bluuebunny/crossref_metadata_2025 huggingface dataset:
Exposed, scaffolded and connected – Foster carers' experiences of dyadic developmental psychotherapy: An interpretative phenomenological analysis
Authors: Murphy Amy , Melia Yvonne , Srejic Gabija
Published: February 2025

Objective

Research is required to better understand the experience and effectiveness of dyadic developmental psychotherapy (DDP), a promising intervention developed to meet the complex needs of developmental trauma‐experienced children in substitute care. DDP is a systemic intervention, within which the child's carer plays a significant role. Given their significant role and the lack of existing research, this study aimed to explore how foster carers experience DDP.

Design

A qualitative design using semi‐structured interviews with 10 foster carers was implemented.

Method

Interviews conducted via Microsoft Teams and telephone were recorded, transcribed and analysed using interpretative phenomenological analysis.

Results

Four group experiential themes and 11 subthemes were formed; ‘from disbelief to clarity’, ‘scaffolded and safe’, ‘attuned and connected’ and "It's worth it". From initial confusion and disappointment, came clarity of self‐understanding and a more attuned, connected attachment relationship. DDP was experienced as both fulfilling and demanding.

Conclusions

Though the need to explore DDP's effectiveness remains, this study suggests foster carers experience DDP as a demanding yet worthwhile intervention. Implications for practice, especially an increased need for relational safety and carer support are explored, as well as avenues for future research.
The Blockchain Treasury Governance Dilemma
Authors: Allen Darcy W. E. , Berg Chris , Lane Aaron M.
Published: February 2025

Blockchain treasuries are pools of cryptocurrency earmarked for funding goods and services within a blockchain ecosystem, such as protocol upgrades. Blockchain participants, such as users and developers, face a trust problem in ensuring that the treasury is robust to opportunism, such as theft or misappropriation of the assets. Treasury governance structures, such as committees or stakeholder voting, seek to create trust in treasury functions. In this paper, we use new comparative economics to examine how treasury governance mechanisms minimize the costs of dictatorship and disorder, thereby bolstering trust. We interpret case studies of innovative treasury governance within this Institutional Possibilities Frontier (IPF) framework, showing that the costs shift throughout the lifecycle of a blockchain community, and those costs are often revealed or learned through governance crises. These changes lead ecosystem participants to choose and innovate on treasury governance.
The Educational Differentiation of African Birth Timing
Authors: Frye Margaret , Lopus Sara
Published: February 2025

As educational access has expanded across Africa, birth timing has remained quite stable. Using data representing 51 birth years and 34 countries, we show that these modest aggregate changes mask more dramatic changes within educational groups. Over time, educational attainment has become an increasingly salient predictor of birth timing, as highly educated women have delayed first births and lengthened subsequent birth intervals more. The educational differentiation of birth timing also varies across contextual factors (educational access and family planning effort). In recent cohorts, women of all educational levels have experienced earlier first births in higher education contexts, suggesting that entry into motherhood is influenced by relative position within one's peer group. Aggregating across educational levels, however, women experience later first births in higher education contexts, driven by the greater share of highly educated women. For women at all levels of educational attainment, first birth timing is responsive to family planning context; in aggregate, women in countries with high family planning investments become mothers one year later than those in countries with lower family planning efforts. Notably, highly educated women lengthen their second birth intervals more when education and family planning are widely available, suggesting further potential for public investments to enable women to achieve their reproductive preferences.
Distinguishing Underlying, Inferred, and Expressed Preferences, Attitudes, and Beliefs: An Absence of (Mental) Flatness?
Authors: Brown Gordon D. A. , Walasek Lukasz
Published: February 2025

People's choices of food and drink, the attitudes they express, and the beliefs that they state are influenced by their political and other identities. At the same time, people's everyday choices depend on the context of available options in ways that are difficult to explain in terms of the choosers’ preferences and beliefs. Such phenomena provoke various questions. Do partisans or conspiracy theorists really believe what they are saying? Given the systematic inconsistency of their choices, in what sense do consumers prefer the items they purchase? More generally, how “flat” is the mind—do we come to decision‐making and choice with pre‐existing preferences, attitudes, and beliefs, or are our explanations for our behavior mere post‐hoc narratives? Here, we argue that several apparently disparate difficulties are rooted in a failure to separate psychologically different types of preferences, attitudes, and beliefs. We distinguish between underlying, inferred, and expressed preferences. These preferences may be expressed in different coordinate spaces and hence support different types of explanatory generalizations. Choices that appear inconsistent according to one type of preference can appear consistent according to another, and whether we can say that a person “really” prefers something depends on which type of preference we mean. We extend the tripartite classification to the case of attitudes and beliefs, and suggest that attributions of attitudes and beliefs may also be ambiguous. We conclude that not all of the mental states and representations that govern our behavior are context‐dependent and constructed, although many are.
Donors in the COVID‐19 era: How did donor characteristics change in Japan?
Authors: Odajima T. , Tsuno N. H. , Okubo R. , Makino S. , Miyagi T. , Ikuta K. , Muroi K. , Kino S.
Published: February 2025

Background and Objectives

The COVID‐19 pandemic caused significant disruptions to the blood service in Japan. Stay‐at‐home policies in schools, organizations and companies made it challenging to access potential blood donors, leading to a substantial decline in blood donation rates. This study aimed to examine the profile of blood donors during the pandemic and compare it with that in the pre‐pandemic period.

