bluuebunny/crossref_metadata_2025 huggingface dataset:
An international comparative analysis and roadmap to sustainable biosimilar markets
Authors: Alnaqbi Khalid A. , Bellanger Agnès , Brill Alex , Castañeda-Hernández Gilberto , Clopés Estela Ana , Delgado Sánchez Olga , García-Alfonso Pilar , Gyger Pius , Heinrich Daniel , Hezard Germain , Kakehasi Adriana , Koehn Cheryl , Mariotte Olivier , Mennini Francesco , Mayra Pérez-Tapia Sonia , Pistollato Michele , Saada Rowan , Sasaki Tadanori , Tambassis George , Thill Marc , Werutsky Gustavo , Wilsdon Tim , Simoens Steven
Published: August 2023

Background: Although biosimilar uptake has increased (at a variable pace) in many countries, there have been recent concerns about the long-term sustainability of biosimilar markets. The aim of this manuscript is to assess the sustainability of policies across the biosimilar life cycle in selected countries with a view to propose recommendations for supporting biosimilar sustainability.

Methods: The study conducted a comparative analysis across 17 countries from North America, South America, Asia-Pacific, Europe and the Gulf Cooperation Council. Biosimilar policies were identified and their sustainability was assessed based on country-specific reviews of the scientific and grey literature, validation by industry experts and 23 international and local non-industry experts, and two advisory board meetings with these non-industry experts.

Results: Given that European countries tend to have more experience with biosimilars and more developed policy frameworks, they generally have higher sustainability scores than the other selected countries. Existing approaches to biosimilar manufacturing and R&D, policies guaranteeing safe and high-quality biosimilars, exemption from the requirement to apply health technology assessment to biosimilars, and initiatives counteracting biosimilar misconceptions are considered sustainable. However, biosimilar contracting approaches, biosimilar education and understanding can be ameliorated in all selected countries. Also, similar policies are sometimes perceived to be sustainable in some markets, but not in others. More generally, the sustainability of the biosimilar landscape depends on the nature of the healthcare system and existing pharmaceutical market access policies, the experience with biosimilar use and policies. This suggests that a general biosimilar policy toolkit that ensures sustainability does not exist, but varies from country to country.

Conclusion: This study proposes a set of elements that should underpin sustainable biosimilar policy development over time in a country. At first, biosimilar policies should guarantee the safety and quality of biosimilars, healthy levels of supply and a level of cost savings. As a country gains experience with biosimilars, policies need to optimise uptake and combat any misconceptions about biosimilars. Finally, a country should implement biosimilar policies that foster competition, expand treatment options and ensure a sustainable market environment.
Prophylactic alpha blockers fail to prevent postoperative urinary retention following orthopaedic procedures: evidence from a meta-analysis and trial sequential analysis of comparative studies
Authors: Shan Lianliang , Sun Ping , Zhang Wenping , Zheng Xuelian , Li Hua , Wang Songling
Published: August 2023

Objective: The present systematic review and meta-analysis aimed to estimate the prophylactic effect of alpha blockers against postoperative urinary retention (POUR) in orthopaedic patients.

Methods: PubMed, Embase, Web of Science and Cochrane Library databases were searched between 1 January 1990 and 1 March 2023. The studies reporting the preventive efficacy of alpha blockers on POUR after orthopaedic procedures were identified. The pooled rates of POUR in the Intervention group (patients receiving alpha blockers) and the Control group (patients not receiving alpha blockers) were estimated and compared. The risk ratios (RRs) were calculated using the random-effects model. Subgroup analysis was performed based on surgical type. Trial sequential analysis (TSA) was conducted to confirm the robustness of pooled results.

Results: Seven studies containing 1,607 patients were identified. The rates of POUR were similar between the two groups (Intervention group: 126/748 [16.8%] VS. Control group: 168/859 [19.6%]; RR = 0.75; 95% confidence interval [CI] 0.51 to 1.09; p = 0.130; Heterogeneity: I2 = 67.1%; p = 0.006). No significant difference in the incidence of POUR was observed in either the Arthroplasty subgroup or Spine surgery subgroup. The result of TSA suggested that the total sample size of the existing evidence might be insufficient to draw conclusive results. Administrating alpha blockers was associated with a higher risk of complications (88/651 [13.5%] VS. 56/766 [7.3%]; RR = 1.73; 95% CI 1.27 to 2.37; p = 0.0005; Heterogeneity: I2 = 0%; p = 0.69).

Conclusion: Prophylactic alpha blockers do not reduce the risk of POUR in orthopaedic procedures, and administrating these drugs was associated with a higher risk of complications.

Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=409388.
Entanglement witness measurement of time-bin two-qubit states using fiber-based Franson interferometers
Authors: Hwang Kyumin , Seong Jiheon , Park Kyungdeuk , Kim Jinwook , Pramanik Tanumoy , Bae Joonwoo , Shin Heedeuk
Published: August 2023

Entanglement, that is, quantum correlations that do not have a classical counterpart, is a precondition to establishing communication protocols beyond the existing classical protocols, such as quantum key distribution, that achieves a higher level of security without computational assumptions. In this work, we present a proof of demonstration of detecting various entangled states, prepared by time-bin encoding with photons that are natural resources for long-distance quantum communication. We generate a maximally entangled state in time-bin qubits and verify the state in two ways. We first consider measurements that realize entanglement witnesses for the verification of entanglement. We then perform a quantum state tomography for the full characterization. Experimental resources are also discussed.
Muscle strength adaptation between high-load resistance training versus low-load blood flow restriction training with different cuff pressure characteristics: a systematic review and meta-analysis
Authors: Chang Hualong , Yan Jing , Lu Guiwei , Chen Biao , Zhang Jianli
Published: August 2023

Purpose: In this systematic review and meta-analysis, blood flow restriction (BFR) with low-load resistance training (BFR-RT) was compared with high-load resistance training (HL-RT) on muscle strength in healthy adults. The characteristics of cuff pressure suitable for muscle strength gain were also investigated by analyzing the effects of applying different occlusion pressure prescriptions and cuff inflation patterns on muscle strength gain.

Methods: Literature search was conducted using PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus databases to identify literature published until May 2023. Studies reporting the effects of BFR-RT interventions on muscle strength gain were compared with those of HL-RT. The risk of bias in the included trials was assessed using the Cochrane tool, followed by a meta-analysis to calculate the combined effect. Subgroup analysis was performed to explore the beneficial variables.

Results: Nineteen articles (42 outcomes), with a total of 458 healthy adults, were included in the meta-analysis. The combined effect showed higher muscle strength gain with HL-RT than with BFR-RT (p = 0.03, SMD = −0.16, 95% CI: −0.30 to −0.01). The results of the subgroup analysis showed that the BFR-RT applied with incremental and individualized pressure achieved muscle strength gain similar to the HL-RT (p = 0.8, SMD = −0.05, 95% CI: −0.44 to 0.34; p = 0.68, SMD = −0.04, 95% CI: −0.23 to 0.15), but muscle strength gain obtained via BFR-RT applied with absolute pressure was lower than that of HL-RT (p < 0.05, SMD = −0.45, 95% CI: −0.71 to −0.19). Furthermore, muscle strength gain obtained by BFR-RT applied with intermittent pressure was similar to that obtained by HL-RT (p = 0.88, SMD = −0.02, 95% CI: −0.27 to 0.23), but muscle strength gain for BFR-RT applied with continuous pressure showed a less prominent increase than that for HL-RT (p < 0.05, SMD = −0.3, 95% CI: −0.48 to −0.11).

Conclusion: In general, HL-RT produces superior muscle strength gains than BFR-RT. However, the application of individualized, incremental, and intermittent pressure exercise protocols in BFR-RT elicits comparable muscle strength gains to HL-RT. Our findings indicate that cuff pressure characteristics play a significant role in establishing a BFR-RT intervention program for enhancing muscle strength in healthy adults.

Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails; Identifier: PROSPERO (CRD42022364934).
Effects of drought hardening on the carbohydrate dynamics of Quercus acutissima seedlings under successional drought
Authors: Li Qiang , Liu Xiao , Sun Xinke , Zhao Mingming , Liu Lele , Wang Ning , Gao Qun , Fan Peixian , Du Ning , Wang Hui , Wang Renqing
Published: August 2023

Introduction

As precipitation patterns are predicted to become increasingly erratic, the functional maintenance of warm-temperate forests constitutes a key challenge for forest managers. In this study, 2-year-old Quercus acutissima seedlings were selected to elucidate the mechanisms whereby they respond to soil water fluctuations and the drought hardening effects on plant carbohydrate dynamics.

Methods

Seedlings were trained under different soil water conditions for 2 months: drought (D), well-watered (W), 1-month drought and then 1-month well-watered (D-W), and 1-month well-watered and then 1-month drought (W-D). The functional traits involved in water- and carbon-use strategies were explored at the end of the hardening period. Compared with seedlings in group W, seedlings in groups D, D-W, and W-D had increased potential for carbon uptake (i.e., light saturated point, maximum ribulose-1,5-bisphosphate (RuBP) saturated rate, and electron transport rate) and water uptake (i.e., fine root–to–coarse root ratio) and downregulated growth and mitochondrial respiration to decrease carbon consumption. After water fluctuation hardening, we performed a successional dry-down experiment for 1 month to detect carbohydrate dynamics and explore the acclimation caused by prior hardening.

