bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence and persistence to direct factor Xa inhibitors in the community following newly diagnosed venous thromboembolism: a retrospective pharmacy-linkage study
Authors: Dix Caroline , Bortz Hadley , da Gama Mike , Treloar Michael , Reynolds Michael , Ramanan Radha , Day Thomas , Tran Huyen
Published: July 2023

Objectives

To assess adherence and persistence to the direct factor Xa inhibitor oral anticoagulants in the community following newly diagnosed venous thromboembolism (VTE).

Methods

We retrospectively reviewed community pharmacy dispensing data on all patients with newly diagnosed VTE who were prescribed direct factor Xa inhibitors, apixaban or rivaroxaban, between January 2018 and December 2019 at our institution. Proportion of days covered (PDC) was used to assess adherence at 90 days, and 6- and 12 months. Persistence was measured by participants having both dispensed supply of a factor Xa inhibitor at the end of the treatment period and no significant gaps (maximum of 60 days) in supply.

Key findings

There were 225 patients identified. Overall PDC at 90 days, 6- and 12 months were 84.6%, 86.2% and 86.1%, respectively. Apixaban had a higher mean overall PDC than rivaroxaban (86.2% and 80.6%, respectively). Females demonstrated higher PDC compared with males (87.3% versus 81.2%). Overall, 133 patients (64%) were persistent with therapy.

Conclusions

In patients with newly diagnosed VTE treated with a factor Xa inhibitor, adherence rates are high at >80%, with females and those prescribed apixaban exhibiting higher adherence. These findings may assist clinicians in identifying those patients with VTE at risk of poor adherence.
The Cluster Multiplication Theorem for Acyclic Quantum Cluster Algebras
Authors: Chen Xueqing , Ding Ming , Zhang Haicheng
Published: July 2023

Let $Q$ be a finite acyclic valued quiver. We give the cluster multiplication formulas in the quantum cluster algebra of $Q$ with arbitrary coefficients, by applying certain quotients of derived Hall subalgebras of $Q$. These formulas can be viewed as the quantum version of the cluster multiplication theorem in the classical cluster algebra proved by Caldero–Keller for finite type, Hubery for affine type, and Xiao–Xu for acyclic quivers.
Intelligent monitoring of vibration and structural-borne noise induced by rail transit
Authors: Liu Qingjie , Xu Lu , Feng Qingsong
Published: July 2023

The monitoring of urban rail transit vibration and structural-borne noise can well solve the problem of small amount of data and large discreteness in traditional evaluation tests. In this study, a monitoring system is utilized to collect and preprocess vibration and noise signals. By employing cellular network and cloud-based services, real-time acquisition and analysis of vibration and noise signals are achieved. In this article, it is proposed to normalize the vibration data obtained after edge computing. After treatment, the gray correlation analysis method was used to determine the correlation between each vibration data component and vibration data classification. Combining frequency domain analysis of vibration data, the data components with high correlation are used as inputs to an improved K-nearest neighbours (KNN) model. Additionally, the correlation of each data component is introduced into the distance calculation formula. The improved KNN model shows improvements in recall rate, precision rate, F-measure, and accuracy compared to the original KNN model, with increases of 0.76 per cent, 2.76 per cent, 1.81 per cent, and 1.61 per cent respectively. Through practical measurements, it is found that different vehicles cause significant variations in vibration, with differences of up to 11 dB in tunnel wall vibration. The differences in tunnel wall vibration caused by the same vehicle at different passenger loads do not exceed 5 dB. Combining practical application cases, the rail transit environmental noise monitoring system established in this study demonstrates its applicability in monitoring vibration and noise-sensitive areas, as well as analysing the effectiveness of vibration reduction and noise control measures.
LC–MS-MS-MS3 for the determination and quantification of ∆9-tetrahydrocannabinol and metabolites in blood samples
Authors: Proença Paula , Teixeira Helena M , Martinho Beatriz , Monteiro Carla , Franco João , Corte-Real Francisco
Published: July 2023

