bluuebunny/crossref_metadata_2025 huggingface dataset:
Accumulated crystal plasticity dissipation energy driven continuum damage two-scale model for fretting fatigue initiation life
Authors: Fang Yuan , Yazhou Xu
Published: October 2024

Fretting fatigue often occurs in the interfaces between components, subjected to complex multi-axial load states and high stress gradients at the contact edge region. For the prediction of fretting fatigue crack initiation and in-depth understanding of the crack initiation mechanism, it is essential to investigate the damage mechanisms across various scales and explore the underlying scale coupling mechanisms. By introducing a power-law based scale coupling relationship, a two-scale model of fretting fatigue crack initiation life is proposed by combining macroscopic continuum damage mechanics (CDM) with microscopic crystal plastic finite element method (CPFEM). The simulation results indicate that the predicted fretting fatigue initiation life shows better accuracy than the result predicted by single-scale CDM model. In case of low stress level the rate of accumulated dissipation energy can be clearly divided into two stages with turning points, whereas it exhibits a relatively uniform damage process under high stress level. Moreover, the proposed two-scale model partly provides physical explanation for fretting fatigue crack initiation based on the information from the microscale.
Vaccination significantly reduced the length of SARS-CoV-2 viral clearance: A story from international healthcare workers
Authors: Wang Hai-Bo , Cheng Zi-Dong , Chen Xin-Bin , Huang Hui-Na , Liao Meng-Hua
Published: October 2024

To investigate the impact of vaccines on sociodemographic characteristics, clinical profiles, and outcomes of SARS-CoV-2 infection among healthcare workers in South China during the period of Omicron variant dominance, a retrospective, analytical cross-sectional study was conducted. The findings revealed that while full vaccination could not prevent Omicron variant infection efficiently (26.51% uninfected vs 14.29% uninfected between vaccinated and unvaccinated participants, p = 0.506), it did substantially reduce the length of viral clearance significantly (p < 0.05), potentially facilitating quicker patient recovery. Unvaccination was found to be an independent risk factor for slow clearance when a linear regression analysis model was used (Coefficient: −3.516; 95% CI: −6.425 to −0.607; p = 0.020). Therefore, all eligible individuals should be fully vaccinated to get prepared for a potential wave of epidemic in the future.
MicroRNA Expression in Chronic Venous Leg Ulcers and Implications for Wound Healing: A Scoping Review
Authors: de Carvalho Magali Rezende , Yang Hyehwan , Stechmiller Joyce , Lyon Debra E.
Published: October 2024

Purpose: Chronic venous leg ulcers (CVLUs) comprise the majority of lower-extremity wounds, yet their pathophysiology is not fully understood. While research has shown that microRNAs are an important component of wound inflammation, few have explored the role of microRNAs (miRNAs) in the healing of CVLUs. This scoping review examines miRNAs in CVLUs and the association with wound healing. Methods: In December 2023, we searched MEDLINE/PubMed, Embase, Scopus, and CINAHL for studies published in 2013–2023 examining miRNAs in CVLU healing. Results: Six studies met inclusion criteria. MicroRNAs were extracted from various specimens including serum, skin biopsy samples, and adipose tissue-derived mesenchymal cells from individuals with CVLUs. Overexpression of miR-221, miR-222, miR-92a, and miR-301a-3p hindered angiogenesis, while overexpression of miR-296, miR-126, miR-378, and miR-210 facilitated angiogenesis. Overexpression of miR-34a/c, miR-301a-3p, miR-450-5p, miR-424-5p, miR-516-5p, and miR-7704 increased local inflammatory responses and inhibited keratinocytes proliferation, impairing healing, while overexpression of miR-19a/b and miR-20 downregulated keratinocytes' inflammatory response, promoting healing. Downregulation of miR-205, miR-96-5p, and miR-218-5p enhanced cellular proliferation and promoted wound healing. Downregulation of miR-17–92 was linked with impaired healing. Discussion: MicroRNAs play a role in regulating angiogenesis, inflammatory responses, and cell migration in chronic-wound healing. However, studies of miRNAs in CVLUs are limited and lack a standardized approach to measurement and quantification. Further research is warranted to elucidate the mechanisms underlying microRNA involvement in CVLU healing to better understand the pathophysiology and for the future development of targeted therapies.
Seismic performance assessment and retrofitted by buckling-restrained braces for half-through concrete-filled steel tubular arch bridge with the vertical suspended deck system
Authors: Zou Yuhe , Wang Dongsheng , Li Xiaoli , Tong Lei , Hui Yingxin , Ge Xiao
Published: October 2024

