bluuebunny/crossref_metadata_2025 huggingface dataset:
Higher incidence of Congenital Aortic Valve Stenosis in higher Magnetic latitudes countries: New Insights and Potential Therapies
Authors: Alabdulgader Abdullah Abdulrhman
Published: July 2024

Bicuspid Aortic valve Stenosis (BCAS) with an incidence of 3% of the world's population constitutes the most frequent Congenital Heart Disease whereas all other subtypes collectively constitute 1% of all life births. Most and the extreme severity spectrum of valvular Aortic Stenosis (VAS) in adulthood are cases of congenital bicuspid aortic valve. It seems that the congenital occurrence of the bicuspid aortic valve is a major prerequisite of the pathological calcifications and fibrosis seen in adults. Those progressive changes can't be explained by sole hemodynamic destructive forces but other factors inherent to the bicuspid valve tissue are also contributing. Therapeutic options of (VAS) are relatively stagnant and have been limited to invasive and surgical options. Prudent observation of the risk factors of some CHDs including BCAS was the epigenetic effect of planetary electromagnetic field on the delicate process of endothelial mesenchymal transformation (EndoMT). The incidence of BCAS is progressively increasing as we depart north from the equator to the north pole. A deeper understanding of the cellular and molecular mechanisms underlying EndoMT in congenital as well as acquired heart diseases is expected to open a new era in reversing heart disease in the human species. The potential to manipulate EndoMT and its signaling pathways or to reverse it with external electromagnetic power is an exciting therapeutic option for a wide array of congenital and acquired heart diseases including bicuspid aortic stenosis (BCAS) in the human species.
Enhancing Patient-Centered Care: Front-End Integration of Phenotypic and Genotypic Data With Medical Ontology Conceptual Frameworks
Authors: Snead R Sterling , Marczika Julia , Ambalavanan Radha , Kozinsky Karina , Nogueira Isaac Prada y , Pardela Robert , Pronin Sergey , Malioukis Alex , Towett Gideon , Mbogori-Kairichi Mercy
Published: July 2024

In the context of modern healthcare, the concept of patient-centered care (PCC) has emerged as a crucial aspect, prompting the need for innovative frameworks to empower patients and enhance healthcare outcomes. This paper introduces the Patient-Oriented Medical Ontology Conceptual Framework (POMOCF), a powerful framework aimed at giving patients control over their personal and healthcare information. It prioritizes patient independence by allowing for direct control of electronic health records (EHRs) and facilitates the gathering of information through document upload or scanning. In the POMOCF front-end framework, we propose to maintain scalability, along with robust authorization, authentication, and secure data protocols, all of which are detailed within the framework. This approach enhances data accuracy and security, improving data management efficiency. As part of our ongoing development, we are planning to implement an innovative inference system that will automatically analyze and extract relevant details from the uploaded authorized document, provide real-time updates, and maintain data accuracy. This approach further strengthens data accuracy and prevents unauthorized modifications, thereby making the data management process more efficient. POMOCF leverages medical ontology principles to ensure standardized clinical concepts and improved semantic interoperability. Our integration plans involve integrating genotypic data for personalized medicine initiatives and strengthening the front-end infrastructure. By linking front-end interfaces with advanced technological solutions, we aim to provide effective healthcare delivery, promoting personalized care and enhancing patient outcomes.
The Features of Comorbidity of Stroke in The Indonesian Population: Findings from The Indonesian Family Life Survey (IFLS-5)
Authors: Muvida  , Amar Filzah
Published: July 2024

Background: Comorbidities are associated with a worse stroke prognosis and more challenging clinical management. However, population-based research related to stroke comorbidities in Indonesia is still limited.
Objective: This study aims to evaluate the features of important comorbidities among stroke patients in the Indonesian population.
Methods: The data was taken from the 2014–2015 Indonesian Family Life Survey (IFLS-5), which represents 83% of the Indonesian population. Data were analyzed by means of logistic regression models using statistical software for data science (STATA) 13.
Results: There was a statistically significant relationship between stroke history and several comorbidities risk factors. The risk of stroke increases in individuals with hypertension (odds ratio (OR): 7.97, 95% confidence interval (CI): 5.19-12.26), diabetes (OR: 1.90, 95% CI: 1.14-3.15), heart disease (OR: 2.67, 95% CI: 1.47-4.85), and hyperlipidemia (OR: 3.68, 95% CI: 2.40-5.64). Of the 309 stroke patients, 41.9% had one comorbid condition; 24.1% had two; and 10.5% had three. Comorbidities increase with age, and 80.50% of stroke patients with comorbidities are aged 50 years or more.
Conclusion: This study showed that the most common comorbidities in stroke patients in Indonesia are hypertension, hyperlipidemia, and diabetes.
The Relationship between Level of D-Dimer Serum with Mortality in Acute Stroke Patiens with COVID-19
Authors: Tarmidi Moch Syahrial Pramudia , Bahrudin Mochamad
Published: July 2024

