bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster 396: Performing Sports Medicine Procedures in Ambulatory Surgery Centers Is More Cost Effective than Hospital Outpatient Departments for Medicare Recipients
Authors: Khan Zeeshan , McCormick Johnathon , Federico Vincent , Morgan Vince , Browning Robert , Harkin William , Salazar Luis , Jackson Garrett , Kaplan Daniel , Verma Nikhil , Cole Brian , Chahla Jorge
Published: September 2024

Objectives:

To compare the overall cost of sports medicine procedures for Medicare beneficiaries in both ambulatory surgery centers (ASC) and hospital outpatient department (HOPD) settings. Secondary aims were to compare facility fees, surgeon fees, Medicare payments, and patient payments between ASCs and HOPDs.

Methods:

Publicly available data from The Centers for Medicare & Medicaid Services (CMS) was accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify sports medicine procedures approved for the outpatient setting by CMS. Facility fees, surgeon fees, total costs, Medicare payment, and patient payment were extracted. Descriptive statistics were used to calculate means and standard deviations. Cost differences were analyzed using Mann Whitney U tests.

Results:

Sixty-two CPT codes were identified. Shoulder procedures (n=25) at ASCs had lower total costs (3,622±1,156 vs 6,262±1,759; p<0.001), facility fees (2,777±1,020 vs 5,416±1,606; p<0.001), Medicare payments (2,898±928 vs 5,009±1,407 p<0.001), and patient payments (724±232 vs 1,252±352; p<0.001) compared to HOPDs. Knee procedures (n=31) at ASCs had lower total costs (4,236±2,741 vs 6,668±3,341; p=0.006), facility fees (3,408±2,507 vs 5,840±3,116; p=0.006), Medicare payments (3,389±2,193 vs 5,458±2,955; p=0.006), and patient payments (847±548 vs 1,209±429; p=0.011). Hip procedures (n=6) at ASCs had lower total costs (3,583±698 vs 6,671±1,451; p=0.025), facility fees (2,725±6689 vs 5,813±1,431; p=0.025), Medicare payments (2,866±558 vs 5,336±1,161; p=0.025), and patient payments (716±139 vs 1,333±290; p=0.025).

Conclusions:

Sports medicine procedures performed at ASCs for Medicare recipients were found to have overall average total cost savings of 40% compared to those performed at HOPDs (42% savings for shoulder, 36% for knee, and 46% for hip procedures). ASC use conferred lower facility fees, patient payments, and Medicare payments in all cohorts. These results inform surgeons, patients, and insurance officials of the cost-effectiveness of outpatient surgical facilities for Medicare recipients undergoing sports medicine procedures.
What Do We Know About the Extent of Teacher Shortages Nationwide? A Systematic Examination of Reports of U.S. Teacher Shortages
Authors: Nguyen Tuan D. , Lam Chanh B. , Bruno Paul
Published: September 2024

Teachers are critical to student learning, but adequately staffing classrooms has been challenging in many parts of the country. Though teacher shortages are widely reported, they are poorly understood, particularly in terms of the magnitude and variation of the shortages, and reported figures are often localized and anecdotal. To address this gap, we systematically examine news reports, Department of Education data, and publicly available information on teacher shortages for every U.S. state. We characterize the data landscape and find there are at least 39,700 vacant positions along with at least 288,000 positions being held by underqualified teachers, both of which are conservative estimates of the extent of teacher shortages nationally. We discuss the implications of our findings for improving data systems, including more specific and consistent reporting of shortage, as well as implications for teacher preparation and education policy.
Academic Ethical Awareness among Undergraduate Nursing Students of a Private University in Nigeria: A Cross-Sectional Descriptive Study
Authors: Dosumu Taiwo Omotayo , Olabisi Oluwaseyi Isaiah , Olatubi Mathew Idowu , Olayanju Grace , Okedele Deborah , Ndikom Chizoma Millicent
Published: September 2024

Introduction

Academic ethical awareness is a crucial prerequisite for practice, serving as the cornerstone for a professional demeanor in clinical settings and ensuring future adherence to nursing ethics.

Objectives

This study assessed academic ethical awareness as well as its related characteristics among undergraduate Nursing students of a private university in Nigeria.

Methods

A descriptive cross-sectional research design was utilized. The study was conducted among undergraduate nursing students of a private university in Nigeria. A convenience sample of 158 nursing students from 300 level to 500 level voluntarily participated in this study. Data were collected using the Academic Ethical Awareness Questionnaire and descriptive statistics, mean and standard deviation were employed to analysis the data collected.

Results

The mean age of nursing students was 21.1. Majority of the respondents were females, Christians and claimed average financial status with 87%, 94%, and 68%, respectively. Nursing students demonstrated moderate academic ethical awareness (69.5%), a mean score of 3.68 ± 0.81. They knew that revealing patient information in public places of the hospital, disregarding, slandering, or making fun of patients in face-to-face interaction, and having someone else attend class as a substitute were unethical behaviors with mean scores of 3.96, 3.90, 3.88, and 3.88, respectively. Academic ethical awareness was low for submitting cut and paste report, not paying attention in class and being late to class, with mean scores 1.81, 2.05, and 2.80, respectively. Gender, level of study, and satisfaction with Nursing as a course of choice are significant determinant of ethical academic awareness with P value of .018, .005, and .011, respectively.

