bluuebunny/crossref_metadata_2025 huggingface dataset:
Contact analysis of output mechanism of cycloidal pinwheel reducer
Authors: Zhang Yueming , Liu Shuo , Ji Shuting
Published: July 2024

In order to study the effect of design parameters on the contact performance of cycloid reducer, a new contact collision force model applicable to various restitution coefficients is proposed. Firstly, based on the L-N nonlinear contact theory and improved Winkler model, a contact force model with contact depth index and damping was proposed. Secondly, Hertzian contact theory was used to clarify the contact area, precise position and relative contact speed between the output pin and the cycloidal wheel in the presence of a clearance. By using the improved contact force model and simulation analysis, the effects of structural design parameters and working condition parameters on contact force were discussed. Finally, with the goal of reducing the contact force and volume of the reducer, the NSGA-II multi-objective genetic algorithm was used to construct an optimization model for the structural parameters of the reducer. The results show that the optimized structural parameters can effectively reduce the contact force of the output mechanism.
Psychometric Reliability, Validity, and Generalizability of MoCA in American Indian Adults: The Strong Heart Study
Authors: Suchy-Dicey Astrid M. , Vo Thao T. , Oziel Kyra , Buchwald Dedra S. , Rhoads Kristoffer , French Brian F.
Published: July 2024

Standardized neuropsychological instruments are used to evaluate cognitive impairment, but few have been psychometrically evaluated in American Indians. We collected Montreal Cognitive Assessment (MoCA) in 403 American Indians 70 to 95 years, as well as age, sex, education, bilingual status, depression symptoms, and other neuropsychological instruments. We evaluated inferences of psychometric validity, including scoring inference using confirmatory factor analysis and structural equation modeling, generalizability inference using reliability coefficient, and extrapolation inference by examining performance across different contexts and substrata. The unidimensional (total score) model had good fit criteria. Internal consistency reliability was high. MoCA scores were positively associated with crystallized cognition (ρ = 0.48, p < .001) and inversely with depression symptoms (ρ = −0.27, p < .001). Significant differences were found by education ( d = 0.79, p < .05) depression ( d = 0.484, p < .05), and adjudicated cognitive status ( p = .0001) strata; however, MoCA was not sensitive or specific in discriminating cognitive impairment from normal cognition (area under the curve <0.5). MoCA scores had psychometric validity in older American Indians, but education and depression are important contextual features for score interpretability. Future research should evaluate cultural or community-specific adaptations, to improve test discriminability in this underserved population.
Vibration control of structure using active tuned mass damper: A new control algorithm
Authors: Mousaviyan Safakhaneh Motasam , Fahimi Farzam Maziar , Ahmadi Hamzeh , Farnam Arash
Published: July 2024

This paper investigates the vibration behavior of a 10-story benchmark building controlled with an active tuned mass damper (ATMD) under earthquake loads. An ATMD, typically installed on the top floor, is a modified form of a tuned mass damper (TMD) that includes a mass, spring, damper, and an actuator enhancing system performance and structural damping. The force and movement direction of the ATMD are controlled by a processor and actuator. In the ATMD system, control algorithms determine the magnitude and direction of the applied force. This research introduces a new control algorithm based on the structure’s dynamic response and ATMD stiffness. To evaluate the performance of this algorithm, linear–quadratic regulator (LQR) and fuzzy logic controller (FLC) algorithms were designed and presented for comparison. The results indicate that the proposed algorithm outperformed the other algorithms, reducing the structure’s displacement and acceleration responses by an average of 40% and 28.16%, respectively, compared to the uncontrolled state.
Effects of Visual Framing in Multimodal Media Environments: A Systematic Review of Studies Between 1979 and 2023
Authors: Geise Stephanie , Xu Yi
Published: July 2024

Framing is considered an important theoretical perspective for analyzing the influence of media information. Despite the explicit inclusion of visual elements within established frame definitions, visuals have long been marginalized in framing research. Based on a systematic review of 552 articles addressing visual framing, this article closely investigates 72 empirical studies on visual/multimodal framing effects. Drawing on framing as a multidimensional process, we discuss how existing studies have examined the sensory, affective, cognitive, and behavioral dimensions of impact. We explain the rising importance of visual communication and multimodality and conclude with implications for mass communication and visual journalism.
Principles of using the Kodály method in Chinese music education: synthesis of traditional educational elements of Chinese musical culture and Zoltan Kodály’s music teaching approaches / Principios de la aplicación del método Kodály en la educación musical china: síntesis de elementos educativos tradicionales de la cultura musical china y el enfoque pedagógico de las enseñanzas musicales de Zoltan Kodály
Authors: Liu Chang
Published: July 2024

