bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Outcomes After Nonoperative Management in Older Adult Low-Energy Stable and Unstable Ankle Fractures: A Retrospective Review of 158 Patients
Authors: Kleinsmith Rebekah M. , Huyke-Hernandez Fernando A. , Abernathy Bailey R. , Sibley Andrew , Ammons Jordan , Qian Lily , Switzer Julie A. , Onizuka Naoko
Published: December 2024

Background

There is ongoing debate regarding the optimal management of older adult ankle fractures. The purpose of this study was to describe baseline characteristics and functional outcomes including complications in older adult patients receiving nonoperative treatment for low-energy ankle fracture and compare the outcomes of those with unstable vs stable fracture patterns.

Methods

Patients aged ≥65 from January 2012 to March 2019 that sustained an ankle fracture were identified. Those who had surgical treatment, age <65, high-energy trauma, bilateral ankle fractures, and patients without adequate follow-up (minimum 12 weeks) were excluded. Baseline demographics, injury characteristics, Charlson Comorbidity Index (CCI) score, and functioning regarding ambulatory status, living environment, and assistance personnel in the household were collected for all patients. The primary outcome of interest was retention of baseline ambulation, living environment, and assistance requirements at follow-up (>12 weeks). Pain improvement, radiographic changes, and adverse clinical events were also assessed.

Results

A total of 158 patients were included with an average follow-up timeframe of 41.6 weeks. Eighty-six percent of patients (n = 136) retained their ambulatory status at long-term follow up. Most patients retained the same living environment (n = 145, 91.8%). Thirty-five patients (22.2%) required additional assistance long-term. Approximately 67.1% of the entire cohort retained all three functional metrics. Patients who experienced functional decline were older (77.8 vs 71.6, P < 0.001), had higher CCI (3.2 vs 1.6, P < 0.001), had a diagnosis of dementia or cognitive impairment (36.5% vs 3.8%, P < 0.001), had lower baseline functional status (ambulation, living environment, and assistance required; all P < 0.001), and had an unstable fracture pattern ( P = 0.003).

Conclusions

Understanding the functional outcomes of non-operative treatment in geriatric ankle fracture cases can contribute to a shared decision-making among healthcare providers, patients, and families.
Patient Preferences and Satisfaction of Nipple Areola Reconstruction with Three-Dimensional Tattoo in the Setting of Bilateral Implant Based Breast Reconstruction
Authors: Jones Alicia , Giles Caitlin , Davis Eden , Bruce Cayla , Costigan Nicole , Boe Lillian A. , White Donovan , Smith-Montes Elizabeth , McCarthy Colleen , Coriddi Michelle
Published: December 2024

Background: Patients undergoing mastectomy for breast cancer treatment can have three-dimensional nipple areola complex (NAC) tattoos as part of their reconstructive journey. The generally accepted size and position of the NAC is noted in the literature, however, patients may have different preferences. Methods: All patients undergoing NAC tattoos were given the option to pick the size of the tattoo and location on their chest. Post-procedure measurements were obtained as well as BREAST-Q surveys to examine patient satisfaction. Results: In 104 patients, average NAC tattoo diameter was 3.62 cm (±0.45), average sternal notch to nipple was 19.53 cm (±2.66) and average nipple to inframammary fold was 8.59 cm (±2.64). On multivariable analysis, areola tattoo diameter was found to be significantly larger in patients with larger size implants ( P = .02), and Asian women ( P = .04). On multivariable analysis, sternal notch to nipple was significantly greater in patients with higher BMI ( P = .04). In patients with pre-operative photos for comparison, post-tattoo size and position of the NAC reconstruction, was significantly smaller and higher on the chest compared to their pre-operative values with an average NAC diameter of 3.60 cm (±0.46) ( P < .001), sternal notch to nipple of 19.45 cm (±2.87) ( P < .001), and nipple to inframammary fold of 8.89 cm (±2.80) ( P < .001). Sexual well-being significantly improved with an average score of 53 (±25) after micropigmentation. Conclusions: This study shows women prefer small areola size with a higher position compared to classic values, and these values may be influenced by race, BMI and implant size. Additionally, sexual well-being is improved after NAC reconstruction.
Factors Influencing the Amount of ACL Remnant Available for Preservation at the Time of ACL Surgery
Authors: Carrozzo Alessandro , Lahsika Mohammed , Lattermann Christian , Saithna Adnan , An Jae-Sung , Giurazza Giancarlo , Cardarelli Silvia , Dutra Vieira Thais , Sonnery-Cottet Bertrand
Published: December 2024

Background:

The preservation of the anterior cruciate ligament (ACL) remnant during reconstruction or repair could offer advantages such as enhanced vascularity, proprioception, and biomechanical properties. However, research on the clinical factors influencing ACL remnant preservation at the time of surgery is limited.

Purpose/Hypothesis:

The purpose was to identify clinical factors influencing the amount of ACL remnant during surgery. It was hypothesized that not solely the delay from injury to surgery influences the amount of ACL remnant present at the time of surgery, but also other patient characteristics such as sex and age, as well as intraoperative findings.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A retrospective analysis of prospectively collected data was performed on patients who underwent arthroscopic ACL reconstruction between January 2013 and December 2022. ACL remnants were categorized based on their location into tibial attachment, midsubstance, and femoral attachment, accounting for 20%, 60%, and 20% of the total ACL length, respectively. A multivariate logistic regression was performed to identify factors predictive of the amount of ACL remnant.

