bluuebunny/crossref_metadata_2025 huggingface dataset:
E-cigarette Smoking and Colorectal Cancer Screening
Authors: Annor Eugene , Atarere Joseph , Glover Quarshie , Ubah Nneoma , Odo Chinenye , Bene-Alhasan Yakubu , Orhurhu Vwaire , Hasoon Jamal , Ufondu Wisdom Chinonyelu , Osman Moyasar , Thompson Christopher
Published: November 2024

Purpose

To evaluate how CRC screening practices differ between e-cigarette users and non-users.

Design

Cross-sectional study design.

Setting

National Cancer Institute’s Health Information National Trends Survey (HINTS 5).

Subjects

Respondents aged 45 to 75 years.

Measures

Demographics, CRC screening, e-cigarette use, cancer history, presence of comorbidities, and access to a primary care provider.

Analysis

The demographic characteristics of the study participants were evaluated by their e-cigarette smoking status using chi-squared tests. The differences in CRC screening between e-cigarette users and non-users were evaluated using a multivariate logistic regression model.

Results

We identified a total of 6963 participants, of which 181 (2.6%) were e-cigarette users. The prevalence of e-cigarette use was inversely related to age. A significant portion were uninsured (10.7% vs 5.9% of non-users), and almost half (49.9%) were current tobacco smokers. E-cigarette users were as likely to undergo CRC screening compared to non-users [OR 1.40; 95% CI (0.74, 2.66)]. Increasing age, educational level, health insurance, comorbidity, access to a primary care provider, personal history of cancer, and presence of a comorbidity were associated with increased participation in CRC screening. However, e-cigarette use was not associated with increased screening.

Conclusion

Our study found no significant difference in CRC screening rates between e-cigarette users and non-users. While screening behaviors appear unaffected for now, ongoing surveillance is important as more users reach screening age given the uncertainties surrounding the long-term effects of e-cigarette use.
Participatory Grant-Making as a Social Innovation: Examining Relational Processes in Social Finance
Authors: Price Michael , Wong Nicholas D. , Russell Mike
Published: November 2024

This study examines how philanthropic foundations develop innovative approaches to grant-making by collaborating with social entrepreneurs who are embedded in marginalized communities. Traditionally, foundations award grants that meet predetermined strategic objectives that support their theories of change. However, this study explores an alternative approach known as participatory grant-making, in which philanthropic foundations cede control over strategy and finance by adopting an innovative approach that is based more on trust and collaboration. By analyzing in-depth interviews from 16 executives, directors, and social entrepreneurs in the United States, we demonstrate how participatory grant-making constitutes a social innovation that inverts traditional power dynamics in the philanthropic field by enhancing legitimacy, and thereby facilitating a more interconnected, inclusive, and equitable approach to solving social problems. This article demonstrates how the implementation of participatory grant-making programs can help to counter the increasing criticisms levied at traditional approaches to grant-making.
EXPRESS: Exploring the Influence of Football Fan Tokens on Engagement: a Study on Fans’ Meaning, Team Brand Identification, and Co-creation Mechanisms
Authors: Vollero Agostino , Sardanelli Domenico , Manoli Argyro Elisavet
Published: November 2024

Sport brands are pursuing new avenues that affect consumer–brand relationships through digital engagement platforms based on fan tokens, a specific type of cryptocurrency. These metaverse-enabling technologies offer novel stimuli to enhance fans’ brand experiences, but their impact on fans’ intentions and behaviors has yet to be determined. Drawing on social identity theory and customer engagement literature as a theoretical lens, this paper examines how the meanings attached to fan-token-related activities impact on team brand identification and the associated social influence mechanisms between fans, concurrently with brand co-creation awareness. Results show that meanings associated with fan-token-related activities have positive influence both on identification and engagement with fans’ favorite team brands, while intentions to continue using and recommending these digital assets depend primarily on the meanings that fans associate with these activities. This study has several theoretical and practical implications. It questions the ways through which metaverse technologies are affecting brand co-creation mechanisms and fan engagement. In managerial terms, it suggests that teams should primarily define an “open brand” structure to keep fans involved in these digital engagement platforms and reap the benefits of positive non-transactional behaviors from these engaged fans.
Lucidity in deeply forgetful people: A national U.S. survey of caregivers’ reactions
Authors: Post Stephen G , Ross John Paul , Bonhag Rebecca , Lu Wei-Hsin
Published: November 2024

Background

Despite the prevalence and challenge of Alzheimer's disease and related dementias, glimmers of hope arise during lucid moments. Caregivers, often burdened, play a crucial role. The study explored emotional responses to witnessed episodes of unexpected lucidity in deeply forgetful people, aiming to highlight the significance and varying reactions, especially among caregivers of this population.

Objective

The aim of this study was to elucidate how moments of unexpected lucidity are experienced by those who witness them, and to examine whether caregivers and non-caregivers, as well as different types of caregivers may have different emotional reactions to the episodes.

Methods

A probability-based sample representative of the United States adult population aged 40 and older with internet access was employed. 5944 respondents completed screening questions regarding whether they knew an individual with dementia and had witnessed unexpected lucidity. Close to 2000 individuals answered questions regarding their emotional reactions to witnessing unexpected lucidity, which we aimed to examine in more detail.

