bluuebunny/crossref_metadata_2025 huggingface dataset:
Load-Aware and Priority Adaptive Traffic Congestion Control Method in Vehicular Ad Hoc Network
Authors: Tadesse Ermias , Demliw Samuel , Zinabie Ayene , Geto Alemu , Endris Nuru
Published: December 2024

Vehicular ad hoc networks (VANET) are a subset of mobile ad hoc networks communicating between vehicles and infrastructure. During vehicular congestion communication, nodes compete to acquire channels, causing the channels to become congested. The congestion on the vehicle network results in increased delay and packet loss, resulting in reduced VANET performance. To address this problem, we developed a load-aware and priority adaptive traffic congestion control method in vehicular ad hoc networks (VANETs). The proposed scheme identifies less-congested road segments based on the network's load and reduces traffic congestion by suggesting other routes between nearby roadside units (RSUs). This research aims to improve the efficiency of the vehicular environment by utilizing the movement of vehicles with (RSUs) and sharing the traffic load between them. Simulation results demonstrate the effectiveness of the proposed protocol in reducing congestion and enhancing the overall performance of VANETs. To validate the proposed algorithm, we have implemented and tested the proposed algorithm using Network Simulator 3 (NS3) for Vehicle-to-Vehicle (V2V) and Vehicle-to-Infrastructure (V2I) communication scenarios and computed the performance of the algorithm on different parameters of the network. The simulation result of the proposed load aware and priority adaptive traffic congestion control method in VANET improved the packet delivery ratio, packet lost ratio, and end-to-end delay by 96%, 4.1%, and 1102 milliseconds, when compared to TDCCA value of 92%, 5.7%, and 1154 milliseconds, respectively.
Dietary Quality and Its Impact on Maternal Nutritional Status in Ondo State, Nigeria
Authors: Oyeyemi Adedayo , Olanrele Dada , Kayode Ajayi
Published: December 2024

Background: Malnutrition is one of the major problems that have bewildered human health in developing countries Objective: The study aimed to assess maternal diet quality and nutritional status of in Ondo state. Methods: This was a community based descriptive and cross-sectional study that consisted of 420 respondents (mothers). Respondents were drawn using multistage sampling procedure. Pre-test, semi-structured Interviewer administered questionnaire was used to elicit information from the respondents while anthropometric indices such as height, weight, waist circumference, hip circumference were measurement and Waist hip ratio, mid upper arm circumference were computed according to standard. Body Mass Index (BMI) was calculated from weight and height measurements and classified into underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9) and obesity (≥30.0). Data were analysed using descriptive and inferential statistics while level of significant was set P (<0.05). Results: The nutritional status of the women shows that there was a double burden of malnutrition indicating 10.7% under nutrition, 29.0% overweight and 4.8% obese. BMI was significantly associated with mothers’ age (p= 0.000), place of residence (p= 0.009), marital status (p= 0.017), mothers’ occupation (p= 0.026), occupation of spouse (p= 0.009), and monthly income (p = 0.008). Conclusion: There were existence of a double burden of malnutrition and high prevalence of overweight and obesity in the study area. Household food insecurity contributed greatly to the malnutrition observed in many mothers in the study. Nutrition and health promotion education intervention is recommended in the study area.
Cervical Inspection With AAVI and Cryotherapy on HPV-Diagnosed Women in Windhoek, Namibia
Authors: Mbadhi Aune , Aboua Yapo Guill , Akai Larai Aku , Omoruyi Beauty Etinosa , Okeleye Benjamin Ifeoluwa , Okudoh Vincent Ifeanyi
Published: December 2024

In 2018, the Ministry of Health and Social Services (MoHSS) introduced acetic acid visual inspection (AAVI) screening program and treatment of cervical precancers with cryotherapy in replacement of Pap smear intervention in Namibia. The study examines the effective use of AAVI-and-cryotherapy treatment on HPV-diagnosed women. Female patients of the reproductive age (20-49 years) group visiting 2 Namibian healthcare facilities for AAVI and cryotherapy treatment were investigated using a cross-sectional approach. The SPSS and coding themes were used to analyze data received through questionnaires and face-to-face interviews from a total of 265 participants. Written informed consent was obtained from participants for treatment and for publication. Among the women that participated in the study, 151 (62%) tested HPV positive, of which 132 (53%) were referred for cryotherapy and 19 (8%) for colposcopy treatments due to Cervical Intraepithelial Neoplasia (CIN I-III) detected. Regardless of the age groups, there was significant evidence of an association between para gravida and HPV positive (χ2(6) = 24.518; P < .001) and HPV negative (χ2(18) = 137.098; P < .001). About 80% of all participants experienced unpleasant pelvic sensations during the examination, with slight abdominal pain during and after the procedure. Ten percent experienced brownish discharges from their pelvis, of which was treated during the cryotherapy treatment. These findings suggest that MoHSS should actively re-evaluate the existing policies to promote AAVI and cryotherapy treatment.
Legacies of Hate: The Psychological Legacy of the Ku Klux Klan
Authors: Primbs Maximilian A. , Wienk Margaux N. A. , Holland Rob W. , Calanchini Jimmy , Bijlstra Gijsbert
Published: December 2024

