bluuebunny/crossref_metadata_2025 huggingface dataset:
Blending Synchronous and Asynchronous Based on Visualization Strategy in Music Lesson to Promote Music Students’ Performance Skill
Authors: Chan Pui Leng  , Atan Noor Azean
Published: March 2024

During the COVID-19 pandemic, music lessons greatly impact teachers and students, especially the constraints of applying proper tools in online music lessons including delivering lessons, classroom interactions, and conducting assessments to ensure students’ learning goals attain a desired end. This research study aimed to examine the effect of blending synchronous and asynchronous music lessons based on visualization strategy towards students’ music performance skill. This research applies a quasi-experimental design where obtaining validation from teachers and experts on the learning activities through blended learning based on visualization strategy, Wilcoxon Signed Rank Test and Spearman Correlation for measuring the effectiveness of learning activities for music lesson based on blended learning approach towards student’s musical performance skill and achievement, and a quantitative design supported with quantitative data where descriptive statistics are used to examine the perception of student’s on learning activities based on blended learning using synchronous and asynchronous towards their performance skill. This study was conducted based on an experiment whereby students participated during their music lesson via synchronous and asynchronous with the support of visual media. Digital platform with learning activities was used to conduct the synchronous and asynchronous lessons, and student’s performance skill were measured in relation to learning effectiveness. Six weeks of planning evaluation variables were tested involved rubric scores according to students’ pre-activity and post-activity in addition to test the interrelationship of students’ achievement grading system during pre-test and post-test conducted. A questionnaire with items of 30 student’s perception on the learning activities based on blended learning using synchronous and asynchronous with visualization strategy towards music performance skill were brought forward after the completion of 5 weeks program. Using visualization strategy positively impacts students’ understanding and enhances their skill in music performance and music theory achievement. Nevertheless, there was no correlation between students’ music performance skill and music theory achievement in promoting students’ music performance skill. Based on the students’ perception, they were able to improve in music performance skill substantially developed from viewing visualized materials, understanding the concept of music performance skill, and implementing on their musical instruments. Teachers’ perceptions should be considered to provide expectations towards students’ motivation and accomplishment.
Practical Research on Flipped Classroom Teaching Model in College English Based on Production-Oriented Approach
Authors: Yang Min , Deris Farhana Diana
Published: March 2024

In the context of integrating technology into higher education and the widespread acceptance of a learning-centered philosophy, flipped learning (FL) is gaining popularity as a flexible new approach. To overcome the problem of input-output separation in the traditional text-centered teaching and learning paradigm in tertiary education in China, a flipped classroom teaching model based on the theory of the Production Oriented Approach (POA) was proposed and implemented for a vocational English course. Mixed research methods, including testing, questionnaire surveys, and interviews, were used to validate the effect of the model. Data analysis shows a notable enhancement in the mastery of new target language items among the experimental class that adopted the flipped classroom teaching model based on the POA. Moreover, this practice also has changed their learning behaviors both in and after class, increasing their time investment in learning and improving their performance and engagement in class, thus enhancing their autonomy in language learning. This study empirically supports the flipped classroom teaching model based on the POA. It aids in transforming traditional input-driven teaching into output-driven teaching and serves as a teaching reference for practitioner teachers.
The Influence of Alumina Particle Size on Sintered Density and Hardness of Discontinuous Reinforced Aluminum Metal Matrix Composite
Authors: Ahmad Khairel Rafezi , Jamaluddin Shamsul Baharin , Hussain Luay Bakir , Ahmad Zainal Ariffin
Published: March 2024

Kertas kerja ini melaporkan kesan saiz partikel alumina (Al2O3) terhadap sifatâ€“sifat komposit matriks logam aluminium (KML) difabrikasi melalui kaedah metalurgi serbuk. Serbuk campuran dipadatkan pada tekanan 250 MPa dan disinter pada suhu 600Â°C selama 5 jam. Sampel KML dihasilkan berdasarkan 10% berat Al2O3. Artikel ini akan membincangkan kesan saiz partikel alumina terhadap mikrostruktur, ketumpatan jasad sinter dan kekerasan komposit. Ketumpatan komposit yang telah disinter adalah dalam julat 2.78 gcmâ€“3 hingga 2.84 gcmâ€“3. Kesan saiz partikel Al2O3 (0.3 Î¼m, 1.0 Î¼m, 3.0 Î¼m, 12.5 Î¼m dan 25.0 Î¼m) ke atas mikrostruktur komposit diperhatikan menggunakan Mikroskop Imbasan Elektron. Nilai kekerasan diukur menggunakan penguji mirokekerasan Vickers. Pemerhatian menunjukkan bahawa partikel penguat halus (0.3 Î¼m) memberikan nilai kekerasan yang tertinggi (70.1 Hv). Partikel alumina yang halus akan mewujudkan penghalang terhadap kehelan yang lebih efisien di dalam komposit aluminium. Komposit yang diperkuat dengan saiz partikel yang kecil mempunyai bilangan penghalang per unit isipadu yang tinggi berbanding dengan komposit yang diperkuat dengan partikel yang bersaiz besar pada peratus berat penguat yang sama.