Due to the high prevalence of cannabinoids in forensic toxicology analysis, it is crucial to have an efficient method that allows the use of a small sample amount and that requires a minimal sample preparation for the determination and quantification of low concentrations. A simple, highly selective and high throughput liquid chromatography–tandem mass spectrometry methodology (LC–MS-MS-MS3) was developed for the determination and quantification of ∆9-tetrahydrocannabinol (THC), 11-hydroxy-∆9- tetrahydrocannabinol (THC-OH) and 11-nor-9-carboxy-∆9-tetrahydrocannabinol (THC-COOH) in blood samples. Chromatographic analysis of THC, THC-OH and THC-COOH and their deuterated internal standards was preceded by protein precipitation (PPT) of 0.1 mL of blood samples with acetonitrile. Chromatographic separation was achieved by use of an Acquity UPLC® HHS T3 (100 mm × 2.1 mm i.d., 1.8 μm) reversed-phase column, using a gradient elution of 2 mM aqueous ammonium formate, 0.1% formic acid and methanol at a flow rate of 0.4 mL/min, with a run time of 10 min. For the MS-MS-MS3 analysis, a SCIEX QTRAP® 6500+ triple quadrupole linear ion trap mass spectrometer was used via electrospray ionization (ESI), operated in multiple reaction monitoring (MRM) and linear ion trap mode (MS3). The method was validated in accordance with internationally accepted criteria and guidelines, and proved to be selective and linear between 0.5 and 100 ng/mL (r2 > 0.995). The lower limits of quantification (LLOQ) corresponded to the lowest concentrations used for the calibration curves. The coefficients of variation obtained for accuracy and precision were <15%. The mean recoveries were between 88.0% and 117.2% for the studied concentration levels (1 ng/mL, 5 ng/mL and 50 ng/mL). No significant interfering compounds, matrix effects or carryover were observed. The validated method provides a sensitive, efficient and robust procedure for the quantification of cannabinoids in blood, using LC–MS-MS-MS3 and a sample volume of 0.1 mL. This work is also a proof of concept for using LC–MS3 technique to determine drugs in biological samples.
Calpain-3 not only proteolyzes calpain-1 and -2 but also is a substrate for calpain-1 and -2
Authors: Ojima Koichi , Hata Shoji , Shinkai-Ouchi Fumiko , Ono Yasuko , Muroya Susumu
Published: July 2023

Calpain is an intracellular cysteine protease that cleaves its specific substrates in a limited region to modulate cellular function. Calpain-1 (C1) and calpain-2 (C2) are ubiquitously expressed in mammalian cells, but calpain-3 (C3) is a skeletal muscle-specific type. In the course of calpain activation, the N-terminal regions of all three isoforms are clipped off in an intramolecular or intermolecular fashion. C1 proteolyzes C2 to promote further proteolysis, but C2 proteolyzes C1 to suspend C1 proteolysis, indicating the presence of C1–C2 reciprocal proteolysis. However, whether C3 is involved in the calpain proteolysis network is unclear. To address this, we examined whether GFP-tagged C3:C129S (GFP-C3:CS), an inactive protease form of C3, was a substrate for C1 or C2 in HEK cells. Intriguingly, the N-terminal region of C3:CS was cleaved by C1 and C2 at the site identical to that of the C3 autoproteolysis site. Furthermore, the N-terminal clipping of C3:CS by C1 and C2 was observed in mouse skeletal muscle lysates. Meanwhile, C3 preferentially cleaved the N-terminus of C1 over that of C2, and the sizes of these cleaved proteins were identical to their autoproteolysis forms. Our findings suggest an elaborate inter-calpain network to prime and suppress proteolysis of other calpains.
Recent Developments in the National Implementation of Biological Weapons Convention: What Happened Since Resolution 1540?
Authors: de Vries Barry
Published: July 2023

The national implementation of the Biological Weapons Convention (BWC) has long been a point of discussion. One aspect of this national implementation concerns the enactment of penal legislation addressing the prohibitions of the BWC. There has been a clear increase in the past 18 years of penal legislation addressing biological weapons. This coincides with the adoption of UN Security Council Resolution 1540. Through a comprehensive assessment of the adopted national legislation it is possible to see trends and consider the extent to which such legislation seeks to address the BWC or Resolution 1540. The assessment clearly indicates that there is a divergence between the legislation addressing biological weapons in a general manner and legislation specifically seeking to address biological weapons in a terrorism context. This analysis will recognize potential avenues to increase national implementation of the BWC by looking at the progress made in the context of Resolution 1540.
Crimes without Humanity?
Authors: Acquaviva Guido
Published: July 2023

The development of autonomous weapons systems (AWS) and, more generally, the role of artificial intelligence in warfare, may come to pose unprecedented challenges to criminal law, including by making it harder to link harm to individuals who can be held responsible, due to the pivotal role of the concepts of actus reus, mens rea and causation in that domain. In this context, the notion of meaningful human control has been proposed to address some of the challenges of ensuring accountability for serious violations of international humanitarian law. One possibility might be to link — conceptually, or even legally — meaningful human control with the ‘control theory’ propounded at the International Criminal Court to assign criminal responsibility. Under this theory, the ascription of criminal responsibility to an individual as a direct perpetrator requires an assessment of whether they enjoy an effective ability to decide on the commission of a crime. This article elaborates on some of the issues posed by this approach, proceeding then to consider the most ‘extreme’ instance of AWS, i.e. the deployment of swarms of drones operating autonomously and coordinating their behaviour in a decentralized manner.
The Role of Intermediate Collaborative Forums in Polycentric Environmental Governance
Authors: Wiechman Adam , Alonso Vicario Sara , Koebele Elizabeth A
Published: July 2023