Materials and Methods

Blood donors who contributed to the Japanese Red Cross Blood Services between April 2018 and March 2021 were evaluated based on age, gender, occupation, donation site, height, body weight (BW) and donation status (first‐time [FT] or repeat). Factors influencing the return of FT donors who contributed before and during the pandemic were also explored.

Results

During the initial phase of the pandemic, a significant decrease in blood donations was observed, particularly in Tokyo. Despite intermittent drops, the required blood volume was ultimately collected. Donations by both female and male repeat donors increased, although the number of male repeat donors decreased, with only female repeat donors experiencing an absolute increase. Before the pandemic, younger age, 200‐mL donation, higher body mass index and fixed donation sites were significantly associated with FT donor returns. During the pandemic, higher age (for males) and 400‐mL donation (for females) emerged as significant factors. With changes in donor profiles during the pandemic, there was a noticeable shift in the characteristics of FT donors who returned for a subsequent donation within the following year, particularly in terms of age and blood donation volume.

Conclusion

Despite the challenges, the required blood volume was successfully collected, thanks to increased donations from repeat blood donors. Recruiting and retaining committed donors is essential for maintaining sustainable blood services, especially during crisis situations.
Cellular effects and orientation of immobilized immunoglobulin are correlated to the charge-mediated influence of the antibody variable region
Authors: Wei Hsi-Ju , Zhang Jun , Barbon Jeffrey , Crosbie Nancy , Dominguez Eric
Published: February 2025

Ligand binding to a cell receptor often insufficiently triggers cellular immune responses. Receptor clustering through cross-linking occurs when a ligand binds to two or more receptors, amplifying cellular responses. This is required in certain monoclonal antibodies (mAbs), including effector mechanism activation [binding to fragment crystallizable receptors (FcRs)] or acting as agonists for therapeutic signaling. Therefore, immobilized immunoglobulin immunoassays were developed for efficient diagnostic and therapeutic approaches. The immobilized mAb density and orientation influence the sensitivity and accuracy of these assays. Limited evidence shows that different epitope motifs with the same target mAbs affect immobilized density and orientation in the solid-phase state. Here, we developed a series of fully humanized antidendritic cell immunoreceptor (DCIR) mAbs with different epitopes but the same Fc region. Immobilized anti-DCIR mAbs trigger the effector response from FcR through the Fc region and induce inhibitory pathways from the DCIR intracellular immunoreceptor tyrosine-based inhibitory motif through the fragment variable (Fv) region. In the immobilized immunoglobulin immunoassay, the isoelectric points (pI) of the DCIR mAb Fv region, not the total pI, significantly correlate to the surface density and orientation of immobilized mAbs on negatively charged plates. Cytokine production and protein phosphorylation in human monocytes were affected by vary binding abilities of immobilized mAbs to the plate. Methods, such as increasing hydrophobicity or ionic interactions, have improved the surface density and consistent orientation of immobilized anti-DCIR mAbs. Our study highlights the critical relationship between the net charge of the antibody Fv region and its immobilization potential in the solid-phase state.
Carbon impurities in oxide thin films: The effect of annealing and laser irradiation
Authors: Ahmed Syeed E. , Ingraham Cody , McCluskey Matthew D. , Huso Jesse , Poole Violet M.
Published: February 2025

Carbon is a common contaminant in oxide thin film semiconductors that can affect important properties such as the work function, surface chemistry, and electrical conductivity. In this work, carbon impurities in sputtered anatase titania (TiO2) and indium tin oxide (ITO) thin films were investigated using Raman and optical transmission spectroscopy. Annealing in a rough vacuum yielded carbon precipitates, which have characteristic disordered and graphitic carbon Raman signatures. Irradiation by a 532 nm laser in the ambient air was effective in removing the carbon precipitates; in the case of ITO, no trace of carbon could be observed in the Raman spectra following irradiation. The combination of vacuum annealing and laser irradiation could provide a practical means for reducing carbon impurities in thin films.
Nanocalorimetry for plasma metrology relevant to semiconductor fabrication
Authors: Diulus J. Trey , Corbella Carles , Yi Feng , LaVan David , Kalanyan Berc , McLean Mark , Narayan Lakshmi Ravi , Osborn William A. , Maslar James E. , Kolmakov Andrei
Published: February 2025

This letter reports on pilot tests of microfabricated nanocalorimeters as a metrology platform for rapid (<40 ms response time) and sensitive (in the range of 1020 m−2 s−1–1017 m−3 for radicals’ flux and density, respectively) detection of neutral radicals generated by reactive cold plasmas. The setup consists of a nanocalorimeter resistive sensor coated with a catalyst alongside an inert reference sensor with identical thermal masses. By measuring the temperature increase in the active sensor caused by radical surface recombination reactions and comparing it to the reference sensor, parasitic stimuli such as IR/visible/UV irradiation and ion- and/or electron-induced heat fluxes can effectively be isolated. The system was successfully tested in a hydrogen plasma environment, and critical performance metrics such as sensitivity and response time were evaluated and benchmarked against the existing plasma radical diagnostic techniques.
Sucrose and malic acid in the tobacco plant induce
hrp
regulon in a phytopathogen
Ralstonia pseudosolanacearum
Authors: Cao Yuzhu , Tsuzuki Masayuki , Kiba Akinori , Hikichi Yasufumi , Zhang Yong , Ohnishi Kouhei
Published: February 2025

