bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracolumbar Interfascial Plane (TLIP) block verses other paraspinal fascial plane blocks and local infiltration for enhanced pain control after spine surgery: a systematic review
Authors: Patel Tarika D. , McNicholas Meagan N. , Paschell Peyton A. , Arnold Paul M. , Lee Cheng-ting
Published: March 2024

Spinal surgeries are accompanied by excessive pain due to extensive dissection and muscle retraction during the procedure. Thoracolumbar interfascial plane (TLIP) blocks for spinal surgeries are a recent addition to regional anesthesia to improve postoperative pain management. When performing a classical TLIP (cTLIP) block, anesthetics are injected between the muscle (m.) multifidus and m. longissimus. During a modified TLIP (mTLIP) block, anesthetics are injected between the m. longissimus and m. iliocostalis instead. Our systematic review provides a comprehensive evaluation of the effectiveness of TLIP blocks in improving postoperative outcomes in spinal surgery through an analysis of randomized controlled trials (RCTs).

We conducted a systematic review based on the PRISMA guidelines using PubMed and Scopus databases. Inclusion criteria required studies to be RCTs in English that used TLIP blocks during spinal surgery and report both outcome measures. Outcome data includes postoperative opioid consumption and pain.

A total of 17 RCTs were included. The use of a TLIP block significantly decreases postoperative opioid use and pain compared to using general anesthesia (GA) plus 0.9% saline with no increase in complications. There were mixed outcomes when compared against wound infiltration with local anesthesia. When compared with erector spinae plane blocks (ESPB), TLIP blocks often decreased analgesic use, however, this did not always translate to decreased pain. The cTLIP and mTLP block methods had comparable postoperative outcomes but the mTLIP block had a significantly higher percentage of one-time block success.

The accumulation of the current literature demonstrates that TLIP blocks are superior to non-block procedures in terms of analgesia requirements and reported pain throughout the hospitalization in patients who underwent spinal surgery. The various levels of success seen with wound infiltration and ESPB could be due to the nature of the different spinal procedures. For example, studies that saw superiority with TLIP blocks included fusion surgeries which is a more invasive procedure resulting in increased postoperative pain compared to discectomies.

The results of our systematic review include moderate-quality evidence that show TLIP blocks provide effective pain control after spinal surgery. Although, the application of mTLIP blocks is more successful, more studies are needed to confirm that superiority of mTLIP over cTLIP blocks. Additionally, further high-quality research is needed to verify the potential benefit of TLIP blocks as a common practice for spinal surgeries.
Delays in Multiple Sclerosis diagnosis (DIMES): protocol for a multicentre, observational study of multiple sclerosis diagnostic pathways in the United Kingdom and Republic of Ireland
Authors: Kuri Ashvin , Henshall David E. , Chaudhry Daoud , Ooi Setthasorn Zhi Yang , Zhang Qiqi , Mathews Joela , Thomson Alison , Rog David , Hobart Jeremy , Dobson Ruth ,   Neurology and Neurosurgery Interest Group (NANSIG)
Published: March 2024

Background

Multiple sclerosis (MS) is a leading cause of non-traumatic disability in young adults. Accumulating evidence indicates early diagnosis and early treatment improves long-term outcomes. However, the MS diagnostic pathway is increasingly complex, and delays may occur at several stages. Factors causing delays remain understudied. We aim to quantify the time taken for MS to be diagnosed, and characterise the diagnostic pathway and initial care provided, in the United Kingdom (UK) and Republic of Ireland (ROI).

Methods

Delays In MultiplE Sclerosis diagnosis (DIMES) in the UK and ROI is a multicentre, observational, retrospective study that will be conducted via the Neurology and Neurosurgery Interest Group (NANSIG) collaborative network. Any hospital in the UK and ROI providing an MS diagnostic service is eligible to participate. Data on consecutive individuals newly diagnosed with MS between 1st July 2022 and 31st December 2022 will be collected. The primary outcomes are 1) time from symptoms/signs prompting referral to neurology, to MS diagnosis; and 2) time from referral to neurology for suspected MS, to MS diagnosis. Secondary outcomes include: MS symptoms, referring specialties, investigations performed, neurology appointments, functional status, use of disease modifying treatments, and support at diagnosis including physical activity, and follow up. Demographic characteristics of people newly diagnosed with MS will be summarised, adherence to quality standards summarised as percentages, and time-to-event variables presented with survival curves. Multivariable models will be used to investigate the association of demographic and clinical factors with time to MS diagnosis, as defined in our primary outcomes.

Discussion

DIMES aims to be the largest multicentre study of the MS diagnostic pathway in the UK and ROI. The proposed data collection provides insights that cannot be provided from contemporary registries, and the findings will inform approaches to MS services nationally in the future.
Immune checkpoint inhibitor plus chemotherapy as first-line treatment for non-small cell lung cancer with malignant pleural effusion: a retrospective multicenter study
Authors: Wei Qi , Deng Taibing , Wu Junhua , Zeng Hao , Qi Chang , Tan Sihan , Zhang Yuanyuan , Huang Qin , Pu Xin , Xu Weiguo , Li Weimin , Tian Panwen , Li Yalun
Published: March 2024

Background

Immune checkpoint inhibitors (ICI) combined with chemotherapy are efficacious for treating advanced non-small cell lung cancer (NSCLC); however, the effectiveness of this approach in the malignant pleural effusion (MPE) population is unclear. This study evaluated ICI plus chemotherapy in NSCLC patients with MPE.

