bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and Tolerability of the Intensification of Canagliflozin Dose from 100 mg to 300 mg Daily in Patients with Type 2 Diabetes in Real Life: The INTENSIFY Study
Authors: Gorgojo-Martinez Juan J. , Ferreira-Ocampo Pablo José , Galdón Sanz-Pastor Alba , Cárdenas-Salas Jersy , Antón-Bravo Teresa , Brito-Sanfiel Miguel , Almodóvar-Ruiz Francisca
Published: June 2023

Aim: This study aimed to evaluate the effectiveness and tolerability of intensifying the dose of canagliflozin from 100 mg/day (CANA100) to 300 mg/day (CANA300) in patients with type 2 diabetes (T2DM) and suboptimal metabolic control in a real-world setting. Methods: A multicenter observational study was conducted on adult patients with T2DM who initiated treatment with CANA100 and subsequently required intensification to CANA300. The primary outcome measures were changes in HbA1c and weight at 6 months after the switch and at the end of the follow-up period. Results: A total of 317 patients met the inclusion criteria (59.6% male, mean age 62.2 years, baseline HbA1c 7.55%, weight 88.6 kg, median duration of treatment with CANA100 9.9 months). Switching to CANA300 resulted in a significant reduction in HbA1c (6 months: −0.33%; last visit: −0.47%, both p < 0.0001) and weight (6 months: −1.8 kg; last visit: −2.9 kg, both p < 0.0001) over a median follow-up period of 20.8 months. The proportion of patients that achieved HbA1c < 7% increased from 26.7% with CANA100 to 51.6% with CANA300 (p < 0.0001). Among individuals with poor baseline glycemic control (HbA1c > 8%, mean 9.0%), HbA1c was significantly reduced by −1.24% (p < 0.0001). Furthermore, significant improvements were observed in fasting plasma glucose (FPG), blood pressure (BP), liver enzymes, and albuminuria. No unexpected adverse events were reported. Conclusions: Intensifying the treatment to CANA300 in a real-world setting resulted in further significant and clinically relevant reductions in FPG, HbA1c, weight, and BP in patients with T2DM. The switch was particularly effective in patients with higher baseline HbA1c levels.
Early Application of ECMO after Sudden Cardiac Arrest to Prevent Further Deterioration: A Review and Case Report
Authors: Kiss Boldizsár , Nagy Bettina , Pál-Jakab Ádám , Lakatos Bálint , Soltész Ádám , Osztheimer István , Heltai Krisztina , Édes István Ferenc , Németh Endre , Merkely Béla , Zima Endre
Published: June 2023

ECMO has become a therapeutic modality for in- and out-of-hospital scenarios and is also suitable as a bridging therapy until further decisions and interventions can be made. Case report: A 27-year-old male patient with mechanical aortic valve prothesis had a sudden cardiac arrest (SCA). ROSC had been achieved after more than 60 min of CPR and eight DC shocks due to ventricular fibrillation (VF). The National Ambulance Service unit transported the patient to our clinic for further treatment. Due to the trauma and therapeutic INR, a CT scan was performed and ruled out bleeding. Echocardiography described severely decreased left ventricular function. Coronary angiography was negative. Due to the therapeutic refractory circulatory and respiratory failure against intensive care, VA-ECMO implantation was indicated. After four days of ECMO treatment, the patient’s circulation was stabilized without neurological deficit, and the functions of the end organs were normalized. Cardiac MRI showed no exact etiology behind SCA. ICD was implanted due to VF and SCA. The patient was discharged after 19 days of hospitalization. Conclusion: This case report points out that the early application of mechanical circulatory support could be an outcome-determinant therapeutic modality. Post-resuscitation care includes cardiorespiratory stabilization, treatment of reversible causes of malignant arrhythmia, and secondary prevention.
Conservative and Surgical Treatment of Osteochondromas in Children, Particularly with or without Surgical Lengthening of the Ulna
Authors: Mercier Julie , Bernasconi Reto , Steiger Christina , Kaempfen Alexandre , Krieg Andreas H.
Published: June 2023

Prevention of rotatory impairment and radial head dislocation in the forearm is an important aspect when treating children with osteochondromas. Various studies tried to determine the best treatment, describing different surgical techniques. No consensus has been reached yet. This retrospective study compares the treatment outcome of patients with osteochondroma of the radius and ulna after surgical or conservative treatment. Seventeen forearms treated over a period of 20 years were analysed. Outcome parameters were the prospectively collected clinical data and the radiological findings: “relative shortening” of ulna/radius, the “radial articular angle” (RAA) and the “carpal slip” (CS). Our study shows an improvement of the range of motion and cosmetic appearance of the forearm after an operative procedure, with or without bone lengthening. We observed an increase in wrist and elbow mobility with a decrease in pain scores and a confirmed high cosmetic satisfaction in almost 70% of the patients after bone lengthening and up to 85% after simple excision. For patients suffering from functional impairment or pain, an operative approach is beneficial. Multiple and repetitive osteochondroma excisions are recommended during growth to prevent deformity and rotatory motion restriction. Lengthening procedures require a careful indication.
Physico-Mechanical Property Evaluation and Morphology Study of Moisture-Treated Hemp–Banana Natural-Fiber-Reinforced Green Composites
Authors: Venkataravanappa Ravi Yerraiahgarahalli , Lakshmikanthan Avinash , Kapilan Natesan , Chandrashekarappa Manjunath Patel Gowdru , Der Oguzhan , Ercetin Ali
Published: June 2023

