bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of low molecular weight heparin combined with air pressure in the prevention of lower extremity venous thrombosis after cesarean section: A single-center retrospective study
Authors: Guo Jian , Li Chenhao , Yu Peidong , Xu Tongjie , Zhou Haoge , Chen Hao
Published: April 2023

In this study, we investigated the effect of low-molecular-weight heparin combined with pneumatic pressure in preventing lower extremity deep vein thrombosis after cesarean section, as well as on the visual analog scale (VAS) score. 120 women who underwent cesarean sections at full term in our hospital from January 2019 to January 2022 were included and divided into a control group (55 cases) and an observation group (65 cases) based on the different treatment methods: the control group was treated with low-molecular-weight heparin and the observation group was treated with pneumatic compression therapy based on the control group. The 2 groups were analyzed for thrombosis, clinical efficacy of the treatment methods, and VAS scores. The incidence of deep vein thrombosis in the observation group were significantly lower than in the control group (4.62% vs 21.82%, P < .05). There were no statistically significant differences in activated partial thromboplastin time, prothrombin time, and thrombin time between the 2 groups (P > .05) before treatment; however, after treatment, activated partial thromboplastin time, prothrombin time, and thrombin time in the observation group were significantly higher than those in the control group (P < .05). The clinical efficacy was significantly higher in the observation group compared with the control group (95.38% vs 78.18%, respectively). The VAS scores in the observation group were significantly lower than those in the control group (P < .05). Hence, low-molecular-weight heparin combined with pneumatic pressure therapy significantly reduces the incidence of lower limb deep vein thrombosis after cesarean section. It also improves the coagulation index and reduces post-operative pain. Therefore, it should be considered for use in clinical practice.
The prognostic impact of lymphovascular invasion for upper urinary tract urothelial carcinoma: A propensity score-weighted analysis
Authors: Chang Yin Lun , Chen Yen Ta , Wang Hung Hen , Chiang Po Hui , Cheng Yuan Tso , Kang Chih Hsiung , Chuang Yao Chi , Lee Wei Chin , Yang Wen Chou , Liu Hui Ying , Su Yu Li , Huang Chun Chieh , Tse Sung Min , Luo Hao Lun
Published: April 2023

Lymphovascular invasion (LVI) predicts poor survival in patients with pathologically localized or locally advanced upper urinary tract urothelial carcinoma (UT-UC). However, LVI is associated with high tumor grade, tumor necrosis, advanced tumor stage, tumor location, concomitant carcinoma in situ, lymph node metastasis, and sessile tumor architecture. These factors might interfere with the analysis of the impact of LVI on oncological prognosis. To address this, this study aimed to clarify the relationship between LVI and patient prognosis in UT-UC using propensity score weighting. Data were collected from 789 patients with UT-UC treated with radical nephroureterectomy without chemotherapy. We evaluated the significance of LVI in predicting metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) using propensity score weighting. All weighted baseline characteristics included in the propensity score model were balanced between the LVI (+) and LVI (−) groups. The MFS, CSS, and OS were all significantly poorer in the LVI (+) group. For patients without LVI, the 5-year MFS, CSS, and OS rates were 65.3%, 73.1%, and 67.3%, respectively, whereas the corresponding rates were 50.2%, 63.8 %, and 54.6%, respectively, for patients with LVI. (all P < .001). For patients without LVI, the 10-year MFS, CSS, and OS rates were 61.5%, 69.6%, and 59.2%, respectively, whereas those for patients with LVI were 44.5%, 57.0%, and 42.7%, respectively (all P < .001). LVI is an important pathological feature that predicts metastasis development and worse survival outcome after radical surgery in UT-UC patients.
Global research trends and hotspots of PI3K/Akt signaling pathway in the field of osteoarthritis: A bibliometric study
Authors: Zhang Rui , Deng Xiaoqin , Liu Quan , Zhang Xintian , Bai Xinxin , Weng Shaohuang , Chen Min
Published: April 2023

The phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway has gradually become a new target for the treatment of osteoarthritis (OA). Numerous studies of PI3K/Akt signaling in OA have been published in the past few years. By analyzing these research characteristics and qualities, we aimed to reveal the current research focus and emerging trends in PI3K/Akt signaling in OA. We searched the Web of Science database for relevant articles concerning the PI3K/Akt signaling pathway in OA published from inception to October 31, 2022. The following data were extracted: author name, article title, keywords, topic, publication country/region, institution, publication journal, journal impact factor, number of times cited, and H-index. VOSviewer and Excel 2019 were used to conduct the bibliometric study and visualize the analysis. A total of 374 publications were included in this study. In all selected articles, “orthopedics” was the dominant topic (252 of 374, 67.38%). The most productive year was 2021. Frontiers in Pharmacology published the most articles. The People’s Republic of China has published the most articles worldwide. The top 5 keywords were “OA,” “expression,” “apoptosis,” “chondrocytes,” and “inflammation.” The keywords “autophagy,” “mitochondrial dysfunction,” “inflammatory response,” “cartilage degeneration,” and “network pharmacology” have increased in recent years. Our study showed a growing trend in published articles related to the PI3K/Akt signaling pathway in OA. Inflammatory response, cartilage degeneration, and apoptosis remain central topics in the field. Research on autophagy, mitochondrial dysfunction, and network pharmacology is on the rise, and the focus on PI3K/Akt will continue to increase.
Application of low molecular weight heparins in umbilical artery thrombosis: A case series and review of the literature
Authors: Wang Ting , Yao Yingsha , Xu Ting , Wang Wenshan , Zhou Yimin , He Jing , Jiang Ruoan
Published: April 2023

