bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence–Based Feature Analysis of Pulmonary Vein Morphology on Computed Tomography Scans and Risk of Atrial Fibrillation Recurrence After Catheter Ablation: A Multi-Site Study
Authors: Asaeikheybari Golnoush , El-Harasis Majd , Gupta Amit , Shoemaker M. Benjamin , Barnard John , Hunter Joshua , Passman Rod S. , Sun Han , Kim Hyun Su , Schilling Taylor , Telfer William , Eldridge Britta , Chen Po-Hao , Midya Abhishek , Varghese Bibin , Harwood Samuel J. , Jin Alison , Wass Sojin Y. , Izda Aleksandar , Park Kevin , Abraham Abel , Van Wagoner David R. , Tandon Animesh , Chung Mina K. , Madabhushi Anant
Published: December 2024

BACKGROUND:

Atrial fibrillation (AF) recurrence is common after catheter ablation. Pulmonary vein (PV) isolation is the cornerstone of AF ablation, but PV remodeling has been associated with the risk of AF recurrence. We aimed to evaluate whether artificial intelligence–based morphological features of primary and secondary PV branches on computed tomography images are associated with AF recurrence post-ablation.

METHODS:

Two artificial intelligence models were trained for the segmentation of computed tomography images, enabling the isolation of PV branches. Patients from Cleveland Clinic (N=135) and Vanderbilt University (N=594) were combined and divided into 2 sets for training and cross-validation (D
1
, n=218) and internal testing (D
2
, n=511). An independent validation set (D
3
, N=80) was obtained from University Hospitals of Cleveland. We extracted 48 fractal-based and 12 shape-based radiomic features from primary and secondary PV branches of patients with AF recurrence (AF+) and without recurrence after catheter ablation of AF (AF-). To predict AFrecurrence, 3 Gradient Boosting classification models based on significant features from primary (M

p

), secondary (M

s

), and combined (M

c

) PV branches were built.

RESULTS:

Features relating to primary PVs were found to be associated with AF recurrence. The M

p

classifier achieved area under the curve values of 0.73, 0.71, and 0.70 across the 3 datasets. AF+ cases exhibited greater surface complexity in their primary PV area, as evidenced by higher fractal dimension values compared with AF- cases. The M

s

classifier results revealed a weaker association with AF+, suggesting higher relevance to AF recurrence post-ablation from primary PV branch morphology.

CONCLUSIONS:

This largest multi-institutional study to date revealed associations between artificial intelligence–extracted morphological features of the primary PV branches with AF recurrence in 809 patients from 3 sites. Future work will focus on enhancing the predictive ability of the classifier by integrating clinical, structural, and morphological features, including left atrial appendage and left atrium–related characteristics.
Direct segmentation of cortical cytoarchitectonic domains using ultra-high-resolution whole-brain diffusion MRI
Authors: Pas Kristofor E. , Saleem Kadharbatcha S. , Basser Peter J. , Avram Alexandru V.
Published: December 2024

We assess the potential of detecting cortical laminar patterns and areal borders by directly clustering voxel values of microstructural parameters derived from high-resolution mean apparent propagator (MAP) magnetic resonance imaging (MRI), as an alternative to conventional template-warping-based cortical parcellation methods. We acquired MAP-MRI data with 200 μm resolution in a fixed macaque monkey brain. To improve the sensitivity to cortical layers, we processed the data with a local anisotropic Gaussian filter determined voxel-wise by the plane tangent to the cortical surface. We directly clustered all cortical voxels using only the MAP-derived microstructural imaging biomarkers, with no information regarding their relative spatial location or dominant diffusion orientations. MAP-based 3D cytoarchitectonic segmentation revealed laminar patterns similar to those observed in the corresponding histological images. Moreover, transition regions between these laminar patterns agreed more accurately with histology than the borders between cortical areas estimated using conventional atlas/template-warping cortical parcellation. By cross-tabulating all cortical labels in the atlas- and MAP-based segmentations, we automatically matched the corresponding MAP-derived clusters (i.e., cytoarchitectonic domains) across the left and right hemispheres. Our results demonstrate that high-resolution MAP-MRI biomarkers can effectively delineate three-dimensional cortical cytoarchitectonic domains in single individuals. Their intrinsic tissue microstructural contrasts enable the construction of whole-brain mesoscopic cortical atlases.
Brain-wide functional connectome analysis of 40,000 individuals reveals brain networks that show aging effects in older adults
Authors: Pan Yezhi , Bi Chuan , Kochunov Peter , Shardell Michelle , Smith J. Carson , McCoy Rozalina G. , Ye Zhenyao , Yu Jiaao , Lu Tong , Yang Yifan , Lee Hwiyoung , Liu Song , Gao Si , Ma Yizhou , Li Yiran , Chen Chixiang , Ma Tianzhou , Wang Ze , Nichols Thomas , Hong L. Elliot , Chen Shuo
Published: December 2024

