bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of time from injury to surgery on the risk of neuropathic pain after traumatic spinal cord injury
Authors: Shi Tengbin , Yu Zhengxi , Chen Zhi , Wu Dingwei , Wang Zhenyu , Liu Wenge
Published: November 2023

Traumatic spinal cord injury (SCI) is a devastating neurological disorder often accompanied by neuropathic pain (NeP), significantly affecting patients' quality of life. This retrospective study aimed to investigate the impact of the time from injury to surgery on the development of NeP following traumatic SCI. Medical records of patients with traumatic SCI who underwent surgical intervention between January 2017 and January 2021 at two specialized centers were reviewed. Variables associated with NeP including demographics, injury profiles, medical history, surgical details, and pain assessments were investigated. Independent risk factors related to NeP were identified using multivariate logistic regression analysis. A total of 320 patients met the inclusion criteria, with 245 (76.6%) being male and a mean age of 56.5 ± 13.2 years. NeP was identified in 48.4% of patients (155 of 320). The multivariate analysis identifies age at injury, Injury Severity Score, and the neurological level of injury as independent risk factors for the development of NeP in both AIS A and AIS B, C, and D subgroups. Additionally, a significant association between the time from injury to surgery and NeP was observed in AIS B, C, and D patients, while no such association was found in AIS A patients. This study highlights the benefits of early and ultra-early surgical intervention in preventing NeP in patients with incomplete traumatic SCI (AIS B, C, and D), underscoring the importance of optimizing surgical timing to improve patient outcomes. Prospective studies are warranted to establish evidence-based surgical guidelines for managing traumatic SCI and preventing NeP effectively.
Testosterone replacement therapy is associated with increased odds of Achilles tendon injury and subsequent surgery: a matched retrospective analysis
Authors: Albright J. Alex , Lou Mary , Rebello Elliott , Ge Jonathan , Testa Edward J. , Daniels Alan H. , Arcand Michel
Published: November 2023

Background

Prescription of testosterone replacement therapy (TRT) has increased in the United States in recent years, and though anabolic steroids have been associated with tendon rupture, there is a paucity of literature evaluating the risk of Achilles tendon injury with TRT. This study aims to evaluate the associative relationship between consistent TRT, Achilles tendon injury, and subsequent surgery.

Methods

This is a one‐to‐one matched retrospective cohort study utilizing the PearlDiver database. Records were queried for patients aged 35–75 who were prescribed at least 3 consecutive months of TRT between January 1, 2010 and December 31, 2019. Achilles tendon injuries and subsequent surgeries were identified using ICD‐9, ICD‐10, and CPT billing codes. Multivariable logistic regression was used to compare odds of Achilles tendon injury, Achilles tendon surgery, and revision surgery, with ap‐value < 0.05 representing statistical significance.

Results

A sample of 423,278 patients who filled a TRT prescription for a minimum of 3 consecutive months was analyzed. The 2‐year incidence of Achilles tendon injury was 377.8 (95% CI, 364.8–391.0) per 100,000 person‐years in the TRT cohort, compared to 245.8 (95% CI, 235.4–256.6) in the control (p < 0.001). The adjusted analysis demonstrated TRT to be associated with a significantly increased likelihood of being diagnosed with Achilles tendon injury (aOR = 1.24, 95% CI, 1.15–1.33,p < 0.001). Of those diagnosed with Achilles tendon injury, 287/3,198 (9.0%) of the TRT cohort subsequently underwent surgery for their injury, compared to 134/2,081 (6.4%) in the control cohort (aOR = 1.54, 95% CI, 1.19–1.99,p < 0.001).

Conclusions

There is a significant association between Achilles tendon injury and prescription TRT, with a concomitantly increased rate of undergoing surgical management. These results provide insight into the risk profile of TRT and further research into the science of tendon pathology in the setting of TRT is an area of continued interest.
Prerequisites to improve surgical cytoreduction in FIGO stage III/IV epithelial ovarian cancer and subsequent clinical ramifications
Authors: de Jong Diederick , Thangavelu Amudha , Broadhead Timothy , Chen Inga , Burke Dermot , Hutson Richard , Johnson Racheal , Kaufmann Angelika , Lodge Peter , Nugent David , Quyn Aaron , Theophilou Georgios , Laios Alexandros
Published: November 2023

Background

No residual disease (CC 0) following cytoreductive surgery is pivotal for the prognosis of women with advanced stage epithelial ovarian cancer (EOC). Improving CC 0 resection rates without increasing morbidity and no delay in subsequent chemotherapy favors a better outcome in these women. Prerequisites to facilitate this surgical paradigm shift and subsequent ramifications need to be addressed. This quality improvement study assessed 559 women with advanced EOC who had cytoreductive surgery between January 2014 and December 2019 in our tertiary referral centre. Following implementation of the Enhanced Recovery After Surgery (ERAS) pathway and prehabilitation protocols, the surgical management paradigm in advanced EOC patients shifted towards maximal surgical effort cytoreduction in 2016. Surgical outcome parameters before, during, and after this paradigm shift were compared. The primary outcome measure was residual disease (RD). The secondary outcome parameters were postoperative morbidity, operative time (OT), length of stay (LOS) and progression-free-survival (PFS).

