bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Metal Exposures and Child Social Responsiveness Scale Scores in 2 Prospective Studies
Authors: Yu Emma X , Dou John F , Volk Heather E , Bakulski Kelly M , Benke Kelly , Hertz-Picciotto Irva , Schmidt Rebecca J , Newschaffer Craig J , Feinberg Jason I , Daniels Jason , Fallin Margaret Daniele , Ladd-Acosta Christine , Hamra Ghassan B
Published: February 2024

Background:

Prenatal exposure to metals is hypothesized to be associated with child autism. We aim to investigate the joint and individual effects of prenatal exposure to urine metals including lead (Pb), mercury (Hg), manganese (Mn), and selenium (Se) on child Social Responsiveness Scale (SRS) scores.

Methods:

We used data from 2 cohorts enriched for likelihood of autism spectrum disorder (ASD): Early Autism Risk Longitudinal Investigation (EARLI) and the Markers of Autism Risk in Babies-Learning Early Signs (MARBLES) studies. Metal concentrations were measured in urine collected during pregnancy. We used Bayesian Kernel Machine Regression and linear regression models to investigate both joint and independent associations of metals with SRS Z-scores in each cohort. We adjusted for maternal age at delivery, interpregnancy interval, maternal education, child race/ethnicity, child sex, and/or study site.

Results:

The final analytic sample consisted of 251 mother-child pairs. When Pb, Hg, Se, and Mn were at their 75th percentiles, there was a 0.03 increase (95% credible interval [CI]: −0.11, 0.17) in EARLI and 0.07 decrease (95% CI: −0.29, 0.15) in MARBLES in childhood SRS Z-scores, compared to when all 4 metals were at their 50th percentiles. In both cohorts, increasing concentrations of Pb were associated with increasing values of SRS Z-scores, fixing the other metals to their 50th percentiles. However, all the 95% credible intervals contained the null.

Conclusions:

There were no clear monotonic associations between the overall prenatal metal mixture in pregnancy and childhood SRS Z-scores at 36 months. There were also no clear associations between individual metals within this mixture and childhood SRS Z-scores at 36 months. The overall effects of the metal mixture and the individual effects of each metal within this mixture on offspring SRS Z-scores might be heterogeneous across child sex and cohort. Further studies with larger sample sizes are warranted.
Exploring the benefits and costs of a growth mindset in a digital app weight management program
Authors: Earl Sydney , Burnette Jeni L , Ho Annabell Suh
Published: February 2024

We explored the potential benefits and costs of believing one can change their weight (i.e. growth mindset) in the context of a digital weight management program. We investigated mechanisms by which growth mindsets relate to weight loss achievement and body shame. Among participants seeking to lose weight ( N = 1626; 74.7% female; 77.9% White; Mage = 45.7), stronger growth mindsets indirectly predicted greater weight loss achievement through positive offset expectations and subsequent increased program engagement. Additionally, stronger growth mindsets predicted less body shame through positive offset expectations but predicted more body shame through increased onset responsibility, replicating the double-edged sword model of growth mindsets. We conclude with applications that leverage growth mindsets for optimal behavior change while mitigating costs such as body shame.
Mind-Stuff and Withdrawal of the Senses: Toward an Interpretation of Pratyahara in Contemporary Postural Yoga
Authors: McKibben Elizabeth
Published: February 2024

Yoga has become a popular health and wellbeing practice that draws on ancient philosophy. Pratyahara is a core tenet of yoga practice and is often translated to mean withdrawal of the senses. Withdrawing from the senses plays a key role in aiding yoga practitioners to find spiritual enlightenment by transcending the worldly. Withdrawing from the material world, however, does not neatly fit within the parameters of the contemporary postural yoga industry. This paper looks at the conceptual origins of pratyahara through stances relevant to health research. The author weaves biomedical, esthetic, and neoliberal onto-epistemological stances through health discourse to discuss how postural yoga both resists and replicates power imbalances. In so doing the author emphasizes the paradoxical nature of pratyahara as it is reflected in socio-political tensions of the yoga industry. To conclude, the author suggests that pratyahara itself can be useful in resolving this tension as yoga fulfills a philosophical prerogative for social change.
Multileaf Collimator Modeling and Commissioning for Complex Radiation Treatment Plans Using 2-Dimensional (2D) Diode Array MapCHECK2
Authors: Guo Jian , Zhu Meng , Zeng Weijin , Wang He , Qin Songbing , Li Zhibin , Tang Yu , Ying Binbin , Sang Jiugao , Ji Ming , Meng Kuo , Hui Zhouguang , Wang Jianyang , Zhou Juying , Zhou Yin , Huan Jian
Published: February 2024