Results

Both caregivers and non-caregivers showed a tendency towards positive emotions in response to lucid episodes, yet negative emotions were also mentioned. We observed group differences (caregivers versus non-caregivers, different caregiver types) in the emotional responses for some of the examined emotions.

Conclusions

Caregivers can find inspiration in these fleeting moments. The research aims to guide caregivers and enhance the understanding of the enduring self-identity of deeply forgetful people, promoting compassionate care and recognizing the significance of our shared humanity.
Percutaneous Carotid Access in Endovascular Aortic Arch Repair: Initial Experience
Authors: Karelis Angelos , Mitta Nivedita , Berczeli Márton , Sonesson Björn , Dias Nuno V.
Published: November 2024

Purpose:

Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events.

Techniques:

A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non–flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months.

Conclusion:

Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes.

Clinical Impact

Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.
Endobronchial ultrasound-guided transbronchial needle aspiration validated with video-assisted mediastinoscopic lymphadenectomy in the mediastinal restaging of patients with stage IIIA non-small cell lung cancer after induction therapy
Authors: García-Cabo Bruno , Reig Nina , Rami-Porta Ramón , Call Sergi , Esteban Lluís , Barreiro Bienvenido , Reyes Efraín , Obiols Carme , Ochoa Juan Manuel , Morlius Xavier , Tarroch Xavier , Serra Mireia , Sanz-Santos José
Published: November 2024

Background:

The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) validated with video-assisted mediastinoscopic lymphadenectomy (VAMLA) for mediastinal restaging of patients with non-small cell lung cancer (NSCLC) after induction therapy has never been described.

Objective:

To report on our experience in this clinical setting.

Design:

Retrospective analysis of a prospectively built database.

Methods:

Patients with stage IIIA (N2) NSCLC who underwent EBUS-TBNA for mediastinal restaging after induction therapy were included. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy of EBUS-TBNA and VAMLA for mediastinal restaging were calculated. The number of patients needed to undergo confirmatory VAMLA (NNT) after a negative EBUS-TBNA for mediastinal restaging to avoid a case of pathologic (p) N2 disease after resection was also calculated.

Results:

Forty-six patients underwent EBUS-TBNA which was positive in 12 patients and negative in 34. Patients with a negative EBUS-TBNA underwent VAMLA which was positive in seven cases. Of the other 27 patients with a negative VAMLA, 26 underwent resection that did not show N2 disease. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of EBUS-TBNA for restaging were 63.1%, 100%, 79.4%, 100%, and 84.7%, respectively. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of confirmatory VAMLA after EBUS-TBNA was 100%. The NNT confirmatory VAMLA after a negative EBUS-TBNA to avoid a case of pN2 disease at resection was five patients.

Conclusion:

EBUS-TBNA must remain as the first-choice test for invasive mediastinal restaging. However, the results of our study in terms of sensitivity and NPV, even considering the small size of our population, suggest that negative results of EBUS-TBNA should be interpreted with caution and surgical exploration of the mediastinum (specially VAMLA, if available) should be considered in these patients.
Exploring the impact of bowling ball properties and performance through the use of technology: An analysis of bowling ball motion
Authors: Ahmad Zahudi Azrena Zaireen , Usman Juliana , Abu Osman Noor Azuan
Published: November 2024

Bowling balls are traditionally drilled with three holes to enhance the grip of the bowler and roll it down the lane. The path of the ball may be either straight or curved, with the intention of knocking over the pins situated at the edge of the lane. Alterations in the trajectory of the ball lead to irregular pinfalls, ultimately affecting the player’s score. This research was initiated to investigate the characteristics of bowling balls (weights), with a focus on examining the motion of bowling balls in relation to various factors such as pocket entry angle, speed, and position on the boards, as well as the impact of different types of drilling on bowling-ball kinematics. The Powerhouse Blueprint software was utilized to simulate thirty-two (32) distinct types of drilling on four separate bowling balls. The arrangement of the drilling proved to have a substantial impact on the kinematic entry factors, as evidenced by the statistically significant result of p < 0.01. It is essential from a practical standpoint to comprehend the characteristics and movement of bowling balls to enhance performance and improve outcomes during tenpin bowling competitions.
Reassessing mirtazapine and akathisia: A case report on its efficacy in treating severe, treatment-resistant akathisia and a review of the evidence
Authors: Chidiac Madeline , Elhusein Bushra , Gajebasia Niman
Published: November 2024

