bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Supply Chain Flexibility in Adapting Marketing Strategies to Changing Consumer Preferences
Authors: Holloway Samuel
Published: June 2024

Supply chain flexibility plays a pivotal role in enabling organizations to adapt their marketing strategies to evolving consumer preferences in dynamic market environments. This qualitative study explores how supply chain flexibility dimensions—responsiveness, agility, resilience, and sustainability—impact marketing strategy adaptation. Through semi-structured interviews and document analysis, insights were gathered from industry practitioners across diverse sectors. Key findings highlight that responsive supply chains facilitate quick adjustments in production, distribution, and sourcing to meet changing consumer demands. Agility enables rapid reconfiguration of operations to capitalize on market opportunities and respond to disruptions effectively. Resilient supply chains mitigate risks and maintain continuity during crises, safeguarding customer satisfaction and brand reputation. Integrating sustainability practices not only meets regulatory standards but also aligns with consumer preferences for eco-friendly products, enhancing corporate social responsibility. Technological advancements such as AI, IoT, blockchain, and cloud computing enhance supply chain visibility, optimize decision-making, and support real-time responsiveness. Despite benefits, challenges like legacy systems, organizational silos, resistance to change, and resource constraints hinder effective implementation. Overcoming these barriers requires strategic leadership, cross-functional collaboration, and continuous investment in technology and talent. Embracing supply chain flexibility empowers organizations to navigate complexities, drive innovation, and sustain competitive advantage. By aligning supply chain capabilities with marketing strategies, companies can enhance market responsiveness, customer satisfaction, and long-term growth in today's dynamic business landscape
The Future of Destruction: Analyzing the Potential Impact of Entropy on Technological Evolution in AGI, Autonomous Drones, and Applied Robotics
Authors: Gaspar Iago , Pedrosa Diogo , Gomes Duarte
Published: June 2024

The rapid convergence of Artificial General Intelligence (AGI), autonomous drones, and applied robotics presents a transformative opportunity for many sectors. However, this advancement also raises critical ethical and existential questions, particularly in warfare. This paper explores the concept of entropy as a metaphor for the potential disorder introduced by these increasingly complex technologies. We examine the risks of AGI surpassing human control in conflict situations, where autonomous decision-making could have disastrous consequences. We then analyze autonomous drones, scrutinizing their impact on warfare tactics and the ethical dilemmas surrounding independent, real-time decision-making. Finally, we investigate applied robotics in military operations, focusing on the delicate balance between enhanced capabilities and the potential for uncontrollable systems. Through a multidisciplinary lens, drawing on technology ethics, military strategy, and AI safety, this paper utilizes the concept of entropy to highlight the need for caution in developing these technologies. We propose a scientifically grounded and ethically sound framework to guide policymakers, technologists, and ethicists in navigating the path between innovation and global stability. This framework concludes with recommendations for responsible development and deployment strategies that can mitigate the risks associated with these powerful tools.
TransNeural: An Enhanced-Transformer based Performance Pre-Validation Model for Split Learning Tasks
Authors: Liu Guangyi , Kang Mancong , Zhu Yanhong , Zheng Qingbi , Zhu Maosheng , Li Na
Published: June 2024

As split learning (SL) becomes popular for addressing data privacy and resource limitation issues in edge model training process, it is crucial to pre-validate whether the extensive use of wireless and computing resources in SL can achieve the expected training latency and convergence. While digital twin network (DTN) can potentially estimate network strategy performance in pre-validation environments, they are still in their infancy for SL tasks, facing challenges like unknown non-i.i.d. data distributions, inaccurate channel states, and misreport resource availability across devices. To address these challenges, this paper proposes a TransNeural algorithm for DTN pre-validation environment to estimate SL latency and convergence. First, the TransNeural algorithm integrates transformers to efficiently model data similarities between different devices, considering different data distributions and device participate sequence greatly influence SL training convergence. Second, it leverages neural network to automatically establish the complex relationships between SL latency and convergence with data distributions, wireless and computing resources, dataset sizes, and training iterations. Deviations in user reports are also accounted for in the estimation process. Simulations show that the TransNeural algorithm improves latency estimation accuracy by 13.44% and convergence estimation accuracy by 116.74% compared to traditional equation-based methods.
Biophysical Analysis of a Minimalistic Kidney Model Expressing SGLT1 Reveals Crosstalk Between Luminal and Lateral Membranes and a Plausible Mechanism of Isosmotic Transport
Authors: Larsen Erik Hviid , Sørensen Jens Nørkær
Published: June 2024

