bluuebunny/crossref_metadata_2025 huggingface dataset:
The formation mechanism of primary health care team effectiveness : a qualitative comparative analysis research
Authors: Li Chanjiao , Cui Lu , Zhou Siyu , He Anning , Ni Ziling
Published: January 2024

Background

Team-based care is an essential part of primary health care (PHC), and its team service delivery process is a systematic one involving multiple and complex influences. Research on the formation mechanism can help improve the effectiveness of primary health care teams (PHCTs).

Methods

First, based on the Donabedian model, we explored the theoretical framework of a PHC team’s effectiveness formation mechanism. Semi-structured interviews were conducted with 23primary health care team members in Hangzhou, Zhejiang Province, China. A total of seven factors were then included as conditional variables using the crisp set qualitative comparative analysis (csQCA) to explore the complex influences between them and the outcome variable through univariate necessity analysis and path configuration analysis.

Results

Univariate necessity analysis showed that only “Clear Goals” in the structural dimension were necessary for team effectiveness perception. Six pathways to good primary health care team perception of effectiveness were identified. Two of these paths were more typical.

Conclusion

“Clear Goals” was the core variable that should be emphasized when exploring the mechanism of PHCT formation. The results suggest that human resources in the management team should be rationally allocated, goal-oriented, and given good attention. Future studies should explore complex combinations of PHCT factors to improve the effectiveness of PHCTs.
Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report
Authors: Ji Ran
Published: January 2024

Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
District health management and stillbirth recording and reporting: a qualitative study in the Ashanti Region of Ghana
Authors: Mensah Abrampah Nana A. , Okwaraji Yemisrach B. , Oteng Kenneth Fosu , Asiedu Ernest Konadu , Larsen-Reindorf Rita , Blencowe Hannah , Jackson Debra
Published: January 2024

Background

Despite global efforts to reduce maternal and neonatal mortality, stillbirths remain a significant public health challenge in many low- and middle-income countries. District health systems, largely seen as the backbone of health systems, are pivotal in addressing the data gaps reported for stillbirths. Available, accurate and complete data is essential for District Health Management Teams (DHMTs) to understand the burden of stillbirths, evaluate interventions and tailor health facility support to address the complex challenges that contribute to stillbirths. This study aims to understand stillbirth recording and reporting in the Ashanti Region of Ghana from the perspective of DHMTs.

Methods

The study was conducted in the Ashanti Region of Ghana. 15 members of the regional and district health directorates (RHD/DHD) participated in semi-structured interviews. Sampling was purposive, focusing on RHD/DHD members who interact with maternity services or stillbirth data. Thematic analyses were informed by an a priori framework, including theme 1) experiences, perceptions and attitudes; theme 2) stillbirth data use; and theme 3) leadership and support mechanisms, for stillbirth recording and reporting.

Results

Under theme 1, stillbirth definitions varied among respondents, with 20 and 28 weeks commonly used. Fresh and macerated skin appearance was used to classify timing with limited knowledge of antepartum and intrapartum stillbirths. For theme 2, data quality checks, audits, and the district health information management system (DHIMS-2) data entry and review are functions played by the DHD. Midwives were blamed for data quality issues on omissions and misclassifications. Manual entry of data, data transfer from the facility to the DHD, limited knowledge of stillbirth terminology and periodic closure of the DHIMS-2 were seen to proliferate gaps in stillbirth recording and reporting. Under theme 3, perinatal audits were acknowledged as an enabler for stillbirth recording and reporting by the DHD, though audits are mandated for only late-gestational stillbirths (> 28 weeks). Engagement of other sectors, e.g., civil/vital registration and private health facilities, was seen as key in understanding the true population-level burden of stillbirths.

Conclusion

Effective district health management ensures that every stillbirth is accurately recorded, reported, and acted upon to drive improvements. A large need exists for capacity building on stillbirth definitions and data use. Recommendations are made, for example, terminology standardization and private sector engagement, aimed at reducing stillbirth rates in high-mortality settings such as Ghana.
Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study
Authors: Jin Yingzhe , Yin Bohao , Shu Linyuan , Fan Zhiyuan , Sherrier Matthew C. , Liu Chenjun , Sun Hui , Zhang Wei
Published: January 2024

Background

A understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs).

Methods

The postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA).

Results

Pauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001).

