bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of a mid-distal adjacent finger defect: a retrospective study
Authors: Ge Meng , Zhang Zhijin , Ren Guohua , Hong Shenghu , chen Cheng , Yang Jun , Hou Qiao , Fu Hongmei
Published: April 2024

Purpose

Assessing the clinical effectiveness of combining with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold to repair mid-distal defects in adjacent fingers.

Methods

From September 2012 to April 2022, 21 patients with 42 mid-distal defects of adjacent fingers underwent treatment using combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold. The flaps size ranged from 2.1 cm * 1.6 to 4.9 cm * 3.2 cm. Follow-up evaluations included assessing function, sensation, and appearance, etc. of the injured fingers and donor areas.

Results

All 42 flaps survived in 21 patients without any vascular crises, and the wounds healed in phase I. The mean follow-up time was 12.2 months (range 7–22 months). During follow-up, in injured fingers, according to the Michigan Hand Outcomes Questionnaire (MHOQ), the functional recovery and appearance were satisfactory; in Dargan Function Evaluation (DFE), the results were both “excellent” in fourteen patients, “excellent” and “good” in five patients, both “good” in one patient, “good” and “general” in one. In static two-point discrimination (2PD), the variation ranges from 4 to 9 mm in injured fingers and 6—10 mm in donor toes. Cold Intolerance Severity Score (CISS) is mild in all patients. The visual analogue score (VAS) showed no pain in the injured fingers and donor toes. No deformities or other complications were noted at the donor toes. According to Chinese Manchester Foot Pain and Disability Index (C-MFPDI), there was no morbidity on foot function in all donor areas.

Conclusion

The surgical procedure of combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of mid-distal adjacent fingers defect is highly satisfactory. This approach helps the injured fingers to achieve good function, sensibility and appearance, while also achieving satisfactory results in the donor toes.
Assessing fragility of statistically significant findings from randomized controlled trials assessing pharmacological therapies for opioid use disorders: a systematic review
Authors: Naji Leen , Dennis Brittany , Rodrigues Myanca , Bawor Monica , Hillmer Alannah , Chawar Caroul , Deck Eve , Worster Andrew , Paul James , Thabane Lehana , Samaan Zainab
Published: April 2024

Background

The fragility index is a statistical measure of the robustness or “stability” of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant. The purpose of this study is to assess the fragility index of randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder. This will provide an indication as to the robustness of trials in the field and the confidence that should be placed in the trials’ outcomes, potentially identifying ways to improve clinical research in the field. This is especially important as opioid use disorder has become a global epidemic, and the incidence of opioid related fatalities have climbed 500% in the past two decades.

Methods

Six databases were searched from inception to September 25, 2021, for randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder, and meeting the necessary requirements for fragility index calculation. Specifically, we included all parallel arm or two-by-two factorial design RCTs that assessed the effectiveness of any opioid substitution and antagonist therapies using a binary primary outcome and reported a statistically significant result. The fragility index of each study was calculated using methods described by Walsh and colleagues. The risk of bias of included studies was assessed using the Revised Cochrane Risk of Bias tool for randomized trials.

Results

Ten studies with a median sample size of 82.5 (interquartile range (IQR) 58, 179, range 52–226) were eligible for inclusion. Overall risk of bias was deemed to be low in seven studies, have some concerns in two studies, and be high in one study. The median fragility index was 7.5 (IQR 4, 12, range 1–26).

Conclusions

Our results suggest that approximately eight participants are needed to overturn the conclusions of the majority of trials in opioid use disorder. Future work should focus on maximizing transparency in reporting of study results, by reporting confidence intervals, fragility indexes, and emphasizing the clinical relevance of findings.

Trial registration

PROSPERO CRD42013006507. Registered on November 25, 2013.
A nonlinear relationship between the triglycerides to high-density lipoprotein cholesterol ratio and stroke risk: an analysis based on data from the China Health and Retirement Longitudinal Study
Authors: Zhang Shike , Cao Changchun , Han Yong , Hu Haofei , Zheng Xiaodan
Published: April 2024

Objective

The connection between triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and stroke risk is controversial. Our goal was to explore this relationship in individuals aged 45 and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS).

Methods

Our analysis encompassed 10,164 participants from the CHARLS cohorts. We applied the Cox proportional-hazards regression model to evaluate the potential correlation between the TG/HDL-C ratio and stroke incidence. Using a cubic spline function and smooth curve fitting within the Cox model allowed us to unearth a possible non-linear pattern in this relationship. We also conducted thorough sensitivity and subgroup analyses to deepen our understanding of the TG/HDL-C ratio’s impact on stroke risk.

Results

Adjusting for various risk factors, we observed a significant link between the TG/HDL-C ratio and increased stroke risk in individuals aged 45 and above (HR: 1.03, 95% CI 1.00–1.05, P = 0.0426). The relationship appeared non-linear, with an inflection at a TG/HDL-C ratio of 1.85. Ratios below this threshold indicated a heightened stroke risk (HR: 1.28, 95% CI 1.06–1.54, P = 0.0089), while ratios above it did not show a significant risk increase (HR: 1.01, 95% CI 0.98–1.04, P = 0.6738). Sensitivity analysis confirmed the robustness of these findings. Notably, non-smokers exhibited a stronger correlation between the TG/HDL-C ratio and stroke risk compared to past and current smokers.