In complex, polycentric environmental governance systems, actors may choose to collaborate with one another to reduce their collective vulnerability and enhance system function. However, collaboration can be costly, and little evidence exists for how particular collaborative forums impact the broader governance system in which they are embedded. To address this gap, we investigate the role of intermediate collaborative forums, which support collaboration among a subset of system actors, in polycentric governance systems. Empirically, we analyze the structural and functional role of an intermediate collaborative forum called the Arizona Municipal Water Users Association (AMWUA) within the municipal surface water governance network for the Phoenix Metropolitan Area (PMA) in Arizona, United States. To do this, we draw from 21 interviews with water professionals in the PMA, which we analyze through a combination of network analysis and qualitative coding. We find that AMWUA facilitates strong bonding capacities among members, allowing for streamlined bridging to the rest of the network that enhances information processing and advocacy of member needs. Our findings advance theory on the role of collaboration in polycentric systems and inform the design of collaborative institutions to improve environmental governance.
Rethinking encounter through parochial meaning-making on the urban margins in South Africa
Authors: Monson Tamlyn
Published: July 2023

Originating in normative interventions aiming to remedy segregation through contact with difference, the notion of ‘meaningful encounter’ has become a portmanteau for contact that results in greater respect and tolerance. This article questions the epistemic justice of such a value-laden concept by presenting four examples of parochial meaning-making around encounters in a South African informal settlement. Drawing on secondary interviews conducted after ‘xenophobic’ expulsions of foreign-born newcomers from the settlement in 2008, as well as primary ethnographic fieldwork conducted four years later, the article highlights the meaningfulness of four encounters that did not lead to increased tolerance or respect for difference—encounters with affluence; with social mobility; with hardship in conditions of poverty and marginality; and with seemingly uncommitted newcomers against a backdrop of contentious politics. In each case, the article illustrates both the meaningfulness of the encounter, and its effect of producing tensions rather than mediating them. The article uses these examples to problematise the assumptions implicit in received notions of ‘meaningful encounter’: that tension necessarily pre-exist encounter, that established/newcomer boundaries are based on prejudice, and that encounters are not meaningful unless they advance a predetermined normative position. Along the way, it highlights the importance of embodiment, materiality, inequality, and space in the production of difference. Having made the case for a conceptual sharpening in the light of these seldom-studied encounters in the urban margins of South Africa, the article concludes by urging scholars to adopt a value-free conception of the meaningfulness of encounter.
Constraints on galaxy formation from the cosmic-far-infrared-background – optical-imaging cross-correlation using Herschel and UNIONS
Authors: Lim Seunghwan , Hill Ryley , Scott Douglas , van Waerbeke Ludovic , Cuillandre Jean-Charles , Carlberg Raymond G , Chisari Nora Elisa , Dvornik Andrej , Erben Thomas , Gwyn Stephen , McConnachie Alan W , Miville-Deschênes Marc-Antoine , Wright Angus H , Duc Pierre-Alain
Published: July 2023

Using Herschel-SPIRE imaging and the Canada-France Imaging Survey (CFIS) Low Surface Brightness data products from the Ultraviolet Near-Infrared Optical Northern Survey (UNIONS), we present a cross-correlation between the cosmic far-infrared background and cosmic optical background fluctuations. The cross-spectrum is measured for two cases: all galaxies are kept in the images; or all individually detected galaxies are masked to produce ‘background’ maps. We report the detection of the cross-correlation signal at $\gtrsim 18\, \sigma$ ($\gtrsim 14\, \sigma$ for the background map). The part of the optical brightness variations that are correlated with the submm emission translates to an rms brightness of $\simeq 32.5\, {\rm mag}\, {\rm arcsec}^{-2}$ in the r band, a level normally unreachable for individual sources. A critical issue is determining what fraction of the cross-power spectrum might be caused by emission from Galactic cirrus. For one of the fields, the Galactic contamination is 10 times higher than the extragalactic signal; however, for the other fields, the contamination is around 20 per cent. An additional discriminant is that the cross-power spectrum is of the approximate form P(k) ∝ 1/k, much shallower than that of Galactic cirrus. We interpret the results in a halo-model framework, which shows good agreement with independent measurements for the scalings of star-formation rates in galaxies. The approach presented in this study holds great promise for future surveys such as FYST/CCAT-prime combined with Euclid or the Vera Rubin Observatory (LSST), which will enable a detailed exploration of the evolution of star formation in galaxies.
Cosmological constraints with the linear point from the BOSS survey
Authors: He Mengfan , Zhao Cheng , Shan Huanyuan
Published: July 2023