Results and discussion

Our results revealed that there were more soluble sugars allocated in the leaves and more starch allocated in the stems and roots of seedlings hardened in the D, W-D, and D-W treatments than that of seedlings hardened in the W treatment. No significant changes in total non-structural carbohydrates were found. In addition, we found near-zero (seedlings trained by D and D-W treatments) or negative (seedlings trained by W-D treatment) growth of structural biomass at the end of the dry-down experiment, which was significantly lower than that of W-hardened seedlings. This suggests that there was a shift in allocation patterns between carbon storage and growth under recurrent soil drought, which can be strengthened by drought memory. We conclude that Q. acutissima seedlings adjusted water- and carbon-use strategies in response to water fluctuations, whereas stress memory can enhance their overall performance in reoccurring drought. Therefore, taking advantage of stress memory is a promising management strategy in forest nurseries, and drought-trained seedlings might be more suitable for afforestation practices in sites characterized by fluctuating soil water content, considering the ongoing global climatic changes.
Resting-state functional connectivity is modulated by cognitive reserve in early Parkinson’s disease
Authors: Di Tella Sonia , De Marco Matteo , Baglio Francesca , Silveri Maria Caterina , Venneri Annalena
Published: August 2023

Background

Fronto-striatal disconnection is thought to be at the basis of dysexecutive symptoms in patients with Parkinson’s disease (PD). Multiple reserve-related processes may offer resilience against functional decline. Among these, cognitive reserve (CR) refers to the adaptability of cognitive processes.

Objective

To test the hypothesis that functional connectivity of pathways associated with executive dysfunction in PD is modulated by CR.

Methods

Twenty-six PD patients and 24 controls underwent resting-state functional magnetic resonance imaging. Functional connectivity was explored with independent component analysis and seed-based approaches. The following networks were selected from the outcome of the independent component analysis: default-mode (DMN), left and right fronto-parietal (l/rFPN), salience (SalN), sensorimotor (SMN), and occipital visual (OVN). Seed regions were selected in the substantia nigra and in the dorsolateral and ventromedial prefrontal cortex for the assessment of seed-based functional connectivity maps. Educational and occupational attainments were used as CR proxies.

Results

Compared with their counterparts with high CR, PD individuals with low CR had reduced posterior DMN functional connectivity in the anterior cingulate and basal ganglia, and bilaterally reduced connectivity in fronto-parietal regions within the networks defined by the dorsolateral and ventrolateral prefrontal seeds. Hyper-connectivity was detected within medial prefrontal regions when comparing low-CR PD with low-CR controls.

Conclusion

CR may exert a modulatory effect on functional connectivity in basal ganglia and executive-attentional fronto-parietal networks. In PD patients with low CR, attentional control networks seem to be downregulated, whereas higher recruitment of medial frontal regions suggests compensation via an upregulation mechanism. This upregulation might contribute to maintaining efficient cognitive functioning when posterior cortical function is progressively reduced.
Can digital health researchers make a difference during the pandemic? Results of the single-arm, chatbot-led Elena+: Care for COVID-19 interventional study
Authors: Ollier Joseph , Suryapalli Pavani , Fleisch Elgar , Wangenheim Florian von , Mair Jacqueline Louise , Salamanca-Sanabria Alicia , Kowatsch Tobias
Published: August 2023

Background

The current paper details findings from Elena+: Care for COVID-19, an app developed to tackle the collateral damage of lockdowns and social distancing, by offering pandemic lifestyle coaching across seven health areas: anxiety, loneliness, mental resources, sleep, diet and nutrition, physical activity, and COVID-19 information.

Methods

The Elena+ app functions as a single-arm interventional study, with participants recruited predominantly via social media. We used paired samples T-tests and within subjects ANOVA to examine changes in health outcome assessments and user experience evaluations over time. To investigate the mediating role of behavioral activation (i.e., users setting behavioral intentions and reporting actual behaviors) we use mixed-effect regression models. Free-text entries were analyzed qualitatively.

Results

Results show strong demand for publicly available lifestyle coaching during the pandemic, with total downloads (N = 7′135) and 55.8% of downloaders opening the app (n = 3,928) with 9.8% completing at least one subtopic (n = 698). Greatest areas of health vulnerability as assessed with screening measures were physical activity with 62% (n = 1,000) and anxiety with 46.5% (n = 760). The app was effective in the treatment of mental health; with a significant decrease in depression between first (14 days), second (28 days), and third (42 days) assessments: F2,38 = 7.01, p = 0.003, with a large effect size (η2G = 0.14), and anxiety between first and second assessments: t54 = 3.7, p = <0.001 with a medium effect size (Cohen d = 0.499). Those that followed the coaching program increased in net promoter score between the first and second assessment: t36 = 2.08, p = 0.045 with a small to medium effect size (Cohen d = 0.342). Mediation analyses showed that while increasing number of subtopics completed increased behavioral activation (i.e., match between behavioral intentions and self-reported actual behaviors), behavioral activation did not mediate the relationship to improvements in health outcome assessments.

