bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization Fraction of Ambulatory Hand Procedures: Cost-Reduction Through Surgical Instrument Tray Optimization
Authors: Onuh Ogechukwu C. , Cassidy Michael F. , Tran David L. , Brydges Hilliard T. , Dorante Miguel I. , Laspro Matteo , Muller John , Guo Lifei , Agrawal Nikhil A. , Chiu Ernest S.
Published: November 2024

Background:

Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement.

Methods:

The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution’s central sterilization processing (CSP) department.

Results:

Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2).

Conclusions:

Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.
Financial Toxicity Among Patients With Traumatic Finger Amputation: A Retrospective Study
Authors: Agbafe Victor , Sears Erika D. , Gaines Clarice E. , Billig Jessica I.
Published: November 2024

Background:

Patients face increasing financial toxicity (FT), defined as emotional distress due to the cost of medical treatment. However, little is known regarding FT in the context of upper extremity trauma.

Methods:

We surveyed patients who sustained traumatic finger amputation (October 21, 2011-January 1, 2021). We collected patient-reported financial distress using the Comprehensive Score for Financial Toxicity (COST-11), where a lower score indicates worse FT. We also collected data of patients’ perceptions regarding the costs of their treatment. We used linear regression to assess patient-level characteristics associated with FT as measured by the COST-11 score.

Results:

Of the 191 eligible patients, 46 patients completed the survey (response rate of 24%). A total of 41 respondents (89%) received an initial treatment of revision amputation, with the remaining patients receiving a semi-occlusive dressing. Patients with commercial insurance had significantly lower COST-11 scores (ie, worse FT) than patients with Medicare (β = 7.5, 95% CI: 0.5 to 14.5) and Worker’s Compensation (β = 8.7, 95% CI: 1.8 to 15.6). Patients who were single/never married had significantly worse FT (β = −11.3, 95% CI: −18.7 to −3.9). Approximately 35% (n = 16) reported that the costs were higher than expected. More than a third of patients (39%) reported decreasing spending on basic items, such as food, at least once since surgery.

Conclusion:

Patients face FT when obtaining surgery following traumatic finger amputation. Variation in the FT is associated with type of insurance and marriage status, highlighting how underinsurance and social support likely affect the overall economic well-being of patients.
Chatbot Demonstrates Moderate Interrater Reliability in Billing for Hand Surgery Clinic Encounters
Authors: Latario Luke D. , Fowler John R.
Published: November 2024

Background:

Artificial intelligence offers opportunities to improve the burden of health care administrative tasks. Application of machine learning to coding and billing for clinic encounters may represent time- and cost-saving benefits with low risk to patient outcomes.

Methods:

Gemini, a publicly available large language model chatbot, was queried with 139 de-identified patient encounters from a single surgeon and asked to provide the Current Procedural Terminology code based on the criteria for different encounter types. Percent agreement and Cohen’s kappa coefficient were calculated.

Results:

Gemini demonstrated 68% agreement for all encounter types, with a kappa coefficient of 0.586 corresponding to moderate interrater reliability. Agreement was highest for postoperative encounters (n = 43) with 98% agreement and lowest for new encounters (n = 27) with 48% agreement. Gemini recommended billing levels greater than the surgeon’s billing level 31 times and lower billing levels 10 times, with 4 wrong encounter type codes.

Conclusions:

A publicly available chatbot without specific programming for health care billing demonstrated moderate interrater reliability with a hand surgeon in billing clinic encounters. Future integration of artificial intelligence tools in physician workflow may improve the accuracy and speed of billing encounters and lower administrative costs.
Lyme disease chemoprophylaxis prescribing before and after pharmacist prescriptive authority in Nova Scotia
Authors: Bell Madison , Ramsey Tasha , Trenaman Shanna , Hatchette Todd , Campbell Samuel , Bishop Andrea , MacInnis Melanie , Hurley Katrina , Black Emily
Published: November 2024

Background:

Lyme disease is a bacterial infection transmitted to humans through bites from infected Ixodes species of ticks. Prophylaxis with a single dose of oral doxycycline following a bite from an infected tick reduces the risk of developing Lyme disease. Pharmacists in Nova Scotia (NS) were among the first in Canada to prescribe for this indication. The primary objective of this study is to describe experiences with pharmacist prescribing of prophylaxis after tick bites in NS.

Methods:

A retrospective cohort study was performed using health administrative data 16 months before and after pharmacists were authorized to prescribe Lyme disease chemoprophylaxis (August 1, 2021). All dispensations of a single dose of oral doxycycline from a community pharmacy in NS were included. Data collected included prescriber type, date, and county of dispensation. Comparisons of dispensations were completed before and after pharmacists gained prescriptive authority and relative to other prescribers. Dispensations were described descriptively.

Results:

Over the study period, 12,549 single-dose doxycycline prescriptions were dispensed in NS: 3900 prescriptions were dispensed before pharmacist prescribing authorization for this indication occurred and 8649 were dispensed after. Pharmacists prescribed 61.3% of all single-dose doxycycline prescriptions following implementation of prescribing authority.