The paper measures the effectiveness and basic principles of the use of Kodály’s method in Chinese music education. The study was conducted among 186 first-year music students at Chinese universities. The methodology involved the following techniques: methodology for assessment of learner motivation (A. A. Rean, V. A. Yakunin, modified by N. C. Badmaeva), methodology for motivating to study at university (T. N. Ilyina), G. Davis’s Test of Creativity. The learning achievements were assessed with grade point averages and the exam outcomes. The research findings demonstrate the impact of Kodály’s methodology on the motivational and creative components of learning. The group’s grade point average on the ‘methodology for motivating to study at university’ scale increased: from 4.2 ± .2 to 4.8 ± .1 for ‘Communication’, from 4.5 ± .2 to 4.8 ± .1 for ‘Proficiency’, from 4.5 ± .2 to 4.8 ± .1 for ‘Learning and cognitive motive’. Kodály’s approach, based on the inclusion of singing, rhythm, movement and other supplementary exercises in music education, as well as authentic folk music, contributes to learning effectiveness.
Research on Drivers and Barriers to the Implementation of Cold Ironing Technology in Zero Emissions Port
Authors: Le Son-Tung
Published: July 2024

Ports play an important role in connecting the domestic and global economies. Zero emissions port models are actively developed and frequently utilized to fulfill economic objectives while reducing environmental effect. The cold ironing system is one of technological methods assisting ports in transitioning to zero emissions port models. Although a number of ports have successfully implemented it, many other seaports, particularly those in developing countries, continue to face numerous challenges in implementing cold ironing. The aim of this research is to investigate the factors influencing the adoption of cold ironing. The study used a quantitative method, conducting a survey of 215 port managers from the North, Central, and South of Vietnam. The findings indicate that economic incentives and regulation have a positive impact on the adoption of cold ironing at ports. While lack of initial capital and lack of standardization are barriers to the implementation of cold ironing. The last section will look over the study’s results and implications in greater detail.
Effect of injection timings and injection pressure on knock mitigation with a compression stroke injection of hydrous ethanol in spark ignition
Authors: Gandolfo John , Lawler Benjamin , Gainey Brian
Published: July 2024

Direct injection fuel systems provide precise control over the amount of fuel injected and can enable higher compression ratio operation and earlier combustion phasing under knock-limited operation, particularly for fuels with a high cooling potential like hydrous ethanol, a blend of 92% ethanol and 8% water. Moving a portion of the total fuel mass from an intake stroke injection to a compression stroke injection can provide a knock suppression benefit, which can enable more efficient operation. In this work, the influence of injection pressure on this split injection spark ignition strategy is examined. The effect of injection pressure on two intake stroke injections were characterized, with an injection pressure of 200 bar improving combustion efficiency by ∼3 percentage points and advancing knock-limited CA50 by 1 crank angle degree over an injection pressure of 30 bar. Then, a compression stroke injection was introduced and swept into the compression stroke while maintaining the two intake stroke injections. Direct injections at an injection pressure of 30 bar enabled a small knock intensity reduction of ∼20%, whereas an injection pressure of 200 bar enabled a larger reduction of ∼90% in knock intensity. The spark timing advance permitted by the reduction in knock intensity with a compression stroke injection timing of −80 degrees after top dead center was 0.3 and 2.0 degrees at an injection pressure of 30 and 200 bar, respectively. Then, the second intake stroke injection was varied at 200 bar to evaluate how the stratification profile prior to the compression stroke injection impacted its ability to reduce knock intensity. It was found that compression stroke injections with an early second intake stroke injection was effective at reducing knock intensity throughout the compression stroke. As the second intake stroke injection was retarded, the early compression stroke injections became less effective at suppressing knock.
Voting in the Mall: Ideology, Grievance, and Political Consumerism
Authors: Poku-Agyemang Kwadwo , Garand James C.
Published: July 2024

In this paper we consider how political ideology, attitudes toward historically-marginalized groups, and identification with grievance groups shape Americans’ self-reported participation in political consumerism (i.e., political boycotts and buycotts). Using data from the 2016 and 2020 American National Election Studies (ANES) surveys, we find that ideological intensity has an asymmetrical effect on boycott behavior in 2016, with strong liberals considerably more likely to engage in boycott behavior than strong conservatives. In 2020 the effect of ideological intensity shifts upward dramatically for conservatives, with both liberals and conservatives likely to engage in boycott behavior. We also find mixed results for the effects of attitudes toward and identification with historically-marginalized groups, though we do find that general political participation (and related variables) are strongly related to boycott activity. We discuss the implications of our findings, particularly as they relate to the effects of ideological intensity for liberals and conservatives.
Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis
Authors: Adams Alexander J. , Kasper Alexis , Tosti Rick
Published: July 2024

Background:

The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy.