The second coming of the Ku Klux Klan popularized the Klan and its ideas in the early 1920s, terrorizing Black American, their allies, and others deemed un-American. This article investigates the extent to which the cultural legacy of racial hatred of the Klan has persisted over the years. We use data from large online databases, multiverse analyses, and spatial models to evaluate whether regions with more historical Klan activity show higher levels of modern-day racial bias, and more modern-day White Supremacist activity. We find that regions with more Ku Klux Klan activity in the 1920s show higher levels of modern White Supremacist activity but, unexpectedly, lower levels of modern implicit and explicit racial bias. We discuss the implications of these findings for models linking historical events with present-day attitudes and behavior, and for situational models of bias more broadly.
Review of the literature on the use of contrast-enhanced ultrasound (CEUS) in vascular malformations.
Authors: Achiti A. , Seinturier C. , Blaise S.
Published: December 2024

Introduction

Vascular malformations (VascM) are difficult to diagnose and manage because of their heterogeneous presentations. Ultrasound represents the first imaging exam for patients with vascular malformations. In some cases, additional and sometimes functional imaging will be necessary to confirm the diagnosis or to highlight a vascular network of drainage. Doppler ultrasound could be not enough and a certain number of complementary examinations are then required. Contrast-enhanced ultrasound (CEUS) is used in current practice in the vascular field and in particular the monitoring of aortic stents.

Method

We present here the interest of using CEUS in VascM through a review of the literature. The search was carried out from Pubmed from 1975 to 2023 using the following keywords « vascular malformation » and « contrast enhanced ultrasound » / « venous malformation” and “contrast enhanced ultrasound”/ “venous malformation and contrast enhanced ultrasound”.

Results

The first search found 887 articles. Among them, 124 articles were retained after the selection of the formats. After reading the abstracts, only 9 articles were retained due to the non-selection of articles dealing with other explorations or irrelevance, as they did not deal with vascular malformation. At the end, 17 articles were selected.

Discussion and conclusion

CEUS allows very usefull dynamic analysis of the perfusion in the diagnosis of VascM . CEUS with time analysis is a promising imaging method for the evaluation of perfusion before and after percutaneous treatment of vascular malformations. Area under the curve reduction indicates therapy-induced changes in perfusion. Nevertheless, CEUS is not yet a standardized test for diagnosing or characterizing peripheral vascular malformations. However, its safety allows it to be used for the diagnosis and even the follow up of the VascM. Unfortunately, we haven’t been able to find any randomized studies comparing CESU with other techniques.
Metformin efficacy and safety as an adjunctive treatment for irritability in children with autism spectrum disorder: A randomized, double-blind, placebo-controlled trial
Authors: Bazrafshan Zahra , Mohammadi Parsa , Hasanzadeh Alireza , Sanjari Moghaddam Mohammad , Kabiri Maryam , Sanjari Moghaddam Hossein , Abdolghaffari Amir Hossein , Mohammadi Mohammad-Reza , Akhondzadeh Shahin
Published: December 2024

Background:

Antidiabetic medications have shown efficacy in alleviating autism symptoms. However, there is a lack of clinical research on the impact of metformin on irritability associated with autism. This study aimed to assess the efficacy and safety of metformin as an adjuvant therapy with risperidone for managing irritability in children diagnosed with Autism Spectrum Disorder (ASD).

Methods:

This is a randomized, 10-week, double-blind, placebo-controlled trial conducted at the children’s autism clinic of Roozbeh Hospital (Tehran, Iran) from March 2024 to May 2024. Participants were divided into two groups of risperidone plus metformin (500 mg per day) and risperidone plus placebo and were assessed at baseline, weeks 5 and 10 with the aberrant behavior checklist-community scale (ABC-C).

Results:

A total of 55 patients were included in the final analysis. Irritability (primary outcome measure) sharply decreased in the metformin compared to the placebo group ( p = 0.008). Among the other four subscales of ABC-C, the hyperactivity/noncompliance score showed a significant drop during the baseline-to-week-5 period ( p = 0.021). In addition, inappropriate speech subscales decreased significantly from baseline-to-week 5 in the metformin compared to the placebo group ( p = 0.045). No other significant finding was observed among ABC-C scores for lethargy/social withdrawal or stereotypic behavior subscales.