Kata kunci: Komposit matriks logam, matriks aluminium, alumina, saiz partikel, metalurgi serbuk

This paper reports the effect of alumina (Al2O3) particle size on the properties of aluminum metal matrix composite (MMC), fabricated via powder metallurgy route. Mixture powders were compacted at 250 MPa and sintered at 600Â°C for 5 hours. The MMC samples were prepared based on 10 wt% of Al2O3. This paper will discuss the effect of alumina particle size on microstructure, sintered density and hardness of the composite. The densities of sintered composites were in the range of 2.78 gcmâ€“3 to 2.84 gcmâ€“3. The effect of Al2O3 particles sizes (0.3 Î¼m, 1.0 Î¼m, 3.0 Î¼m, 12.5 Î¼m and 25.0 Î¼m) on the microstructure of the composites were observed using Scanning Electron Microscope (SEM). The hardness value was measured using Vickers microhardness tester. It is observed that the finest reinforcement particle size (0.3 Î¼m) gave the highest hardness value (70.1 Hv). The finer Al2O3 particles will provide more efficient barriers to dislocation flow in aluminum matrix. Composites reinforced with the smallest particle size have higher number of barriers per unit volume compared with composites reinforced with larger particle size at the same weight percentage.

Key words: Metal matrix composite, aluminum matrix, alumina, particle size, powder metallurgy
Landscape for Children to Play and Learn: A Conceptual Comparison Between Natural Stream and Playground
Authors: Said Ismail , Abu Bakar Mohd. Sarofil
Published: March 2024

Bermain dan bergerak adalah asas kehidupan kanakâ€“kanak. Bermain dengan elemen landskap semula jadi dan buatan membangunkan kemahiran kognitif, fizikal dan sosial kanakâ€“kanak. Pada persepsi kanakâ€“kanak, semua elemen fizikal dan kuasa iklim di dalam alam lingkungan berupaya merangsang deria mereka. Hanya dengan bermain, kemanfaatan atau keburukan elemen atau kuasa tersebut dapat difahami. Kanakâ€“kanak memahami landskap sebagai alam lingkungan secara tiga cara: kognitif, afektif, dan penilaian. Apabila seorang kanakâ€“kanak bergerak, deria mereka dirangsang secara langsung lantas mereka mendapat feedback dan affordances. Dua set landskap yang berbeza iaitu sungai dan taman permainan dianalisa untuk menghuraikan perbezaan dan persamaan ransangan, â€˜feedbackâ€™ dan â€˜affordancesâ€™. Penghuraian ini jelas menyatakan bahawa landskap adalah satu entiti ekologi yang dinamik. Pengalaman secara terus dengan landskap menghasilkan pembangunan kognitif, fizikal dan sosial kanak-kanak. Adalah wajar bagi kita meneliti kesan rangsangan, â€˜feedbackâ€™ dan â€˜affordancesâ€™ apabila mereka bentuk landskap untuk kanakâ€“kanak untuk pembangunan kemahiran kognitif, fizikal dan sosial mereka.

Kata kunci: Kanak-kanak, landskap semula jadi, taman permainan, kognitif, bermain, affordances

Playing and moving are the central of young childrenâ€™s lives. Allowing the children to experience the natural and manâ€“made elements in their living environment would generate cognitive, physical, and social skills development. To them natural forces such as rain and wind, natural features such as vegetation, animals and landform, and manâ€“made elements such as buildings and road are ubiquitous elements in their living environment. By playing with those elements, they learn to perceive their benefits or adversities. Mobility and perception in the landscape stimulate the childrenâ€™s senses and generate feedbacks as well as affordances. Through movement, the children perceive the landscape through three modes of learning which are cognitive, affective, and evaluative. Two contrasting landscape settings, a stream and a playground, are compared to explain the similarities and differences of stimulations, feedbacks, and affordances, and the modes of learning. The landscape is described as an ecological dynamic entity that through direct experience would generate the cognitive, physical and social developments of the children. In conclusion, it is important to design and develop landscapes for children that stimulate their senses, provide feedbacks and afford functional meanings to their cognitive, physical and social skills.

Key words: Children, natural landscape, playground, cognition, play, affordances
INFLUENCE OF THERMOMECHANICAL PROCESSING ON MICROMECHANICAL PROPERTIES OF SN-0.7CU SOLDER ALLOY VIA NANOINDENTATION APPROACH
Authors: Mohd Yusoff Fateh Amera , Jalar Azman
Published: March 2024