Antipsychotic-induced akathisia is a distressing movement disorder marked by intense internal restlessness and an urge to move. This report discusses a 44-year-old man with a diagnosis of schizophrenia who developed severe, treatment-resistant akathisia after taking haloperidol, a first-generation antipsychotic. Standard treatments for antipsychotic-induced akathisia, including benzodiazepines (Clonazepam) and benztropine, failed to alleviate the patient’s persistent symptoms, causing considerable distress. However, the introduction of mirtazapine at a low dose of 15 mg led to substantial improvement, as indicated by a gradual reduction in the Barnes Akathisia Rating Scale score from 8 to 0 and improvements in mood, mobility, and daily activity participation. This case highlights the potential efficacy of mirtazapine in treating severe, resistant akathisia, adding to its established use in antipsychotic-induced akathisia management and contributing to the limited literature on its application in patients unresponsive to other conventional treatments.
The Use of Autologous Omentum Transposition as a Therapeutic Intervention to Reduce the Complication of Ischemia/Reperfusion Injuries in a Rat Model
Authors: Shamshirgaran Amirreza , Mohammadi Abdolreza , Zahmatkesh Parisa , Mesbah Gholamreza , Guitynavard Fateme , Saffarian Zahra , Khajavi Alireza , Oliveira Reis Leonardo , Aghamir Seyed Mohammad Kazem
Published: November 2024

Background:

Ischemia/reperfusion injury (IRI) causes cellular dysfunction and death in organs like the kidney, heart, and brain. It involves energy depletion during ischemia and oxidative stress, inflammation, and apoptosis during reperfusion. Kidney IRI often leads to acute kidney injury (AKI) in various clinical scenarios. The omentum, an adipose tissue with healing properties, has been used to treat injuries in different organs.

Objective:

This study aimed to assess the omentum’s healing effects on reducing IRI’s adverse effects after renal ischemia in Wistar rats.

Method:

A total number of 36 male Wistar rats were used in a study on IRI-induced AKI. Rats were divided into 6 groups of normal kidneys wrapped with omentum “Sham-1” and “Sham-2,” ischemic kidney wrapped with omentum as “OMT-1” and “OMT-2,” and ischemic kidney without omentum as “Control-1” and “Control-2.” Ischemia was induced by clamping the left renal artery for 45 minutes. The omentum was transposed onto the injured kidney in “OMT” group. After sacrifice at weeks 4 and 8, kidney histology and blood samples were analyzed for kidney function markers.

Results:

On the first day after surgery, there was an immediate increase in creatinine and blood urea nitrogen (BUN) levels, which then decreased by day 28. Both OMT groups showed significantly lower levels of creatinine and BUN compared to Control groups on day 1, but after 28 days differences were not statistically significant. Histological analysis using H&E and Masson’s trichrome staining revealed significantly higher levels of inflammatory cell infiltration and hyperemia in the OMT groups. However, fibrosis and glomerular shrinkage were higher in the Control groups.

Conclusion:

Using an omental flap significantly prevented fibrosis within the renal parenchyma, slow down the AKI progression, and potentially serving as a promising therapeutic strategy for kidney dysfunction.
Kindergarten Teachers’ Mindfulness in Teaching and Job Satisfaction: A Moderated Mediation Model
Authors: Yin Pan , Huang Chao , Yin Xiaochun , Yang Fengwan , Qiu Shi , Song Daixue
Published: November 2024

Based on the theory of meaning construction, this research aims to examine the relationship between mindfulness-based instruction and job satisfaction among educators working in kindergarten settings. Specifically, this study will evaluate whether teachers’ self-efficacy mediates this relationship and explore the potential moderating impact of role maladjustment on this mediation process. A total of 531 kindergarten teachers, mostly females participated in the study by responding to self-administered questionnaires measuring their mindfulness in teaching, teachers’ self-efficacy, role maladjustment, and job satisfaction. The findings indicate that there is a notable and favorable correlation between the practice of mindfulness in teaching and job satisfaction among kindergarten teachers. Additionally, the analysis suggested that teachers’ self-efficacy partially mediated this relationship. These results remained significant even after controlling for demographic variables. Further examination using moderated mediation analysis indicated that role maladjustment did not have a moderating effect on either the direct or indirect links between mindfulness in teaching and job satisfaction. The results highlight the importance of teacher self-efficacy as a mediating factor, emphasizing the role of mindfulness in assisting preschool educators in effectively managing challenges and adversities. This, in turn, enhances emotional regulation and coping skills while cultivating a heightened awareness of personal strengths and abilities, ultimately resulting in greater job satisfaction.
Digital Service Trade and the Wage Income Gap Between Urban and Rural Residents: Empirical Evidence from China
Authors: Lu Weixiao , Yuan Wenhua
Published: November 2024

While promoting the high-quality development of foreign trade, digital service trade has also had a complex and far-reaching effect on the wage income gap between urban and rural residents. On the basis of Chinese provincial data from 2009 to 2019, this study uses the fixed effect model and the Difference-in-Differences(DID) model for empirical analysis. The development of digital service trade significantly reduces the wage income gap between urban and rural residents. The development of digital service trade can effectively improve resource allocation efficiency, promote industrial structure optimization and upgrading, and enhance agricultural total factor productivity. In areas with high levels of digital inclusive finance, education resources and marketization, the effect of digital service trade development on narrowing the wage income gap between urban and rural residents is more prominent. The innovative development pilot policy of service trade carried out by the Chinese government in 2016 promoted the development of digital service trade and narrowed the wage income gap between urban and rural residents in the pilot provinces. The conclusions of this study provide a reference for the government to leverage the development of digital service trade to narrow the income gap between urban and rural residents in the future.
Visual Evoked Potential Effects on Magnocellular and Parvocellular Pathways from Athletes After Mild Traumatic Brain Injuries
Authors: Myers Mark H , Kalyanakumar Nidhish , Harris Paul
Published: November 2024

Background:

The objective of this study is to examine magnocellular and parvocellular pathways differentiation based on checkerboard spatial frequency stimulation between normal and visually impaired individuals from athletes with mild traumatic brain injury.

