bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrative taxonomic revision of the Metarctia Walker, 1855 subgenus HebenaWalker, 1856, with descriptions of six new species and one new subspecies(Lepidoptera: Erebidae: Arctiinae: Syntomini)
Authors: FIEBIG RALF , LÁSZLÓ GYULA M. , VOLYNKIN ANTON V. , TABERER TABITHA R.
Published: August 2023

A revision of the subgenus Hebena Walker, 1856 of the syntomine genus Metarctia Walker, 1855 is given based on integrative taxonomic analyses. Six new species (Metarctia (Hebena) manfredi sp. n., M. (H.) elleni sp. n., M. (H.) brigitta sp. n., M. (H). lukaszi sp. n., M. (H.) smithi sp. n., and M. (H.) haraldsulaki sp.n.) and one new subspecies (M. (H.) smithi transvallesiana ssp. n.) are described. Metarctia (H.) kelleni (Snellen, 1886) stat. rev. is reinstated from synonymy with M. (H.) rubra (Walker, 1856) and Metarctia (H.) subincarnata Kiriakoff, 1954 syn. n. is synonymised with M. (H.) henrardi Kiriakoff, 1953 and Metarctia cinnamomea (Wallengren, 1860) syn. n. with M. (H.) rubra (Walker, 1856). DNA barcodes were obtained for 116 specimens representing 7 taxa, and genetic analyses were performed using Maximum Likelihood and Bayesian Inference approaches; a DNA barcode tree resulting from the latter is illustrated. Pairwise distances of barcodes between taxa are provided where available. The adults and genitalia of all taxa, their habitats and distribution are illustrated in 19 colour plates and 5 distribution maps.
We Are STEM: Examining the Significance and Influence of Counterspaces in the Development of Black Girls’ STEM Identity
Authors: Cameron Tajma A.
Published: August 2023

Existing literature has focused on a variety of factors leading to the underrepresentation of Black girls in STEM such as a lack of engagement and encouragement during formative school years, racial and gender biases, as well as student and teacher perceptions of academic abilities. However, there remains a gap when examining the impact of counterspaces on Black girls’ STEM identity development and its influence on their desires to pursue STEM degrees and STEM careers leading to increased representation in STEM fields. As STEM identity remains a powerful indicator of Black girls’ success in persisting in STEM fields, understanding the role of counterspaces in influencing Black girls’ STEM identity development is of critical significance. This conceptual article utilizes the frameworks of Critical Race Feminism (CRF) and Sociotransformative Constructivism as a lens to examine how counterspaces can serve as sites where Black girls challenge deficit notions about themselves as STEM learners that will contribute to building their self-perceptions and aid in the development of their STEM identity. Utilizing a literature review, this conceptual article will examine theoretical and empirical research that will guide me in the examination of the influence of counterspaces in the development of Black girls’ STEM identity. This article concludes with the implications of the need for counterspaces within PK-12 settings that can serve as sites where Black girls’ STEM identities can be cultivated and nurtured.
‘The Skills. . . had to be Used Simply Because They Were There’: Instrumental Rationality in the Military Domain
Authors: Levy Yagil
Published: August 2023

This article is conceptually motivated to show how instrumental rationality is reflected in the military domain. Instrumental rationality refers to the adoption of suitable means to achieve particular ends. However, this conception was criticised by the Frankfurt School for focusing on means rather than on ends. Based on this critique, I present specific categories of instrumental rationality in the military domain. I will argue that instrumental rationality, or at least its faulty application, is reflected in means-centred thinking whereby the means justify the ends. This approach may create specific categories in the military domain: means justify the ends just because they are available, and they can also expand the ends. The means-centred approach may be expanded from subordinating ends to means to focusing on the objects to be attacked, thus developing an objects-centred approach that may also develop into a focus on the direct outcome of the operation of means, thus becoming a tool of legitimation. A similar legitimising impact is produced by the process of moralisation implicit in the focus on means. Finally, a means-centred approach may be translated into overconfidence in the omnipotence of means, and can thereby be elevated to the belief that weapons can obviate the need for political settlement.

« Ces compétences. . . devaient être utilisées simplement parce qu’elles étaient là »: La rationalité instrumentale dans le domaine militaire
Discipline, Erasure, and Silenced Subjectivities: A Critical Discourse Analysis of Florida's 2022 Parental Rights in Education Act
Authors: Fowler Megan Marie , Mountz Sarah
Published: August 2023

