bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness, barriers, and facilitators of interventions delivered by traditional healers for the treatment of common mental disorders: A systematic review
Authors: Bhatti Mujeeb Masud , Siddiqi Najma , Jennings Hannah , Afaq Saima , Arsh Aatik , Khan Bilal Ahmed
Published: September 2024

We investigated the effectiveness of interventions provided by traditional healers for common mental disorders (CMDs) together with associated barriers and facilitators. Electronic databases including MEDLINE, APA Psych Info, Allied and Complementary Medicine, Embase, CINAHL, Social Science Citation Index, and Scopus were searched from inception until October 2021. Randomised controlled trials (RCTs) assessing interventions by traditional healers for CMDs and qualitative and mixed-methods studies examining traditional healers and their attendees’ views about the treatment of CMDs by traditional healers were included. Cochrane Risk of Bias Assessment tool (RoB-1) and Critical Appraisal Skills Programme (CASP) were used for the quality assessment of studies. A meta-analysis and thematic synthesis were conducted. Sixteen RCTs (1,132 participants) and 17 qualitative or mixed-methods studies (380 participants) were included. Improvement in symptoms was greater for interventions by traditional healers compared to control groups for both depression and anxiety. Subgroup analyses indicated that only “spiritual passe” interventions showed improvement in depression and anxiety, and participants with co-morbid anxiety and physical conditions showed improvement in anxiety. Facilitators to engaging with interventions by traditional healers were shared faith-based worldview exhibited by traditional healers and their attendees and perceived effectiveness of traditional healing. Stigma and concealing mental illness were found to be barriers not only to formal healthcare but also to traditional healers’ services. Interventions by traditional healers such as “spiritual passe” are effective in improving CMDs. However, evidence is still limited due to the low quality of studies and lack of long-term evidence.
Semi-Markov process-driven maintenance scheduling for Tainter gate system considering multiplelimit states
Authors: Thedy John , Liao Kuo-Wei , Hung Yi-Ting
Published: September 2024

In extended periods of operation, Taiwan’s reservoir electromechanical systems increasingly require substantial maintenance. This research adopts the semi-Markov process, which accommodates non-exponential distribution of state durations, to formulate optimal maintenance strategies for Tainter gate systems that are noted for their prolonged dormancy and significant operational uncertainties. The methodology initiates with the estimation of failure probabilities across four condition states, analyzing deterioration through the Weibull distribution for both general and latent limit states. The general limit state accounts for time-induced deterioration and effects of dormancy using a Bayesian–Weibull first-order reliability method, while the latent limit state addresses activation failures. Employing the semi-Markov process, an annual transition matrix is computed and combined with failure probabilities to assess the Tainter gates’ system reliability. To identify the most efficient maintenance schedule, a genetic algorithm is applied, targeting the minimization of failure probabilities for both limit states below predefined thresholds and cost reduction. Numerical simulations validate the framework’s efficacy, demonstrating its potential to enhance maintenance planning objectivity and decrease dependence on subjective assessments. The findings highlight the predominance of the general limit state in dictating system failure and underscore the risk Tainter gates face during transition from dormancy to activation, emphasizing the need for thorough monitoring.
Participation Strategies Used by Young People With and Without Physical Disabilities
Authors: Ornella Andrianantenaina , Nikol Baladzhanov , Lauriane Germain , Lyndsay Schneidman , Saeideh Shahin , Dana Anaby
Published: September 2024

Participation strategies used by young people (YP) are understudied. This study aimed to identify strategies used by YP with and without physical disabilities to promote participation at home, school, community, and workplace. In this qualitative descriptive study, 106 participants ages 12 to 30 ([Formula: see text] = 22.7) years, with ( n = 52) and without ( n = 54) physical disabilities, reported up to three strategies to facilitate their participation in four settings using the Youth, Young-Adult Participation and Environment Measure. A total of 1,235 strategies were analyzed using inductive content analysis. As a result, 11 categories emerged; seven were environment-focused and four were person-focused. Both groups used time management, built on intrinsic factors, and utilized social support across all settings. At school, those with disabilities uniquely benefited from accommodative institutional environments. They also reported more strategies involving advocacy, analyzing a situation, and seeking accommodative physical and social environments. The findings illustrate a range of participation strategies YP use that may inform ways to promote participation more effectively.
Reversal of Bone Mineral Density Loss Through Lifestyle Changes: A Case Report
Authors: Potashkin Judith A. , Kim Namhee
Published: September 2024

Approximately 10 million individuals in the United States have osteoporosis and 44 million have low bone mineral density which puts them at risk for bone breaks. This presents a large burden on our health care system since about one-quarter of hip fracture patients never regain full function, need nursing care, and, for those over age 50, 24% die within one year. Oral bisphosphonates are often used as first-line therapy for the treatment of osteoporosis; however, patients frequently experience significant side effects. In addition, bisphosphonates inhibit bone loss by initiating apoptosis in osteoclasts that remove old bone, thus allowing old bone to accumulate and slowing the activity of osteoblasts that create new bone, thereby affecting bone quality. As an alternative, a bone-friendly lifestyle, including calcium and vitamin D consumption, exercise, smoking cessation, and a decrease in alcohol intake, may reduce bone loss. This case report describes lifestyle changes that included diet and exercise that increased bone mineral density in two years in a post-menopausal woman with no negative side effects.
Teaching with wonder: Engaged pedagogy and attentive listening
Authors: Ramos Fabiane , Roberts Laura
Published: September 2024