Rationale:

Low molecular weight heparins are widely used in various thrombotic diseases and exert a preventive effect on thrombosis in high-risk patients. Umbilical artery thrombosis (UAT) is a rare occurrence that is difficult to detect during routine prenatal visits but can lead to adverse perinatal outcomes.

Patient concerns:

The aim of this study was to elucidate the therapeutic effect of low molecular weight heparins on UAT and to provide a new treatment option for the timing of delivery timing.

Diagnoses and interventions:

A retrospective study was conducted on cases involving thrombosis of the umbilical cord enrolled from July 2017 to July 2022. Data were acquired and analyzed from medical records and the final diagnosis was confirmed by histopathology. All included patients received LWMHs therapy after initial diagnosis of UAT.

Outcomes:

The mean age of the 10 pregnant women recruited into this study was 27.9 ± 4.0 year-of-age; 1 (10%) was elderly. The gestational age at diagnosis was 29.9 ± 3.7 weeks, the gestational age at termination was 36.3 ± 2.5 weeks and the mean gestational age of extension was 6.4 ± 4.2 weeks. Low molecular weight heparin sodium was administered after umbilical artery embolism was detected on ultrasound. The LWMHs treatment received by the included patients in this study was subcutaneous injection. The specific usage varies due to the types of LWMHs. Of the 10 cases, 5 (50%) had fetal distress but all fetuses were born alive without neonatal asphyxia. With regards to delivery mode, 9 pregnancies were terminated by cesarean section.

Lesson:

Early anticoagulant treatment with LWMHs may improve pregnancy outcomes. The timing and mode of termination of pregnancy should be determined according to the condition of the mother and the fetus along with the gestational age.
Genotype and clinical phenotype analysis of a Family with Kennedy disease
Authors: Cai Ben-Chi , Zhong Li-Fan , Liu Yan-Hui , Sui Zhi-Yan , Yang Qiang , Zeng Dan-Ting , Li Xi , Xu Wen-Di , Chen Tao
Published: April 2023

To investigate the clinical phenotype-genotype correlations of a family with Kennedy disease (KD) and improve our understanding of the disease. KD was confirmed after clinical phenotypic analyses, laboratory tests, polymerase chain reaction assays for cytosine-adenine-guanine (CAG) repeats, and neuro-electrophysiological tests. The disease was assessed using the KD1234 scale and the spinal and bulbar muscular atrophy functional rating scale. The average age of disease onset was 30.8 ± 2.85 years. Clinically diagnosed members had 48 CAG repeats (≥35 is abnormal) in the androgen receptor gene. The patients exhibited gynecomastia and testicular dysfunction. The lesions mainly involved the medulla oblongata and spinal cord. Progesterone and serum creatine kinase levels were significantly high. Electromyography showed chronic neurogenic damage and abnormal sensory and motor conduction in family members who did not participate in sports, exercise, or physical hobbies. Our study showed that this family had a stable inheritance of CAG repeats, and the genotype was consistent with the clinical phenotype. Gynecomastia was the first symptom, with progressive androgen resistance resulting in testicular atrophy, infertility, and sexual dysfunction. Changes in serum creatine kinase may indicate the progression or relief of symptoms, and rehabilitation may delay the progression of muscle atrophy.
Tidal breathing lung function analysis of wheezing and non-wheezing infants with pneumonia: A retrospective observational study
Authors: Yu Yiyi , Meng Wenjuan , Zhu Xiaoping , Li Bo , Yang Jun , Zhang Yali , Wang Xuesong , Luo Jing , Wang Youyan , Xuan Yingying
Published: April 2023