We extended our model of the S1 tubular segment to address the mechanisms by which SGLT1 interacts with lateral Na/K pumps and tight junctional complexes to generate isosmotic fluid reabsorption via tubular segment S3. The strategy applied allowed simulation of laboratory experiments. Reproducing known experimental results constrained the range of acceptable model outputs and contributed to minimizing the free parameter space.
1. In experimental conditions, published Na and K concentrations of proximal kidney cells were found to deviate substantially from their normal physiological levels. Analysis of the mechanisms involved suggested insufficient oxygen supply as the cause and indirectly, that a main function of the Na/H exchanger (NHE3) is to extrude protons stemming from mitochondrial energy metabolism.
2. The water path from the lumen to the peritubular space is through aquaporins on the cell membrane and claudin-2 at paracellular tight junctions, with a smaller additional contribution to water transport by the coupling of 1 glucose:2 Na:200 H2O in SGLT1.
3. A Na+-uptake component passed through paracellular junctions by solvent drag in Na- and water-permeable claudin-2, thus bypassing the Na/K-pump, in agreement with the findings of early studies.
4. Electrical cross talk between apical rheogenic SGLT1 and lateral rheogenic Na/K pumps results in tight coupling of luminal glucose uptake and transepithelial water flow.
5. Isosmotic transport is achieved by Na-mediated ion recirculation at the peritubular membrane.
Longitudinal Associations between Emotional Resilience and Mental Health among Chinese Adolescents in the School Context: The Mediating Role of Positive Emotions
Authors: Zhu Zhongmin , Sang Biao , Liu Junsheng , Zhao Yuyang , Liu Ying , Liu Ning
Published: June 2024

(1) Background: Emotional resilience is defined as the capacity of individuals to cultivate positive emotions and effectively navigate through negative emotions in terms of stress or adversity. Recent research has focused on the significant impact of adolescents’ negative emotions, as opposed to positive emotions, on mental health. The examination of positive emotion provides a distinct viewpoint on the relationship between emotional resilience and mental health in adolescents. Consequently, the current research conducted two separate investigations to examine the impact of adolescent emotional resilience on mental health, as well as the mediating influence of positive emotion. (2) Methods: Study 1 comprised a cross-sectional analysis of 3086 Chinese adolescents, while Study 2 involved a longitudinal examination of 266 Chinese adolescents. (3) Results: Results indicated that emotional resilience was associated with enhanced levels of life satisfaction, self-esteem, and overall mental health, while also demonstrating a negative correlation with symptoms of depression and anxiety. Positive emotions were found to have a partial mediating effect on the relationship between emotional resilience and mental health. These results indicate that emotional resilience not only has a direct impact on mental health but also influences mental health indirectly through positive emotions. (4) Conclusions: The findings highlighted the role of emotional resilience in mitigating psychological problems and enhancing mental health in Chinese adolescents. The implications and limitations were discussed.
Comparative Analysis of Heat Transfer Performance of Heat Sinks with Lattice Geometry
Authors: Christo Jerome
Published: June 2024

This paper presents a comparative study of heat transfer performance of lattice structured heat sinks. 20 different unit cells were chosen and heat sinks were modelled in nTop with constant unit cell size. Al 6061 alloy was chosen for analysis due to its good thermal conductivity, low weight, low cost, and high strength. Steady state thermal analysis was performed using ANSYS with constant input parameters for all samples. Heat flux and temperature distribution within the heat sinks were analysed. The study aims to provide a comprehensive understanding of the thermal performance of lattice heat sink designs.
Optimizing Groundwater Exploration Strategies in Huarong, China with 2-Dimensional Resistivity Imaging
Authors: Rahim Osama Abdul , Rujun Chen , Chunming Liu , Ahmed Ijaz , Ullah Farid , Ahmad Jawad , Fahad Shah , Ali Shah Shahid , El-Kaliouby Hesham
Published: June 2024

The growing expansion of the economy and population has resulted in an increased inclination towards the utilization of groundwater resources. Conducting a geophysical survey is a widely employed method for subsurface mapping and the detection of groundwater. A geophysical study was conducted in Nanshan township, Huarong County, located in the Hunan province of the South-Central region of China. The investigation involved the utilization of a 2D Electrical Resistivity Imaging technique employing forward and inverse pole-dipole electrode array. A total of six survey lines were established, each with an electrode distance from the nearest measuring point to exceeding 800 m. The maximum current electrode separation was utilized in this setup. The spacing between the electrical resistivity sounding points was established at regular intervals. The findings from the exploration indicate the existence of multiple faults within the surveyed region. The study additionally identified two regions of structural failure, which occurred due to the convergence of faults oriented in different directions. This convergence led to the fracturing of rocks, an increase in water content, and a decrease in resistivity. The findings from the exploration were utilized in the formulation of five verification target boreholes. The results of this study offer significant insights that can inform future investigations into groundwater exploration endeavors within the region.
Energy Efficiency Evaluation of Artificial Intelligence Algorithms
Authors: Penev Kalin , Gegov Alexander , Isiaq Olufemi , Jafari Raheleh
Published: June 2024

This article continues research efforts on performance and energy efficiency of intelligent algorithms and its role for green and sustainable computing. The introduction focusses on Bremermann's Limit and its effect on extensive approach for improvement of computers performance. The article aims to identify role of Intelligent Algorithms energy efficiency, how it differs from general software energy efficiency. An improved empirical investigation on heuristic methods for search and optimisation illustrates algorithms' energy efficiency. Experimental results and consideration of further work conclude the article.
The Effects of Videogame Skills Across Diverse Genres on Verbal and Visuospatial Short-Term and Working Memory, Hand-Eye Coordination, and Empathy in Early Adulthood
Authors: Zioga Triantafyllia , Ferentinos Aristotelis , Konsolaki Eleni , Nega Chrysanthi , Kourtesis Panagiotis
Published: June 2024