Results:

In a cohort of 5725 patients, different variables were associated with an ACL remnant <20% at the time of surgery. Patients aged ≤20 years had an odds ratio of 1.748 (95% CI, 1.473-2.075; P < .0001), and those aged between 20 and 30 years had an odds ratio of 1.440 compared with those aged >30 years. Female patients had an odds ratio of 1.253 (95% CI, 1.087-1.446; P = .0019). A surgical delay >12 months was associated with an odds ratio of 3.134 (95% CI, 2.640-3.720; P < 0001). The presence of meniscal and chondral lesions had odds ratios of 1.784 (95% CI, 1.570-2.028; P < .0001) and 1.761 (95% CI, 1.426-2.171; P < .0001), respectively.

Conclusion:

Increased age at surgery was positively associated with a remnant size ≥20% of the ACL. Female sex, longer delay between accident and surgery, and associated injuries of intra-articular structures were risk factors for a remnant size <20%.
Compassion Fatigue, Compassion Satisfaction and Related Factors in Pediatric Wards: A Narrative Review Study
Authors: Pakdaman Nargess , Naghavi Azam , Samiee Fatemeh , Kalhor Faramarz
Published: December 2024

Working with chronically ill children can overwhelm for professionals. It is necessary to study the factors related to compassion fatigue and satisfaction in order to effectively deal with it. Using a narrative review and inclusion criteria, we searched online databases for related studies from 2000 to 2023. Twelve articles were included in the final review. Understanding compassion fatigue/satisfaction will help to solve personal and professional problems and increase productivity, leading to positive outcomes for the patient, family, and the organization. This study identifies several factors that contribute to compassion fatigue (CF) in pediatric healthcare providers. These factors include workload, patient connections, lack of support, exposure to trauma, personal trauma, job dissatisfaction, and neglecting self-care. It is crucial to address these factors through targeted interventions and organizational support. Implementing evidence-based interventions shows promise in reducing the impact of CF, fostering a resilient healthcare workforce, and improving patient care.
A Non-nuclear US Ally’s Nuclear Option: South Korea’s Case
Authors: Park Hwee-rhak
Published: December 2024

North Korea’s nuclear armament has placed South Korea in a dilemma, as it can neither rely entirely on the United States’ nuclear extended deterrence (NED) nor pursue its own nuclear weapons development (the nuclear option). The reliability of the US NED has diminished, given North Korea’s ability to deploy intercontinental ballistic missiles capable of striking the US mainland. However, pursuing the nuclear option is fraught with difficulties due to the stringent restrictions imposed by the international non-proliferation regime. This article evaluates the feasibility of South Korea’s nuclear option using three factors: opportunity, willingness and the availability of special nuclear materials. The findings suggest that the feasibility of South Korea’s nuclear option is very low. Consequently, the article advises the South Korean public to acknowledge this reality rather than making emotional demands for the nuclear option. Furthermore, it calls upon the international community to engage in discussions and address the dilemma faced by non-nuclear US allies, such as South Korea, in light of the growing threat of nuclear attacks from nuclear-armed states like Russia and North Korea.
Start Something! Effectual Action in the Entrepreneurship Classroom
Authors: Clement Tom
Published: December 2024

This article presents an innovative experiential exercise, Start Something!, designed to bridge the intention–behavior–action gap in entrepreneurship education across online and face-to-face courses at undergraduate and graduate levels. Highlighting in the principles of effectual entrepreneurship and lean startup, the exercise challenges students to enact change through immediate, practical engagement, emphasizing action, diligence, initiative, and agility. Start Something! drives students to adopt an action-oriented mindset, and a critical shift in attitude, tackling the common student challenge of procrastination by catalyzing cognitive and motivational aspects conducive to entrepreneurial behavior. The exercise is not only a pedagogical tool but also a means of immersing students in the realities of entrepreneurial action, encouraging them to leverage available resources to initiate ventures. Through the theoretical foundations, exercise instructions, learning objectives, debrief strategies, and assessment methods, this article underscores the effectiveness of Start Something! in promoting action-oriented behavior, significantly impacting students’ entrepreneurial mindset and capabilities.
Quality of Life of Men Who Have Sex with Men: A Cross-sectional Study from Sagar, Madhya Pradesh
Authors: Das Abhijit , Mishra Shraddha , Gupta Amarnath , Singh Sandhya , Dwivedi Shatkratu
Published: December 2024

Background:

Men who have sex with men (MSM), a high-risk group for HIV/AIDS, face various health issues. However, research is scarce on MSM in India, and available studies generally focus on the mental health of HIV-infected MSM rather than their overall health. Therefore, this study aimed to assess the quality of life (QOL) among MSM.

Materials and Methods:

This observational cross-sectional study was done in Sagar, Madhya Pradesh, involving 100 MSM individuals. Participants were recruited from a non-governmental organization that works toward the welfare of MSM individuals. Socio-demographic data were collected using a semi-structured questionnaire, while QOL was measured using the Hindi version of the WHOQOL-BREF questionnaire. Quantitative variables were summarized using mean and standard deviation, and qualitative variables were summarized using frequency and percentage. The differences between mean QOL scores were analyzed using t-test/analysis of variance, and Pearson’s correlation coefficient was used to assess the correlation between domains.