Conclusions

The present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.
Ultrasound had high accuracy in measuring hip joint capsule thickness
Authors: Gao Guanying , Fang Huaan , Zhou Kaicheng , Mo Zizhi , Liu Jiayang , Meng Lingyu , Wang Jianquan , Xu Yan
Published: January 2024

Background

The hip joint capsule is an essential component of hip joint function and stability, and its thickness is closely associated with certain medical conditions, surgical outcomes, and rehabilitation treatments. Currently, in clinical practice, hip joint capsule thickness is predominantly measured using magnetic resonance imaging (MRI), with limited utilization of ultrasound examinations for this purpose.

Methods

We retrospectively evaluated patients who visited our Sports Medicine Department between February 2017 and March 2023 and underwent both hip joint MRI and ultrasound imaging on the same side. All patients had undergone preoperative hip joint MRI and ultrasound examinations, with the time gap between the two examinations not exceeding three months. Measurements of hip joint capsule thickness were taken on both MRI and ultrasound images for the same patients to analyze their consistency. Additionally, we measured the alpha angle, lateral center-edge angle, acetabular anteversion angle, and femoral anteversion angle of the patients’ hip joints and analyzed their correlation with hip joint capsule thickness measure by ultrasound.

Results

A total of 307 patients were included in this study, with hip joint capsule thickness measured by MRI and ultrasound being 5.0 ± 1.2 mm and 5.0 ± 1.5 mm, respectively. The Bland-Altman analysis demonstrates good agreement or consistency. The paired t-test resulted in a p-value of 0.708, indicating no significant statistical difference between the two methods. The correlation analysis between acetabular anteversion angle and ultrasound-measured capsule thickness yielded a p-value of 0.043, indicating acetabular anteversion angle and capsular thickness may have negative correlation.

Conclusions

The measurements of joint capsule thickness obtained through ultrasound and MRI showed good consistency, suggesting that ultrasound can be used in clinical practice as a replacement for MRI in measuring hip joint capsule thickness. There was a significant correlation between acetabular anteversion angle and hip joint capsule thickness, indicating potential for further research in this area.
Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study
Authors: Janović Aleksa , Bracanović Đurđa , Antić Svetlana , Marković-Vasiljković Biljana
Published: January 2024

Background

The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis.

Methods

We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests.

Results

The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%.

Conclusion

Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis.
Undergraduate students’ perception of cardiorespiratory physiology during exercise: teleological vs. mechanistic thinking
Authors: Araújo Marcela S. , Teixeira André L. , Esteves Amanda , Sabino-Carvalho Jeann , Vianna Lauro C.
Published: January 2024

Background

Physiology is widely recognized as a difficult course, which can potentially increase students’ withdrawal and failures rates. Several factors are likely contributing to the difficulties in learning physiology, including inherent features of the discipline as well as aspects related to instructions and/or students’ perception. With regards to the later, it is currently unknown how students of exercise physiology think and explain physiology in terms of its cause or consequence (i.e., teleological or mechanistic thinking). Therefore, the aims of the present study were to determine 1) whether undergraduate students’ perception of cardiorespiratory physiology during exercise follows a predominant teleological or mechanistic thinking, and 2) whether prior enrollment in physiology courses can influence the predominance of teleological vs. mechanistic thinking.

Methods

The test instrument was an online questionnaire about exercise physiology consisting of nine incomplete sentences about exercise physiology where students had to choose between a teleological or a mechanistic complement. The questionnaire was administered to undergraduate students in the following areas: 1) Movement Sciences (n = 152), 2) Health-related (n = 81) and, 3) Health-unrelated programs (n = 64). Students in Movement Sciences and Health-related programs were also analyzed separately in the following categories: 1) students who previously undertook physiology courses, and 2) students who did not take physiology courses.

Results

Overall, all groups presented a percentage of teleological thinking above 58%, which is considerably high. Teleological thinking was significantly higher in health-unrelated programs than health-related and movement sciences programs (76 ± 16% vs. 58 ± 26% vs. 61 ± 25%; P < 0.01). Further, students with prior enrollment in physiology classes presented a significantly lower percentage of teleological thinking than students without physiology classes (59 ± 25% vs. 72 ± 22%, respectively; P < 0.01), but the overall teleological reasoning remained predominant.

Conclusions

These results confirm the hypothesis that undergraduate students tend to present teleological as opposed to mechanistic thinking in exercise physiology. Furthermore, although undergraduate students with prior enrollment in physiology classes presented significantly lower teleological thinking, it remained highly predominant suggesting that teleological thinking is partially independent of the degree of familiarity with this discipline.
Identification of a hub gene VCL for atherosclerotic plaques and discovery of potential therapeutic targets by molecular docking
Authors: Wu Chong , Li Wei , Li Panfeng , Niu Xiaoyang
Published: January 2024

Background

Atherosclerosis (AS) is a pathology factor for cardiovascular diseases and instability of atherosclerotic plaques contributes to acute coronary events. This study identified a hub gene VCL for atherosclerotic plaques and discovered its potential therapeutic targets for atherosclerotic plaques.