The cognitive and affective impacts of video games are subjects of ongoing debate, with recent research recognizing their potential benefits. This study employs the Gaming Skill Questionnaire (GSQ) to evaluate participants' gaming skills across six genres and overall proficiency. Eighty-eight individuals aged 20-40 participated, completed assessments of empathy and six cognitive abilities: verbal short-term memory, verbal working memory, visuospatial short-term memory, visuospatial working memory, psychomotor speed (hand-eye coordination), and attention. Cognitive abilities were examined using the Digit Span Test, Corsi Block Test, and Deary-Liewald Reaction Time Task, while empathy was assessed using the Empathy Quotient Questionnaire. Findings indicate that high video game skill levels correlate with improvements in visuospatial short-term and working memory, psychomotor speed, and attention. Different genres enhanced specific skills: RPGs positively influenced verbal working and visuospatial short-term memory but negatively affected empathy; action games improved psychomotor speed and attention; and puzzle games benefited visuospatial working memory. These promising results contribute positively to ongoing research on the cognitive and affective effects of video games, highlighting the potential for video games to enhance certain cognitive functions while also underscoring the complexity of their impact on empathy. Future research should further investigate genre-specific effects and long-term outcomes.
Endoplasmic Reticulum Stress Differently Modulates the Release of IL-6 and IL-8 Cytokines in Human Glial Cells
Authors: Sokołowska Paulina , Wiktorowska-Owczarek Anna , Tambor Jakub , Gawlak-Socka Sebastian , Kowalczyk Edward , Jóźwiak-Bębenista Marta
Published: June 2024

Background: Endoplasmic reticulum (ER) stress is a significant player in the pathophysiology of various neurodegenerative and neuropsychiatric disorders. Despite the established link between ER stress and inflammatory pathways, there remains a need for deeper exploration of the specific cellular mechanisms underlying ER stress-mediated neuroinflammation. Methods: This study aimed to investigate how severity of ER stress can impact the release of proinflammatory cyto-kines IL-6 and IL-8 from astrocytes and microglia, comparing the effects with those induced by well-known immunostimulants - tumor necrosis factor alpha (TNF-α) or lipopolysaccharide (LPS). Results: Mild ER stress has a distinct effect on the cytokine release compared to more intense stress levels, i.e. diminished IL-6 production was accompanied by an increase in IL-8 level, which was significantly more pronounced in astrocytes than in microglia. On the contrary, prolonged or more severe ER stress induced inflammation in glial cells, leading to a time- and concentration-dependent buildup of pro-inflammatory IL-6 but unlike inflammatory agents, ER stress inducer diminished IL-8 secretions by glial cells. Conclusion: The differences could hold importance in identifying ER stress markers as potential drug targets for treatment of neurodegenerative diseases or mood disorders, yet it requires confirmation in more complex animal studies.
Novel Approaches Needed: A Suggestion for an Alternative to Mechanical Restraint in the 21st Century
Authors: Steinert Tilman , Maierhofer Bernd , Schmid Peter , Hirsch Sophie
Published: June 2024

Despite many calls to reduce or eliminate the use of mechanical restraint, it is still widely used in many countries. Studies using patient interviews have a very clear message: Patients experience mechanical restraint as the most humiliating intervention. There seems to be a lack of alternatives with violent patients. We developed a method using 30 kg bags, originally designed for fitness purposes, to be attached to a patient's wrist or ankle under 1:1 supervision. The method was tested with 10 experienced nurses and de-escalation trainers. A video was made and presented to six outpatients who had previously experienced mechanical restraint. All participants were interviewed. Transcribed interviews were analysed using qualitative content analysis. All participants approved of the method as a milder and less humiliating alternative to mechanical restraint. Nurses' main concerns were the risk of falls and the use of the bags as a weapon. The latter could be controlled by using an additional bag. Patients were generally positive, especially if there was a history of abuse. The method should be further developed to replace at least part of mechanical restraints. As with all ‘milder means‘, care should be taken to really replace restraint and not to introduce additional coercion.
Analysis of the role of aquatic gases in the formation of sea ice porosity
Authors: Goncharov Vadim Konstantinovich , Klementieva Natalia Yurievna
Published: June 2024

The porosity of freshwater and sea ice is one of the main parameters that determine its strength. The strength of ice varies over a wide range of values, and the differ-ences in the intensity of the mechanisms of ice porosity formation in different water areas can be one of the possible reasons for these variations. The water mass contains gases in two forms: gases dissolved in the water mass, as well as gas bubbles that are formed when wind waves break up, and bubbles that float up from the seabed. The article presents the results of the analysis of the role of each of these forms in the formation of gas inclusions (pores) into the crystal structure of ice. The estimates showed that the main source of gas pores in ice crystals is the gas bubbles coming to the surface from the bottom, formed during the decomposition of bottom sediments or during gas leaks from near-bottom oil and gas fields. The possibility of gas bubbles occurring and rising to the ice-water boundary depends on the presence of bottom sources of the gases, the intensity of dissolution of the bubbles and the depth of the water area. Therefore, the variation in the porosity and the strength of ice over the space of the water areas can be associated with the changes in their depths, and the presence and location of the natural gas sources.
Diagnostic Errors in Obstetric Morbidity and Mortality: Methods for and Challenges in Seeking Diagnostic Excellence
Authors: Krenitsky Nicole M , Perez-Urbano India , Goffman Dena
Published: June 2024