The development of many engineered product applications for automobiles and aircraft parts has initiated the search for novel materials as alternatives to metal matrix composites (MMCs). Natural-fiber-reinforced polymer composites offer distinct advantages such as biodegradability, eco-friendliness, flexibility, low density, and higher specific strengths, etc. This study focuses on natural-fiber (hemp and banana)-fabric-reinforced polymer composites suitable for exterior-engineered parts. The hand lay-up process is used to fabricate these hybrid composites. Exterior-engineered products are highly susceptible to moisture, which can deteriorate their mechanical performances, including their tensile and flexural strength, thereby affecting the durability of the hybrid composites. Therefore, the hybrid composites are subjected to water absorption tests, where samples are immersed in distilled water for week-long intervals. After each interval, the water-absorbed specimens are tested for their tensile and flexural characteristics as per ASTM D-3039 and ASTM D-790, respectively. The moisture treatment had a notable impact on the composite materials, causing a slight decrease in the tensile strength by 2% due to the diminished lateral strength in the interlaminar fibers. Contrary to expectations, the flexural strength of the composites improved by 2.7% after the moisture treatment, highlighting the potential of the moisture treatment process to enhance the elastic properties of such composites. The dimensions of the specimens changed after the water immersion test, resulting in increased longitudinal and decreased lateral dimensions. The surface morphologies of the composite failure samples showed fiber delamination, fiber breakage, voids, and matrix fractures.
Novel Dental Low-Shrinkage-Stress Composite with Antibacterial Dimethylaminododecyl Methacrylate Monomer
Authors: Alhussein Abdullah , Alsahafi Rashed , Wang Xiaohong , Mitwalli Heba , Filemban Hanan , Hack Gary D. , Oates Thomas W. , Sun Jirun , Weir Michael D. , Xu Hockin H. K.
Published: June 2023

Objectives: Current dental resins exhibit polymerization shrinkage causing microleakage, which has the potential to cause recurrent caries. Our objectives were to create and characterize low-shrinkage-stress (LSS) composites with dimethylaminododecyl methacrylate (DMADDM) as an antibacterial agent to combat recurrent caries. Methods: Triethylene glycol divinylbenzyl ether and urethane dimethacrylate were used to reduce shrinkage stress. DMADDM was incorporated at different mass fractions (0%, 1.5%, 3%, and 5%). Flexural strength, elastic modulus, degree of conversion, polymerization stress, and antimicrobial activity were assessed. Results: The composite with 5% DMADDM demonstrated higher flexural strength than the commercial group (p < 0.05). The addition of DMADDM in BisGMA-TEGDMA resin and LSS resin achieved clinically acceptable degrees of conversion. However, LSS composites exhibited much lower polymerization shrinkage stress than BisGMA-TEGDMA composite groups (p < 0.05). The addition of 3% and 5% DMADDM showed a 6-log reduction in Streptococcus mutans (S. mutans) biofilm CFUs compared to commercial control (p < 0.001). Biofilm biomass and lactic acid were also substantially decreased via DMADDM (p < 0.05). Conclusions: The novel LSS dental composite containing 3% DMADDM demonstrated potent antibacterial action against S. mutans biofilms and much lower polymerization shrinkage-stress, while maintaining excellent mechanical characteristics. The new composite is promising for dental applications to prevent secondary caries and increase restoration longevity.
Towards the Testing and Validation of Autonomous Ships: Design of a Variable Stability Ship Control System
Authors: Li Shijie , Xu Ziqian , Liu Jialun , Hu Xinjue
Published: June 2023

Maritime autonomous surface ships (MASSs) have received increased attention in both academic research and industrial applications in the global shipping and shipbuilding industry in recent years. According to its definition, a MASS can independently operate without human interaction. This brings the problem of how to test and evaluate the capabilities of the autonomous navigation control system developed for MASS. This paper proposes the novel concept of a variable stability ship and the design of its control system. A variable stability ship consists of a model-scaled ship, a model-following controller, and a hardware and software platform to implement its functions. The variable stability ship can replicate the dynamic responses of different reference ships despite their dissimilarities in physical parameters and hydrodynamic characteristics with the design of the model-following controller. Therefore, it can be used to test the performance of different control strategies on various ship types such that the R&D costs of physical model-based tests can be reduced, as well as shortening the time spent in developing physical ship models. Preliminary simulations are carried out to show its effectiveness and applicability.
Study of a Machine Vision Approach to Leak Monitoring of a Marine System
Authors: Jiang Xingjia , Dai Yingwei , Zhang Peng , Wang Yucheng , Du Taili , Zou Yongjiu , Zhang Yuewen , Sun Peiting
Published: June 2023

