bluuebunny/crossref_metadata_2025 huggingface dataset:
Figure S3 from Multiplex Tissue Imaging Harmonization: A Multicenter Experience from CIMAC-CIDC Immuno-Oncology Biomarkers Network
Authors: Akturk Guray , Parra Edwin R. , Gjini Evisa , Lako Ana , Lee J. Jack , Neuberg Donna , Zhang Jiexin , Yao Shen , Laface Ilaria , Rogic Anita , Chen Pei-Hsuan , Sanchez-Espiridion Beatriz , Valle Diane M. Del , Moravec Radim , Kinders Robert , Hudgens Courtney , Wu Catherine , Wistuba Ignacio I. , Thurin Magdalena , Hewitt Stephen M. , Rodig Scott , Gnjatic Sacha , Tetzlaff Michael T.
Published: October 2024

Supplementary Figure 3
Data from RASAL2 Confers Collateral MEK/EGFR Dependency in Chemoresistant Triple-Negative Breast Cancer
Authors: Koh Siang-Boon , Ross Kenneth , Isakoff Steven J. , Melkonjan Nsan , He Lei , Matissek Karina J. , Schultz Andrew , Mayer Erica L. , Traina Tiffany A. , Carey Lisa A. , Rugo Hope S. , Liu Minetta C. , Stearns Vered , Langenbucher Adam , Saladi Srinivas Vinod , Ramaswamy Sridhar , Lawrence Michael S. , Ellisen Leif W.
Published: October 2024

AbstractPurpose:
While chemotherapy remains the standard treatment for triple-negative breast cancer (TNBC), identifying and managing chemoresistant tumors has proven elusive. We sought to discover hallmarks and therapeutically actionable features of refractory TNBC through molecular analysis of primary chemoresistant TNBC specimens.
Experimental Design:
We performed transcriptional profiling of tumors from a phase II clinical trial of platinum chemotherapy for advanced TNBC (TBCRC-009), revealing a gene expression signature that identified de novo chemorefractory tumors. We then employed pharmacogenomic data mining, proteomic and other molecular studies to define the therapeutic vulnerabilities of these tumors.
Results:
We reveal the RAS-GTPase-activating protein (RAS-GAP) RASAL2 as an upregulated factor that mediates chemotherapy resistance but also an exquisite collateral sensitivity to combination MAP kinase kinase (MEK1/2) and EGFR inhibitors in TNBC. Mechanistically, RASAL2 GAP activity is required to confer kinase inhibitor sensitivity, as RASAL2-high TNBCs sustain basal RAS activity through suppression of negative feedback regulators SPRY1/2, together with EGFR upregulation. Consequently, RASAL2 expression results in failed feedback compensation upon co-inhibition of MEK1/2 and EGFR that induces synergistic apoptosis in vitro and in vivo. In patients with TNBC, high RASAL2 levels predict clinical chemotherapy response and long-term outcomes, and are associated via direct transcriptional regulation with activated oncogenic Yes-Associated Protein (YAP). Accordingly, chemorefractory patient-derived TNBC models exhibit YAP activation, high RASAL2 expression, and tumor regression in response to MEK/EGFR inhibitor combinations despite well-tolerated intermittent dosing.
Conclusions:
These findings identify RASAL2 as a mediator of TNBC chemoresistance that rewires MAPK feedback and cross-talk to confer profound collateral sensitivity to combination MEK1/2 and EGFR inhibitors.
Table 1 from GALAD Score for the Diagnosis of Hepatocellular Carcinoma in Sub-Saharan Africa: A Validation Study in Ghanaian Patients
Authors: Nartey Yvonne Ayerki , Yang Ju Dong , Zemla Tyler J. , Ayawin Joshua , Asibey Shadrack Osei , El-Kassas Mohamed , Bampoh Sally Afua , Duah Amoako , Agyei-Nkansah Adwoa , Awuku Yaw Asante , Afihene Mary Yeboah , Yamada Hiroyuki , Yin Jun , Plymoth Amelie , Roberts Lewis R.
Published: October 2024

Clinical characteristics of Ghanaian cirrhosis and HCC cohort
Toward Centrality Evaluation of Yearning Symptoms for Prolonged Grief Disorder: A Cross-Cultural Approach
Authors: Mazza Amelie , Maercker Andreas , Forstmeier Simon , Müller Mario , Killikelly Clare
Published: October 2024

Background: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions. Methods: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed. Results: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels. Discussion: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.
“Asian” Principles for the Recognition and Enforcement of Foreign Judgments? Singapore as a Case Study
Authors: Chong Adeline
Published: October 2024