Pregnancy-related morbidity and mortality remains high across the United States and the majority of deaths are preventable. Misdiagnosis and delay in diagnosis are thought to be contributors to preventable harm. These diagnostic errors in obstetrics are understudied. We present selected research methods to ascertain rates of and harm associated with diagnostic errors, the challenges in investigating them, and present future steps toward achieving diagnostic excellence in obstetrics.
Physicochemical Characterization and Antioxidant Activity of Jara Honey Produced in Western Georgia
Authors: Abashidze Nona , Japaridze Indira , Vanidze Maia , Khakhutaishvili Meri , Kharadze Maia , Qarcivadze Inga , Davitadze Ruslani , Kalandia Aleko
Published: June 2024

The purpose of this research article was to study the physicochemical characteristics of semi-wild Jhar honey grown in Western Georgia. Jara honey is produced in the alpine and sub-alpine forest zone of high mountain Adjara,  which is distinguished by the variety of honey plants [1]. The physicochemical characteristics were examined concerning the Alimemtarius Code and EU regulations: moisture content, total carbohydrate, free acidity, pH , electrical conductivity, microelements (Li, Na, K, Mg, Ca), color, total phenols, total phenolic acids, total flavonoids, proline, diastase activity, protein and microscopic study of pollens. Using the UPLC-MSB method, grayanotoxin-III was identified in the semi-wild Jara honey samples. The findings demonstrated that honey has significant concentrations of phenols, phenolic acids, and flavonoids. A directly proportional relationship was established between the quantitative content of phenolic compounds and the antioxidant activity of honey. This article is the first study of the characteristics of Jara honey produced in Western Georgia.
A Unique Case of Supernumerary Teeth Erupting inside a Maxillary Sinus Osteoma
Authors: Kataoka Toshiyuki , Amemiya Kei , Goto Toshiyuki , Kina Hatsuki , Tajima Erica
Published: June 2024

Ectopic eruption of teeth rarely occurs in the mandibular condyle, orbit, nasal cavity, skin, and maxillary sinus. Ectopic eruption of teeth in the maxillary sinus can be accompanied by chronic and recurrent sinusitis, including headache, facial pain, and numbness. Fibro-osseous lesions in the paranasal sinuses are discovered incidentally on X-ray images and are often asymptomatic. Osteoma is the most common fibro-osseous lesion that develops in the paranasal and nasal sinuses. Herein, we report a rare case of osteoma (exostosis) containing supernumerary teeth within the maxillary sinus. A characteristic pedicled bone lesion with a clear border on computed tomography was the undefined orthopantomogram radiopacity in the left maxillary sinus, and the lesion contained teeth. The tumor was excised using the Caldwell–Luc procedure. Pathologically, the surgical specimen revealed an osteoma. The patient’s symptoms of chronic sinusitis disappeared, and the patient had no symptoms 2 years after the surgery. Because the patient had no history of midface trauma or surgery, the supernumerary teeth were speculated to have migrated during a reactive osteogenic process caused by chronic sinusitis.
Comparative Analysis of Mechanical Properties of a Composite Resin for 3D Printing and a Conventional Resin
Authors: Araújo Leonardo Viana , Siqueira Fabiana Figuerêdo , Macedo Rayssa Cavaleiro , Gones Felipe Silva , Castro Gustavo Garcia , Dibai Daniela Bassi , Maia Filho Etevaldo Matos , Tavarez Rudys Rodolfo
Published: June 2024

This study aimed to compare the flexural strength, surface roughness, and microhardness of a resin for three-dimensional (3D) printing and a conventional composite resin and to evaluate whether the printing orientation influences these properties. To evaluate the flexural resistance, test specimens were produced and divided into four groups: three groups of resins for 3D printing with inclinations of 0°, 45°, and 90°, and one group of conventional composite resin. Forty discs were produced and subjected to a sandpaper-polishing sequence, and the surface roughness was measured using a roughness meter. The Vickers microhardness test was performed at three different points, and the average was obtained. The results were subjected to ANOVA statistical analysis and Tukey's test. There were statistical differences in the flexural strength and microhardness between the conventional resin and the resin used for 3D printing. No statistical difference in surface roughness was observed. The resin for 3D printing exhibited lower flexural strength and microhardness than conventional composite resins. We concluded that the resin for 3D printing had lower flexural strength and hardness than the conventional composite resin but similar surface roughness. The printing orientation did not affect the flexural strength, whereas the hardness increased as the printing angle increased.
Developing a Taxonomy to Assess Human Capital Disclosure in Sustainability Reports
Authors: Magau Mpho D.
Published: June 2024