Leak monitoring is essential for the intelligent operation and maintenance of marine systems, and can effectively prevent catastrophic accidents on ships. In response to this challenge, a machine vision-based leak model is proposed in this study and applied to leak detection in different types of marine system in complex engine room environments. Firstly, an image-based leak database is established, and image enhancement and expansion methods are applied to the images. Then, Standard Convolution and Fast Spatial Pyramid Pooling modules are added to the YOLOv5 backbone network to reduce the floating-point operations involved in the leak feature channel fusion process, thereby improving the detection speed. Additionally, Bottleneck Transformer and Shuffle Attention modules are introduced to the backbone and neck networks, respectively, to enhance the feature representation performance, select critical information for the leak detection task, and suppress non-critical information to improve detection accuracy. Finally, the proposed model’s effectiveness is verified using leak images collected by the ship’s video system. The test results demonstrate that the proposed model exhibits excellent recognition performance for various types of leak, especially for drop-type leaks (for which the accuracy reaches 0.97).
Accuracy of GNSS Position Stored in Fishing Boat Location Transmitters in Comparison with That of DGPS Position
Authors: Jung Bong-Kyu , Park Cheor-Hong , Choi Won-Sam
Published: June 2023

Fishing boat laws in Korea require fishing boats to be equipped with a location transmitter. Approximately 91% of registered fishing boats have V-pass terminals, whereas those with a gross tonnage of 10 t or more have either V-pass or automatic identification system (AIS) terminals (or use both). Most navigators, including the fishing boat location transmitter, rely on the satellite signals provided by the global navigation satellite system (GNSS) without considering the accuracy of the navigation instruments that indicate ship location. Many scholars are conducting research to analyze the accuracy of GNSS locations through continuous experiments; however, few of them focus on fishing boat location transmitters. Particularly, the location accuracy of V-pass equipment is unknown. Notably, the V-pass and AIS terminals used in fishing boats are mainly designed to locate fishing boats in need of assistance following a marine accident rather than to provide information on approaching ships and preventing collisions. Therefore, this study aimed to compare GNSS location storage data extracted from the location transmitter (V-pass and AIS terminal) of the accident fishing boat with the DGPS location information from the Electronic Chart Display and Information System to check the position error and use it for accident analysis and investigation.
Cavitation Detection in a Tonpilz-Type Transducer for Active SONAR Transmission System
Authors: Villalobos Ricardo , López Héctor , Vázquez Nimrod , Carrillo-Serrano Roberto V. , Espinosa-Calderón Alejandro
Published: June 2023

The active sound navigation and ranging (SONAR) transmission system emits acoustic pulses underwater using a wave generator, a SONAR power amplifier (SPA), and a projector. The acoustic pulse travel in the direction of the target and return as an echo to a hydrophone to learn the range or speed of the object. Often the same device is used as a hydrophone and a projector; in this context, it is known as a transducer. In order to obtain a maximum range of detection in the SONAR, it is desirable to generate the maximum amount of acoustic power until the point in which the echo can be detectable in an atmosphere with non-wished noise. Therefore, a high value of source level (SL) is required that depends largely on the value of electrical power applied to the transducer (Pe). However, when trying to obtain the maximum range of detection in the SONAR system there are the following three peculiar limitations that affect performance: The cavitation, the reverberation, and the effect of interaction in the near field. In this paper, an experimental measurement methodology is presented to detect the cavitation effects in a tonpilz-type transducer for an active SONAR transmission system using a transducer as a projector and a calibrated hydrophone in a hydroacoustic tank by measuring the parameters of total harmonic distortion of the fundamental waveform (THD-F) of the generated acoustic pulse, transmitting voltage response (TVR) to characterize the system and sound pressure level (SPL) that indicates the intensity of sound at a given distance. Whereas the reverberation and the interaction effect in the near field are objects of other study cases. A 570.21 W and THD-F < 5% switched-mode power amplifier (SMPA) prototype was developed to excite the electroacoustic transducer employing a full-bridge inverter (FBI) topology and a digital controller using a field-programmable gate array (FPGA) for unipolar sine pulse width modulation (SPWM) to generate a continuous wave (CW) acoustic pulse at a frequency 11.6 kHz. The results obtained show that from the level of Pe=196.05 W with the transducer at 1 m of depth, the value of THD-F increases significantly while the behavior of the TVR and SPL parameters is affected since it is not as expected and is attributed when cavitation occurs.
Optimizing Energy Management and Case Study of Multi-Energy Coupled Supply for Green Ships
Authors: Wang Zhe , Ma Yue , Sun Yinyu , Tang Haobo , Cao Menglong , Xia Rui , Han Fenghui
Published: June 2023