Methods

Patients from 3 centers in China with NSCLC and MPE who received ICI plus chemotherapy (ICI Plus Chemo) or chemotherapy alone (Chemo) between December 2014 and June 2023 were enrolled. Clinical outcomes and adverse events (AEs) were compared.

Results

Of 155 eligible patients, the median age was 61.0 years old. Males and never-smokers accounted for 73.5% and 39.4%, respectively. Fifty-seven and 98 patients received ICI Plus Chemo or Chemo, respectively. With a median study follow-up of 10.8 months, progression-free survival (PFS) was significantly longer with ICI Plus Chemo than with Chemo (median PFS: 7.4 versus 5.7 months; HR = 0.594 [95% CI: 0.403–0.874], P = 0.008). Median overall survival (OS) did not differ between groups (ICI Plus Chemo: 34.2 versus Chemo: 28.3 months; HR = 0.746 [95% CI: 0.420–1.325], P = 0.317). The most common grade 3 or worse AEs included decreased neutrophil count (3 [5.3%] patients in the ICI Plus Chemo group vs. 5 [5.1%] patients in the Chemo group) and decreased hemoglobin (3 [5.3%] versus 10 [10.2%]).

Conclusions

In patients with untreated NSCLC with MPE, ICI plus chemotherapy resulted in significantly longer PFS than chemotherapy and had a manageable tolerability profile, but the effect on OS may be limited.
Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index
Authors: An Di , Wang Jianxia , Zhang Fan , Jing Huafang , Gao Yi , Cong Huiling , Su Guodong , Ye Miao , Hu Chunying , Wu Juan , Liao Limin
Published: March 2024

Background

Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.

Methods

Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.

Results

In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43.

Conclusions

Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.

Trial registration

Date of trial registration: November 27, 2023.
In vitro antimicrobial and antibiofilm screening of eighteen Iranian medicinal plants
Authors: Hamidi Maryam , Toosi Ali Mohaghegh , Javadi Behjat , Asili Javad , Soheili Vahid , Shakeri Abolfazl
Published: March 2024

Background

Natural products are one of the best candidates for controlling drug-resistant pathogens, the advantages of which include low production costs and low side effects. In this study, as potential antimicrobials, the anti-bacterial and antibiofilm activities of several Iranian native medicinal plants were screened.

Methods

The antibacterial/antifungal and anti-biofilm activities of 18 medicinal plants including Reseda lutea L., Nepeta sintenisii Bunge., Stachys turcomanica Trautv., Stachys lavandulifolia Vahl, Diarthron antoninae (Pobed.) Kit Tan., Ziziphora clinopodioides Lam., Euphorbia kopetdaghi Prokh, Euphorbia serpens Kunth., Hymenocrater calycinus Benth., Scutellaria pinnatifida A.Ham., Viola tricolor L., Hypericum helianthemoides (Spach) Boiss., Hypericum scabrum L., Convolvulus lineatus L., Scabiosa rotata M.Bieb Greuter & Burdet, Delphinium semibarbatum Bien. Ex Boiss., Glycyrrhiza triphylla Fisch. & C.A.Mey., and Ziziphus jujuba Mill., against two Gram-positive bacteria, Staphylococcus aureus, Bacillus cereus, as well as two Gram-negative bacteria, Pseudomonas aeruginosa, Escherichia coli; and Candida albicans as a fungal strain, were evaluated. The minimum inhibitory concentration (MIC) and minimum bactericidal/fungicidal concentration (MBC/MFC) values of the extracts against tested microorganisms were reported and we investigated their effect on the biofilm inhibition of Pseudomonas aeruginosa PAO1, Staphylococcus epidermis, Staphylococcus aureus and Streptococcus mutans. In addition, the effect of the extracts on the eradication of the biofilms of these bacteria was evaluated.

Results

In this study, H. scabrum was found to exhibit potentially significant activity against Gram-positive bacteria with the MIC range of 6.25–25 µg/mL. This extract also showed a significant effect on inhibiting the biofilm of S. aureus, S. mutans, and S. epidermidis and eradicating the biofilm of S. epidermidis DSMZ 3270. In addition, Hymenocrater calycinus root extract had moderate antibacterial activity against B. cereus with the MIC and MBC 62.5 µg/mL, respectively.

Conclusions

The results of this study showed that the root extracts of two plants, Hypericum scabrum and Hymenocrater calycinus, had antimicrobial and anti-biofilm effects. Based on the observed anti-biofilm effects, these two plants may be considered in future studies to find responsible antimicrobial compounds.
Challenges of home care: a qualitative study
Authors: Shahriari Mohsen , Nia Donya Hafezi , kalij Fatemeh , Hashemi Maryam Sadat
Published: March 2024

Background

Despite countless benefits of home care, unfortunately, the variety and quality of services provided by homecare centers are uncertain. This study was conducted to explore of home care challenges.

Methods

The present qualitative study used the content analysis approach. A total of 17 participants, including nurses, managers of home care centers, and patients, were enrolled through purposive sampling. Data were collected using semi-structured interviews and analyzed through Granheim’s qualitative content analysis method.

