bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological examination of pelvic floor muscles in a rat model of vaginal delivery
Authors: Abe-Takahashi Yui , Kitta Takeya , Ouchi Mifuka , Chiba Hiroki , Higuchi Madoka , Togo Mio , Kusakabe Naohisa , Kakizaki Hidehiro , Shinohara Nobuo
Published: January 2024

Objective

This study investigated morphological changes in the composition of the pelvic floor muscles, degree of atrophy, and urethral function in a rat of simulated birth trauma induced by vaginal distension (VD) model.

Methods

Female Sprague–Dawley rats were classified into four groups: a sham group, and 1, 2, and 4 weeks post-VD (1 W, 2 W, and 4 W, respectively) groups. We measured the amplitude of urethral response to electrical stimulation (A-URE) to evaluate urethral function. After measuring the muscle wet weight of the pubococcygeus (Pcm) and iliococcygeus (Icm) muscles, histochemical staining was used to classify muscle fibers into Types I, IIa, and IIb, and the occupancy and cross-sectional area of each muscle fiber were determined.

Results

There were 24 Sprague–Dawley rats used. A-URE was significantly lower in the 1 W group versus the other groups. Muscle wet weight was significantly lower in the VD groups versus the sham group for Pcm. The cross-sectional area of Type I Pcm and Icm was significantly lower in the VD groups versus the sham group. Type I muscle fiber composition in Pcm was significantly lower in the VD groups versus the sham groupand lowest in the 2 W group. Type I muscle fiber composition in Icm was significantly lower in the 2 and 4 W groups versus the sham group.

Conclusion

Muscle atrophy and changes in muscle composition in the pelvic floor muscles were observed even after improvements in urethral function. These results may provide insight into the pathogenesis of stress urinary incontinence after VD.
Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic
Authors: Wiguna Tjhin , Dirjayanto Valerie Josephine , Maharani Zhahna Siti , Faisal Emir Gibraltar , Teh Sylvie Dominic , Kinzie Erik
Published: January 2024

Background

Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac.

Results

According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p< 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p= 0.151). Dunn’s post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p< 0.001).

Conclusion

Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students’ depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing.
Development and validation a nomogram for predicting new-onset postoperative atrial fibrillation following pulmonary resection
Authors: Zhang Chuankai , Jiang Songsong , Wang Jun , Wu Xianning , Ke Li
Published: January 2024

Background

The new-onset postoperative atrial fibrillation (NOPAF) following pulmonary resection is a common clinical concern. The aim of this study was to construct a nomogram to intuitively predict the risk of NOPAF and offered protective treatments.

Methods

Patients who underwent pulmonary resection between January 2018 and December 2020 were consecutively enrolled. Forward stepwise multivariable logistic regression analyses were used to screen independent predictors, and a derived nomogram model was built. The model performance was evaluated in terms of calibration, discrimination and clinical utility and validated with bootstrap resampling.

Results

A total of 3583 patients who met the research criteria were recruited for this study. The incidence of NOPAF was 1.507% (54/3583). A nomogram, composed of five independent predictors, namely age, admission heart rate, extent of resection, laterality, percent maximum ventilation volume per minute (%MVV), was constructed. The concordance index (C-index) was 0.811. The nomogram showed substantial discriminative ability, with an area under the receiver operating characteristic curve of 0.811 (95% CI 0.758-0.864). Moreover, the model shows prominent calibration performance and higher net clinical benefits.

Conclusion

We developed a novel nomogram that can predict the risk of NOPAF following pulmonary resection, which may assist clinicians predict the individual probability of NOPAF and perform available prophylaxis. By using bootstrap resampling for validation, the optimal discrimination and calibration were demonstrated, indicating that the nomogram may have clinical practicality.
Prediction of recurrence-related factors for patients with early-stage cervical cancer following radical hysterectomy and adjuvant radiotherapy
Authors: Ma Gui-Fen , Lin Gen-Lai , Wang Si-Tong , Huang Ya-Yu , Xiao Chun-Li , Sun Jing , Shi Ting-Yan , Xiang Li-Bing
Published: January 2024

Objective

To analyze recurrent factors in patients with clinical early-stage cervical cancer (ESCC) following hysterectomy and adjuvant radiotherapy.

Methods

We collected data from patients with ESCC, staged according to the 2009 Federation International of Gynecology and Obstetrics (FIGO) staging criteria, who underwent hysterectomy followed by adjuvant radiotherapy between 2012 and 2019. These patients were subsequently restaged using the 2018 FIGO criteria. Univariable and multivariable analyses, along with nomogram analyses, were conducted to explore factors associated with recurrence-free survival (RFS).