Discussion:

An increase in single-dose doxycycline prescriptions was observed in NS. Pharmacists have become the primary prescribers for Lyme disease chemoprophylaxis in the province.

Conclusion:

Patients were willing to be assessed for chemoprophylaxis after tick exposure by pharmacists, and pharmacist prescribing for this indication suggests increased access to post-tick exposure care.
Case report: successful treatment of primary intradural extramedullary extraskeletal Ewing sarcoma in adult patient with intralesional surgery, chemotherapy, and proton beam therapy of the cerebrospinal axis
Authors: Ziomek Mateusz , Placzke Joanna , Urbanek Konrad , Skóra Tomasz , Rutkowski Piotr , Spałek Mateusz Jacek
Published: November 2024

Ewing sarcoma is a rare malignant neoplasm that primarily affects bone in children. Extraskeletal location is less common, while intradural extramedullary Ewing sarcoma (IEES) in adults is a casuistic phenomenon. Due to its rarity, a standardized treatment strategy for IEES has not been established. The clinical use of proton beam therapy (PBT) for craniospinal irradiation (CSI) in the treatment of IEES has not been reported in the literature. A 41-year-old previously healthy man presented with disabling gluteal and lower extremity pain, decreased sensation, and progressive paraparesis without sphincter dysfunction. Imaging showed intradural extramedullary spinal lesions. The patient underwent urgent surgery. Histology and immunohistochemistry suggested a poorly differentiated neuroendocrine tumor. Negative chromogranin staining and a high Ki67 index prompted further investigation. Next-generation sequencing later confirmed an EWSR1/FLI1 translocation, leading to the diagnosis of extraskeletal Ewing sarcoma. The patient received standardized chemotherapy with marked clinical improvement. PBT CSI was initiated but was interrupted due to COVID-19 and other complications. At 20 months follow-up, no recurrence was observed, and the patient reported an active life. Despite intra-spinal spread and multiple complications, intensive chemotherapy combined with PBT CSI led to a favorable outcome. CSI rather than focal radiotherapy should be considered for patients with IEES limited to the cerebrospinal axis. PBT may be used as an alternative to photon radiotherapy to better spare organs at risk.
Patterns of lymph node metastasis in 441 patients with sinonasal squamous cell carcinoma
Authors: Wang Li , Wang Jie , Wang Tian , Li Yi , Song Xinmao
Published: November 2024

Background:

Due to the rarity of sinonasal squamous cell carcinoma (SNSCC), the distribution patterns of lymph node metastasis (LNM), the relationship between LNM and prognosis, and the optimal treatment of LNM lack sufficient evidence-based support.

Objectives:

To investigate the patterns of LNM in SNSCC and evaluate the impact of LNM on prognosis.

Design:

This was a retrospective cohort study.

Methods:

The medical records of 441 patients with SNSCC between 2009 and 2022 in one institution were retrospectively reviewed. We assessed the incidence, the distribution of LNM, and the relationship between LNM and long-term survival.

Results:

Seventy-three out of 441 patients (16.6%) presented LNM initially. Among the 73 patients, 34 patients (46.6%) had LNM in the region of ipsilateral level II; 22 patients (30.1%) had positive retropharyngeal lymph nodes; 20 patients (27.4%) had LNM in the region of ipsilateral level Ib; and nine patients (12.3%) had evidence of parotid LNM. Poor differentiation ( p = 0.001), nasal cavity ( p = 0.018), skin involvement ( p = 0.036), and nasopharynx involvement ( p = 0.009) were the risk factors for LNM. In the univariate and multivariate analyses, the overall survival ( p = 0.25), progression-free survival ( p = 0.22), regional failure-free survival ( p = 0.20), and distant metastasis-free survival ( p = 0.14) rates were not significantly decreased by the LNM. After the propensity score matching, LNM was still not correlated with poor long-term survival.

Conclusions:

The incidence of retropharyngeal and parotid LNM was higher than in previous studies. At initial diagnosis, the risk factors for LNM were identified, and LNM was not associated with poor survival outcomes.
Leadership competencies in early childhood education: Design and validation of a survey tool
Authors: Cross Emma , Dobson Madeleine , Brooks Jeffrey S
Published: November 2024

Leadership competencies in early childhood (EC) education present an intricate policy and practice landscape. This article provides insights into these complexities and shares a novel survey evaluation tool that can be used in services for identifying leadership competencies and gaps for ongoing professional development. The research employed a two-phase approach involving thematic analysis of governing documents and focus group interview data. This resulted in the development of five core domains of leadership competencies represented throughout a survey tool. The subsequent validation of the survey revealed both self-identified roles and demonstrated competencies among educators in Western Australian EC services. The article sheds light on discrepancies between perceived and observed leadership, suggesting the need for tailored professional development and succession planning. Insights into these dynamics contribute to a deeper understanding of effective leadership practices, offering a foundation for ongoing discourse and continual enhancement of leadership competencies in the context of EC education.
Does a Left-Wing Political Orientation Really Go Along With Greater Prosociality? A Large-Scale Empirical Investigation
Authors: Schubach Bernhard , Thielmann Isabel
Published: November 2024

