bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Effectiveness of a Novel, Rapidly Appliable Multifunctional Pulse Oximeter in Neonatal Care
Authors: Salafian Iman , Reid Davika , Laird Morgan E , Klunk Christopher , Rylander Christopher G.
Published: August 2024

Monitoring vital signs in neonates, particularly in resuscitation and intensive care, is crucial for effective neonatal management. Accurate blood oxygen saturation and heart rate measurements are essential for guiding therapeutic interventions and optimizing outcomes. Traditional pulse oximetry devices often face challenges in application speed, ease of use, and the risk of skin injury, especially in preterm infants. This study introduces a newly designed pulse oximeter to enhance the efficiency and safety of neonatal monitoring in clinical settings. It is engineered for fast and convenient attachment without adhesive or abrasive fasteners, reducing skin injury risks. It is compatible with standard bedside monitors and can measure hemoglobin oxygen saturation, heart rate, electrocardiography, and temperature. This pilot observational study in the postpartum unit assesses the new pulse oximeter’s performance against conventional devices. Results show a significant reduction in the time to attach the device and obtain stable and reliable readings for blood oxygen saturation and heart rate from the pulse oximeter’s sensors. Additionally, the nursing team’s satisfaction is enhanced with the redesigned device compared to the conventional one. These findings offer substantial insights into the new pulse oximeter’s effectiveness, potentially leading to a shift in neonatal vital signs monitoring towards a more rapid, safe, and comprehensive approach.
Material Comparison for Surgical Simulation Models
Authors: Dickey Walter J. , Hedge Robert , Bravo Cesar J. , Arena Christopher B.
Published: August 2024

In orthopedic surgical training of the hand, it is common to practice on lower fidelity models to refine sills. However, no comprehensive psychomotor simulator exists for fundamental skill sets considered critical to competency in hand surgery. It is becoming more common to use a three-dimensional (3D) printer to create models that have similar appearances to that of the bones and other anatomical structures. With the increase of the use of additive manufacturing (AM) technology, a more affordable and accessible way to produce in-house training models has been developed. There are many aspects that go into creation of these models with the first one being the selection of the material itself. Without examining the force of multiple different common AM polymers, it can be difficult to select one without countless trial and error. This study used a Stryker drill with wire collet and an Instron universal testing system to collect comparative force data using five different modeling materials compared to chicken bone. The data showed that the material with least average force difference from the bone models was polylactic acid (PLA).
Development and Evaluation of a Novel Flow Loop System for Interventional Training
Authors: Toprani Divek U. , Alias Basil P. , Lo Emily , Garami Zsolt , Corr Stuart J. , Lumsden Alan B.
Published: August 2024

Flow-loop systems are valuable tools due to their ability to mimic the intravascular environment. Here we propose a novel flow-loop system designed to train resident physicians in endovascular procedures with quantitative feedback in the form of size characterization of microemboli within the loop. The flow-loop incorporates a peristaltic pump to mimic physiological pulsatile flow with varying tube diameters to customize vascular resistance and custom housing for a pulsed-wave Doppler ultrasound probe. We conducted proof-of-concept studies using velocity-based, pulsed-wave Doppler ultrasound to correlate signal with particle size and found an inverse relationship between particle size and both displacement and average time per signal spike. These results suggest the ability to distinguish particles down to size 40 μm with sizes differing more than 300 μm. Future research will be focused on reducing data noise from Doppler Ultrasound probes, increasing data granularity, and testing carotid filters with the system. Envisioned for use in academic settings, this system will be a highly customizable tool for training resident physicians, allowing objective metrics for specific interventional procedures.
Migration of Leukocytes in Shear Flows: Insights from Simulations
Authors: Nguyen Tam T. , Akerkouch Lahcen , Le Trung B.
Published: August 2024

The objective of this study is to investigate the rolling dynamics of leukocytes in microchannel flows using a hybrid continuum-particle approach. Leukocytes play an essential role in the immune system, and their margination behavior has been extensively studied both experimentally and numerically. In this study, we have developed a series of numerical experiments using a hybrid DPD-CFD solver with the membrane stiffness of the modeled leukocytes as the primary investigation subject. Our results show that increasing the stiffness of the cell's membrane influences its deformability and trajectory in microchannel flows. The results obtained from this study could be valuable in designing next-generation micro-carriers for targeted drug delivery systems, which mimic the margination behavior of leukocytes.
Validation of the Intu-VR-vention Program for Enhancing Medical Training through Virtual Reality (VR) Storyboard Integration for Intubation
Authors: Jensen Sophia , Leiting McGuire , Romero Bo-Dee , Wester Noah , Runge Henry J. , Nelson Carl A. , Siu Ka-Chun
Published: August 2024

This study introduces a new approach to enhance intubation medical training by developing an immersive Virtual Reality (VR) storyboard. Focused on practicality, our research aims to enhance medical education by leveraging the impact of VR technology. The hypothesized benefits include heightened trainee engagement, improved procedural knowledge retention, and enhanced critical decision-making skills. The VR storyboard comprises ten scenes, each representing a key step in the intubation procedure, aligning with recent developments and incorporating real-life complexities.

Developed collaboratively with board-certified physicians, medical students, and software programmers, our methodology integrates practice-based guidelines and fosters interdisciplinary collaboration. The scenes, spanning from patient interaction to handover to the surgical team, create an authentic yet simulated learning environment. Preliminary results from comprehensive focus group assessments, combining quantitative metrics and qualitative insights, demonstrate positive impacts on trainee engagement, procedural knowledge retention, and critical decision-making skills.