This critical policy analysis is concerned with the discursive linguistic practices and social justice implications surrounding the passage of Florida's controversial “Parental Rights in Education Act” (PREA), which enacts limitations on classroom instruction involving topics related to gender and sexuality. Foregrounding this essay lays a call for social work scholarship to recognize the significance of the critical semiotic and post-structural turn in social science research, which evinces the importance of attending to the nuanced relationship between discourse, power, ideology, and identity formation. As a field espousing the tenets of social justice and commitments to the broader aims of social equality, social work holds an inherent investment in understanding the politics of language and, by extension, the language of emancipatory change. Informed by critical discourse analysis (CDA) and feminist post-structural thought, this analysis brings to the forefront the relevance of discourse, language, and semiotics as crucial objects of inquiry and seeks to examine what norms are in operation in the context of this legislation. What can discourse reveal about the nature of the social problem as postulated by PREA, and what discursive implications might it contain? Ultimately, this analysis contends that PREA represents a new threshold of educational and queer surveillance, best understood when bracketed by the ideologies of neoliberalism, cis-/heteropatriarchy, and the concomitant articulation of transphobia.
Uncertain optimization for initial disturbance of projectile for moving tank based on stochastic programming and deep learning surrogate model
Authors: Li Cong , Yang Guolai , Wang Xiuye , Xu Fengjie , Ma Yuze , Wang Liqun
Published: August 2023

To enhance the hitting accuracy of tank with moving firing, an uncertain optimization method based on stochastic programming is adopted to reduce the initial disturbance of projectile. Firstly, the firing dynamics model of moving tank is modeled to simulate the initial disturbance of projectile. Secondly, the controllable interior ballistic parameters such as projectile structure parameters and propellant parameters are treated as random design variables. The surrogate model for the firing dynamics model of moving tank is constructed by using the neural network based on deep learning. The uncertain optimization problem is transformed into a deterministic optimization problem by stochastic programming method. Then multi-objective genetic algorithm is adopted to settle optimization model, and reasonable design interval of random design variables is obtained. Finally, a six-degree-of-freedom rigid external ballistics model is used to establish a hitting accuracy evaluation model of moving tank based on interval uncertainty analysis. Through this model, the effectiveness of the optimization method is demonstrated.
Predicting pilot behavior during midair encounters using long short-term memory network
Authors: Hu Yang , Wang Xiaoyan
Published: August 2023

Characterized by the wide use of advanced automation and the introduction of new operation concepts, the future air transportation system will be more complex. Advanced pilot behavior models with improved capability are required to support the design and analysis of the midair encounter situations in the future air transportation system. This paper first filters midair encounter data from Automatic Dependent Surveillance-Broadcast (ADS-B) observations. Based on the acquired midair encounter data, a comprehensive pilot behavior model is proposed based on a multi-layer Long Short-Term Memory (LSTM) network. The model is designed for the purpose of enhancing the predicting capability of pilot behaviors in both horizontal and vertical planes. Finally, the performance of the proposed model to predict pilot behavior in both horizontal and vertical planes is studied through evaluating against realistic midair encounter situations.
Loneliness in healthcare providers: Results from a mid-pandemic survey
Authors: Kolcz Diana L. , Ferrand Jennifer , Young Kevin P. , O’Sullivan David M. , Robinson Kenneth
Published: August 2023

Background

Provider loneliness in healthcare can have devastating consequences. The causes of loneliness are not well known and workplace changes during the COVID-19 pandemic likely cause fewer opportunities for socialization.

Objective

We sought to explore the relationships between healthcare worker loneliness and isolation among various specialties and work environments. We evaluated factors that may contribute to increased loneliness/isolation, such as job satisfaction, time with peers, and work-related changes during COVID-19.

Design

An email containing an 18-item survey was sent out to Hartford Hospital’s medical staff.

Setting

Hartford Hospital

Participants

Hartford Hospital’s medical staff including physicians, psychologists, physician assistants, and APRNs

Measurements

Our survey included demographic information, questions regarding frequency of meaningful interactions with colleagues, isolation behaviors, as well as the UCLA 3-Item Loneliness Scale, Patient Health Questionnaire-2, Single-Item Burnout Scale, and Single-Item Measure of Job Satisfaction

Results

Of 1,015 respondents, almost half (48%) reported feeling lonely. Staff in procedure areas had significantly higher loneliness scores, while hospital-based floor/unit staff reported the lowest scores. Isolation was attributed to exhaustion from clinical work (36.1%), being too busy (39.6%), and being cautious due to COVID-19 (39.2%). Those who reported burnout, depression, and having few meaningful interactions all had increased loneliness scores. Those with higher job satisfaction reported lower loneliness.

Limitations

While our study had a 51% response rate, this rate is equivalent or higher than the response rate the organization receives to obligatory engagement surveys. It is likely that the ongoing pandemic affected these results.

Conclusion

We found significant levels of loneliness among our medical staff that appeared strongly related to work setting and environment. Social isolation behaviors were associated with higher loneliness scores. Future research should examine the efficacy of tailored strategies/interventions to reduce loneliness.