The notion that political orientation is linked to prosociality has been voiced by many, suggesting that supporters of left-wing parties and ideologies may favor prosociality more than supporters of right-wing parties and ideologies. However, evidence for this proposition is inconclusive. We conducted a large-scale, preregistered analysis of the relation between political orientation and prosociality in a heterogeneous German sample (189 ≤ n≤ 1,836) using five different measures of political orientation, six incentivized economic game paradigms to measure prosocial behavior, and 10 measures of trait prosociality. Whereas we found only weak support for left-wing political preferences to be associated with more prosocial behavior, stronger evidence for said link was apparent for trait prosociality. Overall, our study suggests that political orientation and prosociality are indeed linked, thus supporting theoretical arguments. However, this link is relatively weak and depends on the way prosociality is measured.
A weight-based efficiency measure for energy dissipating devices for flexible rockfall barriers
Authors: Pimpinella Francesco , Marchelli Maddalena , De Biagi Valerio
Published: November 2024

Flexible barriers are essential passive measures which are able to protect human life, structures and infrastructures from rockfall hazards. When a barrier is impacted, a significant portion of energy dissipation is concentrated in targeted components, named brakes, which can be replaced after the rockfall event. Several technologies exist, differing in both constitutive elements and energy dissipation mechanisms, but experimental data are generally restricted by producers. The present paper compares the various technologies thanks a new efficiency index, that is the ratio between the component potentially dissipated energy and its weight. To analyse the effects of the design parameters, four of the most common brakes are analytically modelled. It is shown that the performance of the devices is variable and depends on the working mechanism and the adopted material. In particular, plastic deformation energy dissipation induced by buckling is generally more efficient than the one caused by bending. Finally, a discussion on the force that activates the brake is proposed. The proposed analyses are of paramount importance for the conceptual design of new energy dissipation devices in rockfall risk mitigation structures.
Disrupted emotion regulation and spontaneous neural activity in panic disorder: a resting-state fMRI study
Authors: Wang Hai-Yang , Guan Bei-Yan , Wang Shi-Yao , Ni Ming-Fei , Miao Yan-Wei , Tian Feng , Chen Yumin , Wu Meng-Li , Li Rui , Zhang Bing-Wei
Published: November 2024

Background:

Emotional dysregulation, particularly unconscious catastrophic cognitions, plays a pivotal role in the genesis of panic disorder (PD). However, no studies have yet applied the percentage of amplitude fluctuation (PerAF) metric in resting-state functional magnetic resonance imaging to examine spontaneous neural functioning and its relation to catastrophic cognitions in PD.

Objectives:

To explore the interplay between resting-state neural activity, functional connectivity (FC), and unconscious emotion regulation in individuals with PD.

Design:

Cross-sectional study.

Methods:

The study encompassed 51 participants, including 26 PD patients and 25 healthy individuals. The PerAF algorithm was employed to explore the local spontaneous neural activity in PD. Regions exhibiting aberrant spontaneous neural activity were used as seed points for whole-brain FC analysis. Correlations were utilized to examine associations between local neural activity patterns and neurocognitive assessments in PD.

Results:

The study revealed that compared to healthy individuals, PD patients exhibited elevated PerAF values in key emotion-regulation-related brain regions, including the ventromedial prefrontal cortex (vmPFC), striatum, amygdala, dorsomedial prefrontal cortex (dmPFC), and cerebellum. In addition, the resting-state FC between vmPFC and precuneus, as well as between the cerebellum and precuneus, was weakened in PD patients. Furthermore, positive associations were noted between PerAF measurements of vmPFC and amygdala and catastrophizing scores.

Conclusion:

PD involves regional and network-level alterations in resting-state brain activity. The fronto-striatal-limbic circuits play a critical role in catastrophic-style emotion regulation in PD patients. Reduced FC within the default mode network and cerebellum-default mode network may signify a coordination anomaly in introspection and cognitive activities in PD. These findings complement the model of implicit emotion regulation in PD and suggest potential intervention targets.
Determinants of Business Model Choices for New Entrant in the Pharmaceutical E-commerce Environment
Authors: Yang Ge
Published: November 2024

The COVID-19 pandemic has significantly impacted the pharmaceutical retail market, leading to rapid growth in the pharmaceutical e-commerce industry. Currently, the new entrant has three options for business models: offline pharmacy model, normal e-pharmacy model, and Direct-To-Patient (DTP) pharmacy model. To address this issue, this study constructs a dual-channel model that considers the enhancement coefficient of medication experience and incorporates a hospital that dominate the pharmaceutical retail market using the Hotelling model for each of the three models. The study utilizes dual-channel competition theory to compare and analyze optimal pricing and maximum profit of supply chain members under the different models, providing a decision-making mechanism for the new entrant. By comparing profits, the study finds that the DTP pharmacy model outperforms the traditional pharmacy and normal e-commerce models, providing the highest profit and the best medication experience for patients.
Can Fulfilling Sports Corporate Social Responsibility Serve as an Immunity During the COVID-19 Pandemic? A Perspective From Social Capital and Corporate Financial Performance
Authors: Lu Huei-Fu
Published: November 2024