Genes encoding a type III secretion system in
Ralstonia pseudosolanacearum
are regulated by HrpB as an
hrp
regulon and induced only in plants. This study aimed to identify the plant signals that induce the
hrp
regulon and confirm the signal recognition mechanism. Signaling molecules that induce
hrpB
expression were screened using resting cells of the
hrpB-lacZ
reporter strain. Only the soluble fraction of smashed tobacco seedlings induced
hrpB
expression. The heated soluble fraction retained its
hrpB
-inducing activity, indicating that the signaling molecules were not proteins. When the soluble fraction was fractionated into acidic, neutral, and basic components, both the acidic and neutral fractions induced
hrpB
expression. As neutral compounds, sucrose, glucose, and fructose have been found to induce
hrpB
expression. Sucrose-induced
hrpB
expression was greatly reduced in the
prhA
mutant, indicating that the TonB-dependent receptor PrhA perceives sugars. Among the organic acids found in the acidic fractions, malic acid most efficiently induced
hrpB
expression, which was reduced by the mutation of a hybrid histidine kinase gene of a two-component system,
rsc1598
, indicating that Rsc1598 may sense malic acid. We demonstrated direct binding of Rsc1598 to malic acid using isothermal titration calorimetry.

IMPORTANCE

Similar to other Gram-negative plant pathogens, the type III secretion system (T3SS) is the most important virulence factor in
Ralstonia pseudosolanacearum
. The genes for the T3SS are regulated as an
hrp
regulon, activated only when the pathogen encounters the plants, indicating that the pathogen must sense plant signals. For the first time, we identified two signaling compounds, sucrose and malic acid, that are abundantly found in tobacco roots. The
hrp
operon was induced even in non-host plants, possibly because sucrose and malic acid are common in plants. We also found that
R. pseudosolanacearum
membrane proteins received sucrose and malic acid independently. As a next step, antagonists of signaling molecules can be screened.
Single-cell transcriptomics reveals a compartmentalized antiviral interferon response in the nasal epithelium of mice
Authors: Wang Xuefei , Dong Meng , Wu Xinchao , Schnepf Daniel , Thiel Julia , Sun Wenfei , Wolfrum Christian , Li Sisi , Jin Wenfei , Staeheli Peter , Ye Liang
Published: February 2025

Type III interferons (IFNs) primarily act on epithelial cells and protect against virus infection of the mucosa, whereas type I IFNs act more systemically. To date, it has been unknown which epithelial subtypes in the upper airways, the primary site for initial infection for most respiratory viruses, primarily rely on type III IFN or type I IFNs for antiviral protection. To address this question, we performed a single-cell transcriptomics analysis of the epithelial IFN-mediated response focusing on the upper airways of mice. This work identified nine distinct cell types derived from the olfactory epithelium and thirteen distinct cell types from the respiratory epithelium. Interestingly, type I IFNs induced a stronger antiviral transcriptional response than type III IFN in respiratory epithelial cells, whereas in olfactory epithelial cells, including sustentacular (SUS) and Bowman’s gland cells (BGC), type III IFN was more dominant compared to type I IFN. SUS and BGC, which provide structural support and maintain the integrity of olfactory sensory neurons, were highly susceptible to infection with a mouse-adapted variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 MA20) but were protected against infection if the animals were prophylactically treated with type III IFN. These findings demonstrate a high degree of cell type heterogeneity in terms of interferon-mediated antiviral responses and reveal a potent role for type III IFNs in protecting the olfactory epithelium.

IMPORTANCE

SARS-CoV-2 infects SUS and BGC in the olfactory epithelium, causing an impairment of structural support and integrity of olfactory sensory neurons that can result in severe olfactory dysfunctions. We observed an unexpected compartmentalization of the IFN-mediated transcriptional response within the airway epithelium, and we found that olfactory epithelial cells preferentially respond to type III IFN, which resulted in robust antiviral protection of SUS and BGC. Given the proximity of the olfactory epithelium to the central nervous system, we hypothesize that evolution favored a type III IFN-biased antiviral immune response in this tissue to limit inflammatory responses in the brain. Cell type-specific antiviral responses in the upper airways, triggered by the different types of IFNs, should be investigated in more detail and carefully taken into consideration during the development of IFN-based antivirals for clinical use.
Gut microbiome metagenomic sequences of honey bees (
Apis mellifera
) exposed to crops
Authors: Tran L. , Lansing L. , Cunningham M. , Ho J. , Deckers T. , Newman T. , Wu L. , Gregoris A. S. , Zorz J. , Muntz L. , Lee K. , Trépanier-Leroux D. , Conflitti I. M. , Pepinelli M. , Walsh E. M. , Morfin N. , Powell J. E. , Moran N. , Hoover S. E. , Pernal S. F. , Currie R. W. , Giovenazzo P. , Guzman-Novoa E. , Jabbari H. , Foster L. J. , Zayed A. , Ortega Polo R. , Guarna M. M.
Published: February 2025