Results

A total of 310 patients met the inclusion criteria, with a median follow-up time of 46 months. Among them, 126 patients with ESCC were restaged to stage III C1 or III C2 after surgery due to lymph node metastasis (LNM) based on the 2018 FIGO staging criteria. Of these, 60 (19.3%) experienced relapse. The 1-, 3-, and 5-year RFS rates were 93.9%, 82.7%, and 79.3%, respectively. Multivariate analysis revealed that the number of positive lymph nodes (LNs), tumor diameter (TD) > 4 cm, and parametrial invasion (PI) were associated with recurrence. The nomogram indicated their predictive value for 3-year and 5-year RFS. Notably, the 5-year recurrence rate (RR) increased by 30.2% in patients with LNM, particularly those with ≥ 3 positive LNs (45.5%). Patients with stage III C2 exhibited a significantly higher RR than those with IIIC1 (56.5% vs. 24.3%, p < 0.001). The 5-year RFS for patients with TD > 4 cm was 65.8%, significantly lower than for those with TD ≤ 4 cm (88.2%). Subgroup analysis revealed higher 5-year RRs in patients with stage III C2 than that in patients with III-C1 (56.5% vs. 24.3%, p < 0.001), demonstrating a significant difference in the RFS survival curve.

Conclusion

RR in patients with clinical ESCC after hysterectomy followed by adjuvant radiotherapy is correlated with the number of positive LNs, TD > 4 cm, and PI. Emphasis should be placed on the common high-risk factor of LNM association with recurrence after radical hysterectomy in ESCC.
The effects of synbiotic supplementation on blood pressure and other maternal outcomes in pregnant mothers with mild preeclampsia: a triple-blinded randomized controlled trial
Authors: Movaghar Rouhina , Abbasalizadeh Shamci , Vazifekhah Shabnam , Farshbaf-Khalili Azizeh , Shahnazi Mahnaz
Published: January 2024

Introduction

Preeclampsia affects a significant percentage of pregnancies which is a leading cause of premature birth. Probiotics have the potential to affect inflammatory factors, and oxidative stress, which are linked to the development of preeclampsia. The study aimed to compare the effect of synbiotic and placebo on blood pressure and pregnancy duration as primary outcomes, and other pregnancy outcomes.

Methods

This study comprised 128 pregnant women with mild preeclampsia and gestational ages exceeding 24 weeks who were referred to the high-risk pregnancy clinic. It was a randomized, controlled, phase III, triple-blinded clinical experiment. The intervention and control groups were distributed to the participants at random. Intervention group received one oral synbiotic capsule, and control group received placebo daily until delivery. Based on gestational age at the time of diagnosis, preeclampsia was stratificated as early (< 34 weeks) or late (≥ 34 weeks). Data obtained from questionnaires, and biochemical serum factors were analyzed using SPSS software version 23 software.

Results

With the exception of the history of taking vitamin D3, there were no statistically significant variations in socio-demographic variables between the research groups. After the intervention, the means of systolic blood pressure (adjusted mean difference: -13.54, 95% CI: -5.01 to -22.07), and diastolic blood pressure (adjusted mean difference: -10.30, 95% CI: -4.70 to -15.90) were significantly lower in the synbiotic-supplemented group than in the placebo group. Compared to the placebo group, the incidence of severe PE (p < 0.001), proteinuria (p = 0.044), and mean serum creatinine level (p = 0.005) significantly declined in the synbiotic-supplemented group after the intervention. However, our analysis found no significant association for other outcomes.

Conclusion

Based on our results, synbiotic had beneficial effects on some pregnancy outcomes. Further studies with larger samples are needed to verify the advantages of synbiotic supplementation for high-risk pregnancies, particularly with regards to higher doses, and longer intervention periods.

Trial registration

IRCT20110606006709N20.
Questionable research practices of medical and dental faculty in Pakistan – a confession
Authors: Fahim Ayesha , Sadaf Aysha , Jafari Fahim Haider , Siddique Kashif , Sethi Ahsan
Published: January 2024

Purpose

Intellectual honesty and integrity are the cornerstones of conducting any form of research. Over the last few years, scholars have shown great concerns over questionable research practices (QRPs) in academia. This study aims to investigate the questionable research practices amongst faculty members of medical and dental colleges in Pakistan.

Method

A descriptive multi-institutional online survey was conducted from June-August 2022. Based on previous studies assessing research misconduct, 43 questionable research practices in four domains: Data collection & storage, Data analysis, Study reporting and Collaboration & authorship were identified and investigated. Descriptive (Frequencies, Percentages, Mean, SD) and Inferential (chi square) statistics were calculated.