To compare lung function in wheezing and non-wheezing infants with pneumonia through tidal breathing analysis and explore the correlation between tidal breathing lung function and clinical characteristics. This retrospective observational study included infants with pneumonia hospitalized in the Affiliated Hospital of Guizhou Medical University between January 2018 and December 2018. Medical records were used to obtain the demographic characteristics, clinical characteristics, tidal breathing lung function results before and after a bronchodilator test, and positive remission rates after the bronchodilator test for each patient. Eighty-six wheezing infants (64 males, aged 6.5 [4.8, 9] months) and 27 non-wheezing infants (18 males, aged 7 [5, 12] months) were included. Non-wheezing infants were more likely to have normal airway function compared to wheezing infants (44.4% vs 23.3%,P= .033). Peak tidal expiration flow/tidal expiratory flow (TEF)25 in wheezing infants was significantly higher than that in non-wheezing infants (162.4 [141.2, 200.7] vs 143.3 [131, 178.8],P= .037). The positive remission rate of tidal inspiratory flow (TIF50)/TEF50 (53.5% vs 29.6%,P= .03) and TEF50 (58.1% vs 33.3%,P= .024) were significantly higher in the wheezing infants compared to non-wheezing infants (P= .03 andP= .024, respectively). Furthermore, respiratory rate, tidal volume, peak expiration flow, TEF25, TEF50, and TEF75 were significantly correlated to the age, height, weight, and platelet counts of infants in both the wheezing and non-wheezing infants (allP< .05). Wheezing infants with pneumonia were more likely to have worse tidal breathing lung function compared to non-wheezing infants with pneumonia. The tidal breathing lung function parameter (respiratory rate, tidal volume, peak expiration flow, TEF25, TEF50, and TEF75) were correlated to the age, height, weight, and platelet counts of both wheezing and non-wheezing infants.
A comparison of the effects of connective tissue massage and classical massage on chronic mechanical low back pain
Authors: Er Göktuğ , Yüksel İnci
Published: April 2023

Background:

The study aimed to compare the effects of connective tissue massage (CTM) and classical massage (CM) in patients with chronic mechanical low back pain on pain and autonomic responses and to determine the most effective manual therapy method.

Methods:

Seventy individuals with chronic mechanical low back pain were randomly divided into CTM (n = 35) and CM (n = 35) groups. The participants were given a 4-week treatment protocol consisting of a hot pack, exercise, and CTM or CM for 20 sessions. A visual analog scale was used to measure pain intensity. Heart rate, blood pressure, and skin temperature were measured for the evaluation of autonomic responses. In addition, disability (Oswestry disability index), quality of life (short form 36), and sleep quality (Pittsburgh sleep quality index) were evaluated. Participants were assessed before and after the 4-week treatment period as well as at the end of the 6-week follow-up period. In addition, visual analog index measurements were repeated at the end of each treatment week.

Results:

Pain intensity was decreased in both groups (P < .05). However, CM was more effective than CTM at the end of the 2nd week (P < .05). In autonomic responses results, there were increases in peripheral skin temperatures in both groups (P < .05). Disability, quality of life, and sleep quality improved in both groups (P < .05). There were no differences between the groups relating to autonomic responses, disability, quality of life, and sleep quality (P > .05).

Conclusion:

The results of this study showed that massages were similar effect. The fact that CM is a frequently used technique in pain management and is as effective as CTM in autonomic responses will make it more preferred in the clinic.
Mapping research performance and hotspots on nanoparticles in cardiovascular diseases
Authors: Yin Dan , Li Mi , Xiang Ping
Published: April 2023

Nanoparticles have broad prospects and profound academic significance in cardiovascular diseases. This study aimed to comprehensively summarize the global scientific achievements of nanoparticles in cardiovascular diseases research. Articles on the application of nanoparticles in cardiovascular diseases published from 2002 to 2021 were retrieved from the science citation index expanded of the Web of Science Core Collection, and knowledge maps were generated by Cite Space, VOS viewer, and Hist Cite for further bibliometric analysis. A total of 4321 records were retrieved, and only reviews and articles were retained with a total of 4258 studies. The number of publications on nanoparticles in the cardiovascular field has steadily increased from 2002 to 2021. China and the US contribute the most to this field, producing nearly all the most influential authors and institutions in the top 10 list. The Chinese Academy of Medical Sciences and Harvard University have obtained many high-quality research results. Targeted drug delivery via nanoparticles, myocardial infarction and atherosclerosis are research hotspots. This is the first time to analyze the application of nanoparticles in the cardiovascular field by using multiple bibliometric software. This study provides evidence for researchers to understand the hotspots and directions in this area.
Efficacy and safety of Jinhua Qinggan granules in the treatment of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis
Authors: Si Xiuying , Ma Xiaoxue , Wang Youpeng , Li Yongjun , Liu Lujia , Yang Yang , Guo Zheng , Liang Yuan , Pan Guangxia
Published: April 2023

Objective:

To evaluate, using meta-analysis, the efficacy and safety profile of Jinhua Qinggan granules (JHQG) in the treatment of novel coronavirus pneumonia.