Primary Funding Source

None
Examining employee willingness to execute shared leadership: The role of leadership behaviour, gender, age, and context
Authors: van Roekel Henrico
Published: August 2023

Shared leadership refers to a post-heroic conceptualization of leadership dispersed among employees. Studies on shared leadership in teams show its emergence depends highly on team and formal team leader characteristics, but employees’ own voice is remarkably absent: we know little about how employees individually consider how they would want to execute shared leadership. Taking a bottom-up perspective, this study presents a large-scale conjoint experiment in which 6742 healthcare employees were asked to evaluate specific leadership behaviours. The results show a notable share of employees are willing to execute shared leadership, but willingness varies dependent on a number of factors. Employees are more willing to share leadership when it is focused on building relationships or bringing about change, when it takes only few hours and when it benefits others. Besides, willingness to execute shared leadership is higher among young or male employees, and in the context of the COVID-19 crisis. This study contributes to understanding how leadership behaviour, personal characteristics and context affect the emergence of shared leadership. The study concludes by critically exploring some of the possible systemic causes for differences in willingness to execute shared leadership, connecting these to broader issues in healthcare employment.
An another perspective of face masks in emotion recognition: Comment on Shepherd and Rippon (2022)
Authors: Almeida-Junior Elias Rodrigues de , Brito-de-Sousa Joaquim Pedro , Silva Elenice Francisco da , Ribas Rosineide Marques
Published: August 2023

In a recent article, Shepherd and Rippon (2022) investigated the impact of widespread face mask use on emotion recognition. They found that mask-wearing led to reduced accuracy in identifying emotions such as fear, sadness, and disgust when participants were exposed to brief facial stimuli. Their study highlights the significance of masks in concealing facial areas crucial for non-verbal communication, potentially affecting emotional well-being. Here in this comment, we have argued that despite concerns about impaired emotional recognition and social interactions, balancing COVID-19 protection and effective communication is essential. We stress the importance of adhering to mask guidelines while enhancing alternative cues and communication strategies. In public health emergencies like COVID-19, such research should acknowledge the whole complexity and prioritize safety aspects in a manner that prevents controversial issues.
Describing and visualizing the patient and caregiver experience of cancer pain in the home context using ecological momentary assessments
Authors: LeBaron Virginia , Homdee Nutta , Ogunjirin Emmanuel , Patel Nyota , Blackhall Leslie , Lach John
Published: August 2023

Background

Pain continues to be a difficult and pervasive problem for patients with cancer, and those who care for them. Remote health monitoring systems (RHMS), such as the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), can utilize Ecological Momentary Assessments (EMAs) to provide a more holistic understanding of the patient and family experience of cancer pain within the home context.

Methods

Participants used the BESI-C system for 2-weeks which collected data via EMAs deployed on wearable devices (smartwatches) worn by both patients with cancer and their primary family caregiver. We developed three unique EMA schemas that allowed patients and caregivers to describe patient pain events and perceived impact on quality of life from their own perspective. EMA data were analyzed to provide a descriptive summary of pain events and explore different types of data visualizations.

Results

Data were collected from five (n = 5) patient-caregiver dyads (total 10 individual participants, 5 patients, 5 caregivers). A total of 283 user-initiated pain event EMAs were recorded (198 by patients; 85 by caregivers) over all 5 deployments with an average severity score of 5.4/10 for patients and 4.6/10 for caregivers’ assessments of patient pain. Average self-reported overall distress and pain interference levels (1 = least distress; 4 = most distress) were higher for caregivers ([Formula: see text] 3.02, [Formula: see text]) compared to patients ([Formula: see text] 2.82, [Formula: see text] 2.25, respectively) while perceived burden of partner distress was higher for patients (i.e., patients perceived caregivers to be more distressed, [Formula: see text] 3.21, than caregivers perceived patients to be distressed, [Formula: see text]). Data visualizations were created using time wheels, bubble charts, box plots and line graphs to graphically represent EMA findings.

Conclusion

Collecting data via EMAs is a viable RHMS strategy to capture longitudinal cancer pain event data from patients and caregivers that can inform personalized pain management and distress-alleviating interventions.
Wrongful Conviction Rates and Death Penalty Support: Acceptability Hypothesis in Japan
Authors: Watamura Eiichiro , Ioku Tomohiro
Published: August 2023

This study tested the hypothesis that presenting people with information about wrongful convictions that are considered an unacceptable cost of administering justice lowers support for the death penalty. We recruited 815 participants using an online crowdsourcing service in Japan, randomly assigned them to eight groups with varying combinations of presence or absence of information emphasizing losses caused by wrongful convictions and asked them to answer questions on the death penalty. Results of the preregistration experiment showed no effect of loss emphasis, but the groups provided with information on wrongful conviction rates were less likely to support the death penalty than those with no information; the higher the wrongful conviction rate, the lower was the support. This study’s findings, which replicated a previous study’s findings with non-U.S. participants, support the acceptability hypothesis and confirm the institutional and cultural universality of the effect of wrongful conviction information on public attitude toward capital punishment.
The effects of pathogenic and likely pathogenic variants for inherited hemostasis disorders in 140 214 UK Biobank participants
Authors: Stefanucci Luca , Collins Janine , Sims Matthew C. , Barrio-Hernandez Inigo , Sun Luanluan , Burren Oliver S. , Perfetto Livia , Bender Isobel , Callahan Tiffany J. , Fleming Kathryn , Guerrero Jose A. , Hermjakob Henning , Martin Maria J. , Stephenson James , Paneerselvam Kalpana , Petrovski Slavé , Porras Pablo , Robinson Peter N. , Wang Quanli , Watkins Xavier , Frontini Mattia , Laskowski Roman A. , Beltrao Pedro , Di Angelantonio Emanuele , Gomez Keith , Laffan Mike , Ouwehand Willem H. , Mumford Andrew D. , Freson Kathleen , Carss Keren , Downes Kate , Gleadall Nick , Megy Karyn , Bruford Elspeth , Vuckovic Dragana
Published: August 2023