Results

A total of 654 faculty members responded. Every respondent reported committing at least one QRP in their career. The most common QRPs included deliberately failing to mention funding, publishing program evaluation data not meant for research purposes or approved by an ethical body, inappropriately storing identifiable information and non-disclosure of any conflicts. There was significant association of age, gender and academic rank with QRPs in ‘Data collection and storage’ and ‘Data Analysis’ domains.

Conclusion

Medical and dental faculty members participating in this study are involved in a range of questionable research practices (QRPs) in Pakistan. Their confession might have contributed to the faculty developing self-awareness and reinforcing academic integrity. There is a need for reviewing policies and practices to improve research culture. Future research should explore the factors resulting in such practices.
Ethical dilemmas in prioritizing patients for scarce radiotherapy resources
Authors: DeBoer Rebecca J. , Ho Anita , Mutoniwase Espérance , Nguyen Cam , Umutesi Grace , Bigirimana Jean Bosco , Nsabimana Nicaise , Van Loon Katherine , Shulman Lawrence N. , Triedman Scott A. , Cubaka Vincent K. , Shyirambere Cyprien
Published: January 2024

Background

Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.

Methods

Semi-structured interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.

Results

Participants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.

Conclusions

Multiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views.
Influence of work-related stress on patient safety culture among nurses in a tertiary hospital: a cross-sectional study
Authors: Sani Mohammed Mohammed , Jafaru Yahaya , Ashipala Daniel Opotamutale , Sahabi Abubakar Kalgo
Published: January 2024

Background

One of the global issues facing the nursing profession is work-related stress because it interferes with care quality and organisational competency. These kinds of stressful situations can cause damage to the mental ability of the affected individual resulting in low job productivity. In a Nigerian healthcare setting, patient safety is under-researched.

Aim

This study aimed to assess the influence of work-related stress on patient safety culture among nurses in a tertiary hospital.

Materials and methods

The study adopted a descriptive cross-sectional survey. The Population of the study was nurses who are currently serving as employees at Federal Medical Center Birnin-Kebbi. Proportional and systematic sampling methods were used in the selection of the sample of the study. The tools used for this study were adapted Hospital Survey on Patient Safety (HSOPS) and Nurses’ Occupational Stressor Scale. Ethical approval was obtained from the research ethical committee of the hospital.

Results

The moderate stress experience was having the highest percentage (45.0%). The highest percentage of the nurses (69.9%) practised a moderate safety culture. There were weak or very weak significant negative correlations (P < 0.01) between patient safety culture practices and occupational stress across all the subscales of the nurses’ occupational stressors scale except in the occupational hazards subscale in which there was extremely weak and non-significant negative correlation. Work–family conflict was a significant predictor of patient safety culture, t (208) = -2.341, P < 0.05. Difficulty in taking leave was a significant predictor of patient safety culture, t (208) = -2.190, P < 0.05.

Conclusion

There was a significant negative correlation between stress and safety practice which implies that as stress increased safety practice decreased. These study findings can be used to develop ongoing strategies and targeted interventions in addressing work-related stress.
Occurrence and molecular characterization of Escherichia coli strains isolated from black grouse (Lyrurus tetrix) from the Karkonosze National Park in Poland
Authors: Kwaśna Natalia , Majewska Maja , Karwańska Magdalena , Siedlecka Magdalena , Pałucki Artur , Piasecki Tomasz
Published: January 2024

The purpose of this study was to characterize Escherichia coli (E. coli) strains isolated from wild black grouse (Lyrurus tetrix), carried out due to the crossing of hiking trails with wild bird habitats from the Karkonosze National Park. Twenty-seven E. coli isolates were obtained from fecal samples collected during the winter months of 2017 and 2018. The strains were assigned to their relevant phylo-groups and the prevalence of virulence genes characteristic of APEC strains (irp2, astA, iss, iucD, papC, tsh, vat, cva/cvi, stx2f) was checked using PCR analysis. In addition, the phenotypic and genotypic resistance to antibiotics was determined. The entire study provided a better understanding of the potential bacteriological threat to wild birds of the Karkonosze National Park. The results showed that 55.6% of the strains belonged to phylo-group B1 (15/27), 33.3% to group B2 (9/27) and 11.1% to group D (3/27). Among the virulence genes tested, irp2 was detected in 25.9% of isolates (7/27), vat in 22.2% (6/27) and iucD in 3.7% (1/27). The tested E. coli strains showed susceptibility to most antimicrobials, only 14 (51.9%) of them were intermediate resistant or resistant to sulfamethoxazole. The presence of none of the tested genes responsible for resistance to selected antibiotics was identified. Our research indicates a low level of transfer of antimicrobial substances to the natural environment and confirms the effectiveness of the Karkonosze National Park’s activities to protect and restore black grouse habitats.
MiR-124-3p negatively impacts embryo implantation via suppressing uterine receptivity formation and embryo development
Authors: Yao Kezhen , Kang Quanmin , Chen Kai , Shi Biwei , Jin Xiaofen
Published: January 2024