The severe acute respiratory syndrome coronavirus 2 (COVID-19) has significantly impacted the global economy. Presently, societies and businesses are facing unprecedented environmental shifts, with the sports industry being caught in this tumultuous tide. COVID-19 has affected all sectors of the global economy, suggesting an urgent need for most enterprises to reconsider their business models. This study investigates the advantages of corporate social responsibility (CSR) engagement during the negative external events of the COVID-19 pandemic, focusing specifically on the relationship between sports CSR and corporate financial performance and risk. Its objective is to provide empirical evidence on how sports CSR activities influence firm value, especially when facing systemic risks, and determine whether engaging in sports CSR serves as an effective protective tool against stock price decline. Methodologically, this study targets 159 companies that have received the Taiwan’s iSport Corporate Award over the years, employing the event study method and regression modeling to analyze the insurance effect of executing sports CSR on corporate financial performance during the COVID-19 pandemic. By offering empirical evidence on the relationship between CSR implementation and financial performance, this study contributes to a deeper understanding of the interconnectedness between sports CSR engagement and corporate financial outcomes, further enriching research in the realm of sports finance.
Digital Organizational Culture, Organizational Readiness, and Knowledge Acquisition Affecting Digital Transformation in SMEs from Food Manufacturing Sector
Authors: Jewapatarakul Darun , Ueasangkomsate Pittawat
Published: November 2024

Small and medium-sized enterprises (SMEs) operating in Thailand’s food manufacturing sector face increasing pressure to embrace digital transformation. This study explores the critical factors influencing digital transformation in SMEs, focusing on digital organizational culture, knowledge acquisition, and organizational readiness. Drawing upon the Technology–Organization–Environment (TOE) framework, we investigate the relationships between digital organizational culture, knowledge acquisition, organizational readiness, and digital transformation. Data were collected from 198 food manufacturing SMEs using purposive sampling and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Our findings underscore the pivotal role of digital organizational culture and knowledge acquisition in facilitating digital transformation within Thai SMEs. We also reveal that organizational readiness acts as a full mediator, significantly impacting the success of digital transformation initiatives. Practically, this study highlights the importance of fostering a robust digital organizational culture through collaborative efforts and advocating for knowledge exchange from external sources. Additionally, it emphasizes the need for SMEs to allocate resources and prioritize readiness for change to ensure seamless digital transformation. Theoretically, our research contributes to a deeper understanding of the digital transformation journey within the context of SMEs in the food manufacturing industry. By aligning with the TOE framework, we provide valuable insights tailored to SMEs, offering guidance for navigating the complexities of digital transformation in today’s rapidly evolving business landscape.
Emerging Adults With a Suicide Attempt History Text More Emotionally With Peers than Family Members
Authors: Ladis Ilana , McGuinn Bailey C. , Glenn Jeffrey J. , Nobles Alicia L. , Barnes Laura E. , Teachman Bethany A.
Published: November 2024

Emotional communication is central to strong interpersonal relationships and mental health. For emerging adults, much of their interpersonal communication happens via texting, but we know little about how and with whom their emotional texting occurs. Understanding these patterns may be especially critical for emerging adults experiencing mental health crises (e.g., suicidality). This study examined how the emotional tone of texts (sent and received) varies based on texting partner (i.e., peers, which includes friends and significant others, vs. family) and within-person suicide risk. Participants were 27 emerging adults with prior, non-lethal suicide attempt(s). Linguistic Inquiry Word Count was used to label 75,928 texts. While there was variation in the specific interactions, results overall indicated that participants exchanged texts containing all emotion category words at greater rates with peers (vs. family), and this pattern generally held across within-person suicide risk level. Implications for suicide prevention/intervention efforts are discussed.
Genocide, Peripheral Fascisms, and Late Neocolonialism in Palestine/Israel and Brazil
Authors: Huberman Bruno
Published: November 2024

The Israeli genocide of the Palestinians in Gaza and the Brazilian genocide against Black and Indigenous populations provide an opportunity to investigate the processes of elimination in settler-colonial nations. This article aims to examine the conditions under which settler states can exercise sovereign power against subaltern populations. It is argued that the escalation of structural genocide to expand settler colonization and govern surplus populations was facilitated by the rise of far-right governments. Nevertheless, the Brazilian state’s capacity to exercise sovereign power has been restricted by the transition to neocolonialism, which enabled Brazilians to contain the far right. The space for the promotion of the largest genocide in recent history in Gaza was created by the Israeli effort to abort any possibility of transition to neocolonialism in Palestine, resulting in the maintenance of direct settler colonialism, the far-right government, and its close alliance with the United States.
Balancing Tradition and Modernity: The Brand Personality of Santiniketan as a Tourist Destination
Authors: Roy Shaunak
Published: November 2024