Conclusion

Our investigation revealed a significant, yet non-linear, association between the TG/HDL-C ratio and the incidence of stroke among individuals aged 45 and above. Specifically, we found that stroke risk increased in correlation with TG/HDL-C ratio below the threshold of 1.85. These insights may guide healthcare providers in advising and developing more effective strategies for stroke prevention in this demographic.
Prevalence of Helicobacter pylori infection and effectiveness of first-line triple eradication therapy among dyspeptic patients at hospitals in Hawassa City, Ethiopia: a cross-sectional follow-up study
Authors: Fekadu Sintayehu , Kibru Seyife , Tesfaye Sisay , Egeno Tariku , Tamiso Alemu , Engiso Hizkel , Deyno Serawit
Published: April 2024

Background

Dyspepsia is a common gastrointestinal illness sometimes associated with Helicobacter pylori (H. pylori) infection. Screening and eradicating the bacterium reduces the risk of infection-related complications. The aim of this study was to determine the magnitude of H. pylori infection among dyspeptic patients and the effectiveness of triple eradication therapy at hospitals in Hawassa city, Ethiopia.

Results

The prevalence of H. pylori infection was 48.5%. The H. pylori eradication rate using first-line triple therapy was 83.8%. Eradication therapy failure is associated with previous exposure compared to no exposure (AOR: 4.8, 95% CI: 1.37–10.97), a regimen for 10-days compared to 14-days (AOR: 4.05, 95% CI: 1.42–11.55), and self-reported side effects compared to no report (AOR: 2.5, 95% CI: 1.12–5.97). Based on Morisky-eight scale 230 (79.0%) patients were adherent to their triple therapy. Participants with no reports of adverse effects showed increased odds of adherence to triple therapy compared to those who had reports (AOR = 2.45, 95% CI: 1.29–4.62).

Conclusions

This study demonstrated that about half of adult dyspeptic patients were infected with H. pylori, and moderate eradication was observed. Factors such as previous history of eradication therapy, duration of the eradication regimen, and perception of potential adverse effects are associated with eradication rate and should be considered during the initiation of eradication therapy.
Utilization of fluid-based biomarkers as endpoints in disease-modifying clinical trials for Alzheimer’s disease: a systematic review
Authors: Oosthoek Marlies , Vermunt Lisa , de Wilde Arno , Bongers Bram , Antwi-Berko Daniel , Scheltens Philip , van Bokhoven Pieter , Vijverberg Everard G. B. , Teunissen Charlotte E.
Published: April 2024

Background

Clinical trials in Alzheimer’s disease (AD) had high failure rates for several reasons, including the lack of biological endpoints. Fluid-based biomarkers may present a solution to measure biologically relevant endpoints. It is currently unclear to what extent fluid-based biomarkers are applied to support drug development.

Methods

We systematically reviewed 272 trials (clinicaltrials.gov) with disease-modifying therapies starting between 01–01-2017 and 01–01-2024 and identified which CSF and/or blood-based biomarker endpoints were used per purpose and trial type.

Results

We found that 44% (N = 121) of the trials employed fluid-based biomarker endpoints among which the CSF ATN biomarkers (Aβ (42/40), p/tTau) were used most frequently. In blood, inflammatory cytokines, NFL, and pTau were most frequently employed. Blood- and CSF-based biomarkers were used approximately equally. Target engagement biomarkers were used in 26% (N = 72) of the trials, mainly in drugs targeting inflammation and amyloid. Lack of target engagement markers is most prominent in synaptic plasticity/neuroprotection, neurotransmitter receptor, vasculature, epigenetic regulators, proteostasis and, gut-brain axis targeting drugs. Positive biomarker results did not always translate to cognitive effects, most commonly the small significant reductions in CSF tau isoforms that were seen following anti-Tau treatments. On the other hand, the positive anti-amyloid trials results on cognitive function were supported by clear effect in most fluid markers.

Conclusions

As the field moves towards primary prevention, we expect an increase in the use of fluid-based biomarkers to determine disease modification. Use of blood-based biomarkers will rapidly increase, but CSF markers remain important to determine brain-specific treatment effects. With improving techniques, new biomarkers can be found to diversify the possibilities in measuring treatment effects and target engagement. It remains important to interpret biomarker results in the context of the trial and be aware of the performance of the biomarker. Diversifying biomarkers could aid in the development of surrogacy biomarkers for different drug targets.
Factors influencing medical expenditures in patients with unresolved facial palsy and pharmacoeconomic analysis of upper eyelid lid loading with gold and platinum weights compared to tarsorrhaphy
Authors: Nowak-Gospodarowicz Izabela , Gospodarowicz Marcin , Rękas Marek
Published: April 2024

There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy.

Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables.

Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell’s phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy.

Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective.
Med1 inhibits ferroptosis and alleviates liver injury in acute liver failure via Nrf2 activation
Authors: Lei Zi-Ying , Li Zhi-Hui , Lin Deng-Na , Cao Jing , Chen Jun-Feng , Meng Shi-Bo , Wang Jia-Lei , Liu Jing , Zhang Jing , Lin Bing-Liang
Published: April 2024

Background

Extensive hepatocyte mortality and the absence of specific medical therapy significantly contribute to the unfavorable prognosis of acute liver failure (ALF). Ferroptosis is a crucial form of cell death involved in ALF. In this study, we aimed to determine the impact of Mediator complex subunit 1 (Med1) on ferroptosis and its potential hepatoprotective effects in ALF.

Results

Med1 expression is diminished in the liver of lipopolysaccharide (LPS)/D-galactosamine (D-GalN)-induced ALF mice, as well as in hepatocytes damaged by H2O2 or TNF-α/D-GalN in vitro. Med1 overexpression mitigates liver injury and decreases the mortality rate of ALF mice by ferroptosis inhibition. The mechanism by which Med1 inhibits erastin-induced ferroptosis in hepatocytes involves the upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream antioxidant genes heme oxygenase-1 (HO-1), glutamate cysteine ligase catalytic (GCLC), and NAD(P)H quinone oxidoreductase 1 (NQO1). Furthermore, Med1 overexpression suppresses the transcription of proinflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the liver of mice with LPS/D-GalN-induced ALF.

Conclusion

Overall, our research findings indicate that Med1 suppresses ferroptosis and alleviates liver injury in LPS/D-GalN-induced ALF through the activation of Nrf2. These findings substantiate the therapeutic viability of targeting the Med1-Nrf2 axis as a means of treating individuals afflicted with ALF.

Graphical Abstract
A review of the current potential of European brown seaweed for the production of biofuels
Authors: Twigg Gail , Fedenko Jeffrey , Hurst George , Stanley Michele S. , Hughes Adam D.
Published: April 2024

Background

In addition to the other uses for macroalgae, since the 1970s, there has been interest in using macroalgae as a source of biofuels, due to the high rates of productivity and intrinsic advantages over other biofuel crops such as not requiring land use or significant freshwater input. A wide range of conversion processes exist but anaerobic digestion was one of the first demonstrated and is still a widely proposed conversion pathway. To be economically viable and scalable within Europe, the industry will need to be based on a small number of fast growing, high-yielding European macroalgae species. There is a wide body of scientific work on the conversion of seaweeds to biofuel via anaerobic digestion.

Main text

These studies demonstrate that the efficiency of this conversion pathway is highly variable between species, processing techniques, composition and digestor conditions. In this paper, we review this body of work specifically linking it to candidate species for European macroalgae bio-energy cultivation with the aim to promote the future development of the European macroalgal cultivation sector and allow for a better alignment with the requirements for biofuel production from macroalgae.

Conclusions

Overall, anaerobic digestion of seaweed offers opportunities for large-scale energy production which avoids some of the issues that have faced previous generations of biofuels, but there are a number of key challenges to overcome to ensure wider adoption and economic viability. (1) Optimising the biomass production to ensure an economic and uniform feedstock with the composition optimised to increase desirable characteristics such as sugar content and the carbon and nitrogen ratio and to reduce inhibitory factors such as halogenated secondary metabolites, sulphur and heavy metals. (2) Improving conversion rates through co-digestion, pre-treatments and tailored microbial communities, using scalable and economically feasible technology. (3) Developing tailored microbial communities capable of utilising the diverse polysaccharides in seaweed feedstock and being tolerant of the saline conditions associated with them. Addressing these issues will deliver significant benefits towards the development of a bio-energy industry based on the anaerobic digestion of cultured seaweeds.
The detailed analysis of the microbiome and resistome of artisanal blue-veined cheeses provides evidence on sources and patterns of succession linked with quality and safety traits
Authors: Alexa Elena A. , Cobo-Díaz José F. , Renes Erica , O´Callaghan Tom F. , Kilcawley Kieran , Mannion David , Skibinska Iwona , Ruiz Lorena , Margolles Abelardo , Fernández-Gómez Paula , Alvarez-Molina Adrián , Puente-Gómez Paula , Crispie Fiona , López Mercedes , Prieto Miguel , Cotter Paul D. , Alvarez-Ordóñez Avelino
Published: April 2024

Background

Artisanal cheeses usually contain a highly diverse microbial community which can significantly impact their quality and safety. Here, we describe a detailed longitudinal study assessing the impact of ripening in three natural caves on the microbiome and resistome succession across three different producers of Cabrales blue-veined cheese.

