bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Logistics Curriculum and Recruitment Requirements Based on Text Mining: A Case Study of China
Authors: Li Ziyao , Jia Xiaobo
Published: April 2024

This study aims to explore the logistics curriculum and the recruitment requirements and to compare the relationship between the two systems. Text mining is applied to collect data from an online recruitment website, extract latent topics, and dynamically visualize the extracted latent topics. The online and on-site survey is conducted to collect logistics curriculum syllabi from 29 selected universities in China. This study demonstrates that (1) The logistics curriculum direction in China mostly meets the employment demands; (2) The curriculum distribution does not fully match the employment demands. That is, knowledge areas of general management and logistics IT are over-supplied, whereas knowledge areas of transportation and distribution are under-supplied. It is suggested that to balance the actual talent demands, Chinese higher education should increase the courses concerning transportation and distribution and appropriately reduce the courses related to logistics IT, and universities need to apply course modules into the logistics curriculum revision to meet the changes in the demand of the employment market.
Influence of Online to Offline on a Chain Store: Two Moderated Mediation Models Investigation
Authors: Liao Shu-Hsien , Hu Da-Chian , Liu Hui-Ling
Published: April 2024

In the online to offline (O2O) model, online marketing and online purchases drive offline (non-Internet) operations and offline consumption. E-commerce must use more effective methods in combination with offline physical stores for consumers to obtain better online services. However, if there are positive effects from offline from customers on the re-purchase, it can generate a positive power return to online. In addition, could online to offline moves on a path that have either stronger or weaker influence of re-purchase on chain stores with customers’ electronic word-of-mouth and online involvement? To understand the influence of O2O on chain stores, this study investigates the relationships between chain store brand images, perceived value, customer satisfaction and re-purchase intention on offline considerations in a Taiwan telecom chain store ( N = 1,602). The research results find that customer satisfaction plays a fully mediating role. In addition, electronic word-of-mouth and online involvement play two moderating roles on the relationships between chain store brand image, perceived value, customer satisfaction, and re-purchase intention respectively. Finally, theoretical and practical implications, conclusion, limitations and future research are presented.
Incidence and Predicting Factors of Opportunistic Infections after Antiretroviral Therapy Initiation among Treatment-naïve Patients with HIV Infection: A Retrospective Cohort Study in A Tertiary Care Hospital
Authors: Wongkittipong Prapon , Kiertiburanakul Sasisopin
Published: April 2024

Objectives

To determine the incidence of opportunistic infections (OIs) and the predictive factors for the development of OIs after antiretroviral therapy (ART) initiation among treatment-naïve patients with HIV infection.

Results

Of 401 HIV-infected patients, 38 (9.5%) HIV-infected patients developed OIs after initiating ART, with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to OI occurrence was 26.5 (14-73) days. In multivariate Cox proportional hazard regression, body mass index ≤18.5 kg/m2(adjusted hazard ratio [aHR] 2.28, 95% confidence interval [CI] 1.18-4.42, P = .015), symptoms at presentation (aHR 13.59, 95% CI 3.24-56.9, P < .001), serum glutamate-pyruvate transaminase >55 U/L (aHR 2.09, 95% CI 1.06-4.15, P = .035), and initiation of a dolutegravir-based regimen (aHR 4.39, 95% CI 1.54-12.48, P = .006) were significantly associated with OIs after ART initiation.

Conclusion

OIs after ART initiation are common. Malnutrition, symptomatic presentation, abnormal liver enzymes, and DTG-based regimens are predictors of OI occurrence after ART initiation. Physicians must monitor and appropriately treat OIs after ART initiation.
Assessing the Level of Electrocardiographic Interpretation Competency among Emergency Nurses in Palestine
Authors: Obied Rawan Nedal Abu , Salameh Basma , Ayed Ahmad , Harazni Lobna , Fashafsheh Imad , Zaben Kefah
Published: April 2024

Introduction

The use of electrocardiograms (ECGs) is widespread among emergency room (ER) nurses for diagnosis and triage, making it crucial for them to have the appropriate level of competency in interpreting ECGs. This can lead to better healthcare and patient outcomes.

Objectives

This study aims to assess the competency level of emergency nurses in Palestine in interpreting normal ECG and certain cardiac arrhythmias, and to explore the association between socio-demographic characteristics and their ECG interpretation competency.

Methods

The study used a cross-sectional descriptive design, and 196 ER nurses were conveniently recruited to fill out a self-administered questionnaire based on previous literature. The data collected were analyzed using SPSS with strict adherence to ethical considerations.

Results

The results showed that 70.9% of the nurses were males, 65.3% held a bachelor's degree in nursing, 46.9% had 1–5 years of experience, and 60.7% had received previous courses on ECG interpretation. The mean competency level of the ER nurses was satisfactory at 60.714%, but 38.8% had a poor level of competency. This was significantly higher among nurses with higher educational levels ( p-value < 0.001), those who had taken previous ECG courses ( p-value = 0.045) and life support ( p-value < 0.05), and those who were exposed to more ECG interpretations per day ( p-value = 0.001).

