bluuebunny/crossref_metadata_2025 huggingface dataset:
How does service supply chain flexibility influence responsiveness in service delivery? An empirical analysis of healthcare units
Authors: Prakash Gyan
Published: March 2024

Purpose

This paper aims to explore the antecedents and consequences of service chain flexibility (SCF) in healthcare service delivery.

Design/methodology/approach

A structural model was developed based on a literature review. A 29-indicator questionnaire was circulated among service providers in the healthcare system across India, and 253 valid responses were received, corresponding to a response rate of 46%. The research model was assessed using a cross-sectional research design, and the data were analyzed by structural equation modeling using analysis of moment structures (AMOS) software.

Findings

Service orientation (SO), technology integration (TI), knowledge sharing (KS) and supply chain integration (SCI) were identified as antecedents of SCF, the consequence of which is responsiveness in service delivery (RSD). Furthermore, patient-centered care moderates the relationship between SCF and RSD.

Research limitations/implications

This paper highlights the impact of SCF on RSD in healthcare organizations. Consideration of the four constructs of SO, TI, KS and SCI as antecedents of SCF and, in turn, RSD may be one of the limitations. Future work may identify other theoretical constructs with potential impacts on SCF and RSD. Furthermore, eight months for data collection could have resulted in early-late response bias. This study was operationalized in India and may reflect political, economic, social, technological, environmental and legal factors unique to India.

Practical implications

The study provides suggestions to practitioners for building RSD by leveraging SO, TI, KS and SCI in flexibility-driven service chain processes. Recognizing the relationships among these constructs can aid in the timely formulation of corrective actions and patient-centric policies.

Social implications

This paper highlights how focusing on a SCF can promote RSD. This understanding may aid the design of processes that develop patient-centricity and deliver health as a social good in an effective manner.

Originality/value

The empirical evidence from this study can help hospitals integrate and build flexibility in their functions, thus enabling them to deliver responsiveness in care.
Shock responsiveness of the Philippine social protection system: Three case studies
Authors: Aldaba Fernando T. , Geronimo John Anthony U.
Published: March 2024

Philippine households face large‐scale risks, like natural disasters and inflation, which can threaten their financial stability and push them into poverty. To manage these risks, the Philippine government needs a shock‐responsive social protection system. Several components of such a system already exist, as proven by the country's responses to Typhoon Haiyan, the COVID‐19 pandemic, and the recent food and energy crisis. However, these events also exposed gaps in the Philippine social protection system, particularly in reaching out to unregistered individuals swiftly. The resolution lies in updating and harmonizing social registries, making verification processes interoperable, enhancing delivery platforms (both digital and physical), and ensuring efficient grievance redress systems.
Evaluating water‐quality trends in agricultural watersheds prioritized for management‐practice implementation
Authors: Webber James , Chanat Jeffrey , Clune John , Devereux Olivia , Hall Natalie , Sabo Robert D. , Zhang Qian
Published: March 2024

Many agricultural watersheds rely on the voluntary use of management practices (MPs) to reduce nonpoint source nutrient and sediment loads; however, the water‐quality effects of MPs are uncertain. We interpreted water‐quality responses from as early as 1985 through 2020 in three agricultural Chesapeake Bay watersheds that were prioritized for MP implementation, namely, the Smith Creek (Virginia), Upper Chester River (Maryland), and Conewago Creek (Pennsylvania) watersheds. We synthesized patterns in MPs, climate, land use, and nutrient inputs to better understand factors affecting nutrient and sediment loads. Relations between MPs and expected water‐quality improvements were not consistently identifiable. The number of MPs increased in all watersheds since the early 2010s, but most monitored nutrient and sediment loads did not decrease. Nutrient and sediment loads increased or remained stable in Smith Creek and the Upper Chester River. Sediment loads and some nutrient loads decreased in Conewago Creek. In Smith Creek, a 36‐year time‐series model suggests that changes in manure affected flow‐normalized total nitrogen loads. We hypothesize that increases in nutrient applications may overshadow some expected MP effects. MPs might have stemmed further water‐quality degradation, but improvements in nutrient loads may rely on reducing manure and fertilizer applications. Our results highlight the importance of assessing MP performance with long‐term monitoring‐based studies.
Disease control in patients with non‐small cell lung cancer using pemetrexed: Investigating the best treatment strategy
Authors: Takahara Yutaka , Abe Ryudai , Sumito Nagae , Tanaka Takuya , Ishige Yoko , Shionoya Ikuyo , Yamamura Kouichi , Nishiki Kazuaki , Nojiri Masafumi , Kato Ryo , Shinomiya Shohei , Oikawa Taku
Published: March 2024

Background

Pemetrexed (PEM) is the primary chemotherapy for non‐small cell lung cancer (NSCLC), showing potential for long‐term disease stability in certain cases. However, studies examining disease control with PEM therapy are lacking. This study aimed to pinpoint clinical traits in patients with NSCLC responding well to PEM therapy, predict factors influencing disease control, and suggest optimal treatment approaches.

