bluuebunny/crossref_metadata_2025 huggingface dataset:
Cycle Syncing and TikTok’s Digital Landscape: A Reasoned Action Elicitation Through a Critical Feminist Lens
Authors: Pfender Emily J. , Kuijpers Katelynn L. , Wanzer Claire V. , Bleakley Amy
Published: November 2024

Cycle syncing is a menstrual health trend on TikTok that involves aligning exercise and diet with the four menstrual cycle phases. Cycle syncing is part of the conversation on social media about women’s reproductive health. However, clinical research on the effects of cycle syncing is inconclusive, and there is the potential that this trend could further perpetuate misinformation and gender stereotypes. Research suggests that social media can affect health behaviors, highlighting the need to understand if women intend to participate in cycle syncing. Guided by the Reasoned Action Approach, this study used focus groups ( n = 39) to examine young women’s attitudes, normative beliefs, and control beliefs about participating in cycle syncing, and critical feminist theory to sensitize resulting themes. Results suggest that normative beliefs emphasize support for the behavior among women, yet participants suggest that men would not support this behavior. Additionally, positive beliefs about cycle syncing content sourced from inconclusive scientific literature underscores concerns regarding the potential dissemination of misinformation in women’s health practices on social media. Findings also fit into a larger discussion about “hormonophobia” and contraception on social media. Theoretical implications for mixed methods research and future directions are discussed.
Factors that Facilitate Informal Advance Care Planning Conversations With Family: A Cross-Sectional Survey of Black Adults With Kidney Failure
Authors: Fisher Marlena C. , Perrin Nancy , Crews Deidra C. , Eneanya Nwamaka D. , Gallo Joseph J. , Hardy Brianna E. , Nelson Katie E. , Owusu Loretta , Petchler Claire M. , Saylor Martha Abshire , Nolan Marie T.
Published: November 2024

Background: Advance care planning in adults with kidney failure has been understudied and limited to written advance directives. Many Black adults prefer informal conversations with family, and yet this form of advance care planning is underexplored in research. In this study, we aimed to identify the multilevel factors that facilitate informal advance care planning with family among Black adults with kidney failure. Methods: Black adults with kidney failure were recruited using the electronic health record to identify prospective participants who met inclusion criteria from a metropolitan hospital in the Mid-Atlantic region of the United States from June 2021 to June 2022. Participants completed a survey capturing the personal, interpersonal, and structural level factors that facilitate informal advance care planning conversations with family, and sociodemographic characteristics. Results: The study included 301 respondents, 66% engaged in informal advance care planning and 37% completed an advance directive. Mean age was 56 years, 52% were female, 25% received a high school education or less. Illness acceptance (OR 1.07, P = 0.04) and emotional support (OR 1.44, P = 0.02) facilitated Informal advance care planning, as did having master’s or doctoral level education (OR 2.37, P = 0.04). A recent hospitalization (OR 1.79, P = 0.04) and experience as a surrogate decision maker (OR = 1.76, P = 0.05) also facilitated Informal advance care planning. Conclusions: Informal advance care planning conversations occur more frequently than written directives among Black adults with kidney failure. Future interventions should consider cultural preferences by developing interventions that facilitate informal advance care planning conversations with family.
Expedited Shipping to Meet a Target Service Level: Analytical Recommendations and Behavioral Biases
Authors: Villa Sebastián , Castañeda Jaime Andrés , Urrea Gloria
Published: November 2024

Maintaining a high service level with customers involves a fundamental tradeoff between investing in inventory and investing in expediting the shipping of the additional units needed to achieve that service level. We use a multi-method approach to show how and when ordering decisions are influenced by different levels of expediting costs and target service levels. First, we derive a mathematical model that provides a closed-form solution to this tradeoff. Second, we run a behavioral study to show how increments in the expediting cost and the target service level impact buyers’ ordering behavior. Results show that ordering decisions are influenced mainly by the expediting cost. Our econometric estimations provide a generalization of the pull-to-center effect to a setting with expedited shipping. Moreover, we find that buyers adjust their orders only when facing a high target service level. To reduce the observed behavioral biases, we propose that managers can increase the salience of key performance metrics in the buyers’ decision-making process. We test for the role of salience with a second behavioral study and a behavioral model. Results show that the extent to which salient information helps improve buyers’ ordering decisions depends on the level of the expediting cost. Interestingly, our behavioral model highlights how ordering decisions improve not by eliminating people’s biases but by amplifying some of those biases. We contribute to the literature on expedited shipping and behavioral operations, and provide practical recommendations for how managers can improve ordering decisions.
A Call to Arms for American Democracy
Authors: Macht Gretchen A. , Kortum Philip , Byrne Michael D.
Published: November 2024