Reflecting, in dialogue, this paper revisits and extends our thinking on wonder as feminist pedagogy, a pedagogy which opens space for critical self-reflection and critical intellectual and embodied engagement to emerge in the classroom. Wonder as feminist pedagogy brings together our teaching experiences with a philosophical engagement of feminist and decolonial theory aiming to articulate and challenge dominant western discourses of knowledge production undergirded by the logic of the Cartesian cogito and its illusory neutrality. In this current paper we theorise how our praxes have developed in response to new teaching contexts, cohorts and the global pandemic. We undertake what Sara Ahmed calls feminist homework, feminist theorising guided by the philosophical lessons and encounters of the everyday, and, using this lens, we extend our thinking to consider bell hooks’ work on engaged pedagogy and teachers’ self-actualisation alongside Luce Irigaray’s work on listening and ethical co-existence. Guided by this work, we argue that we need to learn to reconceptualise the issues we are facing, which ultimately requires a challenge to colonial Cartesian logics and a reimagining of the Human as always-in-relation.
Survival predictors in patients with pancreatic cancer on liposomal irinotecan plus fluorouracil/leucovorin: a multicenter observational study
Authors: Keum Jiyoung , Lee Hee Seung , Park Chan Su , Kim Jeehoon , Jang Wonjoon , Shin Kyung In , Kang Huapyong , Lee Sang Hoon , Jo Jung Hyun , Jang Sung Ill , Chung Moon Jae , Park Jeong Youp , Park Seung Woo , Cho Jae Hee , Bang Seungmin
Published: September 2024

Background:

Approximately half of the patients with advanced pancreatic ductal adenocarcinoma (PDAC) receive subsequent lines of chemotherapy. Recently, the liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) regimen is recommended as subsequent lines of chemotherapy. However, little is known about the predictive factors for the nal-IRI + 5-FU/LV regimen, especially in patients with previous irinotecan (IRI) exposure.

Objectives:

We investigated the predictive factors associated with nal-IRI + 5-FU/LV treatment in patients with PDAC.

Design:

Multicenter, retrospective cohort study.

Methods:

This study included patients with advanced PDAC who received the nal-IRI + 5-FU/LV regimen for palliative purposes.

Results:

Overall, 268 patients were treated with nal-IRI + 5-FU/LV. The median overall survival (OS) was 7.9 months (95% confidence interval (CI): 7.0–8.8), while the median progression-free survival (PFS) was 2.6 months (95% CI: 1.9–3.2). An albumin level of<4.0 g/dL, neutrophil-to-lymphocyte ratio (NLR) of ⩾3.5, liver or peritoneal metastasis, and a history of >3 lines of palliative chemotherapy were associated with worse OS. An NLR of ⩾3.5 and liver metastasis were significant predictive factors for worse PFS. Previous exposure to IRI was not a significant predictor. Patients without prior IRI (no-IRI) treatment showed relatively longer OS and PFS compared to IRI responders and nonresponders, but these differences were not significant when compared specifically to the responders (OS: 8.8 vs 8.1 months, p = 0.388; PFS: 3.6 vs 2.6 months, p = 0.126).

Conclusion:

An NLR of ⩾3.5 and liver metastasis were associated with worse PFS. Prior IRI exposure was not a significant predictive factor for OS and PFS, especially in IRI responders.
The future of work: A centre–right perspective
Authors: Hefele Peter
Published: September 2024

‘The end of work’—the vision of large-scale unemployment due to technological progress—has been discussed since the 1970s. But only now can economic growth be imagined as decoupled from the supply of labour. ‘Work’ as a defining category and organisational principle of modern industrial societies seems to be disappearing, with massive impacts not only on value creation and distribution, but also on social cohesion and human self-esteem. This article proposes a renewed and comprehensive understanding of work which goes beyond the view of work as purely a factor of production, to prepare European societies for the next phase of economic modernisation and societal change.
A Case Report of Systemic Lupus Erythematosus Presenting as Isolated Mononeuropathy Multiplex
Authors: Andreoli Mia , Hollenhorst Cecilia N. , Malavia Tulsi , May Jasmine L. , Priyadarshini Shubadra , Seth Arjun , Dixit Karan
Published: September 2024