The functional connectome changes with aging. We systematically evaluated aging-related alterations in the functional connectome using a whole-brain connectome network analysis in 39,675 participants in UK Biobank project. We used adaptive dense network discovery tools to identify networks directly associated with aging from resting-state functional magnetic resonance imaging (fMRI) data. We replicated our findings in 499 participants from the Lifespan Human Connectome Project in Aging study. The results consistently revealed two motor-related subnetworks (both with permutation test p-values <0.001) that showed a decline in resting-state functional connectivity (rsFC) with increasing age. The first network primarily comprises sensorimotor and dorsal/ventral attention regions from precentral gyrus, postcentral gyrus, superior temporal gyrus, and insular gyrus, while the second network is exclusively composed of basal ganglia regions, namely the caudate, putamen, and globus pallidus. Path analysis indicates that white matter fractional anisotropy mediates 19.6% (p < 0.001, 95% CI [7.6% 36.0%]) and 11.5% (p < 0.001, 95% CI [6.3% 17.0%]) of the age-related decrease in both networks, respectively. The total volume of white matter hyperintensity mediates 32.1% (p < 0.001, 95% CI [16.8% 53.0%]) of the aging-related effect on rsFC in the first subnetwork.
Collection of dna and the Creation of dna Databases in India: A Proportionality Analysis on Whether There is a Violation of Genetic Privacy
Authors: Chandran Rudra
Published: December 2024

Genetic information, which can be processed from human bodily samples, contains three major types of information: first, individual traits such as the skin colour, race, eye colour, and height of the data subject; second, medical information such as information about genetic diseases and genetic predispositions; and third and most importantly, it can provide information about a class of persons who are genetically related to the data subject. Genetic data has huge application potential, from criminal investigations to assisted reproductive techniques. Thus, it is the most sensitive form of personal data. The concept of privacy in India has also evolved by way of judicial pronouncements and, in the case of K.S. Puttaswamy v Union of India, it was recognised as a fundamental right. The Indian Government has passed the Criminal Procedure Identification Act, 2022, which allows for the collection of measurements – including genetic samples – and authorises the National Crime Records Bureau to collect, store, process, share, and disseminate such data. In light of the above developments, this article analyses the constitutionality of section 3 of the Criminal Procedure Identification Act, 2022 through the lens of the principle of proportionality.
Male Rape Victims and the Case for a Gender-Neutral Definition of Rape in Bangladesh
Authors: Rahman Arifur
Published: December 2024

Rape laws in Bangladesh tend to operate on the putative gender binary and understand rape through the prism of penile-vaginal penetration. The idea of male rape, especially adult male rape, remains foreign to the existing rape laws, which leads to the underreporting of rape cases against men. This article argues for a gender-neutral definition of rape in Bangladesh. The justification is premised on two key arguments. First, it demonstrates that, like any other form of sexual and gender-based violence, male rape is a gendered crime. Second, both male rape and the absence of its legal recognition cut across an array of human rights of male rape victims in Bangladesh. The article concludes that a gender-neutral definition of rape would not only recognise the gendered harm that male rape survivors experience but also help Bangladesh fulfil its human rights obligations towards male rape survivors.
Mixed Messages: Reflections on Multiethnic Identity and Narratives in Youth Ministry Pedagogy
Authors: Mayward Joel
Published: December 2024

Drawing upon the work of Gloria E. Anzaldúa and Paul Ricoeur, this article presents a personal and scholarly reflection on the author’s multiethnic identity and how such identities may benefit youth ministry pedagogies and perspectives. The author explains Anzaldúa’s notion of nepantla alongside Ricoeur’s concepts of “narrative identity” and “social imaginary,” then demonstrates how these two thinkers’ perspectives can be interwoven and applied by educators and youth ministry practitioners. Ultimately, in sharing about his “mixed” heritage, the author contends that multiethnic individuals can serve as bridge-builders between cultures and generations.
Sovereignty and Oil
Authors: Stoekl Allan
Published: December 2024

This essay considers the question of sovereignty in relation to oil. First, in the conventional geo-strategic sense: control over oil resources is the sovereign right of a nation. But here national sovereignties conflict with each other, and sovereignty, supposedly absolute (it is by definition the unconditioned) turns out to be malleable, always qualified. Another, second sense involves sovereignty as the general will; here I propose that oil, and energy resources, have their own will, which enters into conflict with what is normally the general will of the people. Finally, a third sovereignty involves the radically unconditioned, in which energy is expended unconditionally, with no goal in sight or possible; this is the sovereignty of the sacred, or of erotism, and is the most basic aspect of energic ‘use.’
Value for whom? Rethinking cost-effectiveness from young people’s perspective
Authors: Holmes Lisa , Lefevre Michelle
Published: December 2024

Background:

This article re-envisions the concept of value in relation to safeguarding and welfare services to young people who are experiencing adversity, risk and disadvantage. Current use of the terms ‘cost-effectiveness’ and ‘value for money’ within the policy and practice sectors is dominated by the concept of financial costs, most particularly with respect to the goals of producing organisational efficiencies and providing lower cost services. Analysis is often driven by outcomes that are easy to measure and can be monetised.

