bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and prognosis in patients with neuronal surface antibody-mediated autoimmune encephalitis: a single-center cohort study in China
Authors: Huang Teng , Liu Fei , Wang Baojie , Wang Chunjuan , Hao Maolin , Guo Shougang
Published: December 2023

Objective

This retrospective observational study primarily aimed to analyse the clinical characteristics of patients with neuronal surface antibody-mediated autoimmune encephalitis (AE) in China and report their prognosis after immunotherapy.

Methods

Clinical characteristics, laboratory or imaging examinations, and treatment outcomes of 103 patients diagnosed with AE between 1 September 2014 and 31 December 2020 were collected. Univariate and multivariate logistic regression analyses were performed to determine the predictors of poor prognosis.

Results

Overall, 103 patients were enrolled in the study. The main clinical symptoms included seizures (74.8%), psychiatric and behavior disorders (66.0%), cognitive deficits (51.5%), disturbances of consciousness (45.6%), and movement disorders/involuntary movements (26.2%). The distribution of clinical syndromes also differed for different AE subtypes. The efficacy rates of first-line immunotherapy for anti-NMDAR, anti-LGI1, anti-GABABR, and anti-CASPR2 encephalitis were 70.2%, 92.3%, 70%, and 83.3%, respectively, and rituximab was administered to 21 patients as second-line immunotherapy, including 14 patients with anti-NMDAR encephalitis, 4 with anti-LGI1 encephalitis, 2 with anti-GABABR encephalitis, and 1 with anti-CASPR2 encephalitis. Five patients with poor effect of the second-line treatment received bortezomib. According to the results of the last follow-up, 78 patients had a good prognosis (mRS 0–2), and 21 patients had a poor prognosis (mRS 3–6). The proportion of patients with a poor prognosis was significantly higher in anti-GABABR encephalitis compared to the other AE subtypes (p<0.001). Multivariate analysis indicated that elevated neutrophil-to-lymphocyte ratio (NLR) and tumour presence were independent risk factors for poor prognosis. The regression equation of the model was logit(P)=-3.480 + 0.318 NLR+2.434 with or without tumour (with assignment =1, without assignment =0). The prediction probability generated by the regression model equation was used as the independent variable for receiver operating curve (ROC) analysis. The results showed that the area under the curve (AUC) of the prediction probability was 0.847 (95% CI, 0.733–0.961; p < 0.001).

Conclusions

Different AE subtypes demonstrated different clinical symptom spectra throughout the disease stage. Anti-LGI1 encephalitis and anti-CASPR2 encephalitis were more sensitive to first-line and second-line treatments. Anti-GABABR encephalitis had the worst prognosis among the abovementioned subtypes. The regression equation constructed using NLR and tumour presence effectively predicted the poor prognosis.
A highly potent anti-VISTA antibody KVA12123 - a new immune checkpoint inhibitor and a promising therapy against poorly immunogenic tumors
Authors: Iadonato Shawn , Ovechkina Yulia , Lustig Kurt , Cross Jessica , Eyde Nathan , Frazier Emily , Kabi Neda , Katz Chen , Lance Remington , Peckham David , Sridhar Shaarwari , Talbaux Carla , Tihista Isabelle , Xu Mei , Guillaudeux Thierry
Published: December 2023

Background

Immune checkpoint therapies have led to significant breakthroughs in cancer patient treatment in recent years. However, their efficiency is variable, and resistance to immunotherapies is common. VISTA is an immune-suppressive checkpoint inhibitor of T cell response belonging to the B7 family and a promising novel therapeutic target. VISTA is expressed in the immuno-suppressive tumor microenvironment, primarily by myeloid lineage cells, and its genetic knockout or antibody blockade restores an efficient antitumor immune response.

Methods

Fully human monoclonal antibodies directed against VISTA were produced after immunizing humanized Trianni mice and sorting and sequencing natively-linked B cell scFv repertoires. Anti-VISTA antibodies were evaluated for specificity, cross-reactivity, monocyte and T cell activation, Fc-effector functions, and antitumor efficacy using in vitro and in vivo models to select the KVA12123 antibody lead candidate. The pharmacokinetics and safety profiles of KVA12123 were evaluated in cynomolgus monkeys.