Conclusion:

Metformin demonstrated promising results in reducing irritability in ASD patients, which is in concordance with previous studies. However, further studies are required before any broad clinical recommendation.
Non-Euclidean motion planning with graphs of geodesically convex sets
Authors: Cohn Thomas , Petersen Mark , Simchowitz Max , Tedrake Russ
Published: December 2024

Computing optimal, collision-free trajectories for high-dimensional systems is a challenging and important problem. Sampling-based planners struggle with the dimensionality, whereas trajectory optimizers may get stuck in local minima due to inherent nonconvexities in the optimization landscape. The use of mixed-integer programming to encapsulate these nonconvexities and find globally optimal trajectories has recently shown great promise, thanks in part to tight convex relaxations and efficient approximation strategies that greatly reduce runtimes. These approaches were previously limited to Euclidean configuration spaces, precluding their use with mobile bases or continuous revolute joints. In this paper, we handle such scenarios by modeling configuration spaces as Riemannian manifolds, and we describe a reduction procedure for the zero-curvature case to a mixed-integer convex optimization problem. We further present a method for obtaining approximate solutions via piecewise-linear approximations that is applicable to manifolds of arbitrary curvature. We demonstrate our results on various robot platforms, including producing efficient collision-free trajectories for a PR2 bimanual mobile manipulator.
Transportation Tunnel Fire Sprinklers and Opportunities
Authors: English Gary
Published: December 2024

Fire sprinklers are widely accepted as a fundamental building safety feature. Yet, in transportation tunnels where fires grow faster and hotter and exits are farther away, fire sprinklers were prohibited until recently and are still not required in underground rail public assembly areas. Fires in transportation tunnels have resulted in deaths, severe damage to tunnel structures and systems, and costly closures, all of which are preventable with fire sprinklers. The inability to suppress a fire unnecessarily exposes hazardous materials in road tunnels to potentially extreme heat and failing containment, and it sometimes allows hazardous materials to react to heat with extreme consequences. This results in the preventative rerouting of hazardous materials around tunnels at considerable expense to shipping. But we know that fire sprinklers are routinely used to protect hazardous materials manufacturing, processing, storage, and handling outside tunnels. This practice is used in four US road tunnels, which routinely allow unrestricted hazardous materials specifically because of the presence of fire sprinkler systems. Adding fire sprinklers to existing road tunnels could prevent tunnel fires from growing beyond the capability of the undersized ventilation systems which exist in many tunnels. Adding sprinklers could be less expensive than difficult ventilation upgrades. Including sprinklers in new tunnels can limit the fire growth rate and maximum heat release rate and thus reduce the ventilation size as well as passive fire system costs. If life safety is a primary consideration, fire sprinklers should be a cornerstone to improving public safety in transportation tunnels, as they protect occupants from fire as well as allow the safe passage of hazardous materials.
Evaluating Human-Robot Interactions to Support Healthy Aging-in-Place
Authors: Sirizi Delaram , Sabet Morteza , Yahyaeian Amir Abbas , Bacsu Juanita-Dawne R. , Smith Matthew Lee , Rahemi Zahra
Published: December 2024

Declines in older adults’ cognitive and physical health pose challenges to maintaining their independence. Robots can improve independent living and facilitate aging-in-place. Despite recent innovations in healthcare robotics, the use of robots has not advanced significantly among older adults. This review seeks to understand human-robot interactions in older adults, focusing on their experiences and perceptions of robots for independent living. We identified 17 studies that utilized qualitative methods to investigate older adults and/or their caregivers’ experiences and perceptions of robots designed to help older adults improve independent living. Drawing on content analysis, we identified eight themes: usefulness, ease of use, safety, reliability, self-efficacy, satisfaction, emotional connection with the robot and reciprocity, and intention to use. The findings provide insights to improve existing robots and guide future research about designing robots with higher acceptance. This review may have implications for policymakers, practitioners, and researchers working with robotics to support healthy aging-in-place.
Managing the e-waste crisis in Africa: A mini-review of policies, practices, technologies and business model innovations
Authors: Lema Meserecordias Wilfred
Published: December 2024

This article aims to undertake a mini-review of the current state of electronic waste (e-waste) challenges on the African continent through a systematic analysis of existing national policies and legal frameworks, inventorying established management practices, and identification of innovative technological solutions. A literature review was conducted synthesizing evidence from over 80 peer-reviewed publications between 2010 and 2022. Content analysis of e-waste laws from 20 African countries supplemented the review of documented collection, recycling and export-related activities across the region alongside associated obstacles. Key findings indicate that while several African countries have enacted initial e-waste regulations, significant gaps persist around implementation and enforcement capabilities. Formal recycling remains minimal due to underdeveloped infrastructure, and the majority of e-scrap continues to be crudely processed informally resulting to health and environmental risks. Monitoring of transboundary trade and treatment standards also requires strengthening to curb the flow of undocumented shipments. Several technological start-ups and social enterprises are piloting novel approaches but require further testing and scale-up support. Based on these insights, the study recommends a harmonized policy framework and monitoring systems established through regional coordination. Recommendations also propose strategies to incentivize reducing consumption and promote eco-industrial parks for integrated recycling.
The sins of the parents: Conceptualizing adult-oriented reforms to family benefits
Authors: Stewart Kitty , Patrick Ruth , Reeves Aaron
Published: December 2024

