bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracellular TAS2Rs act as a gatekeeper for the excretion of harmful substances via ABCB1 in keratinocytes
Authors: Mori Sazanami , Nakamura Natsuki , Fuchigami Ayane , Yoshimoto Satoshi , Sakakibara Moe , Ozawa Toshiyuki , Aoki Junken , Inoue Asuka , Sumida Hayakazu , Ando Hideya , Nakamura Motonao
Published: August 2024

Bitter taste receptors (TAS2Rs) are not only expressed in the oral cavity but also in skin. Extraoral TAS2Rs are thought to be involved in non‐taste perception and tissue‐specific functions. Keratinocytes that express TAS2Rs in the skin provide a first‐line defense against external threats. However, the functional roles of these receptors in host defense remain unclear. Here, we demonstrated the sensory role of intracellularly located TAS2Rs against toxic substances in keratinocytes. Although many G protein‐coupled receptors elicit signals from the surface, TAS2Rs were found to localize intracellularly, possibly to the ER, in human keratinocytes and HaCaT cells. TAS2R38, one of the TAS2R members, activated the Gα12/13/RhoA/ROCK/p38 MAP kinase/NF‐κB pathway upon stimulation by phenylthiocarbamide (PTC), an agonist for this receptor, leading to the production of ABC transporters, such as ABCB1, in these cells. Notably, treatment with bitter compounds, such as PTC and saccharin, induced the upregulation of ABCB1 in HaCaT cells. Mechanistically, intracellular TAS2R38 and its downstream signaling Gα12/13/RhoA/ROCK/p38 MAP kinase/NF‐κB pathway were identified to be responsible for the above effect. Pretreatment with PTC prevented the accumulation of rhodamine 123 because of its excretion via ABCB1. Furthermore, pretreatment with PTC or saccharin counteracted the effect of the toxic compound, diphenhydramine, and pretreated HaCaT cells were found to proliferate faster than untreated cells. This anti‐toxic effect was suppressed by treatment with verapamil, an ABCB1 inhibitor, indicating that enhanced ABCB1 helps clear toxic substances. Altogether, harmless activators of TAS2Rs may be promising drugs that enhance the excretion of toxic substances from the human skin.
Neurocognitive changes in a patient receiving esketamine for treatment-resistant depression
Authors: Kundert Carolyn F. , Sobule Robert M. , Ithman Muaid
Published: August 2024

Esketamine, the s(+) enantiomer of ketamine, was approved in 2019 as the first rapid-acting intranasal spray medication for treatment-resistant depression; the drug is given in combination with an antidepressant. The treatment is self-administered in a clinical setting under the supervision of a healthcare provider and usually is well tolerated. Many of its adverse reactions are mild, temporary, and dose-dependent, and they improve with subsequent treatments. Although the prescribing information lists difficulty remembering or thinking as possible adverse reactions, a neurocognitive evaluation is not part of the initial patient evaluation. This case report focuses on a patient whose neurocognitive symptoms worsened with esketamine treatment, necessitating treatment discontinuation.
Understanding the gastrointestinal microbiome in systemic sclerosis: methodological advancements and emerging research
Authors: Haussmann Alana J. , McMahan Zsuzsanna H. , Volkmann Elizabeth R.
Published: August 2024

Purpose of review

This review highlights the role of the gastrointestinal (GI) microbiome in systemic sclerosis (SSc). We describe techniques for evaluating the GI microbiome in humans, and emerging research linking GI microbiome alterations (i.e., dysbiosis) and distinct SSc clinical manifestations. We also address the evolving treatment landscape targeting dysbiosis in SSc.

Recent findings

Recent literature brings into focus the complex relationship between the GI microbiome and SSc pathogenesis. Advanced techniques (e.g., shotgun metagenomics, meta-transcriptomics) provide deeper insights into microbial taxonomy and active gene expression, exposing dysbiosis as a potential driver of SSc. New studies demonstrate that SSc patients who possess specific SSc clinical features, (e.g., interstitial lung disease), have unique GI microbiome profiles.

Dysbiosis is associated with specific clinical features in patients with SSc. New tools for studying the GI microbiome have furthered our understanding of the relationship between dysbiosis and SSc complications. Therapeutic avenues such as dietary adjustments, probiotics, antibiotics, mindfulness practices, and fecal transplants offer potential for managing SSc and preventing its progression through GI microbiome modulation. By clarifying what is known about the relationship between the GI dysbiosis, GI dysfunction, and SSc, this review enhances our understanding of SSc pathogenesis and proposes targeted interventions.
Interprofessional Education Opportunities for Health Care Educators in the Practice Setting: An Integrative Review
Authors: Dolan Sara , Nowell Lorelli
Published: August 2024

Introduction:

Health care educators in the practice setting are responsible for providing education to frontline staff and require knowledge and skills to interact with interprofessional health care providers and teach content in an effective way. Interprofessional education opportunities for health care educators in the practice setting may be helpful in preparing educators to meet the needs of frontline staff, yet the extant state of literature on this topic has not been recently synthesized. In this integrative review, we aimed to explore what is known about interprofessional education opportunities offered to health care educators who are responsible for educating other health care professionals in practice settings and assess how these education opportunities were described and evaluated in the literature.

