bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracellular vesicles in ageing cold‐stored whole blood may not compensate for the decreasing haemostatic function in vitro
Authors: Ilvonen Petra , Susila Sanna , Impola Ulla , Pusa Reetta , Helin Tuukka , Joutsi‐Korhonen Lotta , Laitinen Saara , Lauronen Jouni , Ilmakunnas Minna
Published: January 2025

Background

Extracellular vesicles (EVs) have procoagulative properties. As EVs are known to accumulate in stored blood products, we compared the EV content and coagulation capacity of leukoreduced cold‐stored whole blood (CSWB) with current prehospital and in‐hospital component therapies to understand the role of EVs in the haemostatic capacity of ageing CSWB.

Materials and Methods

Blood was obtained from 12 O RhD‐positive male donors. CSWB was compared with in‐hospital component therapy of red blood cells (RBCs), OctaplasLG and buffy‐coat platelets and prehospital component therapy of RBC and lyophilized plasma. Samples were drawn on Days 1 and 14 of CSWB and RBC cold storage. Blood count, haemolysis markers, rotational thromboelastometry, sonorheometry and thrombin generation were analysed. EVs were analysed using nanoparticle tracking analysis and cellular origin was determined using imaging flow cytometry.

Results

There was a trend towards increased production of both platelet and RBC‐derived EVs during CSWB storage. Particle count increased during storage, whereas thrombin generation slowed down and in viscoelastic assays, clotting times prolonged, clot formation became impaired, and stiffness of the resulting clot decreased.

Conclusion

Both platelet and RBC‐derived EVs increased in number in CSWB during storage. This did not appear to compensate for the in vitro decreasing haemostatic capacity of ageing CSWB, suggesting EVs produced during storage may not have active procoagulative effects, but rather reflect the ageing of blood cells.
Alloanti‐Hy in antenatal patients: A multi‐case review
Authors: Lewis S. , Kirkpatrick N. , Nawrocki A. , Reyland L. , Jones B. , Laundy R. , McNeil A. , Crew V. Karamatic , Stutt T. , Clinton D. , Anbazhagan A. , Harris C. , Skidmore I. , Bullock T. , Hazell M.
Published: January 2025

Introduction

Introduction The Hy antigen is one of ten red cell antigens belonging to the Dombrock blood group system, with an antigen frequency of almost 100% in the majority of populations. Alloantibodies to high prevalence antigens cause difficulties with antibody identification and exclusion in serological investigations.

Case Presentation

This review describes the management of four antenatal cases where the presence of alloanti‐Hy had been identified. Hy‐red blood cell units may be required for the transfusion of patients with alloanti‐Hy, but currently, there are no published reports of alloanti‐Hy causing haemolytic disease of the fetus and newborn (HDFN). A previous case report involving the care and management of antenatal patients with alloanti‐Hy antibodies indicates a lack of evidence that alloanti‐Hy causes clinical HDFN.

Results

All cases discussed in this review demonstrate a reduction in the strength of alloanti‐Hy levels as pregnancy progressed. Signs or symptoms of HDFN were not observed with any of the pregnancies.

Conclusion

Factors such as antibody levels, antigenic expression, and varying clinical responses enhance our understanding of why alloanti‐Hy has not been known to cause clinical HDFN. The cases presented here aim to improve understanding of alloanti‐Hy in pregnancy and how to manage such cases.
Comparison of conventional coagulation tests and ROTEM in identifying trauma‐induced coagulopathy for massive haemorrhage protocol activation
Authors: Hutspardol Sakara , Borja Tyrone , Kroeker Jenna , Wang Xiu Qing , Mi Jian , Zamar David , Chan Geoffrey , Smith Tyler , Hawes Harvey , Shih Andrew W.
Published: January 2025

Objectives

Trauma‐induced coagulopathy (TIC) can be fatal but preventable if recognised early. With emerging uses of rotational thromboelastometry (ROTEM) to guide transfusions in trauma, patient outcomes with TIC‐defined by initial ROTEM and conventional coagulation tests (CCTs) during massive haemorrhage protocol (MHP) activations were evaluated at a primary trauma centre in British Columbia.

Methods

This retrospective observational study included adult trauma patients requiring MHP from June 1, 2020, to May 31, 2022. TIC, defined by initial results including (1) ROTEM‐based EXTEM A10 <40 mm, EXTEM CT >100 s, EXTEM ML30 >10%, FIBTEM A10 <10 mm; and (2) CCT‐based INR ≥1.8, PTT ≥1.5 times of upper normal limit, platelets <50 x 109/L, and Clauss Fibrinogen <1.5 g/L, was assessed for its correlation with mortality. Modified Poisson regression was used to model 28‐day mortality.

Results

Twenty‐two of sixty‐eight patients (32%) had abnormal ROTEM but normal CCTs. TIC defined by CCTs was associated with increased mortality [24 h: 5/13 (38%) vs. 5/55 (9%), p = 0.025; 28d: 8/13 (62%) vs. 11/55 (20%), p = 0.002]; compared to ROTEM, which was not [24 h: 7/35 (20%) vs. 3/33 (9%), p = 0.307; 28d: 11/35 (31%) vs. 9/33 (27%), p = 0.594], despite requiring significantly higher blood component transfusion within the first 4 and 24 h of MHP (p‐values<0.05).