During embryo implantation, blastocyst interacts with the receptivity endometrium and the endometrial epithelium secretes nurturing fluid to support embryonic development. Interferon-λ (IFN-λ) is a novel, non-redundant regulator that participates in the fetal–maternal interaction; however, the precise molecular mechanism underlying its impact on uterine receptivity remains elusive. Here, microarray profiling revealed that 149 specific miRNAs were differentially expressed in the human endometrial cells following IFN-λ treatment. In particular, miR-124-3p expression was significantly reduced after IFN-λ treatment (p < 0.05). An in vivo mouse pregnancy model showed that miR-124-3p overexpression notably decreased embryo implantation rate and led to an aberrant epithelial phenotype. Furthermore, miR-124-3p negatively impacted the migration and proliferation of endometrial cells, and hindered embryonic developmental competence in terms of blastocyst formation and global DNA re-methylation. Downstream analysis showed that LIF, MUC1 and BCL2 are potential target genes for miR-124-3p, which was confirmed using western blotting and immunofluorescence assays. In conclusion, IFN-λ-driven downregulation of miR-124-3p during embryo implantation modulates uterine receptivity. The dual functional role of miR-124-3p suggests a cross-talk model wherein, maternal endometrial miRNA acts as a transcriptomic modifier of the peri-implantation endometrium and embryo development.
New insights on collagen structural organization and spatial distribution around dental implants: a comparison between machined and laser-treated surfaces
Authors: Belloni Alessia , Argentieri Giulio , Orilisi Giulia , Notarstefano Valentina , Giorgini Elisabetta , D’Addazio Gianmaria , Orsini Giovanna , Caputi Sergio , Sinjari Bruna
Published: January 2024

Background

One of the main factors for the osseointegration of dental implants is the development of an adequate soft tissue barrier, mainly composed by collagen, which protects the implant from bacterial development. The structural features of the peri-implant collagen are influenced by the implant components and, in particular, by the type of the surface. In the clinical practice, healing abutments are characterized by smooth surfaces, named machined. Recently, a new laser technique, Synthegra, has been developed to obtain a topography-controlled surface with micrometric regular pores that seems reducing the risk of peri-implantitis. Based on this background, this study aims investigating the structural organization and spatial distribution of collagen surrounding healing abutments characterized by laser-treated and machined surfaces.

Methods

Gingiva portions surrounding custom-made healing abutments (HA), characterized by alternated laser-treated and machined surfaces, were collected and analyzed by combining Fourier Transform InfraRed Imaging (FTIRI) spectroscopy, a non-invasive and high-resolution bidimensional analytical technique, with histological and multivariate analyses.

Results

Masson’s trichrome staining, specific for collagen, highlighted a massive presence of collagen in all the analyzed samples, evidencing a surface-related spatial distribution. The nature of collagen, investigated by the FTIRI spectroscopy, appeared more abundant close to the laser-treated surface, with a perpendicular disposition of the bundles respect to the HA; conversely, a parallel distribution was observed around the machined surface. A different secondary structure was also found, with a higher amount of triple helices and a lower quantity of random coils in collagen close to the laser treated surfaces.

Conclusions

FTIRI spectroscopy demonstrates that the use of a laser treated transmucosal surface can improve the morphological organization of the peri-implant collagen, which presents a distribution more similar to that of natural teeth.

Trial registration: This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT05754970). Registered 06/03/2023, retrospectively registered, https://clinicaltrials.gov/show/NCT05754970.
Adverse clinical outcomes and immunosuppressive microenvironment of RHO-GTPase activation pattern in hepatocellular carcinoma
Authors: Yang Qi , Zhuo Zewei , Qiu Xinqi , Luo Ruibang , Guo Kehang , Wu Huihuan , Jiang Rui , Li Jingwei , Lian Qizhou , Chen Pengfei , Sha Weihong , Chen Hao
Published: January 2024

Background

Emerging evidence suggests that Rho GTPases play a crucial role in tumorigenesis and metastasis, but their involvement in the tumor microenvironment (TME) and prognosis of hepatocellular carcinoma (HCC) is not well understood.

Methods

We aim to develop a tumor prognosis prediction system called the Rho GTPases-related gene score (RGPRG score) using Rho GTPase signaling genes and further bioinformatic analyses.