Methods:

We conducted an integrative literature review following the methodology put forth by Toronto and Remington.

Results:

Of the 3690 publications identified, 30 met our inclusion criteria. Overall, the publications lacked rigorous methodology. Education interventions varied in content, duration, and teaching strategies. Key findings were identified: (1) educator satisfaction and content relevance, (2) impact on knowledge, skills, and confidence, (3) impact on teaching practice, (4) impact on clinical practice, (5) impact on interprofessional competencies and attitudes, (6) challenges to implementing interprofessional education opportunities, and (7) facilitators to implementing interprofessional education opportunities.

Discussion:

Although interprofessional education opportunities for health care educators in the practice setting may be beneficial to educators and the frontline staff they serve, more rigorous research is needed to understand how these opportunities can influence teaching and clinical practice.
Neurokinin receptor antagonists as potential nonhormone treatments for vasomotor symptoms
Authors: Santoro Nanette
Published: August 2024

Managing menopause symptoms is challenging for women unable or unwilling to take hormone therapy. All nonhormone options thus far have shown less overall efficacy compared with hormone therapy and significant adverse events that limit their use. New science has identified the source of vasomotor symptoms, achieving relief of these bothersome symptoms by directly targeting the neurokinin 3 receptor and its related pathways. ThisPractice Pearlreviews the clinical data available on neurokinin receptor antagonists.
The Impact of Femtosecond Laser on Intraocular Pressure With Cataract Surgery in Healthy Eyes
Authors: Mathalone Nurit , Ben-Shaul Or , Podkovyrin Olga , Lux Chen , Geyer Orna
Published: August 2024

Précis:

Femtosecond laser-assisted cataract surgery (FLACS) leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP.

Purpose:

To evaluate the effect of FLACS using the LDVZ8 laser on IOP during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS).

Patients and Methods:

This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a 6-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed.

Results:

The mean IOP increase after docking was 2.3±4.1 mm Hg (P<0.0001); the maximum increase was 17.6 mm Hg, peak of 38 mm Hg. Sixty-one eyes (25.1%) demonstrated an increase of ≥5 mm Hg and 10 (3.7%) showed an increase of ≥10 mm Hg; predocking IOP was associated with an IOP increase of ≥5 mm Hg (P=0.029). IOP reduction over 6 months postsurgery was similar for FLACS and CPCS (P>0.05), −1.33±3.12 mm Hg for FLACS (P<0.001) and −1.4±2.87 mm Hg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β −0.742, P<0.001) and CPCS (β −0.743, P<0.001).

Conclusions:

Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.
An urgent invasion: lower mandible Ewing’s sarcoma and unleashed massive abscess – a case report study
Authors: Faraji Navid , Goli Rasoul , Bahrami Soheyla , Shaddeli Sevda
Published: August 2024

Introduction and importance:

Ewing’s sarcoma (ES) is a rare and aggressive bone tumor that can affect any bone but is particularly rare when it involves the mandible. Mandible ES often presents with nonspecific symptoms and requires a multimodal approach to treatment.

Case presentation:

This case involves a 19-year-old woman who had ES of the mandible. At the initial stage, she stated that she was bothered by a small round mass that caused her discomfort during chewing. The first examination by a specialist required a more detailed examination by biopsy, which the immunohistochemistry results confirmed the diagnosis of ES based on this detailed information.

Clinical discussion:

Mandible ES is a rare and aggressive bone tumor that requires early diagnosis and prompt multimodal management to achieve good outcomes. Despite being a challenging diagnosis, histologic evaluation and molecular testing have revolutionized the diagnosis and management of these tumors in recent years.

Conclusion:

By the way of conclusion, recognizing the importance of early diagnosis and aggressive multimodal management, clinicians and researchers should continue to work collaboratively to improve the management of mandible ES and enhance outcomes for affected patients.
A systematic review and meta-analysis of hip preservation osteotomy in osteonecrosis of femoral head
Authors: Triangga Aditya F.R. , Magetsari Rahadyan , Muhammad Hilmi , Putra Satria P. , Fazatamma Dandy A. , Saraswati Paramita A. , Huwaidi A. Faiz
Published: August 2024

Background:

Osteonecrosis of the femoral head occurs when there is insufficient vascularization of the femoral head, leading to bone cell death and potential bone collapse. Osteotomy is a hip preservation procedure often reserved for young patients. Necrotic lesion size and site are believed to be crucial factors in predicting the outcome of the procedure.

Methods:

The authors performed this systematic review in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 statement. The review protocol had been registered on PROSPERO. A literature search was performed using electronic databases including studies published within the past 10 years. As our objective was to examine the correlation between preoperative necrotic size and osteotomy outcome, the authors focused on patients with early-stage osteonecrosis of the femoral head who underwent rotational or angular preservation osteotomy. The Newcastle–Ottawa Quality Assessment Scale was utilized to assess the included studies’ quality.

Results:

Of the 1217 articles initially identified, 18 met the inclusion criteria. Pooled data of 78 hips showed favorable outcomes in Kerboul Angle <200o group with an OR 0.06 (95% CI: 0.01–0.39). Meanwhile, pooled 276 hips were assessed using the JIC type yielded in an OR 0.55 (95% CI: 0.10–2.9), which showed better outcomes for hips with JIC types A, B, and C1.