The Linear Point (LP), defined as the mid-point between the baryon acoustic oscillation (BAO) peak and the associated left dip of the two-point correlation function (2PCF), ξ(s), is proposed as a new standard ruler which is insensitive to non-linear effects. In this paper, we use a Bayesian sampler to measure the LP and estimate the corresponding statistical uncertainty, and then perform cosmological parameter constraints with LP measurements. Using the Patchy mock catalogues, we find that the measured LPs are consistent with theoretical predictions at 0.6 per cent level. We find constraints with mid-points identified from the rescaled 2PCF (s2ξ) more robust than those from the traditional LP based on ξ, as the BAO peak is not always prominent when scanning the cosmological parameter space, with the cost of 2–4 per cent increase of statistical uncertainty. This problem can also be solved by an additional data set that provides strong parameter constraints. Measuring LP from the reconstructed data slightly increases the systematic error but significantly reduces the statistical error, resulting in more accurate measurements. The 1 σ confidence interval of distance scale constraints from LP measurements are 20–30 per cent larger than those of the corresponding BAO measurements. For the reconstructed Sloan Digital Sky Survey Data Release 12 data, the constraints on H0 and Ωm in a flat-Lambda cold dark matter framework with the LP are generally consistent with those from BAO. When combined with Planck cosmic microwave background data, we obtain $H_0=68.02_{-0.37}^{+0.36}$  ${\rm km}\, {\rm s}^{-1}\, {\rm Mpc}^{-1}$ and $\Omega _{\rm m}=0.3055_{-0.0048}^{+0.0049}$ with the LP.
Impact of menopausal symptoms on presenteeism in Japanese women
Authors: Ishimaru T , Okawara M , Tateishi S , Yasui T , Horie S , Fujino Y
Published: July 2023

Background

Menopausal symptoms are common among middle-aged women. Working women with severe menopausal symptoms are more likely to experience presenteeism—a condition where employees continue to work despite feeling unwell. However, it remains unclear as to which specific symptoms women experience during the menopausal transition and postmenopausal periods that primarily contribute to presenteeism.

Aims

To evaluate the associations between types of menopausal symptoms and presenteeism among Japanese women.

Methods

A cross-sectional study of 4000 women aged 40–59 years who were currently working was conducted in Japan in September 2022. We used an online self-administered questionnaire that included items on demographic characteristics, the Menopause Rating Scale for measuring menopausal symptoms and the Work Functioning Impairment Scale for measuring presenteeism. Logistic regression analysis was performed.

Results

Women with severe overall menopausal symptoms had 12.18-fold (95% confidence interval [CI] 9.09–16.33, P < 0.001) increased odds of presenteeism compared with those without symptoms. Participants with psychological symptoms also had significantly higher presenteeism (severe: odds ratio: 9.18, 95% CI 6.60–12.78, P < 0.001). However, after controlling for psychological symptoms, there were no significant associations between somatic and urogenital symptoms and presenteeism.

Conclusions

The results indicate that menopausal symptoms, especially psychological symptoms, have a significant impact on presenteeism among Japanese women. Organizations need to address menopausal symptoms in the workplace, with an emphasis on reducing work-related stress for women with menopausal symptoms.
Role of Potassium-Dependent Alternative Splicing of MYB59 in the Maintenance of Potassium Concentration in Shoots of Arabidopsis thaliana
Authors: Enomoto Takuo , Tanaka Nobuhiro , Fujiwara Toru , Nishida Sho
Published: July 2023

Potassium (K) is a major plant nutrient. K+ is taken up by channel and transporter proteins in roots and translocated from roots to shoots via the xylem. In Arabidopsis thaliana, the K+ transporter NPF7.3 mediates K+ loading into the xylem and the transcription factor MYB59 is responsible for NPF7.3 expression. Here, we demonstrate that MYB59 is regulated by alternative splicing in response to K availability. Three splicing isoforms of MYB59 are detected in roots: an isoform with the first intron spliced out encodes a protein with the full DNA-binding motif (MYB59α), and two isoforms with the first intron retained partially or completely encode a protein missing part of the DNA-binding motif (MYB59β). Functional analysis showed that only MYB59α is capable of inducing the expression of NPF7.3. The abundance of the MYB59α isoform increased under low K, but the total abundance of MYB59 transcripts did not change, indicating that MYB59α is increased by modification of the splicing pattern in response to low K. Although MYB59α is increased by low K, NPF7.3 expression remained constant independent of K. In addition, there was no significant difference in NPF7.3 expression between an MYB59 knockout mutant and the wild type under normal K. These results suggest that an unknown mechanism is involved in NPF7.3 expression under normal K and switches roles with MYB59 under low K. We propose that the regulation of MYB59 by alternative splicing is required for the maintenance of shoot K concentration in adaptation to low K.
Homogenisation of Nonlinear Heterogeneous Thin Plate When the Plate Thickness and In-Plane Heterogeneities are of the Same Order of Magnitude
Authors: Pruchnicki E
Published: July 2023

In this work, we propose a new two-scale finite-strain thin plate theory for highly heterogeneous plates described by a repetitive periodic microstructure. For this type of theory, two scales exist, the macroscopic one is linked to the entire plate and the microscopic one is linked to the size of the heterogeneity. We consider the case when the plate thickness is comparable to in-plane heterogeneities. We assume that the nonlinear macroscopic part of the model is of Kirchhoff–Love type. We obtain the nonlinear homogenised model by performing simultaneously both the homogenisation and the reduction of the initial three-dimensional plate problem to a two-dimensional one. Since nonlinear equations are difficult to solve, we linearise this homogenised Kirchhoff–Love plate theory. Finally, we discuss the treatment of edge effects in the vicinity of the lateral boundary of the plate.
Impact of COVID-19 infection experience on mental health status of intensive care unit patients’ family members: a real-world study
Authors: Liu T , Zhao Z , Wu C , Lu C , Liu M , An X , Sha Z , Wang X , Luo Z , Chen L , Liu C , Cao P , Zhang D , Jiang R
Published: July 2023

Purpose

Family members of patients hospitalized in intensive care unit (ICU) are susceptible to adverse psychological outcomes. However, there is a paucity of studies specifically examining the mental health symptoms in ICU patients’ family members with a prior history of coronavirus disease 2019 (COVID-19) infection.

