bluuebunny/crossref_metadata_2025 huggingface dataset:
Cowper Glands Identified in Prostate and Urethral Specimens: A Comprehensive Immunohistochemical Characterization and Potential Diagnostic Pitfall
Authors: Sangoi Ankur R. , Al-Obaidy Khaleel I. , Akgul Mahmut , Mehra Rohit , Chan Emily , Williamson Sean R.
Published: August 2024

Cowper glands recognition remains one of the key histoanatomic benign mimics of prostatic adenocarcinoma. In most instances, these can be identified based on the dimorphic population of lobulated acini and duct(s). However, in the prostate biopsy setting with incomplete/distorted cores, this may not be immediately apparent and may warrant use of immunohistochemistry to argue against prostatic adenocarcinoma. Although immunohistochemical pitfalls in Cowper glands have been described, to our knowledge a comprehensive evaluation of both traditional and purportedly prostate-specific novel markers in Cowper glands has not been previously performed. Herein, we studied the clinicopathological and immunohistochemical features of 21 male patients (age range 39-81 years; mean = 63 years), including 15 prostate biopsies (7 of which also had prostate cancer in the same specimen set and 2 of which had both prostate cancer and Cowper glands in the same biopsy core). Immunohistochemistry showed the following results in Cowper glands: 100% positive for NKX3.1, 100% positive (basal cells) for both high molecular weight keratin and p63, 57% positive for PSAP, 25% positive for PSMA, 5% positive for AMACR, and 0% positive for PSA. In conclusion, for specimens lacking appreciable dimorphic morphology, caution should be rendered when using prostate-specific markers (PSA, PSAP, PSMA, and NKX3.1) as these can show considerable staining in Cowper glands and be a pitfall. Instead, findings from this cohort indicate relying on basal markers (high molecular weight keratin/p63; either individually or in a “cocktail” approach) and PSA are most useful in distinguishing Cowper glands (retained basal cell markers staining) from prostatic adenocarcinoma.
Intrinsic Causes of Nonfibrotic Portal Hypertension—A Clinicopathologic Review of 56 Patients
Authors: Ashmila Hamza , Khatoon Nazia , Keaveny Andrew , Krishna Muli , Nakhleh Raouf
Published: August 2024

Aim: The differential diagnosis of intrinsic nonfibrotic conditions that may lead to portal hypertension include hepatoportal sclerosis (HPS), nodular regenerative hyperplasia (NRH), and sinusoidal obstruction syndrome (SOS). In this article, we characterize the clinical features and outcome of these lesions when they manifest as portal hypertension. Methods: Data was collected through retrospective patient medical records. Results: Patients (HPS: 28, NRH: 17, SOS: 11) were identified more frequently in recent years. All groups presented with signs and symptoms of portal hypertension. All patients had complex medical histories. An elevated serum alkaline phosphatase occurred in all groups and an elevated bilirubin with SOS. Imaging of the liver with HPS and NRH suggested cirrhosis, which was not seen with SOS. 11%, 12%, and 9% of patients in the HPS, NRH, and SOS respectively, underwent transjugular intrahepatic portosystemic shunt placement to manage the complications of portal hypertension, while 43%, 24%, and 36% of patients respectively, received a liver transplant. Conclusions: Patients with HPS, NRH, and SOS had complex medical histories, likely contributing to the development of these lesions. They are recognized more frequently now. In contrast to HPS and NRH, SOS occurred in liver transplant recipients, was associated with elevated serum bilirubin, and imaging did not suggest the presence of advanced fibrosis/cirrhosis. Liver transplantation appeared to be a viable treatment for complications related to HPS and NRH. Retransplantation for SOS yielded mixed results. HPS, SOS, and NRH should be considered when evaluating liver specimens from patients with unexplained nonfibrotic portal hypertension. Key message: Intrinsic nonfibrotic causes of portal hypertension appear to be increasing in frequency. The differential diagnosis includes NRH, HPS, and SOS. These conditions are associated with complex diseases and possibly due to treatments. Pathologists need to be aware of this differential diagnosis when presented with liver biopsies performed to assess portal hypertension.
A Rare Placental Site Nodule Involving the Ovary
Authors: Geetha Saroja Devi , Roychoudhury Sudarshana , Sham Sunder , Truskinovsky Alexander M.
Published: August 2024