Conclusion:

A consensus on eligibility based on necrosis quantification has not been reached when choosing an osteotomy procedure. The ability to predict osteotomy outcomes in patients diagnosed with JIC type A-C1 and a Kerboul angle <200° remains uncertain. It is important to note that prior recommendations to perform osteotomy based on these parameters may still hold relevance attributable to the low importance of the statistical data obtained.
Impaired pain in mice lacking first-order posterior medial thalamic neurons
Authors: Sgourdou Paraskevi , Schaffler Melanie , Choi Kyuhyun , McCall Nora M. , Burdge Justin , Williams Joelle , Corder Gregory , Fuccillo Marc V. , Abdus-Saboor Ishmail , Epstein Douglas J.
Published: August 2024

The thalamus plays an important role in sensory and motor information processing by mediating communication between the periphery and the cerebral cortex. Alterations in thalamic development have profound consequences on sensory and motor function. In this study, we investigated a mouse model in which thalamic nuclei formation is disrupted because of the absence of Sonic hedgehog (Shh) expression from 2 key signaling centers that are required for embryonic forebrain development. The resulting defects observed in distinct thalamic sensory nuclei in Shh mutant embryos persisted into adulthood prompting us to examine their effect on behavioral responses to somatosensory stimulation. Our findings reveal a role for first-order posterior medial thalamic neurons and their projections to layer 4 of the secondary somatosensory cortex in the transmission of nociceptive information. Together, these results establish a connection between a neurodevelopmental lesion in the thalamus and a modality-specific disruption in pain perception.
Clinical Applications of Artificial Intelligence in Occupational Health
Authors: Chaudhry Zaira S. , Choudhury Avishek
Published: August 2024

Objectives

The aims of the study are to identify and to critically analyze studies using artificial intelligence (AI) in occupational health.

Methods

A systematic search of PubMed, IEEE Xplore, and Web of Science was conducted to identify relevant articles published in English between January 2014–January 2024. Quality was assessed with the validated APPRAISE-AI tool.

Results

The 27 included articles were categorized as follows: health risk assessment (n = 17), return to work and disability duration (n = 5), injury severity (n = 3), and injury management (n = 2). Forty-seven AI algorithms were utilized, with artificial neural networks, support vector machines, and random forest being most common. Model accuracy ranged from 0.60–0.99 and area under the curve (AUC) from 0.7–1.0. Most studies (n = 15) were of moderate quality.

Conclusions

While AI has potential clinical utility in occupational health, explainable models that are rigorously validated in real-world settings are warranted.
The Impact of Inflammatory Bowel Diseases on Patients' Quality of Life and Work Functionality
Authors: Leso Veruscka , Testa Anna , Pacella Daniela , Macrini Maria Carmela , Villani Guido Daniele , Gervetti Paola , Barbato Giuseppe , Rispo Antonio , Castiglione Fabiana , Iavicoli Ivo
Published: August 2024

Background

This study aimed to assess the employment status, quality of life, and work functionality in patients affected by inflammatory bowel diseases (IBDs).

Methods

Patients (N = 216) were enrolled between June 2020 and October 2021. Personal, clinical, and occupational features were investigated. The Short Inflammatory Bowel Disease Questionnaire and the Work Productivity and Activity Impairment questionnaire were administered.

Results

Among the enrolled patients, 114 (53%) were employed. The mean absenteeism and presenteeism percentages of 10% and 37% were determined, with 44% and 39% of daily and work activity impairment, respectively. A poor Health-Related Quality of Life (HRQoL) was retrieved (47 ± 12). Extraintestinal manifestations, disease activity, and HRQoL were associated with occupational outcomes.

Conclusions

IBD can impact patients' work functionality. The association between clinical, psychological, and occupational issues suggests the relevance for a multidisciplinary management of the disease.
A novel shockwave-driven nanomotor composite microneedle transdermal delivery system for the localized treatment of osteoporosis: a basic science study
Authors: Hu Fan , Liang Haojun , Xie Jing , Yuan Meng , Huang Wanxia , Lei Yinze , Li Hao , Lv Linwen , Liu Qiuyang , Zhang Junhui , Su Wenxi , Chen Ranran , Wang Zhe , Chang Ya-nan , Li Juan , Wei Cunfeng , Xing Gengyan , Xing Gengmei , Chen Kui
Published: August 2024

Background:

Clinical protocols in osteoporosis treatment could not meet the requirement of increasing local bone mineral density. A local delivery system was brought in to fix this dilemma. The high-energy extracorporeal shock wave (ESW) can travel into the deep tissues with little heat loss. Hence, ESW-driven nanoparticles could be used for local treatment of osteoporosis.

Materials and methods:

An ESW-actuated nanomotor (NM) sealed into microneedles (MNs) (ESW-NM-MN) was constructed for localized osteoporosis protection. The NM was made of calcium phosphate nanoparticles with a high Young’s modulus, which allows it to absorb ESW energy efficiently and convert it into kinetic energy for solid tissue penetration. Zoledronic (ZOL), as an alternative phosphorus source, forms the backbone of the NM (ZOL-NM), leading to bone targeting and ESW-mediated drug release.