Sn-based solder alloys are commonly utilized in electronic packages as an interconnection. In this study, nanoindentation was used to explore the impact of thermomechanical processing on the micromechanical characteristics of Sn-0.7Cu solder alloy. Bar-shaped Sn-0.7Cu solder alloy was cut into 9 cubic-shaped samples with dimension of 6 mm (l) X 6 mm (w) X 10 mm (h). First, cubic-shaped Sn-0.7Cu solder alloys was heat-treated for 20 minutes at temperatures of 30°C, 90°C, and 150°C, followed by compression until the thickness reduced to 40% and 80% and quick quench in water medium. As a control, solder alloys without compression process are employed. The result shows that thermomechanical-processed samples with 80% thickness reduction have the least hardness changes along temperature increment. These values were 6.46 MPa (from 30℃ to 90℃) and 23.73 MPa (from 90℃ to 150℃), respectively. The smaller gap of values when temperature increased were obtained through formation of new recrystallize grains which also referred as grain refinemet. The reduced modulus for thermomehanical-procesed sample with 80% thickness reduction sample also showed the same trend as the hardness value. The value dropped from 56.22 GPa to 42.12 GPa before rising slightly to 48 GPa as the temperature increased. The change of reduced modulus values were lower when compared to control and thermomechanical-processed sample with 40% thickness reduction samples. The findings demonstrate that as the temperature rises, thermomechanical processing with an 80% thickness reduction stabilizes the micromechanical properties of the Sn-0.7Cu solder alloy.
CHARACTERIZATION OF REDUCED GRAPHENE OXIDE/ACTIVATED CARBON-BASED ELECTRODE CONTAINING MIXING CMC-SBR BINDER AND APPLICATION IN SUPERCAPACITOR
Authors: Azam Mohd Asyadi , Aziz M. F. , Adaham T. A. T. , Safie N. E. , Mupit M. , Takasaki Akito
Published: March 2024

In this work, variation of mixing a combination of carboxymethylcellulose (CMC) and styrene-butadiene rubber (SBR) as both used as the binder in the electrode has been studied. The purpose of using CMC-SBR as the binder in the electrode is to achieve a high supercapacitor performance. The electrode preparation has been carried out by mixing the reduced graphene oxide (rGO) and activated carbon (AC) in a blender. The binder preparation started by dissolving the CMC and SBR in the deionized water using a clean glass container. Then, rGO/AC has been stirred with the CMC-SBR for 60 minutes until a homogenous slurry formed. All electrodes have been characterized with Raman spectroscopy. The electrochemical tests such as cyclic voltammetry (CV) and galvanostatic charge-discharge (GCD) for all electrode compositions were performed. The electrode with 4:6 (in weight percentage) of CMC-SBR shows the highest specific capacitance (Csp) of 59.65 F g-1 (CV scan rate of 1 mV s-1) and 12.82 F g-1 from GCD test. This confirmed that the electrode containing 4 wt.% of CMC and 6 wt.% of SBR resulting in the best composition, which is reliable and practical for the supercapacitor application.
Comparison of the Kinematics and Laxity of Total Knee Arthroplasty Bearing Designs Stabilized With Specimen-Specific Virtual Ligaments on a Joint Motion Simulator
Authors: Vakili Samira , Lanting Brent , Getgood Alan , Willing Ryan
Published: March 2024

A variety of total knee arthroplasty (TKA) designs offer increased congruency bearing options, primarily to compensate for a loss of posterior cruciate ligament (PCL) function. However, their efficacy in providing sufficient stability under different circumstances requires further investigation. The preclinical testing of prosthesis components on joint motion simulators is useful for quantifying how design changes affect joint stability. However, this type of testing may not be clinically relevant because surrounding ligaments are either ignored or greatly simplified. This study aimed to assess the kinematics and stability of TKA joints during various motions using condylar-stabilized (CS) bearings without a PCL versus cruciate-retaining (CR) bearings with an intact PCL. TKA prosthetic components were tested on a joint motion simulator while being stabilized with five different sets of specimen-specific virtual ligament envelopes. In comparison to CR knees, CS knees without a PCL exhibited a greater amount of posterior tibial displacement laxity, with a mean increase of 2.7±2.1 mm (p = 0.03). Additionally, significant differences were observed in the anterior–posterior kinematics of the knee joint during activities of daily living (ADL) between the two designs. These results were consistent with previous cadaveric investigations, which indicated that CS knees without a PCL are less resistant to posterior tibial displacement than CR knees with one. This study employing virtual ligaments confirms previous findings that the raised anterior lip of some CS bearings may not completely compensate for the absence of the PCL; however, as both studies used reduced joint contact forces, the contributions of this design feature may be attenuated.
A Histomorphometric and Computational Investigation of the Stabilizing Role of Pectinate Ligaments in the Aqueous Outflow Pathway
Authors: Safa Babak N. , Fraticelli Guzmán Nina Sara , Li Guorong , Stamer W. Daniel , Feola Andrew J. , Ethier C. Ross
Published: March 2024

Murine models are commonly used to study glaucoma, the leading cause of irreversible blindness. Glaucoma is associated with elevated intra-ocular pressure (IOP), which is regulated by the tissues of the aqueous outflow pathway. In particular, pectinate ligaments (PLs) connect the iris and trabecular meshwork (TM) at the anterior chamber angle, with an unknown role in maintenance of the biomechanical stability of the aqueous outflow pathway, thus motivating this study. We conducted histomorphometric analysis and optical coherence tomography-based finite element (FE) modeling on three cohorts of C57BL/6 mice: “young” (2–6 months), “middle-aged” (11–16 months), and “elderly” (25–32 months). We evaluated the age-specific morphology of the outflow pathway tissues. Further, because of the known pressure-dependent Schlemm's canal (SC) narrowing, we assessed the dependence of the SC lumen area on varying IOPs in age-specific FE models over a physiological range of TM/PL stiffness values. We found age-dependent changes in morphology of outflow tissues; notably, the PLs were more developed in older mice compared to younger ones. In addition, FE modeling demonstrated that murine SC patency is highly dependent on the presence of PLs and that increased IOP caused SC collapse only with sufficiently low TM/PL stiffness values. Moreover, the elderly model showed more susceptibility to SC collapse compared to the younger models. In conclusion, our study elucidated the previously unexplored role of PLs in the aqueous outflow pathway, indicating their function in supporting TM and SC under elevated IOP.
Three-Dimensional X-Ray Computed Tomography Image Segmentation and Point Cloud Reconstruction for Internal Defect Identification in Laser Powder Bed Fused Parts
Authors: Xu Boyang , Ouidadi Hasnaa , Handel Nicole Van , Guo Shenghan
Published: March 2024