Conclusion

Nursing students assessed demonstrated moderate academic ethical awareness. Improved instruction is required regarding the value of appropriate classroom behavior and emphasis on the implications of plagiarism in practice.
Defining Caring Efficacy for Nursing Students in South Korea: A Mixed-Method Analysis
Authors: Choi Hyun Ju
Published: September 2024

Introduction

Caring efficacy is a core nursing concept, but its application in nursing practice remains unclear.

Objective

This study analyzed the meaning and attributes of caring efficacy among nursing students, defined caring efficacy in this context, and identified the substantive constituents of the concept.

Methods

This hybrid study analyzed and compared data from a literature review and in-depth interviews with students in the clinical practice stage of a nursing program, according to the model suggested by Schwartz-Barcott and Kim.

Results

The results revealed five attributes of nursing caring efficacy and 17 indicators across two dimensions. Considering the attributes identified in theoretical work and fieldwork, this study defined nursing students’ care efficiency based on their “qualifications and personality for caring” as “self-confidence in caring capabilities,” rooted in their “growth through caring experience” and the conditions of their “educational environment for learning caring and social support.”

Conclusion

The findings could guide the development of nursing caring efficacy scales. Future studies should explore caring efficacy among professional and student nurses in various clinical fields.
“No Future for Black People in Chicago”: Out-Migration as Slow-Motion Disaster
Authors: Ewing Eve L. , Krishnan Samhitha , Lawrence Brianna
Published: September 2024

From 2000 to 2019, the number of Black residents in Chicago dropped 25 percent. In this study, we sought to understand how Black Chicagoans make meaning of out-migration, their desires for the city and its future, and the factors they use to navigate questions of whether to stay or leave. We conducted focus groups and interviews with 80 Black Chicagoans who reported either having close friends and family who departed the city or themselves harboring a strong desire to leave. We find that a complex web of factors—a sense of being displaced by White residents, struggles in education, challenges with employment, a sense of declining public safety, and limited access to services—contributed to participants’ sense of the city as increasingly unlivable. We argue that this out-migration constitutes a slow-motion disaster in which cumulative disinvestments interact with socioeconomic vulnerabilities to create a catastrophe for Black Chicagoans.
Guano and the Rise of the American Empire
Authors: Betancourt Mauricio
Published: September 2024

Ecological imperialism refers to the center’s robbery of nature from the periphery, emphasizing the ecological dimension of trade, often overshadowed by monetary concerns. Examining historical cases like the nineteenth-century guano trade between Peru and Europe reveals this dynamic, wherein the involvement of the United States has been often overlooked. Utilizing archival data from British, French, Peruvian, and U.S. sources, I demonstrate how guano served as an ecological foundation for U.S. expansion overseas starting in the 1850s. This includes the significance of guano islands as the first U.S. overseas territories, considerations of annexing South American islands for guano, and the role of guano in partly inspiring the construction of the Panama Canal. Overall, the guano trade exemplifies an imperial-ecological process that reshaped global legal, geopolitical, and trade systems. Additionally, I discuss the contemporary relevance of this history, particularly concerning lithium, emphasizing the importance of prioritizing ecology in center-periphery analyses.
Conditional Rewarding: Unequal Racialized Returns to Cultural Capital
Authors: Kozlowski Karen Phelan
Published: September 2024

Cultural capital theory has long proposed that class location determines teachers’ responses to students, with less, although increasing, attention to race. Drawing on Calarco’s definition of cultural capital, this ethnographic study examines whether and how first-grade teachers in two schools unequally reward socioeconomically and racially diverse students’ attempts to secure academic advantages. Whether students behave in ways teachers say they expect or attempt to negotiate extra academic advantages, I find that teachers more frequently and effusively reward White and Asian students and more frequently and reproachfully punish Black and Latinx students for similar behaviors. I introduce the term “conditionally rewarding” to describe how cultural capital is unequally rewarded by a salient hierarchical status characteristic other than social class (race). Results support the need to adopt more color-conscious approaches to cultural capital theory and have implications for processes by which educational (dis)advantage is reproduced across student status intersections.
Adaptive networks driven by partner choice can facilitate coordination among humans in the graph coloring game: Evidence from a network experiment
Authors: Chiang Yen-Sheng , Cho Heng-Chin , Chang Chia-Jung
Published: September 2024

Background

Many instances of coordination problems in social networks can be characterized by the well-known graph coloring game—a task in which agents are incentivized to choose an attribute, represented by a color, to be different from linked neighbors. Past work on this topic, however, is limited to static networks of specific topologies of interest.

Purpose

This study aims to explore whether dynamic networks, where players can choose their partners, perform better in the graph coloring game.

Research Design

We replicate the conventional graph coloring game experiment and introduce a new version where players can change their network neighbors.

Study Sample and Data Collection

We recruited over 300 human participants for the experiment, with each session involving an average of 20 participants per network.

Results

We found that dynamic networks that allow agents to switch network neighbors works more effectively and efficiently in solving coloring conflicts than static networks in which people are allowed to change color alone. The networks in the experiment updated by people’s selection of neighbors tend to evolve to a state similar in structure to the small-world network characterized by short path distance and high triadic clustering.