The present case study rigorously investigates the brand personality of Santiniketan, a prominent tourism destination in West Bengal, India. This research aims to explore the dominant personality dimensions that define Santiniketan’s identity and to examine potential differences in perceptions between tourists who have visited the town and those who have not. Santiniketan’s unique identity, rooted in its cultural heritage, customs and the legacy of Rabindranath Tagore, is communicated through diverse marketing campaigns and promotions. A strong and positive brand personality can set a destination apart, providing a significant competitive advantage and facilitating increased visitation rates. To evaluate Santiniketan’s brand personality, traditionally associated with peace, tranquillity and spirituality, while exploring additional dimensions such as sustainability and environmental consciousness, this study used the rigorous Destination Personality Scale by Kumar and Nayak (2018, Journal of Hospitality and Tourism Research, 42, 1, 3–25). The study employed a mixed-method approach, combining qualitative and quantitative tools, to gather data from 97 respondents through focus group interviews and surveys. Participants aged 18–70 were divided into those who had visited Santiniketan and those who had not but were knowledgeable about the destination. The findings indicate that courteousness, conformity, creativity and tranquillity significantly influence tourists’ perceptions of Santiniketan, with notable differences between visitors and non-visitors. This research contributes to the literature on destination branding by comprehensively understanding Santiniketan’s brand personality, emphasizing its cultural attributes and rich heritage as critical factors in its success as a popular tourist destination. The insights gained can assist destination marketers in aligning their strategies to enhance tourists’ perceptions and increase visitation rates. This study addresses the gap in academic inquiry into Santiniketan’s brand personality, offering valuable implications for developing and promoting similar cultural heritage destinations.
Book review: Ruchi Chaturvedi, Violence of Democracy: Interparty Conflict in South India
Authors: Mohanty Biswajit
Published: November 2024

Ruchi Chaturvedi, Violence of Democracy: Interparty Conflict in South India. Orient BlackSwan, 2023, 250 pp., ₹1125.
Enlist Women as Informal Leaders of Cultural Change
Authors: Carroll Glenn R. , Yang Lara
Published: November 2024

Using survey findings and sociolinguistic research, Carroll and Yang explain why executives should enlist women as informal leaders to change organizational culture.
Reinforcement, Erosion, and Infusion: How AI-Powered Algorithms Influence Culture
Authors: Jago Arthur S. , Fast Nathanael J.
Published: November 2024

AI-powered algorithms can reinforce and erode elements of existing organizational culture and can also be used to infuse new changes. Arthur S. Jago and Nathanael J. Fast explain why understanding these processes is critical.
An Overview of Randomized Controlled Trials Examining Prescription and Nonprescription Pharmacological Interventions for Moderate to Severe Traumatic Brain Injury
Authors: Mehrabi Sarvenaz , Flores-Sandoval Cecilia , Teasell Robert , MacKenzie Heather M. , Kurian Maria , Bateman Emma A.
Published: November 2024

Objective: To characterize randomized controlled trials (RCTs) of pharmacological interventions (prescription medications, nonprescription medications, and supplements) for the management of moderate to severe traumatic brain injury (MSTBI). Data sources: Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO for RCTs up to December 2022 inclusive in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection and data extraction: Inclusion criteria were RCT study design; participants’ mean age ≥ 18 years and ≥ 50% had MSTBI; examined ≥ 1 pharmacological intervention(s), either alone or in combination with other interventions. Two independent reviewers conducted Cochrane risk of bias assessment. Data synthesis: Three hundred thirteen RCTs (1978-2022) met inclusion criteria. A total of 146 unique pharmacotherapies and supplements were studied. The most frequently studied intervention was mannitol ( n = 20 RCTs). Mean sample size was 230.4 (4-12 737) and 195 studies (62.3%) were conducted in the acute phase post-MSTBI. Four hundred thirty-five unique outcome measures (OMs) were studied; the most common OMs used were Glasgow Outcome Scale (GOS) (29.4%), mortality (25.2%), and intracranial pressure (25.2%), Glasgow Coma Scale (GCS) (19.5%), and mean arterial pressure (17.3%), and heart rate (10%). Of the included studies, only 7% ( n = 22) had low risk of bias. Conclusion: The paucity of high-quality studies, variability in RCT methodology, sample sizes, and OMs utilization, as well as the low number of RCTs conducted in the subacute- and chronic-phase after injury pose a challenge for conducting meta-analyses to provide strong recommendations for informed decision-making in clinical practice.
Negative stiffness device for seismic protection of MDOF yielding fixed base structures: Experimental and analytical study
Authors: Pasala Dharma-Theja R. , Sarlis Apostolos A. , Nagarajaiah Satish , Reinhorn Andrei M. , Constantinou Michael C. , Taylor Douglas , Sen Debarshi , Herkal Sudheendra
Published: November 2024