Arch bridges with vertical suspended deck systems have been constructed during the last 30 years, different from the existing arch bridges with longitudinal beams or panel beams. The latter have better the seismic inertia forces can be transmitted to the piers or foundations through both the arch rib and the longitudinal beam. However, for arch bridges with vertical suspended deck systems, seismic inertia forces produced by deck systems are transmitted to arch ribs by the geometric nonlinearity of suspenders firstly, and then further transmitted through the arch ribs to the piers or foundations, resulting in greater seismic demands on the arch ribs. In this paper, the seismic performance and weak structural elements of the half-through concrete-filled steel tubular (CFST) arch bridge with a vertical suspension deck system under tri-directional ground motions were studied by numerical simulation, and the bridge model was primarily verified by a static loading test conducted in situ. Moreover, Buckling-Restrained Braces (BRBs) were strategically placed to optimize their seismic mitigation effects by systematically analyzing the bridge’s seismic response. The results identify the arch foot, the 1/8 point of the arch rib, the arch crown, and the transverse bracing as weak structural elements for seismic resistance of the half-through concrete-filled steel tubular (CFST) arch bridge with a vertical suspension deck system. Therefore, a thoughtfully designed arrangement of BRBs targeting the seismic weak structural elements can significantly increase the values of capacity demand ratio (CDR) for weak structural element, thereby strengthening the seismic safety margin of the bridge.
Flag lapel pin ban: Discourses about journalism ethics, patriotism, and the first amendment two decades after a September 11 controversy
Authors: MacNeil Cory W , Khanom Asma , Hinnant Amanda
Published: October 2024

This discourse analysis examined texts produced by citizens, journalists, and politicians in response to a television station news director’s ban on American flag lapel pins for on-air journalists following the September 11, 2001, terrorist attacks. The lapel pin ban sparked a national debate involving citizen outrage, journalistic reasoning, and legislative backlash. Taking advantage of this well-preserved historical context to use as a case study, the research question explored the competing discursive threads on journalism’s normative practices and roles in democracy. Literal and latent meanings embedded in discourses that invoked journalism ethics, symbolic patriotism, and the First Amendment offered a snapshot of how those involved in the public conversation positioned journalistic objectivity as a process and as a performance. Observations on the discursive clashes gleaned from the texts offer renewed considerations for current discussions about sensibilities of the audience, praxis of journalism ethics, editorial independence, and the role and refrain of personal expression for journalists of all mediums and platforms.
Exploring music and visual art relationship through inquiry graphic: A semiotic analysis of visual art students’ work
Authors: Parung Christabel , Saidi Acep Iwan , Sunarya Yan Yan , Sihombing Riama Maslan
Published: October 2024

This research explores the relationship between music and visual art through the visual artworks of four Indonesian students. Focusing on eight paintings inspired by two types of instrumental music, the study employs a qualitative multi-method approach, including Inquiry Graphics and Peircean’s semiotic analysis, to understand the creative process. The study focuses on eight paintings inspired by two instrumental pieces: Yiruma’s “River Flows in You” and Clifford Brown’s “Joy Spring.” Through free-painting experiments and semi-structured interviews, the research results in two key approaches to transduction (intersemiotic translation): one that reflects the formal qualities of music through visual elements and another that interprets the music through the lens of personal and cultural narratives. The result of this study underscores the value of multimodality in art education, showing how this approach enhances creativity and cognitive engagement across disciplines, including music, visual art, fashion, and product design.
Safety and efficacy of newer liquid embolic agents Squid and PHIL in endovascular embolization of cerebral arteriovenous malformations and dural arteriovenous fistulas: A systematic review and meta-analysis
Authors: Günkan Ahmet , Ferreira Marcio Yuri , Vilardo Marina , Scarcia Luca , Bocanegra-Becerra Jhon E. , Alexandre Andrea , Ferreira Christian , Dmytriw Adam , Ciccio Gabriele , Clarençon Frédéric , Jabbour Pascal , Serulle Yafell
Published: October 2024

Background

A wide range of liquid embolic agents has been used in endovascular treatment (EVT) of dural arteriovenous fistulas (dAVFs) and cerebral arteriovenous malformations (cAVMs). Newer liquid embolics, Squid (Balt) and PHIL (MicroVention), aim to improve the safety and efficacy of EVT of dAVFs and cAVMs.

Objective

To assess the safety and efficacy of EVT of cAVMs and dAVFs using Squid or PHIL as an embolic agent.

Methods

We searched major databases following PRISMA guidelines and included studies with ≥ five patients reporting on EVT of dAVFs and/or cAVMs using Squid or PHIL as embolic agent. We analyzed efficacy outcomes including complete occlusion, incomplete occlusion, and recurrence at follow up, and safety outcomes including procedure-related complications, morbidity, and mortality with a random-effects meta-analysis. Separate analyses were performed for cAVMs and dAVFs. Subanalyses were conducted for studies exclusively utilizing PHIL and those exclusively utilizing Squid, for both cAVMs and dAVFs.

Results

Ten studies, comprising 214 patients (53.7% male), were found. Of these, 113 patients had 113 dAVFs, while 101 patients had 101 cAVMs. Complete occlusion rates following embolization were 91% for dAVFs and 32% for cAVMs. A subanalysis of dAVFs embolized solely with Squid and PHIL identified 93% and 86% complete occlusion rates, respectively. The overall procedure-related permanent morbidity rate was 3% for dAVFs and 7% for cAVMs. There was only one procedure-related mortality, which developed in a cAVM case, across 214 cases.