Conclusion

We argue that a self-organized approach demonstrated by our experiment can inspire search of behavioral strategies and network topologies for solving coordination problems in social networks.
A randomized phase II trial on the addition of dutasteride to combined androgen blockade therapy versus combined androgen blockade therapy alone in patients with advanced or metastatic salivary duct carcinoma – the DUCT study protocol
Authors: Weijers Jetty A. M. , Verhaegh Gerald W. , Lassche G. , van Engen-van Grunsven Adriana C. H. , Driessen Chantal M. L. , van Erp Nielka P. , Jonker Marianne A. , Schalken Jack A. , van Herpen Carla M. L.
Published: September 2024

Background

Salivary duct carcinoma (SDC) is a rare and aggressive subtype of salivary gland cancer, frequently associated with incurable recurrences and distant metastases (R/M). Proliferation of SDC relies on androgen receptor (AR) signalling, prompting the use of combined androgen blockade (CAB, i.e., luteinizing hormone-releasing hormone agonist and/or AR antagonists) to R/M SDC patients. However, only a subset of patients benefits from such treatments. We have shown that response to CAB is associated with steroid 5α-reductase 1 (SRD5A1) mRNA expression. SRD5A1 catalyses the intracellular conversion of testosterone into the more potent AR-agonist dihydrotestosterone. This conversion can be inhibited by dutasteride, a potent SRD5A1-inhibitor, which is currently prescribed for benign prostatic hyperplasia. We hypothesize that repurposing dutasteride to target AR signalling in SDC could enhance therapeutic response and clinical outcome in SDC patients.

Methods

This prospective, open-label, randomized controlled phase II clinical trial, is designed to investigate whether dutasteride as an adjunct drug to CAB improves response rate and clinical outcome in patients with AR-positive R/M SDC. Patients are divided in two cohorts based on their prior systemic treatments. In cohort A, CAB-naïve patients (n = 74) will be randomly assigned to either a control arm (Arm 1) receiving CAB (goserelin 10.8 mg/3m and bicalutamide 50 mg/OD) or an experimental arm (Arm 2) where dutasteride (0.5 mg/OD) is added to the CAB regimen. In cohort B, patients with disease progression after adjuvant or first-line palliative CAB therapy (max. n = 24) will receive goserelin, bicalutamide, and dutasteride to assess whether the addition of dutasteride can overcome therapy resistance. The primary endpoints are the objective response rate and duration of response. Secondary endpoints are progression-free survival, overall survival, clinical benefit rate, quality of life, and safety. Translational research will be performed to explore molecular target expression differences and their correlation with clinical outcome.

Discussion

The DUCT study addresses an unmet medical need by investigating the repurposing of dutasteride to enhance treatment response and improve clinical outcome for patients with R/M SDC, especially those with limited alternative treatment options, such as HER2-negative cases. By repurposing a registered low-cost drug, this trial’s findings could be readily applied into clinical practice.

Trial registration

Clinicaltrials.gov Identifier: NCT05513365. Date of registration: August 24, 2022.

Protocol version

Current protocol version 4.0, February 21, 2024.
Type 2-like polarization and elevated CXCL4 secretion of monocyte derived macrophages upon internalization of plasma-derived exosomes from head and neck cancer patients
Authors: Theodoraki Marie-Nicole , Huber Diana , Hofmann Linda , Werner Lotte , Idel Christian , Fleckner Jonas , Plötze-Martin Kirstin , Schütt Lutz , Brunner Cornelia , Depping Reinhard , Hoffmann Thomas K. , Bruchhage Karl-Ludwig , Pries Ralph
Published: September 2024

Background

Exosomes are closely associated with different aspects of tumor-progression in patients with head and neck squamous cell carcinoma (HNSCC), such as angiogenesis or immune regulation. As extracellular vesicles they are involved in the intercellular communication by transferring their cargo such as proteins and nucleic acids from one cell to another. However, the influence of tumor related plasma-derived exosomes on the polarization and characteristics of monocyte derived macrophages is not fully understood.

Methods

Exosomes were isolated from plasma samples of healthy donors (HD) and HNSCC patients and further evaluated with regard to morphology, size and protein composition via transmission electron microscopy, nanoparticle tracking, western blot analysis and cytokine assays. Differentiation and characteristics of monocyte derived macrophages upon exosome internalization were analyzed using flow cytometry and fluorescence microscopy. Macrophage cytokine secretion patterns were analyzed by human cytokine antibody arrays and ELISA measurements.

Results

Our data revealed elevated overall plasma levels of CTLA-4, PD-L1, and TIM-3 as well as elevated exosome-associated CTLA-4, PD-L2, TIM-3, and LAG-3 levels in HNSCC patients compared to HD. Furthermore, we observed a significant type 2-like polarization and elevated CXCL4 secretion of monocyte derived macrophages upon internalization of plasma-derived exosomes from HNSCC patients, which could be visualized by fluorescence microcopy of membrane stained exosomes.