Results

In order to explain the challenges of home care, after analyzing the data, 700 primary codes, 15 initial categories, sub-subcategories and two main categories, including ‘infrastructural challenges’ and ‘challenges related to the process of home care services provision’ emerged. The main category, “infrastructural challenges”, consisted of 4 sub-categories (the challenge of acculturalization of home care services, economic challenges of providing services, challenges related to human resources, and the challenge of policymaking and setting regulations and rules for home care). The second main category, “challenges related to the process of home care services provision”, consisted of 2 subcategories: challenges of improving the quality of home care services and the challenge of facilities for service provision.

Conclusion

In order to promote and improve the quality of home care services, in addition to providing insurance coverage for the services, acculturalization and revising the bylaws, empowering the human resource, enhancing the monitoring of the performance of home care centers, and employing modern technology need to be taken into account.
Trends in household out-of-pocket health expenditures and their underlying determinants: explaining variations within African regional economic communities from countries panel data
Authors: Ngepah Nicholas , Ndzignat Mouteyica Ariane Ephemia
Published: March 2024

Background

The persistently high out-of-pocket health spending (OOPHE) in Africa raise significant concern about the prospect of reaching SDG health targets and UHC. The study examines the convergence hypothesis of OOPHE in 40 African countries from 2000 to 2019.

Methods

We exploit the $${\text{log }}t$$

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, club clustering, and merging methods on a panel of dataset obtained from the World Development Indicators, the World Governance Indicators, and the World Health Organization. Then, we employ the multilevel linear mixed effect model to examine whether countries' macro-level characteristics affect the disparities in OOPHE in the African regional economic communities (RECs).

Results

The results show evidence of full panel divergence, indicating persistent disparities in OOPHE over time. However, we found three convergence clubs and a divergent group for the OOPHE per capita and as a share of the total health expenditure. The results also show that convergence does not only occur among countries affiliated with the same regional economic grouping, suggesting disparities within the regional groupings. The findings reveal that countries' improved access to sanitation and quality of governance, increased childhood DPT immunization coverage, increased share of the elderly population, life expectancy at birth, external health expenditure per capita, and ICT (information and communication technology) significantly affect within-regional groupings’ disparities in OOPHE per capita. The results also show that an increasing countries’ share of elderly and younger populations, access to basic sanitation, ICT, trade GDP per capita, life expectancy at birth, childhood DPT immunization coverage, and antiretroviral therapy coverage have significant impacts on the share of OOPHE to total health expenditure within the regional groupings.

Conclusion

Therefore, there is a need to develop policies that vary across the convergence clubs. These countries should increase their health services coverage, adopt planned urbanization, and coordinate trade and ICT access policies. Policymakers should consider hidden costs associated with access to childhood immunization services that may lead to catastrophic health spending.
Enhancement of neurogenesis and cognition through intranasal co-delivery of galanin receptor 2 (GALR2) and neuropeptide Y receptor 1 (NPY1R) agonists: a potential pharmacological strategy for cognitive dysfunctions
Authors: Sánchez-Varo Raquel , López-Salas Alexander , Beltran-Casanueva Rasiel , Díaz-Sánchez Estela , Alvarez-Contino Jose Erik , Barbancho-Fernández Miguel Angel , Serrano-Castro Pedro , Fuxe Kjell , Borroto-Escuela Dasiel O. , García-Casares Natalia , Narváez Manuel
Published: March 2024

Background

Spatial memory deficits and reduced neuronal survival contribute to cognitive decline seen in the aging process. Current treatments are limited, emphasizing the need for innovative therapeutic strategies. This research explored the combined effects of intranasally co-administered galanin receptor 2 (GALR2) and neuropeptide Y1 receptor (NPY1R) agonists, recognized for their neural benefits, on spatial memory, neuronal survival, and differentiation in adult rats.

After intranasal co-delivery of the GALR2 agonist M1145 and a NPY1R agonist to adult rats, spatial memory was tested with the object-in-place task 3 weeks later. We examined neuronal survival and differentiation by assessing BrdU-IR profiles and doublecortin (DCX) labeled cells, respectively. We also used the GALR2 antagonist M871 to confirm GALR2's crucial role in promoting cell growth.

Results

Co-administration improved spatial memory and increased the survival rate of mature neurons. The positive effect of GALR2 in cell proliferation was confirmed by the nullifying effects of its antagonist. The treatment boosted DCX-labeled newborn neurons and altered dendritic morphology, increasing cells with mature dendrites.

Conclusions

Our results show that intranasal co-delivery of GALR2 and NPY1R agonists improves spatial memory, boosts neuronal survival, and influences neuronal differentiation in adult rats. The significant role of GALR2 is emphasized, suggesting new potential therapeutic strategies for cognitive decline.
High prevalence of carbapenem resistance and clonal expansion of blaNDM gene in Klebsiella pneumoniae isolates in an Iranian referral pediatric hospital
Authors: Pourakbari Babak , Mamishi Setareh , Poormohammadi Shiva , Hosseinpour Sadeghi Reihaneh , Mahmoudi Shima
Published: March 2024

Background

The increasing global concern regarding antibiotic resistance necessitates in-depth studies to comprehend the phenotypic and genotypic characteristics of resistant bacterial strains. This study aimed to investigate the prevalence, antibiotic resistance profiles, and molecular characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in an Iranian referral pediatrics hospital. Methods: In this study, we examined CRKP isolates collected from hospitalized pediatric patients across various wards. The isolates underwent antimicrobial susceptibility testing, the polymerase chain reaction (PCR) analysis for carbapenemase genes (blaNDM, blaVIM and blaIMP), and genetic relatedness assessment using pulsed-field gel electrophoresis (PFGE).