Methods:

A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year. All patients received an examination at each visit to include pain, range of motion, strength, and metacarpal height. Complications, concomitant procedures, and revision procedures were recorded as well.

Results:

A total of 49 arthroscopic trapeziectomy procedures were recorded for 46 patients. The average preoperative visual analog pain scale score was 8.8 out of 10, and the postoperative score was 1 out of 10. All patients had a resolution of the carpometacarpal grind test postoperatively. The average preoperative key pinch, 3-point chuck, and grip strength were 9.8 lbs/in2, 7.8 lbs/in2, and 45 lbs/in2, respectively. Final 6-month postoperative key pinch, 3-point chuck, and grip strength were 11.0 lbs/in2, 9.8 lbs/in2, and 49.2 lbs/in2, respectively. Metacarpal height subsided on average 50%. We report one revision and no cases of radial sensory neuritis or flexor tendon rupture.

Conclusions:

Arthroscopic total trapeziectomy appears to be a safe and effective treatment for end-stage arthrosis of the thumb basal joint.

Level of Evidence:

2b Therapeutic; Individual Cohort Study.
Key components identification of EMU complex system faults with interval intuitionistic fuzzy set and multi-attribute group decision-making based on FMECA method
Authors: Zhang Yuchen , Liu Jinghui , Dai Chengye , Li Qiufen , Guo Zhan , Dai Xianchun
Published: July 2024

With the continuous acceleration of high-speed railway, the high-voltage traction system of the EMU is an important part for ensuring the operation speed and safety. If the failure does not discontinued effectively, it will cause major dangerous accidents, so the key components identification of system is crucial. This paper focus on the contradictions of the expert evaluation information ambiguity, the difference of expert risk appetite and the rationality of risk priority number (RPN) calculation method in the traditional failure analysis method FMECA. The interval intuitionistic fuzzy set (IIFS) is introduced to transform the expert evaluation into the form of membership interval and non-membership interval, which reduced the ambiguity of the specific numerical score. The interval intuitive fuzzy entropy was used to determine the entropy values of the occurrence (O), severity (S), and undetectable degree (D) of each failure mode under each expert score, which was used to calculate the weight value [Formula: see text], to weaken the influence caused by subjective risk preference. The interval intuition fuzzy ensemble operator (AIVIFWM) is used to assemble a single scoring matrix into a comprehensive score, which weakens the subjective influence of expert evaluation. Combined with the multi-attribute group decision-making idea, the score function [Formula: see text] is calculated for each comprehensive evaluation interval of each failure mode after assembly, so as to sort the failure mode risk and finally identify the key components. Based on the fault data of the high-voltage traction system of a certain type of EMU in 2022, 39 failure modes of 30 components are researched and summarized. The results show that rectifier, converter cooling unit, and carbon skateboard are the key components of EMU high-voltage traction system, which provided basic support for the detection and maintenance decision.
Enhancing E-learning in higher education: Lessons learned from the pandemic
Authors: Chenari Mansoureh U , Sarvestani Maryam S , Azarkhavarani Abbas R , Izadi Samad , Cirella Giuseppe T
Published: July 2024

This study delves into the intricate realm of evaluating and refining e-learning practices, drawing upon insights from esteemed higher education professionals. Through a qualitative lens rooted in phenomenology, the research engages in semi-structured interviews with 30 faculty members from seven public universities in Tehran, ensuring theoretical saturation. Employing inductive content analysis, the data examination unveils three core categories of challenges: educational assessment, research evaluation, and university services. Emphasizing the significance of internal task performance, adaptability to dynamic environments, and external institutional promotion, the study advocates for the development of a comprehensive evaluation model and tools to uphold program quality, efficiency, and effectiveness. Against the backdrop of the COVID-19 pandemic, the research highlights the pressing need for Iranian higher education to bolster productivity through strategic resource allocation across education, research, services, and human capital development domains. Such efforts are pivotal in shaping a more prosperous future and bolstering societal scientific and cultural standing.
Packaging code and data for reproducible research: A case study of journey time statistics
Authors: Botta Federico , Lovelace Robin , Gilbert Laura , Turrell Arthur
Published: July 2024