The gut microbiome of the European honey bee (
Apis mellifera
) is vital to its health, yet large-scale studies are scarce. We present metagenomic sequencing data from 180 samples collected near and far from eight crops across Canada over 2 years. These data sets will help address various biological and environmental questions.
Role of sortase-assembled Ebp pili in
Enterococcus faecalis
adhesion to iron oxides and its impact on extracellular electron transfer
Authors: Ho Foo Kiong , Lam Ling Ning , Matysik Artur , Watts Thomas Dean , Wong Jun Jie , Chong Kelvin Kian Long , Choo Pei Yi , Tolar Joe , Low Pui Man , Chua Zhi Sheng , Paxman Jason J. , Heras Begoña , Marsili Enrico , Ajo-Franklin Caroline M. , Kline Kimberly A.
Published: February 2025

Enterococcus faecalis
sortase-assembled endocarditis and biofilm-associated pili (Ebp) are virulence factors implicated in enterococcal biofilm-associated infections and gastrointestinal colonization. We previously showed that
E. faecalis
biofilm metabolism is influenced by extracellular electron transfer (EET) under iron-rich conditions, raising the question of whether Ebp pili also play a role in EET. Here, we report a novel role of Ebp pili in
E. faecalis
adhesion to the iron oxides magnetite, goethite, and hematite, where the EbpA tip adhesin contributes to this interaction. Adhesion by Ebp pili is conditionally important for EET to iron oxides, as pilus mutants are attenuated in EET under non-static growth conditions. In alignment with the established role of EET in redox homeostasis, we find that EET to ferricyanide supports
E. faecalis
anaerobic growth on glycerol. Furthermore, in an antibiotic-treated mouse gastrointestinal colonization model, we show that
E. faecalis
mutants deficient in EET poorly colonize the intestinal niche. Taken together, our findings suggest that Ebp pili can influence
E. faecalis
metabolic fitness by promoting EET to iron oxides, raising new questions about how Ebp pili shape
E. faecalis
interactions with environmental ecosystems. Additionally, the important role of EET in
E. faecalis
colonization of the dysbiotic gastrointestinal environment highlights the need for further inquiry into how EET contributes to
E. faecalis
microbial pathogenesis.

IMPORTANCE

In this study, we explored the interplay between extracellular electron transfer (EET) and an
Enterococcus faecalis
biofilm factor, the endocarditis and biofilm-associated pili (Ebp). We demonstrate that Ebp pili have a novel role in adhesion to iron oxides, which consequently promotes EET to iron oxides under non-static conditions. Along with our findings that
E. faecalis
EET can be coupled to anaerobic cell growth, our results point to a potential ecological role of Ebp pili in natural environments, outside of its established function in adhesion to host ligands. We provide the first evidence of the contribution of EET to
E. faecalis
colonization of the antibiotic-treated murine intestinal niche, which adds to the limited experimental evidence linking EET and microbial pathogenesis, as well as highlights the need for further studies of EET in bacterial pathogens.
‘The right advice’: a qualitative study examining enablers and barriers to recreational running and beliefs about knee health following knee surgery
Authors: Alexander James L N , Ezzat Allison M , Culvenor Adam G , De Oliveira Silva Danilo , Haberfield Melissa , Esculier Jean-François , Barton Christian J
Published: February 2025

Objectives

To examine the experiences, knowledge and beliefs of recreational runners with a history of knee surgery regarding (i) enablers and barriers to running participation, (ii) the association of running and knee joint health, and (iii) perceived benefits and motivations for running.

Methods

17 runners (≥3 times/week, ≥10 km/week) with a history of knee surgery (7±7 years post-surgery, 9 women, age 36±8 years) participated in one-on-one semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Trustworthiness was built by following established qualitative research guidelines and by participant validation of findings in the final analysis stages.

Results

We identified 9 themes (5 subthemes) for aim (i); 3 themes (10 subthemes) for aim (ii); and 2 themes (4 subthemes) for aim (iii). Positive health professional support including education, exercise rehabilitation and a tailored return-to-run plan enabled participants to return to running following surgery. Effective load management either independently or with coach assistance, and consistent strength training were considered key to maintaining participation. Barriers to running following surgery included unhelpful health professional encounters, persistent knee symptoms and muscle weakness, new running-related injuries, anxiety and fear about reinjury, and difficulty finding time. Participants had varying beliefs about running and knee joint health, although most believed that running benefited long-term knee health. Improved mental health and social connection were the most common motivators to run.

Conclusion

Our qualitative findings may inform strategies to support adults to commence, or return to, and maintain running participation following knee surgery.
Novel approach for women’s self-management of rectal emptying difficulty
Authors: Eustice Sharon , Endacott Ruth , Kent Bridie
Published: February 2025

Aim

To pragmatically investigate rectal emptying difficulty in women to identify if managing their symptoms with an innovative device is more effective and satisfactory than their usual care.

Background

Rectal emptying difficulty has a mostly unknown influence on women and frequently a hidden issue. Self-management alternatives are underappreciated. Despite the magnitude of the problem and its influence on women’s lives and healthcare, non-surgical alternatives have received little attention.

Methods

This cohort study of 35 female participants, recruited via secondary care outpatient clinics, used composite questionnaires before and after an 8-week intervention using the device. The questionnaire comprised of a quality of life instrument (International Consultation on Incontinence Questionnaire-Vaginal Symptoms and obstructed defaecation syndrome questionnaires), bowel diary recordings and participant feedback on using the device.