Results

Our work found that HCC patients with a high RGPRG score had significantly worse survival and increased immunosuppressive cell fractions compared to those with a low RGPRG score. Single-cell cohort analysis revealed an immune-active TME in patients with a low RGPRG score, with strengthened communication from T/NK cells to other cells through MIF signaling networks. Targeting these alterations in TME, the patients with high RGPRG score have worse immunotherapeutic outcomes and decreased survival time in the immunotherapy cohort. Moreover, the RGPRG score was found to be correlated with survival in 27 other cancers. In vitro experiments confirmed that knockdown of the key Rho GTPase-signaling biomarker SFN significantly inhibited HCC cell proliferation, invasion, and migration.

Conclusions

This study provides new insight into the TME features and clinical use of Rho GTPase gene pattern at the bulk-seq and single-cell level, which may contribute to guiding personalized treatment and improving clinical outcome in HCC.
Stress hyperglycemia increases short-term mortality in acute ischemic stroke patients after mechanical thrombectomy
Authors: Yang Bing , Chen Xuefang , Li Fangze , Zhang Junrun , Dong Dawei , Ou Huiyue , Lu Longyan , He Niu , Xu Xiaohong , Xin Xiufeng , Lu Jingchong , Guan Min , Qiao Hongyu , Xu Anding , Zhu Huili
Published: January 2024

Background and purpose

Glucose-to-glycated hemoglobin ratio (GAR) is considered a more reliable marker of stress hyperglycemia by correcting for basal blood glucose levels. This study aimed to investigate the extent to which GAR is associated with 3 month and 1 year all-cause mortalities in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT).

Methods

We retrospectively followed 553 AIS patients who underwent MT. The degree of stress hyperglycemia was quantified as the GAR, defined as fasting plasma glucose (mmol/L)/hemoglobin A1c (HbA1c) (%) on the second day after admission. According to the GAR quartiles, the patients were further categorized into four groups (group 1-group 4). We assessed the association between GAR and all-cause mortalities, clinical outcomes during hospitalization and function outcomes at 3 months. The associations between stress hyperglycemia and all-cause mortalities were analyzed using a Cox proportional-hazards model, while other outcomes were analyzed using multiple logistic regression analysis.

Results

The follow-up lasted a median of 18 months (range 0–66 months). The 3 month mortality rate was 9.58% (n = 53) and the 1 year mortality rate was 18.62% (n = 103). The Kaplan–Meier analysis revealed a significant inverse relationship between GAR and mortality (P < 0.001). In the Cox proportional-hazards model at 3 months, compared with group1, group 4 of GAR was associated with a significant increase in the risk of 3 month mortality (hazard ratio [HR] = 4.11, 95% confidence interval [CI] 1.41–12.0, P = 0.01) after adjusting for potential covariates. On multivariate logistic regression analysis, GAR was strongly associated with an increased risk of 3 month poor function outcome.

Conclusions

Stress hyperglycemia, quantified by a higher GAR, is associated with all-cause mortality and poor functional outcomes in patients with AIS who undergo MT. Furthermore, GAR may contribute to improving the predictive efficiency of all-cause mortality in patients with AIS after MT, especially short-term all-cause mortality.
RETRACTED ARTICLE: Improved RFID mutual authentication protocol against exhaustive attack in the context of big data
Authors: Li Kongze
Published: January 2024

The development of big data has epromoted the development of Internet technology, but it has brought more network security and privacy problems. Therefore, how to solve network security problems is the main research direction of current network technology development. In order to deal with the harm of network attacks to personal privacy security, this paper studies and proposes an RFID mutual authentication protocol against exhaustive attacks based on improved Hash function, and proposes a security proof based on BAN logic rules. At the same time, to enhance the computing resources of the improved protocol, this paper proposes an improved authentication query protocol for multi-source RFID tags. In the performance analysis, when the distance between the reader and the tag reaches 10 m, the improved protocol can still be higher than 90%. The application test shows that the improved protocol proposed in the study is capable of resisting exhaustive attacks, its execution time is short, and it is less affected by the number of tags. The above results show that in the context of big data, the improved RFID mutual authentication protocol proposed by the research against network exhaustive attacks has a more significant defense effect, can effectively protect user privacy, and has a greater reference value in network security research.
Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa
Authors: Heywood Lauren , Conti Janet , Touyz Stephen , Madden Sloan , Hay Phillipa
Published: January 2024

Background

Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals’ identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals’ identities were dominated or defined by AN and where alternative identities could be generated.

Method

40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions.

Results

Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants’ sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions.

Conclusion

Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as ‘an anorexic’ and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities.