Mononeuropathy multiplex is a pattern of progressive sensory and motor deficits in the distribution of two or more peripheral nerves. The differential for mononeuropathy multiplex includes vasculitis, autoimmune disorders, infectious diseases, sarcoidosis, amyloidosis, cryoglobulinemia, and paraneoplastic disease. We present a case of a 42-year-old woman with hypothyroidism who presented with 1 week of ascending numbness and weakness, persistent fevers, and 3 months of constant burning pain in both feet. Her neurologic exam was notable for asymmetric weakness, loss of sensation, and diminished reflexes of her lower extremities. Other than mild fever and tachycardia, there were no systemic exam findings. Her laboratory workup was significant for elevated inflammatory markers, positive ANA, anti-ribonucleoprotein, smooth muscle antibody, and lupus anticoagulant, high anti-dsDNA titers, and low complement levels. An MRI of her lumbar spine was negative for lumbosacral nerve root pathology. Cerebrospinal fluid studies demonstrated normal cell counts, glucose, and protein and no evidence of infection. An electromyography (EMG) and nerve conduction studies (NCS) demonstrated asymmetric involvement of multiple individual peripheral nerves. Given the patient’s symptoms, asymmetric exam findings, laboratory results, and EMG/NCS findings, she was diagnosed with mononeuropathy multiplex secondary to systemic lupus erythematosus (SLE) and started on steroid and immunosuppressant therapy with symptomatic improvement. Overall, this case illustrates the unique presentation of mononeuropathy multiplex as the initial manifestation of SLE. The identification of this specific type of neuropathy may play a crucial role in the prompt diagnosis of SLE and timely initiation of treatment, preventing further complications of the disease.
Targeting ROS in osteoclasts within the OA environment: A novel therapeutic strategy for osteoarthritis management
Authors: Jeon Seungho , Min Kim Tae , Kwon Gitae , Park Junyoung , Park Sung Young , Lee Seoung Hoon , Jin Eun-Jung
Published: September 2024

This study investigated the therapeutic potential of a manganese dioxide-polymer dot (MnO2-PD)-incorporated hydrogel, designated as M-PD hydrogel, for modulating reactive oxygen species (ROS) within the osteoarthritis (OA) environment. Our research highlights the ability of the hydrogel to scavenge ROS, thereby influencing the differentiation of osteoclasts and protecting chondrocytes, offering a novel approach to osteoarthritis (OA) management. Our results indicated that the M-PD hydrogel increased electrical resistance and fluorescence recovery in the presence of osteoclasts, correlating with decreased ROS levels and suppressed expression of osteoclast differentiation markers. Coculture experiments revealed the protective effects of the hydrogel on chondrocytes by reducing the expression of matrix-degrading enzymes. In vivo application in burr holes and/or OA-induced mice revealed a significant reduction in osteoclast formation and cartilage destruction, suggesting the dual therapeutic action of the hydrogel in altering the joint microenvironment. These findings highlight the potential of targeting ROS in osteoclasts as a comprehensive therapeutic approach, offering not only symptomatic relief but also targeting the underlying mechanisms of disease progression in OA.
Reparations of the horse? Algorithmic reparation and overspecialized remedies
Authors: Doyle Colin , Alvarez-Garcia Melissa , Tracey Pelle , Grill Gabriel , Whitney Cedric , Chambers Lauren M
Published: September 2024

In his seminal article, “Cyberspace and the Law of the Horse,” Frank Easterbrook criticized the scholarly trend of developing overspecialized legal approaches to emerging technologies. Easterbrook argued that these approaches are confusing, shallow, and superfluous. Algorithmic reparation has emerged as a framework for addressing algorithmic systems’ role in inequity and injustice. One understanding of algorithmic reparation is as a method for repairing algorithmic harms. This article examines how this understanding fares against the “law of the horse” critique by posing two questions. First, is algorithmic reparation overspecialized in its methods? Second, is algorithmic reparation overspecialized in the harm it targets? If its methods are too particularized, then algorithmic reparation will only work within a narrow range of circumstances and may undercut a more robust conception of remedies for algorithmic injustice. If the harm it targets is too particularized, then algorithmic reparation will result in incomplete or misguided redress of harms. We determine that algorithmic reparation is not too specific in its methods by demonstrating how–under algorithmic reparation principles–existing methods for reparations can be applied to address algorithmic harm. We also determine that algorithmic reparation can sometimes be too narrow in the harm it targets, which can reduce its effectiveness. When an algorithmic system is both necessary and sufficient for a harm to occur, algorithmic reparation is an effective method of redress. But when an algorithmic system is not necessary and sufficient for a given harm, algorithmic reparation may be incomplete, only temporarily effective, or miss the mark entirely.
Navigating healthier beverage consumption in adolescents using the “R-Ma Bot” chatbot: A usability and evaluation study
Authors: Lee Jisu , Lee Hyeonkyeong , Lee Hyeyeon
Published: September 2024

Objective

This pilot study aimed to evaluate the usability and effectiveness of a behavior change technique (BCT)-based chatbot developed to promote healthier beverage consumption among adolescents.

Methods

The Read and Manage your health roBot (“R-Ma Bot”), designed with 13 BCTs, was tested with 42 adolescents (13 men, 29 women, mean age 15.0 ± 0.7) for 2 weeks. Usability was assessed after the 2-week intervention using a chatbot usability questionnaire, recruitment, retention, participation, and engagement. Scores above 70 out of 100 were considered high usability. Qualitative data from open-ended questions were collected for evaluation. Effectiveness was measured by changes in knowledge, use and impact of nutrition labels, and weekly consumption of sugar, sodium, and caffeine from carbonated and/or energy drinks before and after the 2-week intervention.

Results

The score of R-Ma Bot's usability averaged 74.7, with participants addressing it useful, friendly, and easy to use, though they suggested improving unnatural conversation flow. All participants engaged with the chatbot for at least 13 out of 14 days, with over half using it daily for the entire period. After intervention, awareness of nutrition labels increased from 64.3% to 92.9%, and nonreaders decreased from 42.9% to 16.7%. Weekly sugar intake from beverages significantly decreased by 60%, from 13.1 ± 20.1 mg to 7.9 ± 12.8 mg.