Purpose: This study aims to develop a data-collecting package ExpressMLC and investigate the applicability of MapCHECK2 for multileaf collimator (MLC) modeling and commissioning for complex radiation treatment plans. Materials and methods: The MLC model incorporates realistic parameters to account for sophisticated MLC features. A set of 8 single-beam plans, denoted by ExpressMLC, is created for the determination of parameters. For the commissioning of the MLC model, 4 intensity modulated radiation therapy (IMRT) plans specified by the AAPM TG 119 report were transferred to a computed tomography study of MapCHECK2, recalculated, and compared to measurements on a Varian accelerator. Both per-beam and composite-beam dose verification were conducted. Results: Through sufficient characterization of the MLC model, under 3%/2 mm and 2%/2 mm criteria, MapCHECK2 can be used to accurately verify per beam dose with gamma passing rate better than 90.9% and 89.3%, respectively, while the Gafchromic EBT3 films can achieve gamma passing rate better than 89.3% and 85.7%, respectively. Under the same criteria, MapCHECK2 can achieve composite beam dose verification with a gamma passing rate better than 95.9% and 90.3%, while the Gafchromic EBT3 films can achieve a gamma passing rate better than 96.1% and 91.8%; the p-value from the Mann Whitney test between gamma passing rates of the per beam dose verification using full MapCHECK2 package calibrated MLC model and film calibrated MLC model is .44 and .47, respectively; the p-value between those of the true composite beam dose verification is .62 and .36, respectively. Conclusion: It is confirmed that the 2-dimensional (2D) diode array MapCHECK2 can be used for data collection for MLC modeling with the combination of the ExpressMLC package of plans, whose doses are sufficient for the determination of MLC parameters. It could be a fitting alternative to films to boost the efficiency of MLC modeling and commissioning without sacrificing accuracy.
The Colonial History of Systemic Racism: Insights for Psychological Science
Authors: Tarlow Kevin R.
Published: February 2024

The psychological study of systemic racism can benefit from the converging insights of “Black Marxism” and development economics, which illustrate how modern systemic racism is rooted in the political and economic institutions established during the historical period of European colonization. This article explores how these insights can be used to study systemic racism and challenge scientific racism in psychology by rethinking traditional research paradigms to incorporate the histories of race, class, and capitalism. Antiracism strategies that make use of these histories are also discussed, which include disrupting the psychological processes that sustain racist systems.
Complications of operatively treated distal radial fractures
Authors: Townsley Sarah H. , Pulos Nicholas , Shin Alexander Y.
Published: February 2024

Distal radial fractures represent the most common fractures of the upper extremity. Operative treatment is performed for approximately one-third of distal radial fractures in the adult population. Complications following operative treatment of distal radial fractures vary depending on the treatment modality and can be stratified into preoperative and postoperative complications. Complications can occur in the near, intermediate and long term. The most common complications seen are tendon irritation and rupture, chronic regional pain syndrome (CRPS), carpal tunnel syndrome, ulnar or radial neuropathy, compartment syndrome, malunion, inadequate fixation or loss of fixation, symptomatic hardware, post-traumatic arthritis, stiffness and infection. Careful planning, treatment and patient selection can help to mitigate these complications.

Level of evidence: V
Central aspects when implementing an electronic monitoring system for assessing hand hygiene in clinical settings: A grounded theory study
Authors: Granqvist Karin , Ahlstrom Linda , Karlsson Jon , Lytsy Birgitta , Erichsen Annette
Published: February 2024

Background

New technologies, such as electronic monitoring systems, have been developed to promote increased adherence to hand hygiene among healthcare workers. However, challenges when implementing these technologies in clinical settings have been identified.

Aim

The aim of this study was to explore healthcare workers’ experiences when implementing an electronic monitoring system to assess hand hygiene in a clinical setting.

Method

Interviews with healthcare workers (registered nurses, nurse assistants and leaders) involved in the implementation process of an electronic monitoring system ( n = 17) were conducted and data were analyzed according to the grounded theory methodology formulated by Strauss and Corbin.

Results

Healthcare workers’ experiences were expressed in terms of leading and facilitating, participating and contributing, and knowing and confirming. These three aspects were merged together to form the core category of collaborating for progress. Leaders were positive and committed to the implementation of the electronic monitoring system, endeavouring to enable facilitation and support for their co-workers (registered nurses and nurse assistants). At the same time, co-workers were positive about the support they received and contributed by raising questions and demands for the product to be used in clinical settings. Moreover, leaders and co-workers were aware of the objective of implementing the electronic monitoring system.