Results:

After the ZOL-NM is sealed into hyaluronic acid (HA)-made microneedles, the soluble MN tips could break through the stratum corneum, injecting the ZOL-NM into the skin. As soon as the ESW was applied, the ZOL-NM would absorb the ESW energy to move from the outer layer of skin into the deep tissue and be fragmented to release ZOL and Ca2+ for anti-osteoclastogenesis and pro-osteogenesis. In vivo, the ZOL-NM increases localized bone parameters and reduces fracture risk, indicating its potential value in osteoporotic healing and other biomedical fields.

Conclusion:

The ESW-mediated transdermal delivery platform (ESW-NM-MN) could be used as a new strategy to improve local bone mineral density and protect local prone-fracture areas.
Computed tomography-based fully automated artificial intelligence model to predict extrapancreatic perineural invasion in pancreatic ductal adenocarcinoma
Authors: Yu Jieyu , Chen Chengwei , Lu Mingzhi , Fang Xu , Li Jing , Zhu Mengmeng , Li Na , Yuan Xiaohan , Han Yaxing , Wang Li , Lu Jianping , Shao Chengwei , Bian Yun
Published: August 2024

Background:

Extrapancreatic perineural invasion (EPNI) increases the risk of postoperative recurrence in pancreatic ductal adenocarcinoma (PDAC). This study aimed to develop and validate a computed tomography (CT)-based, fully automated preoperative artificial intelligence (AI) model to predict EPNI in patients with PDAC.

Methods:

The authors retrospectively enrolled 1065 patients from two Shanghai hospitals between June 2014 and April 2023. Patients were split into training (n=497), internal validation (n=212), internal test (n=180), and external test (n=176) sets. The AI model used perivascular space and tumor contact for EPNI detection. The authors evaluated the AI model’s performance based on its discrimination. Kaplan–Meier curves, log-rank tests, and Cox regression were used for survival analysis.

Results:

The AI model demonstrated superior diagnostic performance for EPNI with 1-pixel expansion. The area under the curve in the training, validation, internal test, and external test sets were 0.87, 0.88, 0.82, and 0.83, respectively. The log-rank test revealed a significantly longer survival in the AI-predicted EPNI-negative group than the AI-predicted EPNI-positive group in the training, validation, and internal test sets (P<0.05). Moreover, the AI model exhibited exceptional prognostic stratification in early PDAC and improved assessment of neoadjuvant therapy’s effectiveness.

Conclusion:

The AI model presents a robust modality for EPNI diagnosis, risk stratification, and neoadjuvant treatment guidance in PDAC, and can be applied to guide personalized precision therapy.
A versatile attention-based neural network for chemical perturbation analysis and its potential to aid surgical treatment: an experimental study
Authors: Fan Zheqi , Zhao Houming , Zhou Jingcheng , Li Dingchang , Fan Yunlong , Bi Yiming , Ji Shuaifei
Published: August 2024

Deep learning models have emerged as rapid, accurate, and effective approaches for clinical decisions. Through a combination of drug screening and deep learning models, drugs that may benefit patients before and after surgery can be discovered to reduce the risk of complications or speed recovery. However, most existing drug prediction methods have high data requirements and lack interpretability, which has a limited role in adjuvant surgical treatment. To address these limitations, the authors propose the attention-based convolution transpositional interfusion network (ACTIN) for flexible and efficient drug discovery. ACTIN leverages the graph convolution and the transformer mechanism, utilizing drug and transcriptome data to assess the impact of chemical pharmacophores containing certain elements on gene expression. Remarkably, just with only 393 training instances, only one-tenth of the other models, ACTIN achieves state-of-the-art performance, demonstrating its effectiveness even with limited data. By incorporating chemical element embedding disparity and attention mechanism-based parameter analysis, it identifies the possible pharmacophore containing certain elements that could interfere with specific cell lines, which is particularly valuable for screening useful pharmacophores for new drugs tailored to adjuvant surgical treatment. To validate its reliability, the authors conducted comprehensive examinations by utilizing transcriptome data from the lung tissue of fatal COVID-19 patients as additional input for ACTIN, the authors generated novel lead chemicals that align with clinical evidence. In summary, ACTIN offers insights into the perturbation biases of elements within pharmacophore on gene expression, which holds the potential for guiding the development of new drugs that benefit surgical treatment.
Pediatric Failure Rates and Speech Outcomes in the HiRes Ultra and Ultra 3D Series Recall
Authors: Siddiqui Taimur , Lovin Benjamin D. , Nguyen Michelle T. , Marsh Megan , Spiro Jessica B. , Wickesberg-Summers Jennifer , Cantu Amy , Vilela Ronald J. , Sweeney Alex D. , Lindquist Nathan R.
Published: August 2024

Objective

The recent Field Corrective Action (FCA) for the HiRes Ultra and Ultra 3D (V1) cochlear implants (CIs) triggered much research investigating clinical identification, failure rates, and postrevision outcomes. Pediatric data remain limited, especially with regards to speech outcomes. We aim to characterize the trajectory of children implanted with these devices with specific attention to speech outcomes.

Patients

Retrospective cohort study of pediatric patients with FCA-affected CIs from March 2017 to January 2020 at a tertiary children’s hospital.

Interventions

CI placement, device monitoring, audiologic evaluation, revision surgery.