Conclusion

Squid and PHIL are safe and effective embolic agents for treatment of dAVFs and cAVMs.
Making (Slowly) as Method: Piecing, Stitching and Steeping Metaphors for Multiple Methodologies
Authors: Pottinger Laura
Published: October 2024

How and what do we make through method? This paper imagines the processes of designing and carrying out socio-environmental research through the lens of a slow, creative craft form: sewing a patchworked piece from hand-dyed fabric samples. In doing so, it contributes to thinking about how methodologies are pieced and stitched together from multiple parts. Based on early findings from an extended research project exploring the practice of natural textile dyeing in the UK, I offer a range of textile processes for thinking through the creative dimensions of the doing of methodological work. The quilt-like piece I am attempting to make from plant-dyed fabric is at once the object, objective, and method in this study. I draw on auto-ethnographic reflections on my attempts to begin learning natural dyeing and sewing skills, suggesting piecing, stitching, and steeping may be useful, tactile metaphors for thinking through the early, often messy and uncertain stages of multi-sited and multi-method qualitative research. As such, I build on and extend recent discussions about ‘patchwork ethnography’, an approach recognising that the realities of ethnographic research in practice are often fragmented, non-linear, and intricately shaped by researchers’ everyday lives and commitments. The paper also offers insight into the potentials and pitfalls of intentionally ‘slow’ scholarship that aims to disrupt the urgent temporalities of research projects as they are often imagined.
Real-world antifibrotic treatment patterns in patients with idiopathic pulmonary fibrosis: retrospective analyses of two large healthcare administrative databases in the United States
Authors: Qiu Ying , Zhu Julia , Chopra Pooja , Elpers Brandon , Dieyi Christopher , Byrne Clare , Tang Jackson , Wang Ye , Govindaraj Kousalya , Fischer Aryeh
Published: October 2024

Background:

Real-world data on the use, healthcare resource utilization (HCRU), and associated costs of antifibrotic therapies in patients with idiopathic pulmonary fibrosis (IPF) are limited.

Objectives:

To assess the prevalence of antifibrotic treatment, characteristics of patients receiving treatment, discontinuation rates, and HCRU and costs associated with treatment.

Design:

This retrospective study analyzed de-identified longitudinal and cross-sectional data, respectively, from two US claims databases: Optum’s de-identified Clinformatics® Data Mart Database (CDM; commercial claims, Medicare Advantage) and the Veterans Health Administration (VHA) database. The study periods were October 1, 2013–March 31, 2019 and October 1, 2014–September 30, 2019, respectively. Eligible individuals were adults with ⩾1 diagnosis claim for IPF.

Methods:

Antifibrotic prevalence, patient demographics, treatment discontinuation rates, and HCRU and costs were determined separately for each cohort and described using summary statistics. Bivariate comparisons were analyzed using Chi-square and Student’s t-tests for categorical and continuous variables, respectively.

Results:

Overall, 4223 and 4459 eligible patients were identified in the CDM and VHA databases, respectively. Prevalence of antifibrotic uptake was 9.2% and 29.1% and the rate of index treatment discontinuation was 47% and 66% during follow-up in the CDM and VHA cohorts, respectively. Antifibrotic-treated patients were significantly younger ( p < 0.0001) with lower mean Charlson Comorbidity Index scores at baseline versus untreated patients in both cohorts. In the CDM cohort, the number of outpatient and pharmacy visits was significantly higher in treated versus untreated patients during follow-up (both p < 0.0001). A similar trend was observed for the VHA cohort. Total follow-up costs in both cohorts were significantly higher in treated versus untreated patients due to higher pharmacy costs (CDM; p < 0.0001) or higher outpatient and pharmacy costs (VHA; p < 0.0001).

Conclusion:

The low prevalence of antifibrotic usage in both cohorts, together with the high rate of antifibrotic discontinuation, and increased HCRU and costs in treated versus untreated patients, support the need for novel treatment options for IPF.

Trial registration:

Not applicable.
Exploring the management and treatment of IBD from the perspective of psychological comorbidities
Authors: Feng Lijuan , Cai Xunchao , Zou Qian , Peng Yao , Xu Long , Wang Linlin , Liu Qing , Lou Ting
Published: October 2024

The prevalence of anxiety, depression, and other psychological comorbidities among patients with inflammatory bowel disease (IBD) significantly exceeds that of the general population. Moreover, a bidirectional relationship exists between psychological comorbidities and IBD. This intricate interplay has substantial clinical implications, impacting treatment adherence, therapeutic efficacy, and disease recurrence rates. In this review, we explore the multifaceted mechanisms through which psychological factors influence IBD progression, treatment response, and prognosis. Specifically, we delve into the involvement of the hypothalamic-pituitary-adrenal axis, autonomic nervous system, enteric nervous system, microbiota-gut-brain axis, systemic inflammatory cytokines, and immune cell function. Additionally, we discuss the potential benefits of antidepressant therapy in mitigating IBD risk and the role of psychotropic drugs in reducing peripheral inflammation. Recognizing and addressing psychological comorbidity is pivotal in comprehensive IBD management. We advocate for the integration of biopsychosocial approaches into IBD treatment strategies, emphasizing the need for innovative psychological interventions as adjuncts to conventional therapies. Rigorous research investigating the impact of antidepressants and behavioral interventions on IBD-specific outcomes may herald a paradigm shift in IBD management.
The Impact of Middle Ear Packing Material Containing Antibiotic Ointment on Postoperative Infection After Myringoplasty
Authors: Lou Zhengcai , Lou Zihan , Chen Zhengnong
Published: October 2024

Objective

The objective of this study was to compare the postoperative infection and graft success rates, and the hearing improvement, after endoscopic cartilage underlay myringoplasty with versus without antibiotic ointment coating.