Results

R0 resection rate in patients with advanced EOC increased from 57.3% to 74.4% after the paradigm shift in surgical management whilst peri-operative morbidity and delays in adjuvant chemotherapy were unchanged. The mean OT increased from 133 + 55 min to 197 + 85 min, and postoperative high dependency/intensive care unit (HDU/ICU) admissions increased from 8.1% to 33.1%. The subsequent mean LOS increased from 7.0 + 2.6 to 8.4 + 4.9 days. The median PFS was 33 months. There was no difference for PFS in the three time frames but a trend towards improvement was observed.

Conclusions

Improved CC 0 surgical cytoreduction rates without compromising morbidity in advanced EOC is achievable owing to the right conditions. Maximal effort cytoreductive surgery should solely be carried out in high output tertiary referral centres due to the associated substantial prerequisites and ramifications.
Database quality assessment in research in paramedicine: a scoping review
Authors: McDonald Neil , Little Nicola , Kriellaars Dean , Doupe Malcolm B. , Giesbrecht Gordon , Pryce Rob T.
Published: November 2023

Background

Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine.

Methods

This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form.

Results

Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness.

Conclusions

There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.
Beneficial effects of the combination of BCc1 and Hep-S nanochelating-based medicines on IL-6 in hospitalized moderate COVID-19 adult patients: a randomized, double-blind, placebo-controlled clinical trial
Authors: Hafizi Maryam , Kalanaky Somayeh , Fakharzadeh Saideh , Karimi Pegah , Fakharian Atefeh , Lookzadeh Somayeh , Mortaz Esmaeil , Mirenayat Maryam Sadat , Heshmatnia Jalal , Karam Mehrdad Bakhshayesh , Zamani Homa , Nadji Alireza , Toutkaboni Mihan Pourabdollah , Oraee-Yazdani Saeed , Akbari Mohammad Esmaeil , Jamaati Hamidreza , Nazaran Mohammad Hassan
Published: November 2023

Background

In the severe forms of COVID-19 and many other infectious diseases, the patients develop a cytokine storm syndrome (CSS) where pro-inflammatory cytokines such as IL-6 and TNF-α play a key role in the development of this serious process. Selenium and iron are two important trace minerals, and their metabolism is tightly connected to immune system function. Numerous studies highlight the role of selenium and iron metabolism changes in the procedure of COVID-19 inflammation. The immunomodulator effect of nanomedicines that are synthesized based on nanochelating technology has been proved in previous studies. In the present study, the effects of the combination of BCc1(with iron-chelating property) and Hep-S (containing selenium) nanomedicines on mentioned cytokines levels in hospitalized moderate COVID-19 patients were evaluated.

Methods

Laboratory-confirmed moderate COVID-19 patients were enrolled to participate in a randomized, double-blind, placebo-controlled study in two separate groups: combination of BCc1 and Hep-S (N = 62) (treatment) or placebo (N = 60) (placebo). The blood samples were taken before medications on day zero, at discharge, and 28 days after consumption to measure hematological and biochemical parameters and cytokine levels. The clinical symptoms of all the patients were recorded according to an assessment questionnaire before the start of the treatment and on days 3 and discharge day.

Results

The results revealed that consumption of the nanomedicines led to a significant decrease in the mean level of IL-6 cytokine, and at the end of the study, there was a 77% downward trend in IL-6 in the nanomedicine group, while an 18% increase in the placebo group (p < 0.05). In addition, the patients in the nanomedicines group had lower TNF-α levels; accordingly, there was a 21% decrease in TNF-α level in the treatment group, while a 31% increase in this cytokine level in the placebo was observed (p > 0.05). On the other hand, in nanomedicines treated groups, clinical scores of coughing, fatigue, and need for oxygen therapy improved.

Conclusions

In conclusion, the combination of BCc1 and Hep-S inhibits IL-6 as a highly important and well-known cytokine in COVID-19 pathophysiology and presents a promising view for immunomodulation that can manage CSS.

Trial registration

Iranian Registry of Clinical Trials RCT20170731035423N2. Registered on June 12, 2020.
Mosquito larvae exposed to a sublethal dose of photosensitive insecticides have altered juvenile development but unaffected adult life history traits
Authors: Meier Cole J. , Martin Lindsay E. , Hillyer Julián F.
Published: November 2023

Background

Larvicides are critical for the control of mosquito-borne diseases. However, even sublethal exposure to a larvicide can alter development and life history traits, which can then affect population density and disease transmission dynamics. Photosensitive insecticides (PSIs) are a promising class of larvicide that are toxic when ingested and activated by light. We investigated whether the time of day when exposure occurs, or the process of pupation, affects larval susceptibility to PSI phototoxicity in the mosquito Anopheles gambiae, and whether sublethal exposure to PSIs alters life history traits.