Findings

The device helped participants reduce the need to use their fingers (z= −2.844; p≤0.004) and offered participants improved lifestyle. There was significant reduction in difficulties to evacuate (p≤0.004), digitation to evacuate (p≤0.018), the feeling of incomplete evacuation (p≤0.002), straining to evacuate (p≤0.008) and lifestyle alteration (p≤0.046). The sense of incomplete emptying before and after using the device was significant (z= −2.646; p≤0.008), and feeling of being blocked improved (z= −3.317; p≤0.001). Stool consistency did not change. Medication to evacuate, returning to the toilet to evacuate and time needed showed no difference. Twenty-four participants (68.5%) completed the Patient Global Impression of Improvement question postintervention. Overall, 16 participants (66.7%) reported that the device was better than not using it. The results have clinical value, suggesting the device can assist women enhance their quality of life and improve physical symptoms associated with rectal emptying difficulties.

Conclusions

Most women with rectal emptying difficulty in this study found the device effective when compared with their usual care. Furthermore, it offers an additional conservative measure option within healthcare provision.
Associations between caregivers’ health behaviours and overweight/obesity among children aged 2–6 years in Beijing, China: a cross-sectional study
Authors: Ji Wenjing , Du Juan , Li Xueling , Hu Yan , Liang Aimin , Xu Xiwei
Published: February 2025

Objective

To investigate the correlation between caregivers’ health-related behaviours and the prevalence of overweight/obesity among children aged 2–6 years in Beijing city in China.

Design

Cross-sectional study.

Setting

Two kindergartens and two community health service centres in Beijing city, China.

Participants

A total of 1967 children aged 2–6 years were included.

Primary and secondary outcome measures

Children’s height and weight were measured and body mass index was computed. The caregivers’ exercise health behaviours and dietary health behaviours were assessed using a questionnaire, encompassing the frequency of exercise and the duration of each exercise session, as well as the frequency of consumption of desserts, late-night snacks, and fast food, regular eating habits, and the proportion of meat and vegetables consumed daily. Logistic regression analysis was performed to identify relationships between caregivers’ health-related behaviours and overweight/obesity in children.

Results

Having caregivers who exercised ≥3 times/week (OR 0.643, 95% CI 0.417 to 0.990) was a protective factor against childhood overweight/obesity compared with having caregivers who exercised <1 time/week; caregivers’ frequent encouragement of children’s participation in physical activity was also a protective factor (OR 0.513, 95% CI 0.352 to 0.749). Additionally, children whose caregivers consumed sweets 2–3 times/week (OR 1.535, 95% CI 1.133 to 2.081) or ≥4 times/week (OR 1.916, 95% CI 1.258 to 2.918), as well as children whose caregivers consumed fast food ≥4 times/week (OR 2.298, 95% CI 1.349 to 3.914), were more likely to be overweight and obesity than children whose caregivers consumed these foods ≤1 time/week. Furthermore, caregivers’ irregular eating habits were positively associated with the occurrence of overweight and obesity in children (OR 1.485, 95% CI 1.056 to 2.089).

Conclusion

Caregivers’ health-related behaviours were significantly associated with overweight/obesity among children in China. Substantial measures should be implemented to address caregivers’ health-related behaviours to prevent and control childhood overweight/obesity.
Outcomes of cataract surgery training among ophthalmology trainees in the independent sector and within the NHS
Authors: Chen Yunzi , Crothers Oonagh , Ting Darren Shu Jeng , Severn Philip , Mansoor Qasim
Published: February 2025

Objective

The surge in National Health Service (NHS) cataract procedures in the independent sector (IS) has reduced opportunities for cataract surgical training among ophthalmology trainees. This study aims to analyse IS cataract surgery training outcomes and explore its potential as a supplement to NHS-based training by comparing IS outcomes with NHS and National Ophthalmology Database (NOD) standards.

Methods and analysis

Two trainees (ST5 and ST3) trained in IS high volume and standard NHS lists. A comprehensive IS training programme included modular cataract training, structured feedback framework and non-technical skills development. Prospective data concerning case numbers, complexity, take-over, outcomes and complication rates were collected and compared.

Results

In total, 161 IS and 62 NHS cases were analysed. On average, trainees did 6 cases/12 patient lists in IS versus 3 cases/6 patient lists in NHS. IS cases had similar complexity to NHS cases (43% IS vs 35% in NHS, p=0.32, adjusted p=1). Intraoperative complications (3% IS vs 5% NHS, p=0.53, adjusted p=1) and posterior capsule ruptures (1% IS vs 0% NHS, p=0.38, adjusted p=1) were similar, aligning with NOD standards. Based on cases without any ocular comorbidity, the proportion of eyes achieving a good visual outcome (≥6/12 Snellen vision) was similar between IS (100%) and NHS (96%) (p=0.12, adjusted p=1). Surgical efficiency was maintained with all lists completed within 4 hours.

Conclusion

A structured training programme on high-volume lists within IS setting provided two trainees with valuable exposure to diverse cataract cases while ensuring safety and efficiency, producing training outcomes comparable to the NHS and NOD standards. This is a pilot study, and a much larger multicentre study will be required before the widespread introduction of training in cataract surgery in the IS can be recommended.
Overview of systemic anticancer treatments: conventional cytotoxics
Authors: Zhang Betty
Published: February 2025

Cancer treatment is rapidly evolving and this review provides healthcare professionals who are not specialists in cancer therapeutics with a broad overview of the role of cancer systemic therapy, with a particular focus on chemotherapy.