Conclusions

ROTEM is more sensitive in identifying TIC. Patients with abnormal CCTs had a higher death rate, and those with abnormal ROTEM had no significantly increased mortality. A prospective study is required to assess the effects of ROTEM further.
An international survey of patient blood management practices
Authors: Gammon Richard , Jindal Aikaj , Dubey Rounak , Shipp Cathy , Tayal Amit , Rajbhandary Srijana , Bocquet Christopher
Published: January 2025

Background

The Association for the Advancement of Blood and Biotherapies (AABB) conducted a global survey of patient blood management (PBM) practices. It determined changes in PBM practices since the last survey.

Study Design and Methods

A working group of AABB's PBM Subsection and AABB staff designed the survey using the Qualtrics™ platform. The survey collected data from January 1, 2021, through December 31, 2021, and data analysis was conducted.

Results

Responses were received from 274 facilities across five World Health Organization (WHO) regions, from which 205 (74.8%) were from North America (NA), and 25.2% (69/274) were from outside of NA or the rest of the world (RoW). Of all respondents, 46.0% (126/274) had a PBM program. NA at 50.2% (103/205) was significantly higher than RoW at 33.3% (23/69) (p = .0049). In NA AABB transfusion guidelines, 36.8% (179/486) were the most followed versus RoW, with the Ministry of Health at 23.2% (29/125). The hemoglobin transfusion threshold of ≤7.0 g/dL (inpatients and outpatients) and platelet transfusion threshold of 5000/μL −10,000/μL (prophylaxis for inpatients and outpatients) were most commonly followed. Areas of improvement since the last AABB 2013 survey included providing PBM training increased to 61.7% (103/167) from 36.5% (219/600) and evaluation of patients undergoing elective surgical procedures for factors predictive of anemia to 46.0% (125/272) from 28% (144/507).

Conclusions

While gains have been made in certain areas of PBM, there remains room for improvement, as more than half of respondents did not have a PBM program.
A Case of Prostatic Lymphoma in a Dog with Symptoms of a Uroperitoneum Evaluated with Ultrasonography and Fluoroscopy
Authors: Seshadri Ashika , Thevelein Britt , Huber Brian Thomas , Perlini Michael
Published: January 2025

A 10‐year‐old neutered male Labrador mix dog presented with a few‐day history of stranguria and dysuria. Results of physical examination, laboratory findings, and imaging were consistent with a uroperitoneum and prostatomegaly. Ultrasound showed an enlarged, heterogeneous, and lobular prostate with mineralization, and fluoroscopy showed extravasation of contrast from the prostatic urethra through the prostatic parenchyma into the abdomen. The dog was diagnosed with prostatic lymphoma via cytology and ultimately euthanized. This is the first report of prostatic lymphoma with a concurrent uroperitoneum due to urine leakage from the prostatic urethra through the prostatic parenchyma and capsule into the abdomen.
Implementation of Conventional and Smart Weed Management Strategies in Sustainable Agricultural Production
Authors: Xuan Tran Dang , Khanh Tran Dang , Minh Tran Thi Ngoc
Published: January 2025

Conventional weed management is known for the use of selective herbicides, tackling issues of herbicide‐resistant weeds, and endeavors to reduce reliance on herbicides, such as employing biological control of weeds and incorporating allelopathy. These strategies are integrated with traditional and other conventional weed management techniques. New challenges in agricultural production, such as declining population involved in agriculture, global warming, and climate changes make conventional weed management inadequate. Rapid advancements over the past decade in artificial intelligence (AI), unmanned aerial vehicles (UAVs), cameras, and sensors, necessitate the development and implementation of smart weed management (SWM) approaches for the 21st century. Wise weed management practices can control weeds and reduce emissions of methane (CH4), carbon dioxide (CO2), and nitrogen dioxide (NO2). Minimizing the use of herbicides in tandem with the application of smart technologies, like weed mapping and identifying spatial variability of weeds using proximal and remote sensors, multispectral and RGB cameras, can effectively manage weeds while also reducing labor costs. The SWM strategies also encompass the integrated use of organic herbicides, bioherbicidal products, and the judicious application of both organic fertilizers and inorganic fertilizers for weed management. Some approaches, such as alternate wetting and drying (AWD), can contribute to both SWM and carbon credits to farmers. The utilization of computing power, weed control robotics, and big data, combined with the education of the next generation of weed scientists and efforts to shift growers' attitudes and behaviors in weed management, may vary among countries. It requires active collaboration between agricultural extensionists and policymakers.
DETECTION OF LOW VOLTAGE ARC SERIES FAULT AND ITS SEVERITY LEVEL USING FAST FOURIER TRANSFOR METHOD
Authors: Afif Yusrizal , Delfianti Rezi , Putra Widyatma Anton , Eka Prahesti Fidya
Published: January 2025

A short circuit is an electrical fault that occurs due to two conductors in contact, which causes the resistance to be minimal, resulting in a substantial electric current. There are cases of interference that cannot be avoided. This disorder is called the arc of fire series. If the arc of fire continues continuously, heat will arise, which can damage the equipment, and fire will occur. In this study, arc series detection will be carried out at low voltage against the influence of nonlinear loads on detection performance. The data retrieval method is divided into three conditions so the detection device can distinguish interference: normal conditions, switching, and arc fire. The three condition current reading is carried out by the current transformer and read by the arc detection device. The arc detection tool processes the signal obtained from the current transformer and converts the analog signal into a digital signal. Then, an analysis is carried out using the Fast Fourier Transform method. This tool consists of rectifiers, signal conditioners, an STM32 microcontroller, and a 16 x 2 LCD. The output of this final is to create an arc detection device that can detect 100% the presence of a series of arc faults in low-voltage equipment in normal and arc fire conditions.
PARAMETRIC STUDY OF WEB-POST BUCKLING FAILURE ON PROTECTED COMPOSITE CELLULAR STEEL BEAM (CSB) AT ELEVATED TEMPERATURE
Authors: Krishnamoorthy Renga Rao , Ahmad Zakwan Fariz Aswan , Ismail Ruqayyah , Ibrahim Azmi
Published: January 2025