This paper considers if there can be said to be an “Asian” body of principles for the recognition and enforcement of foreign judgments. Tapping on the results of a research project which was conducted from 2016 to 2020, it is submitted that the answer to this query is in the negative. However, it is suggested that what marks out the “Asian” approach to private international law is the willingness of Asian countries to look outwards for reform and development and to balance the adoption of international norms against important local norms and objectives. Singapore’s approach to the recognition and enforcement is discussed as a case study of this Asian approach.
Revealing the Baja California Peninsula’s Hidden Treasures: An Annotated checklist of the native bees (Hymenoptera: Apoidea: Anthophila)
Authors: PEDRO DIEGO DE , CECCARELLI FADIA SARA , SAGOT PHILIPPE , LÓPEZ-REYES EULOGIO , MULLINS JESSICA L. , MÉRIDA-RIVAS JORGE A. , FALCON-BRINDIS ARMANDO , GRISWOLD TERRY , ASCHER JOHN S. , GARDNER JOEL , AYALA RICARDO , VIDES-BORRELL ERIC , VANDAME RÉMY
Published: October 2024

To date, the knowledge of bee diversity in the Baja California Peninsula has primarily relied on large, sporadic expeditions from the first half of the 20th century. To address the knowledge gaps, we conducted extensive fieldwork from 2019 to 2023, visited entomological collections in Mexico and USA, and accessed digital databases and community science platforms to compile records. As a result of our field surveys, we identified 521 morphospecies, with 350 recognized as valid species, including 96 new records for the Baja California Peninsula and 68 new findings for Mexico, including the rediscovery of Megachile seducta Mitchell, 1934, ranked as possibly extinct. Additionally, museum visits added 24 new species records for the peninsula, including 12 new to Mexico. Integrating the new and existing records results in a comprehensive checklist that documents 728 species for the peninsula, 613 for Baja California, and 300 for Baja California Sur. Notably, 62 species are endemic to the peninsula, of which 22 are only found in Baja California, and 23 in Baja California Sur. Our findings show a greater bee diversity in northern latitudes, with a sharp decrease to the central and southern peninsula, which corresponds to the geographic distribution of the records. This supports the premise that the Baja California peninsula remains an unexplored area and highlights the importance of conducting studies like the one presented here.
National Weather Service (NWS) Forecasters’ Perceptions of AI/ML and Its Use in Operational Forecasting
Authors: Wirz Christopher D. , Demuth Julie L. , Cains Mariana G. , White Miranda , Radford Jacob , Bostrom Ann
Published: October 2024

Artificial intelligence and machine learning (AI/ML) have attracted a great deal of attention from the atmospheric science community. The explosion of attention on AI/ML development carries implications for the operational community, prompting questions about how novel AI/ML advancements will translate from research into operations. However, the field lacks empirical evidence on how National Weather Service (NWS) forecasters, as key intended users, perceive AI/ML and its use in operational forecasting. This study addresses this crucial gap through structured interviews conducted with 29 NWS forecasters from October 2021 through July 2023 in which we explored their perceptions of AI/ML in forecasting. We found that forecasters generally prefer the term “machine learning” over “artificial intelligence” and that labeling a product as being AI/ML did not hurt perceptions of the products and made some forecasters more excited about the product. Forecasters also had a wide range of familiarity with AI/ML, and overall, they were (tentatively) open to the use of AI/ML in forecasting. We also provide examples of specific areas related to AI/ML that forecasters are excited or hopeful about and that they are concerned or worried about. One concern that was raised in several ways was that AI/ML could replace forecasters or remove them from the forecasting process. However, forecasters expressed a widespread and deep commitment to the best possible forecasts and services to uphold the agency mission using whatever tools or products that are available to assist them. Last, we note how forecasters’ perceptions evolved over the course of the study.
Between Decline and Distress Innovations: The Transformation of the Belgian French-Speaking Christian-democratic Party (cdH)
Authors: Legein Thomas , Rangoni Sacha
Published: October 2024

Political parties are used to adapt in the face of political challenges, but little is known about how party elites actually perceive crises and ultimately opt for certain types of reforms accordingly. To address this gap, we focus on the complete transformation process of the Belgian French-Speaking Christian Democratic Party (cdH) in 2022 as a case study. Interviews with party elites show how challenges shared by many West-European centre-right parties can create a dependence on the party leader to the point of marginalizing other traditional actors from the definition of a response strategy. We reveal the unprecedented strategy employed by the leader, who positioned an advisor as a surrogate, at the cost of creating major internal dissension. We argue that the likely multiplication of mainstream parties slipping into great distress in the near future could lead to a shift in managing party change, making it more technocratic than political.
Pediatric Headache Patients Are at High Risk of Vitamin D Insufficiency
Authors: Deschênes Éloïse R. , Do Jeffrey , Tsampalieros Anne , Webster Richard J. , Whitley Nicole , Ward Leanne M. , Pohl Daniela
Published: October 2024

Background

Vitamin D deficiency has been associated with headaches in adults, but data for children with headaches are sparse.

Objective

To describe vitamin D levels in children with headaches.