Results:

Most participants were 21-40 years of age, with a mean age of 34.8 (±8.1) years. Most participants resided in urban areas and identified as Hindu (92%). The scores of WHOQOL-BREF ranged from 0 to 100, with higher scores indicating better QOL. The mean scores for general QOL and general health among participants were 42 ± 20.4 and 67.5 ± 24.7, respectively. Among the four domains of WHOQOL-BREF, social relationship domain had the highest mean QOL score (72.7 ± 11.5), while the psychological domain exhibited the lowest score (57.2 ± 11.7). The mean scores for the physical and environmental domains were 70.9 ± 8.7 and 59.6 ± 10.7, respectively.

Conclusions:

The findings underscore the importance of addressing various health aspects beyond HIV/AIDS in this population to improve their overall well-being and life satisfaction.
Development and Evaluation of a Strengths-Focused Peer-Led Support Program for Young University Mothers
Authors: Shea Munyi , Nguyen Kimmy K.
Published: December 2024

The increasing enrollment of student parents, particularly mothers, in higher education highlights the crucial need for timely support. Compared to their non-parent peers, student mothers are more likely to encounter financial, logistical, and social barriers. In this study, we evaluated the feasibility and effectiveness of a strengths-focused, peer-led support program for young university mothers (YUM). YUM adapted an evidence-based life skills program previously designed for adolescent mothers. Seventeen mothers ( Mage = 24.59; SDage = 4.65) participated in the 7-week YUM program, and 17 mothers ( Mage = 24.12; SDage = 3.10) were in the control group. Following the intervention, YUM participants demonstrated significant decreases in stress and depression, significant increases in career and academic exploration, and satisfaction with social support compared to the control group. YUM participants also reported an increased sense of campus connectedness over time, although the change was not significantly different between the two groups. In their parenting self-efficacy, the two groups demonstrated no significant differences in the change over time. The qualitative findings from exit interviews indicated high levels of satisfaction and engagement among all YUM participants, suggesting that the program was well received and feasible. YUM participants saw the group as an emotional safe haven and appreciated the peer-led structure. Despite facing multiple challenges as college-going mothers, they expressed a desire for continued skill application and ongoing support on college campuses. The study’s strengths, limitations, and implications for pedagogical and counseling practices as well as for future research are further discussed.
Contextualizing attitudes toward medical aid in dying in a national sample of interdisciplinary US hospice clinicians: hospice philosophy of care, patient-centered care, and professional exposure
Authors: Becker Todd D. , Cagle John G. , Cain Cindy L. , Davitt Joan K. , Kusmaul Nancy , Sacco Paul
Published: December 2024

Background:

Despite extensive theoretical debate, empirical research on medical aid in dying (MAID) largely has disregarded broader, contextual factors as potential correlates of attitudes in hospice clinicians.

Objective:

Informed by institutional theory and neofunctional attitude theory, the objective of the current study was to quantitatively examine hospice clinicians’ attitudes toward MAID as functions of institutional characteristics relating to (Aim 1) individual adherence to hospice values and (Aim 2) state law.

Design:

We used a cross-sectional design.

Methods:

A national convenience sample of interdisciplinary hospice clinicians recruited through US professional membership associations self-administered an online survey. Measures included attitudes toward MAID, attitudes toward the hospice philosophy of care, attitudes toward the principle that hospice care should not hasten death, orientation toward patient-centeredness, professional exposure to working in a state where MAID is legal, and demographic characteristics. Data were analyzed via a partial proportional odds model.

Results:

The sample ( N = 450) comprised hospice physicians (227 [50.4%]), nurses (64 [14.2%]), social workers (74 [16.4%]), and 85 chaplains (85 [18.9%]). Results of the partial proportional odds model indicated that professional exposure to working in a state where MAID is legal was significantly associated with over twice the cumulative odds of MAID support. Although neither orientation toward patient-centered care nor attitudes toward the hospice philosophy of care was significantly associated with attitudes toward MAID, results showed that disagreement with the narrower principle that hospice care should not hasten death was significantly associated with 6-to-7 times the cumulative odds of MAID support.

Conclusion:

Findings suggest that contextual factors—namely, the environments in which hospice clinicians practice—may shape attitudes toward MAID. Unanticipated results indicating that hospice professionals’ adherence to hospice values was not significantly associated with attitudes toward MAID underscore the need for further research on these complex associations, given previous theoretical and empirical support.
News Media Imaginaries of Artificial Intelligence in Healthcare: A Qualitative Analysis Across China, Germany, and the United States
Authors: Brause Saba Rebecca , Yang Heng , Schäfer Mike S. , Zeng Jing
Published: December 2024