Defects shape, volume, and orientation all have a direct impact on the mechanical properties of Laser Powder Bed Fused (L-PBF-ed) parts. Therefore, it is necessary to evaluate and analyze the three-dimensional (3D) geometrical characteristics of these defects. X-ray Computed Tomography (XCT) can reveal an object's internal structure by volumetric scanning through its building direction. Point clouds are 3D data that can be extracted from the stack of XCT images taken from a part to perform further analysis. This study presents a novel approach for 3D segmentation and geometrical analysis of L-PBF defect structures from XCT images. The proposed method integrates Voronoi labeling and 3D point cloud reconstruction to reveal individual defect characteristics from the XCT image stack of a part. A case study showed the proposed methodology's effectiveness in identifying and characterizing defect regions in L-PBF-ed Cobalt-Chrome (CoCr) parts.
Efficient Voxel-Based Workpiece Update and Cutter-Workpiece Engagement Determination in Multi-Axis Milling
Authors: Nie Zhengwen , Feng Hsi-Yung
Published: March 2024

This paper presents a new method to efficiently update workpiece and determine cutter-workpiece engagement (CWE) in multi-axis milling simulation based on a uniform voxel modeling space. At each cutter location, a novel algorithm named direct voxel tracing is developed and used to generate a functional cutter surface voxel model to reliably establish the internal space of the milling cutter. The cutter internal space is represented by its voxel boundary with small memory usage. Through the Boolean subtraction between two successive voxel boundaries of the cutter internal space, a minimal voxel deactivation region is attained within which all active workpiece voxels are deactivated (removed) to update the workpiece model. To determine the associated CWE map, a 3D circle voxelization algorithm is employed. By slicing the cutter surface by a sequence of planes perpendicular to and along the cutter axis, CWE can be determined as the sliced 3D circles are voxelized. Quantitative comparisons of the proposed method against existing voxel modeling and vector modeling-based methods have been made. The results have demonstrated much improved computational efficiency of the proposed method in simulating the complex multi-axis milling operations.
Gender Differences in Physical Activity and Health-Related Authorships Between 1950 and 2019
Authors: Kohn Eduardo Ribes , Hallal Pedro Curi , Niño-Cruz Gloria Isabel , Almentero Julia , Pinzón Diana , Böhlke Maristela , Siefken Katja , Pratt Michael , Ramirez-Varela Andrea
Published: March 2024

Background: The objective of this study was to investigate gender differences in authorship in physical activity and health research. Methods: A bibliometric study including 23,399 articles from 105 countries was conducted to estimate the participation of female researchers in physical activity publications from 1950 to 2019. The frequency of female researchers was analyzed and classified by first and last authors and the overall percentage of female authors by region and country. Results: The proportion of female first authors increased from <10% in the 50s and 80s to 55% in the last decade. On the other hand, the proportion of last authors increased from 8.7% to 41.1% in the same period. Most publications with female researchers were from the United States, Canada, Australia, Brazil, the Netherlands, Spain, England, Germany, Sweden, and China. Nine of these countries had over 50% of the articles published by female first authors. However, in all 10 countries, <50% of the articles were published by female last authors. Conclusions: The proportion of female researchers increased over time. However, regional differences exist and should be addressed in gender equity policies. There is a gap in the participation of female researchers as last authors. By actively addressing the gender gap in research, the global society can harness the full potential of all talented individuals, regardless of gender, leading to more inclusive and impactful scientific advancements.
Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series
Authors: Hortz Brian V. , Falsone Sue
Published: March 2024

Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.
Kinesiotaping Is Not Better Than a Placebo: Kinesiotaping for Postural Control in Anterior Cruciate Ligament-Reconstructed Patients—A Randomized Controlled Trial
Authors: Nazary-Moghadam Salman , Abbasi Zahra , Sekandari Reyhaneh , Razi Amin , Zeinalzadeh Afsaneh , Rostami Somayyeh , Khabbaz Kababi Mohammad Hossein
Published: March 2024