Results

Both the producer and cave in which cheeses were ripened significantly influenced the cheese microbiome. Lactococcus and the former Lactobacillus genus, among other taxa, showed high abundance in cheeses at initial stages of ripening, either coming from the raw material, starter culture used, and/or the environment of processing plants. Along cheese ripening in caves, these taxa were displaced by other bacteria, such as Tetragenococcus, Corynebacterium, Brevibacterium, Yaniella, and Staphylococcus, predominantly originating from cave environments (mainly food contact surfaces), as demonstrated by source-tracking analysis, strain analysis at read level, and the characterization of 613 metagenome-assembled genomes. The high abundance of Tetragenococcus koreensis and Tetragenococcus halophilus detected in cheese has not been found previously in cheese metagenomes. Furthermore, Tetragenococcus showed a high level of horizontal gene transfer with other members of the cheese microbiome, mainly with Lactococcus and Staphylococcus, involving genes related to carbohydrate metabolism functions. The resistome analysis revealed that raw milk and the associated processing environments are a rich reservoir of antimicrobial resistance determinants, mainly associated with resistance to aminoglycosides, tetracyclines, and β-lactam antibiotics and harbored by aerobic gram-negative bacteria of high relevance from a safety point of view, such as Escherichia coli, Salmonella enterica, Acinetobacter, and Klebsiella pneumoniae, and that the displacement of most raw milk-associated taxa by cave-associated taxa during ripening gave rise to a significant decrease in the load of ARGs and, therefore, to a safer end product.

Conclusion

Overall, the cave environments represented an important source of non-starter microorganisms which may play a relevant role in the quality and safety of the end products. Among them, we have identified novel taxa and taxa not previously regarded as being dominant components of the cheese microbiome (Tetragenococcus spp.), providing very valuable information for the authentication of this protected designation of origin artisanal cheese.
Attitudes of nurses, paramedics, and medics towards security prisoners: a cross-sectional study
Authors: Hadida Liel , Wacht Oren , Riven Ilana Livshiz , Grinstein-Cohen Orli
Published: April 2024

Background

Security prisoners in Israel are those imprisoned due to offenses involving harming state security or from nationalistic motivations. On the one hand, they are accused of a serious criminal offense that harmed state security, while on the other hand they have a right to healthcare like any human being. According to the Theory of Planned Behavior, an attitude is one of three components that predict a behavior intention. The study aims to evaluate the attitudes of nurses, paramedics, and medics toward security prisoners, and to identify factors that could be related to their attitudes.

Methods

A cross-sectional study, conducted using a convenience sample. Attitudes toward security prisoners were measured using the Attitudes Towards Prisoners (ATP) questionnaire. The study included 281 participants. The results show that the nationality of staff members (Jewish, Muslim, or Christian) did not influence their attitudes toward security prisoners (p > 0.05).

Results

Staff members who had treated a security prisoner showed a more positive attitude compared with those who had never treated a security prisoner (p < 0.05). The study also found that the youngest group of participants (20–30 years) had a lower average attitude compared with older age groups (p < 0.05). This may be due to the younger participants’ closer age to the experience of military service.

Conclusions

This study showed that there is no connection between staff members’ nationality and their attitudes toward security prisoners. This indicates that the staff treat patients in accordance with the equality value. By characterizing variables related to the staff’s attitudes we can propose appropriate training programs for the studied staff and the introduction of this topic into the various curricula in Israel, thus improving the quality of staff care.
University students’ free time management and quality of life: the mediating role of leisure satisfaction
Authors: Terzi Esranur , Isik Utku , Inan Berat Can , Akyildiz Can , Ustun Umit Dogan
Published: April 2024

The impact of free time management and leisure satisfaction on quality of life is distinct, however, the role of satisfaction in enhancing quality of life through free time management remains uncertain. Hence, the objective of this research is to explore how leisure satisfaction acts as a mediator between free time management and the levels of quality of life among university students. Additionally, this study aims to analyse these concepts in relation to gender, age and the number of days of activity participation. Within this particular framework, a total of 213 university students willingly participated in the survey, which included the administration of the “Free Time Management Scale,” “Leisure Satisfaction Scale,” and “Quality of Life Scale.” The analyses employed the Independent T-Test, Pearson Correlation, and Linear Regression methods. The mediating effect was analysed using Structural Equation Modelling. The study found significant relationships between gender, free time management, and life quality. There was a significant relationship between free time management, leisure satisfaction, and quality of life (p < 0.05). Leisure satisfaction partially mediated the quality of life-free time management relationship. As age and physical activity grow, males have a higher standard of living, and time allocation and quality of life improve. Furthermore, it was found that students who effectively managed their time experienced an enhanced quality of life, as evidenced by their increased satisfaction with leisure activities. Notably, the level of satisfaction with well-managed time was identified as a crucial factor in this association.
Increased levels and activation of the IL-17 receptor in microglia contribute to enhanced neuroinflammation in cerebellum of hyperammonemic rats
Authors: Arenas Yaiza M. , López-Gramaje Adrià , Montoliu Carmina , Llansola Marta , Felipo Vicente
Published: April 2024

Background

Patients with liver cirrhosis may show minimal hepatic encephalopathy (MHE) with mild cognitive impairment and motor incoordination. Rats with chronic hyperammonemia reproduce these alterations. Motor incoordination in hyperammonemic rats is due to increased GABAergic neurotransmission in cerebellum, induced by neuroinflammation, which enhances TNFα-TNFR1-S1PR2-CCL2-BDNF-TrkB pathway activation. The initial events by which hyperammonemia triggers activation of this pathway remain unclear. MHE in cirrhotic patients is triggered by a shift in inflammation with increased IL-17. The aims of this work were: (1) assess if hyperammonemia increases IL-17 content and membrane expression of its receptor in cerebellum of hyperammonemic rats; (2) identify the cell types in which IL-17 receptor is expressed and IL-17 increases in hyperammonemia; (3) assess if blocking IL-17 signaling with anti-IL-17 ex-vivo reverses activation of glia and of the TNFα-TNFR1-S1PR2-CCL2-BDNF-TrkB pathway.