Cellular Steel Beam (CSB) are Widely recognized and used in steel structures due to their numerous benefits, including visually appealing design, flexible structural elements, exceptional structural integrity, and the ability to incorporate utility conduits within the web beam section. These beams are often integrated into construction systems, often requiring the alteration of solid steel beams through the introduction of web holes to preserve their structural integrity. This study investigates the various forms of CSB failure that may arise from the insertion of circular web holes. High temperatures are a significant environmental factor that significantly impacts the performance of CSB, with failure modes associated with elevated temperatures including Vierendeel bending, web-post buckling, and vertical deformation. The study uses extensive finite element simulations with the ABAQUS program to numerically simulate and investigate the performance of shielded CSB with web apertures under increased temperature conditions and applied stresses. The study presents a novel methodology involving the use of intumescent coatings with different thicknesses to provide complete coverage of the CSB, aiming to improve the stiffness of the beam when exposed to high temperatures. The simulation findings show that the use of thicker intumescent coatings leads to marginal enhancements in the reduction of vertical deformation and web-post buckling. These findings are of practical significance for professionals in structural engineering and architecture involved in designing and evaluating structures based on composite steel and concrete materials in fire-prone areas, contributing to the advancement of resilient structural engineering.
THE PHITS SIMULATION STUDY FOR AN ALTERNATIVE PRODUCTION OF ³²P RADIOISOTOPE BY SECONDARY NEUTRON BOMBARDMENT OF ³²S TARGET
Authors: Suharni Suharni , Prabaningrum Nunung , Kambali Imam
Published: January 2025

Different methods of phosphorous-32 (32P) radioisotope production have been of great interest over the past few years due to the wide range of 32P applications in agriculture, health, and the environment. In this present study, using the PHITS simulation, 32P radioisotope was theoretically produced by bombarding a natural sulfur target with secondary neutrons generated from 13, 18, and 30 MeV proton irradiation of Ti targets with thicknesses of 0.7, 1.2, and 3.0 mm, respectively. The calculated results showed that secondary neutron flux ranging from 1.78x1012 to 9.46x1012 n/cm2s was generated from titanium-bombarded protons, which resulted in the 32P radioactivity yields of 0.200, 0.840, and 3.167 MBq/μAh for proton energies of 13, 18, and 30 MeV, respectively. For 13 MeV protons, no radioactive impurity was generated during the bombardment, while radioactive impurities such as 31Si, 30P, 28Al, and 31S were produced from 30 MeV proton bombardment. The 32P radioactivity yield s and the radioactive impurity yields increase further when the 32S target is increased to 10 grams.
A REVIEW OF THE QUALITIES AND UTILIZATION OF WASTE MATERIALS IN WARM MIX ASPHALT CONCRETE
Authors: Babangida Attahiru Yusuf , Mohamed Azman , AH Norhidayah , Mohd Ramli Raimi , Ibrahim Abubakar , Dangoma Umar Kabiru , Yahaya Sanda Bashir , Allami Jabir
Published: January 2025

The amount of unwanted waste produced in recent decades has quickly increased due to rapid population growth, technological advancements, and the widespread use of state-of-the-art products and services in the industry. Different researchers have carried out extensive studies on waste materials. Regretfully, most investigations focus only on the performance of HMA concrete that has been modified using one or two types of waste. Therefore, this study investigates an extensive review of the qualities and utilization of four types of wastes, viz., Coal Bottom Ash (CBA), Waste Cooking Oil (WCO), Waste Engine Oil (WEO), and Rice Husk Ash (RHA), as well as assessing their bibliometric analyses. The wastes that were being investigated showed a notable improvement in Warm Mix Asphalt (WMA) concrete. The WMA technology has successfully reduced the environmental issues of high production and compaction temperatures. The previous publications on CBA, WCO, WEO, and RHA identified 3,914 published documents between 2009 and 2023. Only 32 of these documents were published by Scopus. The academic disciplines of engineering, materials science, environmental sciences, and others have contributed 37%, 29%, 19%, and 15%, respectively, to Scopus publication. The United Kingdom made a significant contribution of 50% to Scopus publication compared to other countries. Furthermore, the findings also revealed that 89.4% (29 documents) were technical articles and only 10.6% (3 documents) were review articles. Further review of the rheological and microscopic properties of the four wastes is needed.
RELATIONSHIP BETWEEN CONVENTIONAL SINGLE LEG STANCE BALANCE ASSESSMENT AND SENSOR-BASED TEST USING ELECTRONIC WOBBLE BOARD
Authors: Hanim Nuria , Su Lee Ming Eileen , Khor Yvonne Y. W. , Khor Kang Xiang , Abdullah Muhammad Najib , Tajwar Fahim , Yeong Che Fai , Holderbaum William
Published: January 2025