Methods

Differential expressed genes (DEGs) were screened between unstable and stable plaques from GSE120521 dataset and then used for construction of a protein-protein interactions (PPI) network. Through topological analysis, hub genes were identified within this PPI network, followed by construction of a diagnostic model. GSE41571 dataset was utilized to validate the diagnostic model. A key hub gene was identified and its association with immune characteristics and pathways were further investigated. Molecular docking and molecular dynamics (MD) simulation were employed to discover potential therapeutic targets.

Results

According to the PPI network, 3 tightly connected protein clusters were found. Topological analysis identified the top 5 hub genes, Vinculin (VCL), Dystrophin (DMD), Actin alpha 2 (ACTA2), Filamin A (FLNA), and transgelin (TAGLN). Among these hub genes, VCL had the highest diagnostic value. VCL was selected for further analysis and we found that VCL was negatively correlated with immune score and AS-related inflammatory pathways. Next, we identified 408 genes that were highly correlated with VCL and determined potential drug candidates. The results from molecular docking and MD simulation showed compound DB07117 combined with VCL protein stably, the binding energy is -7.7 kcal/mol, indicating that compound DB07117 was a potential inhibitor of VCL protein.

Conclusion

This study identified VCL as a key gene for atherosclerotic plaques and provides a potential therapeutic target of VCL for the treatment of atherosclerotic plaques.
Protocol for metadata and image collection at diabetic foot ulcer clinics: enabling research in wound analytics and deep learning
Authors: Basiri Reza , Manji Karim , LeLievre Philip M. , Toole John , Kim Faith , Khan Shehroz S. , Popovic Milos R.
Published: January 2024

Background

The escalating impact of diabetes and its complications, including diabetic foot ulcers (DFUs), presents global challenges in quality of life, economics, and resources, affecting around half a billion people. DFU healing is hindered by hyperglycemia-related issues and diverse diabetes-related physiological changes, necessitating ongoing personalized care. Artificial intelligence and clinical research strive to address these challenges by facilitating early detection and efficient treatments despite resource constraints. This study establishes a standardized framework for DFU data collection, introducing a dedicated case report form, a comprehensive dataset named Zivot with patient population clinical feature breakdowns and a baseline for DFU detection using this dataset and a UNet architecture.

Results

Following this protocol, we created the Zivot dataset consisting of 269 patients with active DFUs, and about 3700 RGB images and corresponding thermal and depth maps for the DFUs. The effectiveness of collecting a consistent and clean dataset was demonstrated using a bounding box prediction deep learning network that was constructed with EfficientNet as the feature extractor and UNet architecture. The network was trained on the Zivot dataset, and the evaluation metrics showed promising values of 0.79 and 0.86 for F1-score and mAP segmentation metrics.

Conclusions

This work and the Zivot database offer a foundation for further exploration of holistic and multimodal approaches to DFU research.
Exosomes: potential targets for the diagnosis and treatment of neuropsychiatric disorders
Authors: Li Haorao , Yuan Yanling , Xie Qinglian , Dong Zaiquan
Published: January 2024

The field of neuropsychiatry is considered a middle ground between neurological and psychiatric disorders, thereby bridging the conventional boundaries between matter and mind, consciousness, and function. Neuropsychiatry aims to evaluate and treat cognitive, behavioral, and emotional disorders in individuals with neurological conditions. However, the pathophysiology of these disorders is not yet fully understood, and objective biological indicators for these conditions are currently lacking. Treatment options are also limited due to the blood–brain barrier, which results in poor treatment effects. Additionally, many drugs, particularly antipsychotic drugs, have adverse reactions, which make them difficult to tolerate for patients. As a result, patients often abandon treatment owing to these adverse reactions. Since the discovery of exosomes in 1983, they have been extensively studied in various diseases owing to their potential as nanocellulators for information exchange between cells. Because exosomes can freely travel between the center and periphery, brain-derived exosomes can reflect the state of the brain, which has considerable advantages in diagnosis and treatment. In addition, administration of engineered exosomes can improve therapeutic efficacy, allow lesion targeting, ensure drug stability, and prevent systemic adverse effects. Therefore, this article reviews the source and biological function of exosomes, relationship between exosomes and the blood–brain barrier, relationship between exosomes and the pathological mechanism of neuropsychiatric disorders, exosomes in the diagnosis and treatment of neuropsychiatric disorders, and application of engineered exosomes in neuropsychiatric disorders.
Tirzepatide prevents neurodegeneration through multiple molecular pathways
Authors: Fontanella Rosaria Anna , Ghosh Puja , Pesapane Ada , Taktaz Fatemeh , Puocci Armando , Franzese Martina , Feliciano Maria Federica , Tortorella Giovanni , Scisciola Lucia , Sommella Eduardo , Ambrosino Concetta , Paolisso Giuseppe , Barbieri Michelangela
Published: January 2024