The effective and ethical use of data to inform decision-making offers huge value to the public sector, especially when delivered by transparent, reproducible, and robust data processing workflows. One way that governments are unlocking this value is through making their data publicly available, allowing more people and organisations to derive insights. However, open data is not enough in many cases: publicly available datasets need to be accessible in an analysis-ready form from popular data science tools, such as R and Python, for them to realise their full potential. This paper explores ways to maximise the impact of open data with reference to a case study of packaging code to facilitate reproducible analysis. We present the jtstats project, which consists of a main Python package, and a smaller R version, for importing, processing, and visualising large and complex datasets representing journey times, for many transport modes and trip purposes at multiple geographic levels, released by the UK Department for Transport (DfT). jtstats shows how domain specific packages can enable reproducible research within the public sector and beyond, saving duplicated effort and reducing the risks of errors from repeated analyses. We hope that the jtstats project inspires others, particularly those in the public sector, to add value to their data sets by making them more accessible.
Centering Communities in Global Health: Using Human-Centered Design to Facilitate Collaboration and Intervention Development
Authors: Baumann Sara E. , Rabin Megan A. , Devkota Bhimsen , Hawk Mary , Upadhyaya Kajol , Shrestha Guna Raj , Joseph Brigit , Burke Jessica G.
Published: July 2024

Background

Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development.

Purpose

The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi.

Research Design and Study Sample

A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights.

Data Collection

In the study’s initial “discovery” phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second “design” phase, the Community Design Team crafted interventions to address harms associated with chhaupadi.

Results

Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants’ literacy levels and engagement preferences, whether through group or individual activities.

Conclusions

Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.
How I treat postimmunotherapy relapsed B-ALL
Authors: Lamble Adam J. , Kovach Alexandra E. , Shah Nirali N.
Published: July 2024

Despite significant advancements in single-antigen targeted therapies for B-cell acute lymphoblastic leukemia (B-ALL), nonresponse and relapse persist as major challenges. Antigen escape after blinatumomab or CD19-directed chimeric antigen receptor (CAR) T cells (CD19-CAR), as CD19-negative B-ALL or lineage switch (LS) to acute myeloid leukemia, present diagnostic and treatment complexities. Given the poor outcomes for patients experiencing a postinfusion relapse, particularly those with loss of the target antigen, a strategic approach to diagnosis and treatment is imperative. In this discussion, we outline a systematic approach to managing postimmunotherapy events, categorized by CD19-positive relapse, CD19-negative relapse, and LS. We explore treatment modalities including CD19-CAR reinfusions, humanized CAR constructs, combinatorial strategies, and alternative antigen-targeted therapies, such as blinatumomab and inotuzumab. Challenges in diagnosis, particularly with antigen-escape, are addressed, highlighting the role of next-generation sequencing and multiparameter flow cytometry for myeloid marker monitoring.
Interleukin-1 blockade in patients with Wiskott-Aldrich syndrome: a retrospective multinational case series
Authors: Naviglio Samuele , Cicalese Maria Pia , Rivers Elizabeth , Ferrua Francesca , Bonfim Carmem , Cenciarelli Sabina , Cheong Kai-Ning , Faraci Maura , Giardino Stefano , Ghosh Sujal , Lee Pamela P. , Lyra Paula Teixeira , Meisel Roland , Sofia Valentina , Tessitore Antimo , Tommasini Alberto , Valencic Erica , Vallée Tanja Christine , Volpi Stefano , Worth Austen J. , Rabusin Marco , Albert Michael H. , Thrasher Adrian J. , Aiuti Alessandro
Published: July 2024