Methods:

We screened multiple publication databases (PubMed, Embase, The Cochrane Library, Web of Science, CNKI, WanFang, and VIP), using parameters designed to identify articles detailing randomized controlled trials relating to the treatment of novel coronavirus pneumonia with JHQG. The inclusion period for each search was the point of database inception to November 2022. Each piece of literature identified in our initial screening was independently reviewed by 2 researchers, who extracted the relevant data and evaluated the bias risk associated with the study. The data was split in 2: the control group (containing patients who had received routine treatment or placebo) and the experimental group (containing patients treated with JHQG). The meta-analysis was performed using Revman 5.4 software. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results:

Four articles were selected for this study and combined included a total of 582 patients, which were subdivided into experimental (n = 347) and control (n = 235) groups. The results showed that treatment with JHQG could significantly: enhance the improvement rate of primary symptoms [relative ratio (RR) = 1.26,95% confidence interval (CI) (1.07, 1.49), P = .007] and fever [RR = 1.48, 95% CI (1.07, 2.04), P = .02]; decrease the viral nucleic acid in patients with coronavirus disease 2019 (COVID-19) [RR = 2.04, 95% CI (1.15, 3.62), P = .02] and reduce the progression of pneumonia [RR = 0.34, 95% CI (0.17, 0.67), P = .002]. However, there was no significant difference between the 2 groups with regards to: the improvement rate of cough, nausea and vomiting, fatigue, computed tomography, or frequency of adverse reactions.

Conclusions:

Current evidence indicates that JHQG is effective in treating COVID-19, increasing the rate of improvement for fever, increasing the negative rate of viral nucleic acid in patients with COVID-19 and reducing the aggravation rate of pneumonia. These conclusions need to be verified by further rigorous studies, as the existing results were limited by the number and quality of the included studies.
Prognostic value of lymphovascular space invasion in stage IA to IIB cervical cancer: A meta-analysis
Authors: Huang Yuan , Wen Weibo , Li Xiangdan , Xu Dongyuan , Liu Lan
Published: April 2023

Background:

Lymphovascular space invasion (LVSI) is a prognostic factor in the existing TNM classification system. The present meta-analysis assessed the role of LVSI in predicting the prognosis of stage IA to IIB cervical cancer (CC).

Materials and methods:

PubMed, EMBASE, and Cochrane Library electronic databases were searched to determine relevant articles published in the English language. Our search deadline was May 2022. Critical Appraisal of Prognostic Studies was used to assess the quality for each article. Pooled hazard ratios (HRs) were used to evaluate the performance of LVSI in prognosis prediction.

Results:

We enrolled 8 studies involving 25,352 patients published after 2010. Thus, high LVSI was an unfavorable factor in predicting overall survival (HR, 2.08; 95% confidence interval, 1.63–2.66; P = .006) and disease-free survival (HR, 2.20; 95% confidence interval, 1.79–2.70; P = .000) for patients with CC. However, the disease-free survival and overall survival were significantly different on univariate analysis based on the subgroup analysis stratified by analysis method, but no obvious heterogeneity was found across diverse articles.

Conclusions:

The present study showed that LVSI predicts the poor prognostic outcome of stage IA to IIB CC. However, well-designed clinical articles should further assess the independent prognosis prediction performance of LVSI in CC.
Climate change impacts on children's respiratory health
Authors: Kline Olivia , Prunicki Mary
Published: April 2023

Purpose of review

This review examines the impact of climate change on the respiratory health of children, with a focus on temperature, humidity, air pollution, and extreme weather events. Climate change is considered the greatest health threat of our time, and children are especially at risk. This review is timely and relevant as it provides an overview of the current literature on the effects of climate change on children's respiratory health, and the implications of these findings for clinical practice and research.

Recent findings

The findings of this review suggest that climate change has a significant impact on children's respiratory health, with temperature, humidity, air pollution, and extreme weather events being key contributory factors. Increases in extreme weather events such as heatwaves, wildfires, floods, droughts, hurricanes and dust storms all cause the health of children's respiratory system to be at increased risk.

The findings of this review suggest that climate change has a significant impact on children's respiratory health, and that mitigation and adaptation strategies are necessary to protect children from the harmful effects of climate change and improve their respiratory health. Overall, a comprehensive and integrated approach is necessary to protect children from the increasing impacts of climate change.
Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation
Authors: Purdy Graeme M. , Nanad Rianna , Ternes Leslie , Dolgoy Naomi D. , Sellar Christopher M. , Francis George , Crisp Nicole , Pituskin Edith , de Guzman Wilding Marie , Perry Sarah , Sandhu Irwindeep , Venner Christopher P. , McNeely Margaret L.
Published: April 2023

Background

Exercise can help mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated before HSCT. However, the exercise-related barriers, facilitators, and preferences of this population remain unclear.

Objective

This study aimed to explore the patient experience to inform future implementation of a prehabilitation intervention.

Interventions/Methods

A 2-phase sequential explanatory mixed-methods study was conducted using (1) cross-sectional survey and (2) focus groups. Survey questions aligned with the Theoretical Domains Framework. Focus group data were analyzed using a directed content analysis approach, followed by inductive thematic analysis to generate themes that represented the exercise-related barriers, facilitators, and preferences of participants.