Artificial intelligence (AI) has attracted much public interest, inspiring both hopes and fears. As countries define pathways for developing and implementing AI, healthcare is emerging as a priority sector. Sociotechnical imaginaries, which can mobilize public support and attract resources for realising sociotechnical visions, play an important role in the trajectories of emerging technologies. News media, in turn, are central to the negotiation, construction, and promotion of such imaginaries. We analyze how news media construct sociotechnical imaginaries of AI in healthcare in China, Germany, and the United States (US), three countries with differing healthcare and media systems, and sociopolitical and -cultural outlook on technologies. Drawing from a thematic analysis of articles from 15 newspapers, we find two powerful, cross-national, collectively held imaginaries: The first imaginary on enhancing healthcare with AI emerged across all three countries; the second imaginary on using AI to manage pandemics or epidemics was only fully developed in Chinese and US coverage, though present as an outlier in German news coverage. Lower-level divergences within each imaginary can be explained by systemic differences between the countries, such as the largely private US healthcare system, the mostly state-controlled Chinese media and healthcare systems, and the German hesitancy toward emerging technologies. This study provides evidence for how powerful imaginaries can emerge across very different sociopolitical and cultural contexts while accounting for contextual national factors.
Women’s Perspectives on Post-partum Family Planning in Banyumas, Indonesia
Authors: Frans Sandra Olivia , Cintyamena Utsamani , Listyadewi Shita , Utomo Ariane
Published: December 2024

Background: A recent programmatic shift in the provision of family planning in the Global South led to a renewed focus on post-partum family planning (PPFP). PPFP embodies a shift in the primary narrative of global family planning programs, from fertility reduction to promoting maternal and child well-being.

Purpose: We examine key factors that shape women’s knowledge, attitudes and practice of PPFP in Banyumas, Indonesia.

Methodology: We employed a qualitative approach utilizing focus group discussions with pregnant women and women with children aged less than 1 year old ( n = 44), and in-depth interviews with health service providers ( n = 10). Guided by the research questions, we conducted a thematic analysis of the transcripts.

Results: Our findings demonstrate how women’s agency within marriage, their social and familial networks, their interactions with healthcare providers, and policy changes related to reproductive health and health insurance schemes, all influence the extent to which women’s rights to information and choice regarding post-partum family planning can be realized.

Conclusions: Key implications for practice include the necessity for health providers to offer unbiased information about contraceptive options, to engage local leadership effectively, and to ensure that government targets for the PPFP program align with women’s needs and the health and social conditions of the community.
The Democratic Paradoxes in Music Education: Proposing “What Ifs”
Authors: Weatherly Katy Ieong Cheng Ho
Published: December 2024

This article examines paradoxes in music education, focusing on tensions between inclusivity, democratization, and the traditional concept of “excellence.” Drawing on theories from Maxine Greene and recent research on democratic education, I explore strategies to bridge the divide between formal and informal learning, institutional music education, and diverse community practices. Through co-construction of knowledge, real-life connections, and pluralism, I advocate for a reimagined, inclusive approach that respects students’ sociocultural contexts. Ultimately, this article challenges educators to ask, “What if. . .?” as a means to unlock new possibilities and create a more inclusive and contextually relevant approach to music education.
Anti-CD19 antibody cotreatment enhances serial killing activity of anti-CD19 CAR-T/-NK cells and reduces trogocytosis
Authors: Koh Seung Kwon , Kim Hyojin , Han Bohwa , Jo Hantae , Doh Junsang , Park Jeehun , Nguyen Minh Ha , Kim Hyun-Young , Kim Haneul , Lee Seung-Hwan , Kim Chan Hyuk , Cho Duck
Published: December 2024

Anti-CD19 chimeric antigen receptor (CAR)–engineered T and natural killer (NK) cell therapies have revolutionized the treatment of B-cell malignancies, but challenges including CD19 antigen loss greatly hinder their full therapeutic potential. Here, we revealed that cotreatment with anti-CD19 monoclonal antibody enhances antitumor activity of anti-CD19 CAR-T and -NK cells. Even though the treated antibody interferes with CD19 antigen binding of CAR, it significantly induces rapid detachment of anti-CD19 CAR effector cells from target cells, facilitating improved serial killing. This reduced interaction between CAR effector cells and target cells also leads to the alleviation of CAR-mediated trogocytosis. Interestingly, cotreatment with anti-CD19 antibody reveals time-dependent effects on the antitumor activity of anti-CD19 CAR-T cells, characterized by a reduction in early T cell activation followed by sustained high activity during prolonged exposure to target cells. This temporal modulation ultimately results in enhanced antitumor potency in vivo. These findings underscore the improved therapeutic efficacy achieved by combining anti-CD19 antibody with anti-CD19 CAR-T or -NK cells against B-cell malignancies.
Effects of Exercise and a Lifestyle App on Sleep-Disordered Breathing, Physical Health, and quality of Life
Authors: Fridgeirsdottir Katrin Y. , Murphy Conor J. , Islind Anna Sigridur , Árnadóttir Birta S. , Hrubos-Strøm Harald , Arnardottir Erna S. , Saavedra Jose M.
Published: December 2024

Background

. Sleep-disordered breathing (SDB) is a growing public health problem, and non-invasive treatments may be a valid option. The objective of this randomized controlled trial was to assess the effects of a 12-week exercise program and a lifestyle app on SDB severity, physical health (anthropometry, body composition, physical fitness), and health-related quality of life (HRQoL) in 18–50 years old adults with mild-to-moderate SDB.