Purpose:

Athletes who exhibited photophobia, and blurriness were subjected to 5 spatial frequency stimuli presented to the left and right eye, and both eyes simultaneously to determine the type of receptive field loss deprecation based on sports-related brain trauma.

Methods:

Checkerboard stimulation enables the measurement between 2 visual processing pathways and enables the determination of the integrity of visual processing through visual evoked potentials (VEPs).

Conclusion:

The principal results reflect P1 responses demonstrated distinct changes in amplitude from mTBI (>5 µV) from normal cohorts concluding higher P1 amplitude of the VEP in mTBI cohorts had increased after injury. Latency in P1 was not as distinct as amplitude changes. Our major conclusion is that most of the mTBI cohort exhibited receptive field loss across all the patients appears to be magnocellular process deprecation due to frequent instances of 8 × 8 and 16 × 16 spatial frequencies input as it relates to amplitude and latency output.
Framework to Support Innovative Recruitment in Rural Secondary Special Education Research
Authors: Rowe Dawn A. , Mazzotti Valerie L. , Frederick Darcy , Hitt Sara Beth , Oswalt Amy K. , Bates Madelyn , Cotter Makensie , Gau Jeff , Smolkowski Keith
Published: November 2024

Secondary special education and transition research is crucial for improving outcomes for students with disabilities during their transition to postschool life. However, rural schools are underrepresented in this field, hindering the development of tailored interventions that can support youth with disabilities as they transition into adult life in rural communities. This manuscript offers a framework for (a) recruiting rural schools in secondary special education and transition research, (b) emphasizing facilitators that can support community partnerships in research, including tailored strategies to support research collaboration with rural communities, and (c) addressing barriers to rural school recruitment such as geographical isolation and limited resources. Drawing from experience with recruiting schools for the Communicating Interagency Relationships and Collaborative Linkages for Exceptional Students (CIRCLES) intervention, we offer guidance for researchers, stressing flexibility and clear communication to effectively engage rural schools. By integrating these insights, researchers can develop more inclusive recruitment approaches, advancing secondary special education and transition research to better support outcomes for secondary students with disabilities in rural settings.
Intestinal IFNα4 promotes 15-HETE diet-induced pulmonary hypertension
Authors: Ruffenach Grégoire , Medzikovic Lejla , Aryan Laila , Sun Wasila , Lertpanit Long , O’Connor Ellen , Dehghanitafti Ateyeh , Hatamnejad Mohammad Reza , Li Min , Reddy Srinivasa T. , Eghbali Mansoureh
Published: November 2024

Objectives

Pulmonary arterial hypertension (PAH) is characterized by the remodeling of the pulmonary vascular bed leading to elevation of the pulmonary arterial pressure. Oxidized fatty acids, such as hydroxyeicosatetraenoic acids (HETEs), play a critical role in PAH. We have previously established that dietary supplementation of 15-HETE is sufficient to cause PH in mice, suggesting a role for the gut-lung axis. However, the mechanisms are not known.

Approach

Analysis of RNA-seq data obtained from the lungs and intestines of mice on 15-HETE diet together with transcriptomic data from PAH patient lungs identified IFN inducible protein 44 (IFI44) as the only gene significantly upregulated in mice and humans. We demonstrate that IFI44 is also significantly increased in PBMCs from PAH patients. In mice, 15-HETE diet enhances IFI44 and its inducer IFN⍺4 expression sequentially in the intestine first and then in the lungs. IFI44 expression in PAH is highly correlated with expression of Tumor Necrosis Factor Related Apoptosis Inducing Ligand (TRAIL), which is upregulated in CD8 cells in PH lungs of both mice and humans. We show that IFNα4 produced by intestinal epithelial cells facilitates IFI44 expression in CD8 cells. Finally, we demonstrate that IFN receptor 1-KO in mice do not develop PH on 15-HETE diet. In addition, silencing IFI44 expression in the lungs of mice on 15-HETE diet prevents the development of PH and is associated with significantly lower expression of IFI44 and TRAIL in CD8 cells in the lungs.