Methods

A retrospective analysis of patients with NSCLC treated with PEM was performed to compare patients who achieved disease control after treatment with those who did not.

Results

Of 73 patients, 56 (76.7%) achieved disease control with PEM therapy. In the disease control group, a significantly higher proportion of patients exhibited good performance status (PS) and received PEM doses without reduction after the second cycle. Multivariate analysis identified bevacizumab (Bev) noncompliance, PEM dose reduction, and thyroid transcription factor‐1 (TTF‐1) negativity as significant independent risk factors for disease progression during PEM therapy. Additionally, overall survival was significantly longer in the disease control group (p < 0.001).

Conclusions

Our findings indicated that maintaining the dose of PEM after the second treatment cycle in patients with NSCLC, along with concurrent use of Bev and the presence of TTF‐1 positivity, could enhance disease control rates and extend survival.
Menstruation and learning disability across the life course: Using a two‐part scoping exercise to co‐produce research priorities
Authors: Earle Sarah , Ledger Susan , Newton Victoria , Rouse Lorna , Tilley Elizabeth
Published: March 2024

Background

Across the life course, women and girls with learning disabilities and their carers report difficulties in accessing information and support with menstruation, yet their experiences are often overlooked in initiatives to improve menstrual health and wellbeing. Our aim was to collaborate with women with learning disabilities to co‐produce future research priorities in a UK context.

Methods

We undertook a two‐part scoping exercise to explore what is known about this topic from a life course perspective, beginning pre‐menarche and extending to post‐menopause support. This combined a rapid scoping review of the literature since 1980 with a stakeholder consultation where people with learning disabilities, family carers, advocacy groups and staff working across education, health and social care were invited to share their experiences of menstruation support.

Findings

UK and international literature provided insight across five narrative themes. Seventy stakeholders took part in our consultation, enabling the identification of five key themes. Findings across both highlight examples of supportive practice and valued resources alongside enduring health inequalities and barriers to menstruation support faced by women and girls with learning disabilities across the life course.

Conclusion

Our scoping exercise identified multiple gaps in research and practice, ongoing reproductive health inequalities and a need for improved access to peer support, resources and training that take a life course approach. The scoping exercise indicates the need for further empirical research on menstruation and learning disability, with a particular focus on collating people's lived experiences.
Antimicrobial resistance in ocular infection: A review
Authors: Cabrera‐Aguas Maria , Chidi‐Egboka Ngozi , Kandel Himal , Watson Stephanie L.
Published: March 2024

Antimicrobial resistance (AMR) is a global public health threat with significant impact on treatment outcomes. The World Health Organization's Global Action Plan on AMR recommended strengthening the evidence base through surveillance programs and research. Comprehensive, timely data on AMR for organisms isolated from ocular infections are needed to guide treatment decisions and inform researchers and microbiologists of emerging trends. This article aims to provide an update on the development of AMR in ocular organisms, AMR in bacterial ocular infections and on AMR stewardship programs globally. The most common ocular pathogens are Pseudomonas aeruginosa, Staphylococcus spp., Streptococcus pneumoniae, and Haemophilus influenzae in ocular infections. A variety of studies and a few surveillance programs worldwide have reported on AMR in these infections over time. Fluoroquinolone resistance has increased particularly in Asia and North America. For conjunctivitis, the ARMOR cumulative study in the USA reported a slight decrease in resistance to ciprofloxacin. For keratitis, resistance to methicillin has remained stable for S. aureus and CoNS, while resistance to ciprofloxacin has decreased for MRSA globally. Methicillin‐resistance and multidrug resistance are also emerging, requiring ongoing monitoring. Antimicrobial stewardship (AMS) programmes have a critical role in reducing the threat of AMR and improving treatment outcomes. To be successful AMS must be informed by up‐to‐date AMR surveillance data. As a profession it is timely for ophthalmology to act to prevent AMR leading to greater visual loss through supporting surveillance programmes and establishing AMS.
Stories With Blurred Contours: Family Displays of Foster Families and Young Children in Out‐of‐Home Care
Authors: Levander Ulrika
Published: March 2024