Results

Twenty-six participants completed phase 1 (n = 22 with multiple myeloma). Fifty percent of participants (n = 13) were fairly/very confident in their ability to exercise pre-HSCT. Eleven participants completed phase 2. Exercise barriers included knowledge/skill limitations, inadequate healthcare provider support, and the emotional toll of treatment. Facilitators included social support and goals. Exercise preferences were related to 2 themes: (1) program structure (subthemes: prescription and scheduling, mode of delivery) and (2) support (subthemes: support from personnel, tailoring, and education).

Conclusion

Key exercise-related barriers included knowledge limitations, disease/treatment effects, and inadequate support. Prehabilitation should be tailored, flexible, and include education and a virtual or hybrid delivery model in this population.

Implications for Practice

Nurses are well positioned to identify functional limitations and counsel and refer patients to exercise programming and/or physiotherapy services. Including an exercise professional in the pretransplant care team would provide key supportive care assistance for the nursing team.
Rounding and Quick Access Education to Reduce Catheter-Associated Urinary Tract Infections
Authors: Garcia Danielle M. , Makic Mary Beth Flynn , Casey Kathy
Published: April 2023

Purpose/Objectives

The acute care division of a tertiary medical center experienced a 167% increase in catheter-associated urinary tract infections, with 2 inpatient surgical units accounting for 67% of infections. A quality improvement project was implemented to address the infection rates on the 2 inpatient surgical units. The aim was to reduce catheter-associated urinary tract infection rates by 75% in the acute care inpatient surgical units.

Description of the Project/Program

A survey identified educational needs of staff, with response data informing the development of a quick response code containing resources for prevention of catheter-associated urinary tract infections. Champions rounded on patients and audited maintenance bundle adherence. Educational handouts were disseminated to increase compliance with bundle interventions. Outcome and process measures were tracked on a monthly basis.

Outcome

Infection rates decreased from 1.29 to 0.64 per 1000 indwelling urinary catheter days, catheter utilization increased 14%, and maintenance bundle compliance was 67%.

Conclusion

The project enhanced quality care through the standardization of preventive practices and education. The data reflect a positive effect on catheter-associated urinary tract infection rates from increased awareness of the nurse's role in the prevention process.
Hospital-Based Credentialing and Privileging
Authors: Dresser Susan C. , Elgin Kimberly W.
Published: April 2023

Purpose/Objectives

The purpose of this article is to provide an overview of hospital-based credentialing and privileging processes for clinical nurse specialists (CNSs), describe barriers to success, and share lessons learned from CNSs who have successfully navigated the credentialing and privileging process.

Description of Project

This article shares knowledge, experiences, and lessons learned from an initiative to achieve hospital credentialing and privileging for CNSs at 1 academic medical center.

Outcome

Policies and procedures for credentialing and privileging CNSs are now consistent with other advanced practice providers.
Advocating for the Vulnerable
Authors: Matays Jennie , Scruth Elizabeth , Kawar Lina Najib , Cluff Sarah Comey , Fogli Alexandra , Salas Mary , Harrington Charlene
Published: April 2023

Introduction

Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care.

Current State

Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths. For-profit nursing homes were associated with more COVID-19 infections and deaths. Nearly 70% of US nursing homes are for-profit ownership, where quality measures and staffing levels are often lower than their nonprofit counterparts. Nursing home reform is urgently needed to improve staffing and care quality in these facilities. Some states, such as Massachusetts, New Jersey, and New York, have made legislative progress in establishing standards for nursing home spending. The Biden Administration has also announced initiatives, through the Special Focus Facilities Program, to improve nursing home quality and the safety of residents and staff. Concurrently, the “National Imperative to Improve Nursing Home Quality” report from the National Academies of Science, Engineering, and Medicine made specific staffing recommendations, including an increase in direct care registered nurse coverage.

Conclusion

There is an urgent need to advocate for nursing home reform by partnering with congressional representatives or supporting nursing home legislation to improve care for this vulnerable patient population. Adult-gerontology clinical nurse specialists have an opportunity to leverage their advanced knowledge and unique skill set to lead and facilitate change to improve quality of care and patient outcomes.
Climate Change and Pregnancy: Risks, Mitigation, Adaptation, and Resilience
Authors: Fan Winnie , Zlatnik Marya G.
Published: April 2023

Importance

Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health.

Evidence and Results

There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change. Pregnant people are especially vulnerable to the health harms resulting from climate change, namely, preterm birth, small for gestational age, hypertensive disorders of pregnancy, and other adverse reproductive health and birth outcomes. Strategies to minimize these harms include mitigation and adaptation.