Background: COVID-19 has significantly increased morbidity and mortality in Indonesia, particularly at Gambiran General Hospital in Kediri, East Java, following the WHO's pandemic declaration. The global incidence of acute stroke with COVID-19 is 1.4%, presenting varying clinical features from mild to severe outcomes, and even death. The identification of specific biomarkers, such as elevated D-dimer serum levels, is crucial for predicting severe complications in acute stroke patients with COVID-19.
Objective: This study aimed to explore the correlation between elevated levels of mild, moderate, and severe D-dimer serum and mortality in acute stroke patients with COVID-19.
Methods: Conducted as an observational analytical study using a cross-sectional approach, this research utilized secondary data from medical records at Kediri Gambiran General Hospital (March 2020 to June 2023). Inclusion and exclusion criteria were applied to hospitalized patients, categorized based on D-dimer levels: normal, mild, moderate, and severe. Statistical analyses, including the Spearman correlation test and Chi-square correlation test, were employed to assess the relationship between D-dimer levels and total mortality.
Results: Among the 101 enrolled patients, 53 were male (52.48%), with 90 exhibiting elevated D-dimer levels. Out of these, 44 patients died. The Spearman correlation test showed a non-significant value of 0.069 (p>0.005). The Chi-square correlation test for mild, moderate, and severe D-dimer levels on total mortality also yielded a non-significant value of 0.878.
Conclusion: This study found no significant relationship between elevated levels of mild, moderate, and severe D-dimer serum and mortality in acute stroke patients with COVID-19 at Gambiran General Hospital.
Influence of Sex and Gender on Musculoskeletal Conditions and How They Are Reported
Authors: Tosi Laura L. , Templeton Kimberly , Pennington Andrew M. , Reid Kendall A. , Boyan Barbara D.
Published: July 2024

There is increasing evidence that musculoskeletal tissues are differentially regulated by sex hormones in males and females. The influence of sex hormones, in addition to other sex-based differences such as in anatomical alignment and immune-system function, impact the prevalence and severity of disease as well as the types of injuries that affect the musculoskeletal system and the outcomes of prevention measures and treatment. Literature specifically addressing sex differences related to the musculoskeletal system is limited, underscoring the imperative for both basic and clinical research on this topic. This review highlights areas of research that have implications for bone and cartilage health, including growth and development, sports injuries, osteoarthritis, osteoporosis, and bone frailty. It is clear that important aspects of the musculoskeletal system have been understudied. Consideration of how sex hormone therapy will affect musculoskeletal tissues in prepuberty, during puberty, and in adults is vital, yet little is known. The purpose of this article is to foster awareness and interest in advancing our understanding of how sex differences influence orthopaedic practice.
Supervisi Klinis dalam Pembinaan Profesionalisme Guru MA Amanatulloh Banyuwangi
Authors: Murtafi’ah Aniq Nasikhatul , Al Rosid Moh. Harun
Published: July 2024

Clinical supervision is an effort by madrasah heads to develop teachers to become more professional in teaching. Implementation of clinical supervision focuses on improving teacher weaknesses in learning This research aims to describe clinical supervision through planning, classroom observation, and evaluation and analysis in the professional development of teachers at MA Amanatulloh at the Amanatulloh Banyuwangi Islamic Boarding School. This research approach is qualitative with a case study type of research. Data collection techniques include interviews, observation and documentation. The research subjects were the school principal as supervisor, teachers and students. Data analysis through data condensation, data presentation, and drawing conclusions. Test the validity of the data through credibility tests and confirmability tests. To ensure whether the data is valid or not through data source triangulation, method triangulation, and member check. The results of the research are (1) madrasa head planning; stimulus through meetings to share perceptions of clinical supervision goals, problem identification, supervision implementation schedule contracts, instruments, implementation concepts, and teacher problem focus. (2) Class observation; The supervisor and teacher enter the classroom together to make observations regarding the teacher's teaching skills, the teacher's interaction with students, and the feedback from the students themselves. (3) Evaluation and analysis; the process of evaluating and analyzing the results which are used as benchmarks for follow-up activities to improve teachers through discussion and analysis. Supervisors direct teachers to take part in training and be actively involved in MGMP forums to strengthen knowledge and benchmark learning to make it more varied.
Nitrogen uptake potential of two wetland plants under varied water temperatures and nitrogen concentrations when grown as floating treatment wetland
Authors: Burlakoti Saroj , Kopp Kelly , Stott Lance , Poudyal Shital
Published: July 2024

Excessive use of commercial fertilizers in nursery production results in substantial fertilizer runoff, leading to surface and groundwater contamination. Therefore, to prevent contamination and comply with regulations, irrigation return flow (runoff water) is generally collected in retention pond before it can be safely discarded or released. Nitrogen, applied as nitrate compounds is among the highest used fertilizer and is prone to leaching and runoff. Employing a phytoremediation strategy to remediate irrigation return flow (runoff water) has the potential to lower nitrate concentrations in water before release. In this study, we assessed the suitability of growing Helianthus maximiliani (maximilian sunflower) and Asclepias speciosa (showy milkweed) in a floating treatment wetland system (FTW) and evaluated the nitrate uptake capacity of these plants grown in three different nitrogen concentrations i.e., 10, 20, and 30 mg/L and two water temperatures of 75°F and 85°F. Increasing water temperature increased growth index for both species and increased dry weight for Asclepias speciosa. However, for Helianthus maximiliani, increasing temperature had a lesser t effect on total dry weight. The accumulation of nitrate nitrogen in plant tissue was higher in Helianthus maximiliani at the nitrate nitrogen concentration of 20 mg/L under both temperature treatments. However, in Asclepias speciosa, the accumulation of nitrate nitrogen in plant tissue was higher at the high temperature treatment of 85⁰F and 20 mg/L nitrate nitrogen concentration. The nitrate nitrogen uptake from both plants in this study indicated suggests that Helianthus maximiliani ‘maximilian sunflower’ and Asclepias speciosa ‘showy milkweed’ can be grown as FTW and be used to remove nitrogen from a nursery retention pond.
Tug of war between source and sink dynamics, evaluating soil phosphorus storage in a subtropical treatment wetland.
Authors: Julian Paul , Osborne Todd Z , NAir Vimala D
Published: July 2024