Results

Here, we report the development of a clinical candidate anti-VISTA monoclonal antibody, KVA12123. KVA12123 showed high affinity binding to VISTA through a unique epitope distinct from other clinical-stage anti-VISTA monoclonal antibodies. This clinical candidate demonstrated high specificity against VISTA with no cross-reactivity detected against other members of the B7 family. KVA12123 blocked VISTA binding to its binding partners. KVA12123 induced T cell activation and demonstrated NK-mediated monocyte activation. KVA12123 treatment mediated strong single-agent antitumor activity in several syngeneic tumor models and showed enhanced efficacy in combination with anti-PD-1 treatment. This clinical candidate was engineered to improve its pharmacokinetic characteristics and reduce Fc-effector functions. It was well-tolerated in preclinical toxicology studies in cynomolgus monkeys, where hematology, clinical chemistry evaluations, and clinical observations revealed no indicators of toxicity. No cytokines associated with cytokine release syndrome were elevated.

Conclusion

These results establish that KVA12123 is a promising drug candidate with a distinct but complementary mechanism of action of the first generation of immune checkpoint inhibitors. This antibody is currently evaluated alone and in combination with pembrolizumab in a Phase 1/2 open-label clinical trial in patients with advanced solid tumors.
Case report: Whole-exome sequencing for a hereditary elliptocytosis case with an unexpectedly low HbA1c
Authors: Pang Lu , Zeng Ziyi , Ding Yadi , Huang Haiming , Li Haixia
Published: December 2023

Objectives

Hereditary elliptocytosis is a group of erythroid hereditary diseases characterized by elliptically shaped erythrocytes in peripheral blood. It is mainly inherited through autosomal dominant inheritance. This study aimed to conduct a genetic etiology analysis in a case with a clinical diagnosis of hereditary elliptocytosis and an unexpectedly low HbA1c.

Methods

Whole-exome sequencing was performed to find the possible pathogenic mutations. At the same time, bioinformatics software was used to predict the mutation function. Sanger sequencing was performed to verify the suspected pathogenic mutations.

Results

Whole-exome sequencing results showed that the proband with mild anemia had a heterozygous c.2303G>A (p.G768D) missense mutation in the 13th exon of the SPTB gene. The Sanger sequencing confirmed this heterozygous mutation. This mutation was extremely rare in the population, and multiple software’s predictions were harmful. Conservative analysis revealed that this site was highly conserved in various species.

Conclusion

The c.2303G>A mutation of the SPTB gene is the suspected cause of hereditary elliptocytosis in the patient. Our data show that microscopic examination of red blood cells on blood smears is an important means of diagnosing hereditary elliptocytosis. Whole-exome sequencing is an effective tool to determine the genetic etiology of erythrocyte membrane diseases, which can promote accurate diagnosis and genetic counseling.
Late-onset cobalamin C deficiency type in adult with cognitive and behavioral disturbances and significant cortical atrophy and cerebellar damage in the MRI: a case report
Authors: Sun Miao , Dai Yingjie
Published: December 2023

Background

Late-onset cobalamin C (cblC) deficiency is associated with a wide range of neurological and psychiatric symptoms, hematological manifestations, anorexia, renal failure, ocular abnormalities, dermatitis, and pancreatitis. However, the neuroimaging characteristics of late-onset cblC deficiency remain insufficiently documented. Common findings include diffuse white matter swelling, varying degrees of severe leukoaraiosis, hydrocephalus, corpus callosum atrophy, and symmetric bilateral basal ganglia lesions. In this report, we present a case of late-onset cblC deficiency in adults presenting with cerebellar ataxia as the primary symptom. The MRI findings revealed bilateral lateral cerebellar hemispheres exhibiting symmetric hyperintensity, primarily observed in diffusion-weighted imaging (DWI), which is a rarely reported imaging change in this context.

Case presentation

Our patient was a male who experienced symptoms starting at the age of 30 years, including unsteady walking, apparent cerebellar ataxia, and cognitive impairment upon nervous system examination. Brain magnetic resonance imaging (MRI) exhibited symmetric hyperintensity in the bilateral lateral cerebellar hemispheres, predominantly manifested in DWI, without any enhancement. Subsequently, significantly elevated blood total homocysteine and urinary methylmalonic acid levels were observed. Genetic analysis confirmed the presence of MMACHC compound heterozygous mutants c.482G > A and c.609G > A, thus confirming the diagnosis of cblC deficiency. These variants were classified as likely pathogenic following the guidelines of the American College of Medical Genetics and Genomics (ACMG) and were verified using Sanger sequencing. Following treatment, the patient experienced improvements in walking ability and cognition, a significant decrease in blood total homocysteine levels, and reversal of the imaging lesions.