Aim

This study aimed to investigate mental health status and its influencing factors of ICU patients’ family members with previous COVID-19 infection experience in China.

Design

Nationwide, cross-sectional cohort of consecutive participants of family members of ICU patients from 10 provinces randomly selected in mainland China conducted between October 2022 and May 2023.

Methods

The basic information scale, Self-rating depression scale, Self-rating Anxiety Scale, Impact of Event Scale-Revised, Pittsburgh sleep quality index, Perceived Stress Scale, Connor-Davidson resilience scale, Simplified Coping Style Questionnaire were employed to explore mental health status among participants.

Results

A total of 463 participants, comprising 156 individuals in Covid-19 family member cohort (infection group) and 307 individuals in control family member cohort (control group), met inclusion criteria. The infection group exhibited significantly higher incidence of composite mental health symptoms compared to control group (P = 0.017). Multivariable logistic regression analysis revealed that being female, engaging in physical/mental labor, residing in rural areas, and having children were identified as risk factors for the development of depression, anxiety, and post-traumatic stress disorder symptoms, while medical history of surgery was protective factor. A predictive model demonstrated a favorable discriminative ability and excellent calibration.

Conclusion

COVID-19 infection experience regarded as new traumatic stressors worsen mental health status of ICU patients’ family members.
Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study
Authors: Sloan Melanie , Wincup Chris , Harwood Rupert , Pollak Thomas A , Massou Efhalia , Bosley Michael , Pitkanen Mervi , Zandi Michael S , Leschziner Guy , Barrere Colette , Ubhi Mandeep , Andreoli Laura , Brimicombe James , Diment Wendy , Jayne David , Gordon Caroline , Naughton Felix , D’Cruz David
Published: July 2023

Objective

A limited range of neuropsychiatric symptoms have been reported in systemic autoimmune rheumatic diseases (SARDs), with varied symptom prevalence. This study aimed to investigate a wider range of potential symptoms than previous studies, compare patient self-reports with clinician estimates, and explore barriers to symptom identification.

Methods

Mixed methods were used. Data from SARDs patients (n = 1853) were compared with controls (n = 463) and clinicians (n = 289). In-depth interviews (n = 113) were analysed thematically. Statistical tests compared means of survey items between patients and controls, 8 different SARD groups, and clinician specialities.

Results

Self-reported lifetime prevalences of all 30 neuropsychiatric symptoms investigated (including cognitive, sensorimotor and psychiatric) were significantly higher in SARDs than controls. Validated instruments assessed 55% of SARDs patients as currently having depression and 57% anxiety. Barriers to identifying neuropsychiatric symptoms included: (i) limits to knowledge, guidelines, objective tests and inter-speciality cooperation; (ii) subjectivity, invisibility and believability of symptoms; and (iii) under-eliciting, under-reporting and under-documenting. A lower proportion of clinicians (4%) reported never/rarely asking patients about mental health symptoms than the 74% of patients who reported never/rarely being asked in clinic (P < 0.001). Over 50% of SARDs patients had never/rarely reported their mental health symptoms to clinicians, a proportion underestimated at <10% by clinicians (P < 0.001).

Conclusion

Neuropsychiatric symptom self-reported prevalences are significantly higher in SARDs than controls, and are greatly underestimated by most clinicians. Research relying on medical records and current guidelines is unlikely to accurately reflect patients’ experiences of neuropsychiatric symptoms. Improved inter-speciality communication and greater patient involvement is needed in SARD care and research.
Acute toxicity study, haematological, biochemical and histopathological effects of Brassica oleracea var. capitata, Allium porrum and Cucurbita maxima in Rattus norvegicus
Authors: Alhaji Saganuwan Saganuwan , Junior Atanu Samuel , Tsekohol Agu Solomon , Wanmi Nathaniel
Published: July 2023

Objectives

The use of vegetables in Nigeria as nutraceutical cannot be over emphasized. However many vegetables are associated with toxicity effects at both low and high doses.

Methods

Hence the study was aimed at investigating acute toxicity, haematological, biochemical and histopathological effects of Allium porrum (leek), Cucurbita maxima (pumpkin) and Brassica oleracea var. capitata (cabbage) in female Rattus norvegicus. The lethal dose50 (LD50) of the three plants were determined.