Conclusions

R-Ma Bot's high usability contributed to high retention and behavioral changes, significantly reduced sugar consumption from beverages and improved awareness of nutrition labels. We suggest integrating strategies that enhance knowledge, motivation, and opportunities through BCTs with youth-friendly design elements in the development of interventions for adolescents.
End-of-life conversations when transitioning to end-of-life care in residential care: A web-based questionnaire survey of registered nurses’ expressed experiences
Authors: Edvardsson Marie , Forsbo Jessica , Gustafsson Lena-Karin , Söderman Mirkka
Published: September 2024

Older individuals within residential care (RC) may have palliative care needs that intensify along the path of their illness to death. An end-of-life (EOL) conversation follows when transitioning from one care to another, to plan for future care, to consider the patient's wishes, and to avoid unnecessary suffering for both patient and family. The aim of this study was to describe registered nurses’ (RNs) experiences of EOL conversations when transitioning to EOL care in RC. The design of this study was a survey study with questionnaire data from RNs working in RC ( n = 71), analyzed with descriptive statistics and using qualitative content analysis. This study is reported in accordance with the COREQ checklist. Three main categories and seven subcategories were identified. The first category was ‘Deficiencies in EOL conversations’ with the subcategories ‘EOL conversations at too late a stage’ and ‘Physicians’ absence in collaboration concerning EOL conversations’. The second category was ‘Nurse’s role in EOL conversations’ with the subcategories ‘Initiate EOL conversations’, ‘Cohesive link between stakeholders concerning EOL conversations’, and ‘Carry out EOL conversations’. The third category was ‘Family involvement in end of life’ with the subcategories ‘Family members’ participation in EOL conversation’ and ‘Unrealistic expectations at EOL conversation’. RNs at RC take a great responsibility regarding EOL conversations by often both initiating and carrying out the conversations. Such conversations need to be initiated at an early stage to enable patients to receive information or express their own wishes, and to have time to create good relationships with family members so they feel informed and involved.
Fostering Women Entrepreneurs: Exploring the Drivers of Successful Social Commerce Business Adoption Among Women
Authors: Al Omoush Khaled Saleh
Published: September 2024

This study explores the determinants that contribute to the successful adoption of social commerce businesses among women, including entrepreneurial mindset, perceived value, social commerce literacy, and collaborative ecosystems. It also explores the potential impact of collaborative ecosystems and the successful adoption of social commerce businesses on women’s entrepreneurship. Targeting 223 women who are actively involved in social commerce businesses, data was analyzed using Smart PLS software. The results indicate that entrepreneurial mindset, perceived value, social commerce literacy, and collaborative ecosystems significantly impact the successful adoption of social commerce business among women. Furthermore, the study also found that the successful adoption of social commerce businesses and collaborative ecosystems has a significant impact on women’s entrepreneurship. This study contributes to the literature and theory of social commerce adoption, women entrepreneurship, and collaborative ecosystems in several ways. It makes a valuable contribution to social commerce theory by spotlighting the intricate interplay among diverse factors that collectively shape the successful adoption of social commerce ventures among women. The study’s findings also hold significant implications for a range of stakeholders, encompassing practical insights that can instigate positive transformations and enrich the realm of social commerce business and women’s entrepreneurship.
The Theory of Emerging Adulthood in Latin America: A Scoping Review
Authors: Muñoz Carreño Nelson , Cova Solar Félix , Sánchez-Queija María Inmaculada , Díez López Marta
Published: September 2024

The existence of a new distinctive stage in the human life cycle, known as “Emerging Adulthood (EA),” is a subject of great discussion and research. The emergence of this stage is attributed to sociodemographic transformations in recent decades, resulting in the prolongation of the acquisition of adult roles, especially in high-income countries. The relevance of the theory of EA in middle- and low-income countries is less clear. The main objective was to analyze the studies conducted to date on the theory of EA in Latin America. Results showed that most of the publications are quantitative and revealed that Brazil, Chile, Argentina and Mexico are the countries that most publications. The most studied topics are identity and developmental transition. Pending challenges include involving more Latin American countries, increasing collaborations, establishing connections with public policies, and incorporating a critical perspective in the conceptualization of the theory of EA in Latin America.
K-Line Tilt May Influence the Short-Term Surgical Outcomes After Laminoplasty in Patients With Degenerative Cervical Myelopathy
Authors: Duan Qifei , Zhuang Jianxiong , Huang Shuaihao , Zheng Xiaoqing , Wang Xiaoping , Chang Yunbing
Published: September 2024

Study Design

A retrospective study.

Objectives

To explore the relationship between K-line tilt and short-term surgical outcomes following laminoplasty in patients with multilevel degenerative cervical myelopathy (DCM), and to evaluate the potential of K-line tilt as a reliable preoperative predictor.

Methods

A retrospective analysis was performed for 125 consecutive patients who underwent laminoplasty for multilevel DCM. The radiographic parameters utilized in this study encompassed T1 slope (T1S), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope minus C2-C7 lordosis (T1S-CL), C2-C7 range of motion (ROM), and K-line tilt. The neurological recovery was evaluated using the Japanese Orthopaedic Association (JOA) score. Pearson correlation coefficients were calculated to assess the relationship between K-line tilt and other classical cervical parameters. Logistic regression analysis was employed to examine the association between K-line tilt and surgical outcomes.