Conclusions

Findings show that: (i) there is public demand for chatbot led digital coaching, (ii) such tools can be effective in delivering treatment success, and (iii) they are highly valued by their long-term user base. As the current intervention was developed at rapid speed to meet the emergency pandemic context, the future looks bright for other public health focused chatbot-led digital health interventions.
Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia
Authors: Cases Laia , Vela Emili , Santaeugènia Gonzàlez Sebastià J. , Contel Joan Carles , Carot-Sans Gerard , Coca Marc , Pastor Marta , Carrasco Ignasi , Barbeta Conxita , Vila Anna , Amil Paloma , Plaza Aina , Pontes Caridad , Piera-Jiménez Jordi , Amblàs Jordi
Published: August 2023

Objectives

To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain).

Design

Observational, retrospective analysis of population-based central healthcare registries.

Setting and participants

Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022.

Methods

Deaths reported during the pre-pandemic period (2015–2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable “mortality”), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020–2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths’ number observed to the expected deaths’ number over the same period.

Results

The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015–2019) and 105,186 within the COVID-19 period (2020–2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, −182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45–2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27–1.34), 1.03 (1.00–1.07), 0.93 (0.89–0.97), 1.13 (1.10–1.17), and 1.07 (1.04–1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to −182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs.

Conclusion

Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people.
Analysis and prediction of improved SEIR transmission dynamics model: taking the second outbreak of COVID-19 in Italy as an example
Authors: Lu Ming , Zheng Xu-yang , Jia Wei-nan , Tian Chun-zhi
Published: August 2023

This study aimed to predict the transmission trajectory of the 2019 Corona Virus Disease (COVID-19) and analyze the impact of preventive measures on the spread of the epidemic. Considering that tracking a long-term epidemic trajectory requires explanatory modeling with more complexities than short-term predictions, an improved Susceptible-Exposed-Infected-Removed (SEIR) transmission dynamic model is established. The model depends on defining various parameters that describe both the virus and the population under study. However, it is likely that several of these parameters will exhibit significant variations among different states. Therefore, regression algorithms and heuristic algorithms were developed to effectively adapt the population–dependent parameters and ensure accurate fitting of the SEIR model to data for any specific state. In this study, we consider the second outbreak of COVID-19 in Italy as a case study, which occurred in August 2020. We divide the epidemic data from February to September of the same year into two distinct stages for analysis. The numerical results demonstrate that the improved SEIR model effectively simulates and predicts the transmission trajectories of the Italian epidemic during both periods before and after the second outbreak. By analyzing the impact of anti-epidemic measures on the spread of the disease, our findings emphasize the significance of implementing anti-epidemic preventive measures in COVID-19 modeling.
Physical fitness, cardiovascular and musculoskeletal health, and occupational performance in firefighters
Authors: Ras Jaron , Smith Denise L. , Kengne Andre P. , Soteriades Elpidoforos S. , Leach Lloyd
Published: August 2023

Introduction

To perform their work efficiently and safely, firefighters should maintain all aspects of physical fitness. Cardiac-related incidents are the leading cause of duty-related deaths in firefighters, and many firefighters have poor musculoskeletal health (MSH) that hinder their occupational performance (OP). Establishing the relationship between physical fitness, cardiovascular health (CVH), MSH and OP may add new insight on the most significant factors influencing OP in firefighters, specifically in the City of Cape Town Fire and Rescue Service (CoCTFS), which had not been studied before. Therefore, the purpose of this study was to investigate whether physical fitness, CVH and MSH were associated with OP in firefighters, in the COCTFRS.

Methods

This cross-sectional study included 283 full-time firefighters aged 20–65 years from Cape Town, South Africa. A researcher-generated questionnaire was used to collect data on sociodemographic characteristics, lifestyle factors and MSH. Physical measures were used to collect information on physical fitness, CVH, and OP [using a physical ability test (PAT)]. Linear and binary logistic regressions, adjusted for age, sex, height and weekly metabolic equivalent minutes (WMETM), multivariate analysis of covariance (MANCOVA), adjusted for age, sex, height and body mass index (BMI) and backward stepwise regressions were used to investigate the associations between the various constructs.

Results

From multivariable analyses, age, lean body mass, body fat percentage (BF%), estimated absolute oxygen consumption (abV̇O2max), grip strength, leg strength, push-ups, sit-ups, WMETM and heart rate variability were associated with PAT completion times (all p < 0.01). The MANCOVA showed a significant difference between performance categories of the PAT based on physical fitness and CVH (both p < 0.001). WMETM, BF%, abV̇O2max, grip strength, leg strength and sit-ups explained the highest proportion (50.5%) of the variation in PAT completion times.