Placental site nodule (PSN) is a benign lesion representing a nodular aggregate of intermediate trophoblast, embedded in a hyalinized stroma, thought to arise from noninvoluted placental site remaining from a past gestation. Uterus is the most common site of PSN. Occurrence in extrauterine sites is rare, with most examples being reported in the fallopian tubes. Here we report an example of PSN in the ovary. A 35-year-old woman, gravida 4, para 1, with history of adnexal ectopic pregnancy treated with methotrexate, at 39 weeks and 1 day of a subsequent pregnancy, underwent a scheduled C-section. The surgery was successful, and a healthy female infant was delivered. Intraoperative adnexal inspection revealed a small pedunculated mass on the right ovary, which was excised and sent for pathological examination. Gross inspection showed a soft, tan-white tissue fragment measuring 2.0 × 1.0 × 0.2 cm. Microscopic examination showed epithelioid cells with hyperchromatic, mildly atypical nuclei and abundant eosinophilic cytoplasm, embedded in a hyalinized stroma, forming a nodule. A diagnosis of placental site nodule was made. Immunohistochemical stains for keratin AE1/AE3, vimentin, and inhibin were strongly positive in the epithelioid cells, and immunostain for p63 was focally positive, supporting the diagnosis. PSN of the ovary is extremely rare. To our knowledge, there has been only one reported patient in the literature so far. Extrauterine PSNs are thought to arise from ectopic pregnancies. Our patient's ovarian PSN is most likely a consequence of her previous adnexal ectopic pregnancy, which was treated medically.
A semi-active adaptive pneumatic vibration isolator based on frequency response analysis and nonlinear control
Authors: Xu Shaofeng , Sun Zhibo , Wang Yixuan , Wu Jifan , Shi Yan
Published: August 2024

In this work, an adaptive nonlinear error feedback controller based on fuzzy state observer is proposed to a novel rubber pneumatic vibration isolator (PVI) system. First, a novel rubber PVI system is designed and developed. Harmonic balance method is applied to establish the dynamic model of the PVI system, so as to analyze the frequency response characteristics of the system. Second, to improve the PVI performance in low-frequency vibration, a nonlinear state error feedback control system based on fuzzy state observer is designed for the active PVI system. Furthermore, the experiment system is established. Finally, through the experimental comparison under 5 Hz, 7 Hz, 20 Hz, and 40 Hz, an adaptive PVI strategy is proposed. The experimental results demonstrate that the adaptive PVI shows better performance in vibration isolation.
Closing the Gap: Foster Parents’ Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers
Authors: Grier Kimberlee , Harlow Ashleigh , Terrell Lindsay , Koch Amie
Published: August 2024

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents’ experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.
The Effect of Statin Treatment on Synaptogenesis in the Hippocampus
Authors: Taylor Sara , Adhikari Rabin
Published: August 2024

Deranged lipid homeostasis has been implicated in neurodegenerative diseases. Cholesterol reducing compounds such as statins have received special attention for the possibility that they may be able to ameliorate or prevent cognitive loss associated with neurodegeneration. However, there is much dissension concerning the actual effect of statins on cognitive function. The aim of this study is to investigate the effects of pitavastatin on hippocampal synaptogenesis because the hippocampus is crucial for memory formation. We also evaluated the effects of pitavastatin on local hippocampal estrogen synthesized in the hippocampus itself and its effect on Brain-Derived Neurotrophic Factor (BDNF). Using a hippocampal cell line, H19-7, we found that hippocampal neurons exposed to pitavastatin demonstrate a significant reduction in the synaptic marker postsynaptic density protein 95 (psd-95). The pitavastatin treated neurons also exhibited decreased production of local estrogen and their expression of BDNF mRNA was decreased. These results suggest that statins reduce the ability of hippocampal neurons to form synapses by restricting the production of local estrogen. Because neural connections in the hippocampus are crucial for memory formation, our findings implicate statins as medications that may compromise cognitive function.
How does information and communication technology promote tourism development? Evidence from the e-commerce pilot city policy in China
Authors: Fu Liping , Yang Jie , Dong Yongqing , Pei Tong
Published: August 2024

Information and communication technology (ICT) drives tourism development. Utilising the e-commerce pilot city policy (CNEP) as a quasi-natural experiment, this study explores the effect of ICT on tourism development and the transmission mechanism. A multi-period difference-in-differences model is used to analyse panel data from 280 Chinese prefecture-level cities from 2003 to 2019. The results show that the CNEP promotes tourism development. The transmission mechanism indicates that the CNEP promotes tourism development by reducing tourism environmental costs and increasing tourism network attention. Additionally, the heterogeneity analysis reveals that the CNEP has a more significant effect on promoting tourism development in large and big-internet-scale cities. These findings provide crucial empirical evidence for the tourism-driven impact of ICT and meaningful policy implications for the tourism industry’s digital transformation.
Comparative VOD catalogue research: Circulation, presence and prominence of British content in Europe
Authors: Bengesser Cathrin , Hilborn Matthew , Steemers Jeanette
Published: August 2024