Rare genetic diseases affect millions, and identifying causal DNA variants is essential for patient care. Therefore, it is imperative to estimate the effect of each independent variant and improve their pathogenicity classification. Our study of 140 214 unrelated UK Biobank (UKB) participants found that each of them carries a median of 7 variants previously reported as pathogenic or likely pathogenic. We focused on 967 diagnostic-grade gene (DGG) variants for rare bleeding, thrombotic, and platelet disorders (BTPDs) observed in 12 367 UKB participants. By association analysis, for a subset of these variants, we estimated effect sizes for platelet count and volume, and odds ratios for bleeding and thrombosis. Variants causal of some autosomal recessive platelet disorders revealed phenotypic consequences in carriers. Loss-of-function variants in MPL, which cause chronic amegakaryocytic thrombocytopenia if biallelic, were unexpectedly associated with increased platelet counts in carriers. We also demonstrated that common variants identified by genome-wide association studies (GWAS) for platelet count or thrombosis risk may influence the penetrance of rare variants in BTPD DGGs on their associated hemostasis disorders. Network-propagation analysis applied to an interactome of 18 410 nodes and 571 917 edges showed that GWAS variants with large effect sizes are enriched in DGGs and their first-order interactors. Finally, we illustrate the modifying effect of polygenic scores for platelet count and thrombosis risk on disease severity in participants carrying rare variants in TUBB1 or PROC and PROS1, respectively. Our findings demonstrate the power of association analyses using large population datasets in improving pathogenicity classifications of rare variants.
CD19/CD22 targeting with cotransduced CAR T cells to prevent antigen-negative relapse after CAR T-cell therapy for B-cell ALL
Authors: Ghorashian Sara , Lucchini Giovanna , Richardson Rachel , Nguyen Kyvi , Terris Craig , Guvenel Aleks , Oporto-Espuelas Macarena , Yeung Jenny , Pinner Danielle , Chu Jan , Williams Lindsey , Ko Ka-Yuk , Walding Chloe , Watts Kelly , Inglott Sarah , Thomas Rebecca , Connor Christopher , Adams Stuart , Gravett Emma , Gilmour Kimberly , Lal Alka , Kunaseelan Sangeetha , Popova Bilyana , Lopes Andre , Ngai Yenting , Hackshaw Allan , Kokalaki Evangelia , Carulla Milena Balasch , Mullanfiroze Khushnuma , Lazareva Arina , Pavasovic Vesna , Rao Anupama , Bartram Jack , Vora Ajay , Chiesa Robert , Silva Juliana , Rao Kanchan , Bonney Denise , Wynn Robert , Pule Martin , Hough Rachael , Amrolia Persis J.
Published: August 2023

CD19-negative relapse is a leading cause of treatment failure after chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia. We investigated a CAR T-cell product targeting CD19 and CD22 generated by lentiviral cotransduction with vectors encoding our previously described fast-off rate CD19 CAR (AUTO1) combined with a novel CD22 CAR capable of effective signaling at low antigen density. Twelve patients with advanced B-cell acute lymphoblastic leukemia were treated (CARPALL [Immunotherapy with CD19/22 CAR Redirected T Cells for High Risk/Relapsed Paediatric CD19+ and/or CD22+ Acute Lymphoblastic Leukaemia] study, NCT02443831), a third of whom had failed prior licensed CAR therapy. Toxicity was similar to that of AUTO1 alone, with no cases of severe cytokine release syndrome. Of 12 patients, 10 (83%) achieved a measurable residual disease (MRD)–negative complete remission at 2 months after infusion. Of 10 responding patients, 5 had emergence of MRD (n = 2) or relapse (n = 3) with CD19- and CD22-expressing disease associated with loss of CAR T-cell persistence. With a median follow-up of 8.7 months, there were no cases of relapse due to antigen-negative escape. Overall survival was 75% (95% confidence interval [CI], 41%-91%) at 6 and 12 months. The 6- and 12-month event-free survival rates were 75% (95% CI, 41%-91%) and 60% (95% CI, 23%-84%), respectively. These data suggest dual targeting with cotransduction may prevent antigen-negative relapse after CAR T-cell therapy.
Genetic diversity and structure of mongolian gazelle (Procapra gutturosa) populations in fragmented habitats
Authors: Shi Lupeng , Yang Xiufeng , Cha Muha , Lyu Tianshu , Wang Lidong , Zhou Shengyang , Dong Yuehuan , Dou Huashan , Zhang Honghai
Published: August 2023

Background

The Mongolian gazelle (Procapra gutturosa) population has shown a considerable range of contractions and local extinctions over the last century, owing to habitat fragmentation and poaching. A thorough understanding of the genetic diversity and structure of Mongolian gazelle populations in fragmented habitats is critical for planning effective conservation strategies.