Oligotrophic wetlands of the Everglades are often the final recipients of nutrients from adjacent ecosystems and tend to accumulate phosphorus (P) in their soils. Understanding P source and sink dynamics in wetlands is critical for managing wetland ecosystems and protecting downstream resources. This study evaluated the soil P storage capacity (SPSC) of the mineral components within two treatment flow-ways of the Everglades Stormwater Treatment Areas (STAs). We hypothesized that SPSC will vary between flow-ways, with soil depth, and spatially along the inflow-to-outflow gradient. The P storage capacity in the STAs depends on the proportion of iron, aluminum, calcium, and magnesium (Fe, Al, Ca, and Mg, respectively) to P. We determined floc and recently accreted soils (RAS) are associated more with Ca and Mg and pre-STA soils are associated more with Fe and Al. Phosphorus loss, as indicated from SPSC values would vary between systems and soil depths suggesting a variable condition of P sink and source within and along flow-ways. This result, while limited, demonstrates the applicability of SPSC to wetlands systems and provides information that will aid operational or management decisions associated with improving P retention of the Everglades STAs.
Unmasking the Peril: Human-Induced Land Use Change vs. Climate Change and Their Threat to Indian Wildlife - A Case Study of Four-Horned Antelope in Indian subcontinent.
Authors: Singh Amar Paul , Dar Shahid Ahmad , Sharief Amira , Kumar Vineet , Singh Hemant , Dutta Ritam , Joshi Bheem Dutt , Banerjee Dhriti , Thakur Mukesh , Sharma Lalit Kumar
Published: July 2024

The impacts of land use change and climate change on biodiversity are significant, leading to substantial range contractions for many species globally. This effect is particularly pronounced in endemic species like the four-horned antelope (FHA), native to the Indian subcontinent. These species are vulnerable due to their low population densities and limited dispersal abilities.To understand the future habitat suitability for the FHA, we employed an ensemble modeling framework. This approach integrated landscape composition and climatic variables to predict current and future habitat changes. The FHA shows a preference for hot, dry climates and is mainly found in areas with extensive forest and grassland coverage. They avoid regions with large diurnal temperature variations. Our study revealed contrasting outcomes under different future scenarios. Under climate-only change projections, the FHA's habitat is expected to expand, with minimal range contractions across all scenarios. However, under land use change and combined scenarios, a significant decline in suitable habitats was observed. By the 2050s, climate-only models predict an 11.3% and 7.8% increase in FHA habitat under low (SSP 2.6) and high (SSP 8.5) emission scenarios, respectively. In stark contrast, land use change models forecast a 51.2% and 54.5% reduction in suitable habitats under low (SSP 126) and high (SSP 585) development scenarios, respectively. These findings highlight the critical impact of land use change on FHA habitat loss, emphasizing the need for comprehensive conservation strategies. Our study provides valuable insights into habitat suitability factors for the FHA, which are crucial for conservation and land-use management. The results underscore the urgency of implementing measures to mitigate habitat loss due to land use changes, as they pose a more immediate and substantial threat to the FHA's survival. Therefore, protecting and restoring forest and grassland areas is vital for conserving this species across its range.
3D anatomy of the Cretaceous-Paleogene age Nadir Crater
Authors: Nicholson Uisdean , Powell William , Gulick Sean , Kenkmann Thomas , Bray Veronica , Duarte Debora , Collins Gareth
Published: July 2024

The Nadir Crater offshore West Africa is a recently proposed near K-Pg impact structure identified on 2D seismic. Here we present 3D seismic data that image this crater in exceptional detail, unprecedented for any such structure, which demonstrates beyond reasonable doubt that the crater-forming mechanism was a hypervelocity impact. Seismic mapping reveals a near-circular crater rim of 9.2 km and an outer brim of ~23 km diameter defined by concentric normal faults. An extended damage zone is evident across the region, well beyond the perceived limit of subsurface deformation for impact craters, except in a ‘sheltered zone’ to the east. The seabed shows evidence for widespread liquefaction because of seismic shaking and scars and gullies formed by tsunami wave propagation and resurge. Deformation within the ~425 m high stratigraphic uplift and annular moat allow us to reconstruct the evolution of the crater, with radial thrusts at the periphery of the uplift suggesting a low-angle impact from the east. Structural relationships allow us to reconstruct the deformation processes during the crater modification stage, with the central uplift forming first, followed by centripetal flow of surrounding sediments into the evacuated crater floor in the seconds to minutes after impact.
Role of mitochondrial derived miR-1978 in nuclear genome
Authors: chen Yucai , Lin Longlong , Luo Xiaona
Published: July 2024