Results

IL-17 levels and membrane expression of the IL-17 receptor are increased in cerebellum of rats with hyperammonemia and MHE, leading to increased activation of IL-17 receptor in microglia, which triggers activation of STAT3 and NF-kB, increasing IL-17 and TNFα levels, respectively. TNFα released from microglia activates TNFR1 in Purkinje neurons, leading to activation of NF-kB and increased IL-17 and TNFα also in these cells. Enhanced TNFR1 activation also enhances activation of the TNFR1-S1PR2-CCL2-BDNF-TrkB pathway which mediates microglia and astrocytes activation.

Conclusions

All these steps are triggered by enhanced activation of IL-17 receptor in microglia and are prevented by ex-vivo treatment with anti-IL-17. IL-17 and IL-17 receptor in microglia would be therapeutic targets to treat neurological impairment in patients with MHE.
The use of Carica papaya seeds as bio coagulant for laundry wastewater treatment
Authors: Vezar Siti Alfinna Naulita , Belinda Zeriyatina Tri , Rendana Muhammad , Agustina Tuty Emilia , Nasir Subriyer , Hanum Laila , Andarini Desheila
Published: April 2024

The study aims to analyze the effectiveness of wastewater treatment by using Carica papaya seeds as bio coagulants to diminish total suspended solids (TSS) and excess phosphate. This method has some advantages because it does not use chemical materials, is simple to apply, and is safe for the environment and human health. The wastewater samples were taken from an active laundry site in Palembang City, South Sumatra Province of Indonesia. The study found that the best dosage of coagulant was 3 g for the wastewater samples. The pH and BOD parameters showed slight changes after treatment, with pH 7.63–7.19 and 33–27 mg/L values, respectively. The TSS removal efficiency ranged from 9.3 to 15.6%, while the COD and phosphate removals were obtained from 11.7 to 39.3% and 56.3 to 68.4%, respectively. The treated TSS, COD, and phosphate concentrations have met the Indonesian domestic wastewater quality standard and environmental protection organization (EPO) guidelines. In addition, the statistical analysis and t-test showed significant differences (p < 0.05) for before and after treatment data of all parameters. The ANOVA test showed significant differences (p < 0.05) for all parameters among the three treatments. Overall, the study indicated that C. papaya seeds are promising materials that are eco-friendly and useful to treat laundry wastewater.
Evaluation of the Safety of Liberalized Systolic Blood Pressure Goals in the Postoperative Period After Intracranial Tumor Resection
Authors: Zeller Sabrina L. , Subah Galadu , Soldozy Sauson , Vazquez Sima , Al-Mufti Fawaz , Hanft Simon J.
Published: April 2024

BACKGROUND AND OBJECTIVES:

Postoperative intracranial hemorrhage (POH) is a serious neurosurgical complication occurring in approximately 1.4% of patients after intracranial tumor resection. The convention across the United States is to maintain an immediate postoperative systolic blood pressure (SBP) of < 140 mm Hg to minimize this risk; however, this SBP goal lacks support in the literature despite widespread adoption. This study aims to investigate the safety of SBP liberalization to 160 mm Hg in the immediate postoperative setting after intracranial tumor resection.

METHODS:

A retrospective review was conducted on consecutive patients, aged 18 to 75 years, undergoing craniotomy for intracranial tumor resection from October 2020 until June 2023. Data were gathered from the electronic medical record per Institutional Review Board guidelines regarding demographics, operative details, perioperative vital signs, resource utilization, and complications. Pharmaceutical prices and insurance charges were approximated from costs provided by the institution's pharmacy. POH was defined as symptomatic hemorrhage within 48 hours requiring intervention.

RESULTS:

The study included 147 patients, with 104 in the liberalized cohort (SBP <160 mm Hg) and 43 in the standard cohort (SBP <140 mm Hg). The average age was 54.5 ± 14.9 years and 57.6 ± 10.6 years in the liberalized and standard groups, respectively (P = .23). Intensive care unit and hospital length of stay were not significantly different between groups. The liberalized group used $81.88 ± $280.19 (95% CI $53.01-$110.75) on as-needed antihypertensive medications vs $108.39 ± $215.91 (95% CI $75.96-$140.82) in the standard (P = .29), with significantly lower labetalol (P = .04). There was no POH in either cohort.