The aim of the study was to investigate foster parents' displays and narratives about family life as foster parents of toddlers and preschool children and how these influence the welfare and sense of family belonging for younger children in foster care. Based on qualitative interviews with 16 foster parents in 10 foster families of looked‐after children aged 1–6, narratives about the children, their needs and roles in the foster family were analysed. Various kinds of narratives of the child and foster family were identified, where the child's differentness and the normative ideas of the foster family often were negotiated in ways that blurred the understanding of the children's needs. Various boundary issues affecting the foster family were also visualized. The results suggested that addressing issues of family boundary ambiguity as a difficult feature of foster care would be beneficial. Not only would this provide opportunities to strengthen the internal life and resilience of the foster family, but it would also help visualize the looked‐after children's individual needs and strengthen their position as family members.
Graph theoretical analysis and independent component analysis of diabetic optic neuropathy: A resting‐state functional magnetic resonance imaging study
Authors: Wei Qian , Lin Si‐Min , Xu San‐Hua , Zou Jie , Chen Jun , Kang Min , Hu Jin‐Yu , Liao Xu‐Lin , Wei Hong , Ling Qian , Shao Yi , Yu Yao
Published: March 2024

Aims

This study aimed to investigate the resting‐state functional connectivity and topologic characteristics of brain networks in patients with diabetic optic neuropathy (DON).

Methods

Resting‐state functional magnetic resonance imaging scans were performed on 23 patients and 41 healthy control (HC) subjects. We used independent component analysis and graph theoretical analysis to determine the topologic characteristics of the brain and as well as functional network connectivity (FNC) and topologic properties of brain networks.

Results

Compared with HCs, patients with DON showed altered global characteristics. At the nodal level, the DON group had fewer nodal degrees in the thalamus and insula, and a greater number in the right rolandic operculum, right postcentral gyrus, and right superior temporal gyrus. In the internetwork comparison, DON patients showed significantly increased FNC between the left frontoparietal network (FPN‐L) and ventral attention network (VAN). Additionally, in the intranetwork comparison, connectivity between the left medial superior frontal gyrus (MSFG) of the default network (DMN) and left putamen of auditory network was decreased in the DON group.

Conclusion

DON patients altered node properties and connectivity in the DMN, auditory network, FPN‐L, and VAN. These results provide evidence of the involvement of specific brain networks in the pathophysiology of DON.
Post‐release mortality of line‐caught snapper Chrysophrys auratus depends on hook site and capture depth
Authors: Maggs Jade Q. , Evans Oliver , Holdsworth John C. , Lumley Thomas , Hartill Bruce W.
Published: March 2024

Catch‐and‐release angling is common in recreational fisheries, but post‐release mortality (PRM) may be high. We conducted a controlled field experiment to estimate mortality of released snapper Chrysophrys auratus. Recreational fishers caught 960 snapper from three depth strata (<15, 15–25, 26–40 m) that were either lip‐hooked, foul‐hooked or gut‐hooked. A bottom longline vessel caught 162 lip‐hooked fish in shallow water to serve as controls. Fish were held in 15‐m deep holding nets. All control fish and 80% of treatment fish survived, with anatomical hook site and capture depth significantly predicting mortality. Probability of mortality was lowest for lip‐hooked fish in shallow water (5 m = 0.00, 95% CI [0.00, 0.03]), but increased rapidly to 20 m (0.24, 95% CI [0.2, 0.3]). Mortality of foul‐hooked fish increased steadily with depth from 0.05 (95% CI [0.00, 0.78]) at 5 m to 0.65 (95% CI [0.13, 0.96]) at 40 m. Gut‐hooking resulted in high mortality at all depths but a low sample size resulted in high uncertainty of estimates. Our results indicate that snapper PRM can be reduced by fishing in shallow water and by mitigating gut‐hooking, possibly by using large circle hooks.
‘It is empowering and gives people dignity in a very difficult process’: A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid
Authors: Veerhuis Nadine , Merizzi Alessandra , Papoulias Stephanie , Bradbury Claire , Sheret Kathy , Traynor Victoria
Published: March 2024

Background

Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence‐based person‐centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom.

Methods

This qualitative study was theoretically underpinned by a person‐centred framework and conducted over three stages: (1) Development of a draft UK‐specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid.

Results

Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice‐centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options.

Conclusions

Decision aids that are underpinned by interactive choice‐driven questions enhance a person‐centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision‐making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics.