Main Outcome Measures

CI failure rates, revision surgery rate, speech recognition outcomes.

Results

Forty-one devices were implanted in 27 pediatric patients. Average age at implantation was 4.01 years (range, 0.87–12.75). To date, 30 devices (73%) are known failures with 90% of these having undergone revision surgery. No statically significant difference was noted on open-set speech testing across best prerevision, immediate prerevision, and best postrevision time points. Best postrevision CNC scores had a mean score of 71% ± 26%, n = 16.

Conclusions

Pediatric patients implanted with FCA-affected CI devices have a high risk of device failure. Open-set speech recognition was not significantly different from prerevision to postrevision testing, suggesting preserved speech outcomes. This may be partially attributable to limitations of cohort size and the pediatric population with open-set speech testing. However, we suspect that close follow-up with standardized testing and a low threshold for revision surgery provided by our multidisciplinary team may have mitigated these changes. Postrevision open-set speech testing remains positive for these patients.
Improvements in activities of daily living among patients with brain tumors are associated with age, baseline physical function, duration of rehabilitation, and tumor recurrence but not type
Authors: Watanabe Takahiro , Noto Shinichi , Natsumeda Manabu , Kimura Shinji , Ikarashi Fumie , Tabata Satoshi , Takano Mayuko , Tsukamoto Yoshihiro , Oishi Makoto
Published: August 2024

Genetic testing has improved the accuracy of diagnosis of brain tumors, and treatment is now tailored to the type of brain tumor. In contrast, the factors that influence the improvement in independence in activities of daily living (ADLs) following rehabilitation have not been clarified, particularly the role of tumor type. In this retrospective cohort study of 358 participants, we analyzed changes in the Functional Independence Measure (FIM) from pre-rehabilitation to post-rehabilitation provided in an acute care hospital. Multiple regression was used to determine whether FIM gain is associated with age, gender, preadmission Karnofsky Performance Status (KPS), number of rehabilitation days, average duration of daily therapy (min/day), and tumor recurrence and type (WHO grade 1, 2, 3, and 4 gliomas; primary central nervous system lymphomas; and metastatic brain tumors). The results showed that older age (β −0.183), tumor recurrence (β −0.137), preadmission KPS < 80 (β −0.180), and higher baseline total FIM score (β −0.470) were associated with lower FIM gain whereas the average duration of daily therapy (β 0.153) was associated with higher FIM gain. Brain tumor type was not associated with FIM gain. Improved independence in ADLs is more influenced by demographic, functional status, and treatment factors than differences in brain tumor type.
Seeking Precision Healthcare in Rural Patients With Cancer: Learning Self-advocacy
Authors: Curtin Martha S. , Somayaji Darryl , Dickerson Suzanne S.
Published: August 2024

Background

Precision medicine initiatives are offering superior treatments for cancer, and equitable distribution of these care measures is desired. Gaining insight into the meanings and shared practices of individuals navigating a cancer diagnosis and treatment in a rural setting will help efforts to mitigate inequities in this domain.

Objectives

To (1) interpret individuals’ common meanings of a cancer diagnosis including what contributes to that meaning; (2) explicate the shared practices of individuals with cancer regarding accessing oncology care, including provider visits, testing, and treatments; and (3) interpret common understanding of testing and treatment options in individuals with cancer.

Methods

Using hermeneutic phenomenology, interviews with individuals who have cancer who may benefit from precision medicine initiatives and who live in a rural area were recorded, transcribed, and analyzed by the research team until common meanings arose from the narratives.

Results

Fifteen participants provided in-depth interviews. Three main themes and a constitutive pattern emerged: (1) “Slipping through the cracks,” (2) Traveling this distance: “Gee, is there something closer?” and (3) Evoking some resilience: “Hope is a powerful word.” The constitutive pattern was: “The necessity of practicing and developing advocacy.”

Conclusions

Access to care in the rural setting is a complex concept and includes challenges with receiving care at a distance, travel to larger cities for adequate care, and coordination of care from multiple providers.

Implications for Practice

Efforts toward providing advocacy in the healthcare setting, as well as developing ways to make access to specialized cancer care more readily available, are important steps toward mitigation of inequities in rural areas.
Baduanjin Exercise Improves Cognitive Function in Older Adults With Mild Cognitive Impairment
Authors: Li Liang , Li Wenlong , Fan Tonggang
Published: August 2024

As a nonpharmacological method for cognitive rehabilitation, older adults with mild cognitive impairment (MCI) may benefit from Baduanjin exercise (BE), a moderate-intensity aerobic exercise. This meta-analysis was conducted to determine if BE is effective in enhancing cognitive performance in older adults with MCI. Using a combination of topic phrases and free words, systematic searches were executed in nine databases. Review Manager 5.4 was used to retrieve and statistically evaluate the data. Fourteen randomized controlled studies comprising 994 individuals aged ≥60 years were included in the meta-analysis. BE enhanced the general cognitive performance in individuals with MCI as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD] = 2.56; 95% confidence interval [CI], 2.17, 2.96; p < 0.001). The level of memory decline (Wechsler Memory Scale; SMD = 12.46; 95% CI, 8.36, 16.57; p < 0.001), executive function (Trail Making Test; SMD = −7.08; 95% CI, −11.21, −2.94; p < 0.001), and frailty (Edmonton Frailty Scale; SMD = −0.97; 95% CI, −1.30, −0.64; p < 0.001) were all improved with BE for older adults with MCI. This study presented a therapeutic practice guide for using BE for cognitive rehabilitation in older adults. BE notably improves cognitive function in older adults with MCI and can be an excellent nonpharmaceutical therapy option.
A Comparative Analysis of Recruitment Methods to Reach Emerging Adults Outside the Clinical Setting
Authors: Walsh Alli , Pathak Dola , Schlegel Emma C.
Published: August 2024