Conclusion

Our data reveal a novel gut-lung axis driven by 15-HETE in PH.
Chimeric antigen receptor-T cell therapy for T cell-derived hematological malignancies
Authors: Zheng Haiqiong , Zhao Houli , Han Shi , Kong Delin , Zhang Qiqi , Zhang Mingming , Chen Yijin , Zhang Meng , Hu Yongxian , Huang He
Published: November 2024

Relapsed/refractory T cell-derived malignancies present with high heterogeneity and poor prognoses. Recently, chimeric antigen receptor (CAR)-T cell therapy has shown remarkable safety and efficacy in the treatment of B cell-derived malignancies. However, the treatment of CAR-T cells in T cell-derived malignancies has more limitations, such as fratricide, T cell aplasia, and tumor contamination, mainly because of the similarity between normal and malignant T cells. Pan-T antigen CAR-T cells (such as CD5 and CD7 targets), the most widely used CAR-T cells in clinical trials, can cover almost all T cell-derived malignant cells but can also induce severe killing of CAR-T cells and normal T cells. Compared to autologous sources of CAR-T cells, allogeneic CAR-T cells can prevent tumor contamination and become universal products by gene-editing. However, none of these CAR-T cells could completely prevent immune deficiency and disease relapse after T-targeted CAR-T cell therapy. In this review, we summarize the current challenges of CAR-T cell therapy for T cell-derived malignancies in clinical practice and potential strategies to address these limitations.
Cultural adaptation and validation of the Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents
Authors: Haywood Sharon , Garbett Kirsty M. , Craddock Nadia , Hayes Chloe , Saraswati L. Ayu , Nasution Kholisah , Medise Bernie E. , Vitoratou Silia , Diedrichs Phillippa C.
Published: November 2024

Background

Although mental health issues among Indonesian adolescents are of growing concern, a psychometrically valid measure of affect in Indonesia to inform related research and prevention and treatment efforts does not exist.

Methods

The present study’s aim was to culturally adapt and validate the widely used Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents. The original 30-item PANAS-C in English underwent forward and back translations to Bahasa Indonesia (the national language of Indonesia) followed by cognitive interviews with private and public school students ages 12–15 (n = 18). The adapted PANAS-C and measures to assess convergent validity were completed by 704 Indonesian adolescents from Greater Jakarta and the Javanese city of Surabaya (Mage = 13.56, SD = 0.906) (56.96% girls; 42.75% boys; 0.28% other). Most participants identified their ethnicity as Javanese (72.59%), Betawi (8.24%), or Sundanese (3.41%).

Results

Exploratory and confirmatory factor analyses were conducted, which resulted in 26 items with a two-factor structure consistent with the original PANAS-C: A 12-item Positive Affect subscale and a 14-item Negative Affect subscale. Internal consistency was satisfactory for the Positive Affect subscale (Cronbach’s alpha was 0.88; McDonald’s omega was 0.88) and excellent for the Negative Affect subscale (Cronbach’s alpha was 0.90; McDonald’s omega was 0.89). Test-retest reliability was acceptable for all items, and convergent validity was confirmed by significant correlations with measures of distress and well-being.

Conclusion

The adapted PANAS-C was found to be a reliable and valid measure of positive and negative affect that can be used with Indonesian adolescent girls and boys. This is the first validated measure of positive and negative affect for young people in Indonesia, which fills a need in mental health research and practice.
Cerebral capillary oxygen diffusion: exploring the concept of intracapillary hemoglobin conformational changes
Authors: Harutyunyan Gurgen , Harutyunyan Jaghatspanyan Varsenik , Harutyunyan Jaghatspanyan Garnik , Martirosyan Emma , Cherkezyan Artur , Varosyan Armen , Soghomonyan Suren
Published: November 2024

The mechanisms of oxygen diffusion in brain capillaries have not been fully clarified to date. According to the laws of physics, the well-documented phenomenon of hyperoxemia-induced excessive increases in brain tissue oxygen pressure (PbtO2) contradicts traditional models of cerebral capillary oxygen diffusion. Circulating models predict a significant drop in oxygen pressure (PO2), and some of them foresee the presence of hypoxic or anoxic corners near the capillary end, regardless of high PbtO2 levels. We propose that the cerebral intracapillary transformation of hemoglobin from the relaxed (R) to the tense (T) quaternary conformational state, driven by deoxygenation and an overload of negative allosteric effectors, and characterized by a lower, more hyperbolic dissociation curve, mitigates the oxygen pressure difference across cerebral capillaries, ensuring a homogeneous pericapillary distribution of oxygen. The hemoglobin R to T state transition is responsible for the high PbtO2 levels observed in viable cerebral tissue during hyperoxemia.
Impact of pharmacist-led aminoglycoside stewardship: a 10-year observational study
Authors: Shinoda Yasutaka , Ohashi Kengo , Matsuoka Tomoko , Arai Kaori , Hotta Nao , Usami Eiseki
Published: November 2024

Background

Aminoglycosides are crucial for treating multidrug-resistant gram-negative infections and endocarditis. However, aminoglycosides are associated with significant risks of nephrotoxicity, necessitating careful dose selection and therapeutic drug monitoring. Therapeutic drug monitoring is essential for minimizing risk; however, few institutions routinely perform it. This study aimed to assess the impact of a pharmacist-driven therapeutic drug monitoring intervention on aminoglycoside usage trends and clinical outcomes.

Methods

This retrospective cohort study included 263 patients treated with aminoglycosides between 2014 and 2023. A pharmacist-led therapeutic drug monitoring intervention began in 2017, focusing on monitoring renal function, documenting patient weight, and closely managing aminoglycoside concentrations. Trends in aminoglycoside use and renal outcomes were analyzed.