Patient and Public Involvement

Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.
Efficacy of dolutegravir + lamivudine q.d. with food in people with TB/HIV using a rifampicin‐based regimen: A retrospective observational case series
Authors: Dou Yanyun , Lu Ruichao , Su Lingsong , Lan Ke , Meng Zhihao , Qin Shanfang , Huang Liling , Huang Wei , Xu Yuanlong , Lv Yu , Wen Yuhong , Lan Shuanglai , Zuo Yong , Zhang Yong
Published: March 2024

Objectives

Dolutegravir + lamivudine (DTG + 3TC) is a first‐line regimen for people with HIV. However, there are still concerns about its efficacy in people with tuberculosis (TB)/HIV due to the lack of available evidence and drug–drug interaction with rifampicin.

Methods

A single‐centre retrospective observational case series was conducted in Guangxi Zhuang Autonomous Region, China. We included all people with TB/HIV on combined use of once‐daily (q.d.) dosing DTG + 3TC and rifampicin (RIF)‐containing anti‐TB regimens between 2020 and 2022. HIV‐RNA, CD4 cell counts were collected and analysed.

Results

In all, 21 people with HIV (PWH) were included in this study. All the PWH were treatment‐naïve and told to take DTG + 3TC q.d. with food. The median age was 53 years, and 71.43% were male. A total of 71.43% PWH had baseline viral load (VL) > 100 000 copies/mL, and 33.33% had baseline VL greater than 500 000 copies/mL. Only one PWH had CD4 cell count greater than 200 cells/μL, and the median CD4 count was 20 cells/μL. A total of 16 PWH started DTG + 3TC after initiation of the RIF‐based anti‐TB regimen, and the other five PWH initiated DTG + 3TC before the treatment of TB. All the PWH had at least 24 weeks of follow‐up visits and all of the TB treatments were successful. A total of 20 PWH (95.24%) achieved viral suppression (VL <50 copies/mL). All detected viral loads between weeks 24 and 48 were less than 200 copies/mL. Among the PWH who started DTG + 3TC after the initiation of RIF‐based anti‐TB regimen, all achieved viral suppression by week 24 except the non‐suppressed PWH. CD4 counts were greatly improved after antiretroviral treatment: the median CD4 counts were raised from 20 to 171 cells/μL at week 48. No serious adverse events were reported.

Conclusions

This case series preliminarily validates the efficacy of DTG + 3TC q.d. with food when combined with RIF‐based anti‐TB regimens in people with TB/HIV.
Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta‐analysis
Authors: Lin Jin , Wang Xiao
Published: March 2024

A meta‐analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX‐A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX‐A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX‐A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: −3.50, 95% confidence interval [CI]: −5.16 to −1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: −2.86, 95% CI: −4.03 to −1.68, p < 0.001), and narrowed scar width (SMD: −1.80, 95% CI: −2.48 to −1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX‐A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar‐related pain and preventing scar widening, and is thus worthy of broader clinical application.
Commentary: Taking stock and moving forward – the need to consider the influence of loss to follow‐up in autism screening research
Authors: Aishworiya Ramkumar , Ma Van Kim , Feldman Heidi M.
Published: March 2024

This commentary highlights the limitations of many existing population‐based studies examining the utility of the Modified Checklist for Autism in Toddlers, Revised/Follow‐Up (M‐CHAT‐R/F) in screening for autism. We expound on three major factors: (a) the limited number of screen‐negative children who undergo diagnostic evaluations, (b) the substantial number of children who screen positive and were subsequently lost to follow‐up (i.e. without further diagnostic evaluations), and (c) the sizeable number of children who did not complete the full two‐stage screening process as intended. Each of these factors can lead to erroneous estimates of the psychometric properties, specifically, the sensitivity, specificity, and negative predictive value. Hence, we emphasize the need for future studies to increase the number of children who screen negative and receive a diagnostic evaluation and ensure that these children are selected at random without a higher likelihood for the presence of autism. It is also imperative that concrete steps are taken to minimize the number of screen‐positive children who are lost to follow‐up both within and after the screening process. Both of these will play a major role in ensuring more robust results from empirical research that can guide the clinical implementation of the M‐CHAT‐R/F.
Attitudes on participation in clinical drug trials: A nationally representative survey of older adults with multimorbidity
Authors: Schwartz Janice B. , Liu Ruey‐ying , Boscardin John , Liu Qi , Lau S. W. Johnny , Khatri Sadhna , Tarn Derjung
Published: March 2024

Background

Older adults with multimorbidity are under‐represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed.

Methods

Cross‐sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March–April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics.

Results

Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African‐American respondents, and those ≥80 years). Sixty‐five percent would join all in‐person trials, 49% would join all‐video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%).