Objective: The primary aim of this study was to investigate the immediate and delayed effects of kinesiotape (KT) on postural control and patient-reported outcome measures under challenging conditions in individuals with anterior cruciate ligament reconstructions. Methods: Thirty-two anterior cruciate ligament-reconstructed patients for whom 6 months had passed since their operation were randomly assigned to either the KT (n = 16, aged 21.8 [5.5] y) or the placebo KT (n = 16, aged 24.0 [5.1] y) groups. Initially, both groups stood barefoot on a force platform while performing postural tasks in 4 randomized conditions (eyes open, eyes closed, cognitive task, and foam). Before the experiment, patients would bring the 4 conditions, which were written on folded papers, one by one, and in this way, the order of conditions for the examiners was determined. The patients’ evaluations were conducted immediately and 48 hours after KT application. Postural control measures, with area and displacement of the center of pressure (CoP) in anterior–posterior and medial–lateral directions, and mean total velocity displacement of CoP (MVELO CoP) served as dependent variables. In addition, the International Knee Documentation Committee score was measured pretreatment and 48 hours posttreatment. Results: Significant group-by-time interactions were observed for displacement of COP in medial–lateral direction (P = .002) and MVELO CoP (P = .034). MVELO CoP significantly decreased (mean difference = 0.60, P = .009) immediately after KT application compared with preapplication measures. In the placebo group, a statistically significant decrease in MVELO CoP (mean difference = 0.869, P = .001) was observed at 48 hours post-KT compared with preapplication values. International Knee Documentation Committee scores significantly improved at 48 hours post-KT application in both groups (P < .05). Conclusions: Though observed at different time points, both KT (immediately after the intervention) and placebo KT (48 h after the intervention) were found to improve postural control measures. It appears that the changes in postural control may be more related to proprioceptive enhancement due to KT rather than the specific KT pattern.
Evaluating Change in Body Composition and Impact of Menarche Across a Competitive Season in Elite Collegiate Gymnasts
Authors: Moore Sam R. , Cabre Hannah E. , Gordon Amanda N. , Smith-Ryan Abbie E.
Published: March 2024

The purpose of this study was to evaluate change in bone mineral density (BMD), BMD percentile (BMDp), lean mass (LM), fat-free mass index, body fat percentage (BF%), and muscle size (mCSA) and quality (EI) in collegiate female gymnasts over a competitive season and characterize the impact of menarche on changes. Twenty gymnasts completed a validated survey to assess age of menarche. Body composition was assessed via whole-body dual-energy X-ray absorptiometry scans at pre- and postseason. mCSA and EI were determined from a panoramic ultrasound scan of the vastus lateralis. Pre- to postseason changes were evaluated using paired sample t tests, and strength of relationships between were analyzed via bivariate correlations and linear regression. Significant losses in body fat percentage (Δ -1.1 ± 1.9%; p = .022) and EI (Δ -5.0 ± 5.8 a.u.; p = .002) were observed. No significant changes were observed in BMDp, mCSA, BMD, LM, or fat-free mass index (p = .310–.869). Age of menarche (15.4 ± 1.5 years) was negatively correlated with Δ BMDp (r = −.454; p = .044) and Δ mCSA (r = −.658; p = .002), explaining 21% and 43% of variation in Δ BMDp and Δ mCSA, respectively. Positive outcomes of gymnastics training, such as gains in LM and mCSA, may be attenuated by delayed menarche, suggested by increased EI and decreased body fat percentage, despite no changes in mCSA or overall LM. These findings may indicate a higher priority of fat utilization within the muscle over muscle and bone growth. Considering menarche as a significant predictor for Δ mCSA, this lack of increase (despite improved EI), may signify increased injury risk resulting from team-specific training style or insufficient energy intake to support appropriate muscle growth.
Glucosylceramide accumulation in microglia triggers STING-dependent neuroinflammation and neurodegeneration in mice
Authors: Wang Rui , Sun Hongyang , Cao Yifan , Zhang Zhixiong , Chen Yajing , Wang Xiying , Liu Lele , Wu Jin , Xu Hao , Wu Dan , Mu Chenchen , Hao Zongbing , Qin Song , Ren Haigang , Han Junhai , Fang Ming , Wang Guanghui
Published: March 2024

Mutations in the gene encoding the lysosomal enzyme glucocerebrosidase (GCase) are responsible for Gaucher disease (GD) and are considered the strongest genetic risk factor for Parkinson’s disease (PD) and Lewy body dementia (LBD). GCase deficiency leads to extensive accumulation of glucosylceramides (GCs) in cells and contributes to the neuropathology of GD, PD, and LBD by triggering chronic neuroinflammation. Here, we investigated the mechanisms by which GC accumulation induces neuroinflammation. We found that GC accumulation within microglia induced by pharmacological inhibition of GCase triggered STING-dependent inflammation, which contributed to neuronal loss both in vitro and in vivo. GC accumulation in microglia induced mitochondrial DNA (mtDNA) leakage to the cytosol to trigger STING-dependent inflammation. Rapamycin, a compound that promotes lysosomal activity, improved mitochondrial function, thereby decreasing STING signaling. Furthermore, lysosomal damage caused by GC accumulation led to defects in the degradation of activated STING, further exacerbating inflammation mediated by microglia. Thus, limiting STING activity may be a strategy to suppress neuroinflammation caused by GCase deficiency.
The human microbiota is a beneficial reservoir for SARS-CoV-2 mutations
Authors: Cao Birong , Wang Xiaoxi , Yin Wanchao , Gao Zhaobing , Xia Bingqing
Published: March 2024