Conclusion

We identified dynamic collective work between leaders and co-workers during the implementation of the electronic monitoring system. Leadership, participation and knowledge were central aspects of enhancing a collaborative process. We strongly recommend involving both ward leaders and users of new technologies to promote successful implementation.
Confucianism, Business Leaders, and Party-State Power in Contemporary China
Authors: Jiang Fu Lan
Published: February 2024

From the beginning of the twenty-first century onwards, China has witnessed a Confucian revival in the business world. Often associated with a revitalisation of cultural tradition among the population, this new trend is characterised by a resurgence of the Confucian merchant (儒商, rushang) model, an ancient term that originally referred to a new type of merchants in the Ming Dynasty (1368–1644), who were close to literati circles. In parallel with this increasing interest in Confucianism by many economic elites, there has been an integration of certain elements of Confucianism into official political discourse through various moral edification campaigns. Based on an analysis of this new official discourse and the fieldwork we carried out between 2016 and 2020 within three private companies, this article aims to analyse interactions between three elements: Confucianism, party-state power, and business leaders claiming to be “Confucian.”
Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman
Authors: Biswas Uttam , León-Ruiz Moisés , Ghosh Ritwik , Sarkar Ritun , Sen Moumita , Benito-León Julián
Published: February 2024

Background

Scrub typhus, a mite-borne zoonosis caused by Orientia tsutsugamushi, is prevalent in the Asia Pacific region and presents with various neurological manifestations, including meningoencephalitis, polyneuropathy, and, rarely, cerebral venous sinus thrombosis (CVST).

Case Report

We report a unique case of CVST following scrub typhus meningoencephalitis in an 18-year-old pregnant woman from West Bengal, India. Her condition was complicated by fever, headache, neck stiffness, and altered sensorium. Laboratory tests revealed leukopenia and thrombocytopenia, while serologies for other infectious diseases were negative. Cerebrospinal fluid analysis was significant for lymphocytic pleocytosis and elevated protein, with a positive O tsutsugamushi-IgM assay. Treatment with azithromycin resulted in initial improvement; however, persistent headaches led to the discovery of CVST. The patient responded well to anticoagulation therapy with low molecular weight heparin and was discharged asymptomatic, with subsequent uneventful pregnancy and delivery.

Discussion

Cerebral venous sinus thrombosis should be ruled out in pregnant women with refractory scrub typhus meningoencephalitis despite antibiotic therapy. Because scrub typhus is treatable with intravenous doxycycline and azithromycin, it should be considered in the workup of febrile patients with acute onset neurological disorders in the tropics or subtropics or travelers coming back from endemic areas, despite the absence of eschar and unremarkable neuroimaging findings.
Towards new knowledge complexes for critical geographies of alcohol, drinking, drunkenness
Authors: Jayne Mark , Valentine Gill
Published: February 2024

This response engages with the commentaries of Gordon Waitt, Anna De Jong, Samantha Wilkinson, Elen-Maarja Trell, Bettina van Hoven, and Harng Luh Sin on our challenge for geographers to work ‘beyond moralizing, disciplining, and normalizing discourses’. We show how, when read together, these authors articulate progressive geographic imaginations and repeat orthodoxies and impasses that constitute problematic academic, political, policy, and popular thinking. In riposte, we sketch opportunities for pluralist, relational, congenic ontologies, and comparative ‘epissedemologies’, as new indicative examples to elaborate, and further advance, our original provocation towards re-thinking geographies of alcohol, drinking, drunkenness.
Review of the limitations of current biomarkers in acute kidney injury clinical practices
Authors: Bufkin Kendra B , Karim Zubair A , Silva Jeane
Published: February 2024

Acute kidney injury is a prevalent disease in hospitalized patients and is continuously increasing worldwide. Various efforts have been made to define and classify acute kidney injury to understand the progression of this disease. Furthermore, deviations from structure and kidney function and the current diagnostic guidelines are not adequately placed due to baseline serum creatinine values, which are rarely known and estimated based on glomerular function rate, resulting in misclassification of acute kidney injury staging. Hence, the current guidelines are still developing to improve and understand the clinical implications of risk factors and earlier predictive biomarkers of acute kidney injury. Yet, studies have indicated disadvantages and limitations with the current acute kidney injury biomarkers, including lack of sensitivity and specificity. Therefore, the present narrative review brings together the most current evidenced-based practice and literature associated with the limitations of the gold standard for acute kidney injury diagnoses, the need for novel acute kidney injury biomarkers, and the process for biomarkers to be qualified for diagnostic use under the following sections and themes. The introduction section situates the anatomy and normal and abnormal kidney functions related to acute kidney injury disorders. Guidelines in providing acute kidney injury definitions and classification are then considered, followed by a discussion of the disadvantages of standard markers used to diagnose acute kidney injury. Characteristics of an ideal acute kidney injury biomarker are discussed concerning sensitivity, specificity, and anatomic location of injury. A particular focus on the role and function of emerging biomarkers is discussed in relation to their applications and significance to the prognosis and severity of acute kidney injury. Findings show emerging markers are early indicators of acute kidney injury prediction in different clinical settings. Finally, the process required for a biomarker to be applied for diagnostic use is explained.
The Method of Portal Making in Lumbar Unilateral Biportal Endoscopic Surgery with Different Operative Approaches According to the Constant Anatomical Landmarks of the Lumbar Spine: A Review of the Literature
Authors: Wang Yixi , Maimaiti Abulikemu , Tuoheti Abudusalamu , Xiao Yang , Zhang Rui , Kahaer Alafate , Liu Dongshan , Rexiti Paerhati
Published: February 2024

Study Design

Review.