Conclusions

The study provides new insights regarding exosome driven pro-tumorigenic immune regulation in the circulation of patients with head and neck cancer and could help to better understand the individual immunologic situation.
Educational differences in years lived with disability due to mental and substance use disorders: a cohort study using nationwide Norwegian and Danish registries
Authors: Weye Nanna Oerslev , Plana-Ripoll Oleguer , Baravelli Carl Michael , Agardh Emilie E. , van der Velde Lode , Kinge Jonas Minet , Knudsen Ann Kristin Skrindo
Published: September 2024

Background

Findings from the Global Burden of Disease (GBD) study have shown that the burden of mental and substance use disorders is considerable, and unevenly distributed across demographic groups in the population. However, there is a lack of knowledge on how this burden differs by socioeconomic position. The aim of this study was to examine educational differences in years lived with disability (YLDs) from mental and substance use disorders among males and females in two high-income countries, taking comorbidity with other diseases into account.

Methods

The study included all registered residents in Denmark and Norway from 2011 to 2021. Diagnostic information was retrieved from records in the Norwegian National Patient Registry (NPR) and the Danish Psychiatric Central Research Register (PCRR) and used as proxy measures for disorder prevalence. Demographical and educational information was taken from administrative registries. The YLD is a measure of the non-fatal health loss in the population and was calculated by multiplying the duration of a disorder with a disability weight (DW), scaled between 0 and 1. Information on remission and DWs were retrieved from the GBD study and other sources, and disorder specific DWs were averaged by severity levels and adjusted for comorbidity.

Results

Educational gradients in YLD rates were found for mental and substance disorders overall, and for most of the specific disorders. The educational gradient was more pronounced for schizophrenia, intellectual disability and substance use disorders than for eating, anxiety, and affective disorders. Both higher YLD rates, and a larger attributed proportion of the total YLDs, were found for schizophrenia, intellectual disability, and substance use disorders in the groups with low versus high education. YLD rates for eating, anxiety, and affective disorders were more equal across educational levels, but constituted a smaller proportion of the total YLDs among the groups with low versus the groups with high educational level.

Conclusion

Most of the disease burden related to mental and substance use disorders falls on those with the fewest years of education. This should be taken into consideration when public health targets aimed at improving mental health and reducing social inequalities in health are developed and implemented.
Clinical application of flexible fiberoptic bronchoscopy in neonatal respiratory diseases
Authors: Zhuang Xuee , Liu Zhiyong , Zheng Jingyang , Xu Jinglin , Chen Dongmei
Published: September 2024

Background

Respiratory disease is a predominantly observed problem in neonates. Moreover, the application of flexible bronchoscopy in newborns is gradually increasing. This study aimed to investigate the value of bronchoscopy in neonates respiratory abnormalities and evaluate the safety of bronchoscopy application.

Methods

Clinical data and outcomes of 56 neonates who underwent flexible bronchoscopy were retrospectively analyzed. Correlations among indications for bronchoscopy, findings, and clinical diseases were assessed.

Results

A total of 56 neonates had a minimum weight of 1200 g at the time of bronchoscopy, while the minimum gestational age at birth was 26 + 1 weeks. A total of 22 cases (39.3%) had two or more clinical indications; the five most common indications were respiratory distress in 24 (42.9%), stridor in 22 (39.3%), pulmonary atelectasis in 10 (17.6%), feeding difficulty in 10 (17.6%), and difficult weaning from mechanical ventilation in 6 (10.7%) cases. A total of 13 types of abnormalities were detected in the respiratory tract. The most common abnormalities were laryngomalacia in 29 (59.2%), tracheobroncomalacia in 8 (16.3%), and vocal cord paralysis in 6 (12.2%) cases. Bronchoalveolar lavage was performed in 39 cases. Eight cases were diagnosed by bronchoscopy and then treated with surgery in the Thoracic Surgery/Otolaryngology Department; all of them were cured and discharged from the hospital after surgery. No serious complications, such as pneumothorax or shock, occurred in any of the children, of whom none died.

Conclusions

Flexible bronchoscopy could play an important role in diagnosing and identifying respiratory disorders in neonates and be safely used with few serious complications.
Chronic stress and functional health in older adults with concerns about falling: a study protocol of a randomized controlled trial with multicomponent exercise intervention (FEARFALL)
Authors: Britting Sabine , Kob Robert , Görlitz Anja , Sieber Cornel C. , Freiberger Ellen , Rohleder Nicolas
Published: September 2024

Background

Maintenance of physical function, mobility, and independent living are important goals for older adults. However, concerns about falling (CaF) play a central role in the vicious cycle of CaF, inflammation, loss of muscle mass, and decreasing physical function ultimately resulting in negative health outcomes. CaF, like other states of chronic stress and anxiety, can be considered as enduring adverse stimuli affecting the stress systems and the inflammatory system. Therefore, the aim of this study is to investigate whether a reduction of CaF leads to a reduction of stress and therefore possibly reduces chronic low-grade inflammation. Understanding the role and directionality of the effects of inflammation on CaF increases our understanding of age-related loss of mobility and physical function.

Methods

In this study, community-dwelling older adults, aged 70 years and older, will be randomly assigned to either a 4-month, multi-component intervention with exercise training and cognitive-behavioral components or to a sham control group with light stretching exercises, cognitive training, and educational health lectures. For the operationalization of specific CaF, the Falls Efficacy Scale—International will be used. Stress and related psychological symptoms will be monitored using established self-reports and by measuring salivary cortisol. Concentrations of C-reactive protein, interleukin 6, interleukin 10, and tumor-necrosis-factor-alpha, as well as gene expression of selected inflammatory transcripts, will be used as surrogate parameters of the inflammatory status at baseline, after the 4-month intervention and 8-month follow-up.