Free, fair, and secure elections are the foundation of a democracy. However, the idea of voting is simple, whereas its execution is complex. There are over 3000 counties in the United States, representing 10,000 election jurisdictions with varying laws, demographics, logistics, and levels of technology integration. There are numerous open challenges that Human Factors expertise can directly translate, such as the design to maximize accessibility and security, improve poll worker training, and minimize errors. The time is now to get involved in this dynamic and rewarding applied research space, as ensuring election integrity has never been more critical.
Health Inequalities in Breast Cancer in England: A Pragmatic Review to Inform National Institute for Care and Excellence (NICE) Recommendations
Authors: Slade Eric , Luckham Kirsty , Heath Andrea , Owen Lesley
Published: November 2024

Health inequalities refer to systematic, unfair and avoidable differences in health across the population and between different groups in society. We reviewed health inequalities related to breast cancer to inform National Institute for Health and Care Excellence (NICE) recommendations. This was a pragmatic, targeted review to identify examples of health inequalities related to breast cancer in England. The search focused on national cancer registries, screening programme datasets, patient experience surveys and reports from key organisations. The results were synthesised using 5 domains of interest, covering health status, risk factors, wider determinants, access to and quality and experience of care. These domains were subdivided across 4 dimensions of health inequalities, including deprivation, geography, protected characteristics, and inclusion health groups. It was found that although breast cancer is less common in more deprived groups, these groups have worse health outcomes and higher mortality rates compared to less deprived groups. Many disadvantaged groups are less likely to participate in breast cancer screening, leading to delayed diagnosis and more advanced cancers. Behavioural risk factors such as obesity, physical inactivity and alcohol consumption vary across groups and impact breast cancer risks and outcomes. While people from ethnic minority groups have lower breast cancer incidence, evidence suggests that the incidence of breast cancer in some groups is increasing. Ethnic minority groups are also often diagnosed at advanced stages due to presenting through non-screening routes. Low health literacy is an issue for many disadvantaged groups. This review demonstrates that late diagnosis and low screening uptake significantly contribute to health inequalities among different groups, including deprived and ethnic minority groups. There are many gaps in the evidence, and this review further highlights potential research areas for the broader health and care system from the perspective of health inequalities.
Contemporary Strategies for Clinical Chemoprevention of Localized Prostate Cancer
Authors: Kumar Nagi B
Published: November 2024

Prostate cancer (PCa) is the most common cancer among men in the United States and the second leading cause of cancer-related deaths. Metastatic castration-resistant PCa is still a fatal disease. On the other hand, between 2016 and 2020, about 70% of PCa cases were diagnosed at a localized stage. Evolving data demonstrates that men with low-grade cancers treated with definitive therapies may now be exposed to morbidities of overtreatment and poor quality of life, with little or no benefit in terms of cancer specific mortality. Active surveillance (AS) is thus the recommended management strategy for men with low-grade disease. Although this subgroup of men have reported anxiety during the AS period, they account to be highly motivated to make positive lifestyle changes to further reduce their risk of PCa progression, underscoring the urgent need to identify novel strategies for preventing progression of localized PCa to metastatic disease through pharmacologic means, an approach termed chemoprevention. Although several promising agents and approaches have been examined over the past 2 decades, currently, there are several limitations in the approach used to systematically examine agents for chemoprevention targeting men on AS. The goal of this review is to summarize the current agents and approaches evaluated, targeting men on AS, recognize the gaps, and identify a contemporary and comprehensive path forward. Results of these studies may inform the development of phase III clinical trials and ultimately provide a strategy for clinical chemoprevention in men on AS, for whom, currently, there are no options for reducing the risk of progression to metastatic disease.
Total Thrombus-Formation System in Patients with Peripheral Artery Disease
Authors: Pfrepper Christian , Franke Careen , Metze Michael , Weise Maria , Siegemund Annelie , Siegemund Roland , Federbusch Martin , Henschler Reinhard , Petros Sirak , Konert Manuela
Published: November 2024

The Total Thrombus-formation Analysis System (T-TAS) is an automated device using coated microchips to assess thrombus formation under flow conditions. Its value to monitor coagulation function in patients under antiplatelet therapy awaits further clarification. This study evaluated T-TAS to detect response to dual antiplatelet therapy (DAPT) in patients with peripheral artery disease (PAD).