Financial transfers to families with children form a core element of welfare state provision. Variation in the design, generosity and implementation of this provision is significant, reflecting underlying perspectives towards children and families and the state’s role in supporting them. Daly developed a new typology of social policy for children, differentiating between ‘childhood-oriented’, ‘child-oriented’ and ‘family-oriented’ policies. In this article, we propose an extension to this typology with financial transfers in mind. We divide the family-oriented category into two distinct types of policy – ‘needs-oriented’ and ‘adult-behaviour-oriented’, with the latter encapsulating support that is child-contingent but conditional on the behaviour of adults in the household. We argue that this new distinction is needed to make sense of recent significant changes to social security support for children in the UK, in particular the two-child limit and the benefit cap. We go on to analyse child benefits across Europe through the lens of this extended framework. Significantly, we find the UK’s approach to be unusual but not exceptional, with other examples of children being rendered invisible or semi-visible within social security systems. Across diverse national contexts, support for children is being withdrawn (or is simply absent) because of the behaviours and circumstances of the adults in their household.
The effect of wearing a weight belt on one-repetition maximum for the parallel back squat and its relation to performance measures
Authors: Enoki Shota , Shiba Junpei , Hakozaki Taisei , Kuzuhara Kenji
Published: December 2024

Background

The use of a weight belt reportedly increases intra-abdominal pressure (IAP), which, in turn, increases the one repetition maximum (RM) of squatting. However, the effect of a weight belt on 1RM of squatting, and the correlation between 1RM with and without a weight belt and athletic performance is unclear.

Objective

This study aimed to determine the effect of using a weight belt on the 1RM for parallel back squats (BSQs), and to examine the relationship between 1RM and 1RM/body weight (BW) with and without a weight belt and performance measures.

Methods

This cross-sectional study included 26 male college athletes. The 1RM for BSQs with and without a weight belt, and its correlations with performance tests, such as the 30-m sprint, 505 agility test, and vertical jump (VJ), were assessed. The 1RM for parallel BSQs was measured by a certified strength and conditioning specialist.

Results

The 1RM for BSQs with the weight belt (116.35 ± 18.03 kg) was significantly higher than without the weight belt (113.56 ± 17.48 kg, mean difference = 2.79 ± 6.13 kg [95%CI, 0.314–5.266], p = 0.029). A significant correlation was only found between the 1RM/BW for BSQs without a weight belt and VJ height ( p = 0.045, r = 0.396 [95%CI, 0.010–0.697]).

Conclusions

Use of a weight belt improves the 1RM of the parallel BSQ, although the relationship between 1RM/BW of parallel squats and other performance metrics might be slightly masked when a belt is used during measurement of squat strength.
The Effect of Physical Activity on Premenstrual Syndrome: A Systematic Review
Authors: Ayyub Sayma , Agrawal Manju , Sharma Vibha , Aravind Arya
Published: December 2024

Background

Physical, emotional, and behavioural symptoms that can significantly impact daily life are the hallmarks of premenstrual syndrome (PMS), a common illness affecting women of reproductive age. There are many different ways to manage PMS, and there is mounting evidence that physical activity may be helpful in reducing symptoms. With an emphasis on different exercise modalities such as weight training, yoga, and aerobic activity, this systematic review attempts to investigate how physical activity affects the management of PMS symptoms.

A systematic review of studies published between 2009 and 2023 was conducted, adhering to PRISMA guidelines. Articles from PubMed, Embase, and the Cochrane Library were evaluated based on inclusion criteria focusing on the effects of physical activity on PMS symptoms. The findings indicate that regular participation in exercises such as weight training, yoga, and aerobic activities significantly reduces fatigue, improves mood regulation, and alleviates physical discomfort associated with PMS. These results highlight the benefits of exercise as an effective, non-pharmacological intervention for managing PMS symptoms.

Key Messages

Incorporating regular physical activity into daily routines can serve as a practical and sustainable approach to managing PMS symptoms. Women suffering from PMS can experience improved physical and psychological well-being through diverse forms of exercise, including yoga and aerobic workouts. This underscores the role of exercise as a holistic and accessible intervention for enhancing women’s health.
Building relationships for shared cases between state and tribal vocational rehabilitation programs
Authors: Boland Elizabeth A , Dagel Wayne W , Emanuel Jamie M , Roberts Kelly D , Beam Kyle W
Published: December 2024

Background

Since their inception, State Vocational Rehabilitation (SVR) and American Indian Vocational Rehabilitation Services (AIVRS) have played pivotal roles in assisting millions of individuals with disabilities in securing and sustaining competitive integrated employment.

Objective

This article aims to inform readers about the historical context and key issues concerning AIVRS while proposing strategies for enhanced collaboration between AIVRS and SVR programs in joint service provision.

Methods

While published research on providing VR services to American Indians or Alaska Natives (AI/AN) is limited, much of the information in this article is based on the extensive knowledge of the authors, who collectively possess decades of experience in SVR and AIVRS.