Findings:

The moral and societal costs associated with not providing the best possible support and services to some of the most vulnerable people in society are largely missing from these debates, as are young people’s views on what counts as value from their perspective. Drawing on learning from our recent and current research in the UK focused on young people at risk of extra-familial risks and harms, we use a case study to consider alternative approaches that would place young people’s views and concerns at the centre of analysis. We explore the integration of ‘softer outcomes’ (such as subjective well-being, educational engagement and qualitative inquiry into what matters to young people) into debates about ‘value for money’.

Conclusion:

We highlight the importance of exploring the lives of young people holistically and taking a life course perspective to understand and engage with the longer-term societal, moral and financial costs associated with providing the right services and support, at the right time, to the children and young people who need them most.
Efficacy of telerehabilitation in inpatients with stroke: A pilot randomized controlled trial
Authors: Lee Hsin-Chieh , Hsu Tzu-Yun , Yu Cheng-Chieh , Kuo Fen-Ling
Published: December 2024

Background:

Telerehabilitation could be a substitution for regular rehabilitation in an epidemic situation. Furthermore, there is no evidence of the effectiveness of telerehabilitation in stroke inpatients.

Objectives:

To assess the effects of telerehabilitation on daily life function, mobility, and quality of life in stroke inpatients.

Methodology:

Inpatients with stroke were randomly assigned to either the telerehabilitation group ( n = 12) or the control group ( n = 12) for 10 treatment sessions.

Results:

No significant differences were found in the outcome measures. However, both groups showed significant improvements in the Modified Barthel Index and Postural Assessment Scale for Stroke scores. The telerehabilitation group improved in Functional Ambulation Categories scores, while the control group showed improvement in Patient Health Questionnaire-9 scores.

Conclusion:

This pilot study suggests that telerehabilitation may be a feasible alternative during the pandemic. However, due to the small sample size and the potential influence of natural recovery, the findings remain preliminary. Larger studies are necessary to more definitively assess the effectiveness of telerehabilitation compared to conventional rehabilitation.
Association of Neuropsychiatric Inventory Questionnaire Score With Caregiver Relationship in Alzheimer’s Disease Dementia and Mild Cognitive Impairment
Authors: Honjo Yasuyuki , Nagai Kuniaki , Yuri Takuma , Nakai Hideaki , Kawasaki Ippei , Harada Shun , Suganuma Ippei , Ogawa Noriyuki
Published: December 2024

Behavioral and psychological symptoms of dementia (BPSD) can appear not only in Alzheimer’s disease dementia (ADD) but in mild cognitive impairment (MCI). This study examined the association of BPSD with caregiver relationship, using the Neuropsychiatric Inventory Questionnaire (NPI-Q) score. The cognitive function of 419 new outpatients with ADD or MCI was evaluated using the Revised Hasegawa Dementia Scale (HDS-R) and the Mini-Mental State Examination (MMSE). Caregiver relationship was significantly associated with patient age, sex, duration of education, cohabitation status, total NPI-Q score, and number of NPI-Q domains. Caregiver (oldest daughter), duration of school education, age, and total HDS-R and MMSE scores were significantly associated with NPI-Q total score and number of NPI-Q domains. The delusions, dysphoria/depression, irritability/lability, and aberrant motor behaviors domains were significantly associated with caregiver relationship. The dysphoria/depression and irritability/lability domain score were scored significantly higher by female caregivers. The delusion domain was significantly associated with cohabitation.
Investigating the effects of a physician’s race and gender on user engagement with and perceived credibility of COVID-19 vaccine news
Authors: Mulupi Dinfin K. , Wong Frankie H. C. , Yaros Ronald A.
Published: December 2024

A quasi-experiment (N = 676) manipulated the gender and race of physician sources in news about COVID-19 vaccinations. Results suggest no differences in perceived credibility across genders, but news featuring an African American or Latinx physician predicted higher reader engagement than news featuring a White physician. These findings address the effects of a source’s gender or race in health news and lend support for equal representation of women and racial minorities as expert sources.
Out-of-Pocket Costs Burden in Marketplace Plans for People With Diabetes
Authors: Ruscitti Brielle , Kern Caroline , Bowser Diana
Published: December 2024

Background:

The Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions.

Objective:

Compare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs.

Design:

Descriptive Cost Analysis.

Methods:

Using Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using t-tests.

Results:

The findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients.

Conclusion:

Despite the ACA’s success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.
Classifying cognitive impairment based on FDG-PET and combined T1-MRI and rs-fMRI: An ADNI study
Authors: Jahani Iman , Jahani Ali , Delrobaei Mehdi , Khadem Ali , MacIntosh Bradley J
Published: December 2024

Background

Mild cognitive impairment (MCI) refers to a memory impairment among non-demented adults. It is a condition that increases the risk of dementia, notably due to Alzheimer's disease (AD). MCI is heterogeneous and there is a need for novel diagnostic approaches. Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging provides robust AD biomarker characteristics, while anatomical and functional magnetic resonance imaging (MRI) offer complementary information.

Objective

Classify MCI and cognitively normal (CN) adults using FDG-PET images; predict individuals with MCI that convert to AD dementia; determine if MRI can achieve comparable performance to FDG-PET classification.