Up to 70% of patients with Wiskott-Aldrich syndrome (WAS) develop autoimmune and inflammatory manifestations. Dysregulation of interleukin 1 (IL-1) may be involved in their pathogenesis, yet there is little evidence on treatment with anti–IL-1 agents in these patients. We conducted a multicenter retrospective analysis of 9 patients with WAS treated with anti–IL-1 agents (anakinra or canakinumab). All patients had prominent inflammatory manifestations, including systemic, cutaneous, articular, and intestinal symptoms; 3 patients presented with a severe systemic inflammatory syndrome since the first months of life. Corticosteroid therapy was associated with partial or no response, whereas treatment with anakinra or canakinumab resulted in prompt, often dramatic, responses in all patients, allowing bridging to gene therapy (4 patients) or hematopoietic stem cell transplantation (HSCT; 5 patients). Treatment was overall well tolerated. Low donor myeloid chimerism developed in 4 patients after HSCT and was associated with the appearance or the recurrence of inflammatory manifestations. A second HSCT was performed in 2 patients, achieving full-donor chimerism and resolution of inflammatory manifestation, whereas the other 2 patients were treated with prolonged therapy with anti–IL-1 agents. Our experience demonstrates that some inflammatory manifestations of WAS are dependent on IL-1 and respond well to its pharmacologic blockade.
Cement loaded with high-dose gentamicin and clindamycin does not reduce the risk of subsequent infection after aseptic total hip or knee revision arthroplasty: a preliminary study
Authors: Hamoudi Ceyran , Hamon Marie , Reiter-Schatz Aurélie , Debordes Pierre-Antoine , Gaudias Jeannot , Rondé-Oustau Cécile , Jenny Jean-Yves
Published: July 2024

Purpose

The aim of this study was to quantify the prophylactic effect of high-dose gentamicin and clindamycin antibiotic-loaded bone cement (ALBC) during revision total hip (rTHA) or knee (rTKA) arthroplasty for aseptic reasons. The hypothesis was that the raw surgical site infection (SSI) rate is lower when this particular cement is used in comparison with cement loaded with standard-dose gentamicin during rTHA or rTKA for aseptic reasons.

Methods

This retrospective study included 290 consecutive patients undergoing aseptic rTHA or rTKA. Two consecutive cohorts were defined: the first (control group) involved 145 patients where ALBC with gentamicin only was used; the second (study group) involved 145 patients where ALBC with high-dose gentamicin and clindamycin was used. The primary endpoint was the raw SSI rate after 24 months.

Results

The raw SSI rate was 8/145 (6%) in the control group and 13/145 (9%) in the study group (odds ratio 0.62, p = 0.26). There was a significant impact of the presence of any risk factor on the SSI rate (15/100 versus 6/169, odds ratio = 4.25, p = 0.002), but no significant impact of any individual risk factor. No complication or side effect related to ALBC was observed in either group.

Conclusion

These results do not support the routine use of gentamicin and clindamycin ALBC for fixation of revision implants after rTHA and rTKA for aseptic reasons.
Sustained gut dysbiosis and intestinal inflammation show correlation with weight gain in person with chronic HIV infection on antiretroviral therapy
Authors: Ishizaka Aya , Koga Michiko , Mizutani Taketoshi , Suzuki Yutaka , Matano Tetsuro , Yotsuyanagi Hiroshi
Published: July 2024

Background

Person with human immunodeficiency virus type-1 (PWH) are prone to chronic inflammation due to residual viral production, even with antiretroviral therapy (ART), which increases the risk of age-related diseases. There is also limited information on changes in the intestinal environment of PWH during ART. In this longitudinal study, we investigated changes in the gut microbiota, persistence of chronic inflammation, interactions between the gut environment and inflammation, and metabolic changes in PWH using long-term ART.

Results

We analyzed changes in clinical parameters and gut microbiota in 46 PWH over a mean period of 4 years to understand the influence of gut dysbiosis on inflammation. Overall, changes in the gut microbiota included a decrease in some bacteria, mainly involved in short-chain fatty acid (SCFA) production, and an increase in certain opportunistic bacteria. Throughout the study period, an increase in bacterial-specific metabolic activity was observed in the intestinal environment. Continued decline in certain bacteria belonging to the Clostridia class and metabolic changes in gut bacteria involved in glucose metabolism. Additionally, patients with a low abundance of Parabacteroides exhibited low bacterial alpha diversity and a significant increase in body mass index (BMI) during the study period. Monocyte chemoattractant protein 1, a marker of macrophage activation in the plasma, continued to increase from baseline (first stool collection timepoint) to follow-up (second stool collection timepoint), demonstrating a mild correlation with BMI. Elevated BMI was mild to moderately correlated with elevated levels of plasma interleukin 16 and chemokine ligand 13, both of which may play a role in intestinal inflammation and bacterial translocation within the gut microbiota. The rate of BMI increase correlated with the rate of decrease in certain SCFA-producing bacteria, such as Anaerostipes and Coprococcus 3.