Result

In this study, we used eight microsatellite loci and mitochondrial cytochrome b (Cytb) to compare the levels of genetic diversity and genetic structure of Mongolian gazelle populations in the Hulun Lake National Nature Reserve (HLH) with those in the China-Mongolia border area (BJ). The results showed that the nucleotide diversity and observed heterozygosity of the HLH population were lower than those of the BJ population. Moreover, the HLH and BJ populations showed genetic differentiation. We concluded that the HLH population had lower genetic diversity and a distinct genetic structure compared with the BJ population.

Conclusion

The genetic diversity of fragmented Mongolian gazelle populations, can be improved by protecting these populations while reinforcing their gene exchange with other populations. For example, attempts can be made to introduce new individuals with higher genetic diversity from other populations to reduce inbreeding.
Is coronary artery calcium an independent risk factor for white matter hyperintensity?
Authors: Jin Hui , Qin Xue , Zhao Fanfan , Yan Yuting , Meng Yu , Shu Zhenyu , Gong Xiangyang
Published: August 2023

Background

Cardiovascular diseases have been considered the primary cause of disability and death worldwide. Coronary artery calcium (CAC) is an important indicator of the severity of coronary atherosclerosis. This study is aimed to investigate the relationship between CAC and white matter hyperintensity (WMH) in the context of diagnostic utility.

Methods

A retrospective analysis was conducted on 342 patients with a diagnosis of WMH on magnetic resonance images (MRI) who also underwent chest computed tomography (CT) scans. WMH volumes were automatically measured using a lesion prediction algorithm. Subjects were divided into four groups based on the CAC score obtained from chest CT scans. A multilevel mixed-effects linear regression model considering conventional vascular risk factors assessed the association between total WMH volume and CAC score.

Results

Overall, participants with coronary artery calcium (CAC score > 0) had larger WMH volumes than those without calcium (CAC score = 0), and WMH volumes were statistically different between the four CAC score groups, with increasing CAC scores, the volume of WMH significantly increased. In the linear regression model 1 of the high CAC score group, for every 1% increase in CAC score, the WMH volume increases by 2.96%. After including other covariates in model 2 and model 3, the β coefficient in the high CAC group remains higher than in the low and medium CAC score groups.

Conclusion

In elderly adults, the presence and severity of CAC is related to an increase in WMH volume. Our findings suggest an association between two different vascular bed diseases in addition to traditional vascular risk factors, possibly indicating a comorbid mechanism.
Association between physical activity and body posture: a systematic review and meta-analysis
Authors: Salsali Mohammad , Sheikhhoseini Rahman , Sayyadi Parisa , Hides Julie A. , Dadfar Mahdis , Piri Hashem
Published: August 2023

Objective

To estimate the possible associations between posture and physical activity (PA).

Design

A systematic review and meta-analysis.

Data sources

The search was conducted in seven databases (PubMed, Web of Science, SportDiscus, EMBASE, Scopus, Cochrane Library, and CINAHL) for studies published from inception to January 2023.

Eligibility criteria for selecting studies

Studies were required to meet following criteria: (1) study design: cross-sectional, case control and cohort studies. (2) Participants: people of all ages without any diagnosed diseases. (3) Exposure and outcome: studies that examined the possible effect or correlations between PA, physical inactivity, physical exertion and human body posture.

Results

Sixteen cross-sectional studies, two cohort studies and one case control study involving a total of 16772 participants aged from 6 to 79 years were included. Correlational studies showed that there was a significant relationship between PA and posture (C = 0.100, CI 95% = 0.012–0.186). However, regression studies demonstrated that there was not a significant association between PA and posture (C = 1.00, CI 95% = 0.998–1.002). Three studies investigated the association between PA and the lumbar lordosis and showed that there was not a significant association between the lordosis and PA (CI 95%: -0.253–0.048, P = 0.180). In addition, four studies showed that there were not any associations between scoliosis and PA (CI 95%: 0.819, 1.123, P = 0.607). The evidence of heterogeneity and publication bias was found among all analyzed data (P < 0.05). Also, meta regression was used for age and BMI and the results were not significant.