Results

Of the 125 patients, 89 were men. The mean age of the patients was 61.74 ± 11.31 years. The results indicated a correlation between the K-line tilt and the cSVA ( r = 0.628, P < 0.001), T1S ( r = 0.259, P = 0.004), and T1S-CL ( r = 0.307, P < 0.001). The K-line tilt showed an association with the failure of the JOA recovery rate (RR) to reach the minimal clinically important difference (MCID) and the occurrence of postoperative kyphotic deformity. We identified cutoff values for the K-line tilt which predict the failure of the JOA RR to reach the MCID and postoperative kyphotic deformity as 10.13° and 9.93°, respectively.

Conclusions

The K-line tilt is an independent preoperative risk factor associated with both the failure of the JOA RR to reach the MCID and the occurrence of postoperative kyphotic deformity in patients with multilevel DCM after laminoplasty.
The Silent Band: Laparoscopic Adjustable Gastric Band Erosion as an Incidental Finding During Endoscopy
Authors: Bathobakae Lefika , Varadi Tiffany , Bashir Rammy , Koodirile Atang , Yuridullah Ruhin , Amer Kamal , Cavanagh Yana
Published: September 2024

Laparoscopic adjustable gastric banding (LAGB) is a bariatric procedure that was introduced in the early 1990s and offers a minimally invasive and reversible option for weight loss. Initially popular due to its simplicity and effectiveness, LAGB’s long-term success has been limited by complications such as port-site infection, pouch dilatation, and gastric band erosion. Herein, we describe a rare case of gastric band erosion found incidentally during endoscopy a decade after placement. The eroded band was successfully removed using a combined endoscopic and laparoscopic approach.
The State of Sex Education in Pakistan: The Way Forward
Authors: Bilal Ahmad , Leygraf Bernd
Published: September 2024

Sex education has been found to be associated with informed sexual decision making and enhanced sexual well-being. But in Pakistan, sex education has been remained a subject of taboo and stigma and has been associated with a number of myths. This article tries to discuss the current state of sex education in Pakistan by justifying the need for the sex education and uncovering the factors responsible for the non-implementation of sex education on mass level in Pakistan. Two major factors considered responsible for a lack of implementation of sex education are several myths associated with the sex education and portrayal of sex education as fundamentally non-Islamic. This article analyzes the scientific validity of several myths associated with the sex education and proposes that sex education is not against the Islamic traditions and values. The sex education needs to be embedded in existing cultural and educational setup of Pakistan so that it may be accepted. This study highlights the comprehensive nature of United Nations Educational, Scientific and Cultural Organization (UNESCO) guidelines in the development and implementation of sex education and explores the implementation of sex education under the umbrella of Life Skills Based Education (LSBE) developed by the School Education and Literacy Department of Government of Sindh. This article further proposes steps to implement LSBE on mass level by involving parents, religious leaders, teachers, provincial education boards, and universities. It is further suggested that LSBE should be delivered as part of traditional educational system in a step by step manner and should be in accordance with the cultural norms of Pakistan.
Outcomes in patients with ETV6::RUNX1 or high-hyperdiploid B-ALL treated in the St. Jude Total Therapy XV/XVI studies
Authors: Purvis Katelyn , Zhou Yinmei , Karol Seth E. , Rubnitz Jeffrey E. , Ribeiro Raul C. , Lee Shawn , Yang Jun J. , Bowman W. Paul , Wang Lu , Dixon Stephanie B. , Roberts Kathryn G. , Gao Qingsong , Cheng Cheng , Mullighan Charles G. , Jeha Sima , Pui Ching-Hon , Inaba Hiroto
Published: September 2024

Children with ETV6::RUNX1 or high-hyperdiploid B-cell acute lymphoblastic leukemia (B-ALL) have favorable outcomes. The St. Jude (SJ) classification considers these patients low risk, regardless of their National Cancer Institute (NCI) risk classification, except when there is slow minimal residual disease (MRD) response or central nervous system/testicular involvement. We analyzed outcomes in children (aged 1-18.99 years) with these genotypes in the SJ Total XV/XVI studies (2000-2017). Patients with ETV6::RUNX1 (n = 222) or high-hyperdiploid (n = 296) B-ALL had 5-year event-free survival (EFS) of 97.7% ± 1.1% and 94.7% ± 1.4%, respectively. For ETV6::RUNX1, EFS was comparable between NCI standard-risk and high-risk patients and between SJ low-risk and standard-risk patients. Of the 40 NCI high-risk patients, 37 who received SJ low-risk therapy had excellent EFS (97.3% ± 2.8%). For high-hyperdiploid B-ALL, NCI high-risk patients had worse EFS than standard-risk patients (87.6% ± 4.5% vs 96.4% ± 1.3%; P = .016). EFS was similar for NCI standard-risk and high-risk patients classified as SJ low risk (96.0% ± 1.5% and 96.9% ± 3.2%; P = .719). However, EFS was worse for NCI high-risk patients than for NCI standard-risk patients receiving SJ standard/high-risk therapy (77.4% ± 8.2% vs 98.0% ± 2.2%; P = .004). NCI high-risk patients with ETV6::RUNX1 or high-hyperdiploid B-ALL who received SJ low-risk therapy had lower incidences of thrombosis (P = .013) and pancreatitis (P = .011) than those who received SJ standard/high-risk therapy. MRD-directed therapy yielded excellent outcomes, except for NCI high-risk high-hyperdiploid B-ALL patients with slow MRD response, who require new treatment approaches. Among NCI high-risk patients, 93% with ETV6::RUNX1 and 54% with high-hyperdiploid B-ALL experienced excellent outcomes with a low-intensity regimen. These trials were registered at www.clinicaltrials.gov as #NCT00137111 and #NCT00549848.
A bulge uridine in the HIF2α IRE allows IRP1 but not IRP2 to selectively regulate HIF2α expression and ensuing EPO levels
Authors: Zhang De-Liang , Ollivierre Hayden , Qi Chen-Feng , Rouault Tracey A.
Published: September 2024