In conclusion

Late-onset cblC deficiency presents with diverse clinical and imaging manifestations. Early diagnosis and treatment are crucial in achieving a favorable prognosis. This case serves as a reminder to clinicians not to overlook genetic metabolic disorders, particularly those causing multisite damage, in adult patients with undiagnosed neurological disorders, especially those affecting the cerebellum. Notably, methylmalonic acidemia should be considered within the spectrum of bilateral cerebellar lesions.
Trends in the incidence of peripheral vestibular disorders: a Nationwide population-based study
Authors: Hung Shih-Han , Xirasagar Sudha , Dang Luong Huu , Chen Yen-Chun , Cheng Yen-Fu , Lin Herng-Ching , Chen Chin-Shyan
Published: December 2023

Purpose

This study aimed to examines the long-term trend of incidence of peripheral vestibular disorders between 2010 and 2018 in Taiwan.

Methods

Study-eligible patients were identified from Taiwan’s Longitudinal Health Insurance Database 2005 maintained by the Ministry of Health and Welfare in Taiwan. We retrieved 230,566 patients with a first-time diagnosis of peripheral vestibular disorders between 2010 and 2018. We calculated annual incidence rates of peripheral vestibular disorders per 100,000 population. We used the annual percent change (APC) to test the trend of peripheral vestibular disorders over time.

Results

The mean annual incidence rate of peripheral vestibular disorders during the study period was 1489.6 per 100,000 population. Incidence showed a statistically significant steady decrease from 2010 to 2018 with a mean APC of −6.15% (95% CI = −6.97% ~ −5.32%). The decline was led by Meniere’s disease (APC = −9.83, 95% CI = −10.66% ~ −8.99%), followed by benign paroxysmal positional vertigo (APC = −3.69, 95% CI = −4.53% ~ −3.03%), vestibular neuritis (APC = −7.85, 95% CI = -8.96 ~ −6.73), and other peripheral vestibular dizziness (APC = −5.56, 95% CI = −6.69% ~ −4.43%).

Conclusion

The incidence of peripheral vestibular disorders, overall, and the four major subgroups, benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, and other peripheral vestibular dizziness, all decreased substantially, year by year within the 2010–2018 period.
Lipidomic insights into the reaction of baking lipases in cakes
Authors: Stemler Charlotte Dorothea , Geisslitz Sabrina , Cutignano Adele , Scherf Katharina Anne
Published: December 2023

Lipases are promising improvers of cake batter and baking properties. Their suitability for use in various cake formulations cannot be predicted yet, because the reactions that lead to macroscopic effects need to be unravelled. Therefore, the lipidome of three different cake recipes with and without lipase treatment was assessed by ultra high performance liquid chromatography-mass spectrometry before and after baking. By comparing the reaction patterns of seven different lipases in the recipes with known effects on texture, we show that lipase substrate specificity impacts baking quality. Key reactions for the recipes were identified with the help of principal component analysis. In the eggless basic cake, glyceroglycolipids are causal for baking improvement. In pound cake, lysoglycerophospholipids were linked to textural effects. Lipase substrate specificity was shown to be dependent on the recipe. Further research is needed to understand how recipes can be adjusted to achieve optimal lipase substrate specificity for desirable batter and baking properties.
Individualized 3D-printed bolus promotes precise postmastectomy radiotherapy in patients receiving breast reconstruction
Authors: Wang Jun , Xiang Zhong-zheng , Tan Chen-feng , Zeng Yuan-yuan , Yang Tian , Wei Xiao-yuan , Yu Si-ting , Dai Ze-lei , Xu Ning-yue , Liu Lei
Published: December 2023

Purpose

To evaluate the efficacy and safety of 3D-printed tissue compensations in breast cancer patients receiving breast reconstruction and postmastectomy radiotherapy (PMRT).

Methods and materials

We enrolled patients with breast cancer receiving breast reconstruction and PMRT. The dose distribution of target and skin, conformability, and dose limit of organs at risk (OARs) were collected to evaluate the efficacy of the 3D-printed bolus. Radiation Therapy Oncology Group (RTOG) radiation injury classification was used to evaluated the skin toxicities.

Results

A total of 30 patients diagnosed between October 2019 to July 2021 were included for analysis. Among all the patients, the 3D-printed bolus could ensure the dose coverage of planning target volume (PTV) [homogeneity index (HI) 0.12 (range: 0.08-0.18)], and the mean doses of D99%, D98%, D95%, D50%, D2% and Dmean were 4606.29cGy, 4797.04cGy, 4943.32cGy, 5216.07cGy, 5236.10cGy, 5440.28cGy and 5462.10cGy, respectively. The bolus demonstrated an excellent conformability, and the mean air gaps between the bolus and the chest wall in five quadrants were 0.04cm, 0.18cm, 0.04cm, 0.04cm and 0.07cm, respectively. In addition, the bolus had acceptable dosage limit of OARs [ipsilateral lung: Dmean 1198.68 cGy, V5 46.10%, V20 21.66%, V30 16.31%); heart: Dmean 395.40 cGy, V30 1.02%, V40 0.22%; spinal cord planning risk volume (PRV): Dmax 1634 cGy] and skin toxicity (grade 1, 76.0%; grade 2, 21.0%; grade 3, 3.3%).