Conclusion

Although a weak correlation was shown to exist between PA and human posture, the odds ratio indicated that there was not a significant association between PA and human posture. The lack of a significant relationship may indicate that multiple biopsychosocial factors may be involved in human posture. In summary, our study highlights the need for caution when interpreting the results of meta-analyses, particularly when there is significant heterogeneity and publication bias in the included studies.
Machine learning-based nomogram for 30-day mortality prediction for patients with unresectable malignant biliary obstruction after ERCP with metal stent: a retrospective observational cohort study
Authors: Zhu Zongdong , Hu Kaixin , Zhao Fengqing , Liu Wen , Zhou Hongkun , Zhu Zongliang , Li Huangbao
Published: August 2023

Background

This study aimed to investigate the risk factors for 30-day mortality in patients with malignant biliary obstruction (MBO) after endoscopic retrograde cholangiopancreatography (ERCP) with endobiliary metal stent placement. Furthermore, we aimed to construct and visualize a prediction model based on LASSO-logistic regression.

Methods

Data were collected from 245 patients who underwent their first ERCP with endobiliary metal stent placement for unresectable MBO between June 1, 2013, and August 31, 2021. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for 30-day mortality. We subsequently developed a logistic regression model that incorporated multiple parameters identified by LASSO regression. The model was visualized and the nomogram was plotted. Risk stratification was performed based on nomogram-derived scores.

Results

The 30-day mortality rate was 10.7% (23/245 patients). Distant metastasis, total bilirubin, post-ERCP complications, and successful drainage were independent risk factors of 30-day mortality. The variables screened by LASSO regression, including distant metastasis, total bilirubin, post-ERCP complications, and successful drainage, were incorporated into the logistic model. The results were visualized through a nomogram based on the model. To assess the model’s performance, discrimination was evaluated using the area-under-the-curve values obtained from receiver operating characteristic analyses with 10-fold cross-validation in the training group and validated in the testing group. The calibration curve showed the good predictive ability of the model. Decision curve analysis is used to evaluate the clinical application of nomogram. Finally, we performed risk stratification based on the risk calculated using the nomogram. Patients were assigned to the low-, moderate-, and high-risk groups based on their probability scores. The Kaplan–Meier survival curves for the different nomogram-based groups were significantly different (p < 0.001).

Conclusions

We developed a nomogram using the LASSO-logistic regression model to forecast the 30-day mortality rate in patients who had undergone ERCP with endobiliary metal stent placement due to MBO. This nomogram can assist in identifying individuals at high-risk of 30-day mortality following ERCP.
Omega-3 nanoemulgel in prevention of radiation-induced oral mucositis and its associated effect on microbiome: a randomized clinical trial
Authors: Morsy Basma M. , El Domiaty Shahira , Meheissen Mohamed A. M. , Heikal Lamia A. , Meheissen Marwa A. , Aly Nourhan M.
Published: August 2023

Background

Oral mucositis (OM) is recognized as one of the most frequent debilitating sequelae encountered by head and neck cancer (HNC) patients treated by radiotherapy. This results in severe mucosal tissue inflammation and oral ulcerations that interfere with patient’s nutrition, quality of life (QoL) and survival. Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) have recently gained special interest in dealing with oral diseases owing to its anti-inflammatory, anti-oxidant and wound healing properties. Thus, this study aims to assess topical Omega-3 nanoemulgel efficacy in prevention of radiation-induced oral mucositis and regulation of oral microbial dysbiosis.

Materials and methods

Thirty-four head and neck cancer patients planned to receive radiotherapy were randomly allocated into two groups: Group I: conventional preventive treatment and Group II: topical Omega-3 nanoemulgel. Patients were evaluated at baseline, three and six weeks after treatment using the World Health Organization (WHO) grading system for oral mucositis severity, Visual Analogue Scale (VAS) for perceived pain severity, and MD-Anderson Symptom Inventory for Head and Neck cancer (MDASI-HN) for QoL. Oral swabs were collected to assess oral microbiome changes.

Results

VAS scores and WHO mucositis grades were significantly lower after six weeks of treatment with topical Omega-3 nanoemulgel when compared to the conventional treatment. The total MDASI score was significantly higher in the control group after three weeks of treatment, and the head and neck subscale differed significantly at both three and six weeks. A significant reduction in Firmicutes/Bacteroidetes ratio was observed after six weeks in the test group indicating less microbial dysbiosis.

Conclusions

Topical Omega-3 nanoemulgel demonstrated a beneficial effect in prevention of radiation-induced oral mucositis with a possibility of regulating oral microbial dysbiosis.
Clinical learning evaluation questionnaire: a reliable and valid tool for the evaluation of clinical education by educators and students
Authors: Ostovarfar Jeyran , Soufi Saeed Kazemi , Moosavi Mahsa , Delavari Somayeh , Moghadami Mana , Ghazanfari Seyed Mehdi , Amini Mitra
Published: August 2023

Background

The clinical learning evaluation questionnaire can be used in the clinical trial period of medical students to measure the effectiveness of the clinical learning environment. The purpose of this study was to collect validity evidence of an adapted questionnaire to measure the transcultural adaptation of a Persian version of CLEQ.

Methods

A total of 200 questionnaires were completed by students who were at the end of their clinical rotation. The study instrument was the latest version of the CLEQ consists of 18 Items in four dimensions. The CLEQ was translated into Persian language through a four-step process of forward and backward translation. Data analysis was performed on two softwares, SPSS, version 22 and Lisrel, version 8.8.