Methods

Four ADNI cohorts were created. Cohort 1: 805 participants (MCI n = 455; CN n = 350) that underwent FDG-PET. FDG-PET images were inputs to a one-channel 3-dimensional (3D) DenseNet deep learning model. Cohort 2: 348 participants (MCI n = 174; CN n = 174) with MRI and functional MRI. Cohort 3: overlapping cases from cohorts 1 and 2 (MCI n = 70; CN n = 70). Cohort 4: 336 participants (MCI-converters n = 168; MCI-stable n = 168) with FDG-PET from cohort 1. The one/two-channel models’ inputs were T1-weighted MRI and/or amplitude of low-frequency fluctuations images, with classification metrics evaluated through 10-fold cross-validation.

Results

The FDG-PET model achieved 88.02%±3.82 accuracy for MCI versus CN classification, with 88.70%±4.70 sensitivity and 87.14%±5.03 specificity. Neither MRI model outperformed the FDG-PET model, as the highest MRI-based accuracy was 76.86%±1.95. The FDG-PET model achieved 63.23%±4.68 accuracy in classifying MCI-converters versus MCI-stable.

Conclusions

FDG-PET images produced the highest accuracy in classifying MCI versus CN. While MRI-based approaches were inferior to FDG-PET, multi-contrast MRI still offers value for neurodegeneration classification.
Using special APF to improve harmonic rate of MRT power system
Authors: Chen Chien-Hsu , Ko Li-Wei
Published: December 2024

Most APFs use improved designs of active power filters of half-bridge and full-bridge circuits, their advantages and disadvantages are compared. International journals often use this filter circuit for small circuit boards. For large power systems, nonlinear loads still need to overcome harmonic pollution and magnetic pollution. Its disadvantage is that it will reduce the power of the system and requires power compensation. For nonlinear load harmonic filtering, RLC high-pass filter is not the best filtering method. Due to high-power rail high-voltage systems (22 KV–161 KV), the industry has not yet applied APF to remove harmonics. Previous research on nonlinear load harmonic filters for high-voltage systems was only 6.9 KV. Later, with the development of industry and the increase in electricity consumption, the high-voltage system increased to 22 KV–161 KV. Experimental data on high-voltage power systems are difficult to obtain. This study verified the feasibility of this method through simulation. Therefore, this study proposes to use a combination of two single-phase high-pass filters form a three-phase APF to filter nonlinear load harmonics in the track’s large power system and effectively increase the capacity of the large power load. APF filters harmonics through three phases to prevent train signal abnormalities and extend the service life of trains. Since the centralized power supply system must be used in conjunction with other loads, harmonic pollution will occur. Electric vehicles accept this kind of pollution source, which is detrimental to on-board equipment and on-board signals. In power electronics theory, the spirit of this article is to use APF to filter out harmonics of the power system through three-phase technology in the range of 22 KV–161 KV. This has not yet been done in the industry. I put forward this theory, which is also the meaning of this job.
National eco-social policies in the framework of EU just transition: The cases of Greece, Italy, Portugal and Spain
Authors: Theodoropoulou Sotiria , Sabato Sebastiano , Akgüç Mehtap
Published: December 2024

This article examines two questions. First, how far have the green and social policy objectives of the European Green Deal and the Recovery and Resilience Facility (RRF) been translated into ‘eco-social policies’ (i.e. demonstrate a ‘socio-ecological’ dimension) in the National Recovery and Resilience Plans (NRRPs) of four of the biggest beneficiary countries, namely, Greece, Italy, Portugal and Spain? And, second, how is the role of national welfare states articulated in these eco-social policies to support this just green transition? Our analysis shows first, that, although the analysed NRRPs have a socio-ecological dimension, this is very limited in terms of the share of ‘eco-social’ measures in the total number of policy measures in the NRRPs. Moreover, we find that the role of national welfare states in the identified eco-social policies of the NRRPs in the four country-cases we examine is significantly tilted in favour of what we call ‘benchmarking’ and ‘enabling’ functions, in contrast to what we call ‘buffering’ and ‘consensus-building’ functions. In that sense, the socio-ecological dimension of these national plans seems ‘unbalanced’ in terms of the functions that national welfare states play in it. The article concludes with some reflections on the implications of these findings for the role of EU policy legacies and frameworks and of national welfare states in shaping the emergence of eco-social policies as means to a just green transition and on some methodological challenges for the study of eco-social policies in the context of the European Green Deal and its implementation.
Evaluation of “Paper Chase”: Enhancing research dissemination and collaborative writing skills
Authors: Moxie Jessamyn , Dahl Alicia A , Benson James Kevin , Sisney Sarah Beth
Published: December 2024