Conclusion

Younger, non-obese, fitter and stronger firefighters, with a better CVH status, performed significantly better and were most likely to pass the PAT in firefighters, in Cape Town, South Africa. Firefighters should maintain high levels of physical fitness and a good level of CVH to ensure a satisfactory level of OP.
Association of dietary patterns and sarcopenia in the elderly population: a cross-sectional study
Authors: Wang Boshi , Wei Yanan , Shao Lin , Li Menghan , Zhang Xue , Li Wei , Zhao Shilong , Xia Xin , Liu Peng
Published: August 2023

Background: Sarcopenia, defined as the loss of muscle mass and strength, has been associated with increased hospitalization and mortality. Dietary pattern analysis is a whole diet approach which in this study was used to investigate the relationship between diet and sarcopenia. This study aims to estimate the prevalence of sarcopenia and explore possible factors associated with it among a large population in Beijing, China.

Methods: A cross-sectional study with 1,059 participants aged more than 50 years was performed. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia. The total score of the MNA-SF questionnaire was used to analyse nutrition status. The baseline demographic information, diet structure and eating habits were collected by clinicians trained in questionnaire data collection and anthropometric and bioimpedance measurements.

Results: The overall prevalence of sarcopenia was 8.8% and increased with age: 5%, 5.8%, 10.3% and 26.2% in the 50–59, 60–69, 70–79, and ≥80 years groups, respectively. Marital status (with or without a spouse) was not an independent factor associated with sarcopenia adjusted by age and sex. However, nutritional risk or malnutrition, vegetable diet, advanced age and spicy eating habits were risk factors for sarcopenia. Meanwhile, daily fruit, dairy and nut consumption were protective factors against sarcopenia adjusted by age, sex, income status and spouse status.

Conclusion: Although further studies are required to explore the association between healthy dietary patterns and the risk of sarcopenia, the present study provides basic data for identifying correlates of sarcopenia in elderly Chinese individual.
Testing the acceptability and feasibility of video observational methodology to measure parent-adolescent communication and interaction
Authors: Lekhuleni Fortunate , Desai Rachana , Coetzee Bronwyne , Pearson Rebecca , Rochat Tamsen Jean
Published: August 2023

Background

Existing research has shown that the parent-adolescent relationship and its associated communication and interaction styles are important for adolescent development and outcomes. Measuring parent-adolescent communication and interaction using self-report methods has substantial research limitations. Video observational methodologies offer a novel and more objective approach to measuring parent-adolescent communication and interaction from the point of view of participants. This study aims to explore the feasibility and acceptability of this methodology, and analysis using automated coding software in an urbanized context.

Methods

This study recruited parent-adolescent pairs in Soweto, South Africa which included 11–15-year-old adolescents and their biological parents. Parent-adolescent communication and interactions were measured using novel video observational portable head cameras called “Teencams”. Feasibility was evaluated by testing three observational game tasks (Matching pairs card game, Jenga and Charades) to stimulate communication and interaction between 16 parent-adolescent pairs, and the Teencam's ability to record video and audio content. Acceptability was explored using one-on-one interviews with the parents (n = 14), on whether they found the Teencam comfortable to wear, whether the parents believed their adolescents acted naturally, and which observational game tasks were feasible during their interactions. The videos were analysed using automated coding software called FaceReader which detects and codes basic facial expressions.

Results

The Teencam methodology was found to be feasible and acceptable amongst parent-adolescent pairs in Soweto, South Africa. The Matching pairs card game stimulated excellent interaction and communication with good video and audio quality. Some feasibility limitations were identified in the operations (switching on/off and starting recording), the ability of the device to cope with the movement of the participants, and the lighting conditions of the room, all of which resulted in poor coding and analytic output from FaceReader. Refinements and adjustments were made to the methodological protocol by improving the head cameras and lighting conditions and refining the Matching pairs card game, which resulted in improved analytic output from FaceReader.

Conclusion

Based on these findings, a methodological protocol was developed to measure parent-adolescent interaction and communication in an urban setting. The unique contribution of this research lies in its potential to lead to improved methodologies for measuring parent-adolescent communication and interactions.
Characterization of initial ankle-foot prosthesis prescription patterns in U.S. Service members following unilateral transtibial amputation
Authors: Monaghan Patrick G. , Knight Ashley D. , Brinkerhoff Sarah A. , Harrison Kenneth D. , Dearth Christopher L. , Hendershot Brad D. , Sefton JoEllen M. , Zabala Michael , Vazquez Adan , Shannon David , Crumbley David , Roper Jaimie A.
Published: August 2023

Introduction

The purpose of this study was to explore relationships between patient-specific characteristics and initial ankle-foot prosthesis prescription patterns among U.S. Service members with unilateral transtibial limb loss.

Methods

A retrospective review of health records identified 174 individuals with unilateral transtibial limb loss who received care at Walter Reed National Military Medical Center between 2001 and 2019. We examined patient-specific factors such as demographics, participant duty status at injury and amputation, amputation etiology, and timing between injury, amputation, and initial prescription. The type of first prescribed ankle-foot prosthesis was categorized as energy storing and return - nonarticulating, energy storing and return - articulating, or computer controlled.