Results

The results showed that the 18-question CLEQ could be applied to the Persian translation of the tool. The response process evidence of the Persian questionnaire was established through feedback from 15 students in the sample group. The content validity index (CVI) for the items were between 0.8 and 0.9, and the content validity ratio (CVR) for the entire questionnaire was 0.9. The 4-factor feature of CLEQ was good model fit. The internal consistency analysis indicated that the Cronbach's alpha values for all items of the 18-item questionnaire were equal to 0.87 and for the subscales were 0.68 to 0.79.

Conclusion

The Persian translation of the 4-factor CLEQ has sufficient validity evidence to measure the transcultural adaptability of clinical education activities by instructors and students. The validity evidence are content, response process and internal structure. We recommend that the English 6-factor and 6-factor versions of CLEQ be tested on medical students at multiple foreign academic institutions to assess their efficiency.
Clinical significance of genetic profiling based on different anatomic sites in patients with mucosal melanoma who received or did not receive immune checkpoint inhibitors
Authors: Wang Hai-Yun , Liu Ye , Deng Ling , Jiang Kuntai , Yang Xin-Hua , Wu Xiao-Yan , Guo Kai-Hua , Wang Fang
Published: August 2023

Background

To date, data on the efficacy of targeted therapies for mucosal melanoma (MM) are limited. In this study, we analyzed genetic alterations according to the primary site of origin, which could provide clues for targeted therapy for MM.

Methods

We conducted a retrospective cohort study of 112 patients with MM. Targeted sequencing was performed to analyze genetic aberrations. Kaplan–Meier analysis was conducted with the log-rank test to compare the significance among subgroups.

Results

In total, 112 patients with MM were included according to the anatomic sites: 38 (33.9%) in the head and neck, 22 (19.6%) in the genitourinary tract, 21 (18.8%) in the anorectum, 19 (17.0%) in the esophagus, 10 (8.9%) in the uvea, and 2 (1.8%) in the small bowel. The most significantly mutated genes included BRAF (17%), KIT (15%), RAS (15%), TP53 (13%), NF1 (12%), SF3B1 (11%), GNA11 (7%), GNAQ (5%), and FBXW7 (4%). A large number of chromosomal structural variants was found. The anatomic sites of esophagus and small bowel were independent risk factors for progression-free survival (PFS, hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.42–9.45, P < 0.0001) and overall survival (OS, HR 5.26, 95% CI 2.51–11.03, P < 0.0001). Casitas B-lineage lymphoma (CBL) mutants showed significantly poorer PFS and OS. In contrast, MM patients who received immune checkpoint inhibitors (ICIs) had a significantly more favorable OS (HR 0.39, 95% CI 0.20–0.75, P = 0.008).

Conclusions

Our findings reveal the genetic features of patients with MM, mainly across six anatomic sites, offering a potential avenue for targeted therapies.
Translating community-based participatory research into broadscale sociopolitical change: insights from a coalition of women firefighters, scientists, and environmental health advocates
Authors: Ohayon Jennifer Liss , Rasanayagam Sharima , Rudel Ruthann A , Patton Sharyle , Buren Heather , Stefani Tony , Trowbridge Jessica , Clarity Cassidy , Brody Julia Green , Morello-Frosch Rachel
Published: August 2023

Background

We report on community-based participatory research (CBPR) initiated by women firefighters in order to share successful elements that can be instructive for other community-engaged research. This CBPR initiative, known as the Women Worker Biomonitoring Collaborative (WWBC) is the first we are aware of to investigate links between occupational exposures and health outcomes, including breast cancer, for a cohort of exclusively women firefighters.

Methods

In order to be reflective of the experiences and knowledge of those most intimately involved, this article is co-authored by leaders of the research initiative. We collected leaders’ input via recorded meeting sessions, emails, and a shared online document. We also conducted interviews (N = 10) with key research participants and community leaders to include additional perspectives.

Results

Factors contributing to the initiative’s success in enacting broadscale social change and advancing scientific knowledge include (1) forming a diverse coalition of impacted community leaders, labor unions, scientists, and advocacy organizations, (2) focusing on impacts at multiple scales of action and nurturing different, yet mutually supportive, goals among partners, (3) adopting innovative communication strategies for study participants, research partners, and the broader community, (4) cultivating a prevention-based ethos in the scientific research, including taking early action to reduce community exposures based on existing evidence of harm, and (5) emphasizing co-learning through all the study stages. Furthermore, we discuss external factors that contribute to success, including funding programs that elevate scientist-community-advocacy partnerships and allow flexibility to respond to emerging science-policy opportunities, as well as institutional structures responsive to worker concerns.