Conclusion

The 3D-printed bolus offers advantages in terms of dose uniformity and controllable skin toxicities in patients receiving breast reconstruction and PMRT. Further research is needed to comprehensively evaluate the effectiveness of the 3Dprinted bolus in this patient subset.
Deciphering the Hypoxia-immune interface in esophageal squamous carcinoma: a prognostic network model
Authors: Hu Jie , Liu Qilong , Feng Bi , Lu Yanling , Chen Kai
Published: December 2023

Introduction

The rapid progress and poor prognosis of the exercise of esophageal squamous cell carcinoma (ESCA) bring great challenges to the treatment. Hypoxia in the tumor microenvironment has become a key factor in the pathogenesis of tumors. However, due to the lack of clear therapeutic targets, hypoxia targeted therapy of ESCA is still in the exploratory stage.

Methods

To bridge this critical gap, we mined a large number of gene expression profiles and clinical data on ESCA from public databases. First, weighted gene co-expression network analysis (WGCNA) and functional enrichment analysis were performed. We next delved into the relationship between hypoxia and apoptotic cell interactions. Meanwhile, using LASAS-Cox regression, we designed a robust prognostic risk score, which was subsequently validated in the GSE53625 cohort. In addition, we performed a comprehensive analysis of immune cell infiltration and tumor microenvironment using cutting-edge computational tools.

Results

Hypoxia-related genes were identified and classified by WGCNA. Functional enrichment analysis further elucidated the mechanism by which hypoxia affected the ESCA landscape. The results of the interaction analysis of hypoxia and apoptotic cells revealed their important roles in driving tumor progression. The validation results of the prognostic risk score model in the GSE53625 cohort obtained a good area under the receiver operating characteristic (ROC) curve, and the risk score was independently verified as a significant predictor of ESCA outcome. The results of immune cell infiltration and tumor microenvironment analysis reveal the profound impact of immune cell dynamics on tumor evolution.

Conclusion

Overall, our study presents a pioneering hypoxiacentered gene signature for prognostication in ESCA, providing valuable prognostic insights that could potentially revolutionize patient stratification and therapeutic management in clinical practice.
Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts
Authors: Wierzbicka Małgorzata , Markowski Jarosław , Pietruszewska Wioletta , Burduk Paweł , Mikaszewski Bogusław , Rogowski Marek , Składowski Krzysztof , Milecki Piotr , Fijuth Jacek , Jurkiewicz Dariusz , Niemczyk Kazimierz , Maciejczyk Adam
Published: December 2023

The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service.

Materials and methods

The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors’ original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage.

Results

Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available.

Conclusion

Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.
Primary biliary cholangitis with features of autoimmune hepatitis in a 19-year-old adolescent with 14q24.1q24.2 deletion: a case report
Authors: Wang Yi-Wei , Chao Hsun-Chin , Wang Huei-Shyong , Lin Ju-Li , Chang Chih-Chen , Huang Shiu-Feng
Published: December 2023

Introduction

Primary biliary cholangitis (PBC) is a rare and chronic autoimmune liver disease characterized by the progressive destruction of small intrahepatic bile ducts that may eventually lead to cirrhosis. PBC with features of autoimmune hepatitis (AIH) has rarely been reported in pediatric patients with genetic defects. We present the case of an adolescent with chromosome 14q24.1q24.2 deletion who was given the diagnosis of stage IV PBC with features of AIH.

Case presentation

A 19-year-old male adolescent with multiple congenital abnormalities and an intellectual disability presented with abnormal liver enzymes levels and pruritus for more than 5 years. Laboratory examinations revealed elevated levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase. After the exclusion of viral hepatitis, alpha-1 antitrypsin deficiency, Wilson's disease, and other genetic cholestatic liver diseases by laboratory tests and whole exome sequencing, a liver biopsy was performed and stage IV PBC was diagnosed. Notably, features of AIH were also noted in the histopathological report, indicating the presence of PBC with AIH features. The patient responded well to a combination therapy of ursodeoxycholic acid and steroids. Array comparative genomic hybridization analysis performed to study the congenital abnormalities revealed a 3.89 Mb 14q24.1q24.2 deletion.