Video-on-demand (VoD) platforms have become primary spaces for encounters with transnational film and television, particularly among younger audiences. The expansion of global US-owned VoD services like Netflix has generated questions about the availability, discoverability, and prominence of domestic and European content, making the issue of how to analyse VoD catalogues pressing. Two perspectives are prevalent in VoD catalogue research: ‘back-end’ research emphasising composition and circulation; and ‘front-end’ analysing content presentation and discoverability. Quantitative methods facilitate comparative and longitudinal analyses of what is found on which VoD catalogues. Qualitative methods examine where and how audiences find content. This article, fostering synergy between the two, probes (1) the significance of VoD catalogue research in understanding the dynamics of transnational content flows and audience behaviours, and (2) its methodological possibilities and limitations. Focusing on British content in European VoD catalogues, it draws on two research projects: EUVoD (Aarhus Universitets Forskningsfond AUFF, 2021–2024), analysing the developing European VoD market within changing conditions of competition and policy; and Screen Encounters with Britain (AHRC, 2022–2025), investigating young Europeans’ use of British film and TV. The article utilises the European Audiovisual Observatory’s databases of European works and the streaming guide JustWatch.com, combined with systematic tracking of VoD landing pages. It thus maps content availability, popularity, and promotional strategies across different European markets and services, showcasing how patterns of presence, prominence and circulation shape probable audience encounters with non-domestic content. The article probes methodological considerations, complexities and caveats applicable to wider catalogue research into transnational media. In the case of British content availability on VoD, it shows how a vast number of ca. 15,000 individual UK titles available in European catalogues boils down to about 200 titles that can be easily found on Netflix, and 70 titles there of that young audiences (aged 16–34) recall as UK shows they know and remember.
Psychological needs satisfaction in physical education predicts a positive development of motivation in early adolescence: A latent growth modeling study
Authors: Yun Sanga , Jaakkola Timo , Huhtiniemi Mikko , Gråstén Arto , Park Junhyuk , Yli-Piipari Sami
Published: August 2024

Self-determination theory (SDT) is a compelling framework for understanding the psychological environment and explaining human motivation. This is especially crucial in school physical education (PE), given that the psychological environment within PE has been demonstrated to be closely related to the formation of physical activity motivation and behaviors. Advancing current knowledge and implementing a longitudinal approach, the aim of this study was, first, to investigate longitudinal changes in psychological needs and motivational regulation, and second, to examine the role of needs in the development of motivational regulation among PE students. A sample of 1148 Finnish adolescents (583 girls, 565 boys, Mage  =  11.27 ± 0.32) participated in annual assessments three times. A latent growth model analysis was used to examine the longitudinal associations between the outcome variables, namely psychological needs and motivational regulation. The results indicated that needs satisfaction (α2 range −0.20[0.03] to −0.06[0.02]), intrinsic motivation (α2 =  −0.38[0.03]), and identified regulation (α2 =  −0.19[0.03]) declined, whereas external regulation (α2 =  0.16[0.02]) and amotivation (α2 =  0.09[0.02]) increased. Furthermore, the results demonstrated that psychological needs significantly predicted autonomous forms of motivational regulation (intrinsic motivation R2 = 0.72[0.13]; identified regulation R2 = 0.69[0.20]). Conversely, positive changes in autonomy (β = −0.29[0.13]) and relatedness (β = −0.45[0.22]) accounted for the negative changes in amotivation ( R2 = 0.62[0.22]). In conclusion, the findings of the study corroborated the central postulations of SDT, providing empirical evidence of the importance of psychological needs in the development of motivation in PE.
A critical hit: Dungeons and Dragons as a buff for autistic people
Authors: Atherton Gray , Hathaway Rhys , Visuri Ingela , Cross Liam
Published: August 2024

Tabletop role-playing games (TTRPGs) are increasingly used in therapeutic and educational settings to improve the well-being of autistic people. This study investigated the potential of TTRPGs to provide a safe space where autistic adults could develop relationships with others while also engaging in character and world-building. Eight autistic adults were split into two groups and taken through a 6-week online Dungeons and Dragons campaign run by one of the researchers. Semi-structured interviews were then conducted to discuss how participants felt interacting in and out of the TTRPG. Several key themes were identified as important aspects of why autistic people could benefit from role-playing environments. The analysis showed that the participants felt a strong level of enjoyment from engaging in tabletop role-playing and, in many ways, experienced better social interactions during the TTRPG. The results suggested that TTRPGs can provide a safe space for autistic adults to engage in meaningful social interactions with like-minded individuals. Role-playing may also allow autistic participants to rewrite their own life stories through their characters’ adventures, leading to improved self-esteem.