Methods

We retrospectively analyzed serum 25(OH)D concentrations in children aged 2-17 years with headaches compared to children with epilepsy at the Children's Hospital of Eastern Ontario between October 1, 2014, and August 19, 2021. Serum 25(OH)D <50 nmol/L was classified as insufficient.

Results

Vitamin D concentrations of 353 children (117 with headaches; 236 with epilepsy) were analyzed. The median age in years was 10 (interquartile range [IQR] 5, 14); 50.4% of subjects were female. The median serum 25(OH)D was 56 nmol/L (IQR 41, 69) in children with headaches and 70 nmol/L (IQR 50, 95) in children with epilepsy. Vitamin D insufficiency was present in 42% of children with headaches and 25% of children with epilepsy ( P = .002). In a multivariable linear regression model adjusting for age, sex and seasonality, children with headaches had serum 25(OH)D concentrations that were on average 9 nmol/L (95% CI-16.76, −0.96) lower compared to children with epilepsy ( P = .029).

Conclusion

The prevalence of vitamin D insufficiency is higher in children with headaches compared to children with epilepsy. Prospective studies are needed to assess if vitamin D supplementation may have a therapeutic effect on pediatric headaches.
Efficacy and Effectiveness Research on Interventions in Sweden Between 1990 and 2019
Authors: Ryan Bengtsson Anna , Hollertz Katarina , Olsson Tina M. , Sundell Knut
Published: October 2024

Purpose: This article investigates the extent of effectiveness studies of behavioral, psychological, and social interventions aiming for measurable changes at the individual level in Sweden 1990–2019. Methods: The data stems from a retrospective analysis of published literature on effect studies between 1990 and 2019. Results: The results show an increase in published articles reporting on effect studies in Sweden the past 30 years, accelerating the past 10 years. However, only 25% of the studies focuses on core social work practices and only certain target groups and areas, especially children and elderly, are covered. Of these studies, only 4% are conducted by social work scholars. Conclusions: Effect studies still holds a weak position in Swedish social work research, despite of processes of professionalization and academization with national efforts to promote knowledge production for practice. This is discussed in relation to competence, opportunity, and motivation in Swedish social work and beyond.
Investigating the Impact of Additional Congenital Malformations on Speech Outcomes at age Five in Children with a Cleft Palate
Authors: Butterworth Sophie , Fitzsimons Kate J. , Britton Lorraine , Van Eeden Stephanie , Medina Jibby , van der Meulen Jan , Russell Craig J.H.
Published: October 2024

Objective

To determine whether children born with a cleft palate ± lip (CP ± L) and additional congenital differences (ACDs – including ‘Congenital malformations and deformations’ as coded in ICD-10), are less likely to meet the three national speech outcome standards at age five compared to children with CP ± L and no ACDs.

Design

An observational study, utilizing national data from the UK Cleft Registry and Audit NEtwork (CRANE) Database linked to national administrative data of hospital admissions.

Setting

National Health Service, England.

Patients

2191 children (993 female, 1198 male) with CP ± L, born 2006-2012 in England, with complete speech data and consent to data linkage.

Outcome Measure

Perceptual speech analysis utilised the Cleft Audit Protocol for Speech – Augmented (CAPS-A) rating and United Kingdom National Speech Outcome Standards (Speech Standard 1 (SS1), Speech Standard 2a (SS2a) and Speech Standard 3 (SS3)).

Results

Of 2191 children, 759 (35%) had at least one ACD. Presence of one ACD did not significantly impact speech outcomes but two or more ACDs reduced the odds of achieving all three speech standards: SS1 aOR 0.602 (CI 0.45-0.82, P = .002), SS2a aOR 0.563 (CI 0.41-0.77, P = .001), SS3 aOR 0.606 (0.43-0.84, P = .003). When exploring ACDs by ICD-10 groupings, congenital malformations of the ‘Eye, ear, face and neck’, ‘Circulatory system’, ‘Digestive system’, ‘Musculoskeletal system’ and ‘Other congenital malformations’ reduced a child's odds of achieving the speech standards.

Conclusions

ACDs, in the absence of a known syndrome, have a significant impact on speech outcome at age five. Incorporating these factors into risk-adjustment models for service level outcome reporting is recommended.
Gray Zone Identity: An Autoethnographic Journey of Chronic Illness, Diagnostic Uncertainty, and Autoimmunity
Authors: Defenbaugh Nicole
Published: October 2024

The author explores what it means to live in a liminal space of medical uncertainty as a person with an autoimmune disease. Autoethnography enables the author to examine the emotional, cognitive, and physical response to being told that her ill body and identity exist in a clinical gray zone. The author coins the term “gray zone identity” to capture the uncertainty and anxiety that accompanied years of symptoms without a diagnosis. Traveling in and out of health care facilities in search of answers, the author learns that not all bodies can be clinically explained by medical language or biomedical tests. It is in the liminal space of diagnostic uncertainty where the author endeavors to understand how to embrace her gray zone identity.
“It’s a Slippery Slope”: Antecedents of Female-Perpetrated Sexual Abuse of Adolescents in Australian Educational Settings
Authors: Robertson Amanda L. , Harris Danielle A.
Published: October 2024