Results

Over the study period, appropriate use of aminoglycosides at the time of initial prescription increased from 49 to 82% (P < 0.01). Pharmacist dosing design at initial prescription increased significantly from 21% pre-intervention to 60% post-intervention (P < 0.01). The proportion of pharmacist intervention in initial dosing design increased over time. The proportion of patients with measured aminoglycoside blood concentrations significantly increased from 53% pre-intervention to 72% post-intervention (P < 0.01). The proportion of patients who were able to manage target blood concentrations from the initial aminoglycoside dose without dose adjustments increased from 31% pre-intervention to 42% post-intervention, although the results were not significantly different (P = 0.07). The incidence rate of renal impairment remained similar (11% vs. 12%; P = 0.85), although the annual average number of cases decreased from 4.3 before the intervention to 2.5 after. Similarly, there were no significant differences in clinical efficacy before and after the intervention (65% vs. 71%; P = 0.35). Furthermore, aminoglycoside stewardship led to a 56% cost saving.

Conclusions

Pharmacist-led aminoglycoside stewardship significantly improved the appropriate use of aminoglycosides and decreased the associated costs. Thus, pharmacist involvement is essential for the proper use of aminoglycosides. However, many patients required aminoglycoside dose reductions despite the pharmacist’s guideline-based dosing design. Therefore, further accumulation of information on the management of aminoglycoside blood concentration may be necessary for the revision of these guidelines.
“I just don’t know enough”: Australian perspectives on community involvement in health and medical research
Authors: Russo Fiona , Sherburn Isabella , Finlay Keri , Nunn Jack , Ferrie Monica , McKenzie Anne , Murray Sean , Cannings John , Pratt Greg , Boughtwood Tiffany
Published: November 2024

Background

There is increasing global support from governments and other funding bodies for community involvement in research, alongside a scientific and moral imperative for responsible and ethical research practice. Ninety per cent of Australian patient-led organisations in rare diseases have clearly articulated research priorities, indicating a desire among people affected by disease to be involved in research that impacts their communities. Philanthropic research, which is likely to have predominantly community-minded priorities, is worth over AU$1 billion annually and increased more than 100% between 2007 and 2017.

Aims

This research aimed to understand public perspectives on community involvement in health-related research activities, and to inform the development of guidelines for genomic researchers to improve this involvement.

Methods

A 37-question survey was completed by 1,156 members of the Australian public via Dynata. The survey was co-designed by the Involve Australia Working Group of community members within Australian Genomics. Results from 1156 responses were analysed.

Results

Key themes emerging from the survey data that impact potential involvement were low community confidence to contribute, a limited understanding of community involvement, roles and recognition, trust and governance of data, perceived trustworthiness of research funders, and factors related to time and personal resources. A variety of motivations for involvement were also stated.

Conclusion

Members of the Australian public are interested in research involvement; however the differences between involvement and participation are poorly understood and a variety of barriers still exist. Researchers must actively reach out into communities and offer opportunities to engage with research and identify community priorities.
Gamma-glutamyl transpeptidase as an indicator for subclinical cardiovascular disease in patients with psoriatic arthritis
Authors: Soliman Wafaa , Adel Nada , Safar Aya
Published: November 2024

Background

Gamma-glutamyl transpeptidase (GGT) is an important molecule produced by hepatocytes that has been noticed as a prooxidative enzyme. GGT has been found to be included in the inflammation process and oxidative damage in multiple diseases in human. Psoriatic arthritis (PsA) is an inflammatory disorder leading to high mortality and morbidity due to cardiovascular events. However, GGT role in PsA remains unclear. The aim of this study is to determine the association of GGT with PsA activity and atherosclerosis in PsA patients. Also, to investigate if GGT can serve as an indicator of subclinical atherosclerosis in PsA patients.

Results

This study was performed on 30 PsA patients and 30 matched healthy subjects. All patients underwent detailed history taking and clinical assessment. Disease activity in PsA (DAPSA) score was used to assess disease activity in PsA patients. GGT level in serum was quantified by utilizing enzyme-linked immunosorbent assay and correlated with carotid intima media thickness (CIMT) and PsA disease activity. Patients’ mean age and disease duration was 43.37 ± 7.65 years (30–55 years) and 7.97 ± 4.214 years (2–15 years) respectively. Levels of GGT in serum were significantly increased in patients compared to GGT serum levels in controls (p < 0.001). Serum GGT levels showed significant positive correlation with DAPSA score, LDL, cholesterol triglycerides, and right and left CIMT (r = 0.913, 0.587, 0.779, 0.803, 0.736, 0.728 and p < 0.001 respectively) and significant negative correlation with HDL (r = − 0.681 and p < 0.001). However, GGT serum levels and PsA disease duration did not show significant correlation.