Conclusion

There is a need to focus more on ECG competency levels in Palestinian literature and compare them between different departments. It is also essential to evaluate nurses’ needs for continuous education.
“What choice do you have knowing your child can’t breathe?!”: Adaptation to Parenthood for Children Who Have Received a Tracheostomy
Authors: Ledin Ellinor Rydhamn , Eriksson Andrea , Mattsson Janet
Published: April 2024

Introduction

A growing number of parents are navigating parenthood influenced by medical complexity and technological dependency as the group of children with long-term tracheostomy grows. However, little is known regarding the parental experiences of parenthood for this heterogeneous group of children now surviving through infancy and intensive care.

Objective

This study aimed to analyze how parents of children who have received a tracheostomy adapted to parenthood.

Methods

Interviews were conducted and analyzed following a constructivist grounded theory approach. Ten parents of seven children living with a tracheostomy in Sweden were recruited via the long-term intensive care unit (ICU).

Results

The core variable of parenthood “Stuck in survival” was explained by two categories and six subcategories. The category “Unaddressed previous history” describes the experiences from being in the ICU environment and how the parents are not able, due to insufficient time and resources, to address these stressful experiences. The category “Falling through the cracks of a rigid system” describes how the parents found themselves and their children to be continuously ill-fitted in a medical system impossible to adapt to their needs and situation. Parents placed the starting point of parenthood with the birth of the child, whilst the tracheotomy only constituted a turning point and would lead to the loss of any previously held expectations regarding parenthood.

Conclusion

This study identified a previously undescribed period prior to tracheostomy placement, which may have long-lasting effects on these families. The care provided in ICUs following the birth of a child who will require tracheostomy may not be tailored or adapted to accommodate the needs of these families leading to long-lasting effects on parenthood.
Evaluation of autologous fat grafting in the treatment of juvenile localized scleroderma with facial involvement
Authors: Sander Louise , Foeldvari Ivan , Glaser Daniel , Klotsche Jens , Stier Rebecca , Roldán Juan Camilo
Published: April 2024

Objectives:

The objective of this study was to evaluate the effect of autologous fat grafting in patients with juvenile localized scleroderma with facial involvement.

Methods:

We retrospectively studied patients with juvenile localized scleroderma who were followed at the Hamburg Center for Pediatric and Adolescent Rheumatology at least 6 months post-operative follow-up and received at least one autologous fat transplantation for a facial lesion. Autologous fat grafting was conducted independent of disease-modifying treatment and/or disease activity. The effectiveness of the intervention was evaluated by assessing the immediate volume enhancement after injection of fat tissue compared with volume retained after 6 months. The volume enhancement was calculated from three-dimensional photo images analyzed in Mirror Medical Imaging Software, Canfield Scientific (New Jersey, USA).

Results:

Data of 22 juvenile patients were assessed from March 2006 to September 2021. In six patients, the photos could not be evaluated for the study. The median age of the remaining 16 patients at the beginning of the first fat graft was 8 years (range = 2.5–22 years). Patients underwent mean three interventions (range = 1–9). Evaluation of three-dimensional images showed that the volume retention at 6 months post autologous fat grafting is approximately 50%. The Modified Localized Scleroderma Skin Severity Index value did not correlate to volume changes at 6 months. In 4 of 16 patients, a decrease of the Localized Scleroderma Damage Index occurred. In all seven patients with cheek involvement, mean tragus-nose distance difference decreased (mean decrease 1.09 cm). We did not observe any significant clinical side effects.

Conclusion:

In this first bigger pediatric case series, the mean facial lesion volume increased around 50% after a mean of three interventions at 25 months of follow-up. No flares of the underlying disease were noted. Autologous fat grafting is a promising method to improve the cosmetic appearance of those patients.
Parkinson's Disease Psychosis and the Marketing of Pimavanserin
Authors: Daeschler Daisy , Fugh-Berman Adriane
Published: April 2024

In 2016, Nuplazid (pimavanserin) became the first FDA-approved treatment for Parkinson's Disease Psychosis (PDP). We explored the possibility that PDP was a term created to market Nuplazid. We examined trends in perceptions of psychosis in Parkinson's disease from the 1990s to 2020 through MEDLINE search term frequency, neurology textbooks, guidance from professional societies, Acadia annual reports, sponsored websites, and a sponsored meeting held by the National Institutes of Health (NIH). We analyzed continuing medical education (CME) activities on PDP and analyzed the connection between payments by the manufacturer of pimavanserin and prescriptions. Our analysis of nine sponsored CME activities reveals misleading themes, including: PDP is common, progressive, and not always drug-induced; there is no such thing as a benign hallucination, and psychotic symptoms always worsen; PDP increases mortality; and competing treatments are ineffective or dangerous while pimavanserin is safe and effective for treating PDP. Industry-sponsored CME was used to disseminate inaccurate and misleading marketing messages on psychosis related to Parkinson's disease. Some professional societies and some textbooks also resisted the PDP label. Reframing PDP as a unique condition is a typical example of condition branding. The establishment of PDP expanded the use of pimavanserin and is likely to have resulted in many avoidable deaths.
School-Based Screening and Brief Intervention for Adolescent Substance Use With Telehealth-Delivered Case Consultation and Education
Authors: Vidal Carol , Kezar Annastasia , Platt Rheanna , Owczarzak Jill , Hammond Christopher J.
Published: April 2024