Results

Among 166 K. pneumoniae isolates, 54 (32.5%) exhibited resistance to carbapenems. Notably, all these resistant isolates were resistant to imipenem, with 35 (65%) displaying resistance to both imipenem and meropenem. Of the 54 CRKP isolates, 24 (44%) were metallo-β-lactamases (MBL)-producing. The prevalence of the blaNDM gene among CKCP and MBL-producing isolates was 20% (n = 11) and 44% (n = 24), respectively. The blaVIM and blaIMP genes were not detected in any of the isolates. Twenty-six CRKP isolates (48%) were recovered from ICUs. PFGE analysis of CRKP isolates revealed 20 clusters, with cluster S being the most prevalent, comprising 24% of the total (n = 13).

Conclusion

Our study reveals a concerning prevalence of carbapenem resistance in K. pneumoniae isolates. Specifically, the detection of the blaNDM gene in 20% of CRKP isolates, with a significant proportion (82%) observed in isolated CRKP from the ICUs and emergency departments, underscores the potential clonal expansion of these resistant strains within these critical hospital wards.
Evaluation of adherence to guideline-directed therapy and risk factors for exacerbation in mild asthma: a retrospective chart review
Authors: Zerr Beth A. , Kruse Jacklyn M. , Glover Jon J.
Published: March 2024

Background

A significant update was made to both the Global Initiative for Asthma (GINA) in 2019 and the National Heart Lung and Blood Institute (NHLBI) asthma guidelines in 2020 for mild asthma. These groups no longer recommend short-acting beta-agonists (SABA) as monotherapy for mild (GINA) or mild-persistent (NHLBI) asthma. With the lag that can occur between guideline or evidence updates and changes in practice, this study sought to evaluate whether guideline adoption had occurred.

Methods

In this retrospective chart review, patient electronic medical records from a large healthcare system were evaluated from July 1 of 2021 to July 1 of 2022 to determine how many patients with mild asthma were prescribed as needed or daily inhaled corticosteroids (ICS) in addition to as needed SABA. The secondary outcome was to evaluate the incidence of exacerbations in patients with mild asthma, comparing those on guideline-directed therapy or not. In addition, we evaluated other patient factors increasing exacerbation risk in mild asthma.

Results

For the primary outcome, of the 1,107 patients meeting inclusion criteria, 284 patients (26%) did not have documentation of guideline-directed therapy for mild asthma during the study period, while 823 (74%) were on guideline-directed therapy (Diff:48.7%; 95% CI:45.1 to 52.3%, p < 0.001). For the secondary objective, 161 patients had an exacerbation (12% on guideline-directed therapy, 15.4% not on guideline-directed therapy). This difference in incidence of exacerbation between the two treatment groups was not statistically significant (Diff: -3.4%; 95% CI: -8 to 1.1%; p = 0.133). In addition, being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among our patient population.

Conclusions

Nearly one-fourth of patients with mild persistent asthma were not on guideline-directed therapy, despite updates in asthma guidelines (GINA 2019, NHLBI 2020). Factors such as being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among patients with mild persistent asthma.
Vallisneria spiralis L. adaptive capacity improves pore water chemistry and increases potential nitrification in organic polluted sediments
Authors: Morini Leonardo , Ferrari Claudio , Bartoli Marco , Zilius Mindaugas , Broman Elias , Visioli Giovanna
Published: March 2024

Background

Macrophytes may modify benthic biodiversity and biogeochemistry via radial oxygen loss from roots. This condition contrasts sediments anoxia, allows roots respiration, and facilitates aerobic microbial communities and processes in the rhizosphere. Simultaneously, the rhizosphere can stimulate anaerobic microorganisms and processes via exudates or by favoring the build-up of electron acceptors as nitrate. As eutrophication often results in organic enrichment in sediments and large internal nutrients recycling, an interesting research question is to investigate whether plants maintain the capacity to stimulate aerobic or anaerobic microbial communities and processes also under elevated organic pollution.

Methods

A manipulative experiment was carried out under laboratory-controlled conditions. Microcosms containing bare sediments and sediments transplanted with the macrophyte Vallisneria spiralis L. were created. The effect of the plant was investigated on sediments with moderate (8%) and elevated (21%) organic matter content, after an acclimatization period of 30 days. Chemical and physical parameters, microbial community composition and the potential rates of nitrification, denitrification and nitrate ammonification were measured at two different depths (0–1 and 1–5 cm) after the acclimatization period to evaluate the role of roots.

Results

Vallisneria spiralis grew and assimilated pore water nutrients at the two organic matter levels and vegetated sediments had always nutrient-depleted porewaters as compared to bare sediments. Nitrifying microbes had a lower relative abundance and diversity compared to denitrifying bacteria. However, regardless of the organic content, in vegetated sediments nitrifiers were detected in deeper horizons as compared to bare sediments, where nitrification was confined near the surface. In contrast, potential denitrification rates were not affected by the presence of roots, but probably regulated by the presence of nitrate and by root-dependent nitrification. Potential nitrate ammonification rates were always much lower (< 3%) than potential denitrification rates.