In summary, this systematic and transformative approach to intubation training offers a tailored learning experience. The VR storyboard method holds promise for reshaping medical training beyond intubation education, marking a significant advancement in immersive educational technology.
Acceleration Photo-Plethysmography Ratios: Effective Predictors of Peripheral Arterial Disease in Diabetes
Authors: Tayade Apakrita , Kumar Saurav , Shrivastava Amber , Bhallamudi Ravi
Published: August 2024

Peripheral Arterial Disease (PAD) is a chronic and progressive disease that affects blood circulation. Poor glycemic control, especially in people with diabetes, might accelerate this illness. Photo-plethysmography (PPG) signals assess vascular health non-invasively. Acceleration Photo-plethysmograph (APG) ratios correlate with aging and vascular health. Very few studies have reported the relationship of APG ratios against age and diabetes. Various APG ratios were measured for 60 subjects (30 healthy and 30 with diabetes). Among healthy subjects, the levels of the APG ratios notably varied with age (p-value is 0.001 for b/a and p-value is 0.008 for b-c-d-e/a). The b/a ratio varied linearly with age (y = 0.001x - 1.1, R2 = 0.36), as did the b-c-d-e ratio (y = 0.008x - 1.2, R2 = 0.13). The b/a and b-c-d-e/a ratios significantly correlated with ABI (p-value 0.001). Subjects with normal ABI exhibited a negative b/a ratio. The b/a ratio increased with the severity of PAD (as per ABI) in both groups. A linear regression model of the b/a ratio effectively differentiates subjects with abnormal ABI from those with normal ABI. The b/a and (b-c-d-e)/a ratios can be used for easy and faster monitoring of peripheral arterial disease in people with diabetes.
Bed-Based Ballistocardiography: Investigating System Effects & Mitigation Techniques
Authors: Knapp Calder , Thompson David E. , Carlson Charles
Published: August 2024

The ballistocardiogram (BCG) is a relevant unobtrusive alternative to traditional vital monitoring signals. Through the measurement of the heart’s ballistic force, representative signals can be collected that contain cardiac related health features. However, the BCG’s morphology can vary based on the measurement system and subject. This paper seeks to quantify the system-level distortion applied to measured BCG signals in a bed-based acquisition system. The characteristic “ring” of commonly acquired signals are modeled and correction techniques including ideal lowpass filtering, band stop filtering, linear predictive coding, and frequency domain deconvolution are utilized to attempt to remove this distortion. The time-domain and frequency-domain characteristics of the resulting signals are analyzed. These results document a reduction in “ring” of characteristically distorted signals and promote further research into the source of this distortion. Such results are relevant to the enhancement of understanding regarding the characteristics of bed-based BCG acquisition as well as future applications in non-contact vitals monitoring systems.
Investigating Muscle Fatigue Using a Low-Cost Emg Armband: Towards a Low-Cost Bionic Hand
Authors: Finger Shehwar F. , Kala Priyanka J. , Mohamed Abdul-Khaaliq
Published: August 2024

Myoelectric prostheses could enable amputees to better perform daily activities. This paper documents a preliminary investigation to identify muscle fatigue using electromyography (EMG), that could enhance the performance of myoelectric prosthetic devices A low-cost wearable myoelectric armband utilizing brass dry-type electrodes was developed. It was tested against a PowerLab medical-grade EMG machine in terms of providing signals from which muscle fatigue can be successfully interpreted. The extracted features representing muscle fatigue were the integral of time-series EMG (IEMG), root mean square (RMS), mean frequency (MNF) and median frequency (MDF). For both the low-cost armband and the PowerLab machine, IEMG and RMS increased with increasing muscle fatigue, while MNF and MDF decreased—which were expected results. The armband and PowerLab devices showed similar performances when compared using RMS and IEMG features (average error of 35% and correlation of 0.71), but not using MNF and MDF features (average error of 112% and correlation of 0.13). This suggests that the low-cost EMG armband may be able to acquire EMG of sufficient quality to enable muscle fatigue interpretation. However, further testing and development is necessary.
A Flexible Patella Fracture Device for Increased Anterior Cortical Compression
Authors: Huxman Connor , Updegrove Gary , Armstrong April , Lewis Gregory , Butler Jared
Published: August 2024

Fractures of the patella can be challenging to treat surgically. The current standard of tension band wiring is susceptible to wire loosening and fracture displacement. In this study we introduce a novel concept involving a flexible patella fixation device which leverages pre-strain to deliver interfragmentary compression concentrated anteriorly. Finite element analysis provides a preliminary exploration of the concept, demonstrating that two different flexible patella plates can provide increased anterior compression both alone and when paired with lag screws.
Lateral Migration of Cancer Cells in a Microchannel
Authors: Akerkouch Lahcen , Le Trung B. , Haage Amanda
Published: August 2024

This work presents the development of a novel approach to model cancer cell dynamics in microcirculation. The proposed numerical model is based on a hybrid continuum-particle approach. The cancer cell model includes the cell membrane, nucleus, cytoplasm and the cytoskeleton. The Dissipative Particle Dynamics method was employed to simulate the mechanical components. The blood plasma is modeled as a Newtonian incompressible fluid. A Fluid-Structure Interaction coupling, leveraging the Immersed Boundary Method is developed to simulate the cell's response to flow dynamics. The model is applied to resolve the transport of cancer cells with realistic morphologies in microcirculatory flows. Our results suggest that the controlling of oscillatory flows can be utilized to induce specific morphological shapes and the surrounding fluid patterns, allowing full manipulation and control of the cell. Furthermore, the intracellular and extracellular dynamics response of the cancer cell is intrinsically linked to their shape, in which certain morphologies displayed strong resistance to the fluid-induced forces and the ability to migrate in various directions. Our computational framework provides new capabilities for designing bioengineering devices for cell manipulation and separation.
Enhanced Deep Vein Thrombosis Anaylsis: A Hybrid Technique of Modified U-NET and Semantic Segmentation Approaches
Authors: Pavihaa Lakshmi B , Vidhya S
Published: August 2024