Materials and methods

This was a retrospective case-control study. The clinical records of patients who underwent endoscopic cartilage underlay myringoplasty and who met the selection criteria were retrieved and divided based on middle ear packing status into groups with antibiotic ointment packing (AOP group) and with no antibiotic ointment packing (no-AOP group). The operation time, postoperative infection, graft success status, and hearing improvement were compared between the 2 groups.

Results

Patients with 166 perforations constituted the AOP group, and patients with 141 perforations comprised the no-AOP group. At 3 months postoperatively, middle ear infections had occurred in 24 (14.5%) ears in the AOP group and 4 (2.8%) ears in the no-AOP group ( P < .01). At 12 months postoperatively, the graft success rate was 81.3% in the AOP group and 97.9% in the no-AOP group ( P < .01). No significant group differences were observed, preoperatively ( P = .657) or postoperatively ( P = .578), in the air-bone gap (ABG) values or mean ABG gains ( P = .758).

Conclusion

Middle ear packing without antibiotic ointment coating does not increase the postoperative infection rate or reduce the graft success rate after endoscopic cartilage underlay myringoplasty compared to antibiotic ointment coating. On the contrary, coating with antibiotic ointment increases the risk of postoperative infection given the complexity of middle ear manipulation.
Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma: A Longitudinal Study
Authors: Issa Khalil , Frisco Nicholas A. , Kilpatrick Kayla W. , Kuchibhatla Maragatha , Barrett Dane M. , Powers David B. , Woodard Charles R.
Published: October 2024

Study Design

Single-institution retrospective financial analysis.

Objective

Trauma care is consistently linked to inadequate reimbursement, posing a significant financial burden for large trauma centers. Data show that declining Medicare reimbursement rates have indirectly led to declining payment for all procedures covered by insurance. The goals of this study are to investigate the opportunity cost associated with contemporary surgical management of CMF trauma at our institution and to evaluate longitudinal financial trends.

Methods

Patients with operative facial fractures between 2015 and 2022 at Duke University Medical Center were included and compared to patients undergoing general otolaryngology, plastic surgery and oral surgery operations in the same period. Procedural codes, payor type, charges billed, collections, relative value units (RVUs) and other financial data were obtained and analyzed among the 2 patient populations. Comparative analysis was performed to assess the financial trends in data reported previously from 2007-2015.

Results

The collection rate at Duke University Medical Center for operatively managed CMF fractures remains significantly lower than non-CMF counterparts. Interestingly, the collection rate gap between CMF and non-CMF surgeries has narrowed when comparing to the data from 2007-2013. This is largely due to a decrease in collection rates for non-CMF procedures from 29.61% (2007-2013) to 26.57% (2015-2022) [ P = 0.0001] and an increase in collection rates for CMF procedures from 17.25% (2007-2013) to 18.05% (2015-2022) [ P = 0.0001].

Conclusions

Despite a slight improvement of the gap in reimbursement rates for CMF and non-CMF surgeries over the last several years, trauma care continues to have a negative financial impact on health care institutions.
Patient Perceived Barriers and Enablers to Medication Adherence in the Treatment of Depression: A Qualitative Study
Authors: Meng Yuki , Chiu Christopher , Kapoor Mamta , Li Shelly-Anne , Kaur Navaldeep , Marr Patricia , Kwan Debbie , Leblanc Kori , Ji Catherine , Papoushek Christine
Published: October 2024

Background:

Depression affects approximately 280 million individuals globally and it is a leading cause of disability. Despite effective medication options, 50% of patients prematurely discontinue antidepressants within 6 months. We sought to understand patients’ perspectives regarding their needs and expectations related to antidepressants.

Objectives:

To identify and describe enablers and barriers that influence adult patients’ medication adherence in depression treatment and to explore patients’ educational needs on initiating or continuing antidepressant therapy.

Methods:

Qualitative descriptive study was conducted using individual, semi-structured interviews of adult patients with depression who were prescribed an antidepressant within 3 months of study recruitment at an urban primary care clinic in Toronto, Canada. Thirteen participants were interviewed. Interviews were recorded and transcribed verbatim for inductive thematic analysis.

Results:

Six themes emerged: safety and effectiveness of antidepressant, understanding of depression and its management, medication administration, healthcare experiences in the treatment of depression, and social influences and relationships. Barriers to adherence included adverse effects of antidepressants, preference for non-pharmacological therapies, uncertainty about therapeutic effects, and social stigma. In contrast, enablers were positive responses from antidepressants, fear of relapse, reminder aids, established routine, and a trusting patient-provider relationship. Participants desired access to reliable, evidence-based, and personalized educational information delivered through verbal, written, and digital formats to support antidepressant adherence.