Shake table tests of single degree of freedom elastic/inelastic structures have confirmed that by adding a negative stiffness device (NSD), capable of exhibiting nonlinear elastic negative stiffness, in conjunction with a viscous damper, the acceleration, inter-story drifts, and base shear can be reduced significantly. However, little is known about how the presence of NSD/damper in the first story influences the response of higher stories of a multistory structure. In this paper, shake table test results are presented that demonstrate the advantages of NSD/damper in the first story of a multidegree of freedom, three-story, fixed-base structure (MDOF-3SFS). Results confirm that deployment of NSD/damper at the first story leads to significant reductions of acceleration as well as base shear and inter-story deformations in the MDOF-3SFS. Essentially, an NSD and a damper in the first floor prevents the transmission of the input energy from the ground motion to the second and third story of the multistory structure by deflecting and dissipating energy. If the first-story displacements become excessive, NSD stiffens and prevents collapse. The efficacy of the NSD/damper system is further demonstrated by comparing it with the performance of a structure with passive viscous dampers deployed in the first story. In addition to the reduction of base shear and maximum accelerations, the NSD/damper system also restricts large deformations to the first story only, leading to minimal damage to the whole structure. Finally, an NSD-based bracing system is introduced that can be deployed in new and existing structures.
The crosstalk between alternative splicing and circular RNA in cancer: pathogenic insights and therapeutic implications
Authors: Hu Hongkun , Tang Jinxin , Wang Hua , Guo Xiaoning , Tu Chao , Li Zhihong
Published: November 2024

RNA splicing is a fundamental step of gene expression. While constitutive splicing removes introns and joins exons unbiasedly, alternative splicing (AS) selectively determines the assembly of exons and introns to generate RNA variants corresponding to the same transcript. The biogenesis of circular RNAs (circRNAs) is inextricably associated with AS. Back-splicing, the biogenic process of circRNA, is a special form of AS. In cancer, both AS and circRNA deviate from the original track. In the present review, we delve into the intricate interplay between AS and circRNAs in the context of cancer. The relationship between AS and circRNAs is intricate, where AS modulates the biogenesis of circRNAs and circRNAs in return regulate AS events. Beyond that, epigenetic and posttranscriptional modifications concurrently regulate AS and circRNAs. On the basis of this modality, we summarize current knowledge on how splicing factors and other RNA binding proteins regulate circRNA biogenesis, and how circRNAs interact with splicing factors to influence AS events. Specifically, the feedback loop regulation between circRNAs and AS events contributes greatly to oncogenesis and cancer progression. In summary, resolving the crosstalk between AS and circRNA will not only provide better insight into cancer biology but also provoke novel strategies to combat cancer.

Graphical Abstract
Molecular mechanism and application of emerging technologies in study of bacterial persisters
Authors: Yuan Shuo , Shen Yamin , Quan Yingying , Gao Shuji , Zuo Jing , Jin Wenjie , Li Rishun , Yi Li , Wang Yuxin , Wang Yang
Published: November 2024

Since the discovery of antibiotics, they have served as a potent weapon against bacterial infections; however, natural evolution has allowed bacteria to adapt and develop coping mechanisms, ultimately leading to the concerning escalation of multidrug resistance. Bacterial persisters are a subpopulation that can survive briefly under high concentrations of antibiotic treatment and resume growth after lethal stress. Importantly, bacterial persisters are thought to be a significant cause of ineffective antibiotic therapy and recurrent infections in clinical practice and are thought to contribute to the development of antibiotic resistance. Therefore, it is essential to elucidate the molecular mechanisms of persister formation and to develop precise medical strategies to combat persistent infections. However, there are many difficulties in studying persisters due to their small proportion in the microbiota and their non-heritable nature. In this review, we discuss the similarities and differences of antibiotic resistance, tolerance, persistence, and viable but non-culturable cells, summarize the molecular mechanisms that affect the formation of persisters, and outline the emerging technologies in the study of persisters.
Prediction of Salicornia europaea L. biomass using a computer vision system to distinguish different salt-tolerant populations
Authors: Cárdenas-Pérez S. , Grigore M. N. , Piernik A.
Published: November 2024

Background

Salicornia europaea L. is emerging as a versatile crop halophyte, requiring a low-cost, non-destructive method for salt tolerance classification to aid selective breeding. We propose using a computer vision system (CVS) with multivariate analysis to classify S. europaea based on morphometric and colour traits to predict plant biomass and the salinity in their substrate.