Deep vein thrombosis (DVT) is a potentially life-threatening condition where a blood clot forms in deep veins, typically in the calf muscle region of our lower extremities. It may cause leg pain or swelling, and it might break down, resulting in pulmonary embolism (PE). When DVT and PE occur concurrently, it is commonly referred to as venous thromboembolism (VTE). This research develops an innovative methodology for DVT segmentation in medical imaging. Using a novel approach, we provide an updated U-Net architecture that includes residual and inception blocks to improve the model's capacity to precisely identify DVT areas. In addition, we investigate the use of Convolutional Neural Networks (CNN), for semantic segmentation in order to obtain an in-depth segmentation of DVT. In comparison to conventional approaches, our results illustrate that the proposed architecture is effective in recognizing DVT edges with better accuracy and resilience. Our model is trained using binary cross-entropy loss and the Adam optimizer and evaluated using performance metrics like accuracy, loss, and sensitivity. Our research enhances the area of medical image processing by presenting a potential path for automated and robust techniques in DVT segmentation.
Design of WMTS Band Implantable Antenna for Biotelemetric Applications
Authors: Vijayanandam N , Vidhya S
Published: August 2024

Bio-Implants are essential to restore normal functionality to the damaged or failing body parts of the patients. A wide range of strategies and methods for wireless powering are being explored. The key components for the proper and reliable powering of implants are biocompatible antennas, that are resonated at any of the different frequency bands such as the wireless medical telemetry service frequency band (WMTS, 1.395–1.4 GHz), the medical implantable communication service frequency band (MICS, 402–405 MHz) and the industrial, scientific, and medical frequency band (ISM, 433–434 MHz, 902–908 MHz, 2.4–2.48 GHz). This paper suggests the design of a WMTS (1.39 – 1.42 GHz) band implantable antenna for bio-telemetric applications such as efficient powering of the implantable device. Moreover, in this design, the size of the proposed antenna is reduced to (19x14) mm2. In order to improve the conductivity of the patch, a shorting pin is utilized. The 1.4 GHz working frequency, small size, low specific absorption rate (SAR) of the proposed antenna and validation using tissue-mimic liquid phantom ensure the suitability for wireless powering of implants and other biotelemetric applications.
Optical and electronic properties of Ge1−xSnx/Si alloys grown by remote plasma-enhanced chemical vapor deposition
Authors: Choe Kevin K. , Felker Daniel , Claflin Bruce , Grzybowski Gordon , Dugan Christina L.
Published: August 2024

Solid state detectors composed of GeSn (germanium-tin) alloys offer improved capabilities compared with mercury cadmium telluride detectors. GeSn detectors may be smaller in size and weight, capable of operating with a noncryogenic detector, and provide increased sensitivity. Recent advances in nonequilibrium remote plasma-enhanced chemical vapor deposition growth enable GeSn crystalline growth with up to 10% Sn concentration, free of surface migration. Absorption spectroscopy combined with Tauc analysis results in 0.79, 0.73, 0.69, 0.59, 0.57, and 0.51 eV direct bandgap energies for GeSn samples with 0%, 2.7%, 4.6%, 6.6%, 7.1%, and 8.0% Sn, respectively. These absorption bandgap energies closely agree with density functional theory energies within ±0.05 eV. However, the rate of change of indirect bandgap narrowing as a function of Sn content is more diverse than a numerical result. The current research evidences that the indirect-to-direct transition crossover point occurs at a Sn content greater than 8%. From the analysis of the Urbach tail, the optical bandgap exhibits a potential structure disorder in the Urbach region. For example, this disorder may cause bandgap narrowing by more than 50% of the intrinsic bandgap energy in the highest Sn content (e.g., 8% Sn) sample. The surface Fermi level approximation validates p-type Fermi level pinning very close to the valence band maximum, often seen in highly doped semiconductors.
Numerical investigation of flow and particles contamination in reticle mini environment for extreme ultraviolet lithography
Authors: Wang Qi , Wang Kuibo , Wu Xiaobin , Gao Zixiang
Published: August 2024

Particle-caused reticle defects contribute to a profound effect on the final integrated circuit (IC) yield, posing a significant technological challenge in extreme ultraviolet (EUV) lithography. This study employs the direct simulation Monte Carlo method to simulate the rarefied flow field within the EUV scanner reticle mini environment, investigating the influence of the rarefied flow field on particle behavior based on a bidirectional coupled gas-solid two-phase model. Simulation results demonstrate that the flow field induces the formation of a “particle inhibition zone” at high flow rates. Consequently, the “stopping distance” of particles released from the reticle masking blade surface remains consistently around 4 mm, and the residual rate of small particles (100 nm) is only 1.4%. The flow field control within the EUV scanner reticle mini environment can effectively mitigates the risk of particle-caused damage to the reticle surface while maintaining internal cleanliness.
Enhancing erosion resistance of ceramic/metal multilayer coating by crack inhibition design
Authors: Zhang Zhaolu , Ren Yuxin , He Guangyu , Yang Zhufang
Published: August 2024