Iron regulatory proteins (IRP1 and IRP2) play a pivotal role in maintaining cellular iron homeostasis by binding to iron-responsive elements (IREs) of target messenger RNAs and regulating the expression of these iron-related genes. Mice and humans who lack functional IRP1 develop erythrocytosis due to erythropoietin (EPO) overproduction, whereas those who lack IRP2 develop microcytic anemia, believed to result from iron deficiency of erythroblasts. Here, we discovered that IRP2 deficiency reduced the expression of hypoxia-inducible factor 2α (HIF2α) and its transcriptional target, EPO, thereby compromising the stress erythropoiesis response to generate red blood cells upon anemia. The distinct consequences of IRP2 and IRP1 on EPO result from the higher binding affinity of the HIF2α IRE for IRP1 than IRP2. This difference in binding affinity arises from a bulge uridine in the upper stem of HIF2α IRE that impairs the ability of IRP2 to bind the IRE. These results reveal that IRP1 and IRP2 play distinct roles in erythropoiesis and unveil an unsuspected IRE binding preference that contributes to the divergent phenotypes observed in IRP1- and IRP2-deficient mammals.
Regulatory role of the lncRNAs MIAT and PVT1 in Behçet’s disease through targeting miR-93-5p and miR-124-3p
Authors: ElMonier Asmaa A. , Shaker Olfat G. , Ali Shimaa O.
Published: September 2024

Background

Noncoding RNAs play pivotal roles in the process of autoimmune diseases. However, the definite contributions of these molecules to Behçet’s disease (BD) are still unknown. This study aimed to explore the clinical value of a novel competing endogenous (ce) RNA network in the pathogenesis of BD and to assess its use in primary diagnosis.

Methods

Bioinformatic analysis was applied to construct a BD-related ceRNA network: lncRNA (MIAT and PVT1)-miRNA (miR-93-5p and miR-124-3p)-mRNA (SOD-2 and MICA). Blood was obtained from 70 BD patients and 30 healthy subjects, and the serum expression of the tested RNAs was estimated via quantitative real-time PCR (qPCR). Serum tumor necrosis factor-alpha (TNF-α) levels were also determined. The associations between these RNAs were further analyzed, and receiver operating characteristic (ROC) curve and logistic regression analyses were employed to validate their diagnostic and prognostic values.

Results

The expression levels of the lncRNAs PVT1 and miR-93-5p were significantly increased, whereas those of the lncRNAs MIAT and miR-124-3p, as well as those of the SOD-2 and MICA mRNAs, were significantly decreased in BD patients compared with controls. BD patients had significantly higher serum TNF-α levels than controls did. ROC curve analysis indicated that the selected RNAs could be candidate diagnostic biomarkers for BD. Moreover, the highest diagnostic efficiency was achieved with the combination of MIAT and miR-93-5p or PVT1 and miR-124-3p with either SOD-2 or MICA. Logistic regression analysis revealed that all RNA expression levels could be predictors for BD.

Conclusion

Mechanistically, our research revealed a novel ceRNA network that is significantly disrupted in BD. The findings reported herein, highlight the noncoding RNA-molecular pathways underlying BD and identify potential targets for therapeutic intervention. These insights will likely be applicable for developing new strategies for the early diagnosis, management and risk assessment of BD as well as the design of novel preventive measures.

Trial registration The protocol for the clinical studies was approved by Cairo University’s Faculty of Pharmacy’s Research Ethics Committee (approval number: BC 3590)
A hybrid features fusion-based framework for classification of breast micronodules using ultrasonography
Authors: Alhajlah Mousa
Published: September 2024

Background

Breast cancer is one of the leading diseases worldwide. According to estimates by the National Breast Cancer Foundation, over 42,000 women are expected to die from this disease in 2024.

Objective

The prognosis of breast cancer depends on the early detection of breast micronodules and the ability to distinguish benign from malignant lesions. Ultrasonography is a crucial radiological imaging technique for diagnosing the illness because it allows for biopsy and lesion characterization. The user’s level of experience and knowledge is vital since ultrasonographic diagnosis relies on the practitioner’s expertise. Furthermore, computer-aided technologies significantly contribute by potentially reducing the workload of radiologists and enhancing their expertise, especially when combined with a large patient volume in a hospital setting.

Method

This work describes the development of a hybrid CNN system for diagnosing benign and malignant breast cancer lesions. The models InceptionV3 and MobileNetV2 serve as the foundation for the hybrid framework. Features from these models are extracted and concatenated individually, resulting in a larger feature set. Finally, various classifiers are applied for the classification task.