Discussion

This study will be the first to test whether CaF are related with stress system activity or reactivity or with markers of inflammation in the context of a multi-component intervention with exercise training and cognitive-behavioral components addressing CaF. The reduction of specific CaF or general psychological symptoms should reverse alterations in stress systems, and / or slow down low-grade inflammation. Changes in activity, as well as psychological and biological pathways leading from CaF to muscle loss will be measured, to disentangle the individual contribution to sarcopenia, and to provide an additional pathway to break or slow-down the vicious cycle of CaF and sarcopenia.

Trial registration

German Clinical Trials Register (DRKS): DRKS00029171. Registered 22 July 2022.
Sustainable and technically smart spectrophotometric determination of PAXLOVID: a comprehensive ecological and analytical performance rating
Authors: Aboras Sara I. , Maher Hadir M. , Alzoman Nourah Z. , Elbordiny Haydi S.
Published: September 2024

The Food and Drug Administration (FDA) authorized the administration of ritonavir (RIT)-boosted nirmatrelvir (NMV) on May 25, 2023, for the treatment of mild to moderate COVID-19 in patients who are at high risk of developing severe COVID-19. In accordance with sustainability and environmental friendliness, simple, eco-friendly, and sustainable spectrophotometric methods were established for concurrently estimating RIT and NMV in newly launched copackaged pills. The suggested solutions for resolving the spectral overlap between RIT and NMV involve the following mathematical methods: the first derivative method (1D), second derivative method (2D), and dual-wavelength zero-order method (DWZ). When ethanol was used as a green dilution solvent, the linearity range was adjusted (10–250 µg/mL) for both drugs. The procedures resulted in a high correlation coefficient (not less than 0.9996) and satisfactory levels of detection and quantification. Additionally, method validation was performed in accordance with International Council for Harmonization norms. Moreover, a detailed ecological and sustainability evaluation protocol was established to confirm the greenness and whiteness of the methods. Finally, the proposed method, along with previously reported methods for analysing NMV and RIT, were reviewed analytically and ecologically.
Leucinostatins from fungal extracts block malaria transmission to mosquitoes
Authors: Niu Guodong , Wang Xiaohong , Gao Wenda , Cui Liwang , Li Jun
Published: September 2024

Background

Malaria is a mosquito-transmitted disease that kills more than half a million people annually. The lack of effective malaria vaccines and recently increasing malaria cases urge innovative approaches to prevent malaria. Previously, we reported that the extract from the soil-dwelling fungus Purpureocillium lilacinum, a common fungus from the soil, reduced Plasmodium falciparum oocysts in Anopheles gambiae midguts after mosquitoes contacted the treated surface before feeding.

Methods

We used liquid chromatography to fraction fungal crude extract and tract the active fraction using a contact-wise approach and standard membrane feeding assays. The purified small molecules were analyzed using precise mass spectrometry and tandem mass spectrometry.

Results

We isolated four active small molecules from P. lilacinum and determined them as leucinostatin A, B, A2, and B2. Pre-exposure of mosquitoes via contact with very low-concentration leucinostatin A significantly reduced the number of oocysts. The half-maximal response or inhibition concentration (EC50) via pre-exposure was 0.7 mg/m2, similar to atovaquone but lower than other known antimalarials. The inhibitory effect of leucinostatin A against P. falciparum during intraerythrocytic development, gametogenesis, sporogonic development, and ookinete formation, with the exception of oocyst development, suggests that leucinostatins play a part during parasite invasion of new cells.

Conclusions

Leucinostatins, secondary metabolites from P. lilacinum disrupt malaria development, particular transmission to mosquitoes by contact. The contact-wise malaria control as a nonconventional approach is highly needed in malaria-endemic areas.

Graphical Abstract
Sepsis-induced coagulopathy (SIC) in the management of sepsis
Authors: Iba Toshiaki , Helms Julie , Levy Jerrold H.
Published: September 2024

The mortality rate of sepsis remains high and further increases when complicated by disseminated intravascular coagulation (DIC). Consequently, early detection and appropriate management of DIC will be helpful for the management of sepsis. Although overt DIC criteria are often used for diagnosing definitive DIC, it was not designed to detect early-phase DIC. The criteria and scoring system for sepsis-induced coagulopathy (SIC) were developed and introduced in 2017 to detect early-stage DIC, and they were subsequently adopted by the International Society on Thrombosis and Haemostasis in 2019. The objective of detecting SIC was not to miss the patients at high risk of developing overt DIC at an earlier time. Although anticoagulant therapies are potential options for the treatment of sepsis-associated DIC, their effectiveness has not been established, and further research is warranted. For that purpose, an international collaborative platform is required for future clinical trials, and SIC criteria have been suggested for such studies. Calculating the SIC score is straightforward and suitable for use in clinical settings. This review aims to introduce SIC criteria and its scoring system for better management of sepsis-associated DIC. We also intended to update the current knowledge regarding this novel diagnostic criterion.
The genetic relationship between human and pet isolates: a core genome multilocus sequence analysis of multidrug-resistant bacteria
Authors: Genath Antonia , Hackmann Carolin , Denkel Luisa , Weber Anna , Maechler Friederike , Kola Axel , Schwarz Stefan , Gastmeier Petra , Leistner Rasmus
Published: September 2024