Background

Several evidence demonstrated that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce the risk of dementia in type 2 diabetes patients by improving memory, learning, and overcoming cognitive impairment. In this study, we elucidated the molecular processes underlying the protective effect of Tirzepatide (TIR), a dual glucose-dependent insulinotropic polypeptide receptor agonist (GIP-RA)/ GLP-1RA, against learning and memory disorders.

Methods

We investigated the effects of TIR on markers of neuronal growth (CREB and BDNF), apoptosis (BAX/Bcl2 ratio) differentiation (pAkt, MAP2, GAP43, and AGBL4), and insulin resistance (GLUT1, GLUT4, GLUT3 and SORBS1) in a neuroblastoma cell line (SHSY5Y) exposed to normal and high glucose concentration. The potential role on DNA methylation of genes involved in neuroprotection and epigenetic modulators of neuronal growth (miRNA 34a), apoptosis (miRNA 212), and differentiation (miRNA 29c) was also investigated. The cell proliferation was detected by measuring Ki-67 through flow cytometry. The data were analysed by SPSS IBM Version 23 or GraphPad Prism 7.0 software and expressed as the means ± SEM. Differences between the mean values were considered significant at a p-value of < 0.05. GraphPad Prism software was used for drawing figures.

Results

For the first time, it was highlighted: (a) the role of TIR in the activation of the pAkt/CREB/BDNF pathway and the downstream signaling cascade; (b) TIR efficacy in neuroprotection; (c) TIR counteracting of hyperglycemia and insulin resistance-related effects at the neuronal level.

Conclusions

We demonstrated that TIR can ameliorate high glucose-induced neurodegeneration and overcome neuronal insulin resistance. Thus, this study provides new insight into the potential role of TIR in improving diabetes-related neuropathy.

Graphical Abstract
Activated phosphoinositide 3-kinase δ syndrome caused by PIK3CD mutations: expanding the phenotype
Authors: Zhao Peiwei , Huang Juan , Fu Huicong , Xu Jiali , Li Tianhong , Zhang Xiankai , Meng Qingjie , Zhang Lei , Tan Li , Zhang Wen , Chen Hebin , Lu Xiaoxia , Ding Yan , He Xuelian
Published: January 2024

Background

Germline heterozygous gain-of-function (GOF) mutations in the PIK3CD gene lead to a rare primary immunodeficiency disease known as activated phosphoinositide 3-kinase (PI3K) δ syndrome type 1(APDS1). Affected patients present a spectrum of clinical manifestations, particularly recurrent respiratory infections and lymphoproliferation, increased levels of serum immunoglobulin (Ig) M, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) viremia. Due to highly heterogeneous phenotypes of APDS1, it is very likely that suspected cases may be misdiagnosed.

Methods

Herein we reported three patients with different clinical presentations but harboring pathogenic variants in PIK3CD gene detected by trio whole-exome sequencing (trio-WES) and confirmed by subsequent Sanger sequencing.

Results

Two heterozygous mutations (c.3061G > A, p.E1021K and c.1574 A > G, p.E525G) in PIK3CD (NM_005026.3) were identified by whole exome sequencing (WES) in the three patients. One of two patients with the mutation (c.3061G > A) presented with abdominal pain and diarrhea as the first symptoms, which was due to intussusception caused by multiple polyps of colon. The patient with mutation (c.1574 A > G) had an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)-like clinical manifestations, including multisystemic inflammation, acute nephritic syndrome, and positive perinuclear ANCA (p-ANCA), thus the diagnosis of ANCA-AAV was considered.

Conclusions

Our study expands the spectrums of clinical phenotype and genotype of APDS, and demonstrates that WES has a high molecular diagnostic yield for patients with immunodeficiency related symptoms, such as respiratory infections, multiple ecchymosis, ANCA-associated vasculitis, multiple ileocecal polyps, hepatosplenomegaly, and lymphoid hyperplasia.