Conclusions

Vallisneria spiralis affects N-related microbial diversity and biogeochemistry at moderate and elevated organic matter content, smoothing bottom water–pore water chemical gradients and stimulating nitrification and nitrogen loss via denitrification. These results suggest the possibility to deploy V. spiralis as a nature-based solution to counteract eutrophication in freshwater systems impacted by high loads of organic matter, for example, downstream of wastewater treatment plants.
A scoping review of willingness to communicate in language education: premises to doubt, lessons to learn, and future research questions to examine
Authors: Kirkpatrick Robert , Vafadar Hossein , Mohebbi Hassan
Published: March 2024

The assessment encompasses essential concepts and their related measures about the information gathered. The conceptualization within a study becomes imperative to ascertain the corresponding variables and establish appropriate methodologies for their measurement. The willingness to communicate (WTC) concept, an individual’s engagement in communication when given the opportunity, has become a crucial point in second language (L2) learning due to language use and communication. While studies have rendered valuable insights into the differing presentations of L1 WTC and L2 WTC, the subject remains largely unexplored concerning the conceptualization and assessment of L2 WTC in the digital settings and English as a foreign language (EFL) context. The scoping review can aid in advancing our knowledge in this area of investigation by exploring the scope of available research literature on a topic by identifying key concepts and sources of evidence as well as identifying strengths, weaknesses, and gaps in the research that inform practice in the field, deepen assessors’ knowledge in the field, and highlight areas that require further inquiry. This study conducted a five-stage scoping review, including (1) establishing the scoping review questions, (2) identifying the related research, (3) determining the inclusion criteria of studies, (4) outlining the data, and (5) analyzing and reporting the results. Six databases, ERIC (ProQuest), APA PsycINFO, JSTORE, Elsevier (Scopus), Web of Science Core Collection, and Semantic Scholar, were used for scoping data. Forty-seven studies were included in the final analysis. The results discuss the WTC conceptualizations and their directions in L1, L2, and EFL contexts. Furthermore, the results discuss the conceptualization of classroom-centered and context-bounded WTC, operationalization of WTC in digital and EFL contexts, methodological approaches applied for evaluating WTC, the evaluation of teachers’ status in WTC conceptualization, and future directions. The discussions would prove useful in expanding our understanding of how to act toward L2 WTC and the assessment knowledge. Moreover, they would have significant implications for teachers, researchers, assessors, and practitioners in this field. Further, we hope this paper sparks renewed interest in L2 WTC by generating new ideas for researchers to conduct further research.
Protocolized abuse screening to decrease provider bias and increase capture of potential events
Authors: Chan Ashley , Feller Mary D. , Dawson Kaylin , Morrissey Kirsten , Ata Ashar , Edwards Mary J.
Published: March 2024

Background

Early identification of child abuse is critical to prevent death and disability. Studies suggest implicit bias of providers may lead to overrepresentation of minority and impoverished children in child abuse reporting. At our institution, universal screening for sexual and physical abuse for all children under 18 years of age was implemented in 2016. A rigorous, objective evaluation protocol focusing on the mechanism of injury and exam findings to improve recognition and eliminate bias was implemented in 2019.

Findings

Demographics and clinical characteristics of patients less than 18 years of age were abstracted by chart review (2014–2015) and from a forensic database (2016–2022). International Classification of Diseases codes 995.5 (version 9) and T76.12XA (version 10) were used to identify patients before the establishment of forensic database. Relative frequency and patient characteristics of the three time periods (pre universal screening: 2014–2015, post universal screening: 2016–2019, post protocol implementation: 2020–2022) were compared using Chi-square tests and modified Poisson regression. Universal screening significantly increased the number of cases identified. The demographic profile of potential victims by race significantly changed over the reporting periods with an increased number of white children identified, consistent with state demographics. The proportion of publicly insured patients trended down with universal screening and protocol implementation, despite a significant increase in the number of children publicly insured in the state during this time.

Conclusion

These single institutional results lend support to objective, evidence-based protocols to help eliminate bias surrounding race and poverty.
An in-depth evaluation of metagenomic classifiers for soil microbiomes
Authors: Edwin Niranjana Rose , Fitzpatrick Amy Heather , Brennan Fiona , Abram Florence , O’Sullivan Orla
Published: March 2024

Background

Recent endeavours in metagenomics, exemplified by projects such as the human microbiome project and TARA Oceans, have illuminated the complexities of microbial biomes. A robust bioinformatic pipeline and meticulous evaluation of their methodology have contributed to the success of these projects. The soil environment, however, with its unique challenges, requires a specialized methodological exploration to maximize microbial insights. A notable limitation in soil microbiome studies is the dearth of soil-specific reference databases available to classifiers that emulate the complexity of soil communities. There is also a lack of in-vitro mock communities derived from soil strains that can be assessed for taxonomic classification accuracy.