CONCLUSION:

Liberalization of SBP goals to <160 mm Hg appears safe in the immediate postoperative period after craniotomy for tumor resection without an increased POH risk. Liberalized SBP parameters may allow reduced antihypertensive medication usage, thereby avoiding excess hospital cost and medication side effects.
From Fog to Smog: The Value of Pollution Information
Authors: Barwick Panle Jia , Li Shanjun , Lin Liguo , Zou Eric Yongchen
Published: April 2024

In 2013, China launched a landmark program to monitor air quality and disclose real-time data, significantly increasing the public’s access to and awareness of pollution information. The program triggered cascading behavioral changes such as stronger avoidance of outdoor pollution exposure and increased spending on protective products. These behavioral responses mitigated the mortality impact of air pollution. Conservative estimates indicate that the program’s health benefits outweigh the costs by an order of magnitude. The findings highlight the benefits of improving public access to pollution information in developing countries which often experience severe air pollution but lack pollution data collection and dissemination. (JEL D83, D91, I12, O13, P28, Q51, Q53)
Shocks, Frictions, and Inequality in US Business Cycles
Authors: Bayer Christian , Born Benjamin , Luetticke Ralph
Published: April 2024

We show how a heterogeneous agent New Keynesian (HANK) model with incomplete markets and portfolio choice can be estimated in state space using a Bayesian approach. To render estimation feasible, the structure of the economy can be exploited and the dimensionality of the model automatically reduced based on the Bayesian priors. We apply this approach to analyze how much inequality matters for the business cycle and vice versa. Even when the model is estimated on aggregate data alone and with a set of shocks and frictions designed to match aggregate data, it broadly reproduces observed US inequality dynamics. (JEL D31, D52, E12, E32, E52, E62)
An evaluation of job satisfaction levels among ASHA workers at the Raipur PHC, Nagpur
Authors: Bisane Priti , Inkane Swapnil , G. Choudhari Sonali , G. Mendhe Harshal
Published: April 2024

Background ASHA (Accredited Social Health Activists) are an essential connection between the community and health care providers, these guidelines were established by The Ministry of Health and Family Welfare, Government of India. An ASHA worker’s level of job satisfaction is influenced by societal, cultural, and economic factors. An ASHA worker who does not receive a sufficient salary will find it difficult to support their family. The ASHA employee is not at all satisfied with this issue. In earlier research investigations, ASHAs voiced unhappiness with the incentives and expectations of greater or regular income. Objectives To assess the job satisfaction of the ASHA workers in the selected area of Nagpur, Maharashtra and find the association between levels of job satisfaction with selected variables. Methods The sample for the study will be conducted by using Multistage Random sampling techniques. Data will be collected by using semi- questionnaires. All responses from the questionnaires will be collated in a Microsoft Excel file, encoded, and processed using chi squared test and SPSS version 26.
Case Report: Percutaneous intercostal artery catheterization to treat a difficult-to-access spinal dural arteriovenous fistula
Authors: Martiel Manrique-Zegarra , Carlos Toledano-Illán , Maria Jesus Garcia-Sanchez , Jorge Escartín López , Josep Puig , Alex Lüttich , Ignacio Muguruza Trueba , Claudio Rodriguez-Fernandez , Miguel A. Vences
Published: April 2024

Spinal dural arteriovenous fistulas (SDAVF) are a subtype of spinal arteriovenous malformation (AVM). Although rare, SDAVF are the most common spinal vascular malformations and have potential devastating neurologic consequences, sometimes irreversible. Originally, they were treated with surgery alone, however endovascular treatment of SDAVF has evolved recently with good results and the understanding of the anatomy plays a key role. The feeder vessel of the AV shunt is supplied by the radiculomedullary or radiculopial artery, the shunt is usually located within the root sleeve of the dura and the SDAVF is drained by the medullary vein via retrograde flow. Generally the endovascular approach uses the catheterization of the segmental arteries; however, aortic thoracolumbar aneurysms can render endovascular access difficult and risky. We present a case where an SDAVF in woman with aneurysmal dilation of the descending aorta and a mural thrombus was successfully treated through percutaneous catheterization of intercostal artery.
Factors associated with inadequate urinary iodine concentration among pregnant women in Mbeya region Tanzania.
Authors: Lukindo Tedson , Masumo Ray , Hancy Adam , John Sauli E. , Paulo Heavenlight A. , Sanga Abraham , Noor Ramadhan , Lankoande Fatoumata , Towo Elifatio , Leyna Germana H. , Bridge Gemma , Bedi Raman
Published: April 2024