We identified micro RNA (miR)-1978 that may originate from the mitochondrial genome, with a nucleotide sequence that perfectly matches the partial series of DHFR, KIF5C, and MSH3 genes of the nuclear genome. Overexpression of miR-1978 in the SHSY5Y cell line reduces DHFR, KIF5C, and MSH3 mRNA and protein expression, results in a division arrest in the G1 phase of the cell cycle, the number of cells in the G2/M stage was observed to decrease, and the number of apoptotic cells increased. Cells overexpressing miR-1978 exhibit a different nuclear DNA methylation status compared to that of controls. Several Alzheimer’s disease-related proteins such as amyloid β precursor protein, Tau, p-Tau or α-synuclein (a Parkinson’s disease-related protein), were increased in SHSY5Y cells overexpressing miR-1978. Neuroid cells induced by SHSY5Y overexpressing miR-1978 using retinoic acid have been observed to lack dendritic spines.
Production of levoglucosan and levoglucosenone from cellulose using Brønsted acid catalysts in polar aprotic solvents
Authors: González-Rosario Alexa M. , Oyola-Rivera Oscar , Cardona-Martínez Nelson
Published: July 2024

Levoglucosan and levoglucosenone are important platform molecules typically produced by pyrolysis of cellulosic feedstocks. Commercial manufacture of levoglucosenone uses phosphoric acid in sulfolane to convert cellulose at high temperatures and catalyst concentrations. We report the synthesis of levoglucosan and levoglucosenone from cellulose at moderate temperatures in polar aprotic solvents using low concentrations of Brønsted acid catalysts. We discovered that the basicity of the solvents has a linear relationship with the cellulose reaction rate. The initial turnover frequency of cellulose conversion increased as the basicity of the solvent decreased. Using a flow reactor with a reactive bed to produce levoglucosan and levoglucosenone we found that moderate temperatures promoted the production of levoglucosan and levoglucosenone, whereas higher temperatures promoted degradation reactions, decreasing the yields of levoglucosan and levoglucosenone. We also found that catalysts with high pKa (lower strength) only promoted the production of levoglucosan and its isomerization, whereas using a catalyst with a low pKa (higher strength) favored subsequent reactions and degradation products, like when we used high temperatures. At 430 K with a flow rate of 1.5 mL/min of 5 mM sulfuric acid in γ-valerolactone, we found yields of up to 34 and 24 wt% for levoglucosan and levoglucosenone, respectively.
Xylooligosaccharides as a tool for sugarcane bagasse valorization: integrated biorefinery modeling, simulation and Life Cycle Assessment
Authors: Longati Andreza Aparecida , Manicardi Taina , Giordano Roberto C. , Milessi Thais S.
Published: July 2024

A critical strategy for the viability and sustainability of lignocellulosic crops is the inclusion of high-value bioproducts in a biorefinery's portfolio. In this context, the production of xylooligosaccharides (XOS) from the underutilized hemicellulose fraction is an interesting option for valorization of the sugarcane bagasse. In this work, a life cycle assessment (LCA) of the XOS production attached to a sugar mill with self-sufficient energy supply was performed, aiming to determine the XOS integration sustainability biorefinery product. The LCA scope was set as cradle-to-gate using 1 kg of XOS as functional unit according to the standardized ISO procedure considering CML Baseline method. The plant was able to produce 4.7 kg/h of 90.3% (w/w) XOS from 0.7 t/h of sugarcane bagasse with GWP estimated as 6.31 kgCO2eq/kgXOS. Hydrolysis and pretreatment stages were responsible for most part of the environmental footprint due to the chemicals and utilities that were used. Sensitivity analyses showed that energy-related variables had the greatest impact on environmental performance, accounting for a significant proportion of environmental impacts in almost all categories. Comparing with other valuable molecules, XOS was found to be an important alternative for the valorization of the underutilized hemicellulose fraction of the lignocellulosic material. Overall, the use of XOS in the sugarcane biorefinery and the integration of energy in the process were found to be crucial for the sustainability of the process and valorization of the sugarcane bagasse with the integration of energy into the XOS production process as key factor in improving its sustainability and productivity.
Spatial Disparities and Determinants of Modern Contraceptive Use Among Reproductive Age Women in Ethiopia: Application of Multilevel Spatial Analysis
Authors: Fenta Wondaya , Muchie Bisrategebrial Tesfay , Kassie Maru Zewdu , Asfaw Muluhabet Alene
Published: July 2024