Conclusion:

To overcome the identified barriers, educational strategies should involve both patients and their prescribers to identify patient-specific needs and treatment goals, engage in shared decision-making, and maintain consistent follow-up to support antidepressant adherence.
“It’s Just Been a Wild Ride”: A Phenomenological Study of Emergency School Counselor Credentialing Experiences
Authors: Harman Lindsay , Ausloos Clark
Published: October 2024

This qualitative study explored the lived experiences of emergency credentialed school counselors in training. We interviewed 10 school counselor trainees across the United States who worked as school counselors while simultaneously completing their graduate coursework. We sought insights about challenges faced and support received. Four superordinate themes emerged: systemic barriers, support dynamics, professional development, and personal attributes that support career success. We discuss implications for credentialing bodies, district and site-level supervisors, school counselors, and school counselors in training.
Air Pollution and Public Health: Study on the Effects and Transmission Mechanism in the Case of China
Authors: Liu Huan , Wang Meng , Hu Tiantian
Published: October 2024

Following with the social-economy development and the increase of the incidence of various respiratory diseases, countries all over the world are increasingly paying attention to the issue of air pollution. This study uses the tracking data of 31 provincial capitals in China from 2013 to 2020, empirically tests the impact of air pollution on public health based on the ordinary least squares regression, and investigates the reliability of research conclusions with single instrumental variables and double instrumental variables based on the 2-Stage Least Squares and 3-stage Least Squares method. The results showed that air pollution significantly increased the “the number of respiratory diseases deaths per 10,000 people,” the effect reached 24.97%; and there were significant differences in the effects due to different pollution levels, along with the cumulation of the number of days with the air pollution index exceeds 300, the deterioration effects of air pollution on public health will reach the highest value as 0.42%. After replacing the indicators of public health and the treating of endogeneity, the above results are still robust. The impact coefficients significantly increased compare to benchmark model, which has increased to 89.66%. The variable coefficients of days with air pollution index exceeding 300 has increased to 6.66%. In the formation mechanism of air pollution, both industrial pollution and domestic pollution play significant roles, their effects reached 14.79% and 39.61%, respectively; they jointly increase the deterioration degree of air pollution and transmit to the impact of air pollution on public health, the interaction effect reached 5.86%. The air pollution has considerable impact on public health, and when the degree of air pollution increases, its impact is enhanced. The main impact mechanism of air pollution is presented as the joint influences of industrial pollution and domestic pollution that transmitting to the public health.
Effect of Handheld Finger-Grip Relaxation Technique on Post-Neurosurgery Patients’ Pain and Anxiety
Authors: Elnosary Asmaa Mohammad Ahmad , Mostafa Heba Abdel-Azeem , Tantawy Nayera , Hani Salam Bani , ALBashtawy Mohammed , Ayed Ahmad , Fathalla Mostafa Marwa
Published: October 2024

Introduction

Post-neurosurgery patients often experience pain and anxiety. Handheld finger-grip relaxation helps the body, mind, and spirit to achieve relaxation.

Objective

This study investigated the effect of a handheld finger-grip relaxation technique on pain and anxiety in post-neurosurgery patients.

Method

A quasi-experimental study of 160 patients was randomly assigned to either the intervention group (received the handheld finger-grip relaxation technique) or the control group (received standard care). The intervention group received the handheld finger-grip relaxation technique for 15 min twice daily for 3 days. The control group received standard care. Pain and anxiety were assessed using a visual analog scale and a Spielberger State-Trait Anxiety Inventory, respectively.

Results

The results showed that the intervention group had a highly statistically significant difference between pre and post-phase ( p < .0000) regarding the severity of pain and anxiety level. Meanwhile, there was a statistically significant difference ( p < .05) between pre and post-phase among the control group.

Conclusion

It is suggested that the handheld finger-grip relaxation technique may be an effective intervention for reducing pain and anxiety in post-neurosurgery patients.
The Treasures of Renal Isle: Evaluating a Gamified Module While Enhancing Student Learning
Authors: Joy Shinu , Rumsey Kimberly , Ford Meredith
Published: October 2024

Introduction

Nursing education continues to evolve with the integration of innovative technologies aimed at enhancing student engagement and understanding of complex medical concepts. Gamification, the application of game elements in nongame contexts, emerges as a promising tool in nursing education.

Method

Faculty members collaborated with instructional designers to develop, The Treasures of the Renal Isles, a gamified module for nursing education. Drawing upon their expertise, faculty provided content knowledge and identified key gaming elements, while designers crafted a virtual world and storyline to contextualize the learning experience. The module was implemented within the curriculum, and student feedback was solicited through the Gameful Experience Scale (GAMEX), a validated tool for assessing gamified learning experiences. Additionally, exam scores were analyzed to determine the gamified module's impact on learning outcomes.

Results

Analysis of student responses to the GAMEX tool revealed favorable perceptions of the gamified renal module. Specifically, 77.3% of students believed that the module facilitated their understanding of renal content, indicating its efficacy in knowledge acquisition. Moreover, 71% of students expressed a desire for additional gamified modules, highlighting their engagement and interest in this instructional approach. However, despite positive feedback, no significant differences in test scores were observed postimplementation.