Background:

Screening, brief intervention, and referral to treatment (SBIRT) is a public health framework for addressing adolescent substance use. Implementation of SBIRT in schools carries the potential to improve substance use treatment access and service acceptance for students, but faces barriers related to knowledge deficits, low comfort, and lack of training in screening and brief interventions among school-based mental health (SBMH) providers. This report describes the development and acceptability evaluation of a school-based SBIRT program designed to overcome common implementation barriers of SBIRT related to provider confidence, knowledge, and training deficits by supplementing the traditional model with telehealth-delivered addiction consultation and education (ACE).

Methods:

Program components include core SBIRT trainings, telehealth-delivered ACE sessions, and outreach support for SBMH providers. Each ACE session included a didactic expert presentation on a clinical topic and a provider-presented patient case with discussion. Sessions were delivered using a Project ECHO-based hub-and-spoke format with monthly 1-hour virtual meetings. Interviews and surveys with SBMH providers on substance use screening and intervention practices and perceived barriers were used to inform program design choices and tailor the curriculum. Acceptability data were collected at 9 months.

Results:

SBMH provider participants reported increased confidence, knowledge, and evidence-based screening and early intervention practices, and high acceptability, satisfaction, and benefit from the program. Ongoing barriers to referral to treatment were reported.

Conclusion:

This pilot study suggests that supplementing traditional SBIRT with telehealth-delivered ACE sessions can address common implementation barriers and serve as a scalable model to improve SBIRT adoption in schools.
Buprenorphine Enhanced Taper Tolerability Evaluation Report (BETTER): A Case Series
Authors: Epland Claudia , Pals Haley , Hayden John
Published: April 2024

Background:

Discontinuing sublingual buprenorphine (SL-BUP) has been identified by some patients as a potential outcome of success for opioid use disorder treatment. The process of tapering SL-BUP can be lengthy as unpleasant opioid withdrawal symptoms limit the pace of dose adjustments. Uncontrolled withdrawal symptoms pose a risk for return to illicit opioid use and more patient-centered options for tapering SL-BUP are needed. Previous case reports have identified using extended-release subcutaneous buprenorphine (ER-BUP) to minimize withdrawal symptoms as the dose self-decreases very gradually. Ideal dosing strategies, appropriate patient characteristics, and duration of buprenorphine release with the ER-BUP injection are not well described.

Patient Cases:

We present 8 cases where a single 100 mg ER-BUP injection was administered to patients experiencing intolerable withdrawal symptoms during SL-BUP taper. Patients were taking between 2 and 6 mg SL-BUP daily prior to injection. Three patients experienced mild adverse effects the day after receiving injection, all of which were taking lower SL-BUP doses (2-3 mg). In the 12 months following injection, 3 patients experienced mild, but tolerable withdrawal symptoms at variable intervals. Two patients returned to taking SL-BUP and no patients returned to illicit opioid use. Buprenorphine urine toxicology showed elimination of buprenorphine occurred after 24 weeks.

Discussion:

Findings from these cases support current evidence-based guidance that ER-BUP tapering is better tolerated than traditional SL-BUP tapering. These patient cases and pharmacokinetic modeling of ER-BUP suggest that a target preinjection dose of 2 to 6 mg SL-BUP will minimize the risk of more severe adverse effects or withdrawal symptoms. Patients and providers should ensure that remission is well-established before initiating SL-BUP taper. A shared decision-making approach can help support patient autonomy and understanding safety risks of discontinuing SL-BUP. Future prospective studies with larger populations could further refine dosing strategies with various SL-BUP preinjection doses and newer ER-BUP formulations.
Distinguishing ASH clinical practice guidelines from other forms of ASH clinical advice
Authors: Cuker Adam , Kunkle Robert , Bercovitz Rachel S. , Byrne Michael , Djulbegovic Benjamin , Haberichter Sandra L. , Holter-Chakrabarty Jennifer , Lottenberg Richard , Pai Menaka , Rezende Suely M. , Seftel Matthew D. , Silverstein Roy L. , Terrell Deirdra R. , Cheung Matthew C.
Published: April 2024