We use Paper Chase as a team science model to engage interdisciplinary learners in research. Paper Chase is a structured collaborative writing approach for rapidly disseminating research findings and serves as a collaborative active learning professional development program for students at a southeastern university. We evaluated the impacts across 2 years of campus-wide Paper Chase trainings (virtual and in-person). Data was collected 1 to 2 years following participation. Trained research assistants unaffiliated with the Paper Chase program conducted semi-structured interviews with a sample of past participants who were undergraduate students, graduate students, and faculty. We analyzed the 21 interviews using thematic analyses. Participants described immediate impacts: training/structure of Paper Chase, mentorship, and scientific integration. Intermediate impacts included teamwork, attitudes toward teamwork, writing skills, and publications. Longer-term impacts were career influences. These findings suggest that Paper Chase active learning exercise fosters favorable changes in individual attitudes and skills and interpersonal skills among participants. Involvement in research dissemination was instrumental in demystifying research and researchers among undergraduate students. More than 2 years from Paper Chase participation evaluations may be needed to understand further longer-term impacts, such as changes in faculty’s team science, mentorship approaches, or publication records.
Thai Fathers’ Involvement in Childcare During Early Childhood: A Mixed-Methods Study
Authors: Sriyasak Atcharawadee , Howharn Chularat , Chookunhom Phatcharee , Ket-in Varunee , Sarakshetrin Atiya
Published: December 2024

This explanatory sequential mixed-methods study investigates the factors influencing Thai fathers’ involvement in early childhood Childcare. In the quantitative phase ( n = 230), fathers’ involvement in Childcare was assessed using a Childcare involvement scale to identify key contributing factors. The qualitative phase ( n = 20) further elaborated on these quantitative findings through content analysis. Stepwise multiple regression analysis demonstrated that fathers’ perceived Childcare skills, division of Childcare responsibilities, and marital satisfaction explained 53% ( p < .001) of the variance in paternal involvement. The qualitative phase expanded on these findings, identifying fathers’ involvement experiences, and revealing three central themes: responsible involvement, father–child interaction, and discipline training. These results offer valuable insights for health care professionals into the support needs of Thai fathers engaged in Childcare, facilitating better strategies for encouraging active fatherhood.
Contextual Narrative Interpretation Model (CNI): Rethinking Qualitative Analysis
Authors: Finkelstein Idit , Soffer-Vital Shira , Lieblich Amia
Published: December 2024

After a brief presentation of the primary qualitative analysis methods in psychological research, this paper proposes a new model for qualitative analysis, the “Contextual Narrative Interpretation” (CNI) model and demonstrates its application. The authors’ primary objectives are to demonstrate the practicality and relevance of the CNI in psychological sciences qualitative research and to assist researchers considering the adoption of this method by offering concrete case studies illustrating its utilization. The CNI emphasizes using both text and context to reveal new aspects of the narrative and represent these cases visually, in three dimensional geometric forms. This in turn aids in the structured identification of themes. The demonstration of the CNI uses data collected from “first-generation” Israeli college students through detailed case studies of their experiences. The authors guide the reader through the steps of the CNI, providing insights into how the narrative was interpreted and offering a reflective discourse on the method’s usage. Our CNI model accommodates multiple dimensions, each corresponding to a distinct aspect of text and context. The three-dimensional representations encapsulate the complexity of the narrative’s interpretation and deepen our understanding of the narrative. Hence, this article serves as an introduction to and a practical illustration of the CNI within the domain of psychological sciences, and suggest broad methodological applications.
A survey of practice on the use of condition-specific patient reported outcome measures with patients who have distal radius fractures
Authors: Nuttall Jocelyn , Rolls Catherine
Published: December 2024

Introduction

Distal radius fractures (DRF) are common injuries seen by therapists. Patient Reported Outcomes Measures (PROMs) are a way to measure recovery, yet previous research suggests PROM utilisation is low amongst therapists. This study looks at current use of condition specific PROMs amongst UK therapists treating patients with DRF and explores possible barriers and facilitators to their use.

Methods

An online anonymised cross-sectional survey hosted on Qualtrics software was distributed to UK physiotherapists, occupational therapists, and therapy technicians via special interest groups and social media. Analysis was carried out on Excel and Qualtrics Software.

Results

There were 60 responses to the survey. For therapists who use PROMs the Quick-Disabilities of the Arm, Shoulder and Hand questionnaire, and Patient Reported Wrist Evaluation were the most used, but many therapists reported never using a PROM. Barriers identified included not having enough time in a therapy session, already collecting generic PROMs, and current PROMs did not add to their clinical reasoning. Therapists reported current condition specific PROMs did not capture the psychosocial impact of a DRF or help to assess return to full function.

Conclusion

NHS managers should explore opportunities to collect generic PROMs in a way that has the least impact on clinician time. The development of a Core Outcome Set for hand and wrist trauma may help therapists to identify a toolkit of PROMs to measure different aspects of recovery from this injury but further research is needed to understand the utility of PROMs over individualised therapist assessment.
Association of cytochrome P450 CYP2C9 (rs1057910) gene polymorphism and ibuprofen response in preterm neonates diagnosed with patent ductus arteriosus
Authors: Said Reem Nabil , Mossalam Dalia , Abdel Massih Antoine Fekhry , Abdel Halim Radwa Marawan , Sweilam Maisa ElSayed Mohamed Morsi
Published: December 2024

Background

Patent ductus arteriosus (PDA) closure is one of the most significant changes necessary to transition to extrauterine life. The failure of closure in preterm infants has been associated with a variety of complications.