T-TAS using the platelet-chip (PL-chip) and atheroma-chip (AR-chip) was performed in 60 patients with PAD on the day after lower extremity revascularization. Results were compared with light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA, ADP- and ASPI-test). To determine T-TAS reference ranges, 30 healthy blood donors were enrolled.

The area under the curve of the PL-chip (AUC-PL) was outside the reference range in 91.2% and AUC-AR in 21.1% of the PAD patients. Low responders in MEA ASPI, MEA ADP or both tests and low responders in LTA induced by ADP had a significantly higher AUC-PL compared to responders (204 vs 70, p = .016 and 140 vs 32, p < .001), respectively. Median AUC-PL in low responders in LTA and MEA, LTA or MEA and in responders in LTA and MEA was 301, 104 and 32 (p = .001), respectively. Our results suggest that the PL-chip can continuously assess the level of response to DAPT and might be helpful to monitor PAD patients.
Repeated use of hospital-based services and delayed hospital discharges in a population-based cohort of autistic adults in Canada
Authors: Lunsky Yona , Balogh Robert , Chung Hannah , Durbin Anna , Lai Meng-Chuan , Tint Ami , Weiss Jonathan , Isaacs Barry , Lin Elizabeth
Published: November 2024

Recognizing higher rates of co-occurring health conditions in autistic adults and the frequent use of hospital-based health care services, this study compared rates of repeat emergency visits, repeat hospitalizations, and delayed discharges in autistic adults to other adults with and without developmental disabilities matched for age and sex, living in Ontario, Canada. Returning to the hospital emergency department within a month, being readmitted to hospital within a month and experiencing a delayed discharge from hospital were each more likely to occur in autistic males and females than their counterparts without developmental disabilities, with the risk ratios being the highest for delayed discharges. Males and females with other developmental disabilities were more likely to return to the emergency department within a month than their autistic counterparts, and males with other developmental disabilities were more likely than autistic males to be readmitted to hospital, but the likelihood of delayed discharge in the two groups was similar. These findings suggest that more needs to be done to both improve hospital-based experiences of autistic adults and adults with other developmental disabilities, and to strengthen community-based care to reduce the likelihood of repeat and extended stays in hospital.

Lay abstract

We know that autistic people have more health problems and are more likely to go to the emergency department and get hospitalized than other people, but we know less about the problems they have once they get to the hospital. In this study, we looked at all autistic adults in Ontario and compared them to adults who were not autistic and to adults who had other kinds of developmental disabilities to see who came back to the emergency department in the month after an emergency department visit, who got re-hospitalized in the month after being sent home from hospital, and who stayed in the hospital longer than they needed to because there was no place appropriate for them to go to. We found that both autistic males and females were more likely to have these things happen to them than the same age- and sex-matched adults who did not have developmental disabilities. We also found that adults with other kinds of developmental disabilities had similar problems to autistic people. This makes us think that we need to work harder to improve health care for autistic adults and adults with other developmental disabilities when they come to hospital. We also need to make community services work better, and work more closely with hospital services, so that people only come to hospital when they need to and that they can go home when they are ready.
Responsibility, constraint, ambiguity. Discursive legitimizations of the European asylum reform in the German and Austrian news media
Authors: Winkel Marek
Published: November 2024

With the New Pact on Migration and Asylum (NPMA), the European Union is attempting to reduce the number of asylum applications in its territory. Restrictive changes to the applicable laws and regulations are the subject of critical public debate. However, an initial examination of German and Austrian reporting reveals that media organs from the center-left to the conservative side sometimes hold similar affirmative views on the NPMA. Rhetorical means of self-distancing and skepticism do accompany those views, though. The article reconstructs the content and rhetoric of three German and two Austrian newspapers by applying a discourse analysis. The analytical inclusion of rhetorical means of self-distancing clarifies whether assessments that approve of the NPMA are based on inner conviction or other motives. The analyzed connection of arguments and narratives explain, why a partially hegemonic attitude toward the restrictive measures of the NPMA is possible across the political–ideological spectra.
Sybil and the screen: A very young child’s digital literacy practices in a home environment
Authors: Perera Kaushalya , Nilaweera Lihini
Published: November 2024