Conclusion

PBC with AIH features has rarely been reported in an adolescent with a chromosomal abnormality. The present case can increase awareness for early-onset PBC and its possible correlation with chromosomal defects.
Lichenoid mucocutaneous reactions associated with sintilimab therapy in a non-small cell lung adenocarcinoma patient: case report and review
Authors: Zhou Shuting , Zhang Zhenyu , Feng Xiaodong , Zhao Chengjian , Jiang Lu
Published: December 2023

The immune checkpoint inhibitor (ICI), anti-programmed cell death receptor-1 (PD-1) antibody, has gained widespread approval for treating various malignancies. Among the immune-related adverse reactions (irAEs) during ICI treatment, the lichenoid reaction is noteworthy. Sintilimab, a new PD-1 inhibitor, has secured approval in China for treating refractory non-Hodgkin’s lymphoma, and phase I/II clinical trials for other solid tumors are ongoing both domestically and abroad. This paper presents a case of a mucocutaneous lichenoid reaction associated with sintilimab therapy, its diagnosis, and management. Our study, using multiplex immunofluorescence staining, reveals localized infiltration of CD4+ and CD8+ T lymphocytes in the subepithelial lamina propria region with upregulated PD-1 expression, implying an association between PD-1 expression upregulation and lichenoid reactions provoked by PD-1 monoclonal antibody. We provide a summary of clinical characteristics and treatment guidelines for lichenoid reactions induced by ICIs from previous reports, highlighting the success of a combined therapeutic regimen of oral antihistamines and topical corticosteroids in controlling symptoms without interrupting ICI treatment.
Adult hippocampal neurogenesis: pharmacological mechanisms of antidepressant active ingredients in traditional Chinese medicine
Authors: Lv Shimeng , Zhang Guangheng , Huang Yufei , Zhong Xia , Yi Yunhao , Lu Yitong , Li Jiamin , Ma Yuexiang , Teng Jing
Published: December 2023

Depression is characterized by prominent indicators and manifestations, such as anhedonia, which refers to the inability to experience pleasure, and persistent feelings of hopelessness. In clinical practice, the primary treatment approach involves the utilization of selective serotonin reuptake inhibitors (SSRIs) and related pharmacological interventions. Nevertheless, it is crucial to recognize that these agents are associated with significant adverse effects. Traditional Chinese medicine (TCM) adopts a multifaceted approach, targeting diverse components, multiple targets, and various channels of action. TCM has potential antidepressant effects. Anomalies in adult hippocampal neurogenesis (AHN) constitute a pivotal factor in the pathology of depression, with the regulation of AHN emerging as a potential key measure to intervene in the pathogenesis and progression of this condition. This comprehensive review presented an overview of the pharmacological mechanisms underlying the antidepressant effects of active ingredients found in TCM. Through examination of recent studies, we explored how these ingredients modulated AHN. Furthermore, we critically assessed the current limitations of research in this domain and proposed novel strategies for preclinical investigation and clinical applications in the treatment of depression in future.
Effect of resistance training programs differing in set structure on muscular hypertrophy and performance in untrained young men
Authors: Mao Jun , Wang Tianjiao , Wang Yidan , Kuan Garry
Published: December 2023

Purpose: This study aimed to compare the effects on muscle hypertrophy and muscular performance of two resistance training (RT) programs that differed only in set structure: traditional set structure (TS) vs. rest redistribution set structure (RR).

Methods: Thirty untrained young men were pair-matched and randomly assigned to a TS (n = 15) or an RR (n = 15) protocol based on individual baseline measures. Participants trained for 8 weeks using the same total body RT routines performed twice weekly. The TS protocol comprised four sets of 10 repetitions per exercise with 120-s interset rest, and the RR involved eight sets of five repetitions per exercise with 51-s interset rest. Participants were tested pre- and post-intervention for body composition, regional muscle thickness, upper- and lower-body muscle maximal strength [1-repetition maximum (1RM)], mean power output and velocity at 75% 1RM and muscular endurance (repetitions to failure at 70% 1RM).

Results: Compared to baseline, both groups exhibited equally significantly decreased body fat mass (p < 0.05), increased fat-free mass (p < 0.001), muscle thickness (p < 0.05), upper and lower-body muscular maximal strength (p < 0.001) and endurance performance (p < 0.001). However, both groups only increase the lower-body power output (p < 0.001) but not the upper-body (p > 0.05). No significant differences existed between groups for all measurements (p > 0.05).