Historically, the majority of cytotoxic chemotherapy was used in patients with incurable or metastatic disease with the goal of disease control and symptom palliation. Now, with the advent of more effective, targeted systemic therapies (incorporating both cytotoxic and non-cytotoxic agents), systemic therapies are being used in more diverse treatment settings, both to increase the likelihood of cure and to induce prolonged disease remission.

Chemotherapy (henceforth referring specifically to cytotoxic chemotherapy) remains important for the treatment of many cancer types. This article will review the principles of chemotherapy and the first-line systemic treatment paradigm of different cancer types. The potential toxicities of chemotherapy will also be described.
Social determinants of health, driving time to trauma hospitals, racial composition, and firearm violence in South Carolina
Authors: Boehme Hunter M , Klein Brent R , Spencer M Dylan , Jones Alex , McMains-Nurisio Morgan , Morgan Kayon , Trowbridge Jeffrey
Published: February 2025

Background

Neighbourhood-level social determinants of health (‘SDOHs’) have been linked to negative health outcomes which may include elevated risk of firearm-related injury. This study investigates whether certain SDOHs, including average drive time to trauma hospitals, are associated with increased risk of firearm-related violence and death.

Methods

We execute a cross-sectional examination of pooled firearm incidents (2018–2023) and the relationship of neighbourhood-level SDOHs across the state of South Carolina using negative binomial count regression models.

Results

Findings indicate that neighbourhood disadvantage, residential mobility, per cent black, the percentage of older housing units, lack of technology access and lack of insurance access were all positively associated with an increased risk of firearm victimisation and death. The relationship between neighbourhoods with longer drive times of firearm incidents to trauma hospitals and firearm-related death was significantly moderated by the per cent black of residents within census tracts.

Conclusions

Public health neighbourhood risk factors that are detrimental to individuals’ physical health are also associated with increased risk of firearm victimisation. Longer drive times from trauma hospitals increase the risk of death and this relationship disproportionately affects black Americans. The built environment of neighbourhoods and extended drive times to trauma centres ‘doubly disadvantages’ historically disadvantaged populations.
Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score
Authors: Xu Yingjie , Alexandre Andrea Maria , Pedicelli Alessandro , Huang Xianjun , Wei Mingtong , Zhang Pan , Hu Miaomiao , Chen Xin , Guo Zhiliang , Zhu Juehua , Chen Hao , Ni Chuyuan , Fan Ligen , Wang Ruyue , Wang Qizhang , Wen Jianshang , Yang Yongliang , Chu Wuwei , Dai Zheng , Tan Shidong , Broccolini Aldobrando , Camilli Arianna , Abruzzese Serena , Cirelli Carlo , Bergui Mauro , Romi Dott Andrea , Scarcia Luca , Kalsoum Erwah , Frauenfelder Giulia , Meder Grzegorz , Scalise Simona , Ganimede Maria P , Bellini Luigi , Sette Bruno Del , Arba Francesco , Sammali Susanna , Salcuni Andrea , Vinci Sergio L , Cester Giacomo , Roveri Luisa , Wang Lei , Duan Zuowei , Zhang Shuai , Xu Guoqiang , Li Shizhan , Liang Yong , Wu Zongyi , Qin Shengfei , Luo Guanglin , Huang Zhixin , Xiao Lulu , Sun Wen
Published: February 2025

Background

Current clinical decision tools for assessing the risk of symptomatic intracranial hemorrhage (sICH) in patients with vertebrobasilar artery occlusion (VBAO) who received endovascular treatment (EVT) have limited performance. This study develops and validates a clinical risk score to precisely estimate the risk of sICH in VBAO patients.

Methods

The derivation cohort recruited patients with VBAO who received EVT from the Posterior Circulation IschemIc Stroke Registry in China. Based on the posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) evaluation method, the cohort was further divided into non-contrast CT (NCCT) and diffusion weighted imaging (DWI) cohorts to construct predictive models. sICH was diagnosed according to the Heidelberg Bleeding Classification within 48 hours of EVT. Clinical signature was constructed in the derivation cohort using machine learning and was validated in two additional cohorts from Asia and Europe.

Results

We enrolled 1843 patients who underwent EVT and had complete data. pc-ASPECTS of 1710 patients was evaluated on NCCT and 699 patients on DWI. In the NCCT cohort, 1364 individuals made up the training set, of whom 101 (7.4%) developed sICH. In the DWI cohort, the training set consisted of 560 individuals, with 44 (7.9%) experiencing sICH. Predictors of sICH were: glucose, pc-ASPECTS, time from estimated occlusion to groin puncture (EOT), poor collateral circulation, and modified Thrombolysis in Cerebral Infarction (mTICI) score. From these predictors, we derived the weighted poor collateral circulation-EOT-pc-ASPECTS-mTICI-glucose (PEACE) score. The PEACE score showed good discrimination in the training set (area under the curve (AUC)NCCT=0.85; AUCDWI=0.86), internal validation set (AUCNCCT=0.81; AUCDWI=0.82), and two additional external validation set (Asia: AUCNCCT=0.78, AUCDWI=0.80; Europe: AUCNCCT=0.74, AUCDWI=0.78).