Assessing balance is essential for determining the likelihood of falling, particularly in older populations and rehabilitative situations. Traditional methods of assessing balance, such as the single leg stance, have been shown to be beneficial. However, these methods do not give the same level of information as more modern instruments. This study examines the accuracy and reliability of a sensor-based balance evaluation tool known as the Fitness Balance Board (FIBOD). FIBOD is a unique instrument that is used for both balance training and correct assessment, besides existing balance evaluation methods. While conducting the study, individuals with good health were recruited and a series of trials were conducted under different ‘test and trial’ settings to assess the efficacy of SLS in comparison to FIBOD. The Overall Stability Index (OSI) of FIBOD has a mean value of 3.66±2.54, which suggests that it is highly sensitivity. The Medio-Lateral Stability Index (MLSI) and Anterior-Posterior Stability Index (APSI) had average values of 2.71±2.32 and 2.21±1.53, respectively. In addition, the angular velocity of the sway was measured at 3.60±2.89 degrees per second. The Pearson correlation coefficient of -0.814 between OSI and SLS in closed-eye situation indicates a significant and substantial negative association. The confidence interval ranging from -0.922 to -0.589 demonstrated a strong connection.
NUMERICAL INVESTIGATION ON THE EFFECTS OF TBM FACE SUPPORT PRESSURES–A PARAMETRIC STUDY
Authors: Chee-Min Khoo
Published: January 2025

Shield tunnelling operations, particularly those employing pressurized face tunnel boring machines (TBMs) such as earth pressure balance and slurry shields, are complex processes influenced by various driving parameters. Among these parameters, face support pressure plays a critical role in controlling ground and pile responses induced by tunnelling. This paper presents a numerical investigation on the effects of TBM face support pressures through a parametric study. Using data obtained from full-scale field research and through a validated numerical framework, this study aims to investigate how variations in TBM face support pressures affect pile responses and ground settlement during tunnelling operations. The findings emphasize the necessity of maintaining adequate face support pressures to mitigate excessive ground settlement and pile deformations. Notably, an optimum face support pressure range between 0.8 to 1.1 times the overburden pressure was identified, associated with minimal pile responses and ground settlement. These insights provide valuable guidance for optimizing face support pressure management strategies in shield tunnelling projects.
EXPERIMENTAL STUDY ON NOTCH SHAPE AND LIQUID CARBONITRIDING SPECIMENS UNDER BENDING LOADING
Authors: H. Nasser Sajjad , Shakir Dumoaa Haider
Published: January 2025

The current work includes studying the effect of heat treatment using liquid carbon nitriding technology on steel notched (Mechanical testing is part of the process; include tests for surface microhardness, fatigue before and after treatment,tensile testing  and chemical analysis of the material. Before treatments, fatigue testing was done on the notched specimens at room temperature under full reverse bending stress. Obusirved that V-notching the specimen reduced strength and fatigue life of steel. The results showed that heat treatments significantly increased strength and fatigue life; in comparison to untreated samples, heat treatments increased fatigue life by 12.5% and 20%, respectively. Finding that the carbonitriding method of hardening produced a surface hardness of 868.71HV, which was 73% higher than the non-hardened samples.The fatigue strength increased to 338.55 MPa and 455.56 MPa at 30° and 90 °, respectively, at the highest temperature due to saturation of the surface with carbon and nitrogen atoms.
Supplemental Material: Postcaldera intrusive magmatism at the Platoro caldera complex, Southern Rocky Mountain volcanic field, Colorado, USA
Authors: Gilmer A.K. , al. et
Published: January 2025

Table S1: Whole-rock compositions of analyzed samples. Table S2: Major and trace element geochemistry of feldspar. Table S3: Major and trace element geochemistry of pyroxene. Table S4: Major and trace element geochemistry of biotite. Table S5: Major and trace element geochemistry of amphibole. Table S6: Zircon geochronology and trace element geochemistry. Table S7: Lutetium and hafnium isotopic compositions of zircon. Table S8: Amphibole-plagioclase thermometry. Table S9: Sample locations and lithologies.
How do socioeconomic inequalities and preterm birth interact to modify health and education outcomes? A narrative systematic review
Authors: McHale Philip , Fahy Katie , Pennington Andy , Schlüter Daniela K , Barr Ben , Taylor-Robinson David
Published: January 2025

Objectives

How are socioeconomic inequalities modified by, or how do they interact with, preterm birth?

Design

Narrative systematic review of quantitative observational studies of an interaction, or effect modification, between preterm birth and socioeconomic status.

Data sources

Five databases were searched for studies published between January 2000 and June 2020. Title and abstract were reviewed to identify articles for dual screening. All included studies were citation searched.

Eligibility criteria

Inclusion criteria were comparison across socioeconomic status and gestational age, interaction between the two, or stratification by either, and health or education as outcome.

Data extraction and synthesis

Data extracted included study design, sample size, outcome, interaction measure, effect and significance. Included studies were assessed for methodological quality and synthesised narratively.

Results

After searches, 52 studies were identified for full-text screening and, with supplementary citation searches, we identified 21 included studies. Eighteen studies studied interaction between gestational age or preterm birth, and socioeconomic status. Three groups of outcomes were identified: cognitive, mental health and developmental. Age at outcome measurement was divided into four categories: preschool, primary school (5–11), secondary school (11–18) and post school (18–29). Seven studies found a significant interaction between the effect of preterm birth and socioeconomic status. Six of these interactions demonstrate that the negative influence of low socioeconomic status was stronger for those born preterm (and vice versa) for cognitive and mental health outcomes, all in studies with a sample size of more than 100 000. One study found that negative effects of low socioeconomic status were reduced for those born preterm (and vice versa) for communication delay.