The ship industry is currently facing numerous challenges, including rising fuel prices, limited fuel resources, and increasingly strict regulations related to energy efficiency and pollutant emissions. In this context, the adoption of green-ship wind–photovoltaic–electricity–fuel multi-energy supply systems has emerged as an efficient and clean technology that harnesses multiple energy sources. These systems have the potential to increase the utilization of renewable energy in ship operations while optimizing management practices in order to enhance overall energy efficiency. To address these challenges, this article presents a comprehensive energy supply system for ships that integrates multi-energy sources for cold–heat–electricity supply. The primary components of this system include fuel cells, photovoltaic equipment, wind turbines, electric heating pumps, electric refrigerators, thermal refrigerators, batteries, and heat storage tanks. By ensuring the safety of the system, our approach aims to minimize daily operating costs and optimize the performance of the multi-energy flow system by running scheduling models. To achieve this, our proposed system utilizes dynamic planning techniques combined with ship navigation conditions to establish an optimized management model. This model facilitates the coordinated distribution of green ship electricity, thermal energy, and cooling loads. The results of our study demonstrate that optimized management models significantly reduce economic costs and improve the stability of energy storage equipment. Specifically, through an analysis of the economic benefits of power storage and heat storage tanks, we highlight the potential for reducing fuel consumption by 6.0%, 1.5%, 1.4%, and 2.9% through the use of electric–thermal hybrid energy storage conditions.
Experimental Study on Motion Characteristics of Cavity Attached to the Tail of Underwater Vehicle
Authors: Yao Xiongliang , Qu Zhaoyu , Ma Guihui , Yang Nana , Quan Xiaobo , Cheng Shaohua
Published: June 2023

The formation and development of an attached cavity at the tail of an underwater moving vehicle involves a complex multiphase flow, which determines the load characteristics and motion stability of the vehicle. In this study, an experimental method was used to explore the formation process and motion characteristics of the cavity at the tail of the vehicle, and a pressure sensor installed at the tail of the model was used to establish the relationship between the evolution of the tail attachment cavity and transient pressure. The study found that the process of pulling and breaking the attached cavity was accompanied by the generation of bidirectional jets, and reducing the cavitation number could weaken the occurrence of jet impact. When the ventilation flow reaches the critical value Q¯in = 1.28, the cavity pulsates. In addition, increasing the ventilation flow does not increase the size of the tail cavity, and the length of the cavity at the closure increases with the decrease of the cavitation number.
Study on Mitigation of Wake Interference by Combined Control of Yaw Misalignment and Pitch
Authors: Zhao Liye , Gong Yongxiang , Gong Feixiang , Zheng Bowen , Wang Jundong , Xue Lei , Xue Yu
Published: June 2023

Yaw misalignment can make a wake steer, which is an effective method to increase the power of wind farms but it also increases the fatigue load of the turbines. In this paper, the combination of yaw offset and pitch control (CYMP) is studied to analyse the potential mitigation of wake, focusing on the wind velocity and turbulence of the wake distribution, power increment, and fatigue load reduction. The simulation case study shows that the method of CYMP can reduce the fatigue load by 10.29% and increase the total power by 1.7% compared with only wake steering in FAST.Fram. The Collaborative MPC (CoMPC) method based on CYMP is proposed to the real-time wake control in this research, which can increase power by more than 2% and reduce thrust by more than 4% than greedy control under 10 m/s turbulent wind.
Model Predictive Energy-Maximising Tracking Control for a Wavestar-Prototype Wave Energy Converter
Authors: Li Doudou , Patton Ron
Published: June 2023

To date, one of the main challenges in the wave energy field is to achieve energy-maximizing control in order to reduce the levelized cost of energy (LCOE). This paper presents a model predictive velocity tracking control method based on a hierarchical structure for a Wavestar-like deivce in the WEC-SIM benchmark. The first part of the system structure aims to estimate the wave excitation moment (WEM) by using a Kalman filter. Then, an extended Kalman filter (EKF) is chosen to obtain the amplitude and angular frequency of the WEM in order to compute the reference velocity. Following this, a low-level model predictive control (MPC) method is designed to ensure the wave energy converter (WEC) tracks the optimal reference velocity for maximum energy extraction from irregular waves. Two Gaussian Process (GP) models are considered to predict the future wave excitation moment and future reference velocity, which are needed in MPC design. The proposed strategy can give a new vision for energy-maximizing tracking control based on MPC.
Seasonal Variability of the Deep Western Boundary Current in the Philippine Sea
Authors: Song Hajin , Zhu Xiao-Hua , Zhu Ze-Nan , Chae Jeong-Yeob , Jeon Chanhyung , Kim Dong-Guk , Min Hong-Sik , Lee Jae-Hak , Park Jae-Hun
Published: June 2023