Across the world, more and more children are introduced to digital literacy alongside print literacy. In many settings, children are initiated to literacy by their families prior to formal education, and emergent research shows that children’s awareness and learning of digital literacy begins in family settings. Yet, there is little awareness of digital literacy practices in children before they enter pre-school. There is also a need for research on children’s home literacy environments, especially from the global South. Our aim in this paper is to provide a detailed description of the emergence of digital (and print) literacy practices of one child in an urban home in Sri Lanka. This is an exploratory qualitative study using photo images, videos and parent interviews of her literacy activities from age 1:09 through 02:05 years. The study period coincided with her initial Covid19 period. The paper provides an overview of the literacy resources used by the child, the digital literacy practices during this time, and the social aspect of familial digital literacy development.
Entropy-based analysis of tensile fracture behavior and mechanical properties in blended yarns
Authors: Peng Laihu , Zhong Yongyi , Qi Yubao , Ru Xin , Hu Xudong
Published: November 2024

Internal structural changes in yarns directly affect yarn tensile fracture behavior. The acoustic emission (AE) technique plays a crucial role in dynamically monitoring the internal structural changes of stressed materials. In this paper, an acoustic emission signal analysis method during the whole process of yarn tensile fracture is proposed to study the yarn tensile fracture behavior and mechanical properties from the internal microscopic changes. Tensile fracture tests and acoustic emission tests were carried out to investigate the behavioral properties of yarns during the whole process of stretching from both macroscopic and microscopic perspectives and to compare the results with those of conventional acoustic emission amplitude analysis. The effects of the selection of key parameters of Shannon entropy (window width and bin width) and external noise on the yarn stretching behavior were investigated. The mechanical properties of different yarns were characterized by the entropy changes in different stretching stages compared with the analysis results of conventional mechanical property tests. The results show that compared with the AE amplitude, the Shannon entropy can extract the weak AE signal under high background noise and effectively characterize the yarn tensile fracture behavior. In addition, key parameters were shown to affect the yarn tensile fracture behavior. Further, the entropy change when the yarn is subjected to stretching reflects the change in mechanical properties of the yarn and the difference in mechanical properties of different yarns.
The Role of Epileptic Activity in Alzheimer’s Disease
Authors: Chen Tsang-Shan , Lai Ming-Chi , Hong Wei-Pin , Huang Chin-Wei
Published: November 2024

Alzheimer’s disease (AD) is the most common cause of dementia. Epileptic seizures or epileptic activity have been detected in AD, and people with epilepsy have a higher risk of dementia compared to the general population. This suggests that seizures or epileptic activity might often coexist with AD. It is increasingly evident that epileptic activity or seizures are common but often overlooked comorbidities of AD. However, the causal relationship between seizures, epileptic activity and cognitive decline remains uncertain. Experimental data show that amyloid-β (Aβ) and Tau protein can cause neuronal hyperexcitability and has epileptogenic effects. Neural network hyperexcitation regulates the ratio of Aβ isoforms and is linked to the initiation of AD, indicating a shared mechanism. Clinical studies suggest that cognitive impairment accelerates in AD patients with seizures or epileptic activity. This review discusses the relationship between epileptic seizures and AD, the impact of epileptic activity in AD, and potential treatments.
Making a Difference in the Workplace: A Systematic Literature Review of Prosocial Impact
Authors: Roberts Brianna S. , Cumberland Denise M. , Ellinger Andrea D.
Published: November 2024

Prosociality at work has attracted academic interest for decades. Particularly, the concept of prosocial impact— the subjective experience of making a positive difference for others through one’s work—calls for more research. Our systematic review of literature from 2018 to 2023 examined: (1) How has prosocial impact been defined in prior research? (2) Which theories underpin the research? (3) In what organizational contexts has prosocial impact been studied, and with what specific samples/populations?, and (4) How has the variable of prosocial impact been used in quantitative studies, mixed methods research, and as a concept in qualitative research? Thirty-six empirical articles met our inclusion criteria. The findings consolidate knowledge on prosocial impact and highlight its relevance in organizational studies, providing insights for both practitioners and researchers. Moreover, the review outlines a research agenda to further explore prosocial impact within human resource development, emphasizing its growing significance in understanding organizational behavior.
Effects of α-Particle Radiation on DNA Methylation in Human Hepatocytes
Authors: Xue Xiangming , Su Lixia , Zhang Teng , Zhan Jingming , Gu Xiaona
Published: November 2024