Results

In this study, we generated a custom in-silico mock community containing microbial genomes commonly observed in the soil microbiome. Using this mock community, we simulated shotgun sequencing data to evaluate the performance of three leading metagenomic classifiers: Kraken2 (supplemented with Bracken, using a custom database derived from GTDB-TK genomes along with its own default database), Kaiju, and MetaPhlAn, utilizing their respective default databases for a robust analysis. Our results highlight the importance of optimizing taxonomic classification parameters, database selection, as well as analysing trimmed reads and contigs. Our study showed that classifiers tailored to the specific taxa present in our samples led to fewer errors compared to broader databases including microbial eukaryotes, protozoa, or human genomes, highlighting the effectiveness of targeted taxonomic classification. Notably, an optimal classifier performance was achieved when applying a relative abundance threshold of 0.001% or 0.005%. The Kraken2 supplemented with bracken, with a custom database demonstrated superior precision, sensitivity, F1 score, and overall sequence classification. Using a custom database, this classifier classified 99% of in-silico reads and 58% of real-world soil shotgun reads, with the latter identifying previously overlooked phyla using a custom database.

Conclusion

This study underscores the potential advantages of in-silico methodological optimization in metagenomic analyses, especially when deciphering the complexities of soil microbiomes. We demonstrate that the choice of classifier and database significantly impacts microbial taxonomic profiling. Our findings suggest that employing Kraken2 with Bracken, coupled with a custom database of GTDB-TK genomes and fungal genomes at a relative abundance threshold of 0.001% provides optimal accuracy in soil shotgun metagenome analysis.
Early-Onset Colorectal Cancer in Egypt: Pathological Characters, Patterns of Care, and Survival Compared to Average-Age Onset Colorectal Cancer: A Retrospective Multicenter Study
Authors: Rashad Noha , Eid Salem Salem , Meheissen Mohamed A.M. , Refaat Ghada , Mahmoud Sami Heba , Temerik Abdelsalam , Kordy Nashwa , Daniel Mina A. , El-Kaffas Mohamed , Esam Mohamed , El Mansy Hazem , Elkerm Yasser , Abdelaziz Elsaid Amr , Attia Ismail Abdelsalam , Saber Abdelhalim Mohyeldin , Moustafa Ahmad Lamiaa , Akram Mahmoud Mai , El Desouky Eman D.
Published: March 2024

PURPOSE

Early-onset colorectal cancer (EOCRC) is a rising health problem. The incidence of EOCRC has increased over the past 2 decades all over the world. Reports from Egypt since the 1990s have reported a higher incidence among young populations with no identifiable risk factors. The aim of this study was to assess EOCRC in Egypt regarding incidence, characteristics, treatment pattern, and survival compared with average age onset and elderly patients.

MATERIALS AND METHODS

This was a retrospective, record-based, cohort study combining data from four different cancer centers in Egypt. We grouped patients according to age into three categories: the EOCRC group for patients age ≤45 years and the average age onset and elderly cancer group (for patients age ≥65 years).

RESULTS

The study included 1,310 patients with histopathologically proven colorectal cancer, representing four different geographical areas in Egypt. Patients with EOCRC represented 42.4% of the study population. Female patients were 50.6% among the EOCRC group and 52.5% among the average age group. Rectal tumors were significantly higher in EOCRC (54.7% v 40.6%; P < .001). There was no significant difference between both groups regarding the tumor stage at presentation, obstruction, or presence of metastases at presentation. Patients with EOCRC had a significantly higher rate of peritoneum/adnexa metastases than the average age ones (12.3% in EOCRC v 6.9% in the average age group; P < .001). No statistically significant differences between EOCRC and average age groups in both disease-free survival and overall survival were reported.

CONCLUSION

A comprehensive framework for the study of EOCRC is required in Egypt as well as a genomic analysis to identify possible underlying genetic alterations responsible for the high incidence of EOCRC.
Durable Responses With Mosunetuzumab in Relapsed/Refractory Indolent and Aggressive B-Cell Non-Hodgkin Lymphomas: Extended Follow-Up of a Phase I/II Study
Authors: Budde Lihua E. , Assouline Sarit , Sehn Laurie H. , Schuster Stephen J. , Yoon Sung-Soo , Yoon Dok Hyun , Matasar Matthew J. , Bosch Francesc , Kim Won Seog , Nastoupil Loretta J. , Flinn Ian W. , Shadman Mazyar , Diefenbach Catherine , Cheah Chan Yoon , Ma Connie Y. , Huang Huang , Kwan Antonia , Wei Michael C. , Yin Shen , Bartlett Nancy L.
Published: March 2024

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.

Mosunetuzumab is a CD20xCD3 T-cell–engaging bispecific antibody administered as an off-the-shelf, fixed-duration treatment in an outpatient setting. We report an updated analysis of the durability of response, by investigator assessment, after an overall median follow-up of 3.5 years in patients with relapsed/refractory indolent or aggressive B-cell non-Hodgkin lymphoma (iNHL/aNHL) from the dose-escalation stage of a phase I/II study of mosunetuzumab (ClinicalTrials.gov identifier: NCT02500407 ). Across dose levels, 65.7% of patients with iNHL and 36.4% with aNHL achieved a complete or partial response to mosunetuzumab. Median duration of response (DoR) in patients with iNHL for all responders was 23.2 months (95% CI, 13.8 to not estimable [NE]), but was not reached in complete responders (95% CI, 21.0 to NE). After a median time on study of 38.9 months, no relapses were observed beyond 26 months in complete responders. In patients with aNHL, median DoR for all responders was 7.8 months (95% CI, 4.6 to 22.8). Among 12 complete responders who progressed postmosunetuzumab treatment and were retreated with mosunetuzumab, 83.3% had an objective response and 58.3% achieved a second complete response. Our study reports the longest follow-up using bispecific antibodies in patients with B-cell non-Hodgkin lymphoma and demonstrates that mosunetuzumab can mediate durable remissions with time-limited treatment.
The ILO, the Politics of Statistics, and Changing Perceptions of Informal Work, 1970–Present
Authors: Marti Sibylle
Published: March 2024