Key findings

The LD50 of aqueous extract of cabbage, leek and pumpkin was 6585 mg/kg body weight. Cabbage caused a decrease in packed cell volume, erythrocytes counts, haemoglobin concentration, white blood cells, neutrophils and monocytes counts, increased basophils and eosinophils counts at dose levels of 5.79 mg/kg and 57.93 mg/kg body weight. At dose levels of 5.79–579.3 mg/kg body weight, the extract caused hypoalbuminaemia, hypoglycaemia, hypercholesterolaemia, increased levels of alanine amino transferase (ALT) and alkaline phosphatase. Cabbage also caused necrosis of hepatocytes, glomerular and tubular necrosis, cylinduria and perivascular cuffing in the brain. At dose level of 5.79 mg/kg and above, cabbage may cause abortion during an early stage of pregnancy due to possible loss of endometrial gland. The combined extract of pumpkin and leek caused haematopoiesis, neutropenia, lymphocytosis, eosinophilia, hypoglycaemia, hypocholesterolaemia, elevation of ALT levels, necrosis of hepatocytes and brain tissues, kidney damage and suppression of the development of ovarian follicle.

Conclusions

Brassica oleracea var. capitata may cause anaemia, immunosuppression, hypoglycaemia, hypercholesterolaemia, abortion, liver and kidney damage. The combined extract of leek and pumpkin may cause haematopoeisis, immunostimulation, hypoglycaemia, hypocholesterolaemia, brain problem and infertility.
Clinical ladders
Authors: Boyd William , Witte Laura , Herman Lawrence
Published: July 2023

As the need for more healthcare providers increases, so does the need for leaders in the healthcare setting. Physician associates/assistants (PAs) are primed to step into these positions, given their key role in the clinical setting. Clinical ladder models are an established system for clinical, administrative, and academic advancement for healthcare providers. Although more research is needed, clinical ladders provide the opportunity for career advancement while helping to promote professional development and improve retention. Moreover, the opportunity for advancement via clinical ladders may help to prevent clinician burnout and turnover by providing more opportunities and career directions.
Streamlining care in two neurosurgical practices in a rural trauma center
Authors: Gibson Kyle , Whitson Daniel , Filson John D. , Grunch Betsy , Pack Leigh
Published: July 2023

To maximize cost-effective care and evaluate the use of physician associates/assistants (PAs) and NPs in an academic inpatient setting, we investigated the effect of streamlining care by using a common PA position between two neurosurgery groups. Trauma registry data were obtained and analyzed to gain insight into hospital length of stay (LOS) and clinical outcomes before and after implementing this new position. The average hospital LOS was reduced for less severely injured patients, and the time to initiation of venous thromboembolism prophylaxis decreased for injured neurosurgical patients. These results indicate the successful facilitation of time-sensitive, value-based healthcare for this specific clinical population at our Level 2 trauma center.
The Effect of Selective Dorsal Rhizotomy on Hip Displacement in Children With Cerebral Palsy
Authors: Miller Stacey D. , Juricic Maria , Bone Jeffrey N. , Steinbok Paul , Mulpuri Kishore
Published: July 2023

Background:

Hip displacement is common in children with cerebral palsy (CP). Spasticity in the hip adductor muscles, hip flexors, and medial hamstrings has been identified as a possible cause of progressive hip displacement. Selective dorsal rhizotomy (SDR) aims to reduce lower extremity spasticity in children with CP. Here, we investigate the influence of SDR on hip displacement in children with CP at long-term follow-up, a minimum of 5 years post-SDR.

Methods:

A retrospective review of children undergoing SDR at a Canadian pediatric hospital was completed. Migration percentage (MP) was measured on pelvis radiographs taken in the 6 months before SDR and minimum 5 years post-SDR or before hip surgery. The number of hips with displacement, defined as MP >30%, and the number of children with at least 1 hip displaced were determined. A linear mixed-effects model was used to assess potential risk factors for poor outcome post-SDR, defined as having MP >40% or surgical intervention for hip displacement.

Results:

Ninety children [50 males, 40 females, Gross Motor Function Classification System (GMFCS) levels I to V: 1/13/24/43/9] with a mean follow-up of 8.5 years (SD 5.1) were included. The mean age at SDR was 4.9 years (SD 1.5); more than half of children (52%) had hip displacement at the time of SDR. Post-SDR, MP exceeded 30% in 0 (0%) of children at GMFCS level I, 1 (8%) at II, 11 (46%) at III, 31 (72%) at IV, and 7 (78%) at V. A poor outcome was associated with preoperative MP, age, and GMFCS level.

Conclusions:

The incidence of hip displacement post-SDR was consistent with population-based studies when evaluated by GMFCS. Our findings suggest that SDR has neither a positive nor negative effect on hip displacement when assessed at least 5 years postintervention.

