ≥25 yr: 12 ± 13 min·d−1). Fewer minutes of moderate-to-vigorous PA were observed on the weekends (β = −0.10, P < 0.001) and in the morning (before 0900 h, β = −0.23, P < 0.001) and evening (after 1900 h, β = −0.32, P < 0.001) compared to weekdays and late afternoon (1500–1659h).

Conclusion

The promotion of PA to individuals with ID is needed, particularly during times when these individuals are not in school or at work (i.e., mornings, evenings, and weekends). Future research should explore PA patterns in adolescents and adults with ID who are normal weight and regularly participating in PA, sport, and fitness programs.
Paravertebral vs. Epidural Analgesia for Liver Surgery (PEALS): Protocol for a randomized controlled pilot study
Authors: Mizubuti Glenio B. , Ho Anthony M.-H. , DuMerton Deborah , Phelan Rachel , Hopman Wilma M. , Cheng Camilyn , Xiong Jessica , Shelley Jessica , Vowotor Elorm , Nanji Sulaiman , Jalink Diederick , Lima Lais Helena Navarro e
Published: July 2024

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing. However, TEA has a high failure rate and is associated with potentially devastating complications (spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. The purpose of this pilot RCT is to compare continuous TEA (traditional standard of care is local anesthetic (LA) + opioids) with PVB (traditional standard of care is with LA without opioid) for patients undergoing hepatectomy. We hypothesise that pain outcomes will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, have fewer opioid-related side effects and a shorter hospital length of stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932
Probiotic effect in preterm neonates with sepsis - A systematic review protocol
Authors: Iqbal Faiza , Siva N , Kolibylu Raghupathy Manasa , Edward S Lewis Leslie , Barche Apurv , Purkayastha Jayashree , S Nayak Baby
Published: July 2024

Background: The microbiota in the intestine is made up of trillions of living bacteria that coexist with the host. Administration of antibiotics during neonatal infection causes depletion of gut flora resulting in gut dysbiosis. Over the last few decades, probiotics have been created and promoted as microbiota management agents to enrich gut flora. Probiotics decrease the overgrowth of pathogenic bacteria in the gut of preterm neonates, reducing the frequency of nosocomial infections in the Neonatal Intensive Care Unit (NICUs). Methods: The systematic review will include randomized control trials (RCTs) of premier neonates with sepsis. Studies will be retrieved from global databases like Cochrane CENTRAL, CINAHL Plus via EBSCO host, MEDLINE via PubMed, EMBASE, SCOPUS, Ovid, Web of Science, ProQuest Medical Library, Microsoft academic, and DOAJ by utilizing database-specific keywords. Screening, data extraction, and critical appraisal of included research will be carried out separately by two review writers. Findings will be reported in accordance with the PRISMS-P 2020 guidelines. Conclusions: The findings of this systematic review will help to translate the evidence-based information needed to encourage the implementation of potential research output in the field of neonatal intensive care, guide best clinical practise, assist policy making and implementation to prevent gut dysbiosis in neonates with sepsis by summarising and communicating the evidence on the topic. PROSPERO registration number: This systematic review protocol has been registered in PROSPERO (Prospective Register of Systematic Reviews) on 10th March 2022. The registration number is CRD42022315980.
Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study
Authors: Vasthare Ramprasad , Ballal Nidambur Vasudev , Nayak Prajna P , Kamath Pujan , Singla Nishu , Hegde Thrisha
Published: July 2024

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Fisher’s Exact Test test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.
The one-humped camel: The animal of future, potential alternative red meat, technological suitability and future perspectives
Authors: Djenane Djamel , Aider Mohammed
Published: July 2024

The 2020 world population data sheet indicates that world population is projected to increase from 7.8 billion in 2020 to 9.9 billion by 2050 (Increase of more than 25%). Due to the expected growth in human population, the demand for meats that could improve health status and provide therapeutic benefits is also projected to rise. The dromedary also known as the Arabian camel, or one-humped camel (Camelus dromedarius), a pseudo ruminant adapted to arid climates, has physiological, biological and metabolic characteristics which give it a legendary reputation for surviving in the extreme conditions of desert environments considered restrictive for other ruminants. Camel meat is an ethnic food consumed across the arid regions of Middle East, North-East Africa, Australia and China. For these medicinal and nutritional benefits, camel meat can be a great option for sustainable meat worldwide supply. A considerable amount of literature has been published on technological aspects and quality properties of beef, lamb and pork but the information available on the technological aspects of the meat of the one humped camel is very limited. Camels are usually raised in less developed countries and their meat is as nutritionally good as any other traditional meat source. Its quality also depends on the breed, sex, age, breeding conditions and type of muscle consumed. A compilation of existing literature related to new technological advances in packaging, shelf-life and quality of camel meat has not been reviewed to the best of our knowledge. Therefore, this review attempts to explore the nutritional composition, health benefits of camel meat, as well as various technological and processing interventions to improve its quality and consumer acceptance. This review will be helpful for camel sector and highlight the potential for global marketability of camel meat and to generate value added products.
Expression of Fascin and SALL4 in odontogenic cysts and tumors: an immunohistochemical appraisal.
Authors: Kulkarni Spoorti , Alampally Harishanker , Guddattu Vasudev , Rodrigues Gabriel , Carnelio Sunitha
Published: July 2024