Conclusions

Our findings suggest that the impact of low socioeconomic status on cognitive and mental health outcomes is exacerbated by preterm birth. The remaining evidence suggests the effects are not modified; however, this is potentially due to underpowered studies. Public health action is indicated to support babies born preterm, particularly for disadvantaged families, to improve educational attainment and mental health.

PROSPERO registration number

CRD42020203613.
Protocol for a systematic review and individual participant data meta-analysis for risk factors for lung cancer in individuals with lung nodules identified by low-dose CT screening
Authors: Alexandris Panos , Quaife Samantha , Berg Christine D , Callister Matthew , Crosbie Philip AJ , Davies Michael PA , de Koning Harry J , Field John K , Hammer Mark M , Horst Carolyn , Janes Sam , Nair Arjun , Rintoul Robert C , Gabe Rhian , Duffy Stephen
Published: January 2025

Background

Worldwide, lung cancer (LC) is the second most frequent cancer and the leading cause of cancer related mortality. Low-dose CT (LDCT) screening reduced LC mortality by 20–24% in randomised trials of high-risk populations. A significant proportion of those screened have nodules detected that are found to be benign. Consequently, many individuals receive extra imaging and/or unnecessary procedures, which can have a negative physical and psychological impact, as well as placing a financial burden on health systems. Therefore, there is a need to identify individuals who need no interval CT between screening rounds.

Methods and analysis

The aim of this study is to identify risk factors predictive of LC, which are known at the time of the scan, in patients with LDCT screen-detected lung nodules. The MEDLINE and EMBASE databases will be searched and articles that are on cohorts or mention cohorts of screenees with nodules will be identified. A data extraction framework will ensure consistent extraction across studies. Individual participant data (IPD) will be collected to perform a one-stage IPD meta-analysis using hierarchical univariate models. Clustering will be accounted for by having separate intercept terms for each cohort. Where IPD is not available, the effects of risk factors will be extracted from publications, if possible. Effects from IPD cohorts and aggregate data will be reported and compared. The PROBAST (Prediction model Risk Of Bias ASsessment Tool) will be used for assessment of quality of the studies.

Ethics and dissemination

Ethical approval was not required as this study is a secondary analysis. The results will be disseminated through publication in peer-reviewed journals and presentations at relevant conferences.

PROSPERO registration number

CRD42022309515
Path analysis of factors influencing length of stay and hospitalisation expenses for oral cancer patients in tertiary hospitals in southeastern China: a cross-sectional study
Authors: Fan Yi , Yang Qiujiao , Chen Chen , Hu Xiaoying , Xu Mingming , Weng Yanfeng , Li Yanni , Wang Yaping , Lin Lisong , Qiu Yu , Wang Jing , Chen Fa , He Baochang , Liu Fengqiong
Published: January 2025

Aims

To investigate the associations between influencing factors with length of stay (LOS) and hospitalisation expenses in oral cancer (OC) patients, and to explore the potential pathways through which these factors influence hospitalisation expenses using path analysis.

Design

Cross-sectional.

Setting

A comprehensive tertiary hospital in southeastern China.

Participants

A total of 810 patients with histologically confirmed primary OC admitted to the First Affiliated Hospital of Fujian Medical University, Fujian Province, between 2015 and 2020.

Main outcome measures

LOS and hospitalisation expenses for OC patients.

Results

The median hospitalisation expenses and LOS for OC patients in southeastern China were substantial, amounting to $6330 and 29 days, respectively. Treatment and surgery fees constituted the largest proportion of total expenses (28.59%), followed by inspection and laboratory test fees (20.63%), comprehensive medical service fees (19.27%), drug fees (18.09%) and medical consumables fees (11.69%). LOS was significantly associated with tumour site, surgery and chemotherapy. Factors such as longer LOS, poor oral hygiene, advanced tumour stage (II–IV), larger tumour size (>2 cm3), surgery and bilateral neck dissection were strongly linked to higher hospitalisation expenses. Path analysis revealed that neck dissection had the highest total effect on hospitalisation expenses (β=0.307), while surgery exerted an indirect effect on expenses via LOS (β=0.021).

Conclusion

This study highlights the significant economic burden imposed by OC on patients and healthcare systems. While prevention and early diagnosis remain critical, our findings underscore several modifiable factors, including improving oral hygiene and optimising surgical protocols, such as chemotherapy and lymph node dissection, that present opportunities to reduce costs and enhance cost-effectiveness. These insights provide actionable targets for mitigating financial burdens and improving patient outcomes.
Exploratory study of patients’ and carers’ preferences for postdischarge surgical wound monitoring using survey and interviews
Authors: Tanner Judith , Brierley Jones Lyn , Westwood Nigel , Rochon Melissa , Wloch Catherine , Rogers Luke J , Vaja Ricky , Dearling Jeremy , Wilson Keith , Harrington Pauline , Brown Colin S , Murphy Gavin
Published: January 2025

Objectives

To explore patients’ and carers’ preferences for postdischarge surgical wound monitoring.

Design

Explanatory mixed methods study with an online survey followed by online interviews.

Setting

The online survey was distributed via the Cardiothoracic Interdisciplinary Research Network and cardiac surgery patient and public involvement groups in London and Leicester, UK. Participants were invited to share the survey link with other patients and carers. Interviewees were recruited through the survey.