Lay abstract

Tabletop role-playing games (TTRPGs) are popular hobbies that may offer specific social benefits for autistic people. This study investigated the ability of TTRPGs to provide a safe space where autistic adults could develop relationships with other autistic adults while engaging in character and world-building. A group of eight autistic adults were split into two groups and taken through a short-form online Dungeons and Dragons campaign over 6 weeks run by one of the researchers. The researcher then led a series of individual semi-structured interviews discussing how participants felt interacting in and out of the TTRPG. Several key themes were identified as important aspects of why autistic people could benefit from such an environment. Analysis showed that while real-life interactions could be challenging, in TTRPG play, they felt they experienced significantly fewer struggles. Results suggested that TTRPGs can provide a safe space environment where autistic adults can engage in productive social interactions with like-minded individuals. It also may allow autistic participants to experience ‘bleed’ or the ability to take on a new character that changes the way they feel about themselves outside of the game. Future directions for this work are discussed.
Modal parameter extraction from improved principal component analysis and structural state identification
Authors: Li Xueyan , Liu E. , Wang Lixin , Lin SJ , Zhao W
Published: August 2024

With the vigorous development of building structures and important infrastructure, structural health monitoring is necessary. Because there is no need to establish structural finite element modeling and train for various structural conditions, the data-driven and unsupervised learning method is very popular. Principal component analysis is a powerful signal analysis tool, but its lack of physical significance and the loss of sensitive information have hindered its wider application. Therefore, the improved principal component analysis based narrowband filtering is proposed to extract mode shapes and construct the structural state vectors, so that the damage index is more sensitive to damage and robust to the environmental factors. After the vibration response of the long-term monitoring is analyzed by the principal component analysis, the Gaussian mixture model clustering analysis is used to classify the structural states. Finally, the proposed method is applied to the analysis of the simulation data of ASCE Benchmark structure and the measured data of steel beams in the lab. The results show that the structural state vector is sensitive to structural damage. The clustering analysis of Gaussian mixture model can distinguish the structural states. The effectiveness of the proposed method is verified.
Digital access among a national sample of currently and formerly homeless veterans in 2022
Authors: Tsai Jack , Lampros Austin , Blue-Howells Jessica
Published: August 2024

Background: Digital technologies are essential for connecting to the Internet and communicating with others. Methods: This study used data from the 2022 Project Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) survey, which surveyed a national sample of 1992 homeless-experienced veterans (HEV) about use of cell phones, smart phones, computers, laptops, and the Internet. Data were analyzed to compare currently and formerly homeless veterans on digital access and to identify characteristics associated with never using the Internet. Results: Over 75% of HEV reported having a cellphone and over 65% reported having a smartphone. Internet use was common among HEV as 74% of currently homeless veterans and 77% of formerly homeless veterans reported using the Internet. Among HEV who used the Internet, over 70% used the Internet at least weekly. There was no significant difference between currently and formerly homeless veterans on their Internet use in the total sample and subsamples of only black and only Hispanic veterans. Overall, HEV who were older, black non-Hispanic, and living in the Southeast were more likely to never use the Internet. Conclusions: These findings highlight the potential for technology-based interventions among HEV, and suggest a digital divide based on age, race, and geography.
Exact closed-form solution for the completely integrable helmholtz-duffing oscillator with applications to real-world problems
Authors: Big-Alabo Akuro , Alfred Peter B.
Published: August 2024

The Helmholtz-Duffing oscillator is an important vibration model that can be used to study many engineering systems and physical phenomena. In this article, we derived new exact closed-form solutions for the completely integrable Helmholtz Duffing oscillator subject to a constant force. The exact solution was derived naturally from the first integral of the governing differential equation. This approach is completely different from the ansatz method, used in previously published studies, where the exact solution was forced to take the form an initially assumed solution. Through various algebraic transformations and with the aid of standard elliptic integral tables, the present exact period was derived in terms of the complete elliptic integral of the first kind while the exact displacement was derived in terms of the Jacobi cosine function. Unlike the exact ansatz solutions, which have limited range of validity, the present exact solutions are applicable to all bounded periodic states of the Helmholtz-Duffing oscillator with constant force. The validity of the present exact solutions was verified using numerical solutions and published exact solutions in the form of the Weierstrass elliptic function. It was found that the numerical differentiation method produced significant errors for some system inputs and cannot be relied on as a benchmark solution. However, the present exact solutions are benchmark solutions that could be used to check the accuracy of new and existing approximate solutions. Finally, the application of the exact solutions to analyze some real-world problems was demonstrated.
Self-reported online science learning strategies of non-traditional students studying a university preparation science course
Authors: Crank Russell , Spence Jenny
Published: August 2024

Student awareness and selection of learning strategies are predictors of academic success. Yet, little is known about learning strategies of students in university preparation science courses, who are frequently mature-aged or underrepresented students. This lack of knowledge potentially hinders tailoring reflective learning experiences, specific to science contexts, supporting novice science students adopting effective learning strategies. A mixed-methods study examined self-reported learning strategies of 88 students in an online university preparation science course, analysed using a convergent parallel research approach and interpreted through a passive–active–interactive framework. The study found preferences for passive learning strategies with considerably less active and interactive strategies reported. The findings suggest, despite the strengths these students bring to their studies, a tendency for naïve and unexamined concepts of science learning, from time-poor students with little experience in collaborative learning. The study recommends embedding science-specific learning strategies in university preparation science courses and building capacity with interactive strategies.
Physician Modified Endograft for Ruptured Dissecting Aortic Arch Aneurysm
Authors: Solano Antonio , Keller Melissa R. , Porras Colon Jesus , Patel Rhusheet , Timaran Carlos H. , Kirkwood Melissa L. , Baig M. Shadman
Published: August 2024

Background

Endovascular repair of thoracic aortic aneurysms (TAA) in elective settings has demonstrated successful clinical outcomes. However, life-threatening conditions such as rupture are more often managed with open surgical repair due to the high complexity of arch endovascular repair, lack of available off-the-shelf devices, and limited long-term data.