Results

Sex, amputation etiology, time from injury to initial prescription, and time from amputation to initial prescription differed by type of initial ankle-foot prosthesis prescription. Service members with shorter intervals between injury-initial prescription and amputation-initial prescription, and those injured by combat blast, were more likely to receive a non-articulating device. Incorporating sex, time from injury-initial prescription, time from amputation-initial prescription, and amputation etiology as predictors of prosthesis type, we were able to correctly classify 72% of all first prostheses prescribed.

Discussion

Patient-specific characteristics such as sex, the time between injury-initial prescription, time from amputation-initial prescription and amputation etiology are essential characteristics that influence initial ankle-foot prosthesis prescription patterns in U.S. Service members.
A theory on ICER pricing and optimal levels of cost-effectiveness thresholds: a bargaining approach
Authors: Berdud Mikel , Ferraro Jimena , Towse Adrian
Published: August 2023

In many health systems around the world, decisions about the reimbursement of—and patient access to—new medicines are based on health technology assessments (HTA) which, in some countries, include the calculation of an incremental cost-effectiveness ratio (ICER). Decision-makers compare the ICER against a pre-specified value for money criterion, known as the cost-effectiveness threshold (CET), to decide in favour of or against reimbursement. We developed a general model of pharmaceutical markets to analyse the relationship between the CET value and the distribution of the health and economic value of new medicines between consumers (payers) and producers (life science industry developers). We added to the existing literature in three ways: including research and development (R&D) cost for developers as a sunk cost; incorporating bargaining using the Nash bargaining solution to model payer bargaining power from regulation and use of competition; and analysing the impact of a non-uniform distribution of developers R&D costs on the supply of innovation. In some circumstances of bargaining power distribution and R&D cost, we found that using a CET value in HTA decision-making higher than the supply-side CET is socially efficient. Decision-makers should consider adjustable levels of the CET or interpretation of ICERs higher than the CET according to the bargaining power effect. The findings of this research pointed to the need for more research on the impact of bargaining power, how R&D investment responds to rewards, i.e. the elasticity of innovation, and pre- and post-patent expiry modelling.
Sea Butterflies Defend Their Homes Against an Acidic Ocean
Authors: Peck Victoria Louise , Manno Clara
Published: August 2023

We all know that carbon dioxide (CO2) is produced from burning fossil fuels, and that it contributes to global warming. But have you heard about the “evil twin” of global warming, also caused by CO2–ocean acidification? The ocean absorbs about 30% of the CO2 that humans emit each year. As CO2 dissolves into the ocean, it forms carbonic acid, effectively making the ocean acidic. Animals that use a substance called calcium carbonate to build their shells and skeletons are vulnerable to acidic conditions, as their hard parts may dissolve. Microscopic swimming snails called pteropods or sea butterflies are common in the Southern Ocean. With incredibly delicate shells thinner than a human hair, pteropods are often considered to be the organisms most vulnerable to ocean acidification. Using microscopes and X-rays, we took extremely detailed images of these tiny shells and found that pteropods have a couple of clever tactics to defend their “homes” against ocean acidification.
New Technologies to Diagnose and Treat Mental Health Problems
Authors: Peled Abraham , Peled Irit
Published: August 2023

This article introduces three novel approaches and technologies to the field of mental health and psychiatry, these are: digital sensors, neural network computing, and neuromodulation pacemakers to the brain. Sensors built into devises such as smartphones and smart watches can monitor and diagnose mental disorders. Neural computing simulate how the brain may function in health and disease, thus offering valuable information about possible causes for these disorders. Finally therapeutic interventions can be achieved with brain-pacemakers technologies. Have you ever wondered what technologies such as smartphones could have to do with mental health? When we talk about mental health problems, we are usually referring to difficulties with emotions and thoughts that can affect our daily functioning. There are three new technologies that are revolutionizing how we diagnose and treat mental disorders. The first is the smartphone. Smartphone-based technology enables continuous monitoring of a patient’s mental state and allows doctors to diagnosis, evaluate, and even treat patients from afar. The second technology is neural computing, which seeks to understand the physical, brain-based causes of mental illnesses. Finally, brain pacemaker technologies may make it possible to cure mental illnesses in the same way that pacemakers currently cure heart problems. Keep reading to hear the details of each of these fascinating advances in mental healthcare!
Feeding of fish oil and medium-chain triglycerides to canines impacts circulating structural and energetic lipids, endocannabinoids, and non-lipid metabolite profiles
Authors: Jackson Matthew I. , Jewell Dennis E.
Published: August 2023

Introduction

The effect of medium-chain fatty acid-containing triglycerides (MCT), long-chain polyunsaturated fatty acid-containing triglycerides from fish oil (FO), and their combination (FO+MCT) on the serum metabolome of dogs (Canis familiaris) was evaluated.

Methods

Dogs (N = 64) were randomized to either a control food, one with 7% MCT, one with FO (0.18% eicosapentaenoate and 1.3% docosahexaenoate), or one with FO+MCT for 28 days following a 14-day washout period on the control food. Serum metabolites were analyzed via chromatography followed by mass spectrometry.