Methods

. One-hundred-ninety-two participants (age 37.4±6.3years, BMI 33.3±4.2kg·m−2, 52.6% males) with mild-to-moderate SDB (apnea-hypopnea index [AHI] ≥5<30.0, objective snore ≥10%) were randomized into: Exercise (three times/week, 60 min), app, and control groups. The assessments included a three-night self-applied polysomnography, anthropometryt, body composition, physical fitness, and HRQoL. Repeated ANOVA, Wilcoxon signed-rank and Kruskal-Wallis test were used to evaluate the changes.

Results

. Time effect was observed in AHI (F=6.290, p=0.014), neck circumference (F=5.253, p=0.024), hand dynamometry (F=7.102, p=0.009), and 6-minute walking test (F=8.340, p=0.005). Group x time interactions were observed in weight (F=9.318, p=<0.001), BMI (F=9.302, p=<0.001), body fat percentage (F=4.756, p=0.01), body fat mass (F=5.916, p=0.004), and skeletal muscle mass (F=9.380, p=<0.001). Intragroup changes were observed in physical functioning, vitality, and general health in both the exercise and app groups, in addition to role limitations due to physical health in the exercise group.

Conclusions

. The 12-week exercise program reduced AHI and increased skeletal muscle mass, physical fitness, and HRQoL in four domains. The lifestyle app program reduced weight, BMI, neck circumference, body fat, visceral adiposity and skeletal muscle mass while increased three HRQoL domains in participants with mild-to-moderate SDB.
Human-in-the-loop active learning for goal-oriented molecule generation
Authors: Nahal Yasmine , Menke Janosch , Martinelli Julien , Heinonen Markus , Kabeshov Mikhail , Janet Jon Paul , Nittinger Eva , Engkvist Ola , Kaski Samuel
Published: December 2024

Machine learning (ML) systems have enabled the modelling of quantitative structure–property relationships (QSPR) and structure-activity relationships (QSAR) using existing experimental data to predict target properties for new molecules. These property predictors hold significant potential in accelerating drug discovery by guiding generative artificial intelligence (AI) agents to explore desired chemical spaces. However, they often struggle to generalize due to the limited scope of the training data. When optimized by generative agents, this limitation can result in the generation of molecules with artificially high predicted probabilities of satisfying target properties, which subsequently fail experimental validation. To address this challenge, we propose an adaptive approach that integrates active learning (AL) and iterative feedback to refine property predictors, thereby improving the outcomes of their optimization by generative AI agents. Our method leverages the Expected Predictive Information Gain (EPIG) criterion to select additional molecules for evaluation by an oracle. This process aims to provide the greatest reduction in predictive uncertainty, enabling more accurate model evaluations of subsequently generated molecules. Recognizing the impracticality of immediate wet-lab or physics-based experiments due to time and logistical constraints, we propose leveraging human experts for their cost-effectiveness and domain knowledge to effectively augment property predictors, bridging gaps in the limited training data. Empirical evaluations through both simulated and real human-in-the-loop experiments demonstrate that our approach refines property predictors to better align with oracle assessments. Additionally, we observe improved accuracy of predicted properties as well as improved drug-likeness among the top-ranking generated molecules.

Scientific contribution

We present an adaptable framework that integrates AL and human expertise to refine property predictors for goal-oriented molecule generation. This approach is robust to noise in human feedback and ensures that navigating chemical space with human-refined predictors leverages human insights to identify molecules that not only satisfy predicted property profiles but also score highly on oracle models. Additionally, it prioritizes practical characteristics such as drug-likeness, synthetic accessibility, and a favorable balance between exploring diverse chemical space and exploiting similarity to existing training data.
Intersecting dimensions: advanced analytical approach to school climate and injury prevention in health policy
Authors: Khalemsky Anna , Jaffe Eli , Khalemsky Michael
Published: December 2024

Background

Child safety in schools is paramount for decision-makers globally, with a focus on ensuring children return home safely. However, the prevalent issue of injuries across educational systems demands a comprehensive investigation into their causes, incorporating interdisciplinary perspectives and social dynamics, to develop effective prevention strategies. The objective of this study is to comprehensively analyze the factors contributing to school-related injuries and examine the impact of school climate on student safety. By employing advanced data analysis techniques, the research aims to develop targeted, effective strategies to enhance child safety in educational settings. This research aims to develop a multidimensional taxonomy to understand child injuries in elementary schools better, enhancing precision in decision-making.

Methods

Data from 363 Israeli primary schools and 10,855 school injuries attended to by MDA, the principal EMS provider, were analyzed. The study utilized a two-level taxonomy, employing clustering methodology to classify schools into distinct climate "patterns," with each pattern further delineating school injury characteristics into sub-patterns. The chosen method proved effective in revealing nuanced relationships between school injuries and climate characteristics.

Results

Analysis revealed five school climate clusters, ranging from "good" to "bad," each exhibiting two homogeneous sub-clusters of school injuries. Schools with a "positive" climate witnessed boys predominantly experiencing head injuries during breaks, while girls often sustained limb injuries from playing in corridors. Conversely, within the "negative" climate cluster, subgroups emerged based on injury nature, whether linked to playing or falling from a height.