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations are rapidly emerging. In particular, beneficial mutations in the spike (S) protein, which can either make a person more infectious or enable immunological escape, are providing a significant obstacle to the prevention and treatment of pandemics. However, how the virus acquires a high number of beneficial mutations in a short time remains a mystery. We demonstrate here that variations of concern may be mutated due in part to the influence of the human microbiome. We searched the National Center for Biotechnology Information database for homologous fragments (HFs) after finding a mutation and the six neighboring amino acids in a viral mutation fragment. Among the approximate 8,000 HFs obtained, 61 mutations in S and other outer membrane proteins were found in bacteria, accounting for 62% of all mutation sources, which is 12-fold higher than the natural variable proportion. A significant proportion of these bacterial species—roughly 70%—come from the human microbiota, are mainly found in the lung or gut, and share a composition pattern with COVID-19 patients. Importantly, SARS-CoV-2 RNA-dependent RNA polymerase replicates corresponding bacterial mRNAs harboring mutations, producing chimeric RNAs. SARS-CoV-2 may collectively pick up mutations from the human microbiota that change the original virus’s binding sites or antigenic determinants. Our study clarifies the evolving mutational mechanisms of SARS-CoV-2.

IMPORTANCE

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations are rapidly emerging, in particular advantageous mutations in the spike (S) protein, which either increase transmissibility or lead to immune escape and are posing a major challenge to pandemic prevention and treatment. However, how the virus acquires a high number of advantageous mutations in a short time remains a mystery. Here, we provide evidence that the human microbiota is a reservoir of advantageous mutations and aids mutational evolution and host adaptation of SARS-CoV-2. Our findings demonstrate a conceptual breakthrough on the mutational evolution mechanisms of SARS-CoV-2 for human adaptation. SARS-CoV-2 may grab advantageous mutations from the widely existing microorganisms in the host, which is undoubtedly an “efficient” manner. Our study might open a new perspective to understand the evolution of virus mutation, which has enormous implications for comprehending the trajectory of the COVID-19 pandemic.
Simultaneous Presentation of Takayasu Arteritis and Crohn’s Disease in a Middle-Aged Patient: Are they two sides of the same coin?
Authors: Suyamburajan Swathi , Bhat Rama , Rao Raghavendra , Srilatha Parampalli Srilatha
Published: March 2024

Autoimmune disorders have a wide spectrum of symptoms, often with multiorgan involvement. Multiple autoimmune disorders also often occur concurrently in the same patient. These two possibilities must be distinguished in patients with multiorgan involvement to ensure early diagnosis and treatment. Here, we report a case of a previously healthy man who presented with simultaneous Takayasu arteritis and Crohn’s disease. He presented with heart failure with reduced ejection fraction and severe aortic regurgitation. An echocardiogram demonstrated a greatly dilated aorta, and a diagnosis of Takayasu arteritis was made, confirmed with CT aortogram. Inpatient treatment was begun, but the patient subsequently developed bloody diarrhoea a few days after admission. Colonoscopy done to locate the source of bleeding showed colonic ulcers; a biopsy confirmed a diagnosis of Crohn’s disease. The patient was successfully managed with medical management of heart failure, steroids, mesalamine and azathioprine, and has been in remission for the last 2 years.
Dengue-associated longitudinally extensive transverse myelitis
Authors: Kumar Naresh , Mishra Rashmi , Bargali Arun , Bhavana Rajam Iyer
Published: March 2024

We diagnosed a patient with dengue fever who developed acute onset of sensorimotor quadriparesis with bladder involvement, and facial nerve involvement. Despite initial negative results in routine investigations and cerebrospinal fluid analysis, spinal MRI confirmed longitudinally extensive transverse myelitis. The aetiological workup was negative, prompting an investigation into the presence of dengue in the cerebrospinal fluid, which returned positive. This case underscores the importance of considering rare neurological complications in dengue, the value of advanced diagnostic techniques and the potential effectiveness of tailored interventions in challenging cases.
Educommunication in nutrition and neurodegenerative diseases: a scoping review protocol
Authors: Coutinho Karla Monica Dantas , Vale Sancha Helena de Lima , Bezerril Manaces Santos , Reis Monica Karina Santos , Leite-Lais Lucia , Lima Kenio Costa
Published: March 2024

Introduction

Neurodegenerative diseases affect the nervous system and are characterised by the deterioration and/or death of neurons. Nutrition care is essential for maintaining an adequate nutritional status, which influences the prognosis and survival of patients with neurological diseases. Caregivers participate assiduously in the care of these patients and must be integrated into the multidisciplinary team. They often need specific training or knowledge regarding food and nutrition to perform their roles with patients. Health educommunication is a learning tool that can positively influence the appropriation of the theme and the construction of care autonomy. This scoping review (ScR) will map educommunication actions/strategies in nutrition and neurodegenerative diseases.

Methods and analysis

This ScR will be designed based on the methodology of Arksey and O'Malley and will follow the methodological guidance for conducting a Joanna Briggs Institute ScR. The research question addressed by the scoping review will be: what actions/strategies for educommunication in nutrition and neurodegenerative diseases have been developed for patients or caregivers? Many search sites it will be used in this review, such as electronic databases (Embase, PubMed/MEDLINE, Scopus, Web of Science), Google Scholar and grey literature sources. No restrictions of date or language will be applied to the search strategy. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data, including the study design, objective, study population, neurodegenerative diseases, nutrition topics and educommunication strategies will be logically organised and tabulated in Microsoft Excel.