The American Society of Hematology (ASH) develops a variety of resources that provide guidance to clinicians on the diagnosis and management of blood diseases. These resources include clinical practice guidelines (CPGs) and other forms of clinical advice. Although both ASH CPGs and other forms of clinical advice provide recommendations, they differ with respect to the methods underpinning their development, the principal type of recommendations they offer, their transparency and concordance with published evidence, and the time and resources required for their development. It is crucial that end users be aware of the differences between CPGs and other forms of clinical advice and that producers and publishers of these resources use clear and unambiguous terminology to facilitate their distinction. The objective of this article is to highlight the similarities and differences between ASH CPGs and other forms of ASH clinical advice and discuss the implications of these differences for end users.
Somatic mutations in FAS pathway increase hemophagocytic lymphohistiocytosis risk in patients with T- and/or NK-cell lymphoma
Authors: Liu Ying , Sardana Rohan , Nemirovsky David , Frosina Denise , Jungbluth Achim , Johnson William T. , Vardhana Santosha , Arcila Maria , Horwitz Steven M. , Derkach Andriy , Dogan Ahmet , Xiao Wenbin
Published: April 2024

Although significant progress has been made in understanding the genetic basis of primary hemophagocytic lymphohistiocytosis (HLH), the pathogenesis of secondary HLH, the more prevalent form, remains unclear. Among the various conditions giving rise to secondary HLH, HLH in patients with lymphoma (HLH-L) accounts for a substantial proportion. In this study, we investigated the role of somatic mutations in the pathogenesis of HLH-L in a cohort of patients with T- and/or natural killer–cell lymphoma. We identified a 3-time higher frequency of mutations in FAS pathway in patients with HLH-L. Patients harboring these mutations had a 5-time increased HLH-L risk. These mutations were independently associated with inferior outcome. Hence, our study demonstrates the association between somatic mutations in FAS pathway and HLH-L. Further studies are warranted on the mechanistic role of these mutations in HLH-L.
Serum chemistry profiling and prognostication in systemic mastocytosis: a registry-based study of the ECNM and GREM
Authors: Lübke Johannes , Schmid Alicia , Christen Deborah , Oude Elberink Hanneke N. G. , Span Lambert F. R. , Niedoszytko Marek , Gorska Aleksandra , Lange Magdalena , Gleixner Karoline V. , Hadzijusufovic Emir , Stefan Alex , Angelova-Fischer Irena , Zanotti Roberta , Bonifacio Massimiliano , Bonadonna Patrizia , Shoumariyeh Khalid , von Bubnoff Nikolas , Müller Sabine , Perkins Cecelia , Elena Chiara , Malcovati Luca , Hagglund Hans , Mattsson Mattias , Parente Roberta , Varkonyi Judit , Fortina Anna Belloni , Caroppo Francesca , Brockow Knut , Zink Alexander , Breynaert Christine , Leven Toon , Yavuz Akif Selim , Doubek Michael , Sabato Vito , Schug Tanja , Hartmann Karin , Triggiani Massimo , Gotlib Jason , Hermine Olivier , Arock Michel , Kluin-Nelemans Hanneke C. , Panse Jens , Sperr Wolfgang R. , Valent Peter , Reiter Andreas , Schwaab Juliana
Published: April 2024

Certain laboratory abnormalities correlate with subvariants of systemic mastocytosis (SM) and are often prognostically relevant. To assess the diagnostic and prognostic value of individual serum chemistry parameters in SM, 2607 patients enrolled within the European Competence Network on Mastocytosis and 575 patients enrolled within the German Registry on Eosinophils and Mast Cells were analyzed. For screening and diagnosis of SM, tryptase was identified as the most specific serum parameter. For differentiation between indolent and advanced SM (AdvSM), the following serum parameters were most relevant: tryptase, alkaline phosphatase, β2-microglobulin, lactate dehydrogenase (LDH), albumin, vitamin B12, and C-reactive protein (P < .001). With regard to subvariants of AdvSM, an elevated LDH of ≥260 U/L was associated with multilineage expansion (leukocytosis, r = 0.37, P < .001; monocytosis, r = 0.26, P < .001) and the presence of an associated myeloid neoplasm (P < .001), whereas tryptase levels were highest in mast cell leukemia (MCL) vs non-MCL (308μg/L vs 146μg/L, P = .003). Based on multivariable analysis, the hazard-risk weighted assignment of 1 point to LDH (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.1-4.0; P = .018) and 1.5 points each to β2-microglobulin (HR, 2.7; 95% CI, 1.4-5.4; P = .004) and albumin (HR, 3.3; 95% CI, 1.7-6.5; P = .001) delineated a highly predictive 3-tier risk classification system (0 points, 8.1 years vs 1 point, 2.5 years; ≥1.5 points, 1.7 years; P < .001). Moreover, serum chemistry parameters enabled further stratification of patients classified as having an International Prognostic Scoring System for Mastocytosis–AdvSM1/2 risk score (P = .027). In conclusion, serum chemistry profiling is a crucial tool in the clinical practice supporting diagnosis and prognostication of SM and its subvariants.
Machine learning approach for predicting post-intubation hemodynamic instability (PIHI) index values: towards enhanced perioperative anesthesia quality and safety
Authors: Te Rigele , Zhu Bo , Ma Haobo , Zhang Xiuhua , Chen Shaohui , Huang Yuguang , Qi Geqi
Published: April 2024

Background

Adequate preoperative evaluation of the post-intubation hemodynamic instability (PIHI) is crucial for accurate risk assessment and efficient anesthesia management. However, the incorporation of this evaluation within a predictive framework have been insufficiently addressed and executed. This study aims to developed a machine learning approach for preoperatively and precisely predicting the PIHI index values.