Conclusion

Our data suggest that despite effective ART, PWH with chronic inflammation exhibit persistent dysbiosis associated with gut inflammation, resulting in a transition to an intestinal environment with metabolic consequences. Moreover, the loss of certain bacteria such as Parabacteroides in PWH correlates with weight gain and may contribute to the development of metabolic diseases.
Tailored approach to participant recruitment and retention to maximize health equity in pediatric cancer research
Authors: Bates Carolyn R. , Gilbert Renee M. , Dean Kelsey M. , August Keith J. , Befort Christie A. , Ward Shallyn , Gibson Mary , Dreyer Gillette Meredith L.
Published: July 2024

Background

Lack of diversity in participants throughout the research process limits the generalizability of findings and may contribute to health disparities. There are unique challenges to recruitment of families to pediatric cancer research studies, especially for those from disadvantaged backgrounds. Thus, there is a need to evaluate the most effective recruitment and retention strategies to optimize equitable recruitment of diverse participants.

Methods

The present study adapted and implemented methods outlined previously in the literature. These previous efforts were developed to address barriers to pediatric research, behavioral health intervention research and research with Black adolescents. Recruitment and retention strategies are described across four different time points: pre-approach, initial connection, building connection and follow-up. Eligible families of children with a pediatric cancer diagnosis were approached during a routine oncology visit. Once consented, enrollment and retention rates over three timepoints of data collection were recorded and evaluated.

Results

Results indicated high rates of enrollment (86%) and retention (95%) for eligible participants. There were no trends in heightened attrition for any specific subgroup.

Conclusions

The findings of this study are promising and suggest these recruitment and retention strategies may be useful in recruiting individuals from disadvantaged backgrounds.
Is serum albumin a pivotal biomarker in anticipating acute pancreatitis outcomes?
Authors: Amri Fakhrddine , Rahaoui Maissae , Aissaoui Hanane , Elmqaddem Ouiam , Koulali Hajar , Zazour Abdelkrim , Abda Naima , Ismaili Zahi , Kharrasse Ghizlane
Published: July 2024

This study aimed to assess the significance of serum albumin levels within 24 h of patient admission in correlation with the incidence of outcomes and mortality in patients diagnosed with acute pancreatitis. A retrospective study was conducted over a 5-year period, from January 2018 to December 2023, at the Mohammed VI University Hospital in Oujda, Morocco. The study included 371 patients diagnosed with acute pancreatitis. Hypoalbuminemia (≤ 30 g/L) was observed in 124 patients (33.4% of cases), and these patients had a higher mean age compared to those with normal albumin levels (P = 0.003). Hypoalbuminemia was significantly associated with persistent Systemic Inflammatory Response Syndrome (SIRS) (70.8% vs. 29.2%, P = 0.000), a higher BISAP score (66.7% vs. 33.3%, P = 0.000), and a higher CTSI score (51.7% vs. 48.3%, P = 0.000). Hypoalbuminemia was also associated with the presence of pleural effusion (P = 0.000). The mortality in the sample was 4.6%, and it was significantly associated with hypoalbuminemia (76.5%, P = 0.000). In conclusion, serum albumin levels within 24 h of patient admission appear to be a significant prognostic biomarker in acute pancreatitis, particularly in anticipating persistent organ failure and mortality.
Salmonella Typhi genotypic diversity, cluster identification and antimicrobial resistance determinants in Mukuru settlement, Nairobi Kenya
Authors: Kasiano Purity , Morita Masatomo , Kodama Toshio , Hiyoshi Hirotaka , Kavai Susan , Kiiru Susan , Kariuki Samuel
Published: July 2024

Background

Understanding the source of typhoid infections and the genetic relatedness of Salmonella Typhi (S. Typhi) by cluster identification in endemic settings is critical for establishing coordinated public health responses for typhoid fever management. This study investigated the genotypic diversity, antibiotic resistance mechanisms, and clustering of 35 S.Typhi strains isolated from cases and carriers in the Mukuru Informal Settlement.

Methods

We studied 35 S.Typhi isolates, including 32 from cases and 3 from carriers, from study participants in the informal settlement of Mukuru, Nairobi, Kenya. Genomic DNA was extracted, and whole-genome sequencing (WGS) was performed to determine the phylogenetic relatedness of strains and detect antimicrobial resistance determinants (AMR). WGS data were analyzed using bioinformatics tools available at the Center for Genomic Epidemiology and Pathogenwatch platforms.