The deep western boundary current (DWBC) in the Philippine Sea has been expected to play a crucial role in transporting lower circumpolar deep water and to contribute to regional and global climate regulation. Two-year-long near-bottom current measurements reveal a southward-flowing DWBC with a mean velocity of 5 cm/s and seasonal variations—weaker in summer and stronger in winter. Seasonal variability in the DWBC is hypothesized to be induced by changes in the North Equatorial Current bifurcation latitude (NECBL) and upper pycnocline depth through potential vorticity conservation. Data-assimilated reanalysis model (GLORYS12V1) outputs, which reproduce the seasonal variability of DWBC similarly to the observation, are used for further analysis. During the seasonal period, the NECBL displays significant coherence (>0.9) with the first-mode empirical orthogonal function principal component of the simulated along-slope DWBC. The upper pycnocline depth, varying seasonally within a range of approximately 27 m, induces seasonal variability in a deep anticyclonic eddy trapped by topography. In summer, the intensified deep anticyclonic eddy obstructs the adjacent southward-flowing DWBC, weakening its strength, whereas in winter, the southward flow of the DWBC is enhanced due to the weakening of the deep anticyclonic eddy.
Evaluating the Joint Effect of Tropical and Extratropical Pacific Initial Errors on Two Types of El Niño Prediction Using Particle Filter Approach
Authors: Hou Meiyi , Duan Wansuo , Zhi Xiefei
Published: June 2023

The accuracy of different types of El Niño-Southern Oscillation (ENSO) predictions is sensitive to initial errors in different key areas of the Pacific Ocean. To improve the accuracy of the forecast, assimilation techniques can be utilized to eliminate these initial errors. However, limited studies have measured the extent to which assimilating ocean temperature data from different key regions in the Pacific Ocean can enhance two types of ENSO predictions. In previous research, three critical regions were identified as having initial errors in ocean temperature most interfering with two types of El Niño predictions, namely the North Pacific for Victoria Mode-like initial errors, the South Pacific for South Pacific Meridional Mode-like initial errors, and the subsurface layer of the western equatorial Pacific. Based on these initial error patterns, we quantified the effect of assimilating ocean temperature observation datasets in these three key regions using the particle filter method. The result indicates that ocean temperature initial accuracy in the tropical western area near the thermocline region is important for improving the prediction skill of CP-El Niño compared with the other two sensitive areas. However, three key areas are all important for EP-El Niño predictions. The most critical area varies among different models. Assimilating observations from the north and south Pacific proves to be the most effective for improving both types of El Niño predictions compared to the other two areas’ choices. This suggests that the initial accuracy of ocean temperature in these two regions is less dependent on each other for enhancing El Niño predictions. Additionally, assimilating observations from all three sensitive areas has the best results. In conclusion, to enhance the accuracy of two types of El Niño predictions, we need to ensure the initial accuracy of ocean temperature in both tropical and extratropical regions simultaneously.
CRISPR-Cas9 Gene Editing and Secondary Metabolite Screening Confirm Fusarium graminearum C16 Biosynthetic Gene Cluster Products as Decalin-Containing Diterpenoid Pyrones
Authors: Hicks Carmen , Witte Thomas E. , Sproule Amanda , Hermans Anne , Shields Samuel W. , Colquhoun Ronan , Blackman Chris , Boddy Christopher N. , Subramaniam Rajagopal , Overy David P.
Published: June 2023

Fusarium graminearum is a causal organism of Fusarium head blight in cereals and maize. Although a few secondary metabolites produced by F. graminearum are considered disease virulence factors, many molecular products of biosynthetic gene clusters expressed by F. graminearum during infection and their associated role in the disease are unknown. In particular, the predicted meroterpenoid products of the biosynthetic gene cluster historically designated as “C16” are likely associated with pathogenicity. Presented here are the results of CRISPR-Cas9 gene-editing experiments disrupting the polyketide synthase and terpene synthase genes associated with the C16 biosynthetic gene cluster in F. graminearum. Culture medium screening experiments using transformant strains were profiled by UHPLC-HRMS and targeted MS2 experiments to confirm the associated secondary metabolite products of the C16 biosynthetic gene cluster as the decalin-containing diterpenoid pyrones, FDDP-D and FDDP-E. Both decalin-containing diterpenoid pyrones were confirmed to be produced in wheat heads challenged with F. graminearum in growth chamber trials. The extent to which the F. graminearum C16 biosynthetic gene cluster is dispersed within the genus Fusarium is discussed along with a proposed role of the FDDPs as pathogen virulence factors.
In Vitro and Ex Vivo Biofilm-Forming Ability of Rhinocladiella similis and Trichophyton rubrum Isolated from a Mixed Onychomycosis Case
Authors: Costa Polyana de Souza , Basso Maria Eduarda , Negri Melyssa , Svidzinski Terezinha Inez Estivalet
Published: June 2023