Background

Emerging adults are a hard-to-recruit population for health researchers, as many do not routinely access health care services and are best recruited outside clinical settings. Social media and research volunteer registries (e.g., ResearchMatch) offer great potential among this population, yet a comparison of these two recruitment methods has not been done.

Objectives

To compare participant enrollment and completion rates, participant demographics, and recruitment costs between recruitment methods (social media advertisements compared to ResearchMatch) deployed with a sample of female-bodied emerging adults.

Methods

Female-bodied emerging adults were recruited from October to November 2022 via ResearchMatch and social media (Instagram and Snapchat) advertisements. This analysis involves a subset of recruitment data from a larger institutional review board-approved study. Enrollment and survey completion rates were calculated using the number of individuals contacted and survey completion data from Qualtrics. Chi-square and independent t-test analyses were used to compare demographic data. Advertisement data collected included total cost, cost per click, link clicks, and paid impressions.

Results

Two hundred and forty-five emerging adults completed the survey, and 24 completed follow-up interviews. ResearchMatch and social media enrollment rates differed (58% and 39%, respectively). Survey completion rates for both methods were the same (~93%). Participants’ ages and levels of education were significantly different. Social media resulted in recruitment of younger participants (18–21 years), and ResearchMatch garnered participants with a higher level of education. Differences in race were also significant, as social media recruited higher numbers of White participants. Lastly, the researcher-incurred cost per survey was $0 for ResearchMatch versus $13 for social media.

Discussion

While social media and ResearchMatch are both successful tools for research recruitment, each provides distinct benefits for recruiting specific populations. ResearchMatch offers a lower-cost option and access to an older emerging adult population with higher education, while social media provides access to a younger emerging adult population. This knowledge can be imperative for deciding which recruitment methods best fit research study needs. Future research should explore differences in race by recruitment method to highlight potential sampling biases or recruitment opportunities.
Cochrane rehabilitation: 2023 annual report
Authors: Arienti Chiara , Kiekens Carlotte , Battel Irene , Cordani Claudio , Del Furia Matteo J. , Engkasan Julia Patrick , Gimigliano Francesca , Lazzarini Stefano G. , Liguori Sara , Miranda Luca , Mosconi Bianca , Negrini Stefano ,   Cochrane Rehabilitation Advisory Committee
Published: August 2024

Throughout 2023, Cochrane Rehabilitation’s primary focus was on the Fifth Cochrane Rehabilitation Methodological Meeting, aiming to improve the current state of evidence in rehabilitation, enhancing comprehension of evidence production and synthesis for practical application, and exploring various study designs. Ongoing projects were advanced, such as the new Rehabilitation definition, the “Best Evidence for Rehabilitation” project, and the Ebook. We provided evidence on assistive technologies for developing a World Health Organization (WHO) global guideline for low back pain. We launched new projects on health policies and systems research, on linking functional assessment tools to the International Classification of Functioning, Disability, and Health, and on psychometrics for patient-reported outcome measures in rehabilitation.
Gerrymandering and the Packing and Cracking of Medical Uninsurance Rates in the United States
Authors: Rushovich Tamara , Nethery Rachel C. , White Ariel , Krieger Nancy
Published: August 2024

Context:

Technological innovation and access to big data have allowed partisan gerrymandering to increase dramatically in recent redistricting cycles.

Objective:

To understand whether and how partisan gerrymandering, including “packing” and “cracking” (ie, respectively concentrating within or dividing specified social groups across political boundaries), distorts understanding of public health need when health statistics are calculated for congressional districts (CDs).

Design:

Cross-sectional study using 2020 CDs and nonpartisan simulated districts.

Setting:

United States, 2017-2021.

Participants:

United States residents.

Main Outcome Measure:

Percent with no medical insurance (uninsured), within-district variance of percent uninsured, and between-district variance of percent uninsured.

Results:

At the state level, states where partisan redistricting plans showed greater evidence of partisan gerrymandering were more likely to contain CDs with more extreme values of uninsurance rates than districts in states with less evidence for gerrymandering (association between z-scores for gerrymandering and between-district variation in uninsurance = 0.25 (−0.04, 0.53), P = .10). Comparing variation in uninsurance rates for observed CDs vs nonpartisan simulated districts across all states with more than 1 CD, in analyses stratified by state gerrymander status (no gerrymander, Democratic gerrymander, and Republican gerrymander), we found evidence of particularly extreme distortion of rates in Republican gerrymandered states, whereby Republican-leaning districts tended to have lower uninsurance rates (the percentage of Republican-leaning districts that were significantly lower than nonpartisan simulated districts was 5.1 times that of Democratic-leaning districts) and Democrat-leaning districts had higher uninsurance rates (the percentage of Democrat-leaning districts that were significantly higher than nonpartisan simulated districts was 3.0 times that of Republican-leaning districts).