Methods

In this retrospective study, the valid features were collected from 23,305 adult surgical patients at Peking Union Medical College Hospital between 2012 and 2020. Three hemodynamic response sequences including systolic pressure, diastolic pressure and heart rate, were utilized to design the post-intubation hemodynamic instability (PIHI) index by computing the integrated coefficient of variation (ICV) values. Different types of machine learning models were constructed to predict the ICV values, leveraging preoperative patient information and initiatory drug infusion. The models were trained and cross-validated based on balanced data using the SMOTETomek technique, and their performance was evaluated according to the mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE) and R-squared index (R2).

Results

The ICV values were proved to be consistent with the anesthetists’ ratings with Spearman correlation coefficient of 0.877 (P < 0.001), affirming its capability to effectively capture the PIHI variations. The extra tree regression model outperformed the other models in predicting the ICV values with the smallest MAE (0.0512, 95% CI: 0.0511–0.0513), RMSE (0.0792, 95% CI: 0.0790–0.0794), and MAPE (0.2086, 95% CI: 0.2077–0.2095) and the largest R2 (0.9047, 95% CI: 0.9043–0.9052). It was found that the features of age and preoperative hemodynamic status were the most important features for accurately predicting the ICV values.

Conclusions

Our results demonstrate the potential of the machine learning approach in predicting PIHI index values, thereby preoperatively informing anesthetists the possible anesthetic risk and enabling the implementation of individualized and precise anesthesia interventions.
Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal
Authors: Chapman Annabel J. , Ebido Chike C. , Tening Rahel Neh , Huang Yanyan , Sougou Ndèye Marème , Kolopaking Risatianti , Diallo Amadou H. , Anggorowati Rita , Dial Fatou B. , Massonnié Jessica , Firoozmand Mahsa , Niang Cheikh El Hadji Abdoulaye , Harder Marie K.
Published: April 2024

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing ‘cultural protocols’ to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which ‘crystallize’ their envelope of local shared values, making them communicable to outsiders.

Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.
On-demand mobile hypertension training for primary health care workers in Nigeria: a pilot study
Authors: Odu Joseph , Osi Kufor , Nguyen Leander , Goldstein Allison , Appel Lawrence J. , Matsushita Kunihiro , Ojji Dike , Orji Ikechukwu A. , Alex-Okoh Morenike , Odoh Deborah , Toma Malau Mangai , Elemuwa Chris Ononiwu , Lamorde Suleiman , Baraya Hasana , Dewan Mary T. , Chijioke Obagha , Moran Andrew E. , Agogo Emmanuel , Thomas Marshall P.
Published: April 2024

Background

Only one out of every ten Nigerian adults with hypertension has their blood pressure controlled. Health worker training is essential to improve hypertension diagnosis and treatment. In-person training has limitations that mobile, on-demand training might address. This pilot study evaluated a self-paced, case-based, mobile-optimized online training to diagnose and manage hypertension for Nigerian health workers.

Methods

Twelve hypertension training modules were developed, based on World Health Organization and Nigerian guidelines. After review by local academic and government partners, the course was piloted by Nigerian health workers at government-owned primary health centers. Primary care physician, nurse, and community health worker participants completed the course on their own smartphones. Before and after the course, hypertension knowledge was evaluated with multiple-choice questions. Learners provided feedback by responding to questions on a Likert scale.

Results

Out of 748 users who sampled the course, 574 enrolled, of whom 431 (75%) completed the course. The average pre-test score of completers was 65.4%, which increased to 78.2% on the post-test (P < 0.001, paired t-test). Health workers who were not part of existing hypertension control programs had lower pre-test scores and larger score gains. Most participants (96.1%) agreed that the training was applicable to their work, and nearly all (99.8%) agreed that they enjoyed the training.

Conclusions

An on-demand mobile digital hypertension training increases knowledge of hypertension management among Nigerian health workers. If offered at scale, such courses can be a tool to build health workforce capacity through initial and refresher training on current clinical guidelines in hypertension and other chronic diseases in Nigeria as well as other countries.
Kilogram scale facile synthesis and systematic characterization of a Gd-macrochelate as T1-weighted magnetic resonance imaging contrast agent
Authors: Shi Meng , Xiong Wei , Feng Jie , Wu Lihe , Yang Jing , Lu Yudie , Lu Xuanyi , Fan Qingdeng , Nie Hemin , Dai Yunlu , Yan Chenggong , Tian Ye , Shen Zheyu
Published: April 2024