Erosive damage of nitride coatings is predominantly attributed to coating delamination caused by crack initiation, propagation, and coalescence. For brittle nitride coating materials, inhibiting the crack initiation and propagation within the coating may enhance their erosion resistance. This paper focuses on TiAlN/TiAl multilayer coatings, and by increasing the thickness of the metallic sublayers, the initiation and propagation of cracks in ceramic/metal multilayer coatings are significantly suppressed. As the metallic sublayer thickness increases from 1 to 4 μm, the TiAlN/TiAl coating erosion rate decreases from 0.032 to 0.002 mg⋅g−1, resulting in an improvement in the erosion resistance of over ten times. Based on the failure mechanism of ceramic/metal multilayer coatings under sand erosion conditions and finite element analysis, there are two reasons for improving the erosion resistance of ceramic/metal multilayer coatings by increasing the toughness of the metal layer. On one hand, increasing the thickness of the ductile metal layer can effectively reduce the maximum tensile stress value on the coating surface and decrease the equivalent plastic deformation of the ductile metal layer, thereby improving the crack initiation suppression ability of the coating. On the other hand, increasing the TiAl layer thickness effectively suppresses the downward propagation of longitudinal cracks and the coalescence of transverse cracks in nitride coatings. This research proposes a new approach for enhancing the erosion resistance of nitride coatings.
Menthol Mouth Rinsing Improves Cycling Performance in Trained Adolescent Males Under Heat Stress
Authors: Hawke Kierstyn V. , Gavel Erica H. , Bentley David J. , Logan-Sprenger Heather M.
Published: August 2024

Purpose: This study investigated the effect of menthol (MEN) mouth rinsing (MR) on cycling performance during a modified variable cycle test (M-VCT) in adolescent athletes under hot conditions (31.4 ± 0.9 °C, 23.4 ± 3.7% relative humidity). Methods: Trained adolescent male cyclists (n = 11, 16.7 ± 1.3 years, height 176.6 ± 8.8 cm, body mass 65.8 ± 11.6 kg, maximal oxygen uptake 62.97 ± 7.47 ml·kg−1·min−1) voluntarily completed three trials (familiarization and two experimental) of a 30-min M-VCT, which included five 6-min laps consisting of three 6-s accelerations and three 10-s sprints throughout each lap. In a randomized crossover design, MEN (0.01%) or placebo (PLA) (crystal-light), was swilled for 5 s before the start of each lap (total of 6 MR). Power output, distance (in kilometers), core temperature, heart rate, perceptual exertion, thermal stimulation (thermal comfort and thermal sensation), and blood lactate concentration were recorded. Results: MEN MR significantly improved M-VCT mean power output by 1.81 ± 1.57% compared to PLA (MEN, 177.8 ± 31.4 W; PLA, 174.7 ± 30.5 W, p < .001, 95% confidence interval [1.73, 4.46], d = 1.53). For maximal intermittent sprints, 6- and 10-s mean power output was significantly higher with MEN than PLA (6 s, p = .041, 95% confidence interval [0.73, 27.19], d = 0.71; 10 s, p = .002, 95% confidence interval [11.08, 35.22], d = 1.29). There was no significant difference in core temperature, heart rate, blood lactate concentration, or any perceptual measure between trials (p > .05) despite significantly higher work with MEN. Conclusion: 64% of athletes (7/11) improved M-VCT performance with MEN. The results of this investigation suggest that a MEN MR may improve power output during a sport-specific stochastic cycling task in elite adolescent male cyclists.
Sleep, Fatigue, and Recovery Profiles of the Longest Solo Unsupported One-Way Polar Ski Journey Across Antarctica
Authors: Scheer Volker , Chandi Harpreet , Valero Encarna , Thuany Mabliny , Knechtle Beat , Steinach Mathias
Published: August 2024

Purpose: Antarctic expeditions are exceptional physiological challenges. Sleep plays a critical role in athletic performance, recovery, and wellness, with sleep disturbances having a negative impact on health and performance. Methods: The authors investigated sleep, fatigue, and recovery profiles of the longest solo unsupported one-way polar ski journey across Antarctica. A 33-year-old woman covered 1484.53 km from Hercules Inlet to the South Pole, finishing at the Ross Ice Shelf, in 70 days and 16 hours. Questionnaires on sleep (Pittsburgh Insomnia Rating Scale and Karolinska Sleepiness Scale), fatigue (Subjective Assessment of Fatigue), recovery (Total Quality Recovery), and wellness were completed at different time points (before, during, and after the expedition). Results: Average daily sleep time was between 4 and 5 hours, increasing to 7 hours for the final part of the expedition. Satisfaction of sleep and lack of energy deteriorated as the expedition progressed, alongside signs of clinical insomnia. Fatigue and muscle soreness increased with increasing milage, with extreme levels and very poor recovery toward the end of the expedition. Despite this, the adventurer continued to perform on extremely high levels. Postexpedition scores returned to baseline, demonstrating the incredible adaptation and ability to recovery. The postexpedition interview showed that prior experience of an Antarctic expedition may have prepared the athlete and made her more resilient for this challenge. Conclusions: The data provide unique insights into Antarctic expeditions and may help us understand the limits of human performance when planning future expeditions of this nature. Female athletes are capable of extreme challenges, breaking established performance boundaries.
Psychological Safety: A Qualitative Study on Coach and Athlete Perceptions
Authors: Cooke Michael , Paradis Kyle F. , Sharp Lee Ann , Woods David , Sarkar Mustafa
Published: August 2024