Conclusions and Relevance

Physicians are in a unique position to protect the health of pregnant persons and children by advocating for policy changes that address climate change and providing clinical recommendations for patients to protect themselves from the health impacts of climate hazards.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning objectives

After participating in this activity, physicians should be better able to describe the adverse health effects and pregnancy outcomes associated with elements of climate change; and identify strategies for patients to minimize the health harms from climate change, including mitigation, adaptations, and building resilience.
Automated Triage of Screening Breast MRI Examinations in High-Risk Women Using an Ensemble Deep Learning Model
Authors: Bhowmik Arka , Monga Natasha , Belen Kristin , Varela Keitha , Sevilimedu Varadan , Thakur Sunitha B. , Martinez Danny F. , Sutton Elizabeth J. , Pinker Katja , Eskreis-Winkler Sarah
Published: April 2023

Objectives

The aim of the study is to develop and evaluate the performance of a deep learning (DL) model to triage breast magnetic resonance imaging (MRI) findings in high-risk patients without missing any cancers.

Materials and Methods

In this retrospective study, 16,535 consecutive contrast-enhanced MRIs performed in 8354 women from January 2013 to January 2019 were collected. From 3 New York imaging sites, 14,768 MRIs were used for the training and validation data set, and 80 randomly selected MRIs were used for a reader study test data set. From 3 New Jersey imaging sites, 1687 MRIs (1441 screening MRIs and 246 MRIs performed in recently diagnosed breast cancer patients) were used for an external validation data set. The DL model was trained to classify maximum intensity projection images as “extremely low suspicion” or “possibly suspicious.” Deep learning model evaluation (workload reduction, sensitivity, specificity) was performed on the external validation data set, using a histopathology reference standard. A reader study was performed to compare DL model performance to fellowship-trained breast imaging radiologists.

Results

In the external validation data set, the DL model triaged 159/1441 of screening MRIs as “extremely low suspicion” without missing a single cancer, yielding a workload reduction of 11%, a specificity of 11.5%, and a sensitivity of 100%. The model correctly triaged 246/246 (100% sensitivity) of MRIs in recently diagnosed patients as “possibly suspicious.” In the reader study, 2 readers classified MRIs with a specificity of 93.62% and 91.49%, respectively, and missed 0 and 1 cancer, respectively. On the other hand, the DL model classified MRIs with a specificity of 19.15% and missed 0 cancers, highlighting its potential use not as an independent reader but as a triage tool.

Conclusions

Our automated DL model triages a subset of screening breast MRIs as “extremely low suspicion” without misclassifying any cancer cases. This tool may be used to reduce workload in standalone mode, to shunt low suspicion cases to designated radiologists or to the end of the workday, or to serve as base model for other downstream AI tools.
Gadolinium Deposition Disease
Authors: Semelka Richard C. , Ramalho Miguel
Published: April 2023

This review describes the current knowledge of a form of gadolinium toxicity termed gadolinium deposition disease (GDD), supplemented with the opinions of the authors developed during 6 years of clinical experience treating GDD. Gadolinium deposition disease can also be considered a subset under the symptoms associated with gadolinium exposure rubric. Young and middle-aged White women of central European genetic origin are the most affected. The most common symptoms are fatigue, brain fog, skin pain, skin discoloration, bone pain, muscle fasciculations, and pins and needles, but a long list of additional symptoms is reported herein. The time of onset of symptoms ranges from immediate to 1 month after gadolinium-based contrast agent (GBCA) administration. The primary treatment is to avoid further GBCAs and metal removal through chelation. Presently, the most effective chelating agent is DTPA because of its high affinity with gadolinium. Flare development is an expected outcome, amenable to concurrent immune dampening. We emphasize in this review the critical nature of recognizing GDD when it first arises, as the disease becomes progressively more severe with each subsequent GBCA injection. It is generally very treatable after the first symptoms of GDD, often arising after the first GBCA injection. Future directions of disease detection and treatment are discussed.
Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer
Authors: Takahashi Hidenori , Akita Hirofumi , Wada Hiroshi , Miyata Hiroshi , Eguchi Hidetoshi , Ohigashi Hiroaki , Sakon Masato , Ishikawa Osamu
Published: April 2023

Objective:

To investigate the long-term dynamics of recurrence risk and the significance of prognostic variables using conditional recurrence-free survival (C-RFS) analysis in neoadjuvant treatment (NAT) for resectable (R) and borderline resectable (BR) pancreatic cancer (PC).

Background:

C-RFS analysis assesses the probability of achieving additional RFS according to the RFS already accrued.

Methods:

Patients with NAT and subsequent resection for R/BRPC were enrolled. In the C-RFS analysis, the actual 5-year RFS (5yRFS) rate was calculated separately in the subgroup that had already gained a given amount of RFS. The significance levels of prognostic variables associated with 5yRFS were assessed regarding their time-dependent dynamics in a conditional fashion.

Results:

Among the total 397 patients, 160 survived for more than 5 years without recurrence after surgery (actual 5yRFS rate: 45%). The probability of 5yRFS incrementally increased based on the RFS already accrued. Pathological nodal and vascular involvement were significant influencers of 5yRFS. The patients with nodal involvement consistently remained at significantly higher risk of recurrence than those without, even after 5yRFS, whereas positivity of vascular involvement was significantly associated with the risk of recurrence only during the early postoperative period and lost its significance after 3yRFS accrued.