Level of Evidence:

Level IV.
Surfaceome Profiling Suggests Potential of Anti-MUC1×EGFR Bispecific Antibody for Breast Cancer Targeted Therapy
Authors: Pourjafar Mona , Saidijam Massoud , Miehe Michaela , Najafi Rezvan , Soleimani Meysam , Spillner Edzard
Published: July 2023

Breast cancer (BC) treatment has traditionally been challenging due to tumor heterogeneity. Bispecific antibodies (bsAbs) offer a promising approach for overcoming these challenges by targeting multiple specific epitopes. In the current study, we designed a new bsAb against the most common BC cell surface proteins (SPs). To achieve this, we analyzed RNA-sequencing data to identify differentially expressed genes, which were further evaluated using Gene Ontology enrichment, Hidden Markov Models, clinical trial data, and survival analysis to identify druggable gene-encoding cell SPs. Based on these analyses, we constructed and expressed a bsAb targeting the mucin 1 (MUC1) and epidermal growth factor receptor (EGFR) proteins, which are the dominant druggable gene-encoding cell SPs in BC. The recombinant anti-MUC1×EGFR bsAb demonstrated efficient production and high specificity for MUC1 and EGFR+ cell lines and BC tissue. Furthermore, the bsAb significantly reduced the proliferation and migration of BC cells. Our results suggested that simultaneous targeting with bsAbs could be a promising targeted therapy for improving the overall efficacy of BC treatment.
Breast Implants Decrease Chest Wall Trauma in Low-speed, Unrestrained Motor Vehicle Crash: An Experimental Model
Authors: Pannucci Christopher J. , Wheeler Chad K. , Cyr Krista M. , Cyr Adam J.
Published: July 2023

Introduction:

Breast implants improve quality of life in patients seeking improved breast aesthetics, and are known to minimize human injury in the less common scenario of penetrating trauma. People commonly sustain rib and sternum fractures and thoracic injury in motor vehicle crashes (MVC), a form of blunt traumatic injury. Whether breast implants minimize injury during MVC is unknown. This study examines the potential protective effect of breast implants in low speed, unrestrained MVC.

Methods:

Control (medical gel) and implant (medical gel with embedded breast implant) blocks were subjected to load approximating a low speed, 10mph MVC (n=12 blocks per group). Colormetric pressure film measured pressure at the neo-chest wall position in response to load, across the gel block base. Maximum pressure and average pressure across the gel block base were compared, by group.

Results:

Presence of an implant significantly decreased, by 22.8%, maximum pressure experienced by the neo-chest wall (333.0 ± 58.7 psi vs 431.6 ± 37.3 psi, p=0.0006). Average pressure experienced by the neo-chest wall across the gel block base was also significantly decreased, by 28.1%, in the implant group (53.4 ± 5.6 psi vs 74.3 ± 15.7 psi, p=0.0017). Subjective analysis of all implant and control blocks supported an overall reduction in pressure for the implant group.

Conclusions:

Presence of a breast implant decreased maximum pressure at the chest wall by 23%, and average pressure by 28%. Patients with breast implants involved in low speed, unrestrained MVC may be less likely to sustain rib and sternum fractures and thoracic injury, when compared to patients without implants.
Comparing Cesarean Birth Utilization Between US Hospitals
Authors: Smith Denise Colter , Phillippi Julia C. , Tilden Ellen L. , Lowe Nancy K. , Carlson Nicole S. , Neal Jeremy L. , Blankstein Breman Rachel
Published: July 2023

Background:

The World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) is a standard reporting mechanism for cesarean birth, yet this approach is not widely adopted in the United States.

Objective:

To describe the application and utility of the TGCS to compare hospital-level cesarean births rates, for use in quality improvement and benchmarking.

Methods:

We conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from 228 438 women's births, from 2002 to 2008, in 12 sites across the United States. We stratified births into 10 mutually exclusive groups and calculated within-group proportions of group size and cesarean birth rates for between-hospital comparisons of cesarean birth, trial of labor after cesarean (TOLAC), and labor induction utilization.

Results:

There is variation in use of cesarean birth, labor induction, and TOLAC across the 12 sites.

Conclusion:

The TGCS provides a method for between-hospital comparisons, particularly for revealing usage patterns of labor induction, TOLAC, and cesarean birth. Adoption of the TGCS in the United States would provide organizations and quality improvement leaders with an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
“All I Can Say Is Thank You”
Authors: Walker Heather R. , Clarkson Gina , Alston Hailey , Chan Belinda
Published: July 2023

Background:

COVID-19-associated visitor restrictions altered parents' involvement in their infant's care in the neonatal intensive care unit (NICU).

Purpose:

The purpose of this article is to explore how restrictions affected parents' perceptions of experience in the NICU and to build a conceptual model of communication flow during times of crisis.

Methods:

This qualitative study was set in a level III 52-bed NICU. Using data from an open-ended survey question, a multitiered thematic analysis was used.

Results:

Four broad themes emerged: communication, gratitude, release, and containment of emotionality. These 4 themes interacted codependently and manifested differently as COVID-related visitor policies were put in place. Parents' characterization of communication also varied depending on the visitation policies. Before COVID, parents were more likely to reflect on communication. During COVID, parents expressed more gratitude, while containing negative emotions—sometimes using gratitude to soften the blow of bad feedback.