Trial registration

Retrospectively registered.
A method for small-sized wheat seedlings detection: from annotation mode to model construction
Authors: Wang Suwan , Zhao Jianqing , Cai Yucheng , Li Yan , Qi Xuerui , Qiu Xiaolei , Yao Xia , Tian Yongchao , Zhu Yan , Cao Weixing , Zhang Xiaohu
Published: January 2024

The number of seedlings is an important indicator that reflects the size of the wheat population during the seedling stage. Researchers increasingly use deep learning to detect and count wheat seedlings from unmanned aerial vehicle (UAV) images. However, due to the small size and diverse postures of wheat seedlings, it can be challenging to estimate their numbers accurately during the seedling stage. In most related works in wheat seedling detection, they label the whole plant, often resulting in a higher proportion of soil background within the annotated bounding boxes. This imbalance between wheat seedlings and soil background in the annotated bounding boxes decreases the detection performance. This study proposes a wheat seedling detection method based on a local annotation instead of a global annotation. Moreover, the detection model is also improved by replacing convolutional and pooling layers with the Space-to-depth Conv module and adding a micro-scale detection layer in the YOLOv5 head network to better extract small-scale features in these small annotation boxes. The optimization of the detection model can reduce the number of error detections caused by leaf occlusion between wheat seedlings and the small size of wheat seedlings. The results show that the proposed method achieves a detection accuracy of 90.1%, outperforming other state-of-the-art detection methods. The proposed method provides a reference for future wheat seedling detection and yield prediction.
Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators
Authors: O’Grady Megan A. , Elkington Katherine S. , Robson Gail , Achebe Ikenna Y. , Williams Arthur Robin , Cohall Alwyn T. , Cohall Renee , Christofferson Monica , Garcia Alejandra , Ramsey Kelly S. , Lincourt Pat , Tross Susan
Published: January 2024

Background

People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment.

Methods

Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding.

Results

Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success).

Conclusions

This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.
Association of adolescent postural tachycardia syndrome classifications with anxiety: a cross sectional study
Authors: Mizutani Midori , Yoshida Seiji , Tanaka Hidetaka , Yamawake Ginroku , Kubo Atsuko , Kurooka Yusuke , Ohta Yoshitaka , Ashida Akira
Published: January 2024

Background

Postural tachycardia syndrome (POTS), a subset of orthostatic dysregulation, has been reported to be associated with anxiety. POTS can be classified into two forms based on the degree of tachycardia during orthostasis. Reportedly, POTS with decreased orthostatic heart rate increase is associated with suppressed cardiac parasympathetic activity and increased sympathetic activity in the supine position. In this study, the relationship between the two types of POTS and anxiety was evaluated in terms of autonomic function.

Methods

Fifty-two patients (23 male, age 10–15 years) who were diagnosed with POTS at the Department of Pediatrics, Osaka Medical and Pharmaceutical University from 2019 to 2021, completed a standing test and were accordingly classified into a Su group, with tachycardia from the supine position and a low heart rate increase on standing, a SI group, with a high heart rate increase during standing. They then completed the State-Trait Anxiety Scale for Children (STAIC) questionnaire. Autonomic function was assessed by frequency analysis (MemCalc method) based on heart rate, blood pressure changes, heart rate and blood pressure variability during the orthostatic test.

Results

Patients in the Su group had higher trait anxiety and state anxiety, lower cardiac parasympathetic activity (RR-HF) in the supine position, and greater variability in cardiac parasympathetic activity during orthostasis than were found for patients in the SI group. The Su group had a greater decrease in cardiac index on standing than that of the SI group.

Conclusions

The Su group results may be partly attributed to chronically low venous return. We also found that patients in the Su group had low parasympathetic activity in the supine position, which may interact with the anxiety-prone characteristics of these patients. Therefore, it seems necessary to consider both physical and psychosomatic treatment approaches for patients with POTS.
Unmanned aerial vehicles and pre-hospital emergency medicine
Authors: Surman Katy , Lockey David
Published: January 2024

Unmanned aerial vehicles (UAVs) are used in many industrial and commercial roles and have an increasing number of medical applications. This article reviews the characteristics of UAVs and their current applications in pre-hospital emergency medicine. The key roles are transport of equipment and medications and potentially passengers to or from a scene and the use of cameras to observe or communicate with remote scenes. The potential hazards of UAVs both deliberate or accidental are also discussed.
Human Trypanosoma cruzi infection in the Argentinean Chaco: risk factors and identification of households with infected children for treatment
Authors: Macchiaverna Natalia P. , Enriquez Gustavo F. , Gaspe M Sol , Rodríguez-Planes Lucía I. , Martinez Patricia R. , Gürtler Ricardo E. , Cardinal M Victoria
Published: January 2024

Background

Chagas disease is a neglected tropical disease (NTD). Cost-effective strategies for large-scale implementation of diagnosis and etiological treatment are urgently needed to comply with NTD control goals. We determined the seroprevalence of Trypanosoma cruzi infection and associated risk factors in a well-defined rural population of Pampa del Indio municipality including creole and indigenous (Qom) households and developed two indices to identify houses harboring infected children.