Conclusions:

Partisan gerrymandering can affect determination of CD-level uninsurance rates and distort understanding of public health burdens.
Care Home Safety Incidents and Safeguarding Reports Relating to Hospital to Care Home Transitions: A Retrospective Content Analysis
Authors: Newman Craig , Mulrine Stephanie , Brittain Katie , Dawson Pamela , Mason Celia , Spencer Michele , Sykes Kate , Young-Murphy Lesley , Waring Justin , Scott Jason
Published: August 2024

Objective

The purpose of this study was to further the understanding of reported patient safety events at the interface between hospital and care home including what active failings and latent conditions were present and how reporting helped learning.

Methods

Two care home organizations, one in the North East and one in the South West of England, participated in the study. Reports relating to a transition and where a patient safety event had occurred were sought during the COVID-19 (SARS-CoV-2) virus prepandemic and intrapandemic periods. All reports were screened for eligibility and analyzed using content analysis.

Results

Seventeen South West England care homes and 15 North East England care homes sent 114 safety incident reports and after screening 91 were eligible for review. A hospital discharge transition (n = 78, 86%) was most common. Pressure damage (n = 29, 32%), medication errors (n = 26, 29%) and premature discharge (n = 21, 23%) contributed to 84% of the total reporting. Many ‘active failings’ (n = 340) were identified with fewer latent conditions (failings) (n = 14, 15%) being reported. No examples of individual learning were identified. Organization and systems learning were identified in 12 reports (n = 12, 13%).

Conclusions

The findings highlight potentially high levels of underreporting. The most common safety incidents reported were pressure damage, medication errors, and premature discharge. Many active failings causing numerous staff actions were identified emphasizing the cost to patients and services. Additionally, latent conditions (failings) were not emphasized; similarly, evidence of learning from safety incidents was not addressed.
Guidance for Triangulating Data and Estimates of HIV Prevalence Among Pregnant Women and Coverage of PMTCT Using the Spectrum AIDS Impact Module
Authors: Walters Magdalene K. , Korenromp Eline L. , Yakusik Anna , Wanyeki Ian , Kaboré André , Poimouribou Arthur , Ki Célestine , Dao Coumbo , Bambara Paul , Derme Salam , Ouedraogo Théophile , Tang Kai Hon , Boily Marie-Claude , Mahy Mary , Imai-Eaton Jeffrey W.
Published: August 2024

Background:

Most countries use the Spectrum AIDS Impact Module (Spectrum-AIM), antenatal care routine HIV testing, and antiretroviral treatment data to estimate HIV prevalence among pregnant women. Nonrepresentative program data may lead to inaccurate estimates of HIV prevalence and treatment coverage for pregnant women.

Setting:

One hundred fifty-four countries and subnational locations across 126 countries.

Methods:

Using 2023 UNAIDS HIV estimates, we calculated 3 ratios: (1) HIV prevalence among pregnant women to all women 15–49 yrs (prevalence), (2) ART coverage before pregnancy to women 15–49 yrs ART coverage (ART prepregnancy), and (3) ART coverage at delivery to women 15–49 yrs ART coverage (PMTCT coverage). We developed an algorithm to identify and adjust inconsistent results within regional ranges in Spectrum-AIM, illustrated using Burkina Faso estimates.

Results:

In 2022, the mean regional ratio of prevalence among pregnant women to all women ranged from 0.68 to 0.95. ART coverage prepregnancy ranged by region from 0.40 to 1.22 times ART coverage among all women. Mean regional PMTCT coverage ratios ranged from 0.85 to 1.51. The prevalence ratio in Burkina Faso was 1.59, above the typical range 0.62–1.04 in western and central Africa. Antenatal clinics reported more PMTCT recipients than estimated HIV-positive pregnant women from 2015 to 2019. We adjusted inputted PMTCT program data to enable consistency of HIV prevalence among pregnant women from programmatic routine HIV testing at antenatal clinics with values typical for western and central Africa.

Conclusions:

These ratios offer Spectrum-AIM users a tool to gauge the consistency of their HIV prevalence and treatment coverage estimates among pregnant women with other countries in the region.
Application of U-Net Network Utilizing Multiattention Gate for MRI Segmentation of Brain Tumors
Authors: Zhang Qiong , Hang Yiliu , Qiu Jianlin , Chen Hao
Published: August 2024

Background

Studies have shown that the type of low-grade glioma is associated with its shape. The traditional diagnostic method involves extraction of the tumor shape from MRIs and diagnosing the type of glioma based on corresponding relationship between the glioma shape and type. This method is affected by the MRI background, tumor pixel size, and doctors' professional level, leading to misdiagnoses and missed diagnoses. With the help of deep learning algorithms, the shape of a glioma can be automatically segmented, thereby assisting doctors to focus more on the diagnosis of glioma and improving diagnostic efficiency. The segmentation of glioma MRIs using traditional deep learning algorithms exhibits limited accuracy, thereby impeding the effectiveness of assisting doctors in the diagnosis. The primary objective of our research is to facilitate the segmentation of low-grade glioma MRIs for medical practitioners through the utilization of deep learning algorithms.