Conclusion

The research delineates a nuanced association between school climate and injury rates, emphasizing the necessity for sophisticated analytical techniques beyond conventional methodologies. Utilizing a diverse dataset from various disciplines, the study highlights the multidimensional aspects of school health. The developed taxonomy reveals the complex dynamics within school environments, advocating for customized health policies to mitigate injuries. Critical findings prompt a reevaluation of established assumptions about the school climate-injury relationship, informing strategic policymaking. For example, it suggests collaboration to enhance school safety through targeted, gender-sensitive interventions and improvements. Integrating different data sources offers a holistic understanding crucial for effective health policy formulation in educational contexts.
Tuft cells promote human intestinal epithelium regeneration as reserve stem cells after irradiation
Authors: Li Yehua , Zhang Mengxian , Ma Xianrun , Chen Ye-Guang
Published: December 2024

Intestinal epithelium regeneration is crucial for homeostatic maintenance of the intestinal functions. A recent study published in Nature uncovers tuft cells as an unexpected key player in the regenerative process. Human tuft cells, traditionally recognized for their involvement in immune defense and pathogen protection, were found to exhibit stem cell-like properties following radiation-induced injury. These cells not only resist damage but also have the ability to generate functional stem cells, promoting the repair of the intestinal epithelium. This finding suggests that tuft cells may function as a reserve pool of stem cells, essential for efficient intestinal regeneration after injury.
Duskward displacement of plasmoids and reconnection in the near-Earth magnetotail
Authors: Ieda Akimasa , Miyashita Yukinaga
Published: December 2024

Magnetic reconnection in the near-Earth magnetotail is responsible for explosive release of energy during substorms and auroral breakups. This near-tail reconnection was previously assumed to occur around the midnight meridian, where earthward flows were typically observed. Based on observations of tailward-moving plasmoids, the Geotail spacecraft mission discovered that the reconnection location was displaced toward dusk. This dusk preference is presumably caused by the Hall electric field, as was suggested later in simulations. However, recent spacecraft observations have indicated that the reconnection was displaced toward dawn, and not dusk, in Mercury’s magnetotail. In response to this controversy, our study aims to clarify the dawn–dusk location of fast plasma flows in the near-Earth magnetotail. Through a comprehensive reinterpretation and integration of previous statistical results, we found that the dusk preference is generally evident for tailward flows but is often absent for earthward flows. These results indicate that the statistical results of earthward flows are sensitive to event selection criteria. We conclude that the dawn–dusk location of earthward flow is statistically unclear at the time of substorm onset. Similarly, in the magnetotail of other planets, the dawn–dusk location of planetward flow may be sensitive to event selection criteria. Hence, reconnection may occur predominantly on the duskside in Mercury’s magnetotail. This hypothesis will be tested using observations of tailward-moving plasmoids by the BepiColombo Mio spacecraft, which will begin orbital observations of Mercury in the year 2026.

Graphical Abstract
The LimPa mission: a small mission proposal to characterize the enigmatic lunar dust exosphere
Authors: Futaana Yoshifumi , Kallio Esa , Knuuttila Olli , Nyman Leo , Shimoyama Manabu , Barabash Stas
Published: December 2024

The lunar environment is known to be characterized by complex interactions between plasma, the exosphere, dust, and the surface. However, our understanding of the environment is limited due to the lack of experimental evidence. Here, we propose a small, low-cost mission to characterize the dust and exosphere environment of the Moon. Named the Limb Pathfinder (LimPa), this is a proof-of-concept mission aimed toward understanding the coupling between plasma, dust, and tenuous neutral atmosphere. The LimPa mission was proposed to a call for the Small Mission to the Moon issued by European Space Agency in 2023. LimPa is designed to examine the dust exosphere above the lunar polar regions by using an utterly novel remote-sensing technique to measure the solar wind hydrogen atoms—the solar wind protons that are neutralized to hydrogen atoms. Its goals are (1) to detect for the first time the neutralized solar wind hydrogen produced by exospheric gas and levitated dust; (2) to measure the height profiles of the levitated dust and exospheric gas densities; and (3) to determine the emission mechanism of the horizon glow. Our baseline design of the LimPa mission is a 12U CubeSat. Three highly matured instruments are used: an energetic neutral atom camera, a proton sensor, and a camera system. The LimPa CubeSat is proposed to be inserted into a circular lunar polar orbit, with an altitude of 100 km as a baseline. The Sun-pointing attitude will allow measurements of neutralized solar wind that are produced by the exosphere and dust grains above the polar regions. The nominal lifetime is for 3 months as a pathfinder mission. The LimPa mission will open a new window to remote characterization of the lunar dust exosphere environment above the poles, and will demonstrate that this monitoring can be achieved with a simple and low-cost instrument system and spacecraft operation. The concept to be proven by the LimPa mission will enable long-term monitoring of the fragile dust exosphere environment, which substantially impacts on lunar exploration and will be significantly altered by human activities.