Results

Genotype 4.3.1.2 EA3 was found to be dominant at 46% (16/35), followed by 4.3.1.2 EA2 at 28% (10/35), and 4.3.1.1 EA1 at 27% (9/35). A comparison of the isolates with global strains from Pathogenwatch identified close clustering with strains from Uganda, Tanzania, Rwanda, and India. Three isolates (9%) distributed in each cluster were isolated from carriers. All genotype 4.3.1.2 EA3 isolates were genotypically multidrug-resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Single mutations in the quinolone resistance-determining region were identified in the gyrA (S83Y) and gyrB (S464F) genes. All isolates associated with multidrug resistance showed the presence of the IncQ1 plasmid with the following genes: blaTEM-1B, catA1, sul1, sul2, and dfrA7.

Conclusion

The close phylogenetic relatedness between antimicrobial-resistant case isolates and carriage isolates indicates that typhoid carriage is a possible source of infection in the community. Comparative analysis with global isolates revealed that the Kenyan isolates share common lineages with strains from neighboring East African countries and India, suggesting regional dissemination of specific MDR clones. AMR was a major feature of the isolates. Surveillance and testing for antimicrobial susceptibility should inform options for the management of cases.
Reduced unilateral sweating caused by varicella zoster virus infection: a case report
Authors: Li Wenju , Leng Bingquan , Zhao Jing , Zhang Yu , Yu Lili , Liu Chang , Hong Kun
Published: July 2024

Background

Herpes zoster is an infectious skin disease caused by the reactivation of the varicella zoster virus (VZV), which has been latent in the posterior root ganglia of the spinal cord or cranial ganglia for an extended period. Neurological complications caused by herpes zoster include aseptic meningitis, white matter disease, peripheral motor neuropathy, and Guillain-Barré syndrome. However, reduced unilateral sweating caused by the VZV is very rare.

Case Presentation

This article reports the case of a 34-year-old woman who was admitted to our hospital with sore throat, dizziness, and reduced sweating on the left side of her body. Physical examination found herpes lesions on the left upper lip and left external ear canal (scabbed) and reduced sweating on the left side of the body. Head magnetic resonance imaging (MRI) with contrast showed no abnormalities. After a lumbar puncture, the patient was diagnosed with viral meningitis by VZV infection. The electromyographic skin sympathetic reflex indicated damage to the left sympathetic nerve.

Conclusions

Secondary unilateral sweating reduction is a rare neurological complication of herpes zoster, caused by damage to the autonomic nervous system. Literature review and comprehensive examination indicated that the reduced unilateral sweating was due to the activation of latent herpes zoster virus in the autonomic ganglia which has damaged the autonomic nervous system. For patients who exhibit acute hemibody sweat reduction, doctors should consider the possibility of secondary autonomic nervous system damage caused by herpes zoster.
Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial
Authors: Porserud Andrea , Karlsson Patrik , Aly Markus , Rydwik Elisabeth , Torikka Simon , Henningsohn Lars , Nygren-Bonnier Malin , Hagströmer Maria
Published: July 2024

Introduction

After radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer.

Materials and Methods

Patients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing.

Results

Ninety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group.

Conclusion

Both the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer.

Trial registration

The study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.
A retrospective study on adjuvant chemotherapy in retinoblastoma: validation of the new recommendation against treatment for pT2a tumors based on the 8th AJCC classification
Authors: Alkatan Hind Manaa , Almuzaini Alaa , Helmi Hala A. , Maktabi Azza MY
Published: July 2024

Background

Retinoblastoma (RB) is an intraocular malignant tumor detected in early childhood with variable global impact. Histopathological classification of the tumor in enucleated globes with RB is the key for the decision of adjuvant chemotherapy use. We aim to validate the use of adjuvant chemotherapy in cases with combined pre-laminar/intralaminar optic nerve (ON) invasion and focal choroidal invasion according to the American Joint Committee on Cancer (AJCC) 8th classification.

Methods

This is a retrospective study conducted at King Abdulaziz University Hospital (KAUH) and King Khalid Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia of all RB cases who underwent enucleation over 22 years (2000 to 2021). The histopathological findings were reviewed to identify the enucleated globes classified as pT2a tumors, as an inclusion criterion. Basic demographic and clinical data were collected via chart review Simple descriptive and basic statistical analysis of the data was used where applicable.