The article contributes to the history of labor statistics by identifying the social, political, and epistemic conditions that led to the recognition of informal work as a countable form of labor. The article traces the ILO's efforts since the 1970s to capture the initially elusive concept of the informal sector in an internationally recognized statistical definition and to introduce it into national accounts. It also elucidates how the understanding of informal work broke away from its original focus on developing countries and expanded in the 1990s, at a time when the spread of nonstandard employment had led to an increase in informal employment in developed countries as well. By analyzing the decades-long attempts to develop statistics on the informal sector and informal employment, the article illuminates labor as an object of contingent (and contested) statistical definition and also shows how actors representing informal workers mobilized statistical knowledge for political action.
Natural catastrophe models for weather related events and insurance applications
Authors: Κρουστάλλης Ευστάθιος
Published: March 2024

Η συχνότητα και η σφοδρότητα των φυσικών καταστροφών σχετικά με τον μετεωρολογικό κίνδυνο αναμένεται να αυξηθούν λόγω της κλιματικής αλλαγής. Οι νέες κλιματικές προβλέψεις αναδεικνύουν ότι στο μέλλον οι ακραίες συνθήκες που σχετίζονται με το κλίμα θα αυξηθούν σε πολλές ευρωπαϊκές περιοχές με σημαντικό κοινωνικό και οικονομικό αντίκτυπο, επηρεάζοντας επίσης τον ασφαλιστικό κλάδο. Επιπλέον, τα συμβάντα που σχετίζονται με τις καιρικές συνθήκες συχνά δεν καταγράφονται πλήρως, επομένως είναι δύσκολο να μοντελοποιήσουμε τη σχέση μεταξύ κλιματικών γεγονότων και της συχνότητας των ασφαλιστικών απαιτήσεων. Παράλληλα, πολλές φορές, υπάρχει δυσκολία στην αναγνώριση της πρωτογενούς αιτίας των σχετικών ασφαλιστικών ζημιών. Με κίνητρο τα παραπάνω ζητήματα, εφαρμόσαμε μια από τις πιο αντιπροσωπευτικές προσεγγίσεις μοντέλου «εποπτευόμενης εκμάθησης», μέθοδο βασισμένη σε δενδροδιαγράμματα αποφάσεων, την «Gradient Boosting», για την ταξινόμηση του πλήθους των ασφαλιστικών απαιτήσεων που προκαλούνται από καταιγίδες στην Ελλάδα και μια νέα κατηγορία μοντέλων σύνθετων κατανομών συχνότητας για την από κοινού μοντελοποίηση της συχνότητας των ασφαλιστικών αποζημιώσεων και του πλήθους των ακραίων μετεωρολογικών φαινομένων. Τα προτεινόμενα μοντέλα καταδεικνύουν την από κοινού κατανομή του πλήθους των μετεωρολογικών συμβάντων και των ασφαλιστικών αποζημιώσεων περιλαμβάνοντας γεωχωρικές μεταβλητές για την αξιολόγηση των επιπτώσεών τους στη συχνότητα εμφάνισης των συμβάντων και των σχετικών ασφαλιστικών απαιτήσεων. Τέλος, προτείνεται μια μεθοδολογική προσέγγιση στον υπολογισμό Κεφαλαιακών Απαιτήσεων Φερεγγυότητας στα πλαίσια των ιδιαιτεροτήτων σχετικά με τα χαρτοφυλάκια ασφαλιστικών εταιρειών, των κινδύνων και των μετεωρολογικών χαρακτηριστικών στην Ελλάδα.
Denaturing and dNTPs reagents improve SARS-CoV-2 detection via single and multiplex RT-qPCR
Authors: Cadena-Caballero Cristian E. , Vera-Cala Lina M. , Barrios-Hernandez Carlos , Rueda-Plata Diego , Forero-Buitrago Lizeth J. , Torres-Jimenez Carolina S. , Lizarazo-Gutierrez Erika , Agudelo-Rodriguez Mayra , Martinez-Perez Francisco
Published: March 2024