Sexual victimization of students endures—especially in secondary schools—and women’s perpetration in this setting is increasingly recognized. Nonetheless, our understanding of this population and contemporary cases remains limited, and research in the Australian context is lacking. This study contributes to the evidence base and represents the first Australian study of its kind. We draw on (1) legal documents ( N = 19) describing 18 established cases of female-perpetrated sexual abuse against 20 adolescent students (aged 13–17 inclusive) and (2) semi-structured expert interviews with professionals possessing specialized experience of female-perpetrated cases involving adolescent students ( N = 8). These data are integrated in a reflexive thematic analysis to identify the personal, contextual, and situational antecedents of female-perpetrated cases thereby exploring the ‘why’ and ‘how’ of their perpetration. Taken together, the results indicate a key interaction between individual emotional and relational needs, environmental opportunities, and contextual tolerance. Practical implications for targeting and disrupting these dynamics are discussed.
Impact of Polypharmacy on Symptoms and Health Outcomes in Older Adults With and Without Alzheimer’s Disease and Related Dementias
Authors: Coates Martha C. , McClure Leslie A. , Vader Daniel , Finley Margaret , Sefcik Justine S. , Gitlin Laura N. , DiMaria-Ghalili Rose Ann
Published: October 2024

Background

There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer’s Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group.

Methods

This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016–2019. The sample was separated into four groups ( N = 2,052): neither ADRD or PPY ( n = 1,048), PPY only ( n = 761), ADRD only ( n = 116), and both ADRD and PPY( n = 127).

Results

The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups.

Conclusions

Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD.
Telehealth versus face-to-face delivery of speech language pathology services: A systematic review and meta-analysis
Authors: Scott Anna M , Clark Justin , Cardona Magnolia , Atkins Tiffany , Peiris Ruwani , Greenwood Hannah , Wenke Rachel , Cardell Elizabeth , Glasziou Paul
Published: October 2024

Background

There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services.

Methods

We searched Medline, Embase and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson's disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated.

Results

Nine randomized controlled trials were included; eight evaluated video and one evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI −0.4 to 0.6, p = 0.70). For people with Parkinson's disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI −1.2 to 2.5, p = 0.49). Four trials investigated interventions for speech sound disorder, voice disorder and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery.

Conclusions

Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson's disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction and economic outcomes.
Gender equality in higher music education: Consecrated and peripheral positions
Authors: Borgström Källén Carina , Ferm Almqvist Cecilia
Published: October 2024

Studies have shown that gender inequality in higher music education is maintained through unreflective actions. Efforts to address the issue have been made and gender-equality programmes have been instigated in several European countries. This study takes a sociological approach to music education, with the goal of revealing constructions of gender inequality in four higher music education institutions in northern, eastern, and central Europe. The aim is to illuminate obstacles to gender-equal education within the field of higher music education. Data was collected through interviews with both students and teachers, with the analysis taking a two-stage structure. The analysis was first performed thematically, and then driven by Connell’s gender theory and Bourdieu’s field theory. The findings are presented as: The objectified body, A natural state of mind, Claming space and Changes in sight. The findings show that gender equality activities seem to increase awareness among both students and staff, but they also show that such awareness does not necessarily lead to changes in practice.
Meta-Analysis of Randomised Controlled Trials Comparing Bypass and Endovascular Revascularisation for Peripheral Artery Disease
Authors: Pegler Angus H. , Thanigaimani Shivshankar , Pai Siddharth S. , Morris Dylan , Golledge Jonathan
Published: October 2024

Objective

Peripheral artery disease affects approximately 250 million people globally. Multiple randomised controlled trials have compared bypass and endovascular interventions but the optimum revascularisation approach remains unclear. The recently published BEST-CLI and BASIL-2 trials provide current and robust data addressing this question, however their findings are not concordant. This systematic review and meta-analysis provides an overview of the worldwide randomised evidence comparing bypass surgery and endovascular revascularisation in lower limb peripheral artery disease.

Methods

A comprehensive literature search of MEDLINE, Embase and CENTRAL databases was performed of all time periods up to 7 May 2023 to identify randomised controlled trials comparing bypass and endovascular revascularisation for treating lower limb peripheral artery disease. The primary outcome was major amputation. Secondary outcomes were mortality, re-intervention, 30-day adverse events and 30-day mortality. Odds ratios were calculated and pooled using the random-effects model. Risk of bias was assessed using the Cochrane risk of bias 2 tool.

Results

Fourteen cohorts were identified across thirteen studies, enrolling 3840 patients. There was no significant difference in major amputation (OR 1.12; 95% CI 0.80-1.57) or mortality (OR 0.96; 95% CI 0.79-1.17) between the bypass and endovascular groups. Bypass was associated with a significant reduction in re-intervention compared with endovascular treatment (OR 0.57, 95% CI 0.40-0.82).