Participants

Seventy participants completed the survey: 74% patients and 26% carers. A range of ages, sex, ethnicities and geographical locations were represented. Six survey patient participants volunteered to be interviewed.

Findings

Themes identified were the impact on patients of having a surgical site infection, patients’ preferences for postdischarge surgical wound follow-up, access to specialist support, wound monitoring using digital technology and receiving information from the hospital about wounds and wound care. Interviewees described feeling isolated after discharge from hospital and 10% of survey patient respondents, including four of the six interviewees, reported hospital readmissions. Survey respondents’ preferred routes for providing hospitals with wound information were over the telephone (30%), emails (24%), text messages (16%) and photos sent securely (14%). All six interviewees’ preference was for digital approaches using images. Survey respondents were least likely (50%) to reply to questionnaires that required software to be downloaded and installed. Interviewees considered digital wound monitoring to be convenient and the best use of patient and staff resources. A new theme was identified where patients wanted to become more involved in treating their surgical wounds at home.

Conclusion

Experiences described by participants suggests there is a need to improve post-discharge wound monitoring. A new approach should be proactive, ongoing and provide easy access to healthcare services. Digital surgical wound monitoring offers these benefits and is acceptable to patients.

Trial registration number

ISRCTN13950775; Post-results.
How can cervical screening meet the needs of vulnerable women? A qualitative comparative study with stakeholder perspectives from seven European countries
Authors: Bøje Rikke Buus , Bardou Marc , Mensah Keitly , Rico Berrocal Raquel , Bonvicini Laura , Iorio Giusy , Auzzi Noemi , Taut Diana , Pașca Nicoleta-Monica , Tisler Anna , Reintamm Kerli , Uusküla Anneli , Teixeira Margarida , Firmino-Machado João , Amorim Mariana , Baia Ines , Lunet Nuno , Panayotova Yulia , Kotzeva Tatyana , Todorova Irina , Andersen Berit , Kirkegaard Pia
Published: January 2025

Objective

This study explored and compared stakeholder perspectives on enhancements to cervical cancer screening for vulnerable women across seven European countries.

Design

In a series of Collaborative User Boards, stakeholders were invited to collaborate on identifying facilitators to improve cervical cancer screening.

Setting

This study was part of the CBIG-SCREEN project which is funded by the European Union and targets disparities in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania.

Participants

Represented stakeholders at various levels, including user representatives (vulnerable women), healthcare professionals, social workers, programme managers and decision makers.

Methods

14 meetings lasting 2 hours each were held in these seven countries between October 2021 and June 2022. The meetings were audio or video recorded, transcribed and translated into English for qualitative framework analysis.

Results

We engaged 120 participants in the Collaborative User Boards. Proposed solutions targeted both provider and system levels. In all countries, fostering trusting relationships between vulnerable women and social or healthcare professionals, coupled with community outreach for awareness and access to testing was a consistent recommendation. Participants in Estonia, Denmark, France, Italy, Portugal and Romania advocated for tailoring healthcare services to meet the unique needs of vulnerable populations through a holistic approach. In Bulgaria and Romania, participants advocated for the need to secure free access, from screening to follow-up, and emphasised the need for organised screening with target population screening registries.

Conclusion

The study offers insights into stakeholders' recommendations for enhancing cervical cancer screening services for vulnerable women across seven European countries. Despite variations in the implementation level of population-based screening programmes, the imperative to optimise outreach and proximity work to improve cervical cancer screening resonated across all countries.
Medication adherence and needs among patients with schizophrenia in China: a qualitative study
Authors: Li Xuping , Xiao Shuiyuan , Sun Yajun , Zheng Ying , Huang Jiaju , Wei Ning , Mao Chun , Zhang Shengjun , Teng Yongyong
Published: January 2025

Objectives

To explore the factors influencing medication adherence and the medication needs of patients with schizophrenia when living in a community in China.

Design

A qualitative study.

Setting

Community and psychiatric ward in Zhuhai city, Guangdong province.

Participants

Patients with schizophrenia and (or) their primary caregivers.

Primary and secondary outcome measures

Facilitators and barriers of medication adherence and the medication needs.

Results

A total of 20 patients with schizophrenia and 12 primary caregivers participated in the study. Based on the Health Ecology Model, the analysis identified four levels of factors influencing medication adherence, categorised as individual (facilitators: effective treatment, positive expectation, establishing a routine and assistive tools; barriers: side effects, inadequate knowledge, forgetfulness and irregular daily schedule), interpersonal (facilitators: caregiver assistance and psychiatrist’s recommendation; barriers: lack of social support), community (facilitators: community mental health services and reducing medication use frequency; barriers: limited medication accessibility and affordability) and policy and culture related (facilitators: collectivist culture and social security policy; barriers: stigma). Additionally, five medication needs (managing side effects, applying for social security, improving medication accessibility, transitioning to long-acting injections and getting health education) were recognised.

Conclusions

These findings offer valuable insights for healthcare providers and policymakers, underscoring the need for targeted interventions to enhance medication adherence among patients with schizophrenia in China.
Predictors of response to low-dose amitriptyline for irritable bowel syndrome and efficacy and tolerability according to subtype: post hoc analyses from the ATLANTIS trial
Authors: Wright-Hughes Alexandra , Ow Pei-Loo , Alderson Sarah L , Ridd Matthew J , Foy Robbie , Bishop Felicity L , Chaddock Matthew , Fernandez Catherine , Guthrie Elspeth A , Muir Delia P , Taylor Christopher A , Farrin Amanda J , Everitt Hazel A , Ford Alexander C
Published: January 2025

Background

Low-dose amitriptyline, a tricyclic antidepressant (TCA), was superior to placebo for irritable bowel syndrome (IBS) in the AmitripTyline at Low-dose ANd Titrated for Irritable bowel syndrome as Second-line treatment (ATLANTIS) trial.