Aim and objectives

This study aim to investigate the correlation between cytochrome P450 CYP2C9 gene polymorphism and the response to ibuprofen treatment in preterm neonates with PDA.

Subjects and methods

This prospective study was conducted on 64 preterm neonates with patent ductus arteriosus (hsPDA). The neonates were treated with ibuprofen and diagnosed using clinical and echocardiographic examinations. The study was carried out at the Neonatal Intensive Care Unit (NICU), Pediatric Department, Kasr Alainy and ElMounira Pediatric Hospitals, Cairo University, in June 2018.

Results

A statistically significant difference in respiratory rate was observed between both groups ( p = 0.047). Additionally, there was a significant difference in the duration of treatment with ibuprofen ( p = 0.021). Treatment with ibuprofen had no impact on renal function parameters. The platelet count decreased after treatment with no statistical difference.

Conclusion

Use of Oral ibuprofen is a highly effective treatment for HsPDA in preterm neonates, demonstrating a remarkable success rate of 92.2% and fewer adverse effects. Whilst no correlation between the CYP2C9 (rs1057910) gene polymorphism and the efficacy of oral ibuprofen response, Other factors affecting the response of oral ibuprofen and subsequent PDA closure include gestational age, birth weight, Apgar score at 5 min, ductal diameter, RDS, and sepsis.
Role of lung ultrasound score in early prediction of bronchopulmonary dysplasia in preterm neonates
Authors: Khandelwal Shikha , Datta Vikram , Anand Rama , Devabathina Narendra Babu
Published: December 2024

Background

The use of lung ultrasound score (LUS) to predict bronchopulmonary dysplasia (BPD) is still evolving. While LUS is widely available and accurate, there is limited evidence from low- and middle-income countries. We aim to assess LUS’s predictive ability for BPD in preterm neonates less than 30 weeks gestation.

Material and methods

We enrolled 160 neonates born at <30 weeks of gestation, who required any form of respiratory support at least for 24 h. Six zone LUS was calculated for all the neonates first within 72 h and then weekly till 36 weeks of post-menstrual age (PMA) or discharge, whichever was earlier. After excluding death and missed scans, 112 neonates were categorized as BPD or non-BPD and were analysed for their LUS.

Result

Neonates who developed BPD ( n = 33) had higher LUS from the first assessment up to nine weeks. An LUS >5 could predict the development of BPD at one week with a sensitivity of 87.88%, specificity 89.87%, and area under ROC Curve (AUC) 0.93, and at two weeks with a sensitivity of 78.79%, specificity of 96.2%, and AUC 0.95. Likewise, at three and four weeks of life, the optimum cutoff of LUS >3 and >2, respectively, predicted the development of BPD with sensitivity 93.99%, specificity 94.94%, and AUC 0.97 at three weeks and sensitivity 87.88%, specificity 92.41 %, and AUC 91.07% at four weeks. Prediction for moderate-severe BPD was also reliable at all scan time points with AUC 0.84 at 1–3 days, 0.91 at one week, 0.92 at two weeks, 0.95 at three weeks, and 0.97 at four weeks, with LUS cutoff >8, >5, >6, >4, and >3, respectively.

Conclusion

LUS can reliably predict the future development of BPD as early as one week of life and can play an important role in optimizing BPD preventive strategies.
A quality improvement project on implementing a standardized pain assessment and opioid stewardship guidance at a level IV NICU
Authors: Durrani Naveed Ur Rehman , Badhawi Isam Abdulaziz , Kurian Simi , Vicente Melanda , Peligrino Melyndee , Sultan Naima , Manuzon Elnora , Yajamanyam Phani Kiran
Published: December 2024

Background

Balancing between adequate analgesia and preventing the harmful side effects of opioids in the NICU is an important clinical conundrum. Lack of awareness among caregivers and guidance on pain management are the key limiting factors. By initiating this quality improvement (QI) project, we aimed to reduce the usage of opioids in a quaternary NICU care by 5% within 1 year.

Methods

A multidisciplinary team developed standardized guidance focusing on regular pain assessment, appropriate initiation, and weaning of opioids for infants undergoing surgical procedures and those requiring mechanical ventilation. The Plan, Do, Study, Act (PDSA) methodology was used for improvement, beginning with a survey and Pareto analysis to identify key drivers. Data were collected for the baseline period and after implementing the QI interventions.

Results

We demonstrated a significant decrease in the cumulative opioid use measured as morphine equivalent (mg/kg) from a mean of 2.7 to below 0.85 mg/kg, demonstrating a reduction of >50%. There was no worsening in pain or opioid withdrawal scores within three and 5 days after weaning of opioids, a surrogate measure for appropriate weaning.

Conclusion

Implementation of standardized guidelines for initiating and weaning of opioids can reduce the overall opioid use and thus minimize opioid withdrawal in critically ill neonates.
Decreased prevalence and altered clinical phenotype of systemic sclerosis and other autoimmune connective tissue diseases in type 1 and type 2 diabetes: A cross-sectional observational study
Authors: Abugharbyeh Aya , Khuder Sadik , Kahaleh Bashar
Published: December 2024

Introduction:

Evidence has demonstrated that autoimmune diseases tend to coexist at a higher rate than expected, reflecting a common pathogenic pathway. In this study, we investigate the co-occurrence of systemic sclerosis, systemic lupus erythematosus, and Sjogren syndrome in patients with type 1 and type 2 diabetes mellitus.