Methods

Larvae were treated with lethal concentrations of the PSIs methylene blue (MB) and rose bengal (RB), and larval survival was measured at various times of day. Additionally, larvae were exposed to two concentrations of each PSI that resulted in low and medium mortality, and the life history traits of the surviving larvae were measured.

Results

Pupation, which predominantly occurs in the evening, protected larvae from PSI toxicity, but the toxicity of PSIs against larvae that had yet to pupate was unaffected by time of day. Larval exposure to a sublethal concentration of MB, but not RB, shortened the time to pupation. However, larval exposure to a sublethal concentration of RB, but not MB, increased pupal mortality. Neither PSI had a meaningful effect on the time to eclosion, adult longevity, or adult melanization potential.

Conclusions

PSIs are lethal larvicides. Sublethal PSI exposure alters mosquito development, but does not affect adult life history traits.

Graphical Abstract
Estimating and visualising the trade-off between benefits and harms on multiple clinical outcomes in network meta-analysis
Authors: Chiocchia Virginia , Furukawa Toshi A. , Schneider-Thoma Johannes , Siafis Spyridon , Cipriani Andrea , Leucht Stefan , Salanti Georgia
Published: November 2023

Background

The relative treatment effects estimated from network meta-analysis can be employed to rank treatments from the most preferable to the least preferable option. These treatment hierarchies are typically based on ranking metrics calculated from a single outcome. Some approaches have been proposed in the literature to account for multiple outcomes and individual preferences, such as the coverage area inside a spie chart, that, however, does not account for a trade-off between efficacy and safety outcomes.

We present the net-benefit standardised area within a spie chart, $$SAWIS$$

SAWIS

to explore the changes in treatment performance with different trade-offs between benefits and harms, according to a particular set of preferences.

Methods

We combine the standardised areas within spie charts for efficacy and safety/acceptability outcomes with a value λ specifying the trade-off between benefits and harms. We derive absolute probabilities and convert outcomes on a scale between 0 and 1 for inclusion in the spie chart.

Results

We illustrate how the treatments in three published network meta-analyses perform as the trade-off λ varies. The decrease of the $$SAWIS$$

SAWIS

quantity appears more pronounced for some drugs, e.g. haloperidol. Changes in treatment performance seem more frequent when SUCRA is employed as outcome measures in the spie charts.

Conclusions

$$SAWIS$$

SAWIS

should not be interpreted as a ranking metric but it is a simple approach that could help identify which treatment is preferable when multiple outcomes are of interest and trading-off between benefits and harms is important.
Protocol: dexmedetomidine on myocardial injury after noncardiac surgery—a multicenter, double-blind, controlled trial
Authors: Liu Huayue , Zhang Juan , Peng Ke , Meng Xiaowen , Shan Xisheng , Huo Wenwen , Liu Hong , Lei Yishan , Ji Fuhai
Published: November 2023

Aims

Myocardial injury after noncardiac surgery (MINS) is common in elderly patients and considered as an independent predictor of 30-day mortality after noncardiac surgery. Dexmedetomidine possesses cardiac-protective profile. Previous clinical studies have found that perioperative application of dexmedetomidine is associated with decreased 1-year mortality in patients undergoing cardiac surgery. The current study protocol aims to investigate the effects of dexmedetomidine on the incidence of MINS, complications, and 30-day mortality in elderly patients subjected to noncardiac surgery.

Methods

A multicenter, randomized, controlled, double-blind, prospective trial is designed to explore cardiac protection of dexmedetomidine in the elderly patients undergoing noncardiac surgery. A total of 960 patients aged over 65 years will be recruited and randomly assigned to dexmedetomidine group (group Dex) and normal saline placebo group (group NS) in a ratio of 1:1. Patients in group Dex will receive a bolus dose of 0.5 μg/kg dexmedetomidine within 10 min before surgical incision, followed by a consistent infusion at the rate of 0.3–0.5 μg/kg/h throughout the operation. Group NS patients will receive the same volume of normal saline. The primary outcome is the incidence of MINS via detecting the hs-TnT level within 3 days after the operation. The secondary outcome includes myocardial ischemic symptoms, the incidence of major adverse cardiovascular events (MACE) in hospital, length of ICU and postoperative hospital stay, the incidence of inhospital complications, and 30-day all-cause mortality.

Discussion

The results of the current study will illustrate the effect of dexmedetomidine on myocardial injury for elderly patients undergoing major noncardiac surgery.