Ethics and dissemination

The data used for this review are from secondary sources and available to the public; thus, no ethical approval and human consent will be required for this study. Dissemination of the results will be published in a peer-reviewed journal and presented at conferences.
Community health workers for health systems resilience during COVID-19: protocol for qualitative evidence synthesis
Authors: Adsul Neha , Tyagi Jyoti , Bhaumik Soumyadeep
Published: March 2024

Introduction

COVID-19 exposed the fragility of health systems, where even the most basic health services in high-income and low-income and middle-income nations could not withstand the health systems shock due to the pandemic. Community health workers (CHWs) can contribute to improving the resilience of health systems, specifically to withstand shocks and emergencies and to avoid disruptions of routine service delivery. We aim to explore and understand the ‘individual’ and ‘systems-level’ resilience factors that shaped the involvement of CHWs in the COVID-19 response.

Methods and analysis

We will search five electronic databases (PubMed, Cochrane Library, EMBASE, CINAHL and SciELO (Spanish)) and conduct citation screening to identify studies on CHWs’ response during the COVID-19 pandemic. Two review authors will independently screen the studies for inclusion and to extract data. The software Rayyan will be used to assist in screening the relevant literature. A thematic analysis approach will be followed to analyse and synthesise the qualitative evidence. The quality of the included studies will be critically assessed using the Critical Skills Appraisal Programme Tool. We will use the GRADE CERQual(Grading of Recommendations, Assessment, Development, and Evaluations - Confidence in the Evidence from Reviews of Qualitative Research) approach to assess certainty in the synthesised findings of the qualitative evidence.

Ethics and dissemination

This study will be conducted on published evidence, with no living participants; thus, no ethical approval is required. The final review will be submitted and published in a peer-reviewed journal. We will also develop a policy brief to communicate the review findings to the stakeholders.
Nomogram for predicting moderate-to-severe sleep-disordered breathing in patients with acute ischaemic stroke: a retrospective cohort study
Authors: Gu Yang , Xie Junchao , Liu Xueyuan , Zhou Xiaoyu
Published: March 2024

Objectives

Moderate-to-severe sleep-disordered breathing (SDB) is prevalent in patients with acute ischaemic stroke (AIS) and is associated with an increased risk of unfavourable prognosis. We aimed to develop and validate a reliable scoring system for the early screening of moderate-to-severe SDB in patients with AIS, with the objective of improving the management of those patients at risk.

Study design

We developed and validated a nomogram model based on univariate and multivariate logistic analyses to identify moderate-to-severe SDB in AIS patients. Moderate-to-severe SDB was defined as an apnoea-hypopnoea index (AHI) ≥15. To evaluate the effectiveness of our nomogram, we conducted a comparison with the STOP-Bang questionnaire by analysing the area under the receiver operating characteristic curve.

Setting

Large stroke centre in northern Shanghai serving over 4000 inpatients, 100 000 outpatients and emergency visits annually.

Participants

We consecutively enrolled 116 patients with AIS from the Shanghai Tenth People’s Hospital.

Results

Five variables were independently associated with moderate-to-severe SDB in AIS patients: National Institutes of Health Stroke Scale score (OR=1.20; 95% CI 0.98 to 1.47), neck circumference (OR=1.50; 95% CI 1.16 to 1.95), presence of wake-up stroke (OR=21.91; 95% CI 3.08 to 156.05), neuron-specific enolase level (OR=1.27; 95% CI 1.05 to 1.53) and presence of brainstem infarction (OR=4.21; 95% CI 1.23 to 14.40). We developed a nomogram model comprising these five variables. The C-index was 0.872, indicated an optimal agreement between the observed and predicted SDB patients.

Conclusions

Our nomogram offers a practical approach for early detection of moderate-to-severe SDB in AIS patients. This tool enables individualised assessment and management, potentially leading to favourable outcomes.
Effectiveness of metformin to pregnant women with PCOS to reduce spontaneous abortion and gestational diabetes mellitus: a protocol for an overview of reviews
Authors: Nassif Darmaris Souza , Januário Bianca Lúcia , Sousa Bianca Antunes , Thabane Lehana , Abbade Joelcio Francisco
Published: March 2024

Introduction

Polycystic ovary syndrome (PCOS) is a globally prevalent endocrinological disorder and has been associated with poor pregnancy outcomes, including a higher rate of gestational diabetes and miscarriage. Metformin is among the drugs investigated to improve the prognosis of pregnant women with PCOS.

Objective

To conduct an overview of systematic reviews examining the effects of metformin versus placebo or no intervention throughout pregnancy among pregnant women with a preconception PCOS diagnosis to reduce the incidence of miscarriage and gestational diabetes.