Background Various stemness markers (SOX2, OCT4, and NANOG) have been studied in odontogenic cysts and tumors. However, studies on SALL4 having similar properties of stemness has not been documented. Additionally, insight into fascin as a migratory molecule is less explored. In this study, the expression of SALL4 and fascin were evaluated in ameloblastoma, adenomatoid odontogenic tumor (AOT), odontogenic keratocyst (OKC), dentigerous cyst (DC), radicular cyst (RC), and calcifying odontogenic cyst (COC). Methods Semi-quantitative analysis of fascin and SALL4 immuno-positive cells was done in a total of 40 cases of ameloblastoma (11 plexiform, 12 follicular, 12 unicystic, and 5 desmoplastic) variants, 6 cases of AOT, 15 each of OKC, DC, RC and 5 of COC. Chi-square test was applied to evaluate the association between SALL4 and fascin expression in odontogenic cysts and tumors. Results Fascin immunopositivity was observed in peripheral ameloblast-like cells, and the expression was weak or absent in stellate reticulum-like cells. A moderate to weak immune-reactivity to SALL4 was observed in the cytoplasm of ameloblastoma, epithelial cells of dentigerous and radicular cysts, having a marked inflammatory infiltrate, which was an interesting observation. COC and AOT had negative to weak expressions. No recurrence has been reported. Conclusions Expression of fascin in ameloblastomas elucidate their role in motility and localized invasion. Its expression in less aggressive lesions like DC, COC, AOT will incite to explore the other functional properties of fascin. SALL4 expression in the cytoplasm of odontogenic cysts and tumors may represent inactive or mutant forms which requires further validation.
Case Report: A case of a multivisceral echinococcosis with atypical localization
Authors: Kaddoussi Rania , Jellazi Mohamed , Mizouni Abdelkader , Chamtouri Ikram , Abdelaaly Mabrouk , Migaou Asma , Ben Brahim Hager , Fahem Nessrine , Ben Saad Ahmed , Joober Sameh , Cheikhmhamed Saoussen , Rouetbi Naceur
Published: July 2024

Hydatidosis is a pathology that is still common. Hydatid cysts commonly involves the liver and lung. Cases of multi visceral echinococcosis with atypical localization are rare. We, herein, report the case of a 53-year-old Maghrebi farmer with multiple organ hydatidosis including 13 hydatid cysts involving the lungs, the liver, the left heart ventricle, the left kidney, the abdomen cavity, the muscles (psoas, adductors), and the subcutaneous gluteal area. The majority of these cysts were already treated surgically, and some of them were due to be removed.
The open field assay is influenced by room temperature and by drugs that affect core body temperature
Authors: Jimenez Jessica A. , McCoy Eric S. , Lee David F. , Zylka Mark J.
Published: July 2024

Background The open field assay is used to study anxiety-related traits and anxiolytic drugs in rodents. This assay entails measuring locomotor activity and time spent in the center of a chamber that is maintained at ambient room temperature. However, the ambient temperature in most laboratories varies daily and seasonally and can differ between buildings. We sought to evaluate how varying ambient temperature and core body temperature (CBT) affected open field locomotor activity and center time of male wild-type (WT, C57BL/6) and Transient Receptor Potential Subfamily M Member 8 (Trpm8) knock-out (Trpm8-/- ) mice. TRPM8 is an ion channel that detects cool temperatures and is activated by icilin. Methods Mice were placed in the open field at 4°C and 23°C for 1 hour. Distance traveled and time spent in the center were measured. Mice were injected with icilin, M8-B, diazepam, or saline, and changes in activity level were recorded. Results The cooling agent icilin increased CBT and profoundly reduced distance traveled and center time of WT mice relative to controls. Likewise, cooling the ambient temperature to 4°C reduced distance traveled and center time of WT mice relative to Trpm8-/- mice. Conversely, the TRPM8 antagonist (M8-B) reduced CBT and increased distance traveled and center time of WT mice when tested at 4°C. The TRPM8 antagonist (M8-B) had no effect on CBT or open field behavior of Trpm8-/- mice. The anxiolytic diazepam reduced CBT in WT and Trpm8-/- mice. When tested at 4°C, diazepam increased distance traveled and center time in WT mice but did not alter open field behavior of Trpm8-/- mice. Conclusions Environmental temperature and drugs that affect CBT can influence locomotor behavior and center time in the open field assay, highlighting temperature (ambient and core) as sources of environmental and physiologic variability in this commonly used behavioral assay.