Conclusions

Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in‐person visits are preferred. Proposed changes in trial design to increase enrollment of under‐represented older adults may not align with patient‐reported preferences.
Actigraphic sleep patterns are associated with bone turnover and bone mineral density among university students
Authors: Petrov Megan E. , Liu Li , Mudappathi Rekha , Whisner Corrie M.
Published: March 2024

Poorer sleep is associated with poorer bone health among older adults but the role of sleep in bone health during younger adulthood is understudied. In this observational study, the averages and variability in total sleep time (TST), sleep efficiency (SE), and sleep midpoint of university students were examined in relation to levels of bone turnover markers (BTMs) and bone mineral density (BMD) at the lumbar spine and femur. A sample of healthy, university students (N = 59, aged 18–25 years, 51.8% female, body mass index <30 kg/m2), wore a wrist actigraph for 7 days, completed a dual‐energy X‐ray absorptiometry scan, and underwent blood sampling to assess serum BTM concentrations of osteocalcin (OC) and N‐terminal telopeptide of type 1 collagen. A sub‐sample (n = 14) completed a one‐year follow‐up. Multiple regression models examined the associations between each sleep metric and bone health outcome at baseline and 1‐year follow‐up. At baseline, greater variability in sleep midpoint was cross‐sectionally associated with greater OC (β = 0.21, p = 0.042). In the exploratory, follow‐up sub‐sample, lower average TST (β = −0.66, p = 0.013) and SE (β = −0.68, p = 0.01) at baseline were associated with greater increases in OC at follow‐up. Greater delays in mean sleep midpoint over follow‐up were significantly associated with decreases in lumbar spine BMD (β = −0.49, p = 0.03). In a sample of young adults, variable sleep schedules were associated with greater bone turnover suggesting the potential importance of regular sleep for optimising bone health into early adulthood.
Three‐dimensional Mapping Analysis of Talus Fractures and Demonstration of Different Surgical Approaches for Talus Fractures
Authors: Wang Ruihan , You Guixuan , Yin Shiqin , Jiang Songtao , Wang Hai , Shi Houyin , Zhang Lei
Published: March 2024

Objective

The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three‐dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three‐dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures.

Methods

We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure.

Results

Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches.

Conclusion

Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.
Characterisation and validation of lactation information from structured electronic health records for use in pharmacoepidemiological studies
Authors: Mohamed Hibo H. , Ehresmann Kirsten , Seburg Elisabeth M. , Vazquez‐Benitez Gabriela , Demerath Ellen W. , Fields David A. , Vesco Kimberly K. , Kharbanda Elyse O. , Palmsten Kristin
Published: March 2024

Background

Breastfeeding information stored within electronic health records (EHR) has recently been used for pharmacoepidemiological research, however the data are primarily collected for clinical care.

Objectives

To characterise breastfeeding information recorded in structured fields in EHR during infant and postpartum health care visits, and to assess the validity of lactation status based on EHR data versus maternal report at research study visits.

Methods

We assessed breastfeeding information recorded in structured fields in EHR from one health system for a subset of 211 patients who were also enrolled in a study on breast milk composition between 2014 and 2017 that required participants to exclusively breastfeed their infants until at least 1 month of age. We assessed the frequency of breastfeeding information in EHR during the first 12 months of age and compared lactation status based on EHR with maternal report at 1 and 6‐month study visits (reference standard).

Results

The median number of breastfeeding records in the EHR per infant was six (interquartile range 3) with most observations clustering in the first few weeks of life and around well‐infant visits. At the 6‐month study visit, 93.8% of participants were breastfeeding and 80.1% were exclusively breastfeeding according to maternal report. Sensitivity of EHR data for identifying ever breastfeeding was at or near 100%, and sensitivity for identifying ever exclusive breastfeeding was 98.0% (95% CI: 95.0%, 99.2%). Sensitivities were 97.3% (95% CI: 93.9%, 98.9%) for identifying any breastfeeding and 94.4% (95% CI: 89.7%, 97.0%) for exclusive breastfeeding, and positive predictive values were 99.5% (95% CI: 97.0%, 99.9%) for any breastfeeding and 95.0% (95% CI: 90.4%, 97.4%) for exclusive breastfeeding.