To overcome the problems of commercial magnetic resonance imaging (MRI) contrast agents (CAs) (i.e., small molecule Gd chelates), we have proposed a new concept of Gd macrochelates based on the coordination of Gd3+ and macromolecules, e.g., poly(acrylic acid) (PAA). To further decrease the r2/r1 ratio of the reported Gd macrochelates that is an important factor for T1 imaging, in this study, a superior macromolecule hydrolyzed polymaleic anhydride (HPMA) was found to coordinate Gd3+. The synthesis conditions were optimized and the generated Gd-HPMA macrochelate was systematically characterized. The obtained Gd-HPMA29 synthesized in a 100 L of reactor has a r1 value of 16.35 mM−1 s−1 and r2/r1 ratio of 2.05 at 7.0 T, a high Gd yield of 92.7% and a high product weight (1074 g), which demonstrates the feasibility of kilogram scale facile synthesis. After optimization of excipients and sterilization at a high temperature, the obtained Gd-HPMA30 formulation has a pH value of 7.97, osmolality of 691 mOsmol/kg water, density of 1.145 g/mL, and viscosity of 2.2 cP at 20 ℃ or 1.8 cP at 37 ℃, which meet all specifications and physicochemical criteria for clinical injections indicating the immense potential for clinical applications.

Graphical Abstract
Unusual origins of cardiac insufficiency: a case of iliac arteriovenous fistula post-spinal disc surgery
Authors: Chen Zheng-Ji , Ahmad Nouman , Huang Ling-Jin
Published: April 2024

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions.
U2AF2-SNORA68 promotes triple-negative breast cancer stemness through the translocation of RPL23 from nucleoplasm to nucleolus and c-Myc expression
Authors: Zhang Wenrong , Song Xinyue , Jin Zining , Zhang Yiqi , Li Shan , Jin Feng , Zheng Ang
Published: April 2024

Background

Small nucleolar RNAs (snoRNAs) play key roles in ribosome biosynthesis. However, the mechanism by which snoRNAs regulate cancer stemness remains to be fully elucidated.

Methods

SNORA68 expression was evaluated in breast cancer tissues by in situ hybridization and qRT‒PCR. Proliferation, migration, apoptosis and stemness analyses were used to determine the role of SNORA68 in carcinogenesis and stemness maintenance. Mechanistically, RNA pull-down, RNA immunoprecipitation (RIP), cell fractionation and coimmunoprecipitation assays were conducted.

Results

SNORA68 exhibited high expression in triple-negative breast cancer (TNBC) and was significantly correlated with tumor size (P = 0.048), ki-67 level (P = 0.037), and TNM stage (P = 0.015). The plasma SNORA68 concentration was significantly lower in patients who achieved clinical benefit. The SNORA68-high patients had significantly shorter disease-free survival (DFS) (P = 0.036). Functionally, SNORA68 was found to promote the cell stemness and carcinogenesis of TNBC in vitro and in vivo. Furthermore, elevated SNORA68 expression led to increased nucleolar RPL23 expression and retained RPL23 in the nucleolus by binding U2AF2. RPL23 in the nucleolus subsequently upregulated c-Myc expression. This pathway was validated using a xenograft model.

Conclusion

U2AF2-SNORA68 promotes TNBC stemness by retaining RPL23 in the nucleolus and increasing c-Myc expression, which provides new insight into the regulatory mechanism of stemness.
A new computational approach for optimal control of switched systems
Authors: Zhu Xi , Bai Yanqin , Yu Changjun , Teo Kok Lay
Published: April 2024

The combination of the time-scaling transformation and control parameterization has proven to be an effective approach in addressing optimal control problems involving switching systems with predefined subsystem sequences. However, this approach has certain limitations. First, the number of control switchings is required to be no less than the number of subsystem switchings. Second, the switching of the subsystem must be accompanied by the switching of the control. Third, this scheme introduces many hyperparameters, leading to combinatorial explosion. To address these drawbacks, we introduce a novel computational approach such that the control switching can be independent of subsystem switching. The superiority of this novel approach can be clearly observed from the solutions obtained using the proposed method for solving two illustrative examples.
Sociodemographic, clinical and treatment characteristics of current rapid-cycling bipolar disorder: a multicenter Chinese study
Authors: Xu Jin-jie , Zhu Xue-quan , Liu Shuang , Ding Lu-yu , Fu Bing-bing , Sun Cong-cong , Pan Yan-li , Wang Wei , Zhang Ling
Published: April 2024

Background

Rapid cycling bipolar disorder (RCBD), characterized by four or more episodes per year, is a complex subtype of bipolar disorder (BD) with poorly understood characteristics.

Method

This multicenter, observational, longitudinal cohort study enrolled 520 BD patients across seven psychiatric institutions in China from January 2013 to January 2014. Participants were divided into RCBD and non-RCBD (NRCBD) groups based on the frequency of mood episodes in the preceding year. Data collection utilized a standardized form, supplemented by a medical record review, focusing on sociodemographic, clinical, and treatment characteristics. Statistical analysis involved independent samples t-tests, Kruskal–Wallis H tests, Chi-square or Fisher's exact tests, with Bonferroni correction applied to account for multiple comparisons, and multivariable logistic regression to identify characteristics associated with RCBD.