Methods:

Our data were obtained using the 2019 Healthcare Cost and Utilization Project, and International Classification of Diseases, 10th Revision diagnosis codes were used to identify patients with systemic sclerosis, systemic lupus erythematosus, lupus nephritis, and Sjogren syndrome, as well as patients with type 1 and type 2 diabetes. We utilized Statistical Analysis System 9.4 for all analyses and included designated weight values to produce nationally representative estimates.

Results:

The prevalence of systemic sclerosis among patients with type 1 diabetes mellitus and type 2 diabetes mellitus was significantly lower than that for the non-diabetes mellitus control group (0.0007% vs 0.09%, p-value = 0.0064 and 0.01% vs 0.07%, p-value < 0.0001), respectively. Similarly, there was a significant decrease in the prevalence of systemic sclerosis with lung involvement in patients with type 1 and type 2 diabetes mellitus, with a statically significant difference in type 2 diabetes mellitus versus nondiabetic group (0.001% vs 0.006%, p-value < 0.0001). We noted a similar pattern regarding the prevalence of systemic lupus erythematosus and lupus nephritis in patients with type 1 and 2 diabetes. Similarly, there was a significant decrease in the prevalence of Sjogren syndrome in patients with type 1 diabetes and type 2 diabetes.

Conclusion:

The collected data demonstrates an inverse relation between some autoimmune connective tissue diseases and diabetes. This suggests that these diseases and diabetes mellitus may have different immune pathogenesis. There was also a significantly lower incidence of organ complications such as lupus nephritis and systemic sclerosis lung disease among patients with diabetes, suggesting that diabetes and treatment of diabetes may alter the clinical expression of these disorders.
A tentative roadmap for consensus building processes
Authors: Leising Daniel , Liesefeld Heinrich , Buecker Susanne , Glöckner Andreas , Lortsch Stefanie
Published: December 2024

Like all other branches of science, psychology is constantly faced with the task of establishing some level of preliminary consensus over term use, methods, and findings, while at the same time leaving open the door to challenging and revising that consensus when necessary. Suboptimal solutions in this regard are likely to lead to inefficient use of resources, and to impede the cumulative acquisition of knowledge. The current culture and incentive structure in academia does not encourage systematic consensus work enough, and there are no clear guidelines as to how this crucial kind of work is to be engaged with. We present a tentative roadmap intended to facilitate systematic consensus building processes (CBPs). It contains a long and diverse list of issues that researchers undertaking consensus work may want to consider before and during a CBP. In discussing these issues, we point to potential complications and offer recommendations on how to avoid them. This mostly concerns questions of communication, transparency, fairness, integrity and legitimacy. We assume that dealing with these topics explicitly and from the get-go will substantially increase the likelihood of a CBP to be successful.
Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era
Authors: Fatola Ayotola , Evans Michael D. , Brown Jenna , Davis Elizabeth , Johnson Andrew , Antun Ana G. , Farland Andrew M. , Woods Ryan , Metjian Ara , Park Yara A. , de Ridder Gustaaf , Gibson Briana , Kasthuri Raj S. , Liles Darla K. , Eubanks Susan , Akwaa Frank , Clover Todd , Kreuziger Lisa Baumann , Sadler J. Evan , Sridharan Meera , Go Ronald S. , McCrae Keith R. , Upreti Harsh Vardhan , Lim Ming Y. , Kocher Nicole K. , Gangaraju Radhika , Zheng X. Long , Raval Jay S. , Masias Camila , Cataland Spero R. , Mazepa Marshall , Chaturvedi Shruti
Published: December 2024

Immune thrombotic thrombocytopenic purpura (iTTP) is a chronically relapsing disorder caused by autoantibody-mediated deficiency of ADAMTS13. Rituximab is frequently administered to prevent relapses, but whether the durability of rituximab effect is maintained with subsequent treatment courses has not been studied. Using the United States Thrombotic Microangiopathy Consortium (USTMA) retrospective iTTP registry, we evaluated clinical relapse-free survival (RFS) with subsequent courses of rituximab treatment in multiply relapsing patients. Separately, we evaluated overall RFS (composite of time to clinical relapse, ADAMTS13 relapse, or preemptive rituximab) in a prospective iTTP cohort from the Johns Hopkins University and the University of Minnesota. In the USTMA registry, median clinical RFS was shorter after the second or subsequent rituximab-treated episode than the first (2.1 vs 6.0 years; P = .04). White patients’ clinical relapse risk after the second and subsequent rituximab courses was not significantly different compared with the first (hazard ratio [HR], 1.86; 95% confidence interval [CI], 0.22-15.80; P = .57), whereas for Black patients, clinical relapse risk was significantly higher after the second or subsequent courses (HR, 2.82; 95% CI, 1.52-5.24; P = .001). In the prospective cohort, overall RFS progressively shortened after each episode of rituximab treatment with the first episode having the longest RFS (2.8 years; interquartile range, 2.0-6.0) and this loss of response durability was most pronounced in Black patients. The durability of rituximab’s effect declines with subsequent treatments, which is more pronounced in Black patients, who may benefit from closer monitoring and alternative immunomodulatory approaches such as maintenance rituximab and consideration of other agents.
Antiviral potential of Vδ2 T cells in children given TCR αβ/CD19 cell-depleted HLA-haploidentical HSCT
Authors: Bordoni Veronica , Guarracino Federica , Galaverna Federica , Bertaina Valentina , Li Pira Giuseppina , Rosichini Marco , Pitisci Angela , Matusali Giulia , Maggi Fabrizio , Velardi Enrico , Merli Pietro , Locatelli Franco , Agrati Chiara
Published: December 2024