Conclusions:

In NAT for R/BRPC, the probability of gaining additional RFS increases as a function of RFS already accrued, and the significance of prognostic variables time-dependently evolves in their own patterns during the long-term postoperative period.
Emergence of common concepts, symmetries and conformity in agent groups—an information-theoretic model
Authors: Möller Marco , Polani Daniel
Published: April 2023

The paper studies principles behind structured, especially symmetric, representations through enforced inter-agent conformity. For this, we consider agents in a simple environment who extract individual representations of this environment through an information maximization principle. The representations obtained by different agents differ in general to some extent from each other. This gives rise to ambiguities in how the environment is represented by the different agents. Using a variant of the information bottleneck principle, we extract a ‘common conceptualization’ of the world for this group of agents. It turns out that the common conceptualization appears to capture much higher regularities or symmetries of the environment than the individual representations. We further formalize the notion of identifying symmetries in the environment both with respect to ‘extrinsic’ (birds-eye) operations on the environment as well as with respect to ‘intrinsic’ operations, i.e. subjective operations corresponding to the reconfiguration of the agent’s embodiment. Remarkably, using the latter formalism, one can re-wire an agent to conform to the highly symmetric common conceptualization to a much higher degree than an unrefined agent; and that, without having to re-optimize the agent from scratch. In other words, one can ‘re-educate’ an agent to conform to the de-individualized ‘concept’ of the agent group with comparatively little effort.
Structural analysis of the Toll-like receptor 15 TIR domain
Authors: Ko Kyung Yeol , Song Wan Seok , Park Jeongho , Lee Geun-Shik , Yoon Sung-il
Published: April 2023

Toll-like receptors (TLRs) activate innate immunity in response to pathogen-associated molecular patterns (PAMPs). The ectodomain of a TLR directly senses a PAMP and the intracellular TIR domain dimerizes to initiate a signaling cascade. The TIR domains of TLR6 and TLR10, which belong to the TLR1 subfamily, have been structurally characterized in a dimer, whereas those of other subfamilies, including TLR15, have not been explored at the structural or molecular level. TLR15 is a TLR unique to birds and reptiles that responds to virulence-associated fungal and bacterial proteases. To reveal how the TLR15 TIR domain (TLR15TIR) triggers signaling, the crystal structure of TLR15TIR was determined in a dimeric form and a mutational study was performed. TLR15TIR forms a one-domain structure in which a five-stranded β-sheet is decorated by α-helices, as shown for TLR1 subfamily members. TLR15TIR exhibits substantial structural differences from other TLRs at the BB and DD loops and αC2 helix that are involved in dimerization. As a result, TLR15TIR is likely to form a dimeric structure that is unique in its intersubunit orientation and the contribution of each dimerizing region. Further comparative analysis of TIR structures and sequences provides insights into the recruitment of a signaling adaptor protein by TLR15TIR.
Supply chain agility and firm performance: testing serial mediations in pharmaceutical industry
Authors: Ahmad Rehan , Shahzad Khurram , Ishaq Muhammad Ishtiaq , Aftab Junaid
Published: April 2023

Purpose

The supply chain agility (SCA) is becoming a source of competitive differentiation but debate on its antecedents which can result in optimal firm performance is still non-pervasive in the literature. Taking this gap into consideration, the current research aimed at investigating various enablers of supply chain agility of Pakistani pharmaceutical industry.

Design/methodology/approach

The data were collected from 204 top executives working in different supply chain functions including planning, supplying, operations and purchasing in national and multinational pharmaceutical companies in Pakistan.

Findings

Through serial-mediation model, results revealed the strength of various SCA enablers, along with the mediating roles of delivery dependability.

Originality/value

This study adds in the literature on how various supply chain enablers and competencies help the organizations to achieve supply chain agility and performance, especially in a developing country.
Estimation of the global number of vapers: 82 million worldwide in 2021
Authors: Jerzyński Tomasz , Stimson Gerry V.
Published: April 2023

Purpose

Nicotine is consumed by one in five of the global adult population, mostly by smoking tobacco cigarettes. Modern electronic cigarettes came onto the market from around 2007 and have considerable potential to improve population health by displacing tobacco smoking. The purpose of this study is to map the use of e-cigarettes, but this is difficult due to absence of data sources for many countries.

Design/methodology/approach

The global number of vapers was estimated to be 68 million in 2020. New data in 2021 offered an opportunity to update that estimate. The method of assumed similarity was used for countries with missing data. The average prevalence of vaping was calculated for each World Health Organization region, World Bank income classification group and the legal status of e-cigarettes in each country. The number of vapers was calculated for the adult population. The estimate was refined by adjusting for changes in market value size and the actual year of surveys.

Findings

Population prevalence data on e-cigarette used were available for 48 countries. We estimate that there were 82 million vapers worldwide in 2021: 9.2 million in the Eastern Mediterranean region; 5.6 million in the African region; 20.1 million in the European region; 16.8 million in the Americas; 16.0 million in the Western Pacific region; and 14.3 million in South-East Asia.