Results

Key topics include (a) challenges encountered by the AI/AN population; (b) prevailing attitudes toward disability and employment within AI/AN communities; (c) a comparative overview of the histories and operations of SVR and AIVRS; (d) supporters of and advocates for AIVRS projects; (e) considerations when sharing cases; and (f) recommendations for fostering cooperative practices that benefit AI/AN communities.

Conclusion

By integrating culturally appropriate services, including holistic traditional healing, AIVRS projects and SVR agencies can offer complementary support while honoring the cultural heritage of AI/AN clients.
Constructing responsibility: Infrastructural harm, citizen oversight and the politics of publics
Authors: Rumé Sam
Published: December 2024

While concepts such as infrastructure and assemblage can make it difficult for scholars to locate responsibility for social injustices, given the diffused nature of action and harm, this article starts from the continuous, competing and negotiated constructions of responsibility that can be explored ethnographically. The argument is based on fieldwork in Cuenca, Ecuador, where the flawed construction of a tram threatened local businesses and led to citizens’ organized attempt to attribute responsibility and be compensated. In the face of an apparently irresponsible state, these citizens thus tried to reconstruct responsibility through what I describe as the weaving of causal chains and the search for alliances of (self)responsibilization. In this analytic, the construction of responsibility proves a key component of how worlds are inhabited and made and, more specifically, how the state, the public good and citizens are configured.
Comparison of meshing characteristics and dynamic behavior of hypoid gear drive under different load conditions
Authors: Wang Xiaole , Yang Yang , Lu Jianwei , Gu Xianguang , Qiu Shaowu , Liu Jianxue , Zhang Zhining , Dai Baobao
Published: December 2024

The study of loaded meshing characteristics and dynamic behavior is significant for evaluating the stability of hypoid gear under actual working conditions. Loaded tooth contact analysis (LTCA) of a hypoid gear drive under different loads is carried out. The equivalent meshing force, loaded transmission error (LTE), comprehensive elastic deformation, and time-varying meshing stiffness (TVMS) are investigated. Results show that the LTE and TVMS are sensitive to load, and the LTE and TVMS curves show obvious asymmetric as the load increases. Under low load conditions, the actual contact ratio increases significantly with the increase of load, but tends to be flat when the load reaches a certain range. The obtained TVMS and LTE are fitted by higher Fourier series and introduced into an 8-DOF dynamic model. By comparing the time history diagram, phase diagram, Poincaré section, and spectrum, the dynamic characteristics of the system under different loads are contrasted. On low load condition, the system may exhibit chaotic motion in certain meshing frequency bands and damping ratio intervals. While the tooth backlash increases to a critical value, the system may change to chaotic motion from periodic motion. The results provided a basis for improving the meshing performance of hypoid gear.
Factors affecting breastfeeding self-efficacy among mothers with preterm infants
Authors: Nayebinia Anvar-Sadat , Faroughi Farnaz , Asadi GholamReza , Fathnezhad-Kazemi Azita
Published: December 2024

Background:

Although challenges in breastfeeding are more common in mothers of preterm infants, maternal breastfeeding self-efficacy is a modifiable factor that may improve breastfeeding rates.

Objective:

To evaluate the factors affecting breastfeeding self-efficacy among mothers with preterm babies.

Design:

A cross-sectional study.

Methods:

This study was carried out using a double-stage cluster sampling method. In total, 360 mothers of preterm infants under 6 months of age were included. Data were collected using sociodemographic characteristics, Breastfeeding Self-efficacy Scale-Short Form (BSES-SF), multiple scales of perceived social support, and Depression, Anxiety, and Stress questionnaires.

Results:

The results showed social support (15.6%), depression (12.2%), anxiety (11%), and stress (12.2%) contributed independently, and together they explained 25% of the variance in BSES-SF. The higher levels of social support (β = 0.283), lower levels of mental health problems (β = −0.340), having breastfeeding experience (β = −0.253), and higher gestational age at birth (β = 0.106) were significantly related to the high level of BSES-SF.

Conclusion:

These findings can help healthcare providers be aware of effective factors in improving breastfeeding self-efficacy. Increased access to counselors, active support for mothers after preterm labor, and increased support facilities for mothers with preterm delivery may be helpful to improve breastfeeding self-efficacy.
Brain invasion by an otherwise benign meningioma in a cat
Authors: Arai Kiyotaka , Nakamura Shinichi , Matsubara Kanami , Ozaki Yuma , Kadekaru Sho , Sugiyama Akihiko , Mitsui Ikki , Akashi Natsuki , Yoshitake Ryohei , Kutara Kenji
Published: December 2024

Case summary

A 13-year-old castrated male American Shorthair cat was referred for evaluation following a 3-week history of poor balance and decreased activity. The MRI findings revealed a well-defined left caudal cerebellar mass with a diameter of 1.2 cm, consistent with a meningioma. CT and MRI scans did not reveal metastasis. After a suboccipital craniotomy, the mass was resected subtotally as a result of parenchymal invasion. A histopathological examination revealed a benign fibrous meningioma with invasion into the cerebellum at the tumour margins. Postoperatively, the cat remained asymptomatic for 25 months, but ataxia recurred, and tumour recurrence was confirmed using MRI and post-mortem examination.