Case Summary

A 49-year-old female with a recent history of prior ascending aortic repair for Type A10 aortic dissection presented with chest pain and dyspnea. Chest computed tomography angiogram (CTA) revealed acute bilateral pulmonary emboli and a 6.2 cm post dissection aneurysm of the posterior aortic arch with the dissection extending to the right iliac artery. She was treated with thrombolysis and subsequently became hemodynamically unstable. Repeat CTA revealed a massive left hemithorax with concern for aortic arch rupture. Given significant cardiorespiratory compromise and recent open repair, she was considered unfit for redo open repair. Thoracic endovascular aortic repair (TEVAR) with a physician-modified endograft (PMEG) was planned. An Alpha Zenith endograft was modified adding an internal branch for the innominate artery and a fenestration for the left common carotid artery. The left subclavian artery was occluded with a microvascular plug and coil embolization up to the level of the vertebral artery. TEVAR PMEG extension to the celiac artery was performed followed by deployment of a Zenith dissection stent to the aortic bifurcation. Completion angiogram demonstrated successful aneurysm exclusion and patency of target vessels.

Conclusion

Endovascular treatment of ruptured TAA with PMEGs is feasible. This approach may be an alternative for unfit patients for open repair in emergent settings.
Transcarotid Artery Revascularization for Symptomatic Retropharyngeal Internal Carotid Artery Stenosis
Authors: Ettleson Ari , Robbins Justin , Ascher Enrico , Hingorani Anil
Published: August 2024

Retropharyngeal internal carotid artery (ICA) is a rare, yet well-described anatomical variant that poses significant challenges to the management of carotid artery stenosis. In this case report, we discuss the treatment of symptomatic ICA stenosis with a retropharyngeal ICA using the transcarotid artery revascularization (TCAR) technique. A 70-year-old female with comorbidities presented with neurological symptoms and severe ICA stenosis. After diagnostic evaluation, TCAR was chosen for surgical intervention. The patient did well postoperatively. This case emphasizes the importance of considering TCAR when treating ICA stenosis in patients with anatomic variation of ICA location. It also supports adding anatomic variants such as retropharyngeal ICA to the list of indications for TCAR.
Transculturation in Latin American Video Game Production: Between Regionalism and Cosmopolitanism
Authors: Ramírez-Moreno Carlos , Navarrete-Cardero Luis
Published: August 2024

This research explores the manifestation of transculturation, a literary paradigm designed to situate Latin American production in the context of globalization, in video game production, evaluating its applicability to the study of cultural representation. Embracing a documentary research and content analysis methodology, the study analyzes 29 video games from nine Latin American countries, classifying them as “regionalist” or “cosmopolitan” based on settings, themes, audiovisual elements, and intertextual references. The regionalist category exhibits a preference for realism, natural settings, representation of myths, and an emphasis on cultural preservation. Conversely, the cosmopolitan category favors the fantastic, urban settings, reinterpretation of myths, and an emphasis on cultural exchange. By scrutinizing video games through the lens of transculturation, the study revalidates this theory as a relevant paradigm for understanding cultural representation in the digital age, offering new insights into the interplay between local and global influences in Latin American video game narratives.
Aspiration tubing diameter is a key determinant of vacuum pressure and is associated with procedural outcome in mechanical thrombectomy for large vessel occlusion: An experimental and cohort study
Authors: Verhey Leonard H , Lyons Leah , Sewell Andrea , Grandfield Ryan M , Khan Muhib , Mazaris Paul , Singer Justin A
Published: August 2024

Background

We (1) evaluated the effect of aspiration tubing diameter on intraluminal pressure and (2) compared thrombectomy outcomes in patients treated using small diameter tubing versus those treated using large diameter vacuum tubing.

Methods

Intraluminal negative pressure was measured in a validated benchtop set up where consistency of negative pressure (inHg) was measured between static and dynamic aspiration. Static aspiration refers to activation of vacuum once the catheter is engaged with the clot. Dynamic aspiration refers to activation of vacuum when the catheter is slightly proximal to the clot. Four different sizes of vacuum tubing were trialed. We performed a retrospective analysis of consecutive patients who underwent mechanical thrombectomy. Procedural and functional outcomes were compared.