Objective

To perform post hoc analyses of ATLANTIS for predictors of response to, and tolerability of, a TCA.

Design

ATLANTIS randomised 463 adults with IBS to amitriptyline (232) or placebo (231). We examined the effect of baseline demographic and disease-related patient characteristics on response to amitriptyline and the effect of amitriptyline on individual symptoms and side effects by subtype.

Results

There was a quantitative difference in amitriptyline effectiveness in those ≥50 years vs <50 on the IBS severity scoring system (IBS-SSS) (interaction p=0.048, mean difference in ≥50 years subgroup −46.5; 95% CI −74.2 to −18.8, p=0.0010), and subjective global assessment of relief (interaction p=0.068, OR in ≥50 years subgroup 2.59; 95% CI 1.47 to 4.55, p=0.0010), and those in the 70% most deprived areas of England compared with the 30% least deprived for a ≥30% improvement in abdominal pain (interaction p=0.021, OR in 70% most deprived subgroup 2.70; 95% CI 1.52 to 4.77, p=0.0007). Stronger treatment effects were seen in men, with higher Patient Health Questionnaire-12 scores, and with IBS with diarrhoea. Mean differences in individual IBS-SSS components favoured amitriptyline, and side effects were similar, across almost all IBS subtypes.

Conclusion

These exploratory analyses demonstrate there are unlikely to be deleterious effects of amitriptyline in any particular IBS subtype and could help identify patients in whom amitriptyline may be more effective.

Trial registration number

ISRCTN48075063.
Assessing the performance of ChatGPT in medical ethical decision-making: a comparative study with USMLE-based scenarios
Authors: Khan Ali A , Khan Ali R , Munshi Saminah , Dandapani Hari , Jimale Mohamed , Bogni Franck M , Khawaja Hussain
Published: January 2025

Introduction

The integration of artificial intelligence (AI) into healthcare introduces innovative possibilities but raises ethical, legal and professional concerns. Assessing the performance of AI in core components of the United States Medical Licensing Examination (USMLE), such as communication skills, ethics, empathy and professionalism, is crucial. This study evaluates how well ChatGPT versions 3.5 and 4.0 handle complex medical scenarios using USMLE-Rx, AMBOSS and UWorld question banks, aiming to understand its ability to navigate patient interactions according to medical ethics and standards.

Methods

We compiled 273 questions from AMBOSS, USMLE-Rx and UWorld, focusing on communication, social sciences, healthcare policy and ethics. GPT-3.5 and GPT-4 were tasked with answering and justifying their choices in new chat sessions to minimise model interference. Responses were compared against question bank rationales and average student performance to evaluate AI effectiveness in medical ethical decision-making.

Results

GPT-3.5 answered 38.9% correctly in AMBOSS, 54.1% in USMLE-Rx and 57.4% in UWorld, with rationale accuracy rates of 83.3%, 90.0% and 87.0%, respectively. GPT-4 answered 75.9% correctly in AMBOSS, 64.9% in USMLE-Rx and 79.6% in UWorld, with rationale accuracy rates of 85.4%, 88.9%, and 98.8%, respectively. Both versions generally scored below average student performance, except GPT-4 in UWorld.

Conclusion

ChatGPT, particularly version 4.0, shows potential in navigating ethical and interpersonal medical scenarios. However, human reasoning currently surpasses AI in average performance. Continued development and training of AI systems can enhance proficiency in these critical healthcare aspects.
Submaximal versus aggressive angioplasty with drug-coated balloons for symptomatic intracranial arterial stenosis
Authors: Li Guangwen , Liu Yayue , Sun Xiaofei , Sun Yujie , Liu Peng , Zhang Xianjun , Anmu Xie , Zhang Yong
Published: January 2025

Background

Drug-coated balloons (DCB) can decrease the incidence of restenosis in the treatment of intracranial atherosclerotic stenosis (ICAS). This study aimed to assess the safety and efficacy of submaximal angioplasty with DCB dilation compared with aggressive angioplasty in patients with symptomatic ICAS.

Methods

This study prospectively and consecutively enrolled patients with symptomatic ICAS who underwent DCB angioplasty between January 2021 and December 2023. Based on the balloon size, the patients were divided into submaximal (50–80% of normal vessel diameter) or aggressive (80–100% of normal vessel diameter) angioplasty groups. The efficacy and safety of angioplasty including ischemic stroke/intracranial hemorrhage, death, arterial dissection, and follow-up outcomes were compared between the two groups.

Results

The patients were divided into submaximal (n=55) and aggressive (n=62) angioplasty groups. All the balloons were successfully delivered to the lesion location and expanded. The dissection rate (3.6% vs 17.7%, P=0.018) and incidence of remedial stenting (7.3% vs 21.0%, P=0.040) after balloon dilation were significantly greater after aggressive angioplasty than after submaximal angioplasty. A residual stenosis rate of ≥30% was more common in the submaximal angioplasty group than in the aggressive angioplasty group (27.3% vs 8.1%, P=0.006). Periprocedural complications (1.8% vs 8.1%, P=0.212), recurrent ischemic events (1.8% vs 4.8%, P=0.621), and restenosis (3.6% vs 8.1%, p=0.445) were comparable between the groups.