Methods

In this study, a UNet glioma segmentation network that incorporates multiattention gates was proposed to address this limitation. The UNet-based algorithm in the coding part integrated the attention gate into the hierarchical structure of the network to suppress the features of irrelevant regions and reduce the feature redundancy. In the decoding part, by adding attention gates in the fusion process of low- and high-level features, important feature information was highlighted, model parameters were reduced, and model sensitivity and accuracy were improved.

Results

The network model performed image segmentation on the glioma MRI dataset, and the accuracy and average intersection ratio (mIoU) of the algorithm segmentation reached 99.7%, 87.3%, 99.7%, and 87.6%.

Conclusions

Compared with the UNet, PSPNet, and Attention UNet network models, this network model has obvious advantages in accuracy, mIoU, and loss convergence. It can serve as a standard for assisting doctors in diagnosis.
Predictors of Long-Term Protraction Headgear Success in Patients With Cleft Lip and Palate: A 5-Year Follow-Up
Authors: Schechter Jill , Alcon Andre , Verzella Alexandra , Diaz Allison , Staffenberg David , Flores Roberto , Shetye Pradip R.
Published: August 2024

Patients with cleft lip and palate (CLP) characteristically present with maxillary hypoplasia and class III malocclusion. Protraction headgear (PHG) is a commonly used treatment for this type of malocclusion, with the goal of reducing future surgical needs. The purpose of this study was to evaluate the long-term effects of PHG treatment and determine the pretreatment predictors of long-term PHG success in patients with CLP. Twenty-nine patients with CLP who had undergone PHG treatment from 2012 to 2017 at a single institution were retrospectively analyzed. Patients were included if they had a lateral cephalogram or CBCT before, immediately after, and at least 5 years after their PHG treatment. Patients were divided into surgery and nonsurgery groups based on their 5-year follow-up clinical presentation. Student t tests, Wilcoxon signed-rank test, and a multivariate logistic regression model were used to compare pretreatment and post-treatment changes in both groups. Immediately post-treatment, the maxilla advanced 2.6 mm, the maxillary dentition advanced 4.7 mm, and the mandible rotated downward 5.0 mm and backward 2.6 mm. At long-term follow up the maxilla advanced 0.0 mm while the mandible advanced an additional 7.5 mm. Thus, PHG treatment is effective at improving class III malocclusion in the short term, but may not prevent future surgical need for patients with more severe skeletal discrepancies. Variables predictive of future surgical need include ANB, anterior facial height, overjet, and starting age of treatment, with ANB as the most reliable early predictor.
Climate-driven context-dependent structure of population cycles
Authors: Samia Noelle I. , Stramer Osnat , Saitoh Takashi , Stenseth Nils Chr.
Published: August 2024

Multiannual population cycles of small mammals are of interest within population biology. We propose an approach for multidimensional autoregressive (AR) time series and analyse monitoring data on grey-sided voles (
Myodes rufocanus
) in Japan to investigate one or possibly multiple multiannual cycles that drive population dynamics. Temperature, through modifying rodent communities, is found to be a key factor shaping population dynamics. Warmer areas are the main habitat for other rodent species resulting in low vole abundance/dominance, as opposed to higher vole dominance in colder areas—a pattern associated with the AR structure and population cycle. Vole populations in simple rodent communities exhibit an AR(2) cycle of 2–3 years. In areas with complex rodent communities, vole dynamics follows an AR(4) process and a combination of two cycles with different lengths. The AR structure varies in relatively small spatial scales, thus widening the scope of AR analyses needed. Historically, vole abundance increased in the late 1970s and decreased from the 1980s, with warm winters shown to be associated with the decline of vole abundance in the AR(4) populations. This significant association between the AR order, population dynamics, temperature and rodent community provides insights into the declining trends observed in rodent populations of the Northern Hemisphere.
Post-failure deformation mode switching in volcanic rock
Authors: Farquharson Jamie I. , Heap Michael J. , Carbillet Lucille , Baud Patrick
Published: August 2024

Beyond a threshold applied compressive stress, porous rocks typically undergo either dilatant or compactant inelastic deformation and the response of their physical properties to deformation mode is key to mass transport, heat transport and pressure evolution in crustal systems. Transitions in failure modes—involving switches between dilatancy and compaction—have also been observed, but to date have received little attention. Here, we perform a series of targeted mechanical deformation experiments on porous andesites, designed to elucidate complex post-failure deformation behaviour. By investigating a sample suite and effective pressure range that straddles the transition between positive and negative volumetric responses to compression, we show two post-failure critical stress states: a transition from compaction to dilation (

C

∗

′

), and a transition from dilation to compaction, which we term

C

′

∗

. We demonstrate that multiple switches in deformation mode can be driven by stress application under conditions relevant to the shallow crust. While the effect on fluid flow properties of compaction-to-dilation switching may be masked by a net reduction in sample porosity, samples that underwent dilatant-to-compactant failure mode switching exhibited an increase in permeability of approximately two orders of magnitude, despite only slight net volumetric change. Such a substantial permeability enhancement underscores the importance of post-failure deformation in influencing solute and heat transfer in the crust, and the generation of supra-hydrostatic fluid pressures in volcanic environments.