Conclusions

These findings suggest that rates of major amputation and mortality are similar following bypass and endovascular interventions. Patients who undergo bypass surgery have a significantly lower re-intervention rate post-operatively.
The applications of CT with artificial intelligence in the prognostic model of idiopathic pulmonary fibrosis
Authors: Chen Zeyu , Lin Zheng , Lin Zihan , Zhang Qi , Zhang Haoyun , Li Haiwen , Chang Qing , Sun Jianqi , Li Feng
Published: October 2024

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and heterogeneous interstitial lung disease with a median survival of 2–5 years. Though the diagnosis has been improved due to newly published guidelines, the recognition of the prognosis of IPF remains a challenge. Recently, several studies attempted to build prognostic models by extracting predictive variates from pulmonary function data, basic information, or chest computed tomography (CT) and CT-derived parameters with clinical characteristics. Artificial intelligence (AI) algorithms, including principal component analysis, support vector machine, random survival forest, and convolutional neural network, could be applied to the procedure of IPF prognostic model, that is, region of interest extraction, image feature selection, clinical feature selection, and model construction. Compared to human visualization, AI algorithms show a higher efficiency in calculating and extracting deep features and a lower inter-observer variation. Thus, this review provides a comprehensive CT evaluation of IPF prognostic models and discusses the role of AI in constructing IPF prognostic models. The potential improvements of AI in CT assessments, including time-series CT analysis, optimization of AI algorithms, utilization of multi-modal data, and discovery of new biomarkers through unsupervised algorithms, could be introduced to make a more accurate and convenient assessment for the prognosis of IPF patients. This review describes the status quo and future direction of AI applications in CT analysis for prognostic models of IPF.

Take home message

The review summarizes the applications of CT and AI algorithms for prognostic models in IPF and procedures of model construction. It reveals the current limitations and prospects of AI-aid models, and helps clinicians to recognize the AI algorithms and apply them to more clinical work.
The farmers’ revolt in the Netherlands: Causes and consequences
Authors: Siegmann Arjen
Published: October 2024

The Netherlands is blessed with abundant water, flat countryside and an openness to trade. This has helped to propel the agricultural sector to be one of the most productive in the world. Dutch farmers are savvy, well-educated and work within strict environmental regulations. What explains, then, the farmers’ revolt that started in 2019? It almost brought the country to its knees, led to the largest post-war electoral shift and started an international movement of farmers. How could such a ubiquitous chemical element, nitrogen, have such a significant effect on farmers, Dutch politics and eventually the biodiversity directive of the European Commission? The revolt led to the strong presence of farmers’ issues in parliament and a new dynamic in the debate about social change in the countryside, agricultural interests and nature protection. This article gives an overview of the events that led up to the farmers’ revolt, its connection with earlier movements and its longer-term ramifications.
Exploring Work-Related Experiences of Newly Hired Hospital Nurses in Ghana: A Qualitative Study
Authors: Darkwah Ernest , Annor Francis , Oppong Seth , Hagan Sylvia
Published: October 2024

Introduction

Early work-related experiences of newly hired employees can have important implications for their work performance over time and their future health and well-being trajectories. In health care work, such outcomes may hold implications for the services delivered and the patients whose lives depend on them.

Objective(s)

This study was conducted to explore the work-related experiences of newly hired hospital nurses in Ghana.

Methods

Using qualitative methods, thirty-six (36) newly hired nurses in three (3) hospitals in the Eastern Region of Ghana were purposively sampled and interviewed. Thematic network analyses were applied to the data collected.

Results

Five main themes emerged which summarized the experiences of the nurses. The themes indicated that newly hired nurses experienced the nursing profession as stressful and yet fulfilling, different from their preentry expectations with multiple sources of stressors and resources. Religion and faith, family support, and a perceived lack of suitable alternative sources of income emerged as the main motivators of the intention to stay.

Conclusion

The findings suggest a highly stressful and quite unpredictable work environment for newly hired nurses. Despite this, they are determined to stay on the job. Employee assistance programs that have specialized components targeted at providing emotional and psychosocial assistance to newly hired nurses are recommended.
The prognostic role of circulating tumour DNA detected prior to clinical diagnosis of colorectal cancer in the HUNT study
Authors: Brenne Siv Stakset , Madsen Poul Henning , Pedersen Inge Søkilde , Hveem Kristian , Skorpen Frank , Krarup Henrik Bygum , Xanthoulis Athanasios , Laugsand Eivor Alette
Published: October 2024

Background

Today, the prognostic tools available at the time of diagnosis in colorectal cancer (CRC) are limited. Better prognostic tools are a prerequisite for personalised treatment.