Results

Thirty-one patients who had an enucleated globe with RB that fit into the above classification were included. Sixteen were males and 15 were females. The median age was 14 months (IQR = 14 months). Most of the patients (93.5%) had no family history of RB. The commonest presentation was leukocoria in 87.1% followed by squint in 32.3%. Fourteen patients (45.2%) were treated by enucleation alone while 17 patients (54.8%) received adjuvant chemotherapy. Out of these, 7 patients had unilateral RB and the remaining 10 patients had bilateral RB. None of our patients developed recurrence or metastatic disease irrespective of the indication for adjuvant chemotherapy use after a maximum period of follow up reaching 17.84 years and a median of 10.6 years (IQR = 5.92).

Conclusions

In patients with 8th AJCC histopathological classification of pT2a, chemotherapy following enucleation might not be justified. The outcome in our untreated group of patients did not differ from the treated group with the absence of metastasis after a relatively long period of follow up with a median exceeding 10 years in both groups. Therefore, the risk and benefit of post enucleation adjuvant chemotherapy in the treatment of unilateral RB should be carefully decided and discussed with the primary caregivers taking into consideration the most recent evidence and recommendations in the literature.
Nurses’ knowledge, attitude and practice regarding non-pharmacologic interventions for behavioral and psychological symptoms of dementia
Authors: Du Hongdi , Wang Xiaojing , Lai Xiaoxing , Wang Wei , Huo Xiaopeng
Published: July 2024

Background

To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD).

Methods

This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022.

Results

The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42–2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35–2.51, P = 0.010 vs. ≤30 years-old) and bachelor’s degree or higher (β = 1.11, 95%CI = 0.12–2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score.

Conclusions

Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China.
Unveiling the hidden pathologies: preoperative endoscopic findings in patients with obesity undergoing bariatric surgery
Authors: Tian Peirong , Fu Jing , Liu Yang , Li Mengyi , Liu Jia , Liu Jingli , Zhang Zhongtao , Zhang Peng
Published: July 2024

Background

Obesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery.

Methods

Retrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023.

Results

A total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001).

Conclusions

Preoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.
Efficacy and safety of oral semaglutide in older patients with type 2 diabetes: a retrospective observational study (the OTARU-SEMA study)
Authors: Oe Yuki , Nomoto Hiroshi , Cho Kyu Yong , Yokozeki Kei , Ono Tsubasa , Miya Aika , Kameda Hiraku , Nakamura Akinobu , Arimura Yoshiaki , Atsumi Tatsuya
Published: July 2024

Background

Oral semaglutide in older subjects with type 2 diabetes was as effective as in younger subjects, according to phase 3 clinical trials. However, its efficacy can be limited in very aged population, due to the presence of impaired cognitive function and the complex instructions for its use. Here, we investigated its efficacy and safety by further age bracket in older subjects in real-world.

Methods

We retrospectively studied subjects > 65 years of age with type 2 diabetes who started oral semaglutide treatment. The primary outcome was the change in glycated hemoglobin (HbA1c) over 6 months. Adverse events and cognitive function were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) and the Hasegawa Dementia Rating Scale-revised (HDS-R). The achievement rate of glycemic targets was evaluated based on the age, health status of subjects and their use of anti-diabetic agents which can cause hypoglycemia, with additional analysis between two subgroups; early (65–74) versus late (≥ 75) older. Furthermore, we evaluated the relationships between their improvements in HbA1c and the baseline characteristics of the subjects, including their cognitive function and insulin secretory capacity.

Results

We studied the efficacy of the drug in 24 subjects. Their HbA1c and body weight significantly decreased (− 13.1 ± 7.5 mmol/mol and − 3.0 ± 2.4 kg, respectively; P < 0.01). Although cognitive function was lower in the late older group (r = −0.57, P < 0.01), changes in HbA1c showed no difference between the two subgroups (P = 0.66) and it correlated with the insulin secretory capacity rather than cognitive function (r = −0.49, P < 0.05). Glycemic targets were more likely to be achieved (P < 0.01), but HbA1c excessively decreased in late older subjects who were also using insulin or an insulin secretagogue. The frequency of adverse events was similar to that in the clinical trial, whereas discontinuation of medication were more frequent among the late older subjects (Early; n = 2, Late; n = 4).

Conclusions

Oral semaglutide improves the glycemic control of older subjects, but it might be a risk for potential hypoglycemia and discontinuation because of adverse events in subjects of ≥ 75 years. Attention should be paid to insulin secretory capacity and concomitant medications rather than concern about adherence.