Aims: The concept of psychological safety has received growing interest within a sport context in recent years. Despite a small but growing body of literature, there is still a lack of conceptual clarity, and thus research is needed to gain a better understanding of how psychological safety manifests in sport. Existing literature suggests psychological safety may allow for positive outcomes in various sport settings. As this may be of interest to many coaches and sporting organisations, a deeper evidence base will prove beneficial for further support to this claim. The aim of the current study was to garner conceptual clarity by gathering coach and athlete perceptions of psychological safety in high-performance pathway sport environments. Methods: Qualitative findings of six focus groups with coaches (two focus groups) and athletes (four focus groups) were comprised of four sports (association football, boxing, field hockey, and swimming). A total of 25 participants included 18 athletes (Mage = 19.6 years; Mexperience = 10.6 years) and seven coaches (Mage = 45 years; Mexperience = 19.6 years) who discussed psychological safety within their high-performance pathway sport environment. Focus groups lasted from 36 to 78 minutes (Mlength = 56 min). Qualitative content analysis was utilised to categorise themes identified from the focus groups. Findings: Findings offer a conceptualisation of the defining attributes (e.g., freedom to speak freely and raise issues), antecedents (e.g., positional competition, selection, and deselection), and outcomes (e.g., positive climate and enjoyment of sport) of psychological safety in sport settings. One of the key takeaways within the findings suggests that psychological safety in a sport context may manifest in a dual process, namely on-field (e.g., the freedom to take risks) and off-field (e.g., the freedom to speak freely and raise issues).
Concussion History Moderates Trunk Motion and Lower Extremity Biomechanical Relationships During Jump Landing and Cutting
Authors: Kowalczyk Kayla M. , Shumski Eric J. , Schmidt Julianne D. , Lynall Robert C.
Published: August 2024

Concussion history, trunk motion, and lower extremity biomechanics associate with musculoskeletal injury risk. We aimed to examine the interaction between concussion history and trunk motion as possible modifiable factors for injury risk biomechanics during jump landing and cutting. Division I female athletes (24 with, 20 without concussion history) performed jump landings and jump-to-cuts at 45° in the opposite direction of the landing limb. We used multiple linear regressions with interaction terms to examine ankle dorsiflexion angle, knee flexion and abduction angle, and external knee flexion and abduction moment. We observed a group by trunk flexion interaction for nondominant external knee flexion moment (P = .042) during jump landing. Concussion history associated with increased external knee flexion moment as trunk flexion increased. We observed a group by trunk flexion interaction for the dominant limb dorsiflexion angle (P = .044), and group by trunk lateral bending interactions for the dominant (P = .039) and nondominant limb (P = .016) external knee flexion moment during cutting. During cutting, concussion history associated with decreased dominant dorsiflexion angles as trunk flexion increased, and decreased dominant and nondominant external knee flexion moment as lateral bending toward the planted limb increased. Concussion history associated with atypical biomechanics as trunk flexion and lateral bending increased.
Reverse Nordic Curl Does Not Generate Superior Eccentric Activation of the Quadriceps Muscle Than Bodyweight Squat-Based Exercises
Authors: Pereira Nicolas da Silva , Chaffe Luiza Pizarro , Marques Matheus Iglesias , Guimarães Rodrigo Freire , Geremia Jeam Marcel , Vaz Marco Aurélio , Baroni Bruno Manfredini , Rodrigues Rodrigo
Published: August 2024

Context: The quadriceps femoris is consistently ranked among the muscles most prone to sustain strain injuries in sports involving kicking and sprinting actions. Given the documented preventive effect of Nordic hamstring curl programs against hamstring strain injuries, incorporating exercises that induce eccentric overload on the quadriceps could potentially help mitigate strain injuries within this muscle group. The Reverse Nordic Curl (RNC) has emerged as a viable field-based exercise for eccentrically working the quadriceps. This study aimed to compare quadriceps muscle eccentric activation during the RNC with 3 bodyweight squat-based exercises: single-leg squat (SLS), Bulgarian squat, and forward lunge. Design: Cross-sectional study. Methods: Twenty-three healthy volunteers (15 men) were monitored for rectus femoris, vastus lateralis, and vastus medialis electromyographic signal, as well as knee range of motion, while performing 10 repetitions of each exercise. Electromyography data acquired during eccentric phases were normalized by maximum voluntary isometric contraction of the knee extensors. The exercises were compared based on the electromyography and knee range of motion values. Results: RNC generated a similar rectus femoris and vastus medialis eccentric activation compared with the squat-based exercises (P > .05 for all), and a lower vastus lateralis activation than SLS (P < .001). Among the bodyweight squat-based exercises, SLS generated greater eccentric activation than forward lunge and Bulgarian squat for the 3 muscles (P < .05 for all). RNC was performed with lower knee-flexion range of motion than bodyweight squat-based exercises (P < .001). Conclusions: RNC did not produce superior eccentric quadriceps activation compared to bodyweight squat-based exercises, even proving to be less demanding for the vastus lateralis compared to the SLS. These findings may assist practitioners in selecting exercises to elicit quadriceps eccentric stimulus, with a focus on preventing strain injuries.
Germline-targeting HIV vaccination induces neutralizing antibodies to the CD4 binding site
Authors: Caniels Tom G. , Medina-Ramìrez Max , Zhang Shiyu , Kratochvil Sven , Xian Yuejiao , Koo Ja-Hyun , Derking Ronald , Samsel Jakob , van Schooten Jelle , Pecetta Simone , Lamperti Edward , Yuan Meng , Carrasco María Ríos , del Moral Sánchez Iván , Allen Joel D. , Bouhuijs Joey H. , Yasmeen Anila , Ketas Thomas J. , Snitselaar Jonne L. , Bijl Tom P. L. , Martin Isabel Cuella , Torres Jonathan L. , Cupo Albert , Shirreff Lisa , Rogers Kenneth , Mason Rosemarie D. , Roederer Mario , Greene Kelli M. , Gao Hongmei , Silva Catarina Mendes , Baken Isabel J. L. , Tian Ming , Alt Frederick W. , Pulendran Bali , Seaman Michael S. , Crispin Max , van Gils Marit J. , Montefiori David C. , McDermott Adrian B. , Villinger François J. , Koup Richard A. , Moore John P. , Klasse Per Johan , Ozorowski Gabriel , Batista Facundo D. , Wilson Ian A. , Ward Andrew B. , Sanders Rogier W.
Published: August 2024