Objective

Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals’ location varies depending on the originator’s preferences or the anatomical structure’s proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches’ portals.

Methods

The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: “Biportal endoscopic spinal surgery”, “Two portal endoscopic spinal surgery”, “Percutaneous biportal endoscopic decompression”, “Unilateral biportal endoscopy”, “Irrigation endoscopic discectomy”, “UBE” and “BESS”.

Results

After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches’ portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method.

Conclusion

The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons’ understanding and proficiency in UBE procedures.
Tobacco control in Qatar from 2002 to 2022: 20 years of progress and challenges
Authors: Al-Kuwari Mohamed Ghaith , Al-Khenji Abdulhmeed Ahmad , Al-Baker Wadha Ahmad , Bala Mohamed Osman
Published: February 2024

Tobacco use and exposure has been known as one of the leading causes of premature mortality worldwide. Tobacco control measures have been considered one of the strategies for reducing the burden of NCDs, improving public health, and strengthening the health system’s response to threats and pandemics. The State of Qatar has put tobacco control a national public health priority as it has adopted various tobacco control measures that the WHO classified as high-impact measures. This has resulted in achieving tobacco control milestones which led to constant monitoring of tobacco use and the provision of smoking cessation services at all healthcare levels. However, there is still much work to be done to fill the gaps and respond to the emergence of novel tobacco products and market strategies in an effective way. This review highlights the status of tobacco use and exposure in the State of Qatar, and focus on the progress, and challenges in the implementation of tobacco control policies and smoking cessation services between 2002 and 2022.
Contested port cities: Logistical frictions and civic mobilization in Genoa and Venice
Authors: Savoldi Francesca
Published: February 2024

This article examines the increasingly conflictual relationship between ports and their surrounding communities at a time of wide-reaching infrastructural expansion. It highlights how the centralization of power and logistical gigantism produce deterritorializing frictions, decoupling inhabitants from their territories and creating the conditions for social contestation. It calls for a rethinking of the role of communities in contemporary port-city governance, with an emphasis on imaginaries of re-territorialization produced through social mobilization. I frame the increasing contestation in port cities through a critical approach to logistics, arguing that citizen engagement holds the potential to drastically readdress the port-city relationship. It examines the cases of Genoa and Venice using ethnographic methods and reconstructs a historically in-depth counter-narrative of interactions between port, city and citizen. I contextualize specific frictions between port and city through the rise in social mobilizations. The article shows how social mobilization challenges the status quo in different ways, producing changes and illuminating pathways toward more sustainable forms of coexistence between ports and cities.
Best Laid Plans: A Guide to Reporting Preregistration Deviations
Authors: Willroth Emily C. , Atherton Olivia E.
Published: February 2024

Psychological scientists are increasingly using preregistration as a tool to increase the credibility of research findings. Many of the benefits of preregistration rest on the assumption that preregistered plans are followed perfectly. However, research suggests that this is the exception rather than the norm, and there are many reasons why researchers may deviate from their preregistered plans. Preregistration can still be a valuable tool, even in the presence of deviations, as long as those deviations are well documented and transparently reported. Unfortunately, most preregistration deviations in psychology go unreported or are reported in unsystematic ways. In the current article, we offer a solution to this problem by providing a framework for transparent and standardized reporting of preregistration deviations, which was developed by drawing on our own experiences with preregistration, existing unpublished templates, feedback from colleagues and reviewers, and the results of a survey of 34 psychology-journal editors. This framework provides a clear template for what to do when things do not go as planned. We conclude by encouraging researchers to adopt this framework in their own preregistered research and by suggesting that journals implement structural policies around the transparent reporting of preregistration deviations.
Contact-FP: A Dimerization-Dependent Fluorescent Protein Toolkit for Visualizing Membrane Contact Site Dynamics
Authors: Miner Gregory E. , Smith Sidney Y. , Showalter Wendy K. , So Christina M. , Ragusa Joey V. , Powers Alex E. , Zanellati Maria Clara , Hsu Chih-Hsuan , Marchan Michelle F. , Cohen Sarah
Published: February 2024