Debates regarding human capital disclosure (HCD) emphasise the usefulness of people-related information in stimulating investor confidence and building stakeholder trust. Despite this, human capital (HC) information is interwoven in most international sustainability reporting standards such as the global reporting initiative (GRI), thereby concealing the impact of human resource (HR) practices in shareholder value creation. The aim of this study is to develop a taxonomy to assess HCD in the sustainability reports to capture the true value of HC distinctively. A content analysis-based study with a deductive approach was followed by utilising the GRI standards to isolate and classify people-related information into an HCD sustainability taxonomy. 40% HC metrics were extracted from the GRI standards and subsequently classified into 7 dimensions, namely, human capital allocation, human capital wellbeing, human capital investment, human capital network, human capital governance, human capital risk and human capital earnings. Furthermore, 40 GRI content indexes of the companies listed in the Johannesburg Stock Exchange (JSE) revealed that most disclosures are covered in the human capital governance and human capital earnings categories. HCD sustainability provides investors and HR professionals with a useful tool to assess people-related information from the sustainability reports for isolating the true value of HC.
Progression of Coronary Artery Calcification According to Changes in Risk Factors in Asymptomatic Individuals
Authors: Yoo Jin Young , Kang Se Ri , Chun Eun Ju
Published: June 2024

This retrospective study aimed to assess coronary artery calcium (CAC) progression in serial computed tomography measurements according to risk factor changes. In 448 asymptomatic adults who underwent CAC measurements with more than one-year intervals, CAC progression was assessed according to age, sex, variable traditional risk factors (diabetes mellitus, hypertension, hyperlipidemia, and smoking), and initial CAC score (0, 0.1–100, and >100). Univariate and multivariate logistic regression analyses were assessed for independent predictors of rapid CAC progression (△CAC/year>20). During the 3.5-year follow-up, coronary artery calcifications occurred in 43 (12.8%) of 336 individuals with an initial CAC score of zero. Of 112 individuals with initial CAC presence, 60 (53.6%) had △CAC/year>20. Age, male sex, body mass index, and all risk factors were significantly associated with △CAC/year>20, but recently diagnosed hypertension (odds ratio [OR], 11.3) and initial CAC score (OR, 1.05) were significant independent predictors in multivariate regression analyses. CAC progression was affected by demographic and traditional risk factors, but adjusting for these factors, recently diagnosed hypertension and initial CAC score were the most influential factors for rapid CAC progression. These findings suggest that patients with higher initial CAC scores may benefit from more frequent follow-up scans and checks regarding risk factor changes.
Searching for a Place in Global IR Through Exceptionalism: Turkey and the Mediation for Peace Initiative
Authors: Karadeniz Radiye Funda , Oğuz Gök Gonca
Published: June 2024

This study is an attempt to rethink exceptionalism both in Turkish Foreign Policy and in Global IR. It critically engages with Turkey’s contribution to the Global IR debate within the discourse of exceptionalism in Turkish foreign policy over its role in the Mediation for Peace Initiative (MPI). Following Nymalm and Plagemann (2019), we rethink exceptionalism used in Global IR, critically analyzing Turkey’s role in the MPI within the framework of internationalist exceptionalism. In doing so, we aim to unbox exceptionalism in Global IR and understand how some exceptional foreign policy discourses of non-Western states may contribute to the interconnectedness between regional worlds, as well as the circulation of ideas and norms between the global and local levels.
Aseptic Revision Total Hip Arthroplasty Using Modular Fluted Tapered Stems
Authors: Carender Christopher N. , Larson Dirk R. , Trousdale Robert T. , Lewallen David G. , Berry Daniel J. , Abdel Matthew P.
Published: June 2024

Background:

Modular fluted tapered (MFT) femoral components are frequently utilized in aseptic revision total hip arthroplasties (THAs). However, long-term follow-up has been limited. The purpose of this study was to update our prior series at long-term follow-up, with specific emphasis on implant survivorship, radiographic results, and complications in a large cohort of aseptic revision THAs using MFT stems.

Methods:

We retrospectively identified 515 aseptic femoral revisions performed with 2 MFT stem designs in the total joint registry of a single tertiary care academic institution from 1999 to 2013. Serial radiographs were reviewed for subsidence of >5 mm. The mean follow-up (and standard deviation) was 10 ± 5 years (range, 2 to 21 years). A competing risk model accounting for death was utilized.

Results:

The 15-year cumulative incidence of any revision was 12%. There were 57 revisions, 27 of which involved revision of the fluted tapered component (FTC). Dislocation (n = 19), periprosthetic joint infection (n = 15), and aseptic loosening of the FTC (n = 11) were the most common reasons for revision. The 15-year cumulative incidence of any reoperation was 16%. The 15-year cumulative incidences were 6% for any FTC revision and 2% for FTC revision for aseptic loosening. Stem subsidence of >5 mm occurred in 2% of unrevised cases, and all but 1 stem was stable at the most recent follow-up.