Results

The large diameter aspiration tubing held a consistent high negative pressure in static and dynamic aspiration (p = 0.152). Tubing types I to III were associated with a significant fall off in negative pressure between static and dynamic technique (p < 0.05). Two-hundred and five patients were included in the retrospective analysis; 124 (60%) underwent thrombectomy using small diameter vacuum tubing, and 81 (40%) using the large tubing. Mean thrombectomy time was shorter with the larger tubing [25.9 (17.9) minutes] versus the small tubing [37.5 (28.5) minutes, p = 0.002]. A greater proportion of patients had a thrombolysis in cerebral infarction score ≥2b in the group treated using the large tubing (78, 99%) than those with the small tubing (96, 78%, p < 0.001).

Conclusion

Vacuum tubing diameter is linearly associated with intraluminal aspiration pressure. These findings have clinical significance as shown by increased recanalization rates and decreased thrombectomy times when large-diameter aspiration tubing is used. Shifting the paradigm toward a flow-based technique using large-bore vacuum tubing ought to be considered.
The swimming habits of women who cold water swim
Authors: Pound Megan , Massey Heather , Roseneil Sasha , Williamson Ruth , Harper Mark , Tipton Mike , Shawe Jill , Felton Malika , Harper Joyce
Published: August 2024

Background:

Cold water swimming is growing in popularity, especially among women. We have previously reported that women felt that cold water swimming helps with their menstrual and menopause symptoms. But little is known about the habits of women who cold water swim.

Objectives:

To determine the habits of women who cold water swim.

Design:

This was a mixed-methods study.

Methods:

An online survey asked women who cold water swim about their experience of swimming and how this affected their menstrual and menopause symptoms. The survey was advertised for 2 months on social media, with a focus on advertising in cold water swimming Facebook groups. In this article, only the questions on the women’s swimming habits were analyzed.

Results:

The analysis of 1114 women, mainly from the United Kingdom, revealed that most had been swimming for 1–5 years (79.5%). Most swim in the sea (64.4%), and only 15.5% swim alone. The majority (89.0%) swim all year around, swimming for mainly 30–60 min in the summer and 5–15 min in the winter. The women mostly swim wearing swimming costumes (skins) throughout the year. The majority of the free-text responses showed women found mental and physical benefits from cold water swimming.

Conclusion:

It was not surprising to learn that women swim for longer in the summer than the winter, but hearing how they feel cold water swimming helps their physical and mental health is important. With the limitations on access and safety of many wild swimming sites in the United Kingdom, it is time to ensure that cold water swimming is safer and more supported.
Dispensing patterns of antidepressant and antianxiety medications for psychiatric disorders after benign hysterectomy in reproductive-age women: Results from group-based trajectory modeling
Authors: Ishiwata Ryota , AlAshqar Abdelrahman , Miyashita-Ishiwata Mariko , Borahay Mostafa A
Published: August 2024

Background:

Women with gynecologic disorders requiring a hysterectomy often have co-existing psychiatric diagnoses. A change in the dispensing pattern of antidepressant (AD) and antianxiety (AA) medications around the time of hysterectomy may be due to improvement in gynecologic symptoms, such as pelvic pain and abnormal bleeding, or the emotional impact of the hysterectomy. Unfortunately, these dispensing patterns before and after hysterectomy are currently undescribed.

Objectives:

To model the dispensing patterns of AD and AA medications over time among women with psychiatric disorders before and after benign hysterectomy for endometriosis and uterine fibroids; and to characterize clusters of patients with various dispensing behaviors based on these patterns.

Design:

Retrospective cohort study.

Methods:

This is a study of women who underwent a benign hysterectomy using data from the Merative MarkertScan® Research Databases (Ann Arbor, MI, USA). Inclusion criteria were reproductive-aged women (18–50 years), diagnosis of at least one mood or anxiety disorder, and at least one dispensing of AD or AA medications. We measured monthly adherence and persistence of AD/AA medication use over 12 months after hysterectomy. Group-based-trajectory modeling (GBTM) was used to identify trajectory groups of monthly AD/AA medication dispensing over the study period. Multinomial logistic regression was used to identify factors independently associated with individual dispensing trajectory patterns.

Results:

For a total of 11,607 patients, 6 dispensing trajectory groups were identified during the study period: continuously high (27.0%), continuously moderate (21.9%), continuously low (17.9%), low-to-high (10.0%), moderate-to-low (9.8%), and low-to-moderate (13.4%). Compared with the continuously high group, younger age, no history of a mood disorder, and uterine fibroids were clinical predictors of low dispensing. The discontinuation rate at 3 months after hysterectomy was higher at 88.6% in the continuously low group and at 66.5% in the continuously low-to-moderate group.