Methods

We serodiagnosed and administered a questionnaire to 1337 residents (48.2% of the listed population) in two sections of the municipality (named Areas II and IV) 6–9 years after deploying sustained vector control interventions. Multiple logistic regression models were used to evaluate the relationship between human infection and a priori selected predictors. Two risk indices were constructed based on environmental and serostatus variables, and we used spatial analysis to test whether households harboring T. cruzi-seropositive children were randomly distributed.

Results

The global seroprevalence of T. cruzi infection was 24.8%. Human infection was positively and significantly associated with exposure time to triatomines, the household number of seropositive co-inhabitants, maternal seropositivity for T. cruzi, recent residence at the current house and the presence of suitable walls for triatomine colonization in the domicile. The pre-intervention mean annual force of infection (FOI) was 1.23 per 100 person-years. Creoles from Area IV exhibited the highest seroprevalence and FOI; Qom people from both areas displayed intermediate ones and creoles from Area II the lowest. Three hotspots of infected children were spatially associated with hotspots of triatomine abundance at baseline and persistent house infestation. No child born after vector control interventions was T. cruzi seropositive except for one putative transplacental case. Two simple risk indices (based on self-reported inhabiting an infested house and suitable walls for triatomines or maternal serostatus) identified 97.3–98.6% of the households with at least one T. cruzi-seropositive child.

Conclusions

We showed strong heterogeneity in the seroprevalence of T. cruzi infection within and between ethnic groups inhabiting neighboring rural areas. Developed indices can be used for household risk stratification and to improve access of rural residents to serodiagnosis and treatment and may be easily transferred to primary healthcare personnel.

Graphical Abstract
Studies over the existence of a certain impulse-based fuzzy integrodifferential equations of the Sobolev type
Authors: Radhakrishnan B. , Nagarajan M. , Anukokila P. , Shanmugasundram P.
Published: January 2024

The present investigation employs impulses and a non-local constraint to prove the existence are some various types of abstract differential and integrodifferential equations related to the Sobolev type. Semigroup theory, specifically variants of constant formula, is utilized to get the analytical results for those equations. Furthermore, findings using the Banach fixed point approach were examined using fuzzy numbers with values spanning the $$\mathscr {E}_n$$

E
n

range, which includes the normal, convex, upper semi-continuous, and compactly supported interval. A description is given for each situation to illustrate the principle.
Diagnostic considerations in the clinical management of sudden swelling of the knee: a case report and review of the literature
Authors: Pavelić Eduard , Glavaš Weinberger David , Čemerin Martin , Rod Eduard , Primorac Dragan
Published: January 2024

Background

Reactive arthritis and septic arthritis rarely present concomitantly in the same joint and patient. Reactive arthritis presenting after coronavirus disease 2019 is also exceedingly rare, with less than 30 cases reported thus far. Less common pathogens such as Clostridium difficile have been reported to cause reactive arthritis, especially in patients with a positive human leukocyte antigen B27, and therefore should be considered in diagnostic algorithms. The aim of this case report is to highlight the difficulties and precautions in discerning and diagnosing patients presenting with sudden swelling of the knee.

Case presentation

We report the case of a 70-year-old Caucasian male with a recent history of coronavirus disease 2019 upper respiratory infection and diarrhea and negating trauma, who presented with a swollen and painful knee. Pain and swelling worsened and inflammatory parameters increased after an intraarticular corticosteroid injection. The patient was therefore treated with arthroscopic lavage and intravenous antibiotics for suspected septic arthritis. Synovial fluid and synovium samples were taken and sent for microbiological analysis. Synovial fluid cytology showed increased leukocytes at 10,980 × 106/L, while polymerase chain reaction and cultures came back sterile. Clostridium difficile toxin was later detected from a stool sample and the patient was treated with oral vancomycin. The patient was tested for the presence of human leukocyte antigen B27, which was positive. We present a review of the literature about the challenges of distinguishing septic from reactive arthritis, and about the mechanisms that predispose certain patients to this rheumatological disease.