Conclusion

The findings of this project highlight the potential of gamification as an interactive learning method in nursing education. While the gamified renal module received positive feedback from students regarding its effectiveness in facilitating understanding, the lack of significant improvement in test scores warrants further refinement. By incorporating student feedback and revising the module accordingly, nursing educators can utilize gamification to bridge the gap between theoretical knowledge and clinical judgment. The development of additional gamified modules holds promise for enriching the learning experience and preparing nursing students for the complexities of clinical practice.
Stemless Reverse Shoulder Arthroplasty Grants Satisfactory Clinical Scores at Minimum 5 Year Follow-up: Comparative Study
Authors: Quemener Alexandre , Dabert Alizé , Rochet Séverin , Antoine Adam , Pozet Astrid , Nourissat Geoffroy , Antoni Maxime , Harris Howard , Agu Chinyelum , van Rooij Floris , Obert Laurent
Published: October 2024

Purpose

To compare outcomes, between stemmed and stemless reverse shoulder arthroplasty (RSA) at a minimum follow-up of 5 years.

Methods

The authors retrospectively assessed a consecutive series of 45 patients that underwent RSA between September 2014 and October 2018 (23 stemless and 22 stemmed). All patients underwent plain anteroposterior and scapular Y-view radiographs for assessment immediately post-operatively and at final follow-up. At a minimum follow-up of 5 years, an independent observer assessed the clinical scores, including Constant score, QuickDASH score, and American Shoulder and Elbow Surgeons score.

Results

Of the 45 patients that underwent RSA, 5 patients died (11%), 2 were revised due to infection (4%), and 4 patients were lost to follow-up (9%). This left a final cohort of 34 patients (18 stemless and 16 stemmed). Significant differences between groups were found immediately post-operatively for lateralisation shoulder angle (LSA) (p = 0.021), but at 5 years post-operative for distalisation shoulder angle (DSA) (p = 0.017) and QuickDASH scores (p = 0.041) (Table 4), while the outcomes were comparable for absolute Constant scores, ASES score, and range of motion. Finally, stemless RSA had a 17% complication rate, while stemmed RSA had a 31% complication rate.

Conclusion

Stemless RSA had significantly more lateralisation, and significantly less distalisation, compared to stemmed RSA. Furthermore, at a 5-year follow-up, stemless RSA granted significantly greater QuickDASH scores. Finally, stemless RSA had comparable complication rates as stemmed RSA. The clinical relevance of this study is that stemless RSA is a safe alternative to stemmed RSA, while granting comparable or greater scores. Level of Evidence: III, Comparative Study
Cardiovascular toxicities associated with novel cellular immune therapies
Authors: Munir Malak , Sayed Ahmed , Addison Daniel , Epperla Narendranath
Published: October 2024

Over the past decade, T-cell–directed therapies, including chimeric antigen receptor T-cell (CAR-T) and bispecific T-cell engager (BTE) therapies, have reshaped the treatment of an expanding number of hematologic malignancies, whereas tumor-infiltrating lymphocytes, a recently approved cellular therapy, targets solid tumor malignancies. Emerging data suggest that these therapies may be associated with a high incidence of serious cardiovascular toxicities, including atrial fibrillation, heart failure, ventricular arrhythmias, and other cardiovascular toxicities. The development of these events is a major limitation to long-term survival after these treatments. This review examines the current state of evidence, including reported incidence rates, risk factors, mechanisms, and management strategies of cardiovascular toxicities after treatment with these novel therapies. We specifically focus on CAR-T and BTE therapies and their relation to arrhythmia, heart failure, myocarditis, bleeding, and other major cardiovascular events. Beyond the relationship between cytokine release syndrome and cardiotoxicity, we describe other potential mechanisms and highlight key unanswered questions and future directions of research.
A lifeline for COPD: prevention strategy
Authors: Percival I.
Published: October 2024

Educational aims

To provide an overview of the medical devices used in support of respiratory diagnosis and management. An outline of the National Clinical Stratergy in the UK.

To provide an outline of the National Clinical Stratergy in the UK.

This review provides an overview of the new National Clinical Strategy in the UK, which is designed to work proactively in preventing the development of chronic obstructive pulmonary disease (COPD) while defining a clear pathway to healthcare for sufferers. The government initiative will aim to associate the education of target groups with the diagnosis and management of COPD. Easy-to-use tools for healthcare professionals are available from the medical technology industry in support of the initiative, for example pre-screening, smoking cessation, spirometry measurements and body plethysmography.
Achieving quality spirometry in the office
Authors: Garbe B.
Published: October 2024

Ever since pioneering technology brought objective lung function measurement out of the laboratory with the introduction of “office spirometers” nearly 50 yrs ago, there has been a debate on whether nonspecialist practitioners can reliably achieve accurate lung function measurements. This debate continues today, because although it is certain that some users can achieve excellent-quality lung function measurements in general practice, occupational medicine and other nonspecialist practices, it is equally certain that some very poor-quality spirometry measurements are being performed. Examples of these poor quality measurements are presented as evidence that respiratory measurements should only be performed in controlled conditions by expert operators. Whether this is true can only be speculated upon, unless it is possible for an expert to review every spirometry measurement. You may think that this would be impossibly time consuming and expensive, but the internet, expert software and other technological advances have made this achievable and inexpensive; much cheaper than inaccurate lung function measurements.
Airway inflammation in asthma: current and future targets and therapies
Authors: Hanania N.
Published: October 2024

Educational aims

To provide an overview of airway inflammation in asthma.