Introduction

The global increase of multidrug-resistant organisms (MDROs) is one of the most urgent public health threats affecting both humans and animals. The One Health concept emphasizes the interconnectedness of human, animal and environmental health and highlights the need for integrated approaches to combat antimicrobial resistance (AMR). Although the sharing of environments and antimicrobial agents between companion animals and humans poses a risk for MDRO transmission, companion animals have been studied to a lesser extent than livestock animals. This study therefore used core genome multilocus sequence typing (cgMLST) to investigate the genetic relationships and putative transmission of MDROs between humans and pets.

Methods

This descriptive integrated typing study included 252 human isolates, 53 dog isolates and 10 cat isolates collected from 2019 to 2022 at the Charité University Hospital in Berlin, Germany. CgMLST was performed to characterize methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and multidrug-resistant gram-negative bacteria. The genetic diversity of the MDROs of the different host populations was determined and compared based on sequence type and core genome complex type.

Results

Within this study the majority of samples from pets and humans was genetically distinct. However, for some isolates, the number of allelic differences identified by cgMLST was low. Two cases of putative household transmission or shared source of VR E. faecium and MDR E. coli between humans and pets were documented.

Conclusions

The interaction between humans and their pets appears to play a minor role in the spread of the MDROs studied. However, further research is needed. This study emphasizes the importance of comprehensive molecular surveillance and a multidisciplinary One Health approach to understand and contain the spread of MDROs in human and animal populations.

Trial Registration

The study is registered with the German Clinical Trials Register (DRKS00030009).
The influence of an emotion regulation intervention on challenges in emotion regulation and cognitive strategies in patients with depression
Authors: Atta Mohamed Hussein Ramadan , El-Gueneidy Mervat Mostafa , Lachine Ola Ahmed Rashad
Published: September 2024

Background

Patients with depression struggle with significant emotion regulation difficulties, which adversely affect their psychological well-being and hinder recovery. Traditional therapeutic approaches often fail to adequately address these challenges, leading to a persistent gap in effective mental health care. This research seeks to address this gap by investigating the impact of emotion regulation skills training on patients with depression.

Aim

To assess the difficulties in emotion regulation among patients with depression and evaluate the impact of an emotion regulation skills training intervention on those with higher levels of emotion regulation difficulties, specifically focusing on increasing the use of adaptive emotion regulation strategies and reducing the use of maladaptive emotion regulation strategies.

Method

A quasi-experimental research design was utilized, using three tools: a socio-demographic and Clinical Data structured interview schedule, Difficulties in Emotional Regulation Scale, and Cognitive Emotion Regulation Questionnaire. Eighty patients with depression were recruited to assess those with higher levels of emotion regulation difficulties; out of those with greater difficulties, 30 patients were chosen to participate in the emotion regulation skills training intervention.

Result

The 80 studied subjects' emotion regulation difficulties scores ranged from 158 to 169 (164.5 ± 3.21), and they indicated less use of adaptive cognitive emotion regulation strategies and more use of maladaptive cognitive emotion regulation strategies (56.07 ± 2.67). Regarding the intervention group, the overall mean score of the 30 patients’ emotion regulation difficulties decreased from 167.35 ± 2.21 pre-intervention to 105.85 ± 3.33 post-intervention (p < 0.0001). Cognitive emotion regulation total scores improved markedly from 54.07 ± 1.66 to 35.2 ± 3.46 (p < 0.01).

Implication

Healthcare providers should routinely assess emotion regulation difficulties in patients with depression and integrate personalized treatment plans that target individual emotion regulation difficulties.

Conclusion

The findings suggest that the emotion regulation intervention has the potential to improve emotion regulation difficulties and cognitive emotion regulation strategies among patients with depression.
Escaping uncertainty: overlapping methods of knowledge production and exchange in the naturalization journey
Authors: Haller Liam , Yanaşmayan Zeynep
Published: September 2024

This paper examines how forced migrants integrate individual perception, interpersonal exchange, and extended networks to navigate the naturalization process. By bringing together these three methods of knowledge creation and exchange, we aim to clarify how these strategies interact and overlap to manage uncertainties stemming from naturalization bureaucracy, a complex and often opaque process. Drawing on personal accounts of 30 Syrians in Berlin and analysis of approximately 100 social media posts, our findings illustrate that these methods could be employed concurrently or interchangeably and on the whole in a symbiotic manner, offering migrants multiple pathways to acquire and (in)validate crucial information. Although this synthesis of knowledge production methods is not necessarily conducive to accessing the right in question, in our case naturalization, it becomes necessary to arrive at “informed” decision-making in uncertain environments characterized by low level of trust and asymmetrical power relations. The paper therefore contributes to broader discussions on migrants’ navigation of legal systems and coping mechanisms in the face of bureaucratic hurdles.
Quality control of elbow joint radiography using a YOLOv8-based artificial intelligence technology
Authors: Lai Qi , Chen Weijuan , Ding Xuan , Huang Xin , Jiang Wenli , Zhang Lingjing , Chen Jinhua , Guo Dajing , Zhou Zhiming , Chen Tian-wu
Published: September 2024

Background

To explore an artificial intelligence (AI) technology employing YOLOv8 for quality control (QC) on elbow joint radiographs.