Infections caused by biofilm-forming agents have important implications for world health. Mixed infections, caused by more than one etiological agent, are also an emerging problem, especially regarding the standardization of effective diagnosis and treatment methods. Cases of mixed onychomycosis (OM) have been reported; however, studies on the microbial interactions between the different fungi in biofilms formed on nails are still scarce. We describe a case of mixed OM caused by the dermatophyte Trichophyton rubrum and the black yeast-like fungus Rhinocladiella similis. Identical growths of both fungi were observed in more than 50 cultures from different nail samples. Additionally, both species were able to form organized single and mixed biofilms, reinforcing the participation of both fungi in the etiology of this OM case. R. similis seemed to grow faster during the process, suggesting that T. rubrum benefits from biofilm development when in combination. Moreover, the biofilm of the Rhinocladiella isolate exhibited exacerbated production of the extracellular matrix, which was not observed with that of a Rhinocladiella reference strain, suggesting that the isolate had natural abilities that were possibly perfected during development in the nail of the patient.
Precision Medicine Is Changing the Roles of Healthcare Professionals, Scientists, and Research Staff: Learnings from a Childhood Cancer Precision Medicine Trial
Authors: Daly Rebecca , Hetherington Kate , Hazell Emily , Wadling Bethany R. , Tyrrell Vanessa , Tucker Katherine M. , Marshall Glenn M. , Ziegler David S. , Lau Loretta M. S. , Trahair Toby N. , O’Brien Tracey A. , Collins Kiri , Gifford Andrew J. , Haber Michelle , Pinese Mark , Malkin David , Cowley Mark J. , Karpelowsky Jonathan , Drew Donna , Jacobs Chris , Wakefield Claire E.
Published: June 2023

Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia’s first precision medicine trial for children with poor-prognosis cancer: the PRecISion Medicine for Children with Cancer (PRISM) national clinical trial of the Zero Childhood Cancer Program. We conducted semi-structured interviews with 85 PRISM professionals from eight professional groups, including oncologists, surgeons, clinical research associates, scientists, genetic professionals, pathologists, animal care technicians, and nurses. We analyzed interviews thematically. Professionals shared that precision medicine can add complexity to their role and result in less certain outcomes for families. Although many participants described experiencing a greater emotional impact from their work, most expressed very positive views about the impact of precision medicine on their profession and its future potential. Most reported navigating precision medicine without formal training. Each group described unique challenges involved in adapting to precision medicine in their profession. Addressing training gaps and meeting the specific needs of many professional groups involved in precision medicine will be essential to ensure the successful implementation of standard care.
COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies
Authors: Favilli Alessandro , Mattei Gentili Marta , De Paola Francesca , Laganà Antonio Simone , Vitagliano Amerigo , Bosco Mariachiara , Cicinelli Ettore , Chiantera Vito , Uccella Stefano , Parazzini Fabio , Gerli Sandro , Garzon Simone
Published: June 2023

The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.
Characterisation of Cartilage Damage via Fusing Mid-Infrared, Near-Infrared, and Raman Spectroscopic Data
Authors: Shaikh Rubina , Tafintseva Valeria , Nippolainen Ervin , Virtanen Vesa , Solheim Johanne , Zimmermann Boris , Saarakkala Simo , Töyräs Juha , Kohler Achim , Afara Isaac O.
Published: June 2023

Mid-infrared spectroscopy (MIR), near-infrared spectroscopy (NIR), and Raman spectroscopy are all well-established analytical techniques in biomedical applications. Since they provide complementary chemical information, we aimed to determine whether combining them amplifies their strengths and mitigates their weaknesses. This study investigates the feasibility of the fusion of MIR, NIR, and Raman spectroscopic data for characterising articular cartilage integrity. Osteochondral specimens from bovine patellae were subjected to mechanical and enzymatic damage, and then MIR, NIR, and Raman data were acquired from the damaged and control specimens. We assessed the capacity of individual spectroscopic methods to classify the samples into damage or control groups using Partial Least Squares Discriminant Analysis (PLS-DA). Multi-block PLS-DA was carried out to assess the potential of data fusion by combining the dataset by applying two-block (MIR and NIR, MIR and Raman, NIR and Raman) and three-block approaches (MIR, NIR, and Raman). The results of the one-block models show a higher classification accuracy for NIR (93%) and MIR (92%) than for Raman (76%) spectroscopy. In contrast, we observed the highest classification efficiency of 94% and 93% for the two-block (MIR and NIR) and three-block models, respectively. The detailed correlative analysis of the spectral features contributing to the discrimination in the three-block models adds considerably more insight into the molecular origin of cartilage damage.
Telemedicine and Its Application in Cystic Fibrosis
Authors: Fainardi Valentina , Capoferri Gaia , Tornesello Marco , Pisi Giovanna , Esposito Susanna
Published: June 2023

The care of cystic fibrosis (CF) traditionally consists of regular visits to the clinic where a multidisciplinary team can visit the patient, adjust treatments and monitor the disease. During the COVID-19 pandemic when access to hospitals and medical environments was very limited, the role of telemedicine was crucial to keep in touch with patients with chronic diseases such as CF. Increasing evidence demonstrates that electronic health can successfully support healthcare professionals in the management of people with CF. The use of devices connected to digital platforms or smartphones results in a continuous flow of data that can be shared with the clinician and the team in order to improve the knowledge of patients’ diseases and the level of care needed. This narrative review aims to describe the application of telemedicine in CF disease with pros and cons. A literature analysis showed that telemedicine has several advantages in the management of patients with CF. With the evolving support of digital technology, telemedicine can promote clinical visits, adherence to daily treatment, including respiratory physiotherapy and physical exercise, early identification of pulmonary exacerbations and management of psychological issues. The main disadvantages are missed physical exam findings, lack of physical contact that can prevent conversation on sensitive topics, lack of access to technology and lack of technological skills. Furthermore, healthcare operators need appropriate training for telemedicine systems and need time to organise and analyse data generated remotely, which may increase the burden of daily work. Hybrid personalised care models that marge telemedicine and traditional care can be an ideal solution.
Impact of Obesity and Bariatric Surgery on Metabolic Enzymes and P-Glycoprotein Activity Using the Geneva Cocktail Approach
Authors: Ghasim Hengameh , Rouini Mohammadreza , Safari Saeed , Larti Farnoosh , Khoshayand Mohammadreza , Gholami Kheirollah , Neyshaburinezhad Navid , Gloor Yvonne , Daali Youssef , Ardakani Yalda H.
Published: June 2023