Eliciting potent and broadly neutralizing antibodies (bnAbs) is a major goal in HIV-1 vaccine development. Here, we describe how germline-targeting immunogen BG505 SOSIP germline trimer 1.1 (GT1.1), generated through structure-based design, engages a diverse range of VRC01-class bnAb precursors. A single immunization with GT1.1 expands CD4 binding site (CD4bs)–specific VRC01-class B cells in knock-in mice and drives VRC01-class maturation. In nonhuman primates (NHPs), GT1.1 primes CD4bs-specific neutralizing serum responses. Selected monoclonal antibodies (mAbs) isolated from GT1.1-immunized NHPs neutralize fully glycosylated BG505 virus. Two mAbs, 12C11 and 21N13, neutralize subsets of diverse heterologous neutralization-resistant viruses. High-resolution structures revealed that 21N13 targets the same conserved residues in the CD4bs as VRC01-class and CH235-class bnAbs despite its low sequence similarity (~40%), whereas mAb 12C11 binds predominantly through its heavy chain complementarity-determining region 3. These preclinical data underpin the ongoing evaluation of GT1.1 in a phase 1 clinical trial in healthy volunteers.
crANKing up the infection: ankyrin domains in
Rickettsiales
and their role in host manipulation
Authors: Hamilton William C. , Newton Irene L. G.
Published: August 2024

Intracellular bacteria use secreted effector proteins to modify host biology and facilitate infection. For many of these microbes, a particular eukaryotic domain—the ankyrin repeat (ANK)—plays a central role in specifying the host proteins and pathways targeted by the microbe. While we understand much of how some ANKs function in model organisms like
Legionella
and
Coxiella
, the understudied
Rickettsiales
species harbor many proteins with ANKs, some of which play critical roles during infection. This minireview is meant to organize and summarize the research progress made in understanding some of these
Rickettsiales
ANKs as well as document some of the techniques that have driven much of this progress.
The multifaceted roles of selective autophagy receptors in viral infections
Authors: Luo Rui , Wang Tao , Lan Jing , Lu Zhanhao , Chen Shengmei , Sun Yuan , Qiu Hua-Ji
Published: August 2024

Selective autophagy is a protein clearance mechanism mediated by evolutionarily conserved selective autophagy receptors (SARs), which specifically degrades misfolded, misassembled, or metabolically regulated proteins. SARs help the host to suppress viral infections by degrading viral proteins. However, viruses have evolved sophisticated mechanisms to counteract, evade, or co-opt autophagic processes, thereby facilitating viral replication. Therefore, this review aims to summarize the complex mechanisms of SARs involved in viral infections, specifically focusing on how viruses exploit strategies to regulate selective autophagy. We present an updated understanding of the various critical roles of SARs in viral pathogenesis. Furthermore, newly discovered evasion strategies employed by viruses are discussed and the ubiquitination-autophagy-innate immune regulatory axis is proposed to be a crucial pathway to control viral infections. This review highlights the remarkable flexibility and plasticity of SARs in viral infections.
Draft genome sequence of
Rhodotorula
sp. BUB8, an oleaginous yeast isolated from Mt. Makiling Forest Reserve, Laguna, Philippines
Authors: Pajares Irene G. , Ramos Kristine Rose M. , Montecillo Andrew D. , Elegado Francisco B. , Raymundo Asuncion K.
Published: August 2024

This paper reports the draft genome sequence of
Rhodotorula
sp. BUB8, an oleaginous yeast isolated from the forest canopy of Mt. Makiling Forest Reserve in the Philippines. The draft genome is 20,394,133 bp with 64.3% guanine-cytosine (GC) content, 6,604 coding genes, 109 tRNA coding, and 6 snRNA-coding genes.
Nine Cluster E mycobacteriophages isolated from soil
Authors: Gaballa Joseph M. , Freise Amanda , Reddi Krisanavane , Moberg Parker Jordan
Published: August 2024

Mycobacteriophages FireRed, MISSy, MPhalcon, Murica, Sassay, Terminus, Willez, YassJohnny, and Youngblood were isolated from soil using
Mycobacterium smegmatis
as a host. Genome sequencing and annotation revealed that they belong to Actinobacteriophage Cluster E. Here, we describe the features of their genomes and discuss similarities within these Cluster E phages.
Isolated masseter muscle fungal invasion: unmasking the culprit
Authors: Tandan Nisha , Reddy Akshara Pal , Verma Hitesh , Kakkar Aanchal
Published: August 2024