Conclusion: These results suggest that RR and TS groups have similar effects for improving muscle hypertrophy and performance in untrained young men.
Perceived risk for falls and decision-making in riding raised ramps in mountain biking: a pilot study
Authors: Chilton Emily P. , Robinovitch Stephen N.
Published: December 2023

Mountain biking (MTB) is a challenging activity where riders face constant decisions on whether to attempt technical paths or features (e.g., wooden ramps and jumps) that pose risk for falls and injuries. Risk homeostasis theory posits that riders pursue an optimal non-zero level of risk that balances the rewards of attempting challenging features with the need to avoid unreasonable risk for injury. Little is known on how riders judge risk, and the level of risk that riders deem unacceptable. We conducted experiments with experienced MTB riders (n = 17) to examine how their willingness to ride raised wooden ramps depended on their perceived probability for falling (Pf) and their perceived probability for injury in the event of a fall (Pi) while riding the ramp. In one experiment, participants viewed ramps of varying widths and heights and described their willingness to ride each ramp, along with Pf and Pi. We found that Pf and Pi were independent predictors of willingness to attempt ramps. Moreover, the product Pf*Pi (the perceived risk for injury in attempting the ramp) was a stronger predictor than Pf or Pi alone. In a second experiment, participants viewed ramps of different widths, and reported the maximum (threshold) height where they would ride each ramp, along with Pf and Pi. We found that Pf*Pi at the threshold height, averaging 13%, did not vary with ramp width. We conclude that decisions on riding ramps are based on the product Pf*Pi. On average, riders refused to ride ramps when Pf*Pi exceeded 13%.
The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design
Authors: Alshammari Bushra , Alkubati Sameer A. , Pasay-an Eddieson , Alrasheeday Awatif , Madkhali Norah , Edison J. Silvia , Bakthavatchaalam Venkat , Alshammari Marim Saud , AlRashidi Amnah Ayed , Alshammari Farhan
Published: December 2023

Background

Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health.

Aim

This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients.

Methods

A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson’s correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support.

Results

Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = −0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = −0.479, p <0.001).

Conclusion

Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.
Leveraging monitoring, evaluation, and learning to scale the Enabling Inclusion® program for children with disabilities in India and globally
Authors: Brien Marie , Coutinho Franzina , Krishna Dinesh , van der Haar Lotte , de Laat Joost , Srinivasan Sankara Raman , Venkatachalapathy Navamani
Published: December 2023

Introduction

Children with disabilities in low- and middle-income countries face many challenges and lack adequate services, including access to rehabilitation professionals. To address this lack of access, Amar Seva Sangam Ayikudy (ASSA), a non-governmental organization (NGO) in India, designed a technology-leveraged rehabilitation program called Enabling Inclusion® (EI®), and implemented it in one state (Tamil Nadu, India) before scaling it. The model is supported by the EI® app, which enables organizations to screen, assess and monitor progress of children with disabilities via rehabilitation specialists and community rehabilitation workers, and to provide family-centered, goal-based interventions. An extensive monitoring, evaluation, and learning (MEL) framework is embedded into the program. This paper explores how this MEL system supported the scaling of the EI® model, reaching additional beneficiaries nationally and globally.

Methods

This paper describes ASSA’s MEL framework and demonstrates its use for decision-making in the process of scaling. It also explores how collaborations with various government departments, NGOs, and private partners contributed to the scaling of the EI® model and technology.

Results

Scaling of the EI® program was achieved by (1) expansion of the program in rural Tamil Nadu (vertical scale-up) in partnership with the Tamil Nadu government and private partners, and (2) by licensing the EI® app and model to other NGOs in various states in India and globally (horizontal scale-up). Systematic examination of key program and performance indicators, as well as stakeholder feedback, informed decisions to modify the EI® app over time. This included further customizing to the needs of children and service providers, covering a greater range of age groups and contexts, and modifying service delivery models. Child functional independence, participation, and inclusion was further strengthened by mobilizing parent empowerment groups, community awareness programs, school advocacy, and entitlements from the government. Flexibility in the implementation model of the EI® app allowed for adaptation to local contexts and organizations, and facilitated its scale-up.