Trial registration

The trial was registered with Chinese Clinical Trial Registry (CHICTR) on Aug 24, 2021 (ChiCTR2100049946, http://www.chictr.org.cn/showproj.aspx?proj=131804).
Prediction factors and clinical significance of different types of hemorrhagic transformation after intravenous thrombolysis
Authors: Hao Yanan , Zhou Huan , Pan Chengzhen , Xie Guomin , Hu Jin , Zhang Bing , Qian Shuxia , Yan Shenqiang ,   the CASE II investigators
Published: November 2023

Background and purpose

Hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in acute ischemic stroke seriously affects the prognosis of patients. This study aimed to investigate the risk factors of different types of HT and their correlation with prognosis after IVT.

Methods

Based on the CASE II registry, we included patients with acute ischemic stroke who received IVT within 4.5 h of onset. HT was further divided into hemorrhagic infarction (HI) and parenchymal hemorrhage (PH). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 3 months. Multivariate logistic regression analysis was used to determine the independent influencing factors of HT subtypes and clinical outcome.

Results

Among 13108 included patients, 541 (4.1%) developed HI and 440 (3.4%) developed PH. In multivariate analysis, age (OR 1.038, 95% CI 1.028 to 1.049, p < 0.001), atrial fibrillation (OR 1.446, 95% CI 1.141 to 1.943, p = 0.002), baseline diastolic pressure (OR 1.012, 95% CI 1.004 to 1.020, p = 0.005), baseline NIHSS score (OR 1.060, 95% CI 1.049 to 1.071, p < 0.001) and onset to treatment time (OR 1.002, 95% CI 1.000 to 1.004, p = 0.020) independently predicted PH after IVT. In the patients with HT, PH (OR 3.611, 95% CI 2.540 to 5.134, p < 0.001) and remote hemorrhage (OR 1.579, 95% CI 1.115 to 2.235, p = 0.010) were independently related to poor outcome.

Conclusions

Different types of HT after IVT had different risk factors and clinical significance. The occurrence of PH and remote hemorrhage independently increased the risk of poor outcome.
Psycho-linguistic and educational challenges in Teaching Chinese (Mandarin) Language: voices from None-Chinese teachers of Mandarin language
Authors: Pan Lei , Sun Dan , Zou Yumei , Cao Yi , Zhang Jingxian , Li Fangfang
Published: November 2023

Background

Chinese/Mandarin language instruction to undergraduate students from non-Chinese speaking countries has become a topic of increasing interest, driven by China’s influential role in global political and economic dynamics. With Mandarin being the language spoken by approximately 70% of Chinese speakers, it is not only taught within China but also in institutions around the world. While teaching any second or foreign language presents unique challenges, the specific challenges faced in Mandarin language education have not received comprehensive scrutiny, prompting the need for further investigation.

Objectives

The primary objective of this study was to explore the challenges associated with teaching and learning Mandarin from the perspectives of non-native Mandarin language teachers. By adopting a qualitative (phenomenological) research approach, we aimed to uncover the multifaceted challenges that confront both educators and learners in the context of Mandarin language instruction.

Methodology

The research methodology employed for this study involved the use of semi-structured interviews conducted with 15 Mandarin language teachers, who were chosen through theoretical sampling. These interviews were transcribed into text files and subsequently subjected to qualitative data analysis, which was facilitated by the use of MAQDA software. This approach allowed us to identify and categorize the various challenges and problems encountered in the teaching and learning of Mandarin.

Findings

The research findings revealed a range of challenges and problems experienced in Mandarin language education. These challenges were grouped into two primary thematic categories: psycho-linguistic and educational challenges. The linguistic challenges are deeply rooted in the distinctive features of the Mandarin language, presenting obstacles that necessitate innovative teaching strategies and materials. Educational challenges extend beyond native speaker proficiency, emphasizing the requirement for a comprehensive pedagogical skill set among instructors.

Implications

: The implications of this research extend to various stakeholders in the field of Chinese/Mandarin language education, including policymakers, educators, curriculum designers, and learners. Understanding the linguistic, educational, and psychological challenges can inform the development of more effective teaching methods, curriculum design, and motivation-enhancing strategies, ultimately promoting a more successful and engaging Mandarin language learning experience for non-native speakers.
Prediction of earth pressure balance for EPB-TBM using machine learning algorithms
Authors: Samadi Hanan , Hassanpour Jafar , Rostami Jamal
Published: November 2023

Face stability control of excavation with earth pressure balance machine (EPB) approach is the best available method to reduce the ground deformation and settlement of surface structures in a tunneling project in urban areas. In the present paper, several models have proposed through a statistical method, including feed-forward stepwise regression (FSR) and machine learning techniques such as support vector machine (SVM), Takagi–Sugeno fuzzy model (TS), and multilayer perceptron neural network (ANN-MLP), to provide a predictive strategy for EPB machine during the tunnel excavation. For this purpose, a monitoring dataset of machine performance parameters including advance speed, screw conveyor speed, screw conveyor torque, thrust force, and cutterhead rotation speed from Tehran Metro Line 6 Southern Extension Sector (TML6-SE) has been compiled. Then, the relation between the performance parameters and target values were investigated to analyze the available inputs and offer a new equation using the FSR. Moreover, evaluation metrics and loss functions were utilized for the evaluation of the developed models’ efficiency. The results proved the significance of the presented methods in this paper that could be used to predict the earth pressure balance operation with high efficiency.
Identification of native entomopathogenic fungi associated with Mahanarva fimbriolata Stahl in silvopastoral systems (Urochloa brizantha cv. MG-5 and Eucalyptus spp.)
Authors: Sarubbi H. , Resquín-Romero G. , Garrido-Jurado I.
Published: November 2023