Trial Registration: Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
Effects of laser cleaning on the condition of different silk model samples using varying wavelengths and pulse durations
Authors: Brockmann Nora , Sicken Anne , Krüger Jörg
Published: January 2024

The cleaning of aged silk fibers poses a common challenge in the conservation of textiles, since traditional cleaning techniques often yield unsatisfactory results or even harm objects. In this regard, cleaning objects with laser radiation is a promising addition to the range of available methods. Due to it being contactless, even brittle and touch-sensitive objects with disfiguring or harmful soiling could potentially be cleaned and therefore made accessible for research and presentation. Examples of treatment have sometimes shown spectacular results. Still there is some skepticism concerning the safety of this treatment for textile materials, which has been strengthened through previous 532 nm wavelength nanosecond laser cleaning studies on silk fibers. Taking these published results into account, the range of examined laser parameters has been extended in this study, from 532 nm nanosecond laser to 1064 nm nanosecond and even 800 nm femtosecond laser, reevaluating the effect of this treatment on the fibers. The physicochemical processes taking place on the silk fibers when cleaning with lasers are complex and still not fully understood. The aim of this project was therefore to bring more clarification about potential effects of those processes on the condition of silk samples treated with a set of different parameters for wavelength, pulse duration, energy density and number of pulses per spot. It also looks at the influence of the presence of soiling on the results. The analysis of potential effects was then carried out using statistical methods and advanced analytics. Scanning electron microscopy, Fourier-transform infrared spectroscopy and colorimetry technology provided the required insights to better assess the effects. Results show that laser cleaning of silk fibers, like most other conventional cleaning techniques, is not completely without risk, but knowing what the possible effects are helps making decisions on whether the benefits of the technique used justify these risks.
Assessment of interleukin 6 (IL-6) as a marker of inflammation among adult patients with pulmonary tuberculosis in Zaria, Nigeria
Authors: Sa’ad Mairiga , Abba Abdullah A. , Musa Bolanle Olufunke Priscilla , Ahmad Abdurrahman El-fulaty , Mohammed Musa
Published: January 2024

Tuberculosis (TB) remains a significant cause of morbidity and mortality worldwide. Complications of the disease are associated with the host’s inflammatory response. The study aimed to determine the plasma level of interleukin-6 as a biomarker of inflammation among adult patients with pulmonary tuberculosis in Zaria.

Method This was a cross-sectional study. Blood samples were taken from 30 treatment-naïve (TN), 30 treatment-experienced (TE), and 30 healthy controls (HC).

Results The means and standard deviations of interleukin-6 plasma levels for tuberculosis treatment naive, treatment experience and apparently healthy control are 64.4 ± 19.4, 57.9 ± 21.4, and 49.9 ± 7.7 pg/L, respectively. This study found upregulated plasma levels of interleukin-6 among treatment naive compared to treatment experience but the statistically not significant and significantly upregulated level of interleukin 6 among treatment naïve compared to apparently healthy control (p = 0.006). There was a downregulated level of interleukin-6 among HC compared to TN and TE but statistically not significant.

Conclusion The role of interleukin-6 as a surrogate biomarker for the management of patients with pulmonary tuberculosis is promising but requires further study.
Association of Medicaid Privatization With Patient Cancer Outcomes
Authors: Sunkara Pranit R. , Waitzman Jacob , Lenze Nicholas R. , Brenner Michael J. , Cramer John D.
Published: January 2024

PURPOSE

Increasingly, states outsource administration of Medicaid insurance to privately administered Medicaid managed care organizations. However, on January 1, 2012, Connecticut transitioned from a privately to publicly administered Medicaid system. New Jersey retained a private model.

METHODS

Our objective was to assess rates of early-stage cancer diagnosis and cancer survival in two states with similar sociodemographic characteristics but differing exposures to Medicaid privatization. Using data from the SEER Program between 2007 and 2016, Connecticut and New Jersey Medicaid patients with 10 common solid cancers including breast, lung, colorectal, prostate, kidney, bladder, cervix, uterus, head and neck cancer, and melanoma were included. A difference-in-differences analysis of stage of cancer presentation and cancer survival in Connecticut (intervention) was compared with New Jersey (control).

RESULTS

Among 29,328 patients (14,424 patients from Connecticut and 14,904 patients from New Jersey) parallel trends were verified in early cancer diagnosis and survival for both states under privately administered Medicaid (pre-exposure). Connecticut's transition from privately to publicly administered Medicaid was associated with an adjusted 4.0% increase in overall early-stage cancer diagnosis (95% CI, +1.7% to +6.2%) and a 4.7% increase in early-stage cancer diagnosis for cancers with US Preventive Services Taskforce A/B recommendations for cancer screening (95% CI, 1.6% to 7.8%). Public administration of Medicaid was also associated with improved overall survival after cancer diagnosis (hazard ratio, 0.92 [95% CI, 0.85 to 0.99]). No changes were observed in New Jersey.