Relevance and novel information

This case demonstrates that even feline meningiomas with benign features can exhibit brain invasion. Since brain invasion is an indicator of malignancy in meningioma, a detailed histopathological evaluation of the tumour margins is essential for accurate grading and prognosis.
Endovascular stent graft treatment for stenosis in isolated infrarenal abdominal aortic dissection: A case report
Authors: Ohta Kengo , Arahata Risa , Horiba Junji , Kaneko Hitomi , Kondo Kurando
Published: December 2024

We report a case of complicated isolated infrarenal abdominal aortic dissection (IAAD) that was treated with stent graft. A 79-year-old man presented with acute bilateral lower limb pain. A contrast-enhanced CT performed 2 h later revealed sever stenosis of infrarenal abdominal aorta due to IAAD. Angiography identified a primary tear just below the upper end of the IAAD. A smaller stent graft was placed distally to avoid stent graft–induced new entry, and a large stent graft was placed proximally to cover the primary entry. The stenosis improved immediately after the procedure, and pain relief was achieved. Stent graft placement for entry closure appeared to be an effective for IAAD.
Patient Preferences for Addressing Unhealthy Behaviors, Mental Health Challenges, and Social Needs in Primary Care
Authors: Gilbert Jennifer L. , Brooks Edward Marshall , Funk Adam , Webel Benjamin , Britz Jacqueline , Kelly Cameron , Wilson Jacqueline , Lee Jong Hyung , Sabo Roy T. , Huebschmann Amy , Glasglow Russell E. , Krist Alex H.
Published: December 2024

Objectives:

Guidelines recommend addressing health behaviors, mental health, and social needs in primary care. However, it is unclear how often patients want support to address these risks. As part of a randomized trial comparing enhanced care planning versus usual care, we evaluated what risks patients wanted to address.

Methods:

All patients with multiple chronic conditions, 1 or more of which was uncontrolled, from 81 clinicians in 30 primary care practices. Using My Own Health Report (MOHR), patients identified and prioritized their health risks to create a care plan.

Results:

All patients had at least 1 unhealthy behavior (100%) and most had a mental health risk (66.8%) and a social need (51.3%). Participants more often chose to create care plans addressing unhealthy behaviors (92.5%) rather than mental health (23.2%), or social needs (12.5%). The most frequently created care plans were for exercise (65.1%), weight loss (37.2%), and nutrition (36.2%).

Conclusion:

All patients had 1 or more unhealthy behaviors, mental health risks, or social needs, and were more likely to address health behaviors. We need to better understand these patient choices, and change the culture to normalize the integration of mental health and social care into primary care.
Working Memory Load, Automaticity, and Problem Solving in College Engineering Students: Two Applications
Authors: Ding Yi , Wang Qian , Liu Ru-De , Trimm Jolene , Wang Jiayi , Feng Shu , Hong Wei , Yang Xian-Tong
Published: December 2024

The paper examined the relations among problem solving, automaticity, and working memory load (WML) by changing the difficulty level of task characteristics through two applications. In Study 1, involving 68 engineering students, a 2 (automaticity) × 2 (WML) design was utilized for arithmetic problems. In Study 2, involving 76 engineering students, a 2 (automaticity) × 2 (WML) design was used for linear algebra tasks. In both studies, there were statistically significant main effects and interaction effects of automaticity and WML on the variable of response time, concurring with the cognitive load theory. The simple effect of WML rendered a larger effect size under the conditions with low automaticity. When the testing condition was easy but contained more steps, the students were more accurate, and response times were faster. When the testing condition was difficult but contained fewer steps, the students were less accurate, and response times were slower. The findings underscore the important role of automaticity in helping engineering students bypass the limits of working memory.
FinTech Monopoly and Systemic Risk: Evidence From China
Authors: Wang Rui , He Zhihao , Yang Shunjing
Published: December 2024

With the rapid development of FinTech, it is of great significance to gain comprehensive insights into its potential risks. This paper focuses on the financial risks brought by the FinTech monopoly. We take the listed FinTech companies in China as samples to build the FinTech monopoly index and the systematic risk indicator, and the effect of the monopoly of Fintech companies on systematic risk is next analyzed using the fixed effect model. The results indicate that the FinTech monopoly will aggravate the systemic risk. Subsequently, the heterogeneous factors for the above nexus are investigated based on the micro characteristics of FinTech companies and the macro environment. On this basis, the mechanism of the above effect is also analyzed, and it is shown that the FinTech monopoly impacts systemic risk mainly via inducing excessive consumption, increasing banks’ credit risk, and inhibiting the development of FinTech.
Climbing the Ladder: An Authentic Leadership Program Boosting Adolescent Girls’ Potential.
Authors: Molina-López Manuel M. , González-Pérez Susana , García-Centeno M. Carmen , Martínez-Martínez Miryam
Published: December 2024