Conclusions:

This large series of MFT stems used in aseptic revision THAs had a 2% incidence of subsequent revision of the FTC for aseptic loosening at 15 years. Dislocation and infection were the most common reasons for any revision.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of the oral health status of nursing home residents using the current and the newly developed interRAI Oral Health Section (OHS-interRAI): a cross-sectional study
Authors: Schoebrechts Emilie , Mello Johanna de Almeida , Vandenbulcke Patricia A. I. , Hout Hein P. J. van , De Lepeleire Jan , Declercq Anja , Declerck Dominique , Duyck Joke
Published: June 2024

Background:
Nursing home residents’ oral health is generally poor, which can negatively affect general health and well-being. Regular dental check-ups and good oral hygiene are important, but often challenging for older adults. The interRAI instrument for Long-Term Care Facilities (LTCF) enables caregivers to evaluate residents’ health, including oral health, and to integrate oral care into general care planning. Because the current oral health section in the interRAI instruments does not accurately identify oral care needs, the interRAI Oral Health Section (OHS-interRAI) was developed. The OHS-interRAI differs from the current section by including more items, response options and guidelines, photographs, instruction videos, and Collaborative Action Points to alert caregivers when oral care is needed.
This study describes and compares residents’ oral health status assessed by caregivers using the current section and the OHS-interRAI.
Methods:
This cross-sectional study includes data from baseline assessments of adults aged 65 years or older in Flemish and Dutch nursing homes, collected by caregivers. Assessments with the current section dated from October 2016 to January 2023, and with the OHS-interRAI from October 2020 to January 2023.
Results:
InterRAI assessments of 12476 residents from 158 nursing homes with the current section were compared with those of 1212 residents from 37 nursing homes with the OHS-interRAI.
Missing oral health data were less common with the current section than with the OHS-interRAI. A higher proportion of oral health problems was detected with the OHS-interRAI compared to the current section for chewing function (6.8% vs. 13.7%), dry mouth (7.6% vs. 9.8%), teeth (16.6% vs. 22.1%), and gums (3.1% vs. 7.8%). There was no significant difference in the proportion of residents with discomfort or pain in the mouth.
Conclusions:
Caregivers identified more oral health problems with the OHS-interRAI, which may be due to its additional features compared to the current section, such as photographs and extensive instructions. The Collaborative Action Points included in the OHS-interRAI support continuity of care and enable integration of oral care into general care. Further research is needed to evaluate whether the OHS-interRAI accurately identifies residents who need help with daily oral hygiene or referral to a dentist.
Unveiling the Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Diagnosis and Inflammatory Phenotyping: A Dissociation from Lung Function and Asthma Control
Authors: Fenhua Jin , Hui Lin , Lihua Yu , Wen Huang
Published: June 2024

Objective: This study aims to examine the association and clinical relevance of fractional exhaled nitric oxide (FENO) with lung function, sputum eosinophils, blood eosinophils, blood total IgE (TIgE), and asthma control test (ACT) score.
Methods: A total of 189 participants, consisting of 99 asthmatic out-patients and 90 healthy individuals, were recruited for the study conducted between May 2013 and December 2013. The study aimed to investigate the correlation between various factors, including the levels of FeNO, FEV1%pred, ACT scores, sputum eosinophils, blood eosinophils, and TIgE, in asthma patients.
Results: The results revealed that the levels of FeNO, blood eosinophils, and TIgE were significantly higher in asthma patients compared to healthy individuals (P<0.05). Additionally, the level of FEV1%pred was significantly lower in asthma patients compared to healthy individuals (P<0.05).There was no significant correlation between FeNO 1evel and FEV1%Pred（r=0.004，P>0.05），nor between FeNO level and ACT scores（r=-0.195，P>0.05）. Correlation analysis showed that，FENO level was positive correlated with sputum eosinophils（r=0.473, P<0.05）, blood eosinophils（r=0.315, P<0.05） and TIgE（r=0.305, P<0.05）.
Conclusion: The FENO can assist diagnosis of asthma because the level of FENO is increased in asthma patients. FENO is no significant correlation with FEV1%Pred and ACT score, but the FENO level is positive correlated with sputum eosinophils, blood eosinophils and TIgE. FENO could reflect airway inflammatory level, especially esoinophilic airway inflammation.
Genetic mapping of QTLs for resistance to bacterial leaf streak in hexaploid wheat
Authors: Acharya Krishna , Liu Zhaohui , Schachterle Jeffrey , Kumari Pooja , Manan Fazal , Xu Steven , Green Andrew , Faris Justin
Published: June 2024

Bacterial leaf streak (BLS), caused by Xanthomonas translucenspv. undulosa (Xtu) poses a significant threat to global wheat production. High levels of BLS resistance are rare in hexaploid wheat. Here, we screened 101 diverse wheat genotypes under greenhouse conditions to identify new sources of BLS resistance. Five lines showed good levels of resistance including the wheat variety Boost and the synthetic hexaploid wheat line W-7984. Recombinant inbred populations derived from the cross of Boost × ND830 (BoostND population) and W-7984 × Opata 85 (ITMI population) were subsequently evaluated in greenhouse and field experiments to investigate the genetic basis of resistance. QTLs on chromosomes 3B, 5A, and 5B were identified in the BoostND population. The 3B and 5A QTLs were significant in all environments, but the 3B QTL was the strongest under greenhouse conditions explaining 38% of the phenotypic variation, and the 5A QTL was the most significant in the field explaining up to 29% of the variation. In the ITMI population, a QTL on chromosome 7D explained as much as 46% of the phenotypic variation in the greenhouse and 18% in the field. BLS severity in both populations was negatively correlated with days to heading, and some QTLs for these traits overlapped, which explained the tendency of later maturing lines to have relatively higher levels of BLS resistance. The findings from this study will contribute to a better understanding of BLS resistance and aid in the development of molecular markers for efficient selection of resistance alleles in wheat breeding programs.
Nomogram for predicting risk factors for moderate to severe pain in critical postoperative patients during the transition from the surgical intensive care unit to the surgical ward
Authors: Tang Zhihong , Li Na , tian yongming
Published: June 2024