Membrane contact sites (MCSs) are sites of close apposition between two organelles used to exchange ions, lipids, and information. Cells respond to changing environmental or developmental conditions by modulating the number, extent, or duration of MCSs. Because of their small size and dynamic nature, tools to study the dynamics of MCSs in live cells have been limited. Dimerization-dependent fluorescent proteins (ddFPs) targeted to organelle membranes are an ideal tool for studying MCS dynamics because they reversibly interact to fluoresce specifically at the interface between two organelles. Here, we build on previous work using ddFPs as sensors to visualize the morphology and dynamics of MCSs. We engineered a suite of ddFPs called Contact-FP that targets ddFP monomers to lipid droplets (LDs), the endoplasmic reticulum (ER), mitochondria, peroxisomes, lysosomes, plasma membrane, caveolae, and the cytoplasm. We show that these probes correctly localize to their target organelles. Using LDs as a test case, we demonstrate that Contact-FP pairs specifically localize to the interface between two target organelles. Titration of LD-mitochondria ddFPs revealed that these sensors can be used at high concentrations to drive MCSs or can be titrated down to minimally perturb and visualize endogenous MCSs. We show that Contact-FP probes can be used to: (1) visualize LD-mitochondria MCS dynamics, (2) observe changes in LD-mitochondria MCS dynamics upon overexpression of PLIN5, a known LD-mitochondrial tether, and (3) visualize two MCSs that share one organelle simultaneously (e.g., LD-mitochondria and LD-ER MCSs). Contact-FP probes can be optimized to visualize MCSs between any pair of organelles represented in the toolkit.
Predictability of the Orthodontic-Surgical Planning: A Comparative Study Between the Post-Operative Outcome and the Visual Treatment Objective
Authors: Roberto Antonio Vernucci , Leda Miriam Valentini , Adriana De Stefano , Roberto Di Giorgio , Gabriella Galluccio
Published: February 2024

Objective:To test the validity of lateral pre-treatment and pre-surgical VTO, by comparing them with the post-treatment lateral cephalometry. Methods: A total of 26 patients affected by Class III who underwent orthognathic surgery were evaluated. For all patients, pre-treatment (T0), pre-surgical (T1) and post-treatment (T2) cephalometric tracings, pre-treatment and pre-surgical VTO were performed. Nine measurements of hard tissues were considered. A comparison was made between pre-treatment and pre-surgical cephalometric measurements, post-treatment cephalometric tracing and pre-treatment VTO, post-treatment cephalometric tracing, and pre-surgical VTO. Descriptive and inferential statistics along with Bland-Altman plot were used to analyze the agreement between the outcome and the program. Results: From the comparison between pre-treatment and pre-surgical values, a statistically significant difference was found for the SNB angle ( P = .0292), the inclination of the upper ( P = .0309) and lower incisors ( P < .000) and the over-jet ( P < .000). The comparison between the post-treatment cephalometry (T2) and pre-treatment VTO (T0) highlighted good agreement between over-bite and over-jet values. The comparison between the post-treatment cephalometry (T2) and pre-treatment VTO (T0) highlighted good agreement with over-jet and IMPA angle. All parameters had high dispersion and the Bland-Altman plot appeared to be scattered. Conclusion: Given the bias and the imprecisions between the orthodontic-surgical program and the outcome, the indications given by 2-dimensional VTO should be used with caution.
Using design research and human-centered design to address growing pains in a busy, urban emergency department: a faculty, clinician, and student collaboration between nursing, design, and medicine
Authors: Avery Mikael L. , Arena Jacquelyn L. , Benson Nicholas D. , Ray Neil A. , Leary Marion
Published: February 2024

In 2021, a large urban university-based hospital transitioned to a new two-floor emergency department. Despite the new environment, there were usability and workflow challenges with the space. The authors of this paper created a multidisciplinary, human-centered design collaborative of clinicians, university faculty, and students in an effort to increase emergency department efficiency. After thorough design-research and clinician-focused collaboration, the authors and design team identified the need to improve medical supply retrieval time, which directly impacts patient care and clinician satisfaction. The primary interventions consisted of a redesign that is as follows: (a) created standardized icons related to organ system, (b) increased visibility of supply labels, and (c) reorganized supplies based on usage data. Although a successful project, it was not without several barriers discussed in this article, including design researcher and clinician-level setting and engagement, academic/institutional policies, and conflicting schedules. In addition, the lessons learned from implementing human-centered design concepts into clinical workflow sets forth future research opportunities and inspiration for other institutions to collaborate.
Mapping pathogenic bacteria resistance against common antibiotics and their potential susceptibility to methylated white kidney bean protein
Authors: Sitohy Mahmoud , Enan Gamal , Abdel-Shafi Seham , El-Wafa Neveen Abou , El-Gazzar Nashwa , Osman Ali , Sitohy Basel
Published: February 2024