Results

Additive effects of serum metabolites were observed for a number of metabolite classes, including fatty acids, phospholipids, acylated amines including endocannabinoids, alpha-oxidized fatty acids, and methyl donors. Some effects of the addition of FO+MCT were different when the oils were combined compared with when each oil was fed separately, namely for acylcarnitines, omega-oxidized dicarboxylic acids, and amino acids. Several potentially beneficial effects on health were observed, including decreased circulating triglycerides and total cholesterol with the addition of FO (with or without MCT) and decreases in N-acyl taurines with the addition of MCT, FO, or FO+MCT.

Discussion

Overall, the results of this study provide a phenotypic characterization of the serum lipidomic response to dietary supplementation of long-chain n3-polyunsaturated and medium-chain saturated fats in canines.
Aerodynamic Characteristics of a Z-Shaped Folding Wing
Authors: Huang Yongchang , Guo Xiangying , Cao Dongxing
Published: August 2023

Z-shaped folding wings have the potential to enhance the flight performance of an aircraft, contingent upon its mission requirements. However, the current scope of research on unmanned aerial vehicles (UAVs) with Z-shaped folding wings primarily focuses on the analysis of their folding structure and aeroelasticity-related vibrations. Computational fluid dynamics methods and dynamic meshing are employed to examine the folding process of Z-shaped folding wings. By comparing the steady aerodynamic characteristics of Z-shaped folding wings with those of conventional wings, this investigation explores the dynamic aerodynamic properties of Z-shaped folding wings at varying upward folding speeds. The numerical findings reveal that the folding of Z-shaped folding wings reduces the lift-to-drag ratio, yet simultaneously diminishes the nose-down pitching moment, thereby augmenting maneuverability. Concerning unsteady aerodynamics, the transient lift and drag coefficients of the folded wing initially increase and subsequently decrease as the folding angle increases at small angles of attack. Likewise, the nose-down pitching moment exhibits the same pattern in response to the folding angle. Additionally, the aerodynamic coefficients experience a slight decrease during the initial half of the folding process with increasing folding speed. Once the wing reaches approximately 40°~45° of folding, there is an abrupt change in the transient aerodynamic coefficients. Notably, this abrupt change is delayed with higher folding speeds, eventually converging to similar values across different folding speeds.
A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone Cement
Authors: Blersch Benedikt Paul , Barthels Michael , Schuster Philipp , Fink Bernd
Published: August 2023

Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections. Methods: We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics—gentamycin and clindamycin—was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0–115.0) months. Results: Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%. Survival for any reason was significantly different between the types of revision (p = 0.026, Log-Rank-test), with lower survival rates after more complex surgical procedures. The 5-year survival rate with regard to revision for any reason was 91.3% [88.2–94.4%] and with regard to revision for PJI 98.2% [98.7–99.9%], respectively. Conclusion: The use of the dual-antibiotic-impregnated bone cement Copal G+C results in a lower rate of periprosthetic infections after aseptic knee prosthesis replacement than that reported in published prosthesis revisions using only one antibiotic in the bone cement.
Knowledge, Attitude, and Practice of Antibiotic Use and Resistance among Poultry Farmers in Nepal
Authors: Subedi Deepak , Jyoti Sumit , Thapa Bhima , Paudel Sanjay , Shrestha Prajjwal , Sapkota Deepak , Bhatt Bhuwan Raj , Adhikari Hari , Poudel Uddab , Gautam Anil , Nepal Rojina , Al-Mustapha Ahmad I.
Published: August 2023