Background Insufficient and above WHO-recommended levels of iodine intake during pregnancy can lead to serious health outcomes. This study aimed to assess median urine iodine concentration and its associated risk factors among pregnant women in the Mbeya region, Tanzania. Method A cross sectional survey involving 420 pregnant women (n=420) aged 15-49, registered in Reproductive and Child Health Clinics was conducted. Socio-demographic and dietary factors were assessed by structured questionnaire and the urine samples were analyzed using the ammonium persulfate digestion method. Results Median urinary iodine concentration (mUIC) was 279.4μg/L and it ranged from 26.1 to 1915μg/L. Insufficient mUIC (below 150μg/L) was observed in 17.14% of participants, sufficient mUIC was 24.29% and 58.57% had mUIC above the recommended level (>250μg/L). Sample women who reported consuming fish in the last 24 hours had an increased risk of insufficient mUIC [Adjusted OR= 2.60 (95%CI 1.31-5.15)] while the risk was lower for those who attended at least primary education [AOR= 0.29 (CI 0.08-0.99)]. Further, sample women resident in Mbarali district, in the oldest age group (35-49) and having a higher socio-economic status were associated with an increased risk of having MUIC above recommended level [AOR=4.09 (CI 1.85-9.010], [AOR=2.51 (CI 0.99-6.330] and, [AOR=2.08 (CI 0.91-4.71) respectively. Conclusion This study demonstrated a significant association between geographical, age and socio-economic factors and median urine iodine concentration above the WHO-recommended level. Further, this study found association between inadequate iodine in diet and insufficient median urine iodine concentration. Therefore, educational programs on iodine intake should be strengthened.
Acute decompensated heart failure in the setting of cavotricuspid isthmus-dependent atrial flutter and thyroid storm
Authors: Castillo Cristian , Abdelmalek John , Juarez Michel
Published: April 2024

Thyroid storm is an extreme form of hyperthyroidism associated with a high mortality rate. Heart failure is considered the leading cause of mortality in these patients. Atrial flutter is the second most common arrhythmia in patients with thyroid storms that can lead to cardiomyopathy and further complications, such as acute decompensated heart failure. In this report, we present a case of acute decompensated heart failure in the setting of cavotricuspid isthmus-dependent atrial flutter and thyroid storm.
 
Keywords: Thyroid storm, Graves’ disease, cardiomyopathy, atrial flutter.
Rise of the Machines: The Impact of Automated Underwriting
Authors: Jansen Mark , Nguyen Hieu Quang , Shams Amin
Published: April 2024

Using a randomized experiment in auto lending, we find that algorithmic underwriting outperforms the human underwriting process, resulting in 10.2% higher loan profits and 6.8% lower default rates. The human and machine underwriters show similar performance for low-risk, less complex loans. However, the performance of human underwritten loans largely declines for riskier and more complex loans, whereas the machine performance stays relatively stable across various risk dimensions and loan characteristics. The performance difference is more pronounced at underwriting thresholds with a high potential for agency conflict. These results are consistent with algorithmic underwriting mitigating agency conflicts and humans’ limited capacity for analyzing complex problems.

This paper was accepted by Will Cong, finance.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2024.4986 .
Enzymatic Hydrolysis of Protein Hydrolysate from Pangasius sp. by-Product using Bromelain
Authors: Nurdiani Rahmi , Firdaus Muhamad , Prihanto Asep Awaludin , Jaziri Abdul Aziz , Jati Muhammad Rayhansyah , Abdurrahman Taufiq Rizki , Ifilah Syaravina , Debataraja Elfriede Rositta , Huda Nurul
Published: April 2024

Fish protein hydrolysate (FPH) is a product resulting from the degradation of fish protein into simple peptides and amino acids through hydrolysis. This study aims to optimise the enzymatic hydrolysis conditions of Pangasius sp. by-products to produce high-quality fish protein hydrolysate. Bromelain enzyme was used as the catalyst for hydrolysis. The degree of hydrolysis (DH), pH and antioxidant activity of FPH were used as response parameters. The optimisation was done using response surface methodology (RSM) by applying two factors (enzyme concentration and incubation time) with a 3-level Central Composite Design (CCD) model. The result showed that the bromelain concentration and incubation time of catfish protein hydrolysate gave significantly different effects (p<0.05) on the response parameters of Pangasius protein hydrolysate. Hydrolysis of Pangasius protein with 0.04% bromelain enzyme and incubation time of 2.8 hours resulted in DH, pH and DPPH antioxidant activity of 35.88%, 7.07 and 29.86%, respectively. The response value of Pangasius protein hydrolysate was within the range of the predicted value of hydrolysate. Therefore, the optimum conditions suggested by RSM can be used in the future production of Pangasius FPH. In addition, amino acid profiles of Pangasius protein hydrolysate showed high concentrations of Glycine, L-glutamic acid and L-aspartic Acid.
High beam quality continuous-wave 320  nm UV laser from a walk-off compensated intracavity frequency-doubled Pr:YLF laser
Authors: Zuo Yue , Wu Bo , Shen Yonghang
Published: April 2024

We report a high beam quality continuous-wave (CW) 320 nm ultra-violet (UV) laser. An end-pumped praseodymium-doped yttrium lithium fluoride (Pr:YLF) laser is constructed in a typical V-shaped cavity structure, while the UV output is obtained through intracavity frequency doubling using LiB3O5 (LBO). We investigate the dependence of the UV output power, as well as the spot profile on the LBO length, and find that the “walk-off” within LBO severely affects both the frequency-doubling efficiency and the beam quality of the UV output. Rotated twin LBO crystals are then applied to substitute for single long LBO crystal to compensate the walk-off effect, resulting in high-power 320 nm output up to 410 mW under the absorbed pump power of 4.0 W at 444 nm, with a high beam quality of M
x
2=1.02 and M
y
2=1.04.
Nonlinear propagation of chirped laser pulses through a dispersive and turbulent atmosphere
Authors: Hafizi B. , Isaacs J. , Palastro J. P. , Peñano J. R.
Published: April 2024