Conclusions

It is still a challenge to differentiate between septic and reactive arthritis of the knee, and it is even more challenging to identify the exact cause of reactive arthritis. This case report of a human leukocyte antigen-B27-positive patient highlights the necessity of contemplating different, less common causes of a swollen knee joint as a differential diagnosis of an apparent septic infection, especially in the coronavirus disease 2019 era. Treating the patient for septic arthritis prevented any possible complications of such a condition, while treating the C. difficile infection contributed to the substantial relief of symptoms.
Automated localization of mandibular landmarks in the construction of mandibular median sagittal plane
Authors: Wang Yali , Wu Weizi , Christelle Mukeshimana , Sun Mengyuan , Wen Zehui , Lin Yifan , Zhang Hengguo , Xu Jianguang
Published: January 2024

Objective

To use deep learning to segment the mandible and identify three-dimensional (3D) anatomical landmarks from cone-beam computed tomography (CBCT) images, the planes constructed from the mandibular midline landmarks were compared and analyzed to find the best mandibular midsagittal plane (MMSP).

Methods

A total of 400 participants were randomly divided into a training group (n = 360) and a validation group (n = 40). Normal individuals were used as the test group (n = 50). The PointRend deep learning mechanism segmented the mandible from CBCT images and accurately identified 27 anatomic landmarks via PoseNet. 3D coordinates of 5 central landmarks and 2 pairs of side landmarks were obtained for the test group. Every 35 combinations of 3 midline landmarks were screened using the template mapping technique. The asymmetry index (AI) was calculated for each of the 35 mirror planes. The template mapping technique plane was used as the reference plane; the top four planes with the smallest AIs were compared through distance, volume difference, and similarity index to find the plane with the fewest errors.

Results

The mandible was segmented automatically in 10 ± 1.5 s with a 0.98 Dice similarity coefficient. The mean landmark localization error for the 27 landmarks was 1.04 ± 0.28 mm. MMSP should use the plane made by B (supramentale), Gn (gnathion), and F (mandibular foramen). The average AI grade was 1.6 (min–max: 0.59–3.61). There was no significant difference in distance or volume (P > 0.05); however, the similarity index was significantly different (P < 0.01).

Conclusion

Deep learning can automatically segment the mandible, identify anatomic landmarks, and address medicinal demands in people without mandibular deformities. The most accurate MMSP was the B-Gn-F plane.
Students’ complex trajectories: exploring degree change and time to degree
Authors: Pêgo João Pedro , Miguéis Vera Lucia , Soeiro Alfredo
Published: January 2024

The complex trajectories of higher education students are deviations from the regular path due to delays in completing a degree, dropping out, taking breaks, or changing programmes. In this study, we investigated degree changing as a cause of complex student trajectories. We characterised cohorts of students who graduated with a complex trajectory and identified the characteristics that influenced the time to graduation. To support this predictive task, we employed machine learning techniques such as neural networks, support vector machines, and random forests. In addition, we used interpretable techniques such as decision trees to derive managerial insights that could prove useful to decision-makers. We validated the proposed methodology taking the University of Porto (Portugal) as case study. The results show that the time to degree (TTD) of students with and without complex trajectories was different. Moreover, the proposed models effectively predicted TTD, outperforming two benchmark models. The random forest model proved to be the best predictor. Finally, this study shows that the factors that best predict TTD are the median TTD and the admission regime of the programme of destination of transfer students, followed by the admission average of the previous programme. By identifying students who take longer to complete their studies, targeted interventions such as counselling and tutoring can be promoted, potentially improving completion rates and educational outcomes without having to use as many resources.
A phase 2/3 randomized study of CTX-009 combination in 2L biliary tract cancer: COMPANION-002.
Authors: Aranha Olivia , Javle Milind M. , Rosales Minori Koshiji , Hu Zishuo Ian , Faridi Amir A. , Paulson Scott , Richards Donald A. , Hochster Howard S. , Cosgrove David , Azad Nilofer Saba , Brown-Glaberman Ursa , Cline Vivian Jean M. , Shumway Nathan M. , Tejani Mohamedtaki Abdulaziz , Nallapareddy Sujatha , Sahin Ilyas , Borad Mitesh J. , Goyal Lipika , Kelley Robin Kate
Published: January 2024