Methods

From January 2022 to August 2023, 2643 consecutive elbow radiographs were collected and randomly assigned to the training, validation, and test sets in a 6:2:2 ratio. We proposed the anteroposterior (AP) and lateral (LAT) models to identify target detection boxes and key points on elbow radiographs using YOLOv8. These identifications were transformed into five quality standards: (1) AP elbow positioning coordinates (XA and YA); (2) olecranon fossa positioning distance parameters (S17 and S27); (3) key points of joint space (Y3, Y4, Y5 and Y6); (4) LAT elbow positioning coordinates (X2 and Y2); and (5) flexion angle. Models were trained and validated using 2,120 radiographs. A test set of 523 radiographs was used for assessing the agreement between AI and physician and to evaluate clinical efficiency of models.

Results

The AP and LAT models demonstrated high precision, recall, and mean average precision for identifying boxes and points. AI and physicians showed high intraclass correlation coefficient (ICC) in evaluating: AP coordinates XA (0.987) and YA (0.991); olecranon fossa parameters S17 (0.964) and S27 (0.951); key points Y3 (0.998), Y4 (0.997), Y5 (0.998) and Y6 (0.959); LAT coordinates X2 (0.994) and Y2 (0.986); and flexion angle (0.865). Compared to manual methods, using AI, QC time was reduced by 43% for AP images and 45% for LAT images (p < 0.001).

Conclusion

YOLOv8-based AI technology is feasible for QC of elbow radiography with high performance.

Relevance statement

This study proposed and validated a YOLOv8-based AI model for automated quality control in elbow radiography, obtaining high efficiency in clinical settings.

Key Points

QC of elbow joint radiography is important for detecting diseases.

Models based on YOLOv8 are proposed and perform well in image QC.

Models offer objective and efficient solutions for QC in elbow joint radiographs.

Graphical Abstract
2024 Egyptian consensus statement on the role of non-statin therapies for LDL cholesterol lowering in different patient risk categories
Authors: El Din Taha Hesham Salah , Kandil Hossam , Badran Hala Mahfouz , Farag Nabil , Khamis Hazem , Nasr Gamila , Samy Mina , Abdrabou Moustafa , Abuelezz Mohamed , Shaker Mirna Mamdouh
Published: September 2024

Background

The new millennium has witnessed increased understanding of cardiovascular (CV) risk factors and improvement in atherosclerotic cardiovascular disease (ASCVD) management. The role of LDL cholesterol and other atherogenic lipid particles in the development of atherosclerosis is now beyond doubt.

Main body

Statins have been widely used and recommended in guidelines for preventing and managing ischemic events. However, statins have side effects, and many patients do not achieve their low-density lipoprotein cholesterol (LDL-C) goals. In recent years, non-statin lipid-lowering agents have gained increasing use as adjuncts to statins or as alternatives in patients who cannot tolerate statins. This consensus proposes a simple approach for initiating non-statin lipid-lowering therapy and provides evidence-based recommendations. Our key advancements include the identification of patients at extreme risk for CV events, the consideration of initial combination therapy of statin and ezetimibe in very high-risk and extreme-risk groups and the extended use of bempedoic acid in patients not reaching LDL-C targets especially in resource-limited settings.

Conclusions

Overall, this consensus statement provides valuable insights into the expanding field of non-statin therapies and offers practical recommendations to enhance CV care, specifically focusing on improving LDL-C control in Egypt. While these recommendations hold promise, further research and real-world data are needed for validation and refinement.
GLP-1, GIP, and Glucagon Agonists for Obesity Treatment: A Hunger Perspective
Authors: D’Ávila Mateus , Hall Samantha , Horvath Tamas L
Published: September 2024

For centuries, increasingly sophisticated methods and approaches have been brought to bear to promote weight loss. Second only to the Holy Grail of research on aging, the idea of finding a single and simple way to lose weight has long preoccupied the minds of laymen and scientists alike. The effects of obesity are far-reaching and not to be minimized; the need for more effective treatments is obvious. Is there a single silver bullet that addresses this issue without effort on the part of the individual? The answer to this question has been one of the most elusive and sought-after in modern history. Now and then, a miraculous discovery propagates the illusion that a simple solution is possible. Now there are designer drugs that seem to accomplish the task: we can lose weight without effort using mono, dual, and triple agonists of receptors for glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon. There are, however, fundamental biological principles that raise intriguing questions about these therapies beyond the currently reported side-effects. This perspective reflects upon these issues from the angle of complex goal-oriented behaviors, and systemic and cellular metabolism associated with satiety and hunger.
Daily Diversity Flows: Racial and Ethnic Context Between Home and Work
Authors: Hess Chris , Hall Matt
Published: September 2024