This study aimed to investigate whether circulating tumour DNA (ctDNA) markers found in plasma before clinical diagnosis of CRC could contribute to the prediction of poor prognosis.

Methods

This observational cohort study included patients diagnosed with CRC stage I-III within 24 months following participation in the Trøndelag Health Study (n = 85). Known methylated ctDNA biomarkers of CRC were analysed by PCR in plasma. Outcomes were overall survival (OS), recurrence-free survival (RFS) and poor prognosis (PP). Candidate clinical and methylated ctDNA predictors of the outcomes were identified by Cox regression analyses.

Results

Methylated GRIA4 (HR 1.96 (1.06–3.63)), RARB (HR 9.48 (3.00–30.00)), SLC8A1 (HR 1.97 (1.03–3.77)), VIM (HR 2.95 (1.22–7.14)) and WNT5A (HR 5.83 (2.33–14.56)) were independent predictors of OS, methylated RARB (HR 9.67 (2.54–36.81)), SDC2 (HR 3.38 (1.07–10.66)), SLC8A1 (HR 2.93 (1.01–8.51)) and WNT5A (HR 6.95 (1.81–26.68)) were independent predictors of RFS and methylated RARB (HR 6.11 (1.69–22.18)), SDC2 (HR 2.79 (1.20–6.49)) and WNT5A (HR 5.57 (3.04–15.26)) were independent predictors of PP (p < 0.05).

Conclusions

Prediagnostic ctDNA markers are promising contributors to predicting poor prognosis in CRC, potentially becoming one of the tools guiding more personalised treatment.
Effect of pulmonary rehabilitation on all-cause mortality in patients with chronic respiratory disease: a retrospective cohort study in an Australian teaching hospital
Authors: Sharifi Vahid , Brazzale Danny J. , McDonald Christine F. , Hill Catherine J. , Michael Chris , Ruehland Warren R. , Berlowitz David J.
Published: October 2024

Background

Pulmonary rehabilitation (PR) is widely recommended for short-term benefits in chronic respiratory diseases, yet long-term outcomes remain uncertain. This retrospective cohort study addresses this gap, comparing 20-year mortality rates between PR participants and matched controls, and hypothesizing that the short-term benefits of PR contribute to improved long-term survival.

Methods

The 20-year mortality of stable chronic respiratory patients who participated in an outpatient PR program was compared with a matched control group based on the type of lung disease. Demographic and clinical variables, and the dates of deaths, were extracted and compared between two groups with two sample t-test and chi-square tests. Kaplan-Meier plots and Cox regression analyses were employed to evaluate survival differences.

Results

Between 2000 and 2002, 238 individuals enrolled in a pulmonary rehabilitation (PR) program (58% male, mean age ± SD: 69 ± 8 years, mean FEV1% predicted ± SD: 46 ± 21%). An equal number of people with comparable lung disease were selected as controls (88% COPD, 5% ILD). Controls had lower FEV1% predicted values (mean ± SD: 39 ± 17%, P < 0.001), smoked more (mean ± SD: 48 ± 35 pack-years, P = 0.032), and no differences in age, BMI, sex, and Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Median (IQR) follow-up time was 68 months (34–123), with 371 (78%) deaths. Univariable (HR = 1.71, p < 0.001) and multivariable (HR = 1.64, p < 0.001) Cox regression found higher mortality risk in controls. Subgroup analysis for COPD replicated these findings (HR = 1.70, P < 0.001).

Discussion

Despite some methodological limitations, our study suggests that clinically stable patients with chronic respiratory disease who undertake PR may have lower mortality than matched controls.

Trial registration

Retrospectively registered.
Association of serum and salivary dipeptidyl peptidase-4 (DPP-4) with oral cancerous and precancerous lesions; an observational diagnostic accuracy study
Authors: Abdel Fattah Tarrad Nayroz , Gamil Shaker Olfat , Abdelkawy Maha , Hassan Sandy
Published: October 2024

Background

Enhancing the prognosis and treatment outcomes of oral cancer relies heavily on its early detection. This study aims to establish a connection between serum and salivary dipeptidyl peptidase-4 (DPP-4) levels and oral squamous cell carcinoma (OSCC), comparing them with oral potentially malignant lesions (OPMLs) and control subjects and validating salivary DPP-4 as a diagnostic marker for the early detection of oral cancer.

Methodology

Forty-five systemically healthy individuals were categorized into three groups: Group I consisted of 15 patients diagnosed with OSCC, Group II comprised 15 patients with OPMLs (including leukoplakia and oral lichen planus), and Group III included 15 participants without any oral mucosal lesions. Serum and whole unstimulated salivary samples were collected from all participants to assess DPP-4 levels using an enzyme-linked immunosorbent assay (ELISA) kit. Receiver operating characteristic (ROC) analysis was conducted to determine the area under the curve (AUC), sensitivity, specificity, and diagnostic accuracy of DPP-4.