Graphical abstract
How to minimize mechanical power during controlled mechanical ventilation
Authors: Fabry Ben
Published: December 2024

High intrapulmonary pressures, large tidal volumes, and elevated respiratory rates during controlled mechanical ventilation can lead to barotrauma, volutrauma, and atelectrauma. Mechanical power—defined as the product of the pressure–volume integral and respiratory rate—consolidates these three risk factors into a single, intuitive parameter. Several studies have demonstrated that higher mechanical power correlates with an increased risk of lung injury and mortality, prompting the suggestion that mechanical power should be minimized. However, under the constraint of maintaining a fixed alveolar minute ventilation and positive end-expiratory pressure (PEEP), it remains unclear how to adjust respiratory rate and tidal volume to minimize mechanical power. This study provides an analytical solution to this optimization problem. Accordingly, only the elastic component of mechanical power should be targeted for minimization. Regardless of lung elastance or resistance, or the mode and settings of the ventilator, the elastic power is minimized at a tidal volume equal to twice the anatomic dead space, or approximately 4.4 ml/kg of body weight.
Neurological involvement in patients with systemic autoimmune rheumatic diseases: a descriptive study in an Egyptian cohort
Authors: Attia Doaa Hassan Sayed , Fotouh Alshaimaa Aboul , Mohammed Reem Hamdy Abdellatif
Published: December 2024

Background

Neurologic manifestations in the systemic autoimmune rheumatic diseases (SARDs) are protean. They add to the disease burden and could contribute to mortality. Increasing awareness about the neuro-rheumatologic syndromes might help with early diagnosis and effective therapy. Our aim is to survey the clinical and imaging patterns of neurological involvement in Egyptian patients with SARDs.

Results

Neurological involvement is common in Behçet’s disease (BD) (12.7%) and systemic lupus erythematosus (SLE) (6.4%) patients compared with other SARDs. Compared with SLE, neurological involvement in BD tends to develop at an older age (31 ± 7.1 versus 28.3 ± 9.6 years = 0.022) with a greater progression risk (13.8% versus 2.6%, P = 0.003). A higher proportion of SLE patients had abnormal neuroimaging without neurological symptoms (15.7% versus 4.3%, P = 0.026, OR = 4.9, 95%CI 1.1–22.4). SLE patients had a higher frequency of seizures (31.3% versus 6.4%, P < 0.001, OR = 6.7, 95%CI 2.7–16.7) and benign intracranial hypertension (9.6% versus 1.1%, P = 0.009, OR = 9.8, 95%CI 1.2–77.7) but a lower prevalence of quadriplegia due to brain insult (1.7% versus 3.2%, P = 0.045, OR = 0.2, 95%CI 0.04–0.9), dural sinus thrombosis (13% versus 33%, P = 0.001, OR = 0.3, 95%CI 0.2–0.6), brainstem syndrome (0.9% versus 6.4%, P = 0.047, OR = 0.1, 95%CI 0–1.1) and cranial neuropathies (9.6% versus 31.9%, P < 0.001, OR = 0.2, 95%CI 0.1–0.5). Concerning neuroimaging, brain atrophic changes were more common (27.4% versus 9.5%, P = 0.002, OR = 3.6, 95%CI 1.6–8.3) while thrombosis was less prevalent (36.3% versus 53.6%, P = 0.016, OR 0.5, 95%CI = 0.3–0.9) in lupus patients. The cerebral cortex was more commonly affected (20.4 versus 4.8%, P = 0.002, OR = 5.1, 95%CI 1.7–15.4) while dural sinuses (14.2% versus 40.5%, P < 0.001, OR = 0.2, 95%CI 0.1–0.5), basal ganglia (1.8% versus 10.7%, P = 0.010, OR = 0.2, 95%CI 0–0.7), diencephalon (0% versus 13.1%, P < 0.001) and brainstem (1.8% versus 22.6%, P < 0.001, OR = 0.1, 95%CI 0–0.3) were less frequently involved in SLE patients. Concerning other SARDs, cranial neuropathies were the most common neurological presentations. Abnormalities in neuroimaging did not correlate with the patients’ clinical presentations.

Conclusions

Neurological presentations associated with SARDs are protean. Neuroimaging abnormalities should be interpreted within the context of the clinical picture and the results of other investigations.
Transitioning from the Green Revolution to the Gene Revolution: strengthening nutritional security using climate resilient traditional crops
Authors: Tahakik Rushikesh R. , Deshmukh Amit G. , Moharil Mangesh P. , Jadhav Pravin V. , Kogade Vinod T. , More Kalyani D. , Shinde Vijay P.
Published: December 2024

Background

World food production has significantly increased, largely attributed to advancements in breeding methods pioneered in previous decades. These advancements can be categorized into three major eras—the pre-Green Revolution era, the Green Revolution era, and the post-Green Revolution era—which we call the Gene Revolution. The pre-Green Revolution era was characterized by the utilization of mutation breeding and forward genetics approaches.

Main body

The Green Revolution (1950s–1980s) brought about major improvements in crop breeding, irrigation, and fertilizer use, leading to a substantial rise in food production and reduced rural poverty. However, the focus was primarily on yield, with less focus on nutritional quality. After the Green Revolution, the production of wheat and rice rapidly increased from 0.4–2 metric tonnes per hectare to 2–4 metric tonnes per hectare due to government initiatives. Nevertheless, the cultivation of other food crops, including indigenous rice varieties and millet, has decreased. In the Gene Revolution era, while advanced genome editing technologies such as CRISPR‒Cas9 and TALENs have enhanced the nutritional content and climate resilience of crops, there has also been a renewed focus on reviving indigenous crops.