Background

Pastures are susceptible to attacks from various species of insects, with Cercopidae being one of the main responsible pests. The species Mahanarva fimbriolata has a wide distribution in the Eastern region of Paraguay, leading to pasture damage. The most promising alternatives to chemical use are bioinsecticides, which could offer effective control while minimizing negative environmental impacts. Beauveria and Metarhizium have been documented as biocontrol fungi for Cercopidae insects. Therefore, identifying and isolating virulent native strains presents potential alternatives for controlling the spittlebug M. fimbriolata.

Results

Based on morphological and molecular characteristics, native strains of Metarhizium anisopliae and Beauveria bassiana were identified in the collected insects. Phylogenetic trees confirmed that the Beauveria sequence (Beauveria seq) obtained in this study aligned with the ARSEF 842 isolate of B. bassiana. The Metarhizium sequence (Metarhizium seq) was in the same clade as ARSEF 7450 and ARSEF 7487, which belong to the Metarhizium anisopliae. Beauveria bassiana displayed conidiophores that were broad at the basal part, forming synnemata or groups of conidiophores closely packed together, with a typical "zig-zag"-shaped rachis. The conidia were hyaline and smooth, ellipsoidal, and globose. On the other hand, M. anisopliae exhibited simple, straight conidiophores with bottle-shaped phialides. The conidia were elongated, ovoid to cylindrical, arranged in chains, and had an olive green color.

Conclusions

This is the first report of Metarhizium anisopliae and Beauveria bassiana obtained from nymphs and adults of Mahanarva fimbriolata in Paraguay.
Alagille syndrome and liver: an adult case report
Authors: Kharmach Oussama , Borahma Mohamed , Ajana Fatima-Zohra
Published: November 2023

Background

Alagille syndrome is a rare autosomal-dominant disorder, representing 10 to 15% of the causes of neonatal cholestasis with no gender predominance. The diagnosis is based on the association of liver, heart, eye, skeleton abnormalities, and characteristic facial appearance.

Case presentation

An 18-year-old male patient, with a family history of benign recurrent intrahepatic cholestasis in a brother, was diagnosed at birth with bile duct paucity. He consulted in adulthood for cholestatic jaundice and pruritus. Physical exam found cutaneous jaundice, particular face, skeletal abnormality of fingers, posterior embryotoxon, and splenomegaly. An echocardiogram found cardiovascular abnormalities. The diagnosis of Alagille syndrome was made in front of five major criteria. A liver biopsy revealed a cirrhosis liver. Upper gastrointestinal endoscopy revealed grade II esophageal varices of portal hypertension. Laboratory tests revealed bicytopenia related to hypersplenism, hypoferritinemia, cytolysis with cholestasis, high bilirubin levels, low prothrombin time, hypoalbuminemia, decreased factor V activity, and hypocholesterolemia. The patient had vitamin K supplementation and was put on ursodeoxycholic acid, propranolol for the liver disease, a high protein hypercaloric diet for malnutrition, vitamin D supplementation and bisphosphonate for the osteoporosis, therapeutic abstention with monitoring for the asymptomatic cardiac disease. After a year of treatment, the patient had an overall health status improvement. Abdominal ultrasound found liver nodules. A biliary MRI showed a multinodular liver. The complement by CT hepatic angiography did not show any nodules while the MRI angiography revealed multiple dysplastic nodules. A liver biopsy was performed and found regenerative nodules.

Conclusion

The treatment of Alagille syndrome is based on managing the cholestasis and its complications, especially pruritus because it can have a significant impact on quality of life. Due to the complexity of presentation and multi-organ involvement, management of cases with Alagille syndrome should be done by a multidisciplinary team. Liver disease is responsible for morbidity while cardiac disease is a mortality risk factor in this population.
Variable cross-sectional effect on bi-directional blades–tower–soil–structure dynamic interaction on offshore wind turbine subject to wind–wave loads
Authors: El Absawy Mostafa A. , Elnaggar Zakaria , Ibrahim Hesham H. , Taha M. H.
Published: November 2023

Background

This study introduces a numerical model designed to simulate interactions occurring between a wind turbine's tower and the surrounding soil, as well as between the nacelle, blades, and the surrounding environment. This simulation accounts for both fore–aft and side-to-side movements. To describe these interactions, the model leverages the Euler–Lagrange equations. It calculates wave loads utilizing the Morison equation, with wave data generated based on the JONSWAP spectrum. Furthermore, aerodynamic loads are determined using the blade element moment theory, and the wind spectrum is generated using the Von Karman turbulence model. The tower is represented as a variable cross-sectional beam, employing a two-noded Euler beam element with two degrees of freedom: transverse displacement and rotation, and utilizing Hermite polynomial shape functions.