Results

The model achieved the best results using the softmax classifier, with an accuracy of over 95%.

Conclusion

Computer-aided diagnosis greatly assists radiologists and reduces their workload. Therefore, this research can serve as a foundation for other researchers to build clinical solutions.
Leaving the profession as a medical assistant: a qualitative study exploring the process, reasons and potential preventive measures
Authors: Mambrey Viola , Dreher Annegret , Loerbroks Adrian
Published: September 2024

Background

Worldwide growing shortages among health care staff are observed. This also holds true for medical assistants in Germany. Medical assistants mainly work in outpatient care and are the first point of contact for patients while performing clinical and administrative tasks. We sought to explore profession turnover among medical assistants, that is, in terms of the underlying decision-making process, the reasons for leaving the medical assistant profession and potential retention measures from the perspective of former medical assistants.

Methods

For this qualitative study, we conducted semi-structured telephone interviews with 20 former medical assistants between August and November 2023. Eligible for participation were medical assistants who (i) were of legal age, (ii) completed medical assistant vocational training and ii) were formerly employed as a medical assistant, but currently employed in another profession. The interviews were recorded, transcribed verbatim and content-analyzed.

Results

Former medical assistants expressed various, often interrelated reasons for leaving the profession. These were changes in priorities throughout their career (e.g., in terms of working hours and salary), a constant high workload, barriers to further training, poor career prospects, and poor interpersonal relationships particularly with supervisors, but also within the team and with patients as well as the perception of insufficient recognition by politics and society. Suggestions of former medical assistants to motivate medical assistants to stay in their profession included amongst others higher salaries, more flexible work structures, improved career prospects, and more recognition from supervisors, patients, and society.

Conclusion

Our study provides insights into the complex decision-making process underlying ultimate medical assistant profession turnover. In light of an already existing shortage of medical assistants, we suggest to further explore how the suggested interventions that aim at retention of working medical assistants can be implemented.
Effects of inactivated Lactobacillus rhamnosus on growth performance, serum indicators, and colonic microbiota and metabolism of weaned piglets
Authors: Shu Zhiheng , Zhang Junhao , Zhou Qingwen , Peng Yingjie , Huang Yuanhao , Zhou Yi , Zheng Jun , Zhao Manya , Hu Chao , Lan Shile
Published: September 2024

Background

To assess the effects of inactivated Lactobacillus rhamnosus (ILR) on growth performance, serum biochemical indices, colonic microbiota, and metabolomics in weaned piglets, 120 piglets were randomly divided into five groups. Samples in the control group were fed a basal diet, while the experimental ILR1, ILR2, ILR3, and ILR4 groups were fed basal diets supplemented with 0.1%, 0.2%, 0.3%, and 0.4% ILR, respectively. The prefeeding period lasted for 5 days and was followed by a formal period of 28 days.

Results

Compared to the control, the average daily gain increased by 4.38%, 7.98%, 19.32%, and 18.80% for ILR1, ILR2, ILR3, and ILR4, respectively, and the ratio of feed to gain decreased by 0.63%, 3.80%, 12.66%, and 10.76%, respectively. Serum IgA, IgG, IgM, total antioxidant capacity, and glutathione peroxidase levels increased significantly in weaned piglets in the treatment groups. Addition of 0.3% ILR significantly increased the Shannon and Simpson indices of the colonic microbiota in weaned piglets and altered the microbiota composition. Changes in metabolic profiles were observed and were primarily related to the urea cycle, amino acid metabolism, and lipid metabolism.

Conclusion

ILR improved growth performance and serum immunological and biochemical indices and optimized the colonic microbiota structure and metabolism of weaned piglets.
Clinical value of peripheral blood miR-21 and miR-486 combined with CT forearly cancer diagnosis in pulmonary nodulessmoking
Authors: Wang Zheng , Liu Jinfeng , Liu Qiang , Ren Yingchun , Wang Qiang , Tian Qing , Li Zhijie , Liu Huining
Published: September 2024

Purpose

This study aimed to investigate the clinical significance of combining peripheral blood miR-21 and miR-486 with CT for the early cancer diagnosis in pulmonary nodules.

Methods

A total of 215 patients diagnosed with isolated pulmonary nodules with a history of smoking were selected as researchsubjects. 30 healthy volunteers with a history of smoking were recruitedas the control group.The selection of subjectswas based on the presence of isolated pulmonary nodules detected on chest CT scans. The training set consisted of 65 patients with lung nodules and 30 healthy smokers, while the verification setincluded 150 patients with lung nodules.

Results

Compared with the control group, the plasma expression level of miR-210 was significantly higher in the group of patients with benign pulmonary nodules (P < 0.05). The level of miR-486-5p was lower in patients with malignant pulmonary nodules compared to those with benign pulmonary nodules (P < 0.05). Moreover, the plasma level of miR-210was higher in patients with malignant pulmonary nodules compared to those with benign pulmonary nodules and healthy smokers (P < 0.05). The combination of miR-21 and miR-486 yielded an AUC of 0.865, which was significantly higher than any other gene combination (95%CI: 0.653–0.764, P < 0.05).