Results

A trial and validation set of 96 and 24 plants from 2 populations confirmed the efficacy. CVS and multivariate analysis evaluated the plants by morphometric traits and CIELab colour variability. Through Pearson analysis, the strongest correlations were between biomass fresh weight (FW) vs. projected area (PA) (0.91) and anatomical cross-section (ACS) vs. shoot diameter (Sd) (0.94). The PA and FW correlation retrieved different equation fits between lower and higher salt-tolerant populations (R2 = 0.93 for linear and 0.90 for 2nd-degree polynomial), respectively. The higher salt-tolerant reached a maximum biomass PA at 400 mM NaCl, while the lower salt-tolerant produced less under 200 and 400 mM. A second Pearson correlation and PCA described sample variability with 80% reliability using only morphometric-colour parameters. Multivariate discriminant analysis (MDA) demonstrated that the method correctly classifies plants (90%) depending on their salinity level and tolerance, which was validated with 100% effectiveness. Through multiple linear regression, a predictive model successfully estimated biomass production by PA, and a second model predicted the salinity substrate (Sal.s.) where the plants thrive. Plants' Sd and height influenced PA prediction, while Sd and colour difference (ΔE1) influenced Sal.s. Models validation of actual vs. predicted values showed a R2 of 0.97 and 0.90 for PA, and 0.95 and 0.97 for Sal.s. for lower and higher salt-tolerant, respectively. This outcome confirms the method as a cost-effective tool for managing S. europaea breeding.

Conclusions

The CVS effectively extracted morphological and colour features from S. europaea cultivated at different salinity levels, enabling classification and plant sorting through image and multivariate analysis. Biomass and salinity substrate were accurately predicted by modelling non-destructive parameters. Enhanced by AI, machine learning and smartphone technology, this method shows great potential in ecology, bio-agriculture, and industry.
Analysis of cutaneous leishmaniasis among military personnel in the Islamic Republic of Iran: a spatiotemporal study between 2018 and 2022, trend forecasting based on ARIMA model
Authors: Tadayonfar Reza , Dabbagh-Moghaddam Arasb , Barati Mohammad , Kazemi-Galougahi Mohammad Hassan , Aminifarsani Zahra , Jalallou Nahid , Shirzadi Mohammad Reza , Ghrachorloo Faranak , Khaghani Ramin
Published: November 2024

Background

Cutaneous leishmaniasis is one of the few infectious diseases whose global prevalence is on the rise. Iran ranks among the eight most affected countries in the world. Iranian military personnel are often sent to endemic areas for cutaneous leishmaniasis without prior immunity, and they have fewer health facilities in military centers than the general population. This study aims to comprehensively investigate the situation of cutaneous leishmaniasis in Iranian military personnel across all units from 2018 to 2022 and predict the disease trend using time series analysis up to the end of 2025.

Methods

We analyzed data from the Iranian Ministry of Health to perform spatiotemporal and descriptive analyses based on patient frequency. Variables examined included age distribution, cutaneous leishmaniasis types (zoonotic or anthroponotic), month of healthcare facility visits, and lesion locations. This study employed the ARIMA model (p = 2, d = 0, q = 1)(P = 3, D = 0, Q = 0), for time series analysis and forecasting the disease trend up to 36 months after 2022.

Results

Over five years, 2,894 patients were reported. The Esfahan, Khuzestan, and Ilam provinces had the highest average patient counts, with hot spots primarily found in central, south, southwestern, and western Iran. Although the total number of patients with zoonotic cutaneous leishmaniasis was almost equal to anthroponotic cutaneous leishmaniasis, in high-risk provinces such as Esfahan, Khuzestan, and Ilam, the confirmed cases of zoonotic cutaneous leishmaniasis were much more than anthroponotic cutaneous leishmaniasis. patient numbers peak in October and November. Demographic analysis revealed that younger patients outnumbered older patients. Lesion locations were frequent on the forelimbs and lower limbs. The time series analysis for 36 months after 2022 indicated the seasonal pattern of the disease and predicted an upward trend after 2022.

Conclusion

While overall cases have declined, provinces such as Esfahan exhibit an upward trend. The expansion of hotspots from the west and southwestern to the center and south of Iran, coupled with an increasing trend in time series analysis, suggests the potential emergence of new foci and a rise in patient numbers in the future. In provinces with high disease prevalence, preventive measures should be prioritized, particularly in Ilam, Khuzestan, and Esfahan.
Development of a habit-based intervention to support healthy eating and physical activity behaviours for pregnant women with overweight or obesity: Healthy Habits in Pregnancy and Beyond (HHIPBe)
Authors: McClelland Julia , Gallagher Dunla , Moore Sarah E , McGirr Caroline , Beeken Rebecca J , Croker Helen , Eastwood Kelly-Ann , O’Neill Roisin F , Woodside Jayne V , McGowan Laura , McKinley Michelle C
Published: November 2024

Background

The number of women entering pregnancy with overweight or obesity is increasing. This can increase the risk for excessive gestational weight gain (GWG) which is associated with health complications for mother and baby. There are limited evidence-based interventions within antenatal care settings to encourage healthy eating and physical activity behaviours and support women with managing GWG.