Results

Both serum and salivary DPP-4 levels were highest in the healthy group, followed by OPMLs, and lowest in the OSCC group, with statistically significant differences observed. ROC analysis demonstrated excellent diagnostic accuracy of salivary DPP-4 in distinguishing OSCC from healthy individuals, OPMLs from healthy individuals, and OSCC from OPMLs, with accuracies of 100%, 100%, and 96.67%, respectively. Salivary DPP-4 levels also exhibited a statistically significant correlation with OSCC grades.

Conclusions

DPP-4 appears to play a protective, anti-oncogenic role in maintaining oral tissue health. The remarkable diagnostic accuracy of both serum and salivary DPP-4 in discriminating between OSCC, OPMLs, and healthy controls suggests its potential utility as a well-established marker for early oral cancer diagnosis. Salivary DPP-4, being non-invasive, could serve as a convenient chair-side diagnostic tool for the early detection of OSCC.

Clinical trial registration

The study was retrospectively registered on clinicaltrial.gov with NCT06087042, date of registration (first posted date): 17/10/2023
A systematic scoping review on group non-written reflections in medical education
Authors: Burla Neha , Ong Rui Song Ryan , Chee Ryan Choon Hoe , Wong Ruth Si Man , Neo Shao Yun , Abdul Hamid Nur Amira Binte , Lim Crystal , Ong Eng Koon , Somasundaram Nagavalli , Krishna Lalit Kumar Radha
Published: October 2024

Background

Medical education is tasked with shaping how medical students and physicians think, feel and act as professionals, or their Professional Identity Formation (PIF). This process has traditionally rested upon imparting knowledge; integrating sociocultural, professional and organizational expectations and codes of conduct; inculcating program and practice beliefs, values and principles (belief systems); and imbuing shared identities – quintessential elements that, together, comprise the socialization process. Key to supporting this socialization process is reflective practice. However, regnant approaches to mobilizing reflective cycles are faced with resource, personnel and time constraints, hindering efforts to nurture PIF. Group non-written reflections (GNWR) – broadly defined as facilitator-led discussions of shared reflective experiences within groups of learners – may prove to be an effective compromise. To address diverse approaches and a lack of effective understanding, we propose a systematic scoping review (SSR) to map the current use of GNWR in medical training and its role in shaping PIF.

Methods

Guided by the Systematic Evidence-Based Approach (SEBA)’s constructivist ontological and relativist epistemological position, this SSR in SEBA searched for articles on GNWR published in PubMed, Embase, Psychinfo, CINAHL, ERIC, ASSIA, SCOPUS, Google Scholar, Open Grey, GreyLit and ProQuest databases. The data found was concurrently analyzed using thematic and direct content analysis. Complementary themes and categories identified were combined, creating the domains that framed the discussion.

Results

Of the 8560 abstracts and 336 full-text articles reviewed, 98 articles were included. The four domains identified were: (1) Indications of use and their value; (2) Structure and how they can be used; (3) Models of reflective practice in GNWR; and (4) Features of communities of practice and the socialisation process.

Conclusion

This SSR in SEBA concludes that GNWR does impact PIF when effectively structured and supported. The Krishna-Pisupati Model for PIF platforms a model that explains GNWR’s effects of PIF and advances fourteen recommendations to maximize GNWR use.
MiR-5195-3p predicts clinical prognosis and represses colorectal cancer progression by targeting TLR4/MyD88 signaling
Authors: Lv Yandong , Guo Shuwei , Jin Lingtong , Wang Kai , Li Yongsheng , Li Haonan , Lu Yikang , Liu Hongzhou
Published: October 2024

Background

Recent studies have highlighted the role of miR-5195-3p in suppressing cell growth in various cancers. However, the specific functional impact of miR-5195-3p in colorectal cancer (CRC) remain to be fully clarified. The importance of miR-5195-3p in CRC was evaluated, aiming to uncover its underlying molecular mechanism and identify it as a potential therapeutic target for CRC.

Results

Our research has shown that miR-5195-3p is markedly under-expressed in CRC tissues and cell cultures, with its reduced presence associated with a higher TNM stage, lymphatic invasion, and unfavorable survival outcome. Ectopic miR-5195-3p expression curtailed proliferation, migration, and invasion of SW1116 and HT29 cells. Additionally, we discovered that miR-5195-3p directly targets and negatively influences Toll-like receptor 4 (TLR4) in CRC cells. Moreover, an inverse relationship was noted between miR-5195-3p and TLR4 expression in CRC tissue samples. Notably, restoring TLR4 expression counteracted miR-5195-3p’s suppressive impact on cell growth, motility, invasiveness, epithelial-mesenchymal transition (EMT), and the TLR4/MyD88 signaling pathway in SW1116 and HT29 cells.