Conclusions:

This study demonstrates that GBTM identified six distinct trajectories of AD/AA medication dispensing in the perioperative period. Trajectory models could be used to identify specific dispensing patterns for targeting interventions.
Help-seeking behaviour in dysmenorrhoea: A cross-sectional exploration using the Behavioural Model of Health Services Use
Authors: Matheson Sophie C , Durand Hannah
Published: August 2024

Background:

Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea.

Objectives:

The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care.

Design:

A cross-sectional observational design was used.

Methods:

Participants ( N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain.

Results:

The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour.

Conclusion:

Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.
Manufacturing concern: Inside Richard Nixon’s “law and order” campaign
Authors: Cheliotis Leonidas K
Published: August 2024

With a view to contributing to an in-depth understanding of political engagement with public opinion about crime or cognate issues in the United States, this article dissects how Richard Nixon and his inner circle dealt with citizens’ views on what he collectively termed “law and order,” both during his 1968 presidential campaign and his first term in office. Based on novel data from heretofore unused or otherwise underused archival sources, the article lends concrete support to a notion which prior works have asserted without sufficient evidence, dismissed as a conspiracy theory, or, more recently, attempted to revise; namely, that Nixon’s “law and order” messaging was meant to manipulate the public so as to reap electoral dividends for him. In the process of so doing, the article investigates a series of previously understudied themes and the ways in which they intersect: Whose views exactly did Nixon try to shape to his advantage? Which strategy did he follow and what precise means did he use? And how effective were his efforts? It is shown that Nixon targeted both the white majority at large and discrete sections of it: his conservative base, disaffected Democrats, and blue-collar immigrants from Europe who lived around black urban ghettos. With each and every one of his target groups, Nixon engaged in an effort to manufacture concern over “law and order,” itself an assemblage of issues through which he hoped to improve his leadership image in a dual sense: strength of purpose and attentiveness to public will. Unlike what is commonly assumed, Nixon’s “law and order” ploys were limited in their success.
Early evaluation of the effectiveness and cost-effectiveness of ctDNA-guided selection for adjuvant chemotherapy in stage II colon cancer
Authors: Kramer Astrid , Greuter Marjolein J. E. , Schraa Suzanna J. , Vink Geraldine R. , Phallen Jillian , Velculescu Victor E. , Meijer Gerrit A. , van den Broek Daan , Koopman Miriam , Roodhart Jeanine M. L. , Fijneman Remond J. A. , Retèl Valesca P. , Coupé Veerle M. H.
Published: August 2024

Background:

Current patient selection for adjuvant chemotherapy (ACT) after curative surgery for stage II colon cancer (CC) is suboptimal, causing overtreatment of high-risk patients and undertreatment of low-risk patients. Postoperative circulating tumor DNA (ctDNA) could improve patient selection for ACT.

Objectives:

We conducted an early model-based evaluation of the (cost-)effectiveness of ctDNA-guided selection for ACT in stage II CC in the Netherlands to assess the conditions for cost-effective implementation.

Methods:

A validated Markov model, simulating 1000 stage II CC patients from diagnosis to death, was supplemented with ctDNA data. Five ACT selection strategies were evaluated: the current guideline (pT4, pMMR), ctDNA-only, and three strategies that combined ctDNA status with pT4 and pMMR status in different ways. For each strategy, the costs, life years, quality-adjusted life years (QALYs), recurrences, and CC deaths were estimated. Sensitivity analyses were performed to assess the impact of the costs of ctDNA testing, strategy adherence, ctDNA as a predictive biomarker, and ctDNA test performance.

Results:

Model predictions showed that compared to current guidelines, the ctDNA-only strategy was less effective (+2.2% recurrences, −0.016 QALYs), while the combination strategies were more effective (−3.6% recurrences, +0.038 QALYs). The combination strategies were not cost-effective, since the incremental cost-effectiveness ratio was €67,413 per QALY, exceeding the willingness-to-pay threshold of €50,000 per QALY. Sensitivity analyses showed that the combination strategies would be cost-effective if the ctDNA test costs were lower than €1500, or if ctDNA status was predictive of treatment response, or if the ctDNA test performance improved substantially.

Conclusion:

Adding ctDNA to current high-risk clinicopathological features (pT4 and pMMR) can improve patient selection for ACT and can also potentially be cost-effective. Future studies should investigate the predictive value of post-surgery ctDNA status to accurately evaluate the cost-effectiveness of ctDNA testing for ACT decisions in stage II CC.
The influence of sex hormones on renal cell carcinoma
Authors: Ladurner Michael , Lindner Andrea Katharina , Rehder Peter , Tulchiner Gennadi
Published: August 2024