Conclusion

Serum GGT was associated with high disease activity, high lipid profile, and large CIMT in PsA patients. GGT might be an indicator of subclinical atherosclerosis and increased disease activity in patients with PsA.
Unusual Management of a Rare Case of Methimazole-Resistant Graves Disease
Authors: Tang Michael , Fteiha Bashar , Meng Shumei
Published: November 2024

As the leading cause of hyperthyroidism, Graves disease (GD) does not often present with its classical triad of pretibial myxedema, goiter, and exophthalmos but instead is often recognized by various manifestations such as tachycardia, weight loss, jaundice, or dermatopathy and requires utmost clinical vigilance. Three treatment modalities for GD exist as antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery, but each bears its own serious side effects. Furthermore, there have been several reports in the literature about ATD resistance that can complicate management. We describe a rare complex case of methimazole (MMI)-resistant GD in a 58-year-old woman with multiple comorbidities including heart failure, atrial fibrillation, liver cirrhosis, and hypertension. She presented with an initial complaint of diffuse swelling and was found to have severe thyrotoxicosis. Despite high doses of MMI, her thyroid function remained significantly elevated. Thyroid uptake and scan while on MMI showed high radioactive iodine uptake. After receiving RAI therapy, her thyroid function and bilirubin improved markedly, liver enzymes remained stable, and anasarca responded to diuretics. This case highlights the challenges in managing resistant GD and emphasizes the necessity of personalized treatment plans.
EFEMP1 contributes to light-dependent ocular growth in zebrafish
Authors: Xie Jiaheng , Bui Bang V. , Goodbourn Patrick T. , Jusuf Patricia R.
Published: November 2024

Myopia (short-sightedness) is the most common ocular disorder. It generally develops after over-exposure to aberrant visual environments, disrupting emmetropization mechanisms that should match eye growth with optical power. A pre-screening of strongly associated myopia-risk genes identified through human genome-wide association studies implicates efemp1 in myopia development, but how this gene impacts ocular growth remains unclear. Here, we modify efemp1 expression specifically in the retina of zebrafish. We found that under normal lighting, efemp1 mutants developed axial myopia, enlarged eyes, reduced spatial vision and altered retinal function. However, under myopia-inducing dark-rearing, compared to control fish, mutants remained emmetropic and showed changes in retinal function. Efemp1 modification changed the expression of efemp1, egr1, tgfb1a, vegfab and rbp3 genes in the eye, and changed the inner retinal distributions of myopia-associated EFEMP1, TIMP2 and MMP2 proteins. Efemp1 modification also impacted dark-rearing-induced responses of vegfab and wnt2b genes and above-mentioned myopia-associated proteins. Together, we provided robust evidence that light-dependent ocular growth is regulated by efemp1.
Is the Force-Velocity Profile for Free Jumping a Sound Basis for Individualized Jump Training Prescriptions?
Authors: Bobbert Maarten F. , Lindberg Kolbjørn , Paulsen Gøran
Published: November 2024

Introduction

Formulating individualized optimized jump training prescriptions based on the force-velocity profile has become popular, but its effectiveness has been contested. Such training programs have opposite effects on ‘maximal average force’ and ‘maximal average shortening velocity’, and we set out to investigate which training-induced changes in the neuromuscular system could cause such effects.

Methods

We used a musculoskeletal simulation model with four body segments and six muscle-tendon actuators to simulate vertical squat jumps with different loads. Independent input was muscle stimulation over time, which was optimized for maximal jump height. We determined the force-velocity profile for a reference model and investigated how it changed when we modified muscle properties and initial postures.

Results

We could not reproduce the reported training effects by realistically improving muscle properties (maximal force, shortening velocity and rate of force development) or modifying initial postures of the model. However, the profile was very sensitive to gains in jump height at low-loads but not high loads, or vice versa. Reaching maximal height in force-velocity profile jumps requires skill. We argued that submaximal performance in low-load or high-load jumps caused by lack of skill could be responsible for large imbalances in profiles before training. Differential skill training promoted by the individualized optimized approach could explain quick changes toward a balanced profile.

Conclusions

If the success of individualized optimized training studies is explained by selective skill improvements, training effects are unlikely to transfer to other tasks, and individualized optimized training will not be superior to other types of training.
Investigating the Influence of Limb Blood Flow on Contraction-Induced Muscle Growth and the Impact of that Growth on Changes in Maximal Strength
Authors: Wong Vickie , Spitz Robert W. , Bentley John P. , Song Jun Seob , Yamada Yujiro , Kataoka Ryo , Hammert William B. , Seffrin Aldo , Bell Zachary W. , Loenneke Jeremy P.
Published: November 2024

Changes in skeletal muscle size may be affected by resting blood flow (e.g., nutrient delivery) and this change in size is a hypothesized mechanism for changes in strength.

Purpose

To determine: 1) whether the relationship between isometric training and muscle growth depends on baseline blood flow or is mediated by a change in blood flow and 2) whether muscle growth mediates changes in maximal isometric strength.

Methods

179 participants were randomized into: low-intensity isometric handgrip exercise (LI), low-intensity isometric handgrip exercise with blood flow restriction (LI-BFR), maximal handgrip exercise (MAX), and a non-exercise control (CONTROL). Muscle thickness, strength, and resting limb blood flow were measured before and after the six-week intervention.