Conclusions

MiR-5195-3p suppresses the CRC cellular functions through the downregulation of TLR4/MyD88 signaling, indicating that targeting miR-5195-3p might offer a viable therapeutic strategy for CRC.
Predictors of Methicillin-resistant Staphylococcus aureus infection in children with acute osteomyelitis
Authors: Wang Kang , Wang Chen , Zhu Hua , Zou Yan , Feng Yanhua , Zhang Fang , Qu Yi , Tian Yiren
Published: October 2024

Background

This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions.

Methods

We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1).

Results

The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05).

Conclusions

In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection.
A deep learning model to enhance the classification of primary bone tumors based on incomplete multimodal images in X-ray, CT, and MRI
Authors: Song Liwen , Li Chuanpu , Tan Lilian , Wang Menghong , Chen Xiaqing , Ye Qiang , Li Shisi , Zhang Rui , Zeng Qinghai , Xie Zhuoyao , Yang Wei , Zhao Yinghua
Published: October 2024

Background

Accurately classifying primary bone tumors is crucial for guiding therapeutic decisions. The National Comprehensive Cancer Network guidelines recommend multimodal images to provide different perspectives for the comprehensive evaluation of primary bone tumors. However, in clinical practice, most patients’ medical multimodal images are often incomplete. This study aimed to build a deep learning model using patients’ incomplete multimodal images from X-ray, CT, and MRI alongside clinical characteristics to classify primary bone tumors as benign, intermediate, or malignant.

Methods

In this retrospective study, a total of 1305 patients with histopathologically confirmed primary bone tumors (internal dataset, n = 1043; external dataset, n = 262) were included from two centers between January 2010 and December 2022. We proposed a Primary Bone Tumor Classification Transformer Network (PBTC-TransNet) fusion model to classify primary bone tumors. Areas under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to evaluate the model’s classification performance.

Results

The PBTC-TransNet fusion model achieved satisfactory micro-average AUCs of 0.847 (95% CI: 0.832, 0.862) and 0.782 (95% CI: 0.749, 0.817) on the internal and external test sets. For the classification of benign, intermediate, and malignant primary bone tumors, the model respectively achieved AUCs of 0.827/0.727, 0.740/0.662, and 0.815/0.745 on the internal/external test sets. Furthermore, across all patient subgroups stratified by the distribution of imaging modalities, the PBTC-TransNet fusion model gained micro-average AUCs ranging from 0.700 to 0.909 and 0.640 to 0.847 on the internal and external test sets, respectively. The model showed the highest micro-average AUC of 0.909, accuracy of 84.3%, micro-average sensitivity of 84.3%, and micro-average specificity of 92.1% in those with only X-rays on the internal test set. On the external test set, the PBTC-TransNet fusion model gained the highest micro-average AUC of 0.847 for patients with X-ray + CT.

Conclusions

We successfully developed and externally validated the transformer-based PBTC-Transnet fusion model for the effective classification of primary bone tumors. This model, rooted in incomplete multimodal images and clinical characteristics, effectively mirrors real-life clinical scenarios, thus enhancing its strong clinical practicability.
Prophylactic regimens for the prevention of pseudophakic cystoid macular edema: systematic review and meta-analysis
Authors: Alqahtani Abdullah S. , Hersi Reem M. , Homsi Jumana J. , Alamoudi Loujen O. , Alghamdi Sara , Alrajhi Rawan K. , AlJehani Reham A.
Published: October 2024

Background

Pseudophakic cystoid macular edema (PCME) is a known complication of cataract surgery that contributes to decreased visual acuity. Mechanical manipulation associated with the release of inflammatory mediators is the leading hypothesis for PCME. To date, no standardized prophylactic protocol has been established to effectively reduce the incidence of PCME. This study assessed the efficacy and safety of nonsteroidal anti-inflammatory drops (NSAIDs) and corticosteroids for the prevention of PCME.

Method

We searched the following databases MEDLINE, EMBASE, and Cochrane Central. Register of Controlled Trials and included randomized controlled trials (RCTs) that studied the efficacy of NSAID vs. placebo, NSAID vs. steroid, or NSAID + steroid vs. placebo, reporting the incidence of PCME, macular thickness, and best-corrected visual acuity. The risk ratio (RR) with a 95% confidence interval (CI) and a random-effects model was used. The risk of bias was assessed using the revised Cochrane risk-of-bias tool.

Results

A total of 18 RCTs were included in this study (n = 2959). Nine RCT showed low risk of bias, 7 RCT showed unclear risk of bias, and 2 RCT had high risk of bias. The incidence of cystoid macular edema among patients treated with NSAIDs was significantly lower (RR = 0.33, P < 0.001). Subgroup analysis revealed a statistically significant low risk of edema among patients treated with NSAIDs alone (P < 0.001) compared to others. NSAIDs were associated with significantly low mean corrected visual acuity values using LogMar (P < 0.001).

Conclusion

NSAID alone or in combination with steroids showed its efficacy in reducing the incidence of PCME post-operatively. Future double-blind randomized controlled trials are required to standardize the protocol for different patient population.