The inter-individual variability of CYP450s enzyme activity may be reduced by comparing the effects of bariatric surgery on CYP-mediated drug elimination in comparable patients before and after surgery. The current research will use a low-dose phenotyping cocktail to simultaneously evaluate the activities of six CYP isoforms and P-gp. The results showed that following weight reduction after surgery, the activity of all enzymes increased compared to the obese period, which was statistically significant in the case of CYP3A, CYP2B6, CYP2C9, and CYP1A2. Furthermore, the activity of P-gp after surgery decreased without reaching a statistical significance (p-value > 0.05). Obese individuals had decreased CYP3A and CYP2D6 activity compared with the control group, although only CYP3A was statistically important. In addition, there was a trend toward increased activity for CYP1A2, CYP2B6, CYP2C9, and CYP2C19 in obese patients compared to the control group, without reaching statistical insignificance (p-value ≥ 0.05). After six months (at least), all enzymes and the P-gp pump activity were significantly higher than the control group except for CYP2D6. Ultimately, a greater comprehension of phenoconversion can aid in altering the patient’s treatment. Further studies are required to confirm the changes in the metabolic ratios of probes after bariatric surgery to demonstrate the findings’ clinical application. As a result, the effects of inflammation-induced phenoconversion on medication metabolism may differ greatly across persons and drug CYP pathways. It is essential to apply these results to the clinic to recommend dose adjustments.
Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models
Authors: Abraham Ivo , Lewandrowski Kai-Uwe , Elfar John C. , Li Zong-Ming , Fiorelli Rossano Kepler Alvim , Pereira Mauricio G. , Lorio Morgan P. , Burkhardt Benedikt W. , Oertel Joachim M. , Winkler Peter A. , Yang Huilin , León Jorge Felipe Ramírez , Telfeian Albert E. , Dowling Álvaro , Vargas Roth A. A. , Ramina Ricardo , Asefi Marjan , de Carvalho Paulo Sérgio Teixeira , Defino Helton , Moyano Jaime , Montemurro Nicola , Yeung Anthony , Novellino Pietro ,   on behalf of Teams/Organizations/Institutions
Published: June 2023

Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible. Confounding factors, such as the variability of the patient population and selection bias regarding comorbidities and anatomical variations are also difficult to control for. Small sample sizes in study groups comparing iterations of a surgical protocol may amplify bias. It is essentially impossible to conceal the surgical treatment from the surgeon and the operating team. Restrictive inclusion and exclusion criteria may distort the study population to no longer reflect patients seen in daily practice. Hindsight bias is introduced by the inability to effectively blind patient group allocation, which affects clinical result interpretation, particularly if the outcome is already known to the investigators when the outcome analysis is performed (often a long time after the intervention). Randomization is equally problematic, as many patients want to avoid being randomly assigned to a study group, particularly if they perceive their surgeon to be unsure of which treatment will likely render the best clinical outcome for them. Ethical concerns may also exist if the study involves additional and unnecessary risks. Lastly, surgical trials are costly, especially if the tested interventions are complex and require long-term follow-up to assess their benefit. Traditional clinical testing of personalized surgical pain management treatments may be more challenging because individualized solutions tailored to each patient’s pain generator can vary extensively. However, high-grade evidence is needed to prompt a protocol change and break with traditional image-based criteria for treatment. In this article, the authors review issues in surgical trials and offer practical solutions.
Model Framework for Consumer Protection and Crypto-Exchanges Regulation
Authors: Alekseenko Aleksandr P.
Published: June 2023