This case report focusses on a unique and infrequently observed event where an isolated masseter muscle fungal invasion was seen. The patient’s symptoms include facial swelling and restricted mouth opening. The rarity of this particular manifestation is emphasised by the fact that there are no previously reported cases where fungal infection was the cause of isolated masseter muscle involvement. This lack of documented cases underscores the novelty and significance of the current case.
Adult ileocaecal intussusception caused by lipoma managed in a remote Western Australian hospital
Authors: Winfield Francis James , Nasim Sana
Published: August 2024

Intussusception is rare in adults, making it a challenging and often delayed diagnosis. Patients may re-present with non-specific and subacute abdominal symptoms. Abdominal CT is the most sensitive imaging modality and is often required to make the diagnosis of intussusception. In contrast to the paediatric population, intussusception in adults is most often associated with a pathological lesion acting as a lead point. In adults, the lead point is often secondary to malignancy, though benign lesions can also be implicated. As such, surgical management with selective resection is the mainstay of treatment in adults. We describe a rare case of ileocaecal intussusception in an adult secondary to a large ileocaecal lipoma, successfully treated with laparotomy and resection in a remote Western Australian hospital. The increasing availability of CT imaging and skilled general surgeons in rural and remote Australia allows for the diagnosis and surgical management of such cases without inter-hospital transfer.
Haemobilia as a primary presentation of cholangiocarcinoma
Authors: Stapleton Peter , Ha Ngochoang , Saxon Sarah , Thomson John-Edwin
Published: August 2024

We present a case of haemobilia as a primary presentation for underlying cholangiocarcinoma. A man in his 50s initially presented to emergency with Quincke’s triad, RUQ pain, jaundice and UGI bleeding. The initial diagnosis of haemobilia was made on endoscopic retrograde cholangiopancreatography (ERCP) on primary presentation, but the presence of blood and the recurrent clot obstruction of the biliary tract made the underlying diagnosis extremely difficult, resulting in the patient having 4 ERCP, 1 spyglass and multiple CTs and magnetic resonance cholangiopancreatography. Eventually, the patient underwent a Whipple’s procedure without tissue diagnosis, confirming cholangiocarcinoma on histopathology. This case emphasises the difficulty of diagnosis of underlying malignancy in the setting of haemobilia, the benefit of multidisciplinary meeting discussions to support significant interventions and the need to be cautious and curious when managing atypical presentations.
Atypical presentation of Wernicke encephalopathy due to thiamine deficiency in a patient post sleeve gastrectomy
Authors: Scharf Keith , Tang Janet , Jamall Selene , Baker Nancy
Published: August 2024

We present a case of a woman in her 20s who presented to the emergency department with a 1-month history of blurry vision, lower extremity weakness in both legs and progressive numbness involving the feet and anterior chest. On admission, the patient was unable to ambulate. She was 3 months status post laparoscopic vertical sleeve gastrectomy for weight loss and using transdermal vitamin patches for nutritional supplementation. Laboratory values revealed low levels of vitamin B1, vitamin A, vitamin D, folic acid and copper levels. The patient was diagnosed with Wernicke encephalopathy and possible peripheral neuropathy secondary to thiamine deficiency. She was started on intravenous thiamine 500 mg three times a day and folate 1 mg one time a day for 3 days and then transitioned to oral thiamine 500 mg along with a multivitamin tablet. Improvement in ophthalmoplegia, weakness, sensation and cognition was noticed after initiating treatment.
Brief Educational Workshops in Secondary Schools Trial (BESST): a cluster randomised controlled trial. Secondary analysis in those with elevated symptoms of depression
Authors: Lisk Stephen , James Kirsty , Shearer James , Byford Sarah , Stallard Paul , Deighton Jessica , Saunders David , Yarrum Jynna , Fonagy Peter , Weaver Timothy , Sclare Irene , Day Crispin , Evans Claire , Carter Ben , Brown June
Published: August 2024

Background

Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief self-referral stress workshop programme for sixth-form students aged 16–18 years old.

Objective

This study conducted a secondary analysis on the outcomes of participants with elevated depressive symptoms at baseline.

Methods

This is an England-wide, multicentre, cluster randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of a brief cognitive–behavioural therapy workshop (DISCOVER) compared with treatment-as-usual (TAU) (1:1). The primary outcome was depression symptoms (Mood and Feelings Questionnaire (MFQ)) at 6-month follow-up, using the intention-to-treat (ITT) population and analysed with a multilevel linear regression estimating a between-group adjusted mean difference (aMD). Cost-effectiveness, taking a National Health Service (NHS) and personal social services perspective, was explored using quality-adjusted life years (QALYs).

Findings

Between 4 October 2021 and 10 November 2022, 900 adolescents at 57 schools were enrolled. 314 students were identified as having elevated symptoms of depression at baseline (>27 on MFQ). In this prespecified subgroup, the DISCOVER arm included 142 participants and TAU included 172. ITT analysis included 298 participants. Primary analysis at 6 months found aMD to be −3.88 (95% CI −6.48, –1.29; Cohen’s d=−0.52; p=0.003), with a similar reduction at 3 months (aMD=−4.00; 95% CI −6.58, –1.42; Cohen’s d=0.53; p=0.002), indicating a moderate, clinically meaningful effect in the DISCOVER arm. We found an incremental cost-effectiveness ratio of £5255 per QALY, with a probability of DISCOVER being cost-effective at between 89% and 95% compared with TAU.