Conclusions

This study offered preliminary evidence supporting the use of peripheral blood miR-21 and miR-486, combined with CT scans, as potential biomarkers for the early cancer diagnosis in lung nodules.
Post-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation
Authors: Rodrigues Antenor , Vieira Fernando , Sklar Michael C. , Damiani L. Felipe , Piraino Thomas , Telias Irene , Goligher Ewan C. , Reid W. Darlene , Brochard Laurent
Published: September 2024

Background

During mechanical ventilation, post-insufflation diaphragm contractions (PIDCs) are non-physiologic and could be injurious. PIDCs could be frequent during reverse-triggering, where diaphragm contractions follow the ventilator rhythm. Whether PIDCs happens with different modes of assisted ventilation is unknown. In mechanically ventilated patients with hypoxemic respiratory failure, we aimed to examine whether PIDCs are associated with ventilator settings, patients’ characteristics or both.

Methods

One-hour recordings of diaphragm electromyography (EAdi), airway pressure and flow were collected once per day for up to five days from intubation until full recovery of diaphragm activity or death. Each breath was classified as mandatory (without-reverse-triggering), reverse-triggering, or patient triggered. Reverse triggering was further subclassified according to EAdi timing relative to ventilator cycle or reverse triggering leading to breath-stacking. EAdi timing (onset, offset), peak and neural inspiratory time (Tineuro) were measured breath-by-breath and compared to the ventilator expiratory time. A multivariable logistic regression model was used to investigate factors independently associated with PIDCs, including EAdi timing, amplitude, Tineuro, ventilator settings and APACHE II.

Results

Forty-seven patients (median[25%-75%IQR] age: 63[52–77] years, BMI: 24.9[22.9–33.7] kg/m2, 49% male, APACHE II: 21[19–28]) contributed 2 ± 1 recordings each, totaling 183,962 breaths. PIDCs occurred in 74% of reverse-triggering, 27% of pressure support breaths, 21% of assist-control breaths, 5% of Neurally Adjusted Ventilatory Assist (NAVA) breaths. PIDCs were associated with higher EAdi peak (odds ratio [OR][95%CI] 1.01[1.01;1.01], longer Tineuro (OR 37.59[34.50;40.98]), shorter ventilator inspiratory time (OR 0.27[0.24;0.30]), high peak inspiratory flow (OR 0.22[0.20;0.26]), and small tidal volumes (OR 0.31[0.25;0.37]) (all P ≤ 0.008). NAVA was associated with absence of PIDCs (OR 0.03[0.02;0.03]; P < 0.001). Reverse triggering was characterized by lower EAdi peak than breaths triggered under pressure support and associated with small tidal volume and shorter set inspiratory time than breaths triggered under assist-control (all P < 0.05). Reverse triggering leading to breath stacking was characterized by higher peak EAdi and longer Tineuro and associated with small tidal volumes compared to all other reverse-triggering phenotypes (all P < 0.05).

Conclusions

In critically ill mechanically ventilated patients, PIDCs and reverse triggering phenotypes were associated with potentially modifiable factors, including ventilator settings. Proportional modes like NAVA represent a solution abolishing PIDCs.
Bridging one health and sustainable analysis: enrofloxacin quantification amid combined therapy and its active metabolite in various matrices using green RP-HPLC
Authors: Mohamed Heba M. , Ragab Mona T.
Published: September 2024

Antibiotics play a crucial role in the treatment of infectious diseases in both humans and animals. However, their extensive utilization has caused significant potential harm to both wildlife and humans. Enrofloxacin (ENR) is a common veterinary antibiotic, which is not approved for human use due to associated toxicities. It is often combined with other antibiotics to expand the antibacterial range. It is crucial to monitor and measure the levels of ENR medication in various matrices. RP-HPLC is highly effective for analyzing antibiotics due to its sensitivity, specificity, and ability to handle complex samples. By adopting eco-friendly solvents, decreasing solvent consumption, and limiting waste we developed a method for determination and quantification of ENR, amoxicillin (AMX), and ENR active metabolite in different matrices. The method utilized a reversed stationary phase and a mobile phase composed of phosphate buffer pH 3.0: ethanol (90:10 v/v) pumped at 1.0 mL/min and UV detection at 254.0 nm. Moreover, a comprehensive assessment of the environmental friendliness of the established method was conducted using various tools including the Green Certificate Classification (GCC) and Analytical Greenness AGREE and RGB12. The method was validated for its accuracy and precision in quantifying ENR, demonstrating its potential for the effective monitoring of ENR and contributing to public health protection.

Graphical Abstract
The influence of e-learning on exam performance and the role of achievement goals in shaping learning patterns
Authors: Janson Marc Philipp , Janke Stefan
Published: September 2024

Digital learning environments provide opportunities to support learning in higher education. However, it is yet unclear why and how learners use these opportunities. We propose that learners’ achievement goals and their beliefs regarding the instrumentality of e-learning tools to achieve those goals are predictive for learning behavior within digital learning environments. Furthermore, we assume learning behavior characterized by longer overall learning time, more distributed learning, and less learning delay predicts higher exam performance. To test these hypotheses, we analyzed log-file data of 91 university students who had used an intelligent tutoring system as exam preparation in a pre-registered study. Beyond the overall predictive validity of the intelligent tutoring system, we found a negative association between learning delay and exam performance. Achievement goals predicted learning time and time distribution, an association that was partly moderated by perceived instrumentality. This suggests that goals and beliefs are important puzzle pieces for understanding e-learning (behavior).