Conclusion

A dynamic, inclusive, and locally grounded MEL system, a flexible and collaborative approach, and an adaptive implementation model increased the accessibility of an early intervention and childhood rehabilitation program for children with disabilities and their families throughout the state of Tamil Nadu, across India, and internationally.
“We have nice policies but…”: implementation gaps in the Ghana adolescent health service policy and strategy (2016–2020)
Authors: Agblevor Emelia Afi , Darko Natasha Afua , Acquah Priscilla Ama , Addom Selasie , Mirzoev Tolib , Agyepong Irene Akua
Published: December 2023

Introduction

Although policies for adolescent health exist in Ghana, their implementation is challenging. Availability of services for adolescent sexual and reproductive health and adolescent mental health remains less than desired, with adolescent mental health being particularly neglected despite being an important contributor to poor health outcomes. This study presents an analysis of gaps in the implementation of the Ghana Adolescent Health Service Policy and Strategy (2016–2020), including how and why the context influenced the observed implementation gaps.

Methods

Data for this study is drawn from 17 in-depth interviews with purposefully identified key stakeholders in adolescent mental, sexual, and reproductive health across the national and subnational levels; four focus group discussions (FGDs) with district health management teams; and 11 FGDs with adolescents in and out of schools in four selected districts in the Greater Accra region. Data were analyzed using both inductive and deductive approaches. The deductive analysis drew on Leichter’s conceptualization of context as structural, cultural, situational, and environmental factors.

Results

Of the 23 planned strategies and programs for implementing the policy, 13 (57%) were partially implemented, 6 (26%) were not implemented at all, and only 4 (17%) were fully implemented. Multiple contextual factors constrained the policy implementation and contributed to the majority of strategies not being implemented or partially implemented. These factors included a lack of financial resources for implementation at all levels of the health system and the related high dependence on external funding for policy implementation. Service delivery for adolescent mental health, and adolescent sexual and reproductive health, appeared to be disconnected from the delivery of other health services, which resulted in weak or low cohesion with other interventions within the health system.

Discussion

Bottom-up approaches that engage closely with adolescent perspectives and consider structural and cultural contexts are essential for effective policy implementation. It is also important to apply systemic and multi-sectoral approaches that avoid fragmentation and synergistically integrate policy interventions.
Exploring the lived experiences of participants and facilitators of an online mindfulness program during COVID-19: a phenomenological study
Authors: Melvin Ashley , Canning Christopher , Chowdhury Fariha , Hunter Sarah , Kim Soyeon
Published: December 2023

The coronavirus pandemic (COVID-19) has placed incredible demands on healthcare workers (HCWs) and adversely impacted their well-being. Throughout the pandemic, organizations have sought to implement brief and flexible mental health interventions to better support employees. Few studies have explored HCWs’ lived experiences of participating in brief, online mindfulness programming during the pandemic using qualitative methodologies. To address this gap, we conducted semi-structured interviews with HCWs and program facilitators (n = 13) who participated in an online, four-week, mindfulness-based intervention program. The goals of this study were to: (1) understand how participants experienced work during the pandemic; (2) understand how the rapid switch to online life impacted program delivery and how participants experienced the mindfulness program; and (3) describe the role of the mindfulness program in supporting participants’ mental health and well-being. We utilized interpretive phenomenological analysis (IPA) to elucidate participants’ and facilitators’ rich and meaningful lived experiences and identified patterns of experiences through a cross-case analysis. This resulted in four main themes: (1) changing environments; (2) snowball of emotions; (3) connection and disconnection; and (4) striving for resilience. Findings from this study highlight strategies for organizations to create and support wellness programs for HCWs in times of public health crises. These include improving social connection in virtual care settings, providing professional development and technology training for HCWs to adapt to rapid environmental changes, and recognizing the difference between emotions and emotional states in HCWs involved in mindfulness-based programs.
Markers and mechanisms of death in Drosophila
Authors: Tower John
Published: December 2023

Parameters correlated with age and mortality in Drosophila melanogaster include decreased negative geotaxis and centrophobism behaviors, decreased climbing and walking speed, and darkened pigments in oenocytes and eye. Cessation of egg laying predicts death within approximately 5 days. Endogenous green fluorescence in eye and body increases hours prior to death. Many flies exhibit erratic movement hours before death, often leading to falls. Loss of intestinal barrier integrity (IBI) is assayed by feeding blue dye (“Smurf” phenotype), and Smurf flies typically die within 0–48 h. Some studies report most flies exhibit Smurf, whereas multiple groups report most flies die without exhibiting Smurf. Transgenic reporters containing heat shock gene promoters and innate immune response gene promoters progressively increase expression with age, and partly predict remaining life span. Innate immune reporters increase with age in every fly, prior to any Smurf phenotype, in presence or absence of antibiotics. Many flies die on their side or supine (on their back) position. The data suggest three mechanisms for death of Drosophila. One is loss of IBI, as revealed by Smurf assay. The second is nervous system malfunction, leading to erratic behavior, locomotor malfunction, and falls. The aged fly is often unable to right itself after a fall to a side-ways or supine position, leading to inability to access the food and subsequent dehydration/starvation. Finally, some flies die upright without Smurf phenotype, suggesting a possible third mechanism. The frequency of these mechanisms varies between strains and culture conditions, which may affect efficacy of life span interventions.
Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis
Authors: Angel Sanne , Steensgaard Randi , Kolbaek Raymond , Frimann Søren
Published: December 2023

Introduction

The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation.