Conclusions and clinical implications

DISCOVER is clinically effective and cost-effective in those with elevated depressive symptoms. This intervention could be used as an early school-based intervention by the NHS.

Trial registration number

ISRCTN90912799.
What has the appraisal for hospitals brought to job satisfaction of healthcare professionals? A cross-sectional survey in China
Authors: Li Xiyang , Lu Mengjie , Shi Chenshu , Song Keyu , Xiao Yuyin , Bian Dongsheng , Xu Shuqiang , Li Guohong
Published: August 2024

Objective

The purpose of this study is to evaluate the effectiveness of hospital appraisals, specifically the Performance Appraisal for Tertiary Public Hospitals (PATPH), and to examine its impact on the job satisfaction of healthcare professionals in tertiary public hospitals in China.

Design

A cross-sectional study using a multistage sampling method. Improvements induced by PATPH in the working environment, job satisfaction and other covariates were measured. A series of weighted linear regressions with weights from the inverse probability-of-treatment weighting method were used to examine the effect of PATPH on job satisfaction.

Setting

Nine tertiary public hospitals across three economic and geographic regions in China.

Participants

In August 2020, a total of 13 211 hospital employees were surveyed, and 8417 doctors and nurses fully completed questionnaires forming the primary dataset for analysis. Of these respondents, males comprised 18.64% and doctors constituted 28.15%.

Results

This study revealed that PATPH had a positive impact on the job satisfaction of healthcare professionals. A ‘more effective’ PATPH working environment resulted in an improvement of 9.57 points (95% CI 8.99 to 10.16) in job satisfaction scores, controlling for all other variables. The finding persisted consistently through a series of sensitivity analyses.

Conclusion

The findings offered insights and inspiration for improving the job satisfaction of healthcare professionals, especially in the development of macrolevel policies targeted towards organisational enhancement.
Exploring the perceptions of senior medical students on gender and pain: a qualitative study of the interplay between formal and hidden curricula
Authors: Brown Megan E L , Costache Cristina , Bull Parker Stephanie , Parekh Ravi , Laughey William , Kumar Sonia
Published: August 2024

Objective

Explore the perceptions of senior medical students on the relationship between gender and pain and examine how formal and hidden curricula in medical education shape their experiences.

Design

We conducted a cross-sectional qualitative interview study, using individual semistructured interviews and adhering to interpretative description methodology. We used Braun and Clarke’s reflexive approach to thematic analysis to analyse our data.

Setting

Six medical schools across the UK. Data collection occurred between the autumn of 2022 and the spring of 2023.

Participants

14 senior (penultimate or final year) medical students.

Results

We created three themes, which describe key educational forces shaping students’ experiences of the relationship between gender and pain. These are (1) the sociocultural influencer, (2) the pedagogical influencer and (3) the professorial influencer. Our findings highlight the influence of both wider societal norms and students’ own identities on their experiences. Further, we explore the nature and detrimental role of formal curricular gaps, and negative role modelling as a key mechanism by which a hidden curriculum relating to gender and pain exerts its influence.

Conclusions

These findings have several educational implications, including the need for a more holistic, person-centred approach to pain management within medical school curricula. Additionally, we recommend the creation of reflective spaces to engage students in critical thinking around bias and advocacy from the early stages of their training. We present actionable insights for medical educators to address issues of gender bias and pain management.
Effectiveness of risankizumab induction and maintenance therapy for refractory Crohn’s disease: a real-world experience from a preapproval access programme and early access to medicines scheme
Authors: Zare Benjamin , Gros Beatriz , Lal Natasha , Dawson Patrick , Sharma Esha , Dart Robin J , Lim Samuel , Ray Shuvra , Anderson Simon H C , Mawdsley Joel , Irving Peter M , Lees Charlie W , Samaan Mark A
Published: August 2024

Objective

Since approval in Crohn’s disease (CD) of risankizumab, there has been widespread use. Real-world data are, however, limited and our aim is to address that gap.

Design/method

We performed a retrospective, observational study of risankizumab use in patients with CD starting treatment between January 2021 and January 2023 at two UK centres. Clinical activity, biochemical and faecal biomarkers were measured at baseline, weeks 4, 12, 28 and 52. The primary outcome was clinical response at weeks 12, 28 and 52.

Results

53 patients (51% women); median (range) age 40 years (20–70); median disease duration 15 years (6–52). Clinical response was observed in 33% (n=14/42), 45% (n=17/38) and 52% (n=13/25), and clinical remission in 31% (n=13/42), 40% (n=15/38) and 44% (n=11/25) at weeks 12, 28 and 52, respectively. Median C reactive protein decreased from 12 mg/L (IQR: 4–30; n=50) at baseline to 6 mg/L (IQR: 2–16; p=0.03 vs baseline; n=49) at week 12, 3 mg/L (IQR: 2–8, p=0.003; n=44) at week 28 and 3 mg/L (IQR 1–4, p=0.007; n=31) at week 52. Median faecal calprotectin concentration was 668 µg/g (IQR: 246–1098; n=32) at baseline, 298 µg/g (IQR: 176–546, p=NS; n=21) at week 12, 358 µg/g (IQR: 133–622, p=0.03; n=14) at week 28 and 63 µg/g (IQR: 38–120, p=0.007; n=12) at week 52.

12 out of 18 patients discontinued corticosteroids at week 12, 16 by week 28 and 18 by week 52. Four major adverse events—three elective and one emergency surgery—were recorded.

Conclusion

Risankizumab is effective in a refractory real-world population with CD.