Conclusions

Submaximal angioplasty has a favorable technical profile, periprocedural safety, and long-term efficacy, suggesting that it is a promising alternative treatment for symptomatic ICAS.
On the consequences of childbirth: obstetrics/gynaecology, comparative anatomy and racial theories in 19th century France and Brazil
Authors: Machado Maria Helena Pereira Toledo
Published: January 2025

The following paper is centred on an analysis of comparative studies of the human pelvis developed over the 19th century by mostly French natural scientists, physical anthropologists, students of the human anatomy and doctors engaged in the initial stages of the emerging fields of gynaecology and obstetrics. As this paper will argue, there was considerable overlap between these specialisations, producing a fundamentally masculine, Eurocentric and racialised knowledge that had an enormous impact in establishing racially informed gynaecological and obstetric practices. This paper argues that comparative pelvic anatomy studies originated from the belief that African and Black women had specifically different pelves and genitalia and served to stratify women of different races and promoted racially oriented obstetric and gynaecological treatments. Despite their European origins, these French publications had profound repercussions across various regions of the Atlantic world and directly influenced the medical care provided to women of African descent in both slave and postemancipation societies, particularly in Brazil. In 1887, a doctoral candidate from the Rio de Janeiro Medical School (Brazil) wrote a dissertation in which he advocated and justified the racialised treatments offered to enslaved, free and soon-to-be-free women of African descendent who delivered their offspring at the medical school’s maternity ward. In his advocacy for such practices, the author drew connections between the prevailing methods at Rio de Janeiro’s Medical School to a long lineage of French medical thought on the racialised comparative anatomy of women’s pelvises throughout the 19th century.
Epidemiology and impact of travellers’ diarrhoea differs during UK military training exercises in Kenya and Oman
Authors: Toriro Romeo , Tabberer B , Davis S I , Reece N L , Woolley S D , O'Shea M K , Fletcher T E , Burns D S , Beeching N J
Published: January 2025

Background

Gastrointestinal illnesses are common during military training and operational deployments. We compared the incidence and burden of travellers’ diarrhoea (TD) reported by British service personnel (SP) during recent training exercises in Kenya and Oman.

Methods

SP completed a validated anonymous questionnaire regarding clinical features of any diarrhoeal illness, associated risk factors and impact on work capability after 6-week training exercises in 2018 in Kenya and 2018–2019 in Oman. Responses were tabulated for descriptive comparisons.

Results

Questionnaires were received from 388 (32%) SP in Kenya and 627 (52%) in Oman. The cumulative incidence of reported diarrhoea over 6-weeks was 14.2% (95% CI 8.02% to 22.61%) in Kenya compared with 3.9% (95% CI 1.10% to 9.91%) in Oman (OR 3.56, 95% CI 2.18 to 5.8; p<0.0001). Attack rates were 9.45 SP/100 exposure-months in Kenya and 2.66/100 in Oman. The number of workdays lost was greater in Kenya (6.26 per 1000 days) compared with Oman (4.13 per 1000 days) (p<0.01). In Kenya, 52.3% of those experiencing diarrhoea became ill during the first 14 days of deployment, but in Oman, 50% were ill in the last deployment week. The strongest risk factor associated with TD at both locations was contact with a colleague experiencing diarrhoea, followed in Kenya by eating locally sourced food and swimming in local water, which had weaker protective associations in Oman.

Conclusions

The epidemiology, risk factors and burden of TD in Kenya were similar to previous descriptions, where overall incidence continues to decline. Incidence and burden were significantly lower in Oman, where both were much lower than historical descriptions. Peak timing of illness and associated risk factors differed between Kenya and Oman. Continued documentation and review of TD during training exercises at different geographical locations is essential to inform the chain of command about risks to operational effectiveness.
Electroweak quantum numbers in the $$D_4$$ root system
Authors: Jansson Henrik
Published: January 2025

We introduce four fundamental quantum numbers based on the

$$D_4$$

D
4

root system, giving a unified description of quarks and leptons. These numbers will make it possible to define electric charge in a simple way. By postulating a fundamental symmetry given by the binary tetrahedral group acting on this root system, we can easily prove conservation of electric charge. Also, possible electroweak interactions are given by a simple rule where the 24-cell acts on itself by quaternion multiplication. The three generations of fermions in the Standard Model are hereby identified with the three imaginary dimensions of the quaternions.
Dynamics in a Filippov–Gause Predator–Prey Model with Hunting Cooperation or Competition Among Predators for High or Low Prey Densities
Authors: Cortés-García Christian
Published: January 2025

A Filippov–Gause predator–prey model is proposed, which suggests that cooperation and competition among predators depend on prey abundance. In this case, when the prey abundance is high, predators cooperate in hunting, but when the prey abundance decreases and falls below a critical level, predators compete for scarce food. The proposed model is analyzed in terms of the existence and stability of its equilibria and its pseudo-equilibrium, which is located on the differentiable curve separating the two vector fields. Given the conditions found which determine the existence of cycles and limit cycles, contrasted with a bifurcation diagram, we find that the proposed model can have an asymptotically stable limit cycle around the pseudo-equilibrium and two positive inner equilibria, together with an unstable limit cycle around the pseudo-equilibrium. Similarly, if the model has a pseudo-equilibrium and no positive inner equilibria, then we could have at least two limit cycles, one stable and one unstable, surrounding the pseudo-equilibrium.