Conclusions

Breastfeeding information in structured EHR fields have the potential to accurately classify lactation status. The validity of these data should be assessed in populations with a lower breastfeeding prevalence.
Rhizome fragment weight and density of competing shoots determine belowground regrowth of Elymus repens
Authors: Skorupinski Solèmne , Colbach Nathalie , Busset Hugues , Matejicek Annick , Moreau Delphine
Published: March 2024

Management of perennial weeds has become increasingly complex with the reduction of herbicide use and tillage. Their capacity to store nutrients into vegetative organs and to regenerate to establish new individuals makes them very persistent and hard to control. A key aspect for managing perennial weeds is to minimise storage reserves to reduce vegetative regeneration. For that prospect, better knowledge of the regrowth capacities from storage organs is needed. Our work focused on the mechanistic understanding of belowground regrowth dynamics from fragments of Elymus repens rhizomes by analysing the effect of source and sink factors. The effect of rhizome fragment weight (i.e., source) and the number of regrowing buds and belowground shoots (i.e., sinks) was assessed for four mechanisms: sprouting, belowground shoot elongation, belowground shoot biomass to length conversion and biomass allocation to belowground shoots versus roots. Heavier fragments contributed to faster sprouting, faster belowground shoot elongation and increased the proportion of remobilised biomass allocated to belowground shoots. Higher belowground shoot density increased the proportion of remobilised biomass allocated to belowground shoots but decreased individual elongation rate. In other words, larger reserves resulted in a better regeneration capacity and a higher number of growing belowground shoots increased the competition for reserves among them. The belowground shoot that sprouted first on a fragment grew faster and dominated the other shoots on the same fragment. Dominant belowground shoots were located toward the apical end of the fragment. These findings support the fact that tillage should aim at cutting storage organs into the smallest fragments possible to reduce regeneration capacity. This study also emphasised that belowground regrowth mechanisms are complex, and further studies should investigate other species with different types of storage organs.
High-performance of ZnO/TiO2 heterostructured thin-film photocatalyst fabricated via atomic layer deposition
Authors: Park Ji Young , Han Jeong Hwan , Choi Byung Joon
Published: March 2024

Oxide semiconductor is one of the most promising candidates for photocatalysts due to its light absorption ability, electronic properties, and stability. It is used in various applications such as solar-energy conversion, CO2 reduction, and water splitting. In this research, ZnO, TiO2, and ZnO/TiO2 heterostructured thin films are fabricated via atomic layer deposition (ALD), and their photocatalytic performances are evaluated. The film thickness can be controlled using ALD, and surface reactions can easily occur in thin films owing to the short distances between the active sites and charge carriers. In addition, unlike a powder catalyst, the bilayer photocatalyst is fixed in the solution; therefore, it does not make the solution turbid or disturb the light penetration. Diethylzinc and titanium tetraisopropoxide are used as precursors for Zn and Ti, and the thin films are deposited on soda-lime glass substrates at 150 °C using H2O as the reactant gas. The photocatalytic activity and stability are evaluated through photodegradation tests using methylene blue aqueous solution. The ZnO single-substance thin film exhibits a high degradation rate, but its performance significantly decreases after three consecutive experiments. The TiO2 single-substance thin film exhibits a relatively low degradation rate, but high reusability, exhibiting characteristics opposite to that of ZnO. Therefore, a TiO2 thin film is coated on ZnO to leverage both these advantages. The thin films are heat-treated at 400 °C for 10 min after deposition in a vacuum atmosphere. The surface morphology, crystal structure, and electrical characteristics of the photocatalyst specimens are analyzed through high-resolution scanning electron microscopy, Cs-corrected scanning transmission electron microscopy, and x-ray diffraction analysis. Their photocatalytic performances under ultraviolet (UV) irradiation are measured through UV–visible spectroscopy. The heat-treated ZnO/TiO2 heterostructured thin film exhibits a photodegradation rate exceeding 80%, with little degeneration after three cycles, indicating enhanced photodegradation performance and stability.
Effects of training length on adaptation to noise-vocoded speech
Authors: Drouin Julia R. , Flores Stephany
Published: March 2024

Listeners show rapid perceptual learning of acoustically degraded speech, though the amount of exposure required to maximize speech adaptation is unspecified. The current work used a single-session design to examine the length of auditory training on perceptual learning for normal hearing listeners exposed to eight-channel noise-vocoded speech. Participants completed short, medium, or long training using a two-alternative forced choice sentence identification task with feedback. To assess learning and generalization, a 40-trial pre-test and post-test transcription task was administered using trained and novel sentences. Training results showed all groups performed near ceiling with no reliable differences. For test data, we evaluated changes in transcription accuracy using separate linear mixed models for trained or novel sentences. In both models, we observed a significant improvement in transcription at post-test relative to pre-test. Critically, the three training groups did not differ in the magnitude of improvement following training. Subsequent Bayes factors analysis evaluating the test by group interaction provided strong evidence in support of the null hypothesis. For these stimuli and procedure, results suggest increased training does not necessarily maximize learning outcomes; both passive and trained experience likely supported adaptation. Findings may contribute to rehabilitation recommendations for listeners adapting to degraded speech signals.
Kidins220 and Aiolos promote thymic iNKT cell development by reducing TCR signals
Authors: Herr Laurenz A. , Fiala Gina J. , Sagar  , Schaffer Anna-Maria , Hummel Jonas F. , Zintchenko Marina , Raute Katrin , Velasco Cárdenas Rubí M.-H. , Heizmann Beate , Ebert Karolina , Fehrenbach Kerstin , Janowska Iga , Chan Susan , Tanriver Yakup , Minguet Susana , Schamel Wolfgang W.
Published: March 2024