Conclusions

While WWBC shares characteristics with other successful CBPR partnerships, it also advances approaches that increase the ability for CBPR to translate into change at multiple levels. This includes incorporating partners with particular skills and resources beyond the traditional researcher-community partnerships that are the focus of much CBPR practice and scholarly attention, and designing studies so they support community action in the initial stages of research. Moreover, we emphasize external structural factors that can be critical for CBPR success. This demonstrates the importance of critically examining and advocating for institutional factors that better support this research.
Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis
Authors: Farah Emile , Abreu Andres A. , Rail Benjamin , Salgado Javier , Karagkounis Georgios , Zeh Herbert J. , Polanco Patricio M.
Published: August 2023

Background

Robotic colorectal surgery is becoming the preferred surgical approach for colorectal cancer (CRC). It offers several technical advantages over conventional laparoscopy that could improve patient outcomes. In this retrospective cohort study, we compared robotic and laparoscopic surgery for CRC using a national cohort of patients.

Methods

Using the colectomy-targeted ACS-NSQIP database (2015–2020), colorectal procedures for malignant etiologies were identified by CPT codes for right colectomy (RC), left colectomy (LC), and low anterior resection (LAR). Optimal pair matching was performed. “Textbook outcome” was defined as the absence of 30-day complications, readmission, or mortality and a length of stay < 5 days.

Results

We included 53,209 out of 139,759 patients screened for eligibility. Laparoscopic-to-robotic matching of 2:1 was performed for RC and LC, and 1:1 for LAR. The largest standardized mean difference was 0.048 after matching. Robotic surgery was associated with an increased rate of textbook outcomes compared to laparoscopy in RC and LC, but not in LAR (71% vs. 64% in RC, 75% vs. 68% in LC; p < 0.001). Robotic LAR was associated with increased major morbidity (7.1% vs. 5.8%; p = 0.012). For all three procedures, the mean conversion rate of robotic surgery was lower than laparoscopy (4.3% vs. 9.2%; p < 0.001), while the mean operative time was higher for robotic (225 min vs. 177 min; p < 0.001).

Conclusions

Robotic surgery for CRC offers an advantage over conventional laparoscopy by improving textbook outcomes in RC and LC. This advantage was not found in robotic LAR, which also showed an increased risk of serious complications. The associations highlighted in our study should be considered in the discussion of the surgical management of patients with colorectal cancer.
Exploring health insurance and knowledge of the ovulatory cycle: evidence from Demographic and Health Surveys of 29 countries in Sub-Saharan Africa
Authors: Zegeye Betregiorgis , Idriss-Wheeler Dina , Oladimeji Olanrewaju , Yaya Sanni
Published: August 2023

Background

Unplanned pregnancy continues to be a major public health concern in Sub-Saharan Africa (SSA). Understanding the ovulatory cycle can help women avoid unplanned pregnancy. Though a wide range of factors for ovulatory cycle knowledge in SSA countries has not been well assessed, the influence of health insurance on ovulatory cycle knowledge is largely unknown. As a result, we set out to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age. This study aims to investigate the relationship between health insurance enrollment and knowledge of the ovulatory cycle among women of childbearing age in sub-Saharan Africa (SSA).

Methods

Demographic and Health Surveys (DHSs) data from 29 SSA countries were analyzed. The association between health insurance and ovulatory cycle knowledge was investigated using bivariate and multivariate multilevel logistic regression models among 372,692 women of reproductive age (15–49). The findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of 0.05 was considered statistically significant.

Results

The pooled result shows that the prevalence of knowledge of ovulatory cycle in the studied 29 SSA countries was 25.5% (95% CI; 24.4%-26.6%). Findings suggest higher odds of ovulatory cycle knowledge among women covered by health insurance (AOR = 1.27, 95% CI; 1.02–1.57), with higher education (higher-AOR = 2.83, 95% CI; 1.95–4.09), from the richest wealth quintile (richest-AOR = 1.39, 95% CI; 1.04–1.87), and from female headed households (AOR = 1.16, 95% CI; 1.01–1.33) compared to women who had no formal education, were from the poorest wealth quintile and belonged to male headed households, respectively. We found lower odds of ovulatory cycle knowledge among women who had 2–4 parity history (AOR = 0.80, 95% CI; 0.65–0.99) compared to those with history of one parity.

Conclusions

The findings indicate that the knowledge of the ovulatory cycle is lacking in SSA. Improving health insurance enrollment should be considered to increase ovulatory cycle knowledge as an approach to reduce the region's unplanned pregnancy rate. Strategies for improving opportunities that contribute to women’s empowerment and autonomy as well as sexual and reproductive health approaches targeting women who are in poorest quintiles, not formally educated, belonging to male headed households, and having high parity should be considered.
Comparison of thoracolumbar versus non-thoracolumbar osteoporotic vertebral compression fractures in risk factors, vertebral compression degree and pre-hospital back pain
Authors: Wang Feng , Sun Rui , Zhang Shao-Dong , Wu Xiao-Tao
Published: August 2023

Background

Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF).

Methods

OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF.

Results

A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was − 2.99 ± 1.11, − 3.24 ± 1.14, − 3.05 ± 1.40 in < 70, 70–80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior–posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1–2, and 2–4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1–2, 2–4, and > 4 weeks.

Conclusions

Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.