Methods

A previous habit-based intervention ‘Ten Top Tips for a Healthy Weight’ (10TT) was adapted and made suitable for pregnancy in line with the Medical Research Council’s (MRC) complex intervention development guidelines. It involved three key activities: (1) identifying the evidence base; (2) identifying appropriate theory; and, (3) modelling processes. A core element was integrating lived experience via personal and public involvement (PPI).

Results

The original 10TTs were adapted with PPI in line with current advice on nutrition and physical activity in pregnancy. New intervention materials were devised, including a leaflet and a logbook and app for self-monitoring to be delivered alongside a brief 1:1 conversation. Behaviour change techniques (BCTs) included in the new materials were coded using a number of behavioural taxonomies. An E-learning resource was created to help standardise the approach to delivery of the intervention and avoid stigmatising conversations.

Conclusion

Following MRC guidance for the development of complex interventions alongside significant PPI allowed for the adaption of 10TT habit-based weight management intervention into the ‘Healthy Habits in Pregnancy and Beyond’ (HHIPBe) intervention. The feasibility and acceptability of implementing this intervention in the antenatal setting will be explored in a feasibility randomised controlled trial.

Trial Registration

This study was registered on Clinical Trials as ‘Healthy Habits in Pregnancy and Beyond (HHIPBe)’ ClinicalTrials.gov Identifier: NCT04336878. The study was registered on 07/04/2020.
“It was really helpful for me, and at the same time it was really tough”: a qualitative study among Afghan peer refugee helpers in Greece
Authors: Lavdas Michalis , Sandal Gro Mjeldheim , Bendixsen Synnøve
Published: November 2024

Background

Aid workers with a refugee background are increasingly engaged in the humanitarian field. These individuals, known as peer refugee helpers (PRHs), contribute to providing psychosocial support for other refugees. However, few studies have focused on the mental health and wellbeing of PRHs.

Objectives

This study aims to investigate the experiences of PRHs of Afghan origin in the humanitarian field in Greece.

Methods

Seven focus group interviews took place in a hybrid format, online or in-person. PRHs of Afghan origin (N = 18), working for various Aid/Humanitarian Organizations (AOs), participated. Data was analyzed using template analysis.

Results

The analysis identified job resources reflected in the dimensions of sense of coherence (meaningfulness, manageability, comprehensibility) and job demands associated with role overload, role conflict, and role boundaries. Gender differences were noticeable. Specifically, female PRHs experienced empowerment, through accessing new opportunities often not available within Afghan communities. Female PRHs frequently reported going against traditional gender roles and faced negative reactions from their peers. Male PRHs reported feeling empowered through their engagement as a PRH, as it helped them fulfill their personal goals, such as becoming a good example within their families or communities.

Conclusions

Recommendations for policymakers and AOs based on the study results include: (1) Offer training, supervision, and psychosocial support for PRHs to enhance work engagement and prevent emotional exhaustion; (2) Address gender differences ensuring the protection and support of female PRHs; (3) Adopt scalable psychosocial interventions to promote agency and a concrete way of engaging with beneficiaries; (4) Formalize job roles outlining responsibilities and expectations for PRHs.
Self-directed learning in Orthopaedic trainees and contextualisation of knowledge gaps, an exploratory study
Authors: Maksoud Ahmed , AlHadeed Farah
Published: November 2024

Background

Self-Directed Learning (SDL) is a subjective concept with no universally agreed definition. The aim of this project was to obtain the perspectives of Orthopaedic trainee registrars on SDL.

Methods

Seven Orthopaedic trainees in the Southwest Peninsula region were recruited in person by the primary author as an Orthopaedic trainee on the same programme as the participants. A one-hour Microsoft teams video interview was arranged at a mutually convenient time exploring several topics including learning resources, experiential learning, learning strategies, training programme requirements and assessment. The interviews were audio recorded and transcribed verbatim. Transcripts were coded using Corbin’s and Strauss’s published coding method and analysed to develop a model of SDL in this training context.

Results

Six learning stages were identified from the coded transcripts and these stages were like Knowles’s stages of SDL. Participants felt less autonomous during the identification of knowledge gaps, goal setting and evaluation of learning stages. Participants perceived to have more control over the selection of strategies, and learning stages of SDL. The factors which influenced autonomy at various stages of SDL included supervisors, experiential learning opportunities, service provision competing with learning opportunities, training programme requirements and the power dynamic between trainees and supervisors. Self-advocacy by the trainees for experiential learning opportunities and for their progression was an additional action relevant to SDL that was evident. Online learning resources such as Orthobullets.com, YouTube videos, external revision courses, collaboration and webinars encouraged more autonomy with SDL.

Conclusions

Although the United kingdom’s Trauma and Orthopaedic curriculum is described as trainee led and SDL is encouraged, in practice Orthopaedic trainees felt limited autonomy with the various stages of SDL due to external factors including their level of experience and the training environment. Trainees’ experiences around self-advocacy highlighted the importance of a collaborative and supportive learning culture emphasising dialogue, receiving high quality feedback, and openness for successful progression.