Background: Patients may face the risk of pain during transition from the surgical intensive care unit (SICU) to the surgical ward. The incidence and risk factors of pain during this period are currently unclear.
Objective: To investigate the prevalence and risk factors of moderate to severe pain in critical postoperative patients during the transition period (24 h before and 24 h after transfer) from the SICU to the surgical ward and to construct a nomogram for predicting the moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward.
Design: A prospective survey study
Methods: 552 patients，data were collected between June 2021 and April 2022 at West China Hospital, Sichuan University by convenience sampling. Descriptive, bivariate, and logistic regression analyses were performed, after which a prediction nomogram was constructed. The Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the nomogram, and the area under the receiver operating characteristic curve (AUC) was used to evaluate its discriminatory ability.
Results: In total, 552 patients were included in the study, 28.44% of whom experienced moderate to severe pain during the 24-h transition period. The independent risk factors for moderate to severe pain identified by logistic regression analysis were acute pain 24 h before transfer out (odds ratio [OR] = 4.644; P < 0.001), APACHE II score (OR = 6.721; P < 0.001), length of stay in the SICU (OR = 3.344; P = 0.012), and number of drainage tubes (OR = 1.382; P = 0.023). A nomographic prediction model was established based on the weighting of these four risk factors. The AUC of the model was 0.975 (95% confidence interval: 0.964–0.987). The Hosmer-Lemeshow test (P=0.551) and calibration curve showed good calibration for the prediction of the moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward.
Conclusions: A high incidence of pain was observed among critically ill postoperative patients during the 24-h transition period from the SICU to the surgical ward. Acute pain 24 h before transfer out, APACHE II score, length of stay in the SICU, and number of drainage tubes were found to be significantly associated with moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward. The predictive nomogram was useful in identifying the risk factors of moderate to severe pain in critical postoperative patients.
Decoding the Impact of Lipid Metabolism on Osteoporosis: A Study on Phosphatidylcholine, Inflammatory Factors, and Immune Cells
Authors: Ye Huihuang , Wu Shaohao , Meng Hongming , Chen Chun , Bai Zhibiao
Published: June 2024

Objective: This study utilized Mendelian randomization to elucidate the causal relationship between Phosphatidylcholine (O-17:0_15:0) levels and osteoporosis, exploring the mediating roles of inflammatory factors and immune cells.
Methods: The genetic information of osteoporosis patients was obtained from the Finnish FinnGen project, with supplementary data including sequencing results for 179 liposome, 91 inflammatory factors, and 713 immune cells sourced from GWAS summary datasets. In this study, we analyzed liposome profiles as the exposure and osteoporosis as the outcome, with inflammatory factors and immune cells being examined as mediating factors. Two-sample Mendelian randomization, employing the inverse variance weighted method, and mediation analyses were conducted to assess the impact of Phosphatidylcholine on osteoporosis through inflammatory and immune pathways. Analyses of heterogeneity and pleiotropy was also conducted to assess the complexity and potential biases in the causal relationship between identified liposome and osteoporosis.
Results: Our analysis has unveiled a significant positive causal relationship between the levels of Phosphatidylcholine (O-17:0_15:0) in serum and the risk of osteoporosis. Notably, it was observed that the levels of Phosphatidylcholine (O-17:0_15:0) in serum contribute to the downregulation of tumor necrosis factor (TNF) and the activation of CD16-CD56 positive natural killer (NK) cells, both of which are protective factors against osteoporosis. This dual mechanism underscores the complex interplay between liposome and bone health, providing new insights into the pathophysiology of osteoporosis and highlighting potential targets for therapeutic intervention. Sensitivity analyses confirmed the robustness of these findings, showing no evidence of pleiotropy or reverse causation.
Conclusion: This study provides compelling evidence that Phosphatidylcholine (O-17:0_15:0) levels causally affect osteoporosis risk, with significant mediation effects observed through both inflammatory and immune mechanisms. These findings offer new insights into the complex interplay between lipid metabolism, inflammation, and immune regulation in osteoporosis, suggesting potential targets for therapeutic intervention in bone-related diseases.
Financing Immunisation in Kenya: Examining bottlenecks in health sector planning and budgeting at decentralised level
Authors: Adjagba Alex O. , Akoth Catherine , Oguta James Odhiambo , Wambiya Elvis O , Nonvignon Justice , Jackson Debra
Published: June 2024

Background
Decentralisation has increasingly been adopted by countries as an important health sector reform with the aim of increasing community participation in decision making while enhancing swift response at decentralised levels, thereby accelerating the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level.
Methods
Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software.
Findings:
The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Delayed and untimely disbursement of funds was reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation influenced resource allocation to the programs.
Conclusion
The findings highlight the need for effective strategies to address bottlenecks facing planning and budgeting to ensure adequate immunisation and health sector funding at the county level.
Comparing Health Insurance-ReimbursedFirst Line Lenvatinib and Self-paid Atezolizumab plus Bevacizumab in Patients with Unresectable Hepatocellular Carcinoma
Authors: Kuo Yuan-Hung , Chen Yen-Hao , Tsai Ming-Chao , Lu Sheng-Nan , Hu Tsung-Hui , Hung Chao-Hung , Chen Chien-Hung , Wang Jing-Houng
Published: June 2024

Background/Purpose: Atezolizumab plus bevacizumab (Ate/Bev) and lenvatinib (Len) are first-line therapies for unresectable hepatocellular carcinoma (uHCC). However, Ate/Bev's high cost limits its common use in real-life practice, while Len is usually covered by national health insurance (NHI). We conducted this study to compare their effectiveness and safety in real-world settings.
Methods: We retrospectively evaluated 346 uHCC patients treated with first-line Ate/Bev (n=80) or Len (n=266) from December 2019 to December 2022, using 1:2 ratio propensity score matching (PSM) analyses.
Results: Compared to the Len group, the Ate/Bev group exhibited higher incidences of Child-Pugh class B (14.1% vs. 5.7%, p=0.014), larger main tumors (58.8% vs. 40.2%, p=0.003), and more main portal vein invasion (25% vs. 12.8%, p=0.008). Treatment-related adverse events were notably lower in the Ate/Bev group (56.3% vs. 72.3%, p=0.007). After PSM, no significant differences were observed in the objective response rate (21.9% vs. 21.6%, p=0.983), progression-free survival (5.1 vs. 6 months, p=0.783), and overall survival (13.3 vs. 14.1 months, p=0.945) between the Ate/Bev (n=73) and Len (n=142) groups. Patients in the Ate/Bev group received more sequential post-treatments compared to the Len group (45.2% vs. 24.6%, p=0.009). Len-based therapies (n=28, 84.8%) and mono- or combined-immunotherapy (n=19, 54.3%) were the most frequently administered sequential therapies following Ate/Bev and Len, respectively.
Conclusion: Patients with uHCC who received first-line self-paid Ate/Bev appeared to have lower liver function reserve and more advanced tumor characteristics compared to those who underwent NHI-reimbursed Len. However, the treatment outcomes and safety profiles were similar between these two groups.
Screening for intrinsic capacity and frailty in the primary care population with multimorbidity using the Integrated Care for Older People Screening Tool and two different frailty measures – the Frailty Phenotype and Clinical Frailty Scale: a cross-sectional study
Authors: Sim Sai Zhen , Ng Xinyao , Lee Poay Sian Sabrina , Koh Hui Li , Tan Shu Yun , Ding Teck Yong Gabriel , Lee Eng Sing
Published: June 2024

Background
Intrinsic capacity (IC) co-exists with frailty and multimorbidity in primary care. To improve health outcomes, guidelines recommend IC and frailty screening and it is thought that IC screening can support the concurrent and subsequent evaluation of frailty. For feasible implementation of such screening, it is important to understand the association between IC and frailty, including the discriminative ability of IC against frailty in a primary care population with multimorbidity.
Method
A cross-sectional study was conducted across three primary care clinics. Participants were elderly and had the multimorbidity triad of diabetes mellitus, hypertension, and hyperlipidemia. Data collected included sociodemographic variables, IC (Integrated Care Older People Screening Tool), social vulnerability, chronic conditions, functional disability, modified Frailty Phenotype (mFP), and Clinical Frailty Scale (CFS). Logistic regression was used to assess the association between IC and the two measurements of frailty while area under the curve of the receiver operating characteristic (AUC-ROC) was used to assess the discriminative ability of IC against frailty.
Results
411 participants were included. Mean age was 69.9 (± 6.2) years and almost all (98.0%) the participants had reduced IC on screening, of which the most affected domains were the sensory (90.0%), locomotion (44.0%), and cognition (30.9%) domains. 12.4% were mFP frail while 7.4% were CFS frail. While higher IC was associated with reduced odds of frailty regardless of the frailty measure (p ≤ 0.001), the IC domains associated with frailty depended on the frailty measure used. Vitality and locomotion were associated with being mFP frail while the sensory and locomotion domains were associated with being CFS frail. An IC cut-off score of 3 was able to discriminate moderately against the mFP and CFS (AUC 0.72 and 0.74, respectively), but with a high false-positive rate 85.4% and 81.9%, respectively.
Conclusions
In a primary care population with multimorbidity, IC screening discriminates moderately against frailty. In view of the very high prevalence of IC losses, the high false-positive rate of frailty in this population and limited healthcare resources, IC screening followed by frailty screening of selected patients with IC losses may not be feasible and other approaches should be considered.