This study explores the realm of authentic leadership theory to examine how female teenagers can enhance relational authenticity and develop authentic leadership skills through a specialized program. Employing multigroup Structural Equation Modeling (SEM), we assess the impact of this leadership intervention on female teenagers, comparing pre- and post-intervention results. Additionally, we contrasted the outcomes of program participants with those of same-aged, non-participating students from similar backgrounds. The analysis revealed a significant increase in the scores for the four constructs of authentic leadership among the program’s participants. Notably, their academic grades also improved post-intervention. Focusing on high school females aged 16 years and above, the study addresses a critical age for developing self-perception of competence and confidence. The persistent underrepresentation of females in leadership roles underscores the necessity for early interventions like this one. These findings contribute to a deeper understanding of how a leadership program can positively influence the development of authentic leadership skills among participants, while also observing enhancements in academic achievement following this particular intervention
Pediatric Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report
Authors: Zheng Jasper X , Betts Elham Vali , Dwyre Denis M , Chung Jong H , Mitra Ananya Datta
Published: December 2024

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive neoplastic process of precursor plasmacytoid dendritic cells. The diagnostic evaluation of this heterogenous entity is challenging, requiring a comprehensive approach of incorporating clinical, morphologic, immunohistochemical, and molecular/cytogenetic evaluations. Optimal management of BPDCN remains controversial, and clinical outcomes continues to be poor. Pediatric cases of BPDCN are rare and to our knowledge, this is the second case of BPDCN described in a Hispanic child, first one was described outside the US in Peru. Here, we report a case of a juvenile patient of Hispanic origin presenting with cutaneous and bone marrow involvement and initially misdiagnosed as a cutaneous infection that resulted in subsequent delaying of necessary chemotherapy for 2 months. Biopsy of the lesion showed diffuse infiltration of immature cells involving the dermis with classical sparring of epidermis. A huge panel of immunohistochemical stains were performed to reach the diagnosis of BPDCN. Staging bone marrow biopsy also revealed involvement by BPDCN. Treatment was not only delayed in this patient but also due to the rarity of BPDCN in pediatric population, the subsequent therapeutic decisions were challenging for the primary oncology team as it was based solely on published literature on adult population. Our case report will not only add one more case in the pediatric age group, but also will also emphasize that although BPDCN has a grave prognosis in the elderly, timely diagnosis with prompt treatment is the key to complete remission in pediatric BPDCN population.
Redesigning paramedicine systems in Canada with “IMPACC”
Authors: Tavares Walter , Kaas-Mason Sanne , Spearen Chris , Kedzierski Natalie , Watts Jeremy , Moran Phil , Leyenaar Matthew S
Published: December 2024

In this perspective, the authors argue that paramedicine's core structure and mandate (i.e., the 9-1-1 system) can innovate to better align with the needs of the public and address the evolving healthcare landscape. Examining Canada as a case, paramedic services are increasingly utilized by the public as a first point of contact for health and social care and often for nonemergent events. Existing emergency-focused paradigms leave the health profession poorly aligned or underprepared to meet the needs of the public and isolated from other healthcare providers and systems. While advances in healthcare policy, infrastructure, and best practices have been proposed to address Canada's healthcare challenges, these advances have yet to sufficiently translate into core paramedicine systems. To illustrate these points, the authors critically examine the alignment of paramedicine models of care with public need, paramedicine's response to government and scholarly advances in healthcare policy and practice, and contemporary public healthcare issues in Canada. Paramedicine's changing landscape is also examined as context for innovation and change. The authors argue that core paramedicine systems be augmented with (not replaced by) an integrated interprofessional primary care paradigm and introduce a novel conceptual strategy, approach, and model of care referred to as IMPACC—Improving Patient Access to Care in the Community, including its guiding principles, conceptual framing, intended outcomes and domains for education. The authors conclude that paramedicine in Canada stands at a pivotal juncture and that the traditional emergency-focused model is increasingly misaligned with contemporary health and social care needs, necessitating a shift toward a more integrated, interprofessional primary care approach. The IMPACC concept offers a viable conceptual blueprint for this transformation, proposing a redesigned 9-1-1 system that incorporates timely primary care services and fosters interprofessional collaboration and integration for differentiated and undifferentiated patients in the community within core paramedicine systems.
Primary care in rural areas: a qualitative study on medical students’ images and experiences of working in rural areas in southern Germany
Authors: Gehrmann Jan , Barth Niklas , Brandhuber Tom , Berberat Pascal O. , Gigou Sophie , Schneider Antonius
Published: December 2024

Background

Rural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is ’Beste Landpartie Allgemeinmedizin’ (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest.

Methods

Qualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods.

Results

The images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions.