Originality/value

Global, regional and national estimates of the numbers of vapers are important indicators of trends in nicotine use, and monitoring the uptake of vaping is important to inform international and national policy.
Future libraries’ blockchain opportunities and challenges: a systematic literature review and research agenda
Authors: Bashir Faiza , Warraich Nosheen Fatima
Published: April 2023

Purpose

The purpose of this study is to look into the concept of blockchain technology which stores data in a distributed, tamper-resistant setting and how this technology may affect the future library and information (LI) centers’ operations and policy. It explores the potential benefits and limitations of this technology, for LI centers are the core objectives of this paper.

Design/methodology/approach

A systematic review of both academic and practitioner literature was conducted. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (2020) standards.

Findings

The review shows that the decentralized nature of blockchain will transform the work in libraries and improve the inter-communication among communities. It can provide better privacy of user data thus increasing collaboration. However, there might be technological, financial, legal and social challenges that may act as hurdles to the realization of these goals in the true sense. The overall result shows that by keeping data updated, libraries can evaluate blockchain opportunities and make the best use of this technology.

Practical implications

Given the huge investments by industry, academic research that explores potential ramifications and supports libraries is required. The adoption of blockchain was investigated in this study from a variety of perspectives for LI center’s while also providing directions for future research.

Originality/value

It is evident that globally there is progress in blockchain technology development in terms of research and adoption in many industries, but the intention to adopt blockchain by libraries is still a fantasy. The lack of empirical evidence in the existing literature justifies the gap that needs to be filled. This systematic review attempts to fill the gaps in the existing knowledge which may serve as a reference for future initiatives in this field.
Using affixed labels in persuasion: perceived product newness as a mediator
Authors: Ku Hsuan-Hsuan , Hsu Yun-Hsuan
Published: April 2023

Purpose

Capturing consumers’ notice by differentiating a product from competing brands in attaching an affixed label featuring product claims, as an alternative front-of-package (FOP) cue, has been widely used in fast-moving consumer goods retailing. This paper aims to apply perceived product newness as the basis for examining how affixed labeling, manipulated in terms of design features and message claims, can impact consumer evaluation.

Design/methodology/approach

Four between-subjects experiments examined the persuasive impact of the use of affixed labels. In particular, how product evaluation, in response to affixed labeling, varied as a function of its shape (Study 1a), location (Study 1b), the combination of shape and location cues (Study 1c) and the strength of message claims conveyed by such labels (Study 2). Perceived product newness is assessed as a mediator for all studies.

Findings

The results show the power of affixed labels in persuasion. Specifically, consumers tend to perceive the item as newer, achieving persuasion, when the affixed label has a distinctive shape or location. Yet, incorporating several unusual design components fails to trigger an elevated result if a singular visual stimulus serves as a cue for an item’s newness. Further, the strength of claims highlighted in an affixed label correlates to positive impact on evaluations.

Research limitations/implications

This study offers an empirically based examination of consumers’ responses to affixed labeling and identifies perceived product newness as a mediator of the observed effect.

Practical implications

A salient, affixed label enables a credible cue for product newness, therefore, driving evaluation.

Originality/value

This paper contributes to understanding the influence on the persuasion of FOP labeling, with salience to retail promotional and sales messaging tactics.
Patient and wearable device authentication utilizing attribute-based credentials and permissioned blockchains in smart homes
Authors: Kembo Solomon Hopewell , Mpofu Patience , Jacques Saulo , Chitiyo Nevil , Mukorera Brighton
Published: April 2023

Purpose

Coronavirus Disease 2019 (COVID-19) necessitated the need for “Hospital-at-home” improvisations that involve wearable technology to classify patients within households before visiting health institutions. Do-It-Yourself wearable devices allow for the collection of health data leading to the detection and/or prediction of the prevalence of the disease. The sensitive nature of health data requires safeguards to ensure patients’ privacy is not violated. The previous work utilized Hyperledger Fabric to verify transmitted data within Smart Homes, allowing for the possible implementation of legal restrictions through smart contracts in the future. This study aims to explore privacy-enhancing authentication schemes that are operated by multiple credential issuers and capable of integration into the Hyperledger ecosystem.

Design/methodology/approach

Design Science Research is the methodology that was used in this study. An architecture for ABC-privacy was developed and evaluated.

Findings

While the privacy-by-design architecture enhances data privacy through edge and fog computing architecture, there is a need to provide an additional privacy layer that limits the amount of data that patients disclose. Selective disclosure of credentials limits the number of information patients or devices divulge.

Originality/value

The evaluation of this study identified Coconut as the most suitable attribute-based credentials scheme for the Smart Homes Patients and Health Wearables use case Coconut user-centric architecture Hyperledger integration multi-party threshold authorities public and private attributes re-randomization and unlinkable revelation of selective attribute revelations.