TPS587

Background: Biliary tract cancer (BTC) is characterized by generally poor prognoses with limited treatment options. Systemic chemotherapy usually begins with gemcitabine, platinum agents, and a checkpoint inhibitor followed by 5-FU and oxaliplatin, irinotecan or a taxane. Presently, there is no consensus second-line therapy for patients with BTC. The DLL/Notch signaling pathway has been described to be a major driver of cholangiocarcinogenesis and VEGF-A overexpression has been reported in BTC tumors, correlating with stage, metastasis, and prognosis of the disease. CTX-009 is a recombinant bispecific antibody that binds both delta-like ligand-4 (DLL4) and vascular endothelial growth factor A (VEGF-A). The antibody simultaneously inhibits the DLL4-Notch 1 and VEGF A-VEGF receptor signaling pathways. Methods: COMPANION-002 (CTX-009 -002) is an open-label, randomized, controlled study in patients in second line advanced or metastatic BTC. To be eligible, patients must have radiologically documented progression after a prior gemcitabine and platinum containing chemotherapy regimen as first line therapy for locally advanced unresectable or metastatic disease. 150 patients will be randomized in a 2:1 ratio to receive either CTX-009 plus paclitaxel or paclitaxel alone. The stratification factors to be used at randomization include stage (locally advanced vs. metastatic), anatomic subsite of primary tumor (intrahepatic cholangiocarcinoma vs. other, i.e. extrahepatic cholangiocarcinoma, gallbladder, or ampullary), and Eastern Cooperative Oncology Group (ECOG) Performance status (0 vs. 1). Patients will be treated in 28-day cycles, with CTX-009 administered at 10 mg/kg IV on Day 1 and 15, and paclitaxel administered at 80 mg/m2 on days 1, 8, and 15. The patients randomized to paclitaxel arm can crossover after disease progression if selection criteria continue to be met. The primary objective of the study is to assess the efficacy of CTX-009 in combination with paclitaxel vs. paclitaxel alone, as measured by Overall Response Rate (ORR) assessed by an Independent Central Radiology (ICR) review. Key secondary objectives include overall survival, progression-free survival, and duration of response. Clinical trial information: 251040.
Safety outcomes in patients with metastatic castration-resistant prostate cancer treated with radium-223 following external beam radiation therapy: REASSURE US subset.
Authors: Sartor A. Oliver , Conti Peter , Taplin Mary-Ellen , Song Daniel , George Saby , Tomaszewski Jeffrey John , Sylvester John , Mantz Constantine Anastasios , Given Robert , Brookland Robert K. , Meltzer Jeffrey , Korn Matthew J. , Parkin Jacqueline , Babajanyan Svetlana , Higano Celestia S.
Published: January 2024

106

Background: In the Phase 3 ALSYMPCA trial, radium-223 (Ra-223) demonstrated an overall survival (OS) benefit and a favorable safety profile in patients with metastatic castration-resistant prostate cancer (mCRPC). REASSURE (NCT02141438) is a global, prospective, single-arm, observational study of Ra-223 use in patients with mCRPC with bone metastases within routine clinical settings. Utilizing data from the second planned interim analysis, we evaluated safety outcomes in patients with mCRPC treated with Ra-223 following external beam radiation therapy (EBRT) in the US. Methods: In this descriptive analysis (data cutoff 3-20-2019), we included patients who received EBRT to bone prior to Ra-223 (≤2 years prior to Ra-223 first dose); results are presented relative to the overall US subset of patients enrolled into REASSURE. The focus of this abstract is on incidence of hematological toxicities, bone fractures, and second primary malignancies (SPM). Results: Of N=498 patients in the US subset, 118 patients received prior EBRT to bone. Median duration of observation was 11.7 months among patients who received EBRT and 11.9 months for the overall US subset. Any-grade drug-related hematological treatment-emergent adverse events (TEAEs) occurred in 8% (10/118) and 9% (47/498) of patients who received EBRT and the overall subset, respectively (Table). Grade ≥3 drug-related hematological TEAEs occurred in 5% (6/118) and 6% (32/498) of patients who received EBRT and the overall subset, respectively. Bone fractures occurred in 7% (8/118) and 4% (19/498) of patients who received EBRT and the overall subset, respectively. Six SPMs occurred in 5/118 patients who received EBRT (4%), and 11 SPMs occurred in 10/498 patients in the overall subset (2%). Results of bone fracture events by bone health agent use will be included in the full presentation. Conclusions: In this descriptive analysis of real-world data, patients who received EBRT prior to Ra-223 did not demonstrate an increased incidence of hematological toxicities relative to the overall US subset. Although percent of SPMs and bone fractures seems higher among patients treated with EBRT relative to the overall US subset, the real-world incidence of these events remains low. [Table: see text]