Methods and analysis

We will perform an overview of systematic reviews by searching Embase, PubMed, Virtual Health Library, Cochrane Central Register of Controlled Trials, Trip Database, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature from inception to 17 August 2023. Language, publication status and year indexed or published filters will not be applied. Two reviewers will independently screen and select papers, assess their quality, evaluate their risk of bias and collect the data. The included reviews will be summarised narratively. The quality and risk of bias of the systematic review and meta-analysis studies included will be assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Second Version) and ROBIS (Risk of Bias in Systematic Reviews), respectively.

Ethics and dissemination

This overview of reviews will analyse data from systematic reviews on the use of metformin for prepregnancy diagnosis of PCOS to reduce adverse outcomes. As there will be no primary data collection, a formal ethical analysis is unnecessary. The study outcomes will be submitted to a peer-reviewed journal and presented at conferences.

PROSPERO registration number

CRD42023441488.
Intercostal nerve cryoablation versus thoracic epidural analgesia for minimal invasive Nuss repair of pectus excavatum: a protocol for a randomised clinical trial (ICE trial)
Authors: Janssen Nicky , Daemen Jean H T , Franssen Aimée J P M , van Polen Elise J , van Roozendaal Lori M , Hulsewé Karel W E , Vissers Yvonne , de Loos Erik R
Published: March 2024

Introduction

Epidural analgesia is currently considered the gold standard in postoperative pain management for the minimally invasive Nuss procedure for pectus excavatum. Alternative analgesic strategies (eg, patient-controlled analgesia and paravertebral nerve block) fail in accomplishing adequate prolonged pain management. Furthermore, the continuous use of opioids, often prescribed in addition to all pain management strategies, comes with side effects. Intercostal nerve cryoablation seems a promising novel technique. Hence, the primary objective of this study is to determine the impact of intercostal nerve cryoablation on postoperative length of hospital stay compared with standard pain management of young pectus excavatum patients treated with the minimally invasive Nuss procedure.

Methods and analysis

This study protocol is designed for a single centre, prospective, unblinded, randomised clinical trial. Intercostal nerve cryoablation will be compared with thoracic epidural analgesia in 50 young pectus excavatum patients (ie, 12–24 years of age) treated with the minimally invasive Nuss procedure. Block randomisation, including stratification based on age (12–16 years and 17–24 years) and sex, with an allocation ratio of 1:1 will be performed.

Postoperative length of hospital stay will be recorded as the primary outcome. Secondary outcomes include (1) pain intensity, (2) operative time, (3) opioid usage, (4) complications, including neuropathic pain, (5) creatine kinase activity, (6) intensive care unit admissions, (7) readmissions, (8) postoperative mobility, (9) health-related quality of life, (10) days to return to work/school, (11) number of postoperative outpatient visits and (12) hospital costs.

Ethics and dissemination

This protocol has been approved by the local Medical Ethics Review Committee, METC Zuyderland and Zuyd University of Applied Sciences. Participation in this study will be voluntary and informed consent will be obtained. Regardless of the outcome, the results will be disseminated through a peer-reviewed international medical journal.

Trial registration number

NCT05731973.
COVID-19 vaccine uptake in Skåne county, Sweden, in relation to individual-level and area-level sociodemographic factors: a register-based cross-sectional analysis
Authors: Mitchell Adam , Inghammar Malin , Bennet Louise , Östergren Per-Olof , Moghaddassi Mahnaz , Björk Jonas
Published: March 2024

Objectives

Better understanding of societal factors associated with COVID-19 vaccination can have important implications for public health policy to increase uptake.

Methods

This study investigated sociodemographic determinants of COVID-19 vaccine uptake with ≥2 doses vs 0 doses, and ≥3 doses vs 2 doses, among adults (≥18 years) in a general population from Sweden followed from 27 December 2020 (n=1 064 548 at the present cross-section—12 June 12 2022). Associations between individual-level and area-level sociodemographic factors and vaccine uptake were modelled with logistic regression, with average marginal effects and estimated proportion vaccinated subsequently estimated.

Results

Being vaccinated with ≥2 doses vs 0 doses was positively associated with education (tertiary vs primary, OR 1.5, 95% CI 1.3 to 1.7), household disposable income (Q5 vs Q1, OR 2.3; 95% CI 1.9 to 2.7), comorbidities (≥2 doses vs none, OR 1.9, 95% CI 1.8 to 1.9) and residential area type (affluent socioeconomic conditions vs poor, OR 2.0, 95% CI 1.6 to 2.4). Whereas, being born outside Sweden was associated with a lower uptake (low and middle-income countries vs Swedish born, OR 0.6, 95% CI 0.5 to 0.7). The associations were generally similar when comparing booster vs remaining on only two doses. From these ORs, there were consistent differences in the estimated proportion vaccinated both for ≥2 doses and booster vaccination. Absolute changes in percentage vaccinated between affluent and poor areas were largely similar across individual country of birth, income and education, both for at least two doses and for the booster doses.

Conclusions

COVID-19 vaccine uptake was associated with higher sociodemographic classifications both at the individual level and area level. The predicted proportion vaccinated increased with more affluent socioeconomic conditions and concurrent increases in individual household income were the strongest indicators. This sociodemographic selection showed consistency with respect to entering (obtaining ≥2 doses) and remaining (obtaining at least one booster dose) in the vaccination programme.