Results

In a comparative analysis against experimental data, this modified model demonstrates significant enhancements in accurately reproducing the dynamic behavior of wind turbines with variable cross-sectional towers, outperforming models that approximate the tower with a constant cross section. Our findings reveal that the modified model achieves a remarkable improvement of 15% in replicating the tower's dynamic response when compared to the constant cross-sectional models. As a case study, a 5 MW monopile wind turbine with a flexible foundation, specifically the one provided by the National Renewable Energy Laboratory (NREL), is employed to simulate its dynamic response.

Conclusions

This research presents a robust numerical model for simulating wind turbine behavior in various environmental conditions. The incorporation of variable cross-sectional tower representation significantly improves the model's accuracy, making it a valuable tool for assessing wind turbine dynamics. The study's findings highlight the importance of considering tower flexibility in wind turbine simulations to enhance their real-world applicability.
Progesterone Activates the Histone Lactylation–Hif1α-glycolysis Feedback Loop to Promote Decidualization
Authors: Zhao Wei , Wang Yue , Liu Juan , Yang Qianying , Zhang Shuai , Hu Xiao , Shi Zhicheng , Zhang Zhenni , Tian Jianhui , Chu Dapeng , An Lei
Published: November 2023

Decidualization is a progesterone-dependent cellular differentiation process that is essential for establishing pregnancy. Robust activation of glycolysis and lactate synthesis during decidualization is remarkable, but their developmental functions remain largely unknown. Herein, we identify that endometrial lactate production plays a critical role in establishing local histone lactylation, a newly identified histone modification, and is important for ensuring normal decidualization. Enhanced endometrial glycolysis is the hallmark metabolic change and is tightly coupled with H4K12la during decidualization. Inhibition of histone lactylation impaired decidualization, in either physiological conception or in vivo and in vitro induced decidualization models. Mechanistic study based on CUT&Tag and ATAC-seq revealed that a transcriptional factor hypoxia-inducible factor 1 α (Hif1α) is the critical regulatory target of H4K12la, and in turn forms an H4K12la–Hif1α-glycolysis feedback loop to drive decidualization. Moreover, we demonstrate that the loop is directly activated by progesterone during decidualization. Our study not only advances the current knowledge of the role of lactate in regulating uterine function, but also establishes a novel functional link among the major endocrine factors, endometrial metabolic change, and epigenetic modification during endometrial remodeling. These findings present valuable clues to develop clinical intervention strategies to improve pregnancy outcomes following both natural conception and assisted reproduction.
Factors influencing dressing choice in wound care: a discussion
Authors: Bishop Alexandra
Published: November 2023

Dressing choice can be challenging for clinicians, with many different product types and makes now available. The cost of wound care products is 93% higher for unhealed wounds than for those that heal, so planning appropriate care is essential. Wound care planning requires wound assessment and identification of the aim of care. In turn, this supports dressing selection. Using an assessment framework can help ensure that this is done in a structured way. Reassessment and review of the care plan at agreed intervals is also recommended. In addition to the aim of care, other factors influence the choice of dressing. These include local formulary requirements and allergies and sensitivities. An extensive range of dressings is available and these can be grouped into 10 types: hydrocolloid; wound contact layer; hydrogel; gelling fibre; alginate; foam; absorbent pads; film; odour absorbent; and antimicrobial. Clinicians should use available resources to support decision making and consider continuity of care when selecting the dressing to be used.
Prevention of skin tears: intrinsic and extrinsic factors
Authors: Stephen-Haynes Jackie
Published: November 2023

Skin tears are traumatic wounds caused by mechanical forces, which can be caused by the removal of adhesive dressing. Although they are common – especially in individuals with vulnerable skin, such as older people – their prevalence is underestimated, they are often misdiagnosed and they have a high risk of developing into complex, chronic wounds. However, skin tears are largely preventable. There are a number of intrinsic and extrinsic factors relating to skin tears and preventive strategies that may be undertaken. Health professionals, patients and caregivers/family members should aim to manage modifiable intrinsic and extrinsic factors to promote and maintain skin integrity to prevent skin tears. Where a skin tear does occur, an evidence-based approach should be taken to management, with referral to specialist care if necessary.
Medical device-related pressure injury from compression therapy
Authors: Robinson Hollie , Atkin Leanne , Gray Susan
Published: November 2023