Discussion

The images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.
Evidence for in vivo resistance against allopurinol in a dog infected with Leishmania infantum by reduction in copy numbers of the S-adenosylmethionine synthetase (METK) gene
Authors: Schäfer Ingo , Faucher Mathieu , Nachum-Biala Yaarit , Ferrer Lluís , Carrasco Marina , Kehl Alexandra , Müller Elisabeth , Naucke Torsten J. , Baneth Gad
Published: December 2024

Background

In Europe, canine leishmaniasis is commonly caused by Leishmania infantum. Allopurinol is the main drug for long-term management of the disease, and clinical relapses of L. infantum infection treated with this drug are described. Resistance to allopurinol has been demonstrated in-vitro, but there is only little knowledge on in vivo resistance in dogs.

Findings

A two-year-old female spayed Akita Inu that was adopted from a breeding facility near Nice in France was initially diagnosed with primary immune-mediated hemolytic anemia. Immunosuppressive treatment was initiated, and the dog was referred for a second opinion to the Clinique Veterinaire Alliance in France. PCR testing for L. infantum was performed out of EDTA blood and IFA as well as ELISA testing out of serum. Resistance to allopurinol was associated with chromosome and gene copy number (CN) variations including a decrease in the S-adenosylmethionine synthetase (METK) gene CN.

Results

The dog showed pale mucous membranes, fever (39.1 °C), and a relapse of the anemia. The diagnosis of leishmaniasis was based on the cytological finding of Leishmania amastigotes (bone marrow, spleen, liver), positive PCR testing, and positive IFAT serology. The dog was treated with allopurinol over a period of 1316 days and additionally received two cycles of Glucantime® (meglumine antimoniate), before samples were submitted to the LABOKLIN laboratory to test for resistance against allopurinol. The laboratory work-up revealed mild thrombocytopenia, mild hyperproteinemia with hyperglobulinemia, a marked elevation of the c-reactive protein, and decreased iron concentration. Serum protein electrophoresis showed a polyclonal peak in the gamma globulins. Serology was positive in both ELISA (21.5 LE) and IFAT (1:1024). Quantitative PCR testing of blood was positive with low numbers of Leishmania (10/ml blood) at the timepoint of suspicion for resistance. The urinary protein-to-creatinine ratio was markedly elevated (2.5) and xanthine crystalluria was detected. A CN level of below 3 is considered suspicious for resistance, as revealed in the described Akita Inu dog.

Conclusions

Relapse of L. infantum infection after applying allopurinol for 1316 days due to resistance was suspected clinically. Positive PCR testing, consistent hematological and biochemistry abnormalities, and reduction in the METK gene CN backed up the clinical suspicion of resistance. Dogs infected with allopurinol resistant strains of L. infantum may represent a great risk for infection of naïve dogs, cats, and humans.

Graphical Abstract
Astrocytes contribute to toll-like receptor 2-mediated neurodegeneration and alpha-synuclein pathology in a human midbrain Parkinson’s model
Authors: Weiss Fiona , Hughes Laura , Fu Yuhong , Bardy Cedric , Halliday Glenda M. , Dzamko Nicolas
Published: December 2024

Background

Parkinson’s disease (PD) is characterised by degeneration of ventral midbrain dopaminergic (DA) neurons and abnormal deposition of α-synuclein (α-syn) in neurons. Activation of the innate immune pathogen recognition receptor toll-like receptor 2 (TLR2) is associated with exacerbation of α-syn pathology. TLR2 is increased on neurons in the PD brain, and its activation results in the accumulation and propagation of α-syn through autophagy inhibition in neurons. In addition to the aggregation and propagation of pathological α-syn, dysfunction of astrocytes may contribute to DA neuronal death and subsequent clinical progression of PD. However, the role of astrocytes in TLR2-mediated PD pathology is less explored but important to address, given that TLR2 is a potential therapeutic target for PD.

Methods

Induced pluripotent stem cells from three controls and three PD patients were differentiated into a midbrain model comprised of neurons (including DA neurons) and astrocytes. Cells were treated with or without the TLR2 agonist Pam3CSK4, and α-syn pathology was seeded using pre-formed fibrils. Confocal imaging was used to assess lysosomal function and α-syn pathology in the different cell types, as well as DA neuron health and astrocyte activation.

Results

TLR2 activation acutely impaired the autophagy lysosomal pathway, and potentiated α-syn pathology seeded by pre-formed fibrils in PD neurons and astrocytes, leading to degeneration and loss of DA neurons. The astrocytes displayed impaired chaperone-mediated autophagy reducing their ability to clear accumulated α-syn, and increases of A1 neurotoxic phenotypic proteins SerpinG1, complement C3, PSMB8 and GBP2. Moreover, the phenotypic changes in astrocytes correlated with a specific loss of DA neurons.

Conclusions

Taken together, these results support a role for astrocyte dysfunction in α-syn accumulation and DA neuronal loss following TLR2 activation in PD.