To review current management guidelines' recommendations for the use of anti-inflammatory therapies in asthma.

To discuss current treatment options for airway inflammation in asthma.

To outline unmet needs for treating airway inflammation in asthma.

To describe novel targets for treating airway inflammation in asthma based on current knowledge.

Asthma is a chronic inflammatory disease of the airways that requires long-term anti-inflammatory therapy. Inhaled corticosteroids (ICS) are recommended for first-line treatment of persistent disease, but not all patients achieve asthma control even when these agents are used in high doses and in combination with other medications, such as a long-acting β2-agonist (LABA) or a leukotriene modifier. Such patients may require additional therapy. As information about asthma pathophysiology and inflammatory phenotypes continues to accumulate, and additional anti-inflammatory options become available, it may be possible to target anti-inflammatory therapy to various aspects of the disease and consequently to improve treatment of patients who respond inadequately to standard ICS-based therapy. Several novel anti-inflammatory therapies are at different stages of clinical development. This article will provide an overview of current and future approaches targeting airway inflammation in asthma.
Home noninvasive ventilation in COPD
Authors: Cheung A.P.S. , Chan V.L. , Chu C-M.
Published: October 2024

Educational aims

To explain the rationales for home noninvasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients.

To review available evidence on the use of home NIV in COPD patients.

To review the current consensus on the indications for home NIV in COPD patients.

To describe recent evidence in support of home NIV in a selected group of severe COPD patients.

To outline future research directions in this area.

NIV is now considered the standard care for COPD patients with hypercapnic exacerbations of their disease. There are theoretical benefits of long-term NIV in COPD patients, but evidence from randomised controlled trials (RCTs) is conflicting and inconclusive. This article will address the following issues:

• What are the physiological and clinical rationales for the use of home NIV in COPD patients?

• What is the available evidence on the use of home NIV in COPD patients?

• What are the limitations of previous studies performed in this area?

• Recent advances in home NIV.

• Future directions.
Prognostic value of the CRM-status in pancreatic ductal adenocarcinoma - data from a regional cancer registry
Authors: Schuhbaur Jasmin , Surovtsova Irina , Seufferlein Thomas , Kokh Daria , Szotyori-Artz Gertrud , Winzler Claudia , Schütz Juliane , Uhl Waldemar , Tannapfel Andrea , Morakis Philipp
Published: October 2024

Background

Ductal pancreatic adenocarcinoma (PDAC) still has a dismal prognosis even when deemed resectable. A cancer free resection margin (R0) is associated with a more favourable prognosis than the presence of tumour cells at resection margin (R1). However, the precise definition of the R0 status is still a matter of debate in PDAC. For a more accurate determination of R0 in PDAC the concept of circumferential resection margins (CRM) has been established and has been incorporated into the German national S3 guideline on exocrine pancreatic cancer. However, an international standardized nomenclature of CRM is still missing, and the clinical value of the CRM concept is not yet fully established. Here we evaluate whether the CRM status as defined in the national German S3 guideline corresponds with overall and progression free survival in PDAC using data from the regional cancer registry of the State of Baden Württemberg in Germany.

Methods

Data from the cancer registry of the State of Baden-Württemberg, Germany, were used to assess the relationship between CRM-status and progression free survival (PFS) as well as 3-year overall survival (OS) using documented patients diagnosed with resectable ductal adenocarcinoma of the pancreas between 2015 and 2020. Patients were residents of the State of Baden-Württemberg and underwent surgery for PDAC. The R-status was assessed according to the national German S3 guideline with R0 wide/CRM- when CRM is > 1 mm from the tumour, R0 narrow/CRM + when CRM is ≤ 1 mm from the tumour and R1 when tumour cells are found at the resection margin.

Results

In total we identified 1098 cases surgically treated for pancreatic cancer and fulfilling the inclusion criteria. 340 patients had an R0 wide/CRM- resection, 410 patients an R0 narrow/CRM + resection, and 348 patients an R1 resection. The R0 wide/CRM- status was associated with a significantly increased median OS rate compared to the other two groups (51,5%, 37,4% and 26,7% for R0 wide/CRM-, R0 narrow/CRM + and R1, respectively). mPFS was also longer in the R0 wide/CRM- group. These findings were robust with regards to grading and tumour location.

Conclusions

CRM is prognostic for patients with resectable PDAC making the pathological assessment of the R-status according to the CRM concept worthwhile.
Factors influencing the choice of specialization - a cross-sectional study with civilian medical students and prospective medical officers in Germany
Authors: Goetz Katja , Grienitz Katharina , Steinhäuser Jost
Published: October 2024

Background

The recruitment of physicians is an increasing challenge. The aim of the study was to explore factors that might influence future civilian and military doctors’ choice of specialization.