Development of T cells is controlled by the signal strength of the TCR. The scaffold protein kinase D–interacting substrate of 220 kilodalton (Kidins220) binds to the TCR; however, its role in T cell development was unknown. Here, we show that T cell–specific Kidins220 knockout (T-KO) mice have strongly reduced invariant natural killer T (iNKT) cell numbers and modest decreases in conventional T cells. Enhanced apoptosis due to increased TCR signaling in T-KO iNKT thymocytes of developmental stages 2 and 3 shows that Kidins220 down-regulates TCR signaling at these stages. scRNA-seq  indicated that the transcription factor Aiolos is down-regulated in Kidins220-deficient iNKT cells. Analysis of an Aiolos KO demonstrated that Aiolos is a downstream effector of Kidins220 during iNKT cell development. In the periphery, T-KO iNKT cells show reduced TCR signaling upon stimulation with α-galactosylceramide, suggesting that Kidins220 promotes TCR signaling in peripheral iNKT cells. Thus, Kidins220 reduces or promotes signaling dependent on the iNKT cell developmental stage.
Matte surfaces with broadband transparency enabled by highly asymmetric diffusion of white light
Authors: Chu Hongchen , Xiong Xiang , Fang Nicholas X. , Wu Feng , Jia Runqi , Peng Ruwen , Wang Mu , Lai Yun
Published: March 2024

The long-standing paradox between matte appearance and transparency has deprived traditional matte materials of optical transparency. Here, we present a solution to this centuries-old optical conundrum by harnessing the potential of disordered optical metasurfaces. Through the construction of a random array of meta-atoms tailored in asymmetric backgrounds, we have created transparent matte surfaces that maintain clear transparency regardless of the strength of disordered light scattering or their matte appearances. This remarkable property originates in the achievement of highly asymmetric light diffusion, exhibiting substantial diffusion in reflection and negligible diffusion in transmission across the entire visible spectrum. By fabricating macroscopic samples of such metasurfaces through industrial lithography, we have experimentally demonstrated transparent windows camouflaged as traditional matte materials, as well as transparent displays with high clarity, full color, and one-way visibility. Our work introduces an unprecedented frontier of transparent matte materials in optics, offering unprecedented opportunities and applications.
Single-cell NAD(H) levels predict clonal lymphocyte expansion dynamics
Authors: Turner Lucien , Van Le Tran Ngoc , Cross Eric , Queriault Clemence , Knight Montana , Trihemasava Krittin , Davis James , Schaefer Patrick , Nguyen Janet , Xu Jimmy , Goldspiel Brian , Hall Elise , Rome Kelly , Scaglione Michael , Eggert Joel , Au-Yeung Byron , Wallace Douglas C. , Mesaros Clementina , Baur Joseph A. , Bailis Will
Published: March 2024

Adaptive immunity requires the expansion of high-affinity lymphocytes from a heterogeneous pool. Whereas current models explain this through signal transduction, we hypothesized that antigen affinity tunes discrete metabolic pathways to license clonal lymphocyte dynamics. Here, we identify nicotinamide adenine dinucleotide (NAD) biosynthesis as a biochemical hub for the T cell receptor affinity–dependent metabolome. Through this central anabolic role, we found that NAD biosynthesis governs a quiescence exit checkpoint, thereby pacing proliferation. Normalizing cellular NAD(H) likewise normalizes proliferation across affinities, and enhancing NAD biosynthesis permits the expansion of lower affinity clones. Furthermore, single-cell differences in NAD(H) could predict division potential for both T and B cells, before the first division, unmixing proliferative heterogeneity. We believe that this supports a broader paradigm in which complex signaling networks converge on metabolic pathways to control single-cell behavior.
Promising aryl selenoate derivatives as antileishmanial agents and their effects on gene expression
Authors: Fernández-Rubio Celia , Rubio-Hernández Mercedes , Alcolea Verónica , Burguete-Mikeo Aroia , Nguewa Paul A. , Pérez-Silanes Silvia
Published: March 2024