As antibiotics cannot inhibit multidrug-resistant bacteria (MDR), continuous research is mandatory to find other antibacterials from natural resources. Native legume proteins and their modified forms exhibited broad spectra of high antimicrobial activities. Sixteen bacterial isolates were mapped for antibiotic resistance, showing resistance in the range of (58–92%) and (42–92%) in the case of the Gram-negative and Gram-positive bacteria, respectively. White native Phaseolus vulgaris protein (NPP) was isolated from the seeds and methylated (MPP). The MIC range of MPP against 7 MDR bacteria was 10–25 times lower than NPP and could (1 MIC) considerably inhibit their 24 h liquid growth. MPP showed higher antibacterial effectiveness than Gentamycin, the most effective antibiotic against Gram-positive bacteria and the second most effective against Gram-negative bacteria. However, MPP recorded MICs against the seven studied MDR bacteria in the 1–20 µg/mL range, the same for Gentamycin. The combination of Gentamycin and MPP produced synergistic effects against the seven bacteria studied, as confirmed by the Transmission Electron Microscopic images. The antimicrobial activity of MPP against the seven MDR bacteria remained stable after two years of cold storage at 8–10 °C as contrasted to Gentamycin, which lost 20–72% of its antimicrobial effectiveness.
Association of antenatal corticosteroids with mortality and morbidities in very preterm infants born to women with hypertensive disorders of pregnancy: a multicenter prospective cohort study
Authors: Dong Xiao-Yu , Qi Jian-Hong , Zhuo Qing-Cui , Ding Yan-Jie , Qiao Xin , Wang Yan , Yang De-Juan , Li Dan , Li Li , Jiang Hai-Yan , Liu Qiong-Yu , Li Zhong-Liang , Zhang Xiang , Zhang Bing-Jin , Yu Yong-Hui
Published: February 2024

Background

Hypertensive disorders of pregnancy (HDP) is the most common cause of indicated preterm delivery, but the impact of prenatal steroid exposure on the outcomes of preterm infants born to HDP mothers, who may be at risk for intrauterine hypoxia-ischemia, remains uncertain. The study objective is to evaluate the mortality and morbidities in HDP for very preterm infants (VPIs) exposed to different course of ANS.

Methods

This is a prospective cohort study comprising infants with < 32 weeks gestation born to women with HDP only from 1 Jan. 2019 to 31 Dec. 2021 within 40 participating neonatal intensive care units (NICUs) in Sino-northern network. ANS courses included completed, partial, repeated, and no ANS. Univariate and multivariable analyses were performed on administration of ANS and short-term outcomes before discharge.

Results

Among 1917 VPIs born to women with HDP only, 987(51.4%) received a complete course of ANS within 48 h to 7 days before birth, 560(29.2%) received partial ANS within 24 h before delivery, 100(5.2%) received repeat ANS and 270 (14.1%) did not receive any ANS. Compared to infants who received complete ANS, infants unexposed to ANS was associated with higher odds of death (AOR 1.85; 95%CI 1.10, 3.14), Severe Neurological Injury (SNI) or death (AOR 1.68; 95%CI 1.29,3.80) and NEC or death (AOR 1.78; 95%CI 1.55, 2.89), the repeated ANS group exhibits a significant negative correlation with the duration of oxygen therapy days (correlation coefficient − 18.3; 95%CI-39.2, -2.1). However, there were no significant differences observed between the full course and partial course groups in terms of outcomes. We can draw similar conclusions in the non-SGA group, while the differences are not significant in the SGA group. From KM curve, it showed that the repeated group had the highest survival rate, but the statistical analysis did not indicate a significant difference.

Conclusions

Even partial courses of ANS administered within 24 h before delivery proved to be protective against death and other morbidities. The differences mentioned above are more pronounced in the non-SGA group. Repeat courses demonstrate a trend toward protection, but this still needs to be confirmed by larger samples.
Response to immune checkpoint inhibitor combination therapy in metastatic RET-mutated lung cancer from real-world retrospective data
Authors: Yan Ningning , Zhang Huixian , Shen Shujing , Guo Sanxing , Li Xingya
Published: February 2024

Background

The impact of immune checkpoint inhibitors (ICIs) based treatments on non-small cell lung cancers (NSCLCs) with RET fusions remains poorly understood.

Methods

We screened patients with RET fusions at the First Affiliated Hospital of Zhengzhou University and included those who were treated with ICIs based regimens for further analysis. We evaluated clinical indicators including objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS).