Implications for Practice and Research:

Our theoretical model suggests that gratitude may serve as a form of “reciprocal care” to providers during a period of crisis and extreme stress. Use of high-quality communication between providers and parents in the NICU is necessary to understand parental concerns or negative experience.
Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge
Authors: Breman Rachel Blankstein , Neerland Carrie , Iobst Stacey E. , Bradford L. Latéy , Barr Eric , Malloy Shannon , Burgess Adriane
Published: July 2023

Introduction:

The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support.

Methods:

This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted.

Results:

A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety.

Discussion:

The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.
An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy
Authors: Vandenplas Yvan , Broekaert Ilse , Domellöf Magnus , Indrio Flavia , Lapillonne Alexandre , Pienar Corina , Ribes‐Koninckx Carmen , Shamir Raanan , Szajewska Hania , Thapar Nikhil , Thomassen Rut Anne , Verduci Elvira , West Christina
Published: July 2023

A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta‐analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over‐diagnosis. CMA is also over‐diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over‐diagnosis of CMA occurs much more frequently than under‐diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2–4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
What Is Important to the Younger Person (≤50 Years) When Having a Total Hip Arthroplasty
Authors: Mew Louise , Heaslip Vanessa , Immins Tikki , Wainwright Thomas
Published: July 2023

Total hip arthroplasties (THAs) are usually performed in older patients. Despite a growing number of THAs in younger adults, it is unclear whether they have similar priorities in recovery compared with their older counterparts. The purpose of this systematic review was to explore younger patients' priorities when undergoing a THA. Multiple databases were searched in September 2021 prioritizing qualitative data. This review was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 14,495 articles screened, nine remained for analysis. Four common themes were discovered: improving function and mobility; pain; relationships; and patient expectations and education. However, there was insufficient information to clarify whether these themes could be attributed directly to younger adults undergoing a THA. The absence of research on THA patients younger than 50 years results in the loss of the voices of these patients. Further research is essential to ensure their needs are identified, addressed, and met.
The Use of Lavender Aromatherapy for Pain After Total Hip and Total Knee Arthroplasty
Authors: Hawkins Kelley , Coffey Mary , Cooper Maureen , Markwell Ashley , Boyd Pamela , Zuk Kathy , Thompson Elizabeth
Published: July 2023

A randomized clinical trial was conducted over a threemonth period with 102 participants undergoing a total hip arthroplasty (THA) or total knee arthroplasty (TKA). The study purpose was to assess whether there was a reduction in the use of opioids in the postoperative period for THA or TKA participants that utilized lavender aromatherapy as an adjunct to pain medication. The participants in the control and intervention group were administered nonopioid pain medication around the clock and opioids as needed after surgery. However, the intervention group also received a pre-packaged lavender essential oil inhaler. Total oral morphine equivalents (OME) were calculated for each participant to determine opioid usage. Although the total OME was similar for the groups overall, the total OME was slightly lower for THA patients that were enrolled in the intervention group (median 22.5) compared to THA patients that were enrolled in the control group (median 31.2). In the intervention group, 58% of participants reported that the lavender inhaler was a useful tool for pain management and 76% indicated they would continue to use the lavender inhaler after discharge.
Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence—A Randomized Trial
Authors: Grigoriadis Themos , Kalantzis Christos , Zacharakis Dimitrios , Kathopoulis Nikolaos , Prodromidou Anastasia , Xadzilia Sofia , Athanasiou Stavros
Published: July 2023

Importance

Urinary incontinence affects millions of women worldwide.

Objective

The aim of the current study was to evaluate the efficacy and safety of periurethral platelet-rich plasma (PRP) injections in women with stress urinary incontinence (SUI).

Study Design

This was a single-center, double-blind, randomized sham-controlled trial. Fifty participants with SUI and urodynamic stress incontinence were randomized in 2 equally sized groups. Women in the PRP group received 2 PRP injections at 3 levels of the urethra at 4- to 6-week intervals. Women in the sham group were injected with sodium chloride 0.9%. At baseline, participants underwent urodynamic studies and a 1-hour pad test and completed the International Consultation on Incontinence Questionnaire—Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Patient Global Impression Scale of Improvement, and the King's Health Questionnaire. At follow-up visits (1, 3, and 6 months), women underwent the 1-hour pad test and completed the King's Health Questionnaire and the ICIQ-FLUTS. Primary outcome was the subjective evaluation as indicated by the response to question 11a of the ICIQ-FLUTS questionnaire. Secondary outcomes included scores of questionnaires and urine loss assessed on the 1-hour pad test. The level of discomfort during injections and any adverse events were also evaluated.

Results

During follow-up, the mean score of the 11a question decreased significantly in the PRP group compared with sham. Subjective cure was significantly higher in the PRP group (32% vs 4%,P< 0.001). A significant reduction of urine loss assessed on the 1-hour pad test was observed in the PRP group compared with the sham group at 6-month follow-up. No adverse events were observed.

Conclusions

Periurethral PRP injections were superior to sham injections in improving SUI symptoms with an excellent safety profile.