Results

Among the BD cohort, 9.4% were identified as current RCBD. Compared to NRCBD, RCBD patients had a shorter duration from the first psychiatric consultation to the diagnosis of BD, a reduced duration of their longest period of euthymia, a lower proportion of lifetime hospitalization history due to BD, and less use of electroconvulsive therapy (ECT) within the last 12 months. Additionally, they presented higher baseline scores on the Mood Disorder Questionnaire (MDQ) and the Brief 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). However, after applying the Bonferroni correction, these differences were not statistically significant. Multivariable logistic regression analysis identified three factors that were independently associated with RCBD: time from first psychiatric consultation to BD diagnosis (Odds Ratio [OR] = 0.512, P = 0.0416), lifetime hospitalization history due to BD (OR = 0.516, P = 0.0476), and ECT treatment within the past 12 months (OR = 0.293, P = 0.0472).

Conclusion

This study revealed that the duration from first psychiatric consultation to BD diagnosis, lifetime hospitalization history due to BD, and ECT treatment in the past year were associated with RCBD. Recognizing these factors could contribute to enhance the early identification and clinical outcomes of RCBD.

Trial Registration Number Registry ClinicalTrials.gov NCT01770704. Date of Registration: First posted on January 18, 2013.
Digital storytelling online: a case report exploring virtual design, implementation opportunities and challenges
Authors: Mansfield Elizabeth , Jalal Nafeesa , Sanderson Rani , Shetty Geeta , Hylton Andrea , D’Silva Chelsea
Published: April 2024

Background

Digital storytelling is an arts-informed approach that engages short, first-person videos, typically three to five minutes in length, to communicate a personal narrative. Prior to the pandemic, digital storytelling initiatives in health services research were often conducted during face-to-face workshops scheduled over multiple days. However, throughout the COVID-19 lockdowns where social distancing requirements needed to be maintained, many digital storytelling projects were adapted to online platforms.

Methods

As part of a research project aiming to explore the day surgery treatment and recovery experiences of women with breast cancer in Peel region, we decided to pivot our digital storytelling process to an online format. During the process, we observed that the online digital storytelling format had multiple opportunities and challenges to implementation.

Results

This paper outlines our promising practices and lessons learned when designing and implementing an online digital storytelling project including pre-production, production and post-production considerations.

Conclusions

We provide lessons learned for future teams intending to conduct an online digital storytelling project.
Serum metabolism alteration behind different etiology, diagnosis, and prognosis of disorders of consciousness
Authors: Ge Qianqian , Lu Hezhen , Geng Xiaoli , Chen Xueling , Liu Xiaoyan , Sun Haidan , Guo Zhengguang , Sun Jiameng , Qi Feng , Niu Xia , Wang Aiwei , He Jianghong , Sun Wei , Xu Long
Published: April 2024

Background

Patients with disorders of consciousness (DoC) exhibit varied revival outcomes based on different etiologies and diagnoses, the mechanisms of which remain largely unknown. The fluctuating clinical presentations in DoC pose challenges in accurately assessing consciousness levels and prognoses, often leading to misdiagnoses. There is an urgent need for a deeper understanding of the physiological changes in DoC and the development of objective diagnostic and prognostic biomarkers to improve treatment guidance.

Methods

To explore biomarkers and understand the biological processes, we conducted a comprehensive untargeted metabolomic analysis on serum samples from 48 patients with DoC. Patients were categorized based on etiology (TBI vs. non-TBI), CRS-R scores, and prognosis. Advanced analytical techniques, including PCA and OPLS-DA models, were employed to identify differential metabolites.

Results

Our analysis revealed a distinct separation in metabolomic profiles among the different groups. The primary differential metabolites distinguishing patients with varying etiologies were predominantly phospholipids, with a notable decrease in glycerophospholipids observed in the TBI group. Patients with higher CRS-R scores exhibited a pattern of impaired carbohydrate metabolism coupled with enhanced lipid metabolism. Notably, serum concentrations of both LysoPE and PE were reduced in patients with improved outcomes, suggesting their potential as prognostic biomarkers.

Conclusions

Our study underscores the critical role of phospholipid metabolism in the brain’s metabolic alterations in patients with DoC. It identifies key biomarkers for diagnosis and prognosis, offering insights that could lead to novel therapeutic targets. These findings highlight the value of metabolomic profiling in understanding and potentially treating DoC.
Pedicle subtraction osteotomy in patient with congenital kyphosis
Authors: Rezvani Majid , Mahmoodkhani Mehdi , Fallahpour Soheil , Rahmani Payman , Koohgard Hamed , Tehrani Donya Sheibani
Published: April 2024

Introduction

A disorder causes congenital kyphosis in the last stages of ossification and cartilage formation during embryonic development. The main treatment for this disease is surgery with various methods. The present study was performed to evaluate the results of the posterior surgery.