Results

A total of 232 patients with RET fusions were included in the study. Of these, 129 patients had their programmed death-ligand 1 (PDL1) expression levels tested, with 22 patients (17.8%) having a PDL1 level greater than or equal to 50%. Additionally, tumor mutational burden (TMB) status was evaluated in 35 patients, with the majority (30/35, 85.8%) having a TMB of less than 10 mutations per megabase. Out of the 38 patients treated with ICI based regimens, the median PFS was 5 months (95% confidence interval [CI]: 2.4–7.6 months) and the median OS was 19 months (95% CI: 9.7–28.3 months) at the time of data analysis. Stratification based on treatment lines did not show any significant differences in OS (18 vs. 19 months, p = 0.63) and PFS (6 vs. 5 months, p = 0.86). The ORR for patients treated with ICIs was 26.3%. Furthermore, no significant differences were found for PFS (p = 0.27) and OS (p = 0.75) between patients with positive and negative PDL1 expression. Additionally, there was no significant difference in PD-L1 levels (p = 0.10) between patients who achieved objective response and those who did not.

Conclusions

Patients with RET fusion positive NSCLCs may not benefit from ICI based regimens and therefore should not be treated with ICIs in clinical practice.
Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff
Authors: Moell Astrid , Rozental Alexander , Buchmayer Susanne , Kaltiala Riittakerttu , Långström Niklas
Published: February 2024

Background

Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care.

Methods

During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context.

Results

The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators’ understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy.

Conclusions

The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
Investigation of the 1-week effect of traffic light nutrition labeling on diet selection among Japanese university students: a randomized controlled trial
Authors: Wakui Nobuyuki , Matsuoka Raini , Ichikawa Kotoha , Togawa Chikako , Okami Aika , Kawakubo Shoko , Kagi Hinako , Watanabe Mai , Tsubota Yuika , Yamamura Miho , Machida Yoshiaki
Published: February 2024

Background

The method of displaying nutrition information labels on the front of food packaging (FOP: Front of Pack) has been implemented worldwide to prevent lifestyle-related diseases. This study aimed to investigate whether the use of the UK’s Traffic Light Food (TLF) label, known as the FOP label, influences the dietary choices of Japanese youth and promotes healthy dietary choices.

Methods

Diet selection was performed for one week each during the baseline and intervention periods. During the intervention period, TLF labels were displayed on meal images of the intervention group. Participants chose what they would like to have for dinner of the day from 15 images. Each meal was scored based on the color of the nutrition label, and a comparison between groups was made to determine whether TLF labeling influenced meal selection for dinner. The psychological stress caused by the presence or absence of nutrition labels and nutritional components when choosing meals was also evaluated.

Results

A total of 69 participants were randomly assigned to two groups. Dietary choice scores indicated that the TLF-labeled group made significantly healthier dietary choices than the unlabeled group. Additionally, the TLF-labeled group showed a significant increase in the percentage of people conscious of nutritional components when choosing meals. Furthermore, a significant increase in the number of people conscious of protein, a nutritional ingredient not indicated on the TLF label, was observed. During the test period, no difference in psychological stress caused by the presence and absence of the TLF labels was observed.

Conclusions

The use of TLF labels also encouraged healthy dietary choices among Japanese university students. The use of FOP nutrition labels should be considered in Japan to prevent lifestyle-related diseases through healthy dietary choices.

Trial registration

UMIN Clinical Trials Registry Number: UMIN000047268. Registered March 23, 2022.
Morphological analysis of isolated hemivertebra: radiographic manifestations related to the severity of congenital scoliosis
Authors: Rong Tianhua , Jiao Yang , Huang Yizhen , Feng Erwei , Sun Heng , Zhao Junduo , Shen Jianxiong
Published: February 2024

Purpose

The natural history of congenital scoliosis (CS) caused by hemivertebra varies greatly. This study aimed to explore the association between the morphology of hemivertebra and the severity of CS, since the diagnosis of the hemivertebra.

Methods

Patients with isolated (single fully segmented) hemivertebra were enrolled. The degree and progression of deformity were compared by three morphological parameters of hemivertebra, comprising whether the width of hemivertebra extends across the central vertical line of lower adjacent vertebra (midline); the lateral height ratio (LHR, lateral height of hemivertebra× 2/(lateral height of HV-1 plus HV + 1) with the cut-point being 0.9; and the sagittal position of hemivertebra that was divided into the lateral and posterolateral group.

Results

In total, 156 patients (mean age 9.7 ± 6.2 years, 81 males) were enrolled. The number of thoracic, thoracolumbar (T12/13-L1), and lumbar hemivertebrae were 63, 41, and 52, respectively. Hemivertebrae across the midline had larger scoliosis and kyphosis (58.3 ± 20.6° vs. 42.8 ± 15.0°, P <  0.001; 45.1 ± 32.5° vs. 29.5 ± 25.7°, P = 0.013, respectively). Hemivertebrae with LHR ≥0.9 was associated with larger scoliosis (55.7 ± 20.6° vs. 41.4 ± 13.3°, P <  0.001). Larger scoliosis and kyphosis were observed in posterolateral hemivertebrae (54.4 ± 21.0° vs. 44.4 ± 15.6°, P = 0.026; 51.4 ± 31.5° vs. 20.6 ± 17.1°, P <  0.001, respectively). Co-occurrence of more than one of the three positive parameters above indicated higher annual progression (5.0 ± 2.2° vs. 3.3 ± 1.3°, P <  0.001).