Conclusion

The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.
Pre-operative internal maxillary artery embolization for temporomandibular joint replacement: safety and outcomes from a 10-year institutional experience
Authors: Sujijantarat Nanthiya , Padmanaban Varun , Smith William J , McCain Joseph P , Kaban Leonard B , Burris Briana J , Choi Daniel D , Larson Anna M , Elsamadicy Aladine A , Serrato Paul , Dabus Guilherme , Regenhardt Robert W , Stapleton Christopher J , Patel Aman B , Rabinov James D
Published: February 2025

Background

Temporomandibular joint replacement (TMJR) can result in large volume blood loss (BL) from the underlying internal maxillary artery (IMA). Pre-operative IMA embolization has been utilized to reduce intra-operative BL, but prior studies are limited to small case series.

Methods

Adult patients undergoing pre-operative IMA embolization for TMJR between June 2014 and September 2024 at a single institution were included. Electronic medical records were reviewed for demographic information, treatment details, and outcomes. Historical controls were identified via citations and PubMed searches.

Results

Pre-operative IMA embolization was performed in 73 patients (108 sides) undergoing TMJR. Coils were used in 96% of the patients, with a median of three coils used per side (interquartile range (IQR) 3–4). Middle meningeal artery (MMA) was occluded in 26% of the sides completed. There was one intra-procedural complication of a self-limited retrograde femoral artery dissection. Median operative BL/side during TMJR was 100 mL (IQR 50–181). There were no embolization-related complications in hospital or at follow-up (median follow-up of 12 months (IQR 4–24)). Using the BL per side beyond the third quartile of the historical controls as the definition of excessive BL, the embolized cohort contained half the number of patients with excessive BL (12.5%) compared with the historical cohort (25.0%).

Conclusion

Pre-operative IMA embolization is safe and may be effective at reducing BL and excessive hemorrhage during TMJR. A randomized controlled trial is needed to ascertain its benefits compared with the conventional approach.
Burden and risk factors for plantar fasciopathy in the military population from 2006 to 2015: a retrospective cohort study
Authors: Xu Jennifer , Saliba S , Fraser J
Published: February 2025

Introduction

Ankle and foot injuries are highly prevalent in the US Armed Forces, incurring medical and personnel costs for the Department of Defense. The purpose of this study was to evaluate the burden and risk factors of plantar fasciopathy (PF) in the US Military.

Methods

The Defense Medical Epidemiology Database identified all diagnosed PF cases in military service members from 2006 to 2015. A custom spreadsheet calculated incidence of PF and relative risk between sexes, military occupations and ranks. Relative risk of injury per demographic category (sex, age, service branch, rank and year) was also calculated.

Results

The overall incidence of PF from 2006 to 2015 was 12.85 per 1000 person-years, affecting 176 601 service members. 37 939 officers incurred PF at a rate of 17.65 per 1000 person-years (male 18.20 per 1000 person-years; female 14.80 per 1000 person-years). There were 116 122 enlisted personnel with PF that occurred at a rate of 12.22 per 1000 person-years (male 12.07 per 1000 person-years; female 13.22 per 1000 person-years). When compared with ground and naval gunfire officers, all officer specialties except for aviation and logistics had significantly higher risk of PF; aviation (relative risk (RR): 0.83, p<0.001) and logistics (RR: 0.94, p<0.001) had significantly lower risk. Regarding enlisted specialties, when compared with infantry, all occupations had significantly increased risk for PF except for Special Operations Forces (RR: 0.94, p=0.13). There were multiple associated factors identified with PF, including female sex, age >30, junior enlisted rank, a variety of military occupations and service in the Army.

Conclusions

PF was common in the US military during the study period, with multiple salient risk factors identified. These findings highlight the need for prophylactic interventions for populations with the greatest risk.
Exposure to ambient high temperature and increased risk of hospitalisation for non-infectious bowel diseases during 2000–2019: a case-crossover study in 1816 Brazilian cities
Authors: Zhuang Mengwei , Cao Yanwen , Coelho Micheline de Sousa Zanotti Staglior , Guo Yuming , Li Shanshan , Huang Tao , Yan Jie , Zhao Qi
Published: February 2025

Objectives

Although human intestine is sensitive to high ambient temperature, the heat-related morbidity burden remains rarely explored. This study quantified the association between high ambient temperature and non-infectious bowel disease (NBD) hospitalisations in Brazil during 2000–2019—a country experiencing substantial threats both from global warming and NBDs.

Methods

Daily data on weather and NBD hospitalisations were collected from 1816 cities. A time-stratified case-crossover design was used to assess the effect size of ambient temperature during the hot season. Stratified analysis by regions, population subgroups and disease types was performed.

Results

For each 5℃ increase in mean daily temperature, the cumulative OR of NBD hospitalisation over lag 0–3 days was 1.042 (95% CI 1.031 to 1.054) at the national level, reaching the maximum in the northeast and the minimum in the southeast. Assuming a causal relationship, ambient heat exposure explained 12.09% (95% CI 8.69% to 15.09%) of the total hospitalisations. The effect size was the highest in the youth, with no significant gender difference observed. Inflammation-related and function-related NBDs showed significantly higher susceptibility compared with other types of NBDs. The cumulative effect of ambient high temperature attenuated over the 20 years and from early to late hot season, suggesting both long-term and intraseasonal adaptations to heat.