The racial and ethnic diversification of the U.S. population has transformed the demographic makeup of communities and rapidly increased exposure to diversity in American neighborhoods. Although diversity exposure occurs throughout people's daily lives, the conventional approach to describing diversity only at places of residence potentially understates the full extent of this phenomenon. In this study, we explore short-term, within-day changes in the diversity of different neighborhoods by considering U.S. workers’ work and residential locations. Using estimates for daytime and nighttime populations among metropolitan census tracts, our empirical analyses investigate the extent to which the process of daytime mobility for work relates to changes in the racial and ethnic diversity of different spaces. Our results indicate widespread daily shifts toward diversity for most neighborhood types, especially those with residential (nighttime) populations that are predominantly Black, Latino, or Asian. We find that patterns of intraday diversification experienced minor declines across recent decades but are present in most metropolitan areas. Our findings also show that intraday changes in racial and ethnic diversity overlap with nonracial forms of daily diversity change. Further, average within-day changes in diversity are more pronounced in areas with greater residential segregation.
foxg1a is required for hair cell development and regeneration in the zebrafish lateral line
Authors: Bell Jon M. , Turner Emily M. , Biesemeyer Cole , Vanderbeck Madison M. , Hendricks Roe , McGraw Hillary F.
Published: September 2024

Mechanosensory hair cells located in the inner ear mediate the sensations of hearing and balance. If damaged, mammalian inner ear hair cells are unable to regenerate, resulting in permanent sensory deficits. Aquatic vertebrates like zebrafish (Danio rerio) have a specialized class of mechanosensory hair cells found in the lateral line system, allowing them to sense changes in water current. Unlike mammalian inner ear hair cells, lateral line hair cells can robustly regenerate following damage. In mammals, the transcription factor Foxg1 functions to promote normal development of the inner ear. Foxg1a is expressed in lateral line sensory organs in zebrafish larvae, but its function during lateral line development and regeneration has not been investigated. Our study demonstrates that mutation of foxg1a results in slower posterior lateral line primordium migration and delayed neuromast formation. In developing and regenerating neuromasts, we find that loss of Foxg1a function results in reduced hair cell numbers, as well as decreased proliferation of neuromast cells. Foxg1a specifically regulates the development and regeneration of Islet1-labeled hair cells. These data suggest that Foxg1 may be a valuable target for investigation of clinical hair cell regeneration.
Neuromuscular junction dysfunction in Lafora disease
Authors: Shukla Monica , Chugh Deepti , Ganesh Subramaniam
Published: September 2024

Lafora disease (LD), a fatal neurodegenerative disorder, is caused by mutations in the EPM2A gene encoding laforin phosphatase or NHLRC1 gene encoding malin ubiquitin ligase. LD symptoms include epileptic seizures, ataxia, dementia and cognitive decline. Studies on LD have primarily concentrated on the pathophysiology in the brain. A few studies have reported motor symptoms, muscle weakness and muscle atrophy. Intriguingly, skeletal muscles are known to accumulate Lafora polyglucosan bodies. Using laforin-deficient mice, an established model for LD, we demonstrate that LD pathology correlated with structural and functional impairments in the neuromuscular junction (NMJ). Specifically, we found impairment in NMJ transmission, which coincided with altered expression of NMJ-associated genes and reduced motor endplate area, fragmented junctions and loss of fully innervated junctions at the NMJ. We also observed a reduction in alpha-motor neurons in the lumbar spinal cord, with significant presynaptic morphological alterations. Disorganised myofibrillar patterns, slight z-line streaming and muscle atrophy were also evident in LD animals. In summary, our study offers insight into the neuropathic and myopathic alterations leading to motor deficits in LD.
Satisfactory result of great saphenous vein endovenous laser ablation until below the knee on active venous leg ulcer: a case series
Authors: Taofan Taofan , Dakota Iwan , Kartamihardja Achmad Hafiedz Azis , Afandy Jonathan Edbert , Indriani Suci , Adiarto Suko
Published: September 2024

Background Active venous leg ulcer (VLU) is the most severe manifestation of chronic venous disease which not only affects patients’ health, but also decreases the quality of life, and delivers economic burdens. Treatment of superficial venous reflux with early endovenous laser ablation (EVLA) has been associated with reducing ulcer recurrence levels and promoting faster VLU healing. We reported three cases of patients with active VLU undergoing EVLA with different approaches. Case illustration Three patients came with complaint of leg ulcer, diagnosed with C6sEpAsdPr, with venous clinical severity scores (VCSS) of 15, 23, and 22 respectively. Severe great saphenous veins (GSV) reflux was found in all patients by duplex ultrasound examination. The second patient had undergone above-the-knee EVLA. All patients underwent EVLA using 1470-nano meter wavelength laser device and ELVeS radial fiber (Biolitec, Bonn, Germany). The laser energy protocol used was 6 W linear endovenous energy density (LEED) 50 J/cm for proximal until media ATK GSV ablation, 5 W LEED 40 J/cm for media ATK until proximal below-the-knee (BTK) GSV, and 2 W LEED 20 J/cm for proximal until distal BTK GSV. The third patient was also treated with EVLA for small saphenous vein severe reflux. Follow-up until 6 months post-EVLA showed significant healing of the ulcer with 14, 16, and 17 VCSS reduction consecutively without any complication. Conclusion We’ve reported three cases of patients with active VLU undergoing EVLA until BTK with significant results. The EVLA of GSV until BTK where there is still significant reflux is safe and provides satisfactory results in patients with VLU.