The use of compression therapy is known to be effective in the management of patients with venous leg ulceration and is commonly recommended as a first-line treatment. A rare but known complication of compression therapy is pressure damage to the limb, also referred to as bandage damage, which should be categorised as a medical device-related pressure injury. Patients should receive a comprehensive, holistic assessment before any compression therapy is applied. Risk factors for compression therapy injury include peripheral arterial disease, older age, fragile skin, pronounced bony prominences or tendons, calf atrophy, foot drop, neuropathy/absent sensation, limited movement, cognitive impairment and receiving end of life care. Risks can be mitigated through a variety of approaches, and practitioners should be aware that these can change depending on the patient's condition. A community improvement initiative, illustrated with a case study, introduced a clinical pathway that can facilitate the identification and management of patients who are at risk of developing pressure injuries as a result of compression therapy.
Safeguarding, cyber security and IT in early years settings
Authors: Lloyd Rob
Published: November 2023

Rob Lloyd, technical manager at easipc, discusses issues around the use of technology in early education, including safeguarding and cyber security and shares tips for settings to fulfil their obligations in these areas.
Professional Book Reviews
Authors: Barclay Meg
Published: November 2023

Richard Willis, visiting professor at the University of South Wales, reviews a book about technology in early childhood education. Meg Barclay, educational consultant and early years reviewer for the School Library Association, reviews seasonal picture books which introduce children to winter and Christmas, as well as how to cope with and understand anxiety in an age appropriate way.
A Manifesto for real change
Authors: Wright Caroline , Fisher Julie , O'Sullivan June , Dubiel Jan , Leitch Neil , Wright David
Published: November 2023

2023 has been a year in which early years settings have had to cope with extraordinary amounts of change and development, on top of the wider pressures society is dealing with from the cost of living crisis and the legacy of the Covid-19 pandemic. As the year draws to a close, we ask key voices in the early years space what they would like to see in an Early Years Manifesto which would set the direction of the sector from next year; their hopes and aims for the sector, and what they think would help improve the existing crisis.
Mesenchymal stem cells: application in chronic lung disease
Authors: Adamič Neza
Published: November 2023

Chronic lung diseases such as asthma, chronic obstructive lung disease and idiopathic lung fibrosis have limited treatment options and researchers are exploring new avenues to improve patient outcomes. Mesenchymal stem cell therapy has shown promising potential as a treatment option for chronic lung diseases, however, it is essential to note that it is still considered an experimental approach. Studies in animal models and some small-scale clinical trials have shown encouraging results. Mesenchymal stem cell therapy can reduce inflammation, promote tissue repair and potentially slow disease progression. However, it is crucial to understand that stem cell therapy is still in its early stages and many challenges and questions need to be addressed before widespread clinical application. Some of these challenges include determining optimal dose and delivery methods, ensuring the safety of the procedure, understanding long-term effects and addressing potential ethical concerns.
The role of the equine veterinarian in end-of-life phase of geriatric horses
Authors: van Proosdij ER
Published: November 2023

The role of a veterinarian during the end-of-life phase can be divided into four stages, which are covered in detail in this article. The decision-making process involves both the horse's owner and the veterinarian. In a welfare assessment, ‘a life worth living’ should be aspired to. Euthanasia should be advised by the veterinarian if a horse is found to have ‘a life not worth living’. The decision to end the horse's life is made considering the welfare of the horse and involving the owner. Communicating the decision should be done via the COMFORT and SPIKES protocols. The COMFORT protocol contains elements used for communication, and the SPIKES protocol relates to the order in which the decision is made. After communicating the decision, the veterinarian should also address matters related to the logistics of the horse's euthanasia. Enacting the decision by the veterinarian: the medical and technical aspects of the procedure of euthanasia are important, as well as the interaction and support of the owner by the veterinarian. Finally, after euthanising a horse, attention should be given to the aftercare of the body and to the emotional support of the owner.
A touch of glass: cryopreservation of equine embryos by vitrification
Authors: Wilsher Sandra
Published: November 2023

The cryopreservation of equine embryos larger than 300 µm in diameter has proved problematic for many decades. However, there now exist protocols to undertake vitrification of such embryos with good pregnancy rates following their subsequent warming and transfer to recipient mares. This article discusses the reasons why equine embryos have proved so difficult to cryopreserve, and looks at cryopreservation methods before focusing on embryo vitrification. It also provides a historical perspective on the development of vitrification and details the latest techniques and emerging methodologies aimed at making embryo cryopreservation more accessible for practitioners.
Lipid disorders in horses and foals
Authors: Bertin François-René
Published: November 2023

Equine lipid disorders are characterised by an increase in levels of circulating triglycerides resulting from a negative energy balance, which happens because of various factors such as inflammation or inadequate dietary intake. Lipids are absorbed from the equine diet as fatty acids and can be stored or directly used for energy depending on metabolic demand, with a positive energy balance favouring lipogenesis and a negative balance promoting lipolysis. Hyperlipaemia is a syndrome defined by high triglyceride concentrations and opalescent serum. It is common in ponies, donkeys and miniature breeds, especially during late gestation or early lactation. Stressful events like transportation or hospitalisation can precipitate the development of the condition. Although the prognosis is guarded in severe cases, clinical signs are often overlooked and diagnosis relies on measurement of triglyceride levels. Management involves treating the initial cause, where possible, and addressing negative energy balance through enteral or parenteral nutrition. A similar syndrome is described in sick neonatal foals, requiring similar management strategies.
Extracellular vesicles in osteoarthritis: from biomarkers to therapeutic potential
Authors: Clarke Emily J , Peffers Mandy J
Published: November 2023