Conclusion

This review discusses methods to bring these orphan nutria crops back into cultivation and emphasizes the importance of passing this knowledge to future generations, ensuring their place in sustainable agriculture and food and nutritional security.
Outcome predictors in patients with temporal lobe epilepsy after temporal resective surgery
Authors: Yu Jiabin , Li Yinchao , Xie Xuan , Cheng Liming , Zhu Shaofang , Sui Lisen , Wu Youliang , Xie Xuemin , Xie Haitao , Zhang Xiaojing , Chen Chun , Liu Yingying
Published: December 2024

Background

Temporal lobe epilepsy is one of the most common types of partial epilepsy. Although surgical treatment has led to significant improvements in seizure-free rates, nearly one-third of patients still have poor seizure control after surgery. Moreover, the long-term outcome is less favorable compared to short-term outcome, with 48–58% of patients experiencing seizures five years after surgery. The aim of this study was to investigate the surgical outcomes and the predictive value of prognostic factors associated with poor surgical outcomes in temporal lobe epilepsy patients receiving surgery.

Methods

We retrospectively reviewed 94 patients undergoing temporal resective surgery in the Epilepsy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine between July 2016 and July 2020. Patient information including age, gender, personal and family history, as well as preoperative and postoperative clinical data (clinical type and duration of disease) was collected.

Results

The differences of postoperative clinical efficacy in both seizure free group and non-seizure free group patients were observed. A log-rank test was used for univariate analysis, and a Cox proportional hazard model was used for multivariate analysis. Ninety-four patients were followed up for at least 1 years. At 12 months of follow-up, 71 (75.5%) patients achieved Engel class I, 5 (5.3%) patients were classified as Engel class II, 5 (5.3%) patients were classified as Engel class III, and 13 (13.8%) patients were classified as Engel class IV. Univariate analysis and multivariate Cox regression analysis indicated that the postoperative EEG abnormalities were significantly correlated with seizure recurrence and were significant independent predictive factors, with a hazard ratio of 12.940.

Conclusions

The relapse rate in our study was similar to commonly reported overall rates in temporal lobe epilepsy patients receiving surgery. Anterior temporal lobectomy is a reliable treatment option for temporal lobe epilepsy patients. Postoperative electroencephalograph abnormalities are independent risk factors for poor surgical prognosis.
A rare case of Gorlin–Goltz syndrome
Authors: Hassan Sara R. , Youssef Ayda A. , ElMallah Esraa S.
Published: December 2024

Background

The Gorlin–Goltz syndrome (the Nevoid basal cell carcinoma syndrome (NBCCS)) is reviewed as a rare autosomal dominant syndrome caused by gene mutations located on chromosome arm 9 q. It has a variety of presentations and is characterized by basal cell carcinomas (BCC), odontogenic keratocysts (OKCs), and ectopic calcifications of the falx cerebri or plantar pits. The diagnosis depends mainly on a number of minor and major criteria. This syndrome can be misdiagnosed, which makes its early detection important in preventing consensual complications.

Case presentation

In our case a 50-year-old male was reported and presented with one minor and four major criteria of the Gorlin–Goltz syndrome, the first presentation was pathologically proven facial basosquamous carcinoma post-surgical excision, subsequent contrast-enhanced maxillofacial MRI as well as CT Head, Neck revealed OKCs of the maxillary and mandible as well as calcifications of the falx and vertebral fusion with palmar pits on physical examination with definite diagnosis of Gorlin–Goltz syndrome.

Conclusion

Gorlin–Goltz syndrome is an unusual inherited multi-systemic syndrome, which may be misdiagnosed. It is crucial that health care specialists have the necessary knowledge of the fundamental features of NBCC syndrome and the determination of its associated disorders. All patients should undergo genetic screening as well as their first-degree relatives. Morbidity can be avoided by early treatment of BCC and OKCs to avoid deformities of surrounding dermal and osseous structures.
Bioactive phytochemicals from leaf extract of Erlangea tomentosa S. Moore (Bothriocline longipes (Oliv. & Hiern.) used to treat bacterial infections in Uganda
Authors: Namukobe Jane , Ekyibetenga Yeremiah , Oyedeji Adebola Omowunmi , Byamukama Robert , Heydenrech Mathias
Published: December 2024

Background

The leaves of Erlangea tomentosa (ET) are used to treat several bacterial infections like respiratory tract infections, skin infections, diarrhea and gastrointestinal disorders. However, there is limited information about the compounds responsible for its bacterial activities. The study aimed at isolation and characterisation of phytochemicals from the leaf extracts of ET.

Results

Three compounds were isolated from leaf extracts of ET and characterised. Two compounds; eriodictyol-7-O-β-glucoside (1) and 5, 7, 3′, 4′-tetrahydroxy-7-O-[6"-O-(acetyl)-β-D-glucopyrancsyloxy]-flavanone (coccinoside A) (2) were identified from ethyl acetate extract while one compound; di-(2-ethylhexyl) phthalate (3) was identified from dichloromethane extract.

Conclusion

Compounds; 1, 2 and 3 were isolated and identified from ET and genus Erlangea for the first time. The reported antibacterial properties of compound 3 in literature could be responsible for the antibacterial activities of ET and the traditional use of ET.