Background
Contraception involves the intentional prevention of conception or pregnancy during sexual activity. Globally, unintended pregnancies can occur due to the non-use, misuse, or failure of modern contraceptive methods. Non-use of modern contraceptives is a significant contributor to maternal and infant mortality rates in Sub-Saharan Africa, including Ethiopia. Hence, the main purpose of this study was to determine the factors of modern contraceptive use among reproductive-age women in Ethiopia.
Method
The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset with 8,196 weighted samples of reproductive women aged 15 to 49 was used. Data management was done using STATA version 17 software, R version 4.2.2, and Arc GIS 10.8 software was used for mapping. To investigate the determinants factor, we used both multilevel and spatial analysis.
Results
In this study, 26% of women used modern contraceptives, with significant spatial clustering (Global Moran’s Index = 0.237776, p < 0.001). Hot spot areas were observed in Benishangul gumuz, Gambela, SNNP, and Eastern parts of the Oromia region. The model that includes individual-level, community-level variables, and spatial auto covariate variables was the best-fitted model for the data based on lower AIC and BIC fit statistics compared to the other models. The estimated intra-class correlation coefficient (ICC) indicates that 15.57% of the total variability for modern contraceptive use was due to the difference between clusters, leaving 84.43% of the variability to be accounted for the women or other unknown factors. The estimated odds of women at a higher educational level using modern contraceptives were 91.9% higher than the estimated odds of women with no education.
Conclusions
This study revealed that the use of a modern contraceptive method among women varies across the clusters. There is a low magnitude of modern contraceptive use among women in Ethiopia. Based on the result of the selected model, Women’s Aged (25–34), educated, married, living in Amhara Region, having higher community education, and having higher community wealth index were positively associated with the use of modern contraceptive methods. While the women aged 35–49, having 3 or more children, living in Somali Region were negatively associated with the use of contraceptive methods. The intervention measures should be undertaken by the concerned body at the community level to enhance the use of modern contraceptive methods among women across the clusters.
Tuning Vision Foundation Models for Rectal Cancer Segmentation from CT Scans: Development and Validation of U-SAM
Authors: Wan Shouhong , zhang hantao , Guo Weidong , Zou Bingbing , Wang Wanqin , Qiu Chenyang , Liu Kaige , Jin Peiquan , yang jiancheng
Published: July 2024

Background: Rectal cancer segmentation in CT is crucial for timely diagnosis. Despite promising methods, challenges remain due to the rectum's complex anatomy and the lack of a comprehensive annotated dataset.
Methods: A total of 33,024 slice pairs from 398 rectal cancer patients in a new source center are enrolled into our dataset, named CARE Dataset, with pixel-level annotations for both normal and cancerous rectum tissue. We split it into 317 cases for training and 81 for testing. Additionally, we introduce a novel segmentation model, U-SAM, designed to handle the complex anatomy of the rectum by incorporating prompt information. Segmentation performance for normal and cancerous rectum is evaluated using Intersection-over-Union (IoU) and Dice Coefficient (Dice). With the assistance of 46 clinical practitioners, an observer study is conducted to benchmark the U-SAM with human performance and evaluate its clinical applicability. The original new source 398 CT scans and our code are openly available for research.
Findings: Our method achieves Dice of 71.23% for normal rectum and 76.38% for rectal tumor, with IoU of 55.32% and 61.78%, respectively, surpassing state-of-the-art methods. The observer study validates that U-SAM can produce diagnostic results comparable to those of highly experienced doctors in just 3 seconds of inference time in clinical settings.
Conclusions: The proposed U-SAM offers an efficient and reliable method for segmenting rectal cancer and normal tissue, significantly reducing time in clinical settings and effectively assisting radiologists. We believe this initial exploration in CT-based rectal cancer segmentation will be instrumental for future diagnosis.
I-RANT: Training Session on Novel, Scripted, Bystander Microaggression Intervention Tool for Medical Students
Authors: Grass Emily , Astemborski Caroline , Lewis James
Published: July 2024

Background: Microaggressions, subtle and often unintentional acts of hostility, have been recognized as a significant issue in healthcare, adversely affecting learners’ emotional and physical well-being. Current strategies for addressing microaggressions are broad frameworks without empirical substantiation that leave learners without a clear direction for intervention. This study introduces a novel scripted, succinct, bystander intervention tool to combat microaggressions. The intervention tool, named I-RANT, follows the script of introduction, role naming, affirming the target, negating the microaggression, and transitioning. The study goal was to assess the ability of a training session to impact learners’ recognition of microaggressions, confidence in intervening, and competency in applying the I-RANT tool.
Methods: A pre-experimental study was conducted in November 2023 with 97 second-year medical students at a large academic center in the Southeast United States. The I-RANT tool was taught through a 90-minute training session. The session included an introduction lecture, small group discussions, and role-play scenarios. Pre- and post-intervention surveys assessed microaggression recognition via a multiple-choice questionnaire (MCQ) and self-reported confidence in intervening on a Likert scale. Differences were compared via paired T-test. Role-play scenarios were observed by trained faculty and graded for competence using a rubric.
Results: Participants showed significant improvement in microaggression identification with increase in MCQ score from 4.17 pre-intervention to 4.74 post-intervention (p < 0.001) and increased self-reported confidence from 3.2 to 4.2 (p < 0.001). Trained faculty evaluated a random sampling of students’ role-play scenarios (n=30) revealing that 97% of sampled students demonstrated competence in utilizing the I-RANT tool.
Discussion: The I-RANT training session empowered learners to address microaggressions, fostering inclusive learning environments and enhancing well-being. Learners demonstrated a statistically significant improvement in recognition of microaggressions and confidence in intervening. The majority of learners demonstrated competency in utilizing the I-RANT tool by the end of the training session.
Conclusions: This study supports the effectiveness of our training session in enhancing medical students’ ability to recognize and address microaggressions. I-RANT empowers learners with a tool to intervene against microaggressions contributing to more inclusive and supportive healthcare environments, ultimately promoting cultural empathy, and improving the well-being of all healthcare team members.
APOE4 and sedentary lifestyle synergistically impair neurovascular function in the visual cortex of awake mice
Authors: Hall Catherine , Anderle Silvia , Bonnar Orla , Henderson Joseph , Shaw Kira , Chagas Andre , McMullan Letitia , Webber Alexandra , Mcgowan Kirsty , King Sarah
Published: July 2024