Kidney cancer is a common malignancy that constitutes around 5% of all cancer cases. Males are twice as likely to acquire renal cell carcinoma (RCC) compared to females and experience a higher rate of mortality. These disparities indicate that sex hormone (SH)-dependent pathways may have an impact on the aetiology and pathophysiology of RCC. Examination of SH involvement in conventional signalling pathways, as well as genetics and genomics, especially the involvement of ribonucleic acid, reveal further insights into sex-related differences. An understanding of SHs and their influence on kidney cancer is essential to offer patients individualized medicine that would better meet their needs in terms of prevention, diagnosis and treatment. This review presents the understanding of sex-related differences in the clinical manifestation of kidney cancer patients and the underlying biological processes.
Factors influencing the use of big data within healthcare services: a systematic review
Authors: Khosravi Mohsen , Mojtabaeian Seyyed Morteza , Zare Zahra
Published: August 2024

Background: The emergence of big data holds the promise of aiding healthcare providers by identifying patterns and converting vast quantities of data into actionable insights facilitating the provision of precision medicine and decision-making. Objective: This study aimed to investigate the factors influencing use of big data within healthcare services to facilitate their use. Method: A systematic review was conducted in February 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Database searches for articles published between 01 January 2020 and 18 February 2024 and included PubMed, Scopus, ProQuest and Cochrane Library. The Authority, Accuracy, Coverage, Objectivity, Date, Significance ( AACODS) checklist was used to evaluate the quality of the included articles. Subsequently, a thematic analysis was conducted on the findings of the review, using the Boyatzis approach. Results: A final selection of 46 studies were included in this systematic review. A significant proportion of these studies demonstrated acceptable quality, and the level of bias was deemed satisfactory. Thematic analysis identified seven major themes that influenced the use of big data in healthcare services. These themes were grouped into four primary categories: performance expectancy, effort expectancy, social influence, and facilitating conditions. Factors associated with “effort expectancy” were the most highly cited in the included studies (67%), while those related to “social influence” received the fewest citations (15%). Conclusion: This study underscored the critical role of “effort expectancy” factors, particularly those under the theme of “data complexity and management,” in the process of using big data in healthcare services. Implications: Results of this study provide groundwork for future research to explore facilitators and barriers to using big data in health care, particularly in relation to data complexity and the efficient and effective management of big data, with significant implications for healthcare administrators and policymakers.
A 22-Year-Old Man With Headache, Facial Numbness, Diplopia and Left Leg Numbness
Authors: Moreira Daniel Gabay , Sanmartin Paul E.
Published: August 2024

We present a 22-year-old male with a subacute course of chin numbness, ophthalmoplegia, headache and left leg numbness in the setting of fever, chills and night sweats. Initial imaging investigations revealed cauda equina enhancement plus an infiltrative process at the basis of the skull associated with extensive bone marrow infiltration and lymphadenopathy elsewhere. We discuss the localization, differential diagnosis, and appropriate investigations for this unique clinical scenario. Important laboratory findings and treatment considerations are reviewed for this unusual final diagnosis.
Glycaemic outcomes in people living with diabetes under 65 and over 65 years old using an intermittently scanned continuous glucose monitoring system
Authors: Wong Carol , De Bray Anne , Ul Hassan Naeem , Almohandes Ahmed , Thant Kyi Zin , Gill Sofia , Gill Dayna , Forsdick Hayley , Sinclair Alan J , Karamat Muhammad Ali , Bellary Srikanth
Published: August 2024

Objective:

Intermittently scanned continuous glucose monitoring (isCGM) has revolutionised the care of people with diabetes but its uptake and benefits in older adults are not well known. We examined the impact of isCGM (Freestyle Libre, FSL) on glycaemic outcomes in younger (⩽65 years) and older adults (>65 years) with diabetes.

Design and methods:

In total, 2260 adult patients registered on the Libreview account at University Hospitals Birmingham NHS Foundation Trust, UK, were included. Inclusion criteria: all patients with type 1 and type 2 diabetes aged >18 years, use of isCGM >6 months, scanning at least 6 times/day. Demographics, diabetes history and glycaemic outcomes (time in range (TIR), time above range and time below range (TBR), estimated HbA1c, HbA1c at start and at end of study) were collected by accessing electronic patient records and Libreview. Outcomes were compared between age groups ⩽65 or >65 years old.

Results:

Most patients were of Caucasian ethnicity (⩽65 years 68%, >65 years 73%) and had type 1 diabetes. Mean duration of diabetes was 19.5 years (range 0–65 years) and 34.5 years (range 0–79 years) for ⩽65 and >65 years, respectively. Only a quarter of those ⩽65 years achieved (219/943; 23.2%) their age specific TIR target compared to 69% (78/113) of those >65 years cohort, while 70.1% (663/946) of ⩽65 years and 40.7% (46/113) of >65 years achieved their age-specific TBR target. When the less strict ⩽65 years TBR target was applied, 75% (85/113) of >65 years cohort achieved this.

Conclusion:

FSL use was associated with improved glycaemic outcomes across all age groups. Individualised targets may be needed to improve TBR in those aged >65 years.