Conclusions

The spatial, temporal and demographic variations in the strength of association should be considered for the development of health preventive strategies towards extreme ambient heat.
Tissue Doppler echocardiography predicts long-term cardiovascular mortality: the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) legacy 20-year follow-up study
Authors: Ratneswaren Anenta , Wu Tong , Kaura Amit , Wasan Devan , Rostamian Somayeh , Sharp Andrew , Poulter Neil R , Sever PS , Stanton Alice , Thom Simon , Francis Darrel , Hughes Alun D , Shah Anoop SV , Mayet Jamil
Published: February 2025

Background

Left ventricular diastolic function as assessed by tissue Doppler echocardiography predicts cardiovascular event rates at 4 years of follow-up in patients with hypertension. Our aim was to evaluate whether this extends to predicting cardiovascular mortality after 20 years of follow-up.

Methods

Conventional (E) and tissue Doppler (e′) echocardiography was performed on hypertensive participants in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) with long-term follow-up ascertained via linkage to the Office of National Statistics. Cardiovascular mortality was defined as death from coronary heart disease, stroke and other cardiovascular aetiology such as heart failure or peripheral vascular disease. Unadjusted and adjusted Cox regression survival models were constructed to investigate the association between tissue Doppler echocardiography measurements and long-term cardiovascular mortality.

Results

Among 506 hypertensive patients (median age 64, interquartile range (58, 69), 87% male), there were 200 (40%) deaths over a 20-year follow-up period. 60 deaths (12%) were cardiovascular-related.

A reduction in e′ was independently associated with increased cardiovascular mortality, after adjusting for the ACC/AHA Atherosclerotic Cardiovascular Disease (ASCVD) risk score, with an inverse HR of 1.22 per 1 cm/s decrease (95% CI 1.04–1.43). A higher E/e′ ratio was independently associated with increased cardiovascular mortality, after adjusting for the ASCVD risk score, with an HR of 1.12 per 1-unit increase (95% CI, 1.02 to 1.23).

Conclusions

Impaired left ventricular diastolic function, measured using tissue Doppler echocardiography through e′ and E/e′, independently predicts increased cardiovascular mortality over 20 years in hypertensive patients, highlighting its long-term prognostic significance.
Understanding hospital length of stay in trauma laparotomy patients: a National Trauma Database Study
Authors: Uchino Hayaki , Wong Evan G , Khwaja Kosar , Grushka Jeremy
Published: February 2025

Introduction

The diverse procedures and varying patient conditions in trauma laparotomy cases lead to significant variability in hospital length of stay (HLOS), posing challenges for effective patient care. Strategies to reduce HLOS are varied, with multiple factors potentially modifiable through targeted interventions. These interventions are most effective when target populations and their associated factors are clearly defined. This study aimed to stratify trauma laparotomy patients by their HLOS and identify factors associated with HLOS to enhance patient care.

Methods

A retrospective analysis was conducted using the National Trauma Data Bank from January 2017 to December 2019. Adult trauma patients who underwent trauma laparotomy following blunt or penetrating abdominal injuries were identified using International Classification of Diseases, 10th Revision codes and Abbreviated Injury Scales. HLOS was stratified into three groups based on the IQR of the study population: short (< 5 days), medium (5–11 days) and long (> 11 days).

Results

A total of 27 434 trauma laparotomy patients were identified. The overall median HLOS was 7.0 (5.0, 11.0) days. Penetrating mechanisms, particularly stab wounds, were strongly associated with a short HLOS. Additionally, isolated abdominal trauma, splenic injuries or spleen-related procedure were more likely to result in a short HLOS. Patients with a long HLOS experienced higher rates of in-hospital complications and were more frequently discharged to home with home health services or to extended care facilities. Most comorbidities were associated with a long HLOS, and patients with Medicaid or Medicare had a higher likelihood of a long HLOS.

Conclusion

Despite the relatively homogenous trauma population, HLOS distribution varied significantly. Stratification based on HLOS revealed distinct factors associated with short and long HLOS categories, indicating that targeted interventions for each category could potentially reduce HLOS and enhance patient outcomes in the current era of constrained healthcare resources.

Level of evidence, study type

Level IV, therapeutic/care management.
Role of Calcined-Clay-Based Geopolymers for Effective Stabilization of Expansive Soils
Authors: Chou Sopharith , Puppala Anand J , Biswas Nripojyoti , Huang Oscar , Radovic Miladin
Published: February 2025

Effective stabilization of expansive soils remains a challenge for transportation infrastructure. In line with the United Nations' sustainability goals, most research on eco-friendly stabilizers is still in its early stages, focusing primarily on laboratory evaluations. This study aims to evaluate the efficacy of alkali-activated calcined clay-based geopolymers (CCBGPs) and investigate the most effective minerals contributing to its stabilization of expansive soils. Four locally available clays were used to synthesize CCBGPs, and based on unconfined compressive strength, two of them were selected for further stabilization of expansive soils. The treated soils underwent comprehensive engineering, microstructural, and mineralogical analyses. A machine learning (ML)-based regression model was developed and tested to examine the effects of CCBGP and soil mineralogy on engineering performance of the treated soils. Engineering tests on treated specimens showed improved performance with increasing CCBGP dosage and curing periods, while microstructural and mineralogical analyses revealed physical and chemical interactions with soil particles that enhanced engineering properties. The ML model identified kaolinite as the most influential factor, which enhanced geopolymerization by forming more binder gel, and improved engineering properties. Overall, the research indicated that selection of kaolinite-rich, locally available CCBGPs could serve as sustainable source for improving expansive soils in transportation infrastructure.