The abuse and misuse of antibiotics is one of the main drivers of antimicrobial resistance (AMR). Globally, AMR in food-producing animals is a significant public health concern. This study, therefore, assessed the knowledge, attitudes, and practices related to antibiotic usage (AMU) and AMR among poultry farmers in Nepal. We conducted a cross-sectional survey of 605 poultry farmers from six districts of Nepal from May to June 2022 to assess the status of knowledge, attitude, as well as practices toward prudent antibiotic usage (AMU) and AMR. The majority of the participants in our study were from the Chitwan district (31.6%; n = 191/605), aged 30–44 (54.2%; n = 328/605), males (70.4%; n = 426/605), and farmers with a higher secondary (28.76%; n = 174/605) level of education. The tetracyclines (28%, n = 228/828), aminoglycosides (23%, n = 188/828), and fluoroquinolones (15%, n = 126/828) were the most used antibiotics classes among poultry farmers. Although 87.8% (n = 531/605) of poultry farmers used antibiotics, 49.8% (n = 301/605) of them were aware of AMR, and 55.7% (n = 337/605) knew that the misuse of antimicrobials could affect human and environmental health. There were significant differences in the knowledge, attitude, and practices toward prudent AMU and AMR among farmers who reared different birds. The mean knowledge, attitude, and practice score of the respondents were 7.81 ± 3.26, 5.8 ± 2.32, and 7.59 ± 3.38 when measured on a scale of 12, 10, and 15, respectively. Based on a cut-off of 75% of the maximum score, 49.4% (n = 299/605), 62.8% (n = 380/605), and 12.73% (n = 77/605) of the respondents had good knowledge, attitude, and practices toward prudent AMU and AMR, respectively. The multivariable logistic regression analyses revealed that the positive predictors of good knowledge and attitude were male gender, higher level of education, district, and the types of birds (layers). Similarly, those of the male gender (OR: 3.36; 95% CI: 1.38–8.20; p = 0.008) and those that rear layers (OR: 4.63; 95% CI: 1.75–12.25; p = 0.003) were more likely to practice prudent usage of antimicrobials. The findings of this study show poor practice toward prudent antibiotic usage despite good knowledge of AMR. This study provides essential baseline data on the knowledge, attitudes, and practices of poultry farmers in Nepal and offers valuable insights that could help in the design of interventions and policies aimed at addressing illicit AMU and AMR in poultry in Nepal.
Effect of Alpha Lipoic Acid Supplementation on Oxidative Stress and Lipid Parameters in Women Diagnosed with Low-Grade Squamous Intraepithelial Lesions (LSILs): A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Divković Anja , Karasalihović Zinaida , Rumora Samarin Ivana , Sabitović Damir , Radić Kristina , Golub Nikolina , Vujić Lovorka , Rajković Marija Grdić , Vitali Čepo Dubravka
Published: August 2023

Limited scientific evidence shows that alpha lipoic acid (ALA) can induce regression rates of low-grade squamous intraepithelial lesions (LSILs), but the mechanisms of these effects have not been elucidated. To gain a broader insight into its therapeutic potential and mechanisms of action, the effects of 3 months of supplementation with 600 mg of ALA on antioxidant and lipid status parameters in 100 patients with LSILs were investigated in a randomized, placebo-controlled study. The obtained results are discussed in terms of patients’ initial metabolic status and diet quality (particularly nutritional intake of antioxidants). The obtained results showed that oxidative status biomarkers were not significantly affected by ALA supplementation. However, serum superoxide dismutase (SOD) activity was positively affected in the subgroup of patients with higher dietary antioxidant intake. Surprisingly, ALA supplementation resulted in a small but statistically significant increase in serum low density lipoprotein (LDL), and the observed effect was significantly affected by the initial lipid status of the participants. Larger studies are necessary to gain additional insights on the clinical significance of ALA as an antioxidant and hypolipemic agent and to optimize its potential application in LSIL treatment.
Construction Quality of Prefabricated Buildings Using Structural Equation Modeling
Authors: Chai Ying , Liang Xiufeng , Liu Yi
Published: August 2023

Prefabricated construction has emerged as an inevitable trend in the development of the construction industry due to its numerous advantages, such as safety, energy saving, environmental protection, and sustainability. However, a series of operations and processes, such as prefabricated components, transportation of finished products, and on-site lifting required for fabricated buildings, can affect the quality of prefabricated buildings, especially during the construction process. This study aims to establish a systematic approach to analyzing the factors that influence the construction quality of prefabricated buildings and their interrelationships. A questionnaire was issued based on a literature review, and a model of the factors that influence the construction quality of fabricated buildings was established using structural equation modeling. Results showed that construction organization and management have a significant impact on building quality, prefabricated components, and the construction process. Moreover, they exerted the greatest influence on building quality, unlike the traditional belief that the construction process primarily affects building quality, and identified core factors influencing the quality of prefabricated construction.
CBMC: A Biomimetic Approach for Control of a 7-Degree of Freedom Robotic Arm
Authors: Li Qingkai , Pang Yanbo , Wang Yushi , Han Xinyu , Li Qing , Zhao Mingguo
Published: August 2023

Many approaches inspired by brain science have been proposed for robotic control, specifically targeting situations where knowledge of the dynamic model is unavailable. This is crucial because dynamic model inaccuracies and variations can occur during the robot’s operation. In this paper, inspired by the central nervous system (CNS), we present a CNS-based Biomimetic Motor Control (CBMC) approach consisting of four modules. The first module consists of a cerebellum-like spiking neural network that employs spiking timing-dependent plasticity to learn the dynamics mechanisms and adjust the synapses connecting the spiking neurons. The second module constructed using an artificial neural network, mimicking the regulation ability of the cerebral cortex to the cerebellum in the CNS, learns by reinforcement learning to supervise the cerebellum module with instructive input. The third and last modules are the cerebral sensory module and the spinal cord module, which deal with sensory input and provide modulation to torque commands, respectively. To validate our method, CBMC was applied to the trajectory tracking control of a 7-DoF robotic arm in simulation. Finally, experiments are conducted on the robotic arm using various payloads, and the results of these experiments clearly demonstrate the effectiveness of the proposed methodology.