CONCLUSION

Transition from private to public administration of Medicaid in Connecticut was associated with earlier-stage cancer diagnosis and improved cancer survival.
Establishing Regionalized Acute Care Across a Health Care System to Decentralize Postoperative Care After Oncologic Surgery
Authors: Brauer David G. , Gonen Mithat , Drebin Jeffrey A. , Groeger Jeffrey S. , Jewell Elizabeth L.
Published: January 2024

PURPOSE

Patients undergoing oncologic surgery at major referral centers frequently experience postdischarge care fragmentation, which has been associated with poor outcomes. This report describes and evaluates the outcomes of an intervention at Memorial Sloan Kettering Cancer Center (MSKCC) to decentralize postdischarge postoperative acute care within our health care system.

METHODS

In 2018, MSKCC completed the addition of six regional acute care clinics called symptom care clinics (SCCs) to existing regional outpatient clinics. Acute care was previously only available within our system at a single centralized urgent care center (UCC). All patients undergoing surgery in our system between January 1, 2019, and June 30, 2021, were followed for 90 days. The exposure was the site of initial acute care presentation—UCC or SCC—and outcomes included utilization, access, financial toxicity, and mortality. Mortality was adjusted using hierarchical modeling at the level of the region.

RESULTS

A total of 6,992 postsurgical patients experienced 10,525 acute care visits in our system within 90 days of surgery. Twenty-nine percent of these patients presented to the SCC first. These patients were older but had fewer comorbidities and shorter index length of stay compared with UCC patients. Utilization of SCCs increased substantially while UCC utilization decreased during a period of stable case volume. SCCs were closer to patients' homes, and wait times were shorter. Rates of financial toxicity were similar between groups. Of this high-risk cohort accessing acute care postoperatively, 90-day mortality was similar for UCC and SCC patients ( P = .731).

CONCLUSION

This model of decentralized acute care after oncologic surgery was increasingly used over time with comparable patient safety. Health systems should emphasize patient-centered care by supporting safe strategies for regionalized care even when treatments are delivered at centralized referral centers.
Liquid Biopsy of Lung Cancer Before Pathological Diagnosis Is Associated With Shorter Time to Treatment
Authors: Russo Alessandro , Lee Jessica K. , Pasquina Lincoln W. , Del Re Marzia , Dilks Holli H. , Murugesan Karthikeyan , Madison Russell W. , Lee Yi , Schrock Alexa B. , Comment Leah , Dietrich Martin , Oxnard Geoffrey R. , Rolfo Christian
Published: January 2024

PURPOSE

Studies have investigated the early use of liquid biopsy (LBx) during the diagnostic workup of patients presenting with clinical evidence of advanced lung cancer, but real-world adoption and impact has not been characterized. The aim of this study was to determine whether the use of LBx before diagnosis (Dx; LBx-Dx) enables timely comprehensive genomic profiling (CGP) and shortens time until treatment initiation for advanced non–small-cell lung cancer (aNSCLC).

MATERIALS AND METHODS

This study used the Flatiron Health-Foundation Medicine electronic health record-derived deidentified clinicogenomic database of patients with aNSCLC from approximately 280 US cancer clinics.

RESULTS

Of 1,076 patients with LBx CGP ordered within 30 days prediagnosis/postdiagnosis, we focused on 56 (5.2%) patients who ordered LBx before diagnosis date (median 8 days between order and diagnosis, range, 1-28). Compared with 1,020 patients who ordered LBx after diagnosis (Dx-LBx), LBx-Dx patients had similar stage and ctDNA tumor fraction (TF). LBx-Dx patients received CGP results a median of 1 day after Dx versus 25 days for Dx-LBx patients. Forty-three percent of LBx-Dx were positive for an National Comprehensive Cancer Network driver, and 32% had ctDNA TF >1% but were driver negative (presumed true negatives). In 748 patients with previously untreated aNSCLC, median time from Dx to therapy was shorter in the LBx-Dx versus Dx-LBx group (21 v 35 days; P < .001).