The evolution of ultrashort laser pulses in dispersive, turbulent, nonlinear, and dissipative media is discussed in connection with nonlinear self-focusing collapse and the onset of laser filamentation. In quiescent air, a laser pulse propagating with a peak power greater than a critical power for self-focusing will undergo a catastrophic, transverse collapse until the intensity is large enough for photoionization. At this point, self-focusing is arrested and balanced by plasma refraction, forming a laser filament. By applying an appropriate chirp, the dispersive properties of the medium can be used to enhance this process and control its onset, and to counter dissipative effects such as molecular absorption and atmospheric scattering. This paper presents an analysis of the effect of atmospheric turbulence on the propagation of nonlinear pulses with dispersion compensation (chirp). The analytical results are compared with wave optics simulations and found to be in reasonable agreement as long as the pulse maintains a near-Gaussian spatiotemporal profile.
Learnable sparse dictionary compressed sensing for channeled spectropolarimeter
Authors: Huang Chan , Liu Huanwen , Zhang Hanyuan , Wu Su , Jiang Xiaoyun , Fang Yuwei , Zhou Leiming , Hu Jigang
Published: April 2024

Channeled spectropolarimetry enables real-time measurement of the polarimetric spectral information of the target. A crucial aspect of this technology is the accurate reconstruction of Stokes parameters spectra from the modulated spectra obtained through snapshot measurements. In this paper, a learnable sparse dictionary compressed sensing method is proposed for channeled spectropolarimeter (CSP) spectral reconstruction. Grounded in the compressive sensing framework, this method defines a variable sparse dictionary. It can learn prior knowledge from the measured modulated spectra, continuously optimizing its own structure and parameters iteratively by removing redundant basis functions and refining the matched basis functions. The learned sparse dictionary, post-training, can provide a more accurate sparse representation of the Stokes parameters spectra, enabling the proposed method to achieve more precise reconstruction results. To assess the efficacy of the proposed method, simulations and experiments were conducted, both of which consistently demonstrated the superior performance of the proposed approach. The suggested method is well-positioned to enhance the efficiency and accuracy of polarimetric spectral information retrieval in CSP applications.
Design of an optically transparent and broadband absorber based on a multi-objective optimization algorithm
Authors: Zhao Yulin , Fu Jiahui , Zhang Qunhao , Feng Hao , Wei Wei , Chen Wan , Zhang Kuang , Wu Qun
Published: April 2024

In this Letter, an optically transparent and broadband absorber designed using a multi-objective genetic algorithm (MOGA) is proposed. The absorption of the multilayer lossy frequency selective surface-based absorber is calculated by multilayer absorption equations and equivalent circuit models. To solve the problem of the unbalanced structure absorption bandwidth and thickness, an algorithm is used for optimizing the geometric and sheet resistance parameters of the structure. A multilayer and optically transparent absorber with 90% absorption bandwidth covering a frequency range of 2–18 GHz (S-band to Ku-band) is developed based on the MOGA design method with optical transmittance of 60%. Its total thickness consists of a wavelength of only 0.095, and it has high oblique incidence stability, which makes it useful in the stealth technology and transparent electromagnetic shielding applications.
Concussion response and recovery in men and women’s rugby union: A reflexive thematic analysis of player interviews
Authors: Petrie Freja J. , Mackintosh Kelly A. , Starbuck Chelsea , Williams Elisabeth M. P. , McNarry Melitta A.
Published: April 2024

Numerous concussion-management protocols have been developed in rugby, though little is known about player’s personal experiences of concussion. Specifically, research typically refers to clinical recovery, with social and psychological sequelae post-concussion gaining little attention. This study aimed to explore the experiences of rugby players in relation to being concussed and recovering from concussion. UK-based rugby players (10 men, 9 women and 1 non-binary person) from school, university, club, military and semi-professional teams took part in semi-structured interviews (36 ± 12 minutes). Interviews were transcribed verbatim, and a reflexive thematic analysis was conducted. Players considered pitch-side healthcare a necessity, though amateur players highlighted the difficulty in consistently accessing this resource. In the absence of medical staff, players were reliant on the goodwill of volunteers, but their response to concussion did not always align with current concussion guidance. Players highlighted that concussion recovery could be socially isolating and that current return-to-play programmes did little to restore lost confidence, resulting in retirement from the game in some instances. Participants expressed a desire for more in-person concussion education and for greater coverage of holistic methods to support their recovery. This study highlights a need for further investigation of the post-concussion social and psychological changes that players may experience during their recovery. Greater focus on information relating to concussion recovery and return-to-contact in education programmes would likely benefit player welfare.