Methods

This study was a descriptive study comparing the results before and after surgery which was performed in 2022 on 14 patients with the congenital kyphosis referred to Al-Zahra Hospital in Isfahan. Initial assessments were performed, and the patient underwent surgery. The patients were re-evaluated immediately after surgery which were followed up and evaluated two years after surgery. Data were collected by a checklist and described and analyzed in SPSS software version 22.

Results

The mean age of the patients was 23.15 ± 13.24 years, 7 patients (50%) were male, and the mean duration of surgery was 405.85 ± 123.99 min. Seven patients (50%) were under 18 years old. No disease died and the highest T12 involvement was in 5 patients (35.8%). Sagittal Vertical Axis, Kyphosis Angle and Lumbar Lordosis decreased in two stages immediately after surgery and follow-up, which were statistically significant (P < 0.05). No associated neurologic abnormalities was found during a physical examination or magnetic resonance imaging. In three phases (before, immediately after surgery, and follow-up), the mean of the Sagittal Vertical Axis, and Lumbar Lordosis in adults (over 18 years) and children (under 18 years) was not substantially different (P > 0.05). The mean Kyphosis Angle were significantly different in adults, and children at follow-up stages (P < 0.05). Because one of the children had a device filler in the follow-up stage.

Conclusions

PSO can be used as a safe and effective technique to treat and correct Sagittal Vertical Axis, Kyphosis angle, Lumbar lordosis.
Application of optimized photovoltaic grid-connected control system based on modular multilevel converters
Authors: Xie Jun
Published: April 2024

Photovoltaic power generation is a promising method for generating electricity with a wide range of applications and development potential. It primarily utilizes solar energy and offers sustainable development, green environmental benefits, and abundant solar energy resources. However, there are many external factors that can affect the output characteristics of Photovoltaic cells and the effectiveness of the grid-connected control system. This study describes the introduction of Modular Multilevel Converter (MMC) technology into photovoltaic power generation systems to improve power generation efficiency. It proposes optimizing and improving the technology by adjusting the temperature and magnitude of lighting and combining traditional algorithms to propose a composite control algorithm. The photovoltaic power generation system employs the modular multi-level converter technology to enhance power generation efficiency alongside optimization and improvement. The temperature and size of light are regulated alongside the traditional algorithm to introduce the composite control algorithm. The improved composite algorithm surpasses the traditional one after experimental comparison of the results. The testing of a model photovoltaic power grid-connected system shows that the combination of modular multi-level converter technology and a photovoltaic grid-connected system, incorporating composite proportional integral control and quasi-proportional resonant control algorithms, yields improved results and feasibility. With rationality and effective control. The simulation results show that at 0.5 s, the light intensity suddenly increases from 750 to 1000 W/m2, and the direct-current voltage suddenly increases for a short time, but then decreases rapidly and finally returns to a stable level close to the rated voltage. From this, it can be seen that when the light intensity continues to change, the voltage value on the direct-current bus side of this MMC grid-tied photovoltaic system can still be maintained close to the rated value, ensuring the operational stability of the entire system. Sensibly and effectively controlled. The implementation of MMC technology in photovoltaic power generation systems enhances power generation efficiency, whilst simultaneously supporting the advancement of photovoltaic power generation and contributing towards environmental protection in the long term.
Chest ultrasound to detect postoperative pulmonary complications after thoracic surgery: a comparative study
Authors: Elabdein Ali Zein , Hassan Ramy Abdelrheim , Elhaish Mahmoud Khairy , Elkhayat Hussein
Published: April 2024

Background

Patients who underwent thoracic surgery procedures were usually subjected to daily chest X-rays until discharge, exposing patients to ionizing radiation and requiring patient movement with chest drains, difficult positioning, and time-consuming. Unlike chest ultrasound, which is a good alternative because it is bedside and accurate in the detection of pulmonary complications. We hypothesize that a thoracic surgery resident with a short training program in chest ultrasound can achieve comparable results to a chest X-ray. Our study aims to analyze the agreement between the two techniques.

Results

This is an observational prospective study. Eighty-six adult patients who underwent thoracic surgery were included. Every patient had a chest X-ray and chest ultrasound follow-up on day 0, day 3, and day 5 post-operative. Chest ultrasound examinations were performed by the same resident, and the results were revised by an expert sonographer for the detection of pneumothorax, pleural effusion, pulmonary consolidation, and interstitial pattern. Both diagnostic procedures showed substantial agreement for pneumothorax (K = 0.661). For pleural effusion, they showed moderate agreement (K = 0.448, P < 0.001), and no cases developed an interstitial pattern. Overall, both diagnostic procedures showed perfect agreement (K = 0.838, P < 0.001). The time lag to perform a chest ultrasound was statistically lower than that to perform. chest X-ray, with a median of 7 min versus 80 min, respectively.

Conclusions

Performing chest ultrasound by a thoracic surgery resident is a less time-consuming and easy bedside diagnostic tool. Compared chest ultrasound to the postoperative X-ray showed a perfect diagnostic agreement for pulmonary consolidation and moderate agreement for pleural effusion and pneumothorax.

Trial registration

NCT04118621