CONCLUSION

Early LBx in anticipation of pathologic diagnosis of aNSCLC was uncommon in this real-world cohort, yet this emerging paradigm was associated with an abbreviated time to CGP results and faster therapy initiation. Forthcoming prospective studies will clarify the utility of LBx in parallel with biopsy for diagnostic confirmation for patients presenting with suspected advanced lung cancer.
Biographies in the Album: Reading Lives between the Lines
Authors: Ridley Glynis
Published: January 2024

Is it possible to use an album's contents to construct a narrative about the interpersonal relationships between those who signed and dated their transcriptions? A flea-market purchase of an album bearing poetry transcriptions in multiple hands, all signing from 1824 to 1827, and most from a single Dublin address, made me curious about the album's creator, Thomasina Newcomen, and the circumstances surrounding the creation of her album. In tracing the album's signatories in the archives, I discovered that the entries reflected both the personal story of a teenage courtship and also national questions regarding Anglo-Irish relations in the early nineteenth century. Is it time for a poetics of the album as a distinct form, that recognizes the possibility of the interrelation of transcribers’ entries, and the many stories that may be written between the lines?
Manuscript Devotional Culture in Eighteenth-Century English Convents: A Case Study
Authors: Myers Joanne E.
Published: January 2024

This article examines the manuscript practices of Sister Cecily Joseph (Elizabeth) Cornwallis, an Englishwoman and Poor Clare sister who served as the scrivener for her Rouen convent from 1688 to 1737, when she created many beautiful and eclectic prayer books for the use of her order. These prayer books, I argue, constitute a form of “devotional authorship” that registers authorial presence while paradoxically effacing the author, through the devotion that the books both facilitate and enact. To give context for this analysis of Sister Cecily Joseph's work, I survey the broad outlines of the “bookscape” of the Poor Clare convents founded in the seventeenth century on the Continent to allow young English women to pursue a religious vocation that was proscribed at home. Typical of the broader book culture of continental English convents at the time, the libraries of the Poor Clares included not only printed works but also numerous manuscripts—many of them translations—that fostered a devotional culture drawing on diverse strands of continental Catholicism. Sister Cecily Joseph's prayer books, often highly miscellaneous in their contents, shed light on how manuscripts were used to cultivate a dynamic devotional life in the English convents.
“Where Are Your Books?”: William Wordsworth's Commonplaces
Authors: Chema Alexis
Published: January 2024

In this essay, I will analyze William Wordsworth's commonplace book, DC MS26, alongside his poetic and critical statements on the idea of the commonplace in order to reevaluate his stance on book reading, especially on the role of books in rural life. Although his actual commonplace book is relatively sparse, including several dozen entries made over an eight-year period, it illuminates a profound curiosity about the figurative affordances of commonplace books. In the Essays upon Epitaphs, his longest and most sustained work of literary criticism, Wordsworth develops a deeply textual model of rural community enabled by the idea that the country churchyard is a kind of commonplace book. With its collection of homely epitaphs accessible to anyone who visits, the country churchyard emblematizes a mode of bookishness unalienated from rural life.
“To Repulse the State from Our Uteri”
Authors: Beswick Spencer
Published: January 2024

This article analyzes how anarcha-feminists in the United States critiqued the state and attempted to build feminist dual power in response to the New Right’s attacks on reproductive freedom. Anarcha-feminists in the Love and Rage Revolutionary Anarchist Federation (1989–98) argued that petitioning the state for reproductive rights was a dead end because, as their political statement put it, patriarchy “operates as a foundation of state power, used to justify a paternalistic relationship between the rulers and the ruled.” Anything the state gives—including Roe v. Wade—can be taken away, for it is ultimately a tool of sexual and class violence in the hands of the patriarchal, capitalist ruling class. Building on the legacy of anarcha-feminists in the women’s liberation movement, Love and Rage argued that the only way to guarantee reproductive freedom was to struggle for autonomy against the state rather than reform within it. This article explores how anarcha-feminists sought to build grassroots infrastructure, knowledge, and organizations with an orientation toward establishing feminist dual power. Ultimately, Love and Rage argued, the only way to guarantee reproductive freedom and women’s liberation is the revolutionary construction of a libertarian socialist society.
Behavioral Responses to State Income Taxation of High Earners: Evidence from California
Authors: Rauh Joshua , Shyu Ryan
Published: January 2024

Using administrative data, we analyze the response to Proposition 30, a 2012 measure that increased California marginal tax rates by up to 3 percentage points for high-income households. Relative to baseline departure rates, an additional 0.8 percent of the residential tax base that landed in the top bracket left California in 2013. Using matched out-of-state taxpayers as controls reveals an income elasticity with respect to the marginal net-of-tax rate of 2.5–3.2 for high earners who stayed. These responses eroded 45.2 percent of state windfall tax revenues within the first year and 60.9 percent within 2 years, driven largely by the intensive margin. (JEL D91, H24, H31, H71, H73, J61, R23)