Equine osteoarthritis is a leading welfare concern. Currently, it can only be diagnosed in its late stages – radiographically and upon clinical examination. There are no curative therapeutic options, with treatment aiming to provide symptom relief and reduce the rate of progression. Thus far, no biochemical diagnostic panels have been produced to diagnose osteoarthritis in its infancy, nor have there been transformative therapeutics to improve disease management. As such, the exploration has continued, with attention now focused on the emerging role of extracellular vesicles in the pathogenesis of osteoarthritis, their potential to carry biomarkers of disease and their therapeutic capacity in the context of popular regenerative therapeutics, such as mesenchymal stromal cell therapy. This article provides a brief overview of the role of extracellular vesicles in equine osteoarthritis for veterinary clinicians, and the future directions this growing field may explore.
Deslocamento perpendicular à direção do movimento na teoria da relatividade especial
Authors: Assunção Davi Antonio , Soltau Samuel Bueno
Published: November 2023

Os problemas de Relatividade Especial envolvendo a transformação de Lorentz propostos em manuais de Física alinham o movimento dos projéteis e dos observadores que o descrevem numa única coordenada, ou seja, na mesma direção e sentido. Contudo, estudar a situação na qual o movimento de um projétil é perpendicular à direção dos referenciais dos observadores permite graduar a dificuldade na análise até enfrentar a situação de movimentos em qualquer direção. Neste contexto, apresentamos aqui um caso simples, bidimensional ao estudarmos a quantidade de movimento de um projétil lançado perpendicularmente contra um alvo conforme descrito na perspectiva de observadores em dois referenciais distintos com a intenção de desenvolver a intuição física a respeito de fenômenos relativísticos e aprimorar a habilidade no uso das equações e conceitos Relatividade Especial.
“The Strange Artistic Genius of This People”: The Ephemeral Art and Impermanent Architecture of Italian Immigrant Catholic Feste
Authors: Sciorra Joseph
Published: November 2023

abstract: During the late nineteenth and early twentieth centuries, Italian working-class immigrants in the United States staged religious feste (street feasts) in honor of the Madonna and other Catholic saints to express their beliefs in a socially acceptable, aesthetically pleasing, and recognizable manner. Impermanent edifices and other ephemeral constructions were integral parts of these cultural-religious extravaganzas. Hanging decorative illuminations, elaborate sidewalk altars, freestanding multistoried chapels, and various ambulatory structures were architectural wonders that boldly transformed, sacralized, and claimed American urban landscapes. A vernacular baroque aesthetic permeated the occupation and sacralization of the streets that engendered hallowed and convivial topographies that would have lasting ramifications for how people imagined their lives and neighborhoods. This article examines how these transient objects of devotion, predominantly in East Coast cities, enacted and proclaimed a diasporic community of believers that challenged hegemonic notions of artistry, religion, the built environment, and the public sphere. Ephemeral festival architecture captivated the attention of outsiders, including photographers, journalists, and visual artists, who depicted them in words and imagery. The article also contextualizes this source material as part of the Progressive era’s xenophobic climate and, in particular, the picturesque gaze that racialized and othered Italian immigrants.
Hiring Out: Enslaved Black Building Artisans in North Carolina
Authors: Bishir Catherine W.
Published: November 2023

abstract: Central to the construction of much of the architecture of the antebellum South were enslaved artisans in every building trade. A large proportion of these men were hired out as part of an economic system that operated in most slaveholding states, but their importance has seldom been addressed. Using North Carolina as an example, this article explores their work and their experiences.
A Critical Ecological Exploration of Peer Socialization Agents’ Sense of Belonging
Authors: Irwin Lauren N. , Miller Jaime S. , Morgan Katie , Linley Jodi
Published: November 2023

Abstract: Peer socialization agents (PSAs; e.g., resident assistants, orientation leaders) are trained to facilitate belonging through formal socialization initiatives. We used secondary qualitative data analysis, in combination with a critical constructivist approach, to explore PSAs’ sense of belonging and the contexts in which they experience it through ecological systems theory. Findings demonstrated that PSAs rarely experienced a broad sense of belonging, contrary to prevailing wisdom that links involvement and belonging. PSAs are charged with fostering belonging for others while simultaneously navigating systems that undermine their feelings of belonging. Rather than experiencing widespread feelings of belonging, PSAs often experienced it only in specific microsystems that affirmed their identities and experiences, including student groups, organizations, or affinity spaces. Finally, we highlight implications for research and practice.