Cross-border insolvency of crypto-exchanges, cyber-risks, transnational character of activities with cryptocurrencies, and financial frauds on the Internet are among the key threats for individuals who use Bitcoin as an investment. Moreover, crypto-exchanges impose consumer agreements containing provisions limiting their liability for hacker attacks and other clauses promoting inequality in relations with investors. All the named obstacles highlight the vulnerability of unsophisticated individuals investing in digital assets and have pointed out the necessity to adopt an internationally recognized model of rules for crypto-exchanges, otherwise, it will be impossible to effectively protect the rights of investors engaged in the activities of intermediaries exchanging and keeping decentralized cryptocurrencies. The purpose of the study is to elaborate on the fundamentals for constructing an international legal framework protecting consumers from risks arising from the activities of crypto-exchanges dealing with decentralized cryptocurrencies. Based on the methodology of comparative legal study, this paper examines the judicial practice of various countries and the legislation of jurisdictions popular among crypto-exchanges. The research explores the nature of Bitcoin, describes the types of crypto-exchanges and discusses the main approaches to crypto-exchanges regulation. It argues that an international framework on crypto-exchanges should be based on understanding Bitcoin as a commodity which is situated in the place of crypto-exchange incorporation, licensing of crypto-exchanges, and self-regulation.
The Moderating Effect of the COVID-19 Pandemic on the Relation between Corporate Governance and Firm Performance
Authors: Tarighi Hossein , Hosseiny Zeynab Nourbakhsh , Akbari Maryam , Mohammadhosseini Elaheh
Published: June 2023

The present study aims to investigate the association between corporate governance mechanisms and financial performance among companies listed on the Tehran Stock Exchange (TSE). We also want to know if the COVID-19 global crisis moderates the relationship between them. The study sample consists of 1098 observations and 183 companies listed on the TSE from 2016 to 2021; furthermore, the statistical method used to test the hypotheses is panel data with random effects. In line with our expectations, the results show that the coronavirus pandemic worsened Iranian corporate performance. In support of agency theory, we figure out that board independence, board meeting frequency, and board financial expertise are correlated positively with firm value. In favor of resource dependency theory, this study finds robust evidence that audit committee size and independence have a positive effect on corporate performance. Most importantly, the positive linkage between board independence, board financial expertise, size, and independence of audit committee with firm performance was reversed during the COVID-19 pandemic, although the positive role of board meeting frequency in corporate profitability remained stable even during the COVID-19 outbreak. Furthermore, the outcomes indicate that CEO duality affects firms negatively, and this devastating effect became even stronger with the COVID-19 pandemic. Finally, we find that firms involved in mergers and acquisitions (M&A) managed to increase shareholders’ wealth using competitive advantage even during the pandemic.
Investigating the Nexus between Corporate Governance and Firm Performance in India: Evidence from COVID-19
Authors: Anas Mohd , Gulzar Ishfaq , Tabash Mosab I. , Ahmad Gayas , Yazdani Wasi , Alam Md. Firoz
Published: June 2023

The COVID-19 pandemic has had a dreadful influence on both economic activities and human life, in view of which management has to play a strategic role to focus on effective board leadership in order to optimize firm performance. The present study analyses the role of corporate governance practices in determining firm performance during the pandemic. A total of 151 non-financial companies from 11 diversified industries representing the NIFTY200 index for two years, 2019–2020 (pre-COVID-19) and 2020–2021 (duringCOVID-19), were selected. Paired sample t-tests, panel data regression, and one-way ANOVA were used for the analysis. The findings confirm that there is a significant difference between some corporate governance practices (board size, board independence, board’s female proportion, board attendance, and audit committee size) as well as financial performance (Tobin’s Q) before and during the COVID-19 period. The regression results of the full sample show that only board busyness has a positive and significant impact on ROA and Tobin’s Q. However, after splitting the sample year-wise, board size and audit committee meetings positively affected ROA during COVID-19. On the other hand, board independence had a negative influence. Female directors and audit committee meetings positively affected ROA in the pre-COVID-19 period, while board busyness had a negative influence. The results of one-way ANOVA show a substantial difference in the financial performance among industries.
Sustainable Tourism of Important Plant Areas (IPAs)—A Case of Three Protected Areas of Vojvodina Province
Authors: Trišić Igor , Milojković Danka , Ristić Vladica , Nechita Florin , Maksin Marija , Štetić Snežana , Candrea Adina Nicoleta
Published: June 2023

In the northern part of Serbia, where the Autonomous Province (AP) of Vojvodina is located, a total of 27 important plant areas (IPAs) have been established. Within three selected IPAs, there are different biocenoses inhabited by endemic plant and animal species, which form a unique sensitive ecosystem. Furthermore, in these areas, there are wetlands and areas important for geodiversity maintenance. The three studied IPAs include the territory of special nature reserves of the same name: the Special Nature Reserve (SNR) Zasavica, the SNR Obedska Bara, and the SNR Koviljsko-Petrovaradinski Rit. In these selected protected areas, tourist activities are carried out at different levels of development and through various forms of tourism. This research used quantitative methodology to examine the degree of sustainable tourism development and its impact on residents. A total of 1134 respondents were surveyed using a questionnaire as an instrument. The obtained results indicate that the selected IPAs can be destinations for sustainable tourism development. Ecological and sociocultural dimensions of sustainability contribute to this type of tourism to the greatest extent. Analyzing the data related to the impact of sustainable tourism on the respondents’ satisfaction, we concluded that they feel a certain satisfaction with sustainable tourism in all three investigated protected areas. The survey results called attention to the possibility of developing nature-based forms of tourism, in which the residents’ role in tourism planning and development should be strengthened. All forms of tourism that are developed here should have the primary goal of protecting nature in these IPAs.