γδ T cells represent key players in immune surveillance after T-cell receptor α/β (αβ)/CD19-depleted HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Although encouraging data are available on the impact of Vδ2-targeting therapy in improving HSCT clinical outcomes, their role in providing antimicrobial immunity is largely unexplored. This study aimed to investigate the antiviral protective profile of Vδ2 T cells in pediatric patients given haplo-HSCT. The characterization of γδ T cells was performed in pediatric recipients (n = 26) in the donor graft and at 30, 60, and 120 days after haplo-HSCT. The antiviral activity of Vδ2 T cells and the cytomegalovirus (CMV)-specific αβ T-cell immunity was analyzed. Early after HSCT, Vδ2 T cells was significantly higher in patients who did not experience viral reactivation (No-VR) than in patients with CMV reactivation. Interestingly, this difference was already present in the grafts. Clustering analysis identified a protective subset of Vδ2 T cells in patients with No-VR, expressing CD16, NKG2D, and CD107a, and producing Th1 cytokines. This subset directly correlated with interleukin-15 and inversely with the CMV DNA level. Stimulated Vδ2 T cells inhibit CMV replication, acquired CD86/HLA-DR molecules, induced HLA-DR on monocytes, and improved the αβ CMV–specific T-cell response. Altogether, these results identify an antiviral protective profile displayed by Vδ2 T cells early after HSCT, and define their ability to inhibit CMV replication, to induce antigen-presenting cell maturation and to improve αβ virus–specific T-cell response, opening a new application of Vδ2-targeting immunotherapy after HSCT, adding the antiviral to the antitumor potential.
Development and validation of predictive models of early immune effector cell–associated hematotoxicity
Authors: Liang Emily C. , Huang Jennifer J. , Portuguese Andrew J. , Ortiz-Maldonado Valentín , Albittar Aya , Wuliji Natalie , Basom Ryan , Jeon Yein , Wu Qian , Torkelson Aiko , Kirchmeier Delaney , Chutnik Abigail , Pender Barbara , Sorror Mohamed , Hill Joshua A. , Kopmar Noam E. , Banerjee Rahul , Cowan Andrew J. , Green Damian , Gopal Ajay K. , Poh Christina , Shadman Mazyar , Hirayama Alexandre V. , Till Brian G. , Kimble Erik L. , Iovino Lorenzo , Chapuis Aude G. , Otegbeye Folashade , Cassaday Ryan D. , Milano Filippo , Turtle Cameron J. , Maloney David G. , Gauthier Jordan
Published: December 2024

Immune effector cell–associated hematotoxicity (ICAHT) is associated with morbidity and mortality after chimeric antigen receptor (CAR) T-cell therapy. To date, the factors associated with ICAHT are poorly characterized, and there is no validated predictive model of ICAHT as defined by current consensus criteria. Therefore, we performed comprehensive univariate analyses to identify factors associated with severe (grade 3-4) early ICAHT (eICAHT) in 691 patients who received commercial or investigational CAR T-cell therapy for hematologic malignancies. In univariate logistic regression, preinfusion factors associated with severe eICAHT included disease type (acute lymphoblastic leukemia), prelymphodepletion (pre-LD) blood counts including absolute neutrophil count (ANC), lactate dehydrogenase (LDH), and inflammatory (C-reactive protein [CRP], ferritin, and interleukin-6 [IL-6]) and coagulopathy biomarkers (D-dimer). Postinfusion laboratory markers associated with severe eICAHT included early and peak levels of inflammatory biomarkers (CRP, ferritin, and IL-6), coagulopathy biomarkers (D-dimer), peak cytokine release syndrome grade, and peak neurotoxicity grade. We trained (n = 483) and validated (n = 208) 2 eICAHT prediction models (eIPMs): eIPMPre including preinfusion factors only (disease type and pre-LD ANC, platelet count, LDH, and ferritin) and eIPMPost containing both preinfusion (disease type and pre-LD ANC, platelet count, and LDH) and early postinfusion (day +3 ferritin) factors. Both models generated calibrated predictions and high discrimination (area under the receiver operating characteristic curve in test set, 0.87 for eIPMPre and 0.88 for eIPMPost), with higher net benefit in decision curve analysis for eIPMPost. Individualized predictions of severe eICAHT can be generated from both eIPMs using our online tool (available at https://eipm.fredhutch.org).