Reduced cerebral blood flow occurs early in the development of Alzheimer’s disease (AD), suggesting an impairment in how the brain maintains its energy supply may contribute to disease onset. The ε4 allele of the Apolipoprotein (APOE) gene, the strongest risk factor for late onset AD, alters cerebrovascular function, increasing blood-brain barrier permeability. However, reports are mixed as to whether it affects cerebral blood flow regulation, and therefore could contribute to the altered cerebral blood flow observed early in disease. We hypothesised that APOE4 genotype increases risk of vascular dysfunction but requires additional factors to generate a significant reduction in the brain’s regulation of its blood supply that could promote dementia.
To test this, we asked whether a modifiable lifestyle factor, physical activity, affected cerebrovascular and neuronal function in APOE3 and 4 targeted replacement (TR) mice. We used in vivo two-photon microscopy and haemodynamic measures to record neurovascular function from the visual cortex of APOE3 and APOE4-TR mice that were physically active or sedentary.

Energy supply and demand were mismatched in APOE4 mice, with smaller increases in cerebral blood flow, blood volume and blood oxygenation observed during neuronal activation as blood vessels failed to adequately respond to increased neuronal energy needs. Exercise dose-dependently overall improved neurovascular function, with an increased impact of exercise apparent at later ages. Several haemodynamic measures showed a larger beneficial effect of exercise in APOE4 vs. APOE3 mice.
Thus, APOE4 genotype in conjunction with sedentary behaviour produced the worst neurovascular function, which was improved by physical activity. Our results support the requirement for APOE4 genotype to combine with other factors to produce large deficits in cerebrovascular function and suggest that promotion of physical activity may be particularly important to improve cerebrovascular function and potentially to reduce dementia risk in APOE4 carriers.
Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture
Authors: Zhao Hongxian , Wang Zijia , Yang Mingming , Liang Anlin , Gao Shichang
Published: July 2024

Objective
The aim of this study is to compare the efficacy of plate fixation via the tarsal sinus approach with screw fixation alone in treating Sander type II, III, and IV fractures.
Method
Between 2016 and 2023, a comprehensive study encompassing 73 patients and 78 feet with calcaneus fractures was conducted. The investigation compared the efficacy of open reduction plate fixation (ORPF) (18 cases) against open reduction screw fixation (ORSF) (60 cases). Parameters such as operation duration, intraoperative blood loss, hospital stay duration, postoperative imaging metrics (including calcaneal length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus), postoperative complications, and the AOFAS score one year post-surgery were meticulously analyzed and compared across both treatment groups.
Results
No significant discrepancies were observed between the two groups concerning calcaneal dimensions, including length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus post-operation (p > 0.05). Moreover, throughout the long-term postoperative monitoring period, no notable distinctions were evident in these parameters between the two groups. Notably, the ORSF group exhibited reduced intraoperative hemorrhage (p = 0.026), shorter procedural duration (p = 0.028), and fewer occurrences of postoperative complications such as pain or superficial infections. However, the incidence of long-term postoperative complications did not demonstrate statistical significance. Furthermore, there were no discernible variations in AOFAS scores between the groups at the latest follow-up assessment.
Conclusion
Both open reduction screw internal fixation and open reduction plate internal fixation have been shown to be effective methods for clinically treating calcaneal fractures, with both techniques yielding positive postoperative imaging results. However, internal fixation with open reduction screws has been found to have several advantages over open reduction plate internal fixation, including less bleeding, shorter operation time, and fewer short-term complications.
Upper-Gastrointestinal Tract Metabolite Profile Regulates Glycaemic and Satiety Responses to Meals with Contrasting Structure
Authors: Frost Gary , Cai Mingzhu , Tejpal Shilpa , Tashkova Martina , Ryden Peter , Moral Natalia Perez , Saha Shikha , Garcia-Perez Isabel , Contreras Jose Ivan Serrano , Wist Julien , Holmes Elaine , Bernal Andres , Dou Bowen , Becker Georgia , Edwards Cathrina
Published: July 2024

Dietary interventions to combat non-communicable diseases focus on optimising food intake but overlook the influence of food structure. Food processing often causes the loss of foodstructure, but how this influences human gastrointestinal digestion and the signals it generates, such as gut hormones that affect homeostatic mechanisms is unclear. In this randomised cross-over study, 10 healthy participantsconsumed iso-nutrient chickpea meals with contrasting cellular structures and underwent gastric, duodenal, and blood sampling. Here, we reported that the ‘Broken’ and ‘Intact’ cell structures of meals resulted in different digestive and metabolomic profiles, leading to distinct postprandial glycaemia, gut hormones, and satiety responses. ‘Broken' meal resulted in high starch digestibility and a sharp rise in gastric maltose within 30 minutes, which acutely elicited higher blood glycaemia, GIP, and GLP-1. ‘Intact’ meal produced a prolonged release of appetite-suppressing hormones GLP-1 and PYY, elevated duodenal amino acids, and undigested starch at 120 minutes. This work highlights how plant food structure alters upper gastrointestinal-nutrient-sensing hormones, providing insights into the adverse effects of modern diets on obesity and type 2 diabetes.
Engineering Properties of Expansive Clay Soils with Sustainable Stabilization Methods
Authors: Navagire Omkar Prakash , V. Srinivasan , Sharma Shashi Kant
Published: July 2024