Results

Baseline blood flow did not moderate training effects on muscle thickness changes (MTHchg) (p = 0.666), and moderated mediation tests were non-significant. Although the LI-BFR group showed a significant effect on MTHchg (p = 0.018), MTHchg was not significantly related to handgrip strength change (HGchg) (p = 0.281), suggesting no mediation of the training-to-strength effect by MTHchg. Both the LI-BFR (p = 0.004) and MAX (p < 0.001) groups exhibited positive direct effects on HGchg compared to CONTROL. Furthermore, there were no differences between training groups and CONTROL on blood flow change (BFchg), BFchg and MTHchg were not significantly related, and neither BFchg nor MTHchg predicted HGchg, providing no evidence for mediated pathways.

Conclusions

Muscle growth may not have occurred to an extent that would require vascular adaptation. Training maximally induced the greatest strength adaptations but was seemingly not driven by muscle growth.
País das Maravilhas
Authors: Rebelo Júlia Pereira , Oliveira Edirley Rodrigues de , Monteiro Igor Angelo , Ferreira Paulo Afonso de Alcântara , Souza Rodrigo Valadão de
Published: November 2024

Informamos que as notas de ensino dos casos possuem acesso restrito e são exclusivas para docentes e instrutores vinculados à uma instituição acadêmica. Saiba mais.
A Experiência do Rock in Rio: Navegando no Oceano Azul com Inovação e Entretenimento
Authors: Filardi Fernando , Lavrado Fernando Passeri , Biscaia Gabriel , Coco Vivian Luiz
Published: November 2024

Informamos que as notas de ensino dos casos possuem acesso restrito e são exclusivas para docentes e instrutores vinculados à uma instituição acadêmica. Saiba mais.
Mari Elen vive!
Authors: Encarnação Ana Isabela Gil de Brito da , Vieira Guilherme Costa , Melo Juliana de Almeida , Silva Rosenilda Freitas da
Published: November 2024

Informamos que as notas de ensino dos casos possuem acesso restrito e são exclusivas para docentes e instrutores vinculados à uma instituição acadêmica. Saiba mais.
Em busca do microcrédito tupiniquim
Authors: Evaristo Luciana Bassani , Paris Marcelo Viana
Published: November 2024

Informamos que as notas de ensino dos casos possuem acesso restrito e são exclusivas para docentes e instrutores vinculados à uma instituição acadêmica. Saiba mais.
Correlação das biopsias renais com as manifestações clínicas e laboratoriais em receptores de transplante renal
Authors: CASTELO BRANCO FERNANDES MARQUES LEYLA , HELLANO GONÇALVES LIMA PAIVA JOSÉ HÍCARO , NUNES MEDEIROS VITÓRIA , COSTA DE OLIVEIRA CLÁUDIA MARIA , VILARINHO OLIVEIRA ADRIANA REGINA , LEITE SILVA SÔNIA , CARVALHO FONTENELE FERNANDA MARIA , CASTELO BRANCO CAMURÇA FERNANDES PAULA FRASSINETTI
Published: November 2024

O transplante renal é considerado o tratamento de excelência para a doença renal terminal, com a biópsia renal servindo como padrão ouro para avaliar lesões do enxerto e rejeição. O objetivo do estudo foi analisar a correlação entre resultados da biópsia do enxerto renal e aspectos clínicos e laboratoriais em receptores de transplante, contribuindo significativamente para o manejo clínico destes pacientes. Foram analisadas 89 biópsias realizadas entre 1 de janeiro de 2015 e 31 de julho de 2016. A maioria dos pacientes era do sexo masculino (62,9%), com idade mediana de 41 anos. Os achados mais frequentes nas biópsias incluíram necrose tubular aguda (31,5%), fibrose intersticial e atrofia tubular (16,9%), resultados normais (12,4%), hialinose do doador (10,1%), rejeição celular aguda (5,6%) e rejeição aguda mediada por anticorpos (5,6%). Mais da metade das biópsias (51%) foi realizada nos primeiros seis meses após o transplante, geralmente devido ao aumento da creatinina e proteinúria. A rejeição mediada por anticorpos com C4d-negativo apresentou prevalência de 8,3%. As intervenções terapêuticas após as biópsias incluíram tratamento da rejeição em 12,4% dos casos, mudança para inibidores da mTOR em 6,7%, e redução da exposição a inibidores da calcineurina em 19,1%. Surpreendentemente, nem a creatinina nem a proteinúria foram preditores confiáveis de alterações histológicas. Ao final do estudo, 79,8% dos pacientes mantinham um enxerto funcionante. Estes resultados destacam a importância da biópsia renal no manejo pós-transplante e no ajuste das estratégias terapêuticas, sublinhando que indicadores comuns como creatinina e proteinúria podem não revelar todas as alterações histológicas significativas.
Feedback na educação média: um componente formativo essencial
Authors: Castelo Branco Fortaleza Simone , Almeida Livia , Macedo Silva Francisco Theogenes , Façanha Joyce Rodrigues , Otavio Ferreira Da Costa Grijalva
Published: November 2024

O feedback é um componente essencial na educação médica, desempenhando um papel crucial na formação de profissionais competentes e na melhoria contínua do aprendizado. Este texto revisa a literatura recente sobre o uso de feedback no ensino médico, abordando suas definições, tipos, aplicabilidade, benefícios e potenciais. A análise é baseada em 15 referências publicadas nos últimos cinco anos, destacando a importância do feedback eficaz e as práticas recomendadas para sua implementação.