Leishmaniasis remains one of the main public health problems worldwide, with special incidence in the poorest populations. Selenium and its derivatives can be potent therapeutic options against protozoan parasites. In this work, 17 aryl selenoates were synthesized and screened against three species of
Leishmania
(
Leishmania major
,
Leishmania amazonensis
, and
Leishmania infantum
). Initial screening in promastigotes showed
L. infantum
species was more sensitive to selenoderivatives than the others. The lead Se-(2-selenocyanatoethyl) thiophene-2-carboselenoate (
16
) showed a half-maximal effective concentration of 3.07 µM and a selectivity index > 32.57 against
L. infantum
promastigotes. It was also the most effective of all 17 compounds, decreasing the infection ratio by 90% in
L. infantum
-infected macrophages with amastigotes at 10 µM. This aryl selenoate did not produce a hemolytic effect on human red blood cells at the studied doses (10–100 µM). Furthermore, the gene expression of infected murine macrophages related to cell death, the cell cycle, and the selenoprotein synthesis pathway in amastigotes was altered, while no changes were observed in their murine homologs, supporting the specificity of Compound
16
against the parasite. Therefore, this work reveals the possible benefits of selenoate derivatives for the treatment of leishmaniasis.
Combining CRISPR/Cas9 and natural excision for the precise and complete removal of mobile genetic elements in bacteria
Authors: Wang Pengxia , Du Xiaofei , Zhao Yi , Wang Weiquan , Cai Tongxuan , Tang Kaihao , Wang Xiaoxue
Published: March 2024

Horizontal gene transfer, facilitated by mobile genetic elements (MGEs), is an adaptive evolutionary process that contributes to the evolution of bacterial populations and infectious diseases. A variety of MGEs not only can integrate into the bacterial genome but also can survive or even replicate like plasmids in the cytoplasm, thus requiring precise and complete removal for studying their strategies in benefiting host cells. Existing methods for MGE removal, such as homologous recombination-based deletion and excisionase-based methods, have limitations in effectively eliminating certain MGEs. To overcome these limitations, we developed the Cas9-NE method, which combines the CRISPR/
Cas9
system with the
n
atural
e
xcision of MGEs. In this approach, a specialized single guide RNA (sgRNA) element is designed with a 20-nucleotide region that pairs with the MGE sequence. This sgRNA is expressed from a plasmid that also carries the Cas9 gene. By utilizing the Cas9-NE method, both the integrative and circular forms of MGEs can be precisely and completely eliminated through Cas9 cleavage, generating MGE-removed cells. We have successfully applied the Cas9-NE method to remove four representative MGEs, including plasmids, prophages, and genomic islands, from
Vibrio
strains. This new approach not only enables various investigations on MGEs but also has significant implications for the rapid generation of strains for commercial purposes.

IMPORTANCE

Mobile genetic elements (MGEs) are of utmost importance for bacterial adaptation and pathogenicity, existing in various forms and multiple copies within bacterial cells. Integrated MGEs play dual roles in bacterial hosts, enhancing the fitness of the host by delivering cargo genes and potentially modifying the bacterial genome through the integration/excision process. This process can lead to alterations in promoters or coding sequences or even gene disruptions at integration sites, influencing the physiological functions of host bacteria. Here, we developed a new approach called Cas9-NE, allowing them to maintain the natural sequence changes associated with MGE excision. Cas9-NE allows the one-step removal of integrated and circular MGEs, addressing the challenge of eliminating various MGE forms efficiently. This approach simplifies MGE elimination in bacteria, expediting research on MGEs.
Subcutaneous pythiosis in human treated successfully with antimicrobial treatment, debridement and immunotherapy
Authors: Roy Moni , Borden Joel , Kasper Douglas J
Published: March 2024

Pythiosis is caused due to a filamentous eukaryotic micro-organism calledPythium insidiosumand the disease occurs commonly in horses and cattle. Subcutaneous pythiosis infection in humans is rare with no clear clinical guidelines for treatment. We present a case of a man in his 20s with non-resolving ulcers noted over lower extremity after exposure to swamp water draining animal remains. The patient received several courses of oral antibiotics with no improvement in symptoms before getting admitted to our institution. A diagnosis of subcutaneous pythiosis was made after deep wound culture following debridement detectedP. insidiosumby use of PCR. Due to the rare incidence of such infection in humans and no clear guidelines available for treatment, the case was discussed with infectious disease specialists outside our institution and with veterinary physicians. An emergent approval for use of immunotherapy in conjunction with surgical debridement and antimicrobials was obtained from Food and Drug administration. The patient underwent successful treatment of infection and skin graft following treatment.