The production of Industrial waste is increasing day by day in many countries around the world. One of the industrial wastes is Coal Bottom Ash (CBA) which is a coal combustion by-product of thermal power plants, which is categorized as creating environmental pollution if it is not disposed of properly. The objective of the present study is to evaluate the compressive strength and bearing capacity of Black Cotton (BC) soil/Subgrade soil by conducting the Unconfined Compressive Strength (UCS) test and California Bearing Ratio (CBR) test. In the present study, a total of 20 combinations of mix proportions were prepared using the following materials: BC soil, Coal Bottom Ash (CBA), and Wollastonite Microfiber (WMF). The mix proportions involved replacing BC soil with (10%, 20%, 30%, and 40%) CBA and (5%, 10%, and 15%) WMF. Samples were prepared by following the curing process for up to 28 days for UCS testing. The results of standard Proctor tests reveal that the addition of CBA and WMF leads to a decrease in the Optimum Moisture Content (OMC) and an increase in the Maximum Dry Density (MDD). It is also observed that the swelling of the soil reduces drastically with the addition of CBA and WMF mixture. Engineering behaviour delineates the corresponding increase in UCS and CBR values with the increase in mix proportions of CBA-WMF mixes. Assessment of the UCS and CBR values confirms that the utilisation of the CBA and the WMF in Subgrade soil stabilisation provides improved engineering behaviour to deploy in several construction applications.
The perceptions of Dutch General Practitioners on the implementation of a Proactive Integrated Care Approach for Hotspotters
Authors: Leming Kimberley A. , Gestel Laurens C. , Bruijnzeels Marc A. , Vos Rimke C. , Adriaanse Marieke A.
Published: July 2024

Background.
For a subgroup of patients with complex health problems called “Hotspotters”, a new proactive and integrated care (PIC) approach in the primary care setting is being developed to stimulate health improvement among these patients. To ensure sustainable implementation of this approach it is important to study implementation outcomes in preliminary implementation phase. In this study, we explore whether general practitioners (GPs) recognise Hotspotters patients, their needs, and how they perceive the acceptability, appropriateness, and feasibility of the PIC approach.
Methods. GPs were recruited in the regions of Utrecht and The Hague in the Netherlands. They filled in a questionnaire on recognition of Hotspotters, Hotspotters’ needs, acceptability, appropriateness, and feasibility.
Results. Most GPs (90.90%) recognise Hotspotters as a patient group, but only 42.90% are aware of their needs. Also, most GPs (80.90%) agreed that care change is needed. Furthermore, only 4.50% of GPs did not find the PIC approach acceptable, while a larger percentage reported to disagree on the appropriateness (22.70%) and feasibility (22.70%). Conclusions. Most of the GPs recognise Hotspotters, are somewhat aware of their needs, open for care change and would consider adopting the PIC approach if it was made to be more feasible.
The characteristics of coronary arteries in angiography of women; a national-based registry in Iran
Authors: Kermani-Alghoraishi Mohammad , Arani Hamid Reza Bandshahi , Mansouri Asieh , Taheri Marzieh , Safaei Ali , Farshidi Hossein , Kazemi Tooba , Assareh Ahmadreza , Kojuri Javad , Khaledifar Arsalan , Sadrnia Saeed , Ghaffari Samad , Khosravi Alireza
Published: July 2024

Introduction:The current study aims to investigate the characteristics of coronary artery angiography (CAG) and the contributed factors to coronary artery disease (CAD) in women.Methods:The current cross-sectional study is derived from a national registry on cardiovascular disease known as the Persian cardiovascular disease registry (PCVDR). The demographic, medical, clinical and angiographic data of 39207 women underwent CAG have been retrieved.Results:Traditional CVD risk factors and the past medical history of cardiovascular events were statistically higher among those who aged over 50 years old (P-value<0.05) except smoking (P-value<0.001) and obesity (P-value<0.001) that were remarkably higher among younger subjects. Normal epicardial coronary artery was remarkably higher among younger women (49.1%) compared to those aging more than 50 years old (20.1%) (P-value<0.001). Regardless of age, LAD, RCA and LCX territories were involved with severe stenosis accounting for 58.8%, 37.7% and 36.2% of the individuals, respectively. Ectasia, aneurysm, calcified artery, thrombus formation and ostial lesion were remarkably higher among older individuals (P-value<0.05), but dissection was statistically higher in young women (P-value=0.012). The severity of coronary arteries involvement was associated with advanced age, diabetes mellitus, hypertension, dyslipidemia and smoking (P-value<0.05); while obesity had an inverse association (P-value<0.001).Conclusion:Based on the findings of this study, women aging more than 50 years old are prone to be hospitalized for CVDs, require more intensive cardiac intervention and have more severe CAD involvements found in CAG. Age, diabetes mellitus, hypertension, dyslipidemia and smoking were remarkably associated with more severe CAD; however, obesity had paradoxically an inverse association.
Multimorbidity and tooth loss: Data from Chilean National Health Survey 2016-2017
Authors: Santos-López Matías , Gómez Priscila , Margozzini Paula , Ortuño Duniel
Published: July 2024