Objective: This paper explores the role of DNA methylation in α-irradiation damage at the cellular level. Methods: Human normal hepatocytes L-02 were irradiated using a 241 Am α source at doses of 0, 1.0, and 2.0 Gy. The methylation levels of the six differentially methylated genes were examined by pyrophosphate sequencing, and the mRNA expression levels of the six differentially methylated genes were examined by real-time fluorescence quantitative PCR. Results: The rate of γH2AX foci positive cells was significantly higher than that of the control group after irradiation of cells in different dose groups for 1 h and 2 h respectively ( P < .05). The proportion of S-phase cells was significantly increased in the 1.0 Gy and 2.0 Gy dose groups compared with the control group ( P < .05). The methylation levels of CDK2AP1, PDGFRL, PCDHB16 and FAS genes were significantly increased, while the mRNA expression levels were significantly decreased ( P < .05). The expression levels of CDK2Apl, PCDHB16 and FAS were significantly negatively correlated with the methylation levels ( P < .05). Conclusion: The α-particle radiation can affect gene expression at the epigenetic level, which led to the speculation that altered methylation levels of CDK2AP1, PCDHB16, and FAS genes may be involved in the α radiation damage process.
Transformative strategies for enhancing women’s resilience to climate change: A policy perspective for low- and middle-income countries
Authors: Aziz Mudassar , Anjum Gulnaz
Published: November 2024

This policy paper advocates for a transformative strategy to address the disproportionate impact of climate change on women in low- and middle-income countries (LMICs), emphasizing the need to integrate gender considerations into climate resilience initiatives. Recognizing the multifaceted nature of women’s vulnerabilities, the paper calls for the dismantling of discriminatory socio-cultural norms and the enhancement of women’s capacities through digital health literacy, political empowerment, and the protection of sexual and reproductive health rights. Focusing on the health implications of climate change, particularly for pregnant women and newborns, the paper promotes a multi-sectoral approach that strengthens health systems and encourages community-based interventions. It underscores the importance of incorporating gender perspectives into climate adaptation and mitigation strategies, advocating for tailored health services in LMICs, and promoting women’s active involvement in climate-related decision-making processes. The methodology involves a qualitative, expert, and narrative synthesis of existing literature and policy analysis. The paper synthesizes existing research and policy recommendations to argue for a comprehensive policy framework and backs it with case studies from LMICs. This framework recognizes the complex interplay between women’s vulnerabilities and climate change, advocating for women’s empowerment as central to climate resilience efforts in LMICs. By integrating gender perspectives, enhancing health services for women, and fostering international collaboration, it proposes a holistic approach to mitigate the adverse effects of climate change on women’s health and well-being. This approach not only acknowledges the specific challenges faced by women but also leverages their unique insights and experiences, positioning them as pivotal contributors to global climate resilience and sustainability efforts.
The effects of alternating current (AC) electrification on the tribological performance of gear materials with internal combustion engine (ICE) and electric vehicle (EV) transmission lubricants
Authors: Khan Thawhid , Armitage Joshua L , Bryant Michael G
Published: November 2024

Electric Vehicles (EVs) present a vastly different set of tribological challenges to internal combustion engine (ICE) vehicles. Not only does the high torque production and high rotor speeds experienced in EV motors extenuate existing tribological challenges in the automotive sector; the inherent electrified nature of EV drivetrains is a key challenge. Many forms of stray electric current are prevalent within such systems, which cause the deterioration of key mechanical components through several electrochemical and electromechanical wear mechanisms. In this study, a novel electromechanical apparatus has been implemented to investigate the effects of alternating current (AC) discharge across ball-on-disc unidirectional sliding contacts, lubricated by commercially available transmission fluids. Three lubricants were compared at 80°C under both unelectrified and AC conditions. The three lubricants were used: a group IV poly-α-olefin (PAO 4) synthetic base oil and two commercially available transmission fluids – currently implemented within ICE vehicles and EVs, respectively. The key findings of this study highlight a reduction in friction under electrified conditions, combined with expedited material wear and tribochemical surface modification. The friction behaviour of the ICE transmission lubricant deteriorated