Background The COVID-19 pandemic, caused by the SARS-CoV-2, can be effectively managed with diagnostic tools such as RT-qPCR. However, it can produce false-negative results due to viral mutations and RNA secondary structures from the target gene sequence. Methods With High Performance Computing, the complete SARS-CoV-2 genome was obtained from the GenBank/GISAID to generate consensus sequences to design primers/probes for RT-qPCR. ORF8 gene was selected, meanwhile, E and N and RNAse P were according to CDC protocol. Nasopharyngeal swab samples were collected from patients diagnosed with SARS-CoV-2. Total RNA was purified according MagMAX kit, it was used in single, and multiplex RT-qPCR. To avoid templated secondary structures, compensate nucleotide proportions and improve Ct values, a solution composed of tetraethylammonium chloride and dimethyl sulfoxide and other with corresponding to dNTPs proportions in accordance SARS-CoV-2 genome were included. Sensitivity and specificity according to Ct values were determined with the Caret package in R software. Results 126,576 SARS-CoV-2 genomes from January to December 2020 comprised a database. From this, a region near of 5′ ORF8 gene showed three stem-loops was used for primers/FAM-probe. 49 samples were obtained, from them, 22 were positive to gene selected regions. Interestingly, samples from October to November 2020 were positive for all regions, however, in January 2021 different results were observed in ORF8. An improvement in Ct with the adjuvant solutions was determined in all samples with others SARS-CoV-2 primers/probes, for both single and multiplex RT-qPCR. The inclusion of the denaturing solution in single RT-qPCR increased its sensitivity with respect to the commercial method, while in multiplex the opposite was generated. Conclusions Including adjuvant solutions to prevent the formation of RNA secondary structures and the adjustment of the nucleotide ratios of SARS-CoV-2 improved single and multiplex RT-qPCR for viral identification, demonstrating its potential application in health public.
Graph neural network-based anomaly detection for river network systems
Authors: Buchhorn Katie , Santos-Fernandez Edgar , Mengersen Kerrie , Salomone Robert
Published: March 2024

Background Water is the lifeblood of river networks, and its quality plays a crucial role in sustaining both aquatic ecosystems and human societies. Real-time monitoring of water quality is increasingly reliant on in-situ sensor technology. Anomaly detection is crucial for identifying erroneous patterns in sensor data, but can be a challenging task due to the complexity and variability of the data, even under typical conditions. This paper presents a solution to the challenging task of anomaly detection for river network sensor data, which is essential for accurate and continuous monitoring. Methods We use a graph neural network model, the recently proposed Graph Deviation Network (GDN), which employs graph attention-based forecasting to capture the complex spatio-temporal relationships between sensors. We propose an alternate anomaly threshold criteria for the model, GDN+, based on the learned graph. To evaluate the model’s efficacy, we introduce new benchmarking simulation experiments with highly-sophisticated dependency structures and subsequence anomalies of various types. We also introduce software called gnnad. Results We further examine the strengths and weaknesses of this baseline approach, GDN, in comparison to other benchmarking methods on complex real-world river network data. Conclusions Findings suggest that GDN+ outperforms the baseline approach in high-dimensional data, while also providing improved interpretability.
Radiographic assessment of dental post and core placement at different educational levels in an undergraduate student clinic: a 4-year retrospective study
Authors: Alshehri Turki , Aly Nourhan M. , Altayyar Raand , Alghamdi Deena , Alotaibi Shahad , Ellakany Passent
Published: March 2024

Background Dental post and core is one of the common procedures performed after endodontic treatment. The aim of this study was to radiographically assess the quality of post and core procedures performed by dental students at different education levels in addition to determining the most critical errors encountered during their clinical practice. Methods A retrospective cross-sectional study design was conducted in the College of Dentistry, Imam Abdulrahman Bin Faisal University. A total of 550 periapical radiographs (PAs) of cemented posts were retrieved from the records of patients treated by dental students. Parameters and guidelines for assessing the quality of post treatment have been determined and statistically analyzed. A P value <0.05 was considered statistically significant. Results The study included 502 students and most of them were females (66.5%). Data were obtained from 502 patients (62% females) with fiber posts used in 98.2% of the cases. About 50% of the posts were inserted in premolars, 62.9% in the upper arch, and 66.7% were restored with crowns as a final restoration. Regarding the quality of posts, 98.4% showed good preparation quality and 98% showed good radiographic quality. The post diameter was equal to 1/3 of the root diameter in 31.9% of the cases; post length was equal to 2/3 of root length in 5% of the cases and equal to or more than crown height in all cases (100%). Length of the remaining gutta percha (GP) was between 3–5 mm in 38.8%, and there was no gap between the post and remaining GP in 95.6% of the cases. There were no statistically significant differences between dental students at different clinical educational levels regarding the quality of post placement. Conclusions The quality of post and core procedures performed by students showed acceptable radiographic quality and were within the recommended standards.
Assessment of dental morbidity in school-going children (6–10-year-old): A cross-sectional study
Authors: Shende Vaibhavi , Wagh Vasant
Published: March 2024

Background Restricted activity days are prevalent in children with oral health problems. Oral health issues cause over 50 billion hours of education to be lost each year, which has an impact on children’s school performance and the potential for success. Mostly it is concluded that dental caries is the most common disease among individuals. In addition, it may create chronic systemic conditions in healthy individuals. In children, it may induce deformities in the growth of the unerupted teeth. This study will help identify the factors and causes of risk factors for morbidities associated with dental problems. It also includes the educational status and socioeconomic condition of their parents, which is conducted in the Wardha district of Maharashtra in the field practice of villages among children. Aim To Assess dental morbidity among schoolchildren in rural areas and their relationship with their socioeconomic status in rural areas of Wardha District. Methodology A questionnaire-based face-to-face interview was conducted in this community-based cross-sectional study to assess dental morbidity in school-going children. The study participants will be children aged 6–10 years in the rural areas of the Wardha district. The variables of this study were the sociodemographic profile, habits, and morbidities of the children.