Methods

A 28 item author developed questionnaire was used to survey civilian medical students and prospective medical officers. The questionnaire consisted of 20 items addressing choice of specialization, and eight socio-demographic factors. Response options were available in the form of open and closed questions as well as in the form of a Likert scale (1 ‘not at all’ to 6 ‘very much’). The questionnaire was completed online by prospective medical officer from June to September 2021 and by civilian students from November 2020 to March 2021.

Results

In total, 2,030 students (56.1% female, mean age = 24, mean semester 6.5) participated in the survey, 1,553 civilian students and 477 prospective medical officers. Regular feedback and clear structures (mean = 5.35) followed by good teamwork (mean = 5.33) during postgraduate training was rated particularly important. Moreover, a secure job after graduation (mean = 5.23) and a compatibility of family and job (mean = 5.14) were important parameters for career choice. The specializations most frequently chosen were surgery (32.0%), internal medicine (27.1%) and anesthesiology (22.1%). The regression models showed that the choice depends on own attitude concerning the specialty would be a patient-orientation job, or a job with more manual work or more career option within in the job preferred.

Conclusions

Considering the value students place on receiving feedback and the structure of their specialist training, this seems to be a promising strategy for future recruitment. Good team dynamics and job security are key concerns for prospective physicians.
Review of MrsFreqPhase methods: methods designed to estimate statistically malaria parasite multiplicity of infection, relatedness, frequency and phase
Authors: Taylor Aimee R. , Neubauer Vickers Eric , Greenhouse Bryan
Published: October 2024

Malaria parasites are haploid within humans, but infections often contain genetically distinct groups of clonal parasites. When the per-infection number of genetically distinct clones (i.e., the multiplicity of infection, MOI) exceeds one, and per-infection genetic data are generated in bulk, important information are obfuscated. For example, the MOI, the phases of the haploid genotypes of genetically distinct clones (i.e., how the alleles concatenate into sequences), and their frequencies. This complicates many downstream analyses, including relatedness estimation. MOIs, parasite sequences, their frequencies, and degrees of relatedness are used ubiquitously in malaria studies: for example, to monitor anti-malarial drug resistance and to track changes in transmission. In this article, MrsFreqPhase methods designed to estimate statistically malaria parasite MOI, relatedness, frequency and phase are reviewed. An overview, a historical account of the literature, and a statistical description of contemporary software is provided for each method class. The article ends with a look towards future method development, needed to make best use of new data types generated by cutting-edge malaria studies reliant on MrsFreqPhase methods.
Human mesenchymal stroma/stem-like cell-derived taxol-loaded EVs/exosomes transfer anti-tumor microRNA signatures and express enhanced SDF-1-mediated tumor tropism
Authors: Hass Ralf , von der Ohe Juliane , Luo Tianjiao
Published: October 2024

Background

The release of extracellular vesicles (EVs) including exosomes from human mesenchymal stroma/stem-like cells (MSC) represents valuable cell-free carriers for the delivery of regenerative and medicinal compounds.

Methods

EVs/exosomes were isolated by differential centrifugation from four individual MSC as controls and after treatment with a sub-lethal concentration of 10 mM taxol for 24 h, respectively. The isolated EVs/exosomes were characterized and quantified by nano-tracking-analysis and by Western blots. MicroRNAs (miRs) were isolated from the different EVs/exosome populations and expression levels were quantified by qPCR using 1246 miR templates. Cytotoxic effects of the different MSC-derived taxol-loaded EVs/exosomes were determined in five different GFP-transduced cancer cell lines and quantified by a fluoroscan assay with a GFP-detecting fluorimeter. The presence of stroma cell-derived factor 1 (SDF-1) in MSC-derived EVs/exosomes and its enhanced expression in the vesicles after taxol treatment of MSC was quantified by a specific ELISA.

Results

EVs/exosomes isolated from four individual taxol-treated MSC displayed a larger size and higher yields as the control EVs/exosomes and were used as anti-tumor therapeutic vehicles. Application of each of the four MSC-derived taxol-loaded EVs/exosome populations revealed significant cytotoxic effects in cell lines of five different tumor entities (carcinomas of lung, breast, ovar, colon, astrocytoma) in a concentration-dependent manner. Expression analysis of 1246 miRs in these taxol-loaded EVs/exosomes as compared to the corresponding MSC-derived control EVs/exosomes unraveled a taxol-mediated up-regulation of 11 miRs with predominantly anti-tumorigenic properties. Moreover, various constitutively expressed protein levels were unanimously altered in the MSC cultures. Taxol treatment of the different MSC revealed an up-regulation of tetraspanins and a 2.2-fold to 5.4-fold increased expression of SDF-1 among others. Treatment of cancer cells with MSC-derived taxol-loaded EVs/exosomes in the presence of a neutralizing SDF-1 antibody significantly abolished the cytotoxic effects between 20.3% and 27%.

Conclusions

These findings suggested a taxol-mediated increase of anti-cancer properties in MSC that enhance the tropism of derived EVs/exosomes to tumors, thereby specifically focusing the therapeutic effects of the delivered products.