Background: Oral diseases are a significant global public health challenge. Current evidence indicates that several chronic conditions are individually associated with tooth loss. Currently, people are living with more than one chronic condition, known as multimorbidity. This study aimed to evaluate the association between multimorbidity and tooth loss in the Chilean population, considering the common risk factors for oral and chronic diseases.
Methods: Cross-sectional study with secondary data from the latest Chilean National Health Survey (ENS 2016-17). The number of remaining teeth was classified into four groups: functional dentition (≥20 remaining teeth), moderate tooth loss (10 to 19 remaining teeth), severe tooth loss (1 to 9 remaining teeth), and edentulism if there were no remaining teeth. Multimorbidity was defined based on the number of chronic conditions present as a binary variable (MMC≥2) and as a 4-level categorical variable (MMCG0-G3). The sample was divided into <65 and ≥65 years for statistical analysis. Mean and SD were calculated for crude and adjusted remaining teeth. Poisson regression models with robust variance, crude and adjusted for sex, age, geographic area, and educational level, were fitted to calculate the prevalence ratio between multimorbidity and tooth loss.
Results: The study sample was 4,151 individuals between the ages of 18 and 98. Adults aged <65 years with multimorbidity have a 1.07 times higher prevalence of moderate tooth loss (95% CI 0.84; 1.36), 1.12 times higher prevalence of severe tooth loss (95% CI 0.67; 1.89), and a 0.92 times lower prevalence of edentulism (95% CI 0.39; 2.20). Adults aged ≥65 years with multimorbidity have 1.13 times higher prevalence of moderate tooth loss (95% CI 0.94; 1.37), 1.66 times higher prevalence of severe tooth loss (95% CI 1.04; 2.66), and 1.26 times higher prevalence of edentulism (95% CI 0.76; 2.08).
Conclusions: There was an association between multimorbidity and tooth loss in the Chilean population, resulting in a higher prevalence of moderate tooth loss, severe tooth loss and edentulism in those with higher number of chronic diseases. This association was more robust in adults aged ≥65 years.
Automated Structural Integrity Assessment of Bridges: A Deep Learning Fusion Methodology
Authors: Alseid Bara , Seo Hyungjoon
Published: July 2024

This study presents a detailed evaluation of two advanced deep learning methodologies, Sequential Feature Isolation (SFI) and Filtration-Based Structuring (FBS), for classifying and analysing structural elements such as cracks, bricks, and joints in Silver Jubilee Bridge models. The SFI method employs successive stages of CANUPO analysis followed by dip angle filtration, whereas the FBS method begins with dip angle filtration before proceeding with CANUPO analysis. A critical aspect of this research is optimizing the Local Neighbour Radius (LNR) for dip angle filtration. By testing LNR values ranging from 0.01m to 0.025m, the study identified 0.01m, paired with an 80-degree dip angle, as the optimal setting, significantly enhancing filtration precision. The application of these methods on large-scale models demonstrated their scalability and effectiveness. The SFI and FBS method effectively reduced the number of brick points by an average of 99% and joint points by 90%, while retaining 28% of crack points crucial for shaping crack configurations. The comparative analysis revealed that the SFI method is ideal for projects requiring high precision and detailed feature isolation, whereas the FBS method is better suited for tasks needing a broader retention of structural details. The study underscores the importance of selecting the appropriate method based on specific research objectives and provides clear guidelines for method selection and structural feature analysis. This comprehensive approach enhances the precision and reliability of structural assessments, offering significant contributions to the field of geological and structural analysis.
Box-Behnken design-based development of eco-friendly RP-HPLC analytical method for the quantification of erastin from the mesoporous silica nanoparticles
Authors: Gupta Ashutosh , P Rachana S , Moorkoth Sudheer , Dhas Namdev
Published: July 2024

The current work aims to optimize, stablish, validate a high-performance liquid chromatography (HPLC) method that possesses sufficient sensitivity and specificity to measure erastin (ERT) in mesoporous silica nanoparticles. The HPLC method was optimized using Design of Experiments (DoE) technique. The Box-Behnken design (BBD) was used and buffer ratio, injection volume, buffer pH, and flow rate were used as the independent factors. The dependent variables were retention time (Rt) of ERT, peak area of ERT, and tailing factor (Tf) of ERT. The optimized chromatographic condition were: buffer ration 80%, buffer pH 3.8 and flow rate 0.9 mL/min, and injection volume 8 µL. The established HPLC method was validated as per ICH Q2 (R1) recommendations. The established method showed the good linearity (R2 = 0.9991) having a range of 12–500 ng/mL and LOD and LOQ was 2.71 ng and 6.25 ng, respectively. The mesoporous silica nanoparticle (MSN) matrix did not affect the specificity of our validated RP-HPLC method of analysis for ERT. Analysing the formulation's surface morphology helped with the confirmation of the synthesized MSNs. The proposed RP-HPLC method was effectively used to calculated the medication loaded in the MSNs as well as to measure the amount of ERT entrapped. The % EE for ERT in MSNs was found to be 76.07% and % DL for ERT in MSNs was found to be 14%, respectively. The established HPLC method was found ecofriendly as per the AGREE analysis.