Method

We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts.

Results

Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.
Labor trafficking in marijuana production: a hidden epidemic in the shadows of the cannabis industry
Authors: Prakash Jaya , Erickson Timothy B. , MacGibbon Marti , Stoklosa Hanni
Published: December 2023

Labor trafficking in marijuana production remains a concealed epidemic within the expanding cannabis industry. This abstract brings attention to the systemic exploitation of vulnerable individuals engaged in cultivating, harvesting, and processing cannabis. It explores the factors contributing to labor trafficking, including demand for cheap labor, inadequate regulation, and the vulnerability of the workforce. By compiling published cases, both in peer-reviewed literature and the media, this perspective piece investigates the extent of health issues experienced by labor-trafficked victims. These include chronic pain from repetitive tasks, respiratory problems due to exposure to pesticides and other toxic substances, musculoskeletal injuries, malnutrition, and mental health disorders stemming from trauma and extreme stress. Additionally, this perspective article examines the factors contributing to poor health outcomes of labor-trafficked victims, including hazardous working conditions, lack of access to healthcare, and physical and psychological abuse. Addressing the health challenges faced by labor-trafficked victims in the cannabis industry requires multidimensional solutions: awareness among healthcare providers, comprehensive medical services, and mental health support. Furthermore, collaborative efforts among government agencies, healthcare providers, labor organizations, and the cannabis industry are essential in preventing trafficking and addressing the health disparities faced by labor-trafficked victims.
Intrapancreatic accessory spleens in African swine fever infection of wild boar (Sus scrofa)
Authors: Porras Néstor , Chinchilla Blanca , Rodríguez-Bertos Antonio , Barasona José Á. , Kosowska Aleksandra , Vázquez-Fernández Esther , Sánchez-Cordón Pedro J. , Sánchez-Vizcaíno José M.
Published: December 2023

Intrapancreatic accessory spleen (IPAS) is one of the most frequent congenital splenic anomalies in humans; however, studies in veterinary medicine are scarce. This study aimed to describe the macroscopic, histopathological and immunohistochemical features of 11 suspected cases of IPAS in wild boar piglets of 3–4 months old. Seven of the 11 animals were immunised with a low virulence isolate of African swine fever virus (ASFV) and subsequently challenged with a highly virulent ASFV isolate (LVI-HVI group). The remaining four animals were exclusively infected with a highly virulent isolate of ASFV (HVI group). Grossly, lesions comprised focal or multifocal reddish areas of variable shape, located on the surface of the pancreatic tail or within the parenchyma. Histological and immunohistochemical studies (anti-CD79 and CD3) confirmed the presence of IPAS in eight of the 11 cases. IPAS shared the same histological structure and alterations as those observed in the original spleen. The immunohistochemical study against ASFV revealed the presence of VP72+ cells in both the spleen and IPAS of seven of the eight piglets. The results of this study describe for the first time the presence of IPAS in ASFV infection of wild boar (Sus scrofa) regardless the isolate and suggest that the infection may induce the development of ectopic splenic tissue due to an increased demand for phagocytic cells from the reticuloendothelial system. However, further studies are needed to understand the immunological mechanisms that trigger the formation of these accessory organs.
On Solving Nonlinear Elasticity Problems Using a Boundary-Elements-Based Solution Method
Authors: Korbeogo Aly Rachid , Bonzi Bernard Kaka , Kouitat Njiwa Richard
Published: December 2023

The attractiveness of the boundary element method—the reduction in the problem dimension by one—is lost when solving nonlinear solid mechanics problems. The point collocation method applied to strong-form differential equations is appealing because it is easy to implement. The method becomes inaccurate in the presence of traction boundary conditions, which are inevitable in solid mechanics. A judicious combination of the point collocation and the boundary integral formulation of Navier’s equation allows a pure boundary element method to be obtained for the solution of nonlinear elasticity problems. The potential of the approach is investigated in some simple examples considering isotropic and anisotropic material models in the total Lagrangian framework.