Conclusion

Three positive parameters, width across the midline, LHR ≥0.9, and posterolateral position were associated with a more severe deformity in patients with isolated hemivertebra. Hemivertebrae with more than one positive parameter may cause progressive deformity, and thus need prompt surgery.

Level of evidence

Prognostic, level IV.
Multimedia design for learner interest and achievement: a visual guide to pharmacology
Authors: Bland Tyler , Guo Meize , Dousay Tonia A.
Published: February 2024

Background

Medical education increasingly relies on digital learning materials. Despite recognition by the Association of American Medical Colleges Institute for Improving Medical Education, medical education design often fails to consider quality multimedia design principles. Further, the AAMC-IIME issued a call to study the role of design principles in medical education. Thus, the current study investigated the cognitive and affective effects of redesigningPowerPointslides used to support pharmacology content during the preclinical years of medical school training.

Methods

Researchers implemented a quasi-experimental design, using traditionally-designed (original) slides with a Traditional group (n = 100) and slides redesigned to follow principles from the Cognitive Theory of Multimedia Learning with an Experimental group (n = 40). Participants in the Experimental group completed a post-survey incorporating the Situational Interest Survey for Multimedia to indicate motivational engagement with the media. Students in the Experimental group also responded to additional preference questions. Researchers analyzed survey responses and students’ scores in pharmacology-related coursework across the preclinical Foundations Phase of training to determine the impact on achievement and motivation.

Results

Findings related to learner achievement showed a modest but significant increase in the Experimental group compared to the Traditional group in the Cardiac, Pulmonary, and Renal (CPR) educational block (105%, normalized to Traditional group,p = 0.013) and cumulative pharmacology grades (101%, normalized to Traditional group,p = 0.043). Additionally, participants in the Experimental group indicated a significantly higher average triggered situational interest in redesigned slides (M = 4.85, SD = 0.25) than the original slides (M = 3.23, SD = 1.40, t=-6.33,p < 0.001). Similarly, the interest rating of the redesigned slides (M = 4.87, SD = 0.24) was significantly greater than that of the original slides (M = 3.89, SD = 0.86, t=-6.824,p < 0.001). Moreover, results further indicated significant differences in the maintained-feeling and maintained-value constructs, and all participants in the Experimental group indicated a preference for the redesigned slides.

Conclusions

The findings provide strong evidence in support of using the Cognitive Theory of Multimedia Learning design principles to intentionally design media in medical education. In addition to increased achievement scores, students in the Experimental group demonstrated significantly higher levels of situational interest in the redesigned slides, especially triggered interest and maintained-feeling interest. Medical education learning designers should seriously consider redesigning media to achieve similar results.
Bridging the chasm between patients’ needs and current rehabilitation care: perceptions of adults presenting for primary care in the Eastern Cape
Authors: Charumbira Maria Yvonne , Conradie Thandi , Berner Karina , Louw Quinette Abegail
Published: February 2024

Background

The need for rehabilitation in low-to-middle income countries (LMICs) is rapidly increasing as more people are living longer with chronic diseases. Primary health care (PHC) is ideally placed to provide the spectrum of care required to meet most of the complex and evolving population's health needs locally. This study aimed to describe the patient journeys of adults attending primary care in the Eastern Cape province of South Africa to understand the factors that affected their access to primary care rehabilitation services (or the lack thereof) and obtain suggestions on how rehabilitation may be enhanced at primary care.

Methods

A maximum variation sampling approach was used to purposefully select persons with varied chronic health conditions and demographic characteristics to gain diverse perspectives regarding their rehabilitation needs and ways in which the current rehabilitation services at primary care may be enhanced. Data were collected via face-to-face semi-structured interviews between March and June 2022 which were electronically recorded. Inductive thematic analysis of transcribed data was done and coded in Atlas.ti.22®.

Results

Twenty-five adult patients participated in the study. The patients had different experiences at their local PHC facilities that affected their access to rehabilitation at primary care. The study found that most patients were not able to access rehabilitation at primary care. There were several personal and contextual factors that resulted in the patients having a low perceived need to receive rehabilitation that potentially lowered patients' demand for and utilization of rehabilitation at primary care. Patients suggested increasing rehabilitation workforce at primary care, improving availability of assistive devices, increasing their knowledge regarding rehabilitation, and facilitating socio-economic integration into their communities.

Conclusions

Patients attending primary care are not guaranteed access to rehabilitation by virtue of having entered the PHC system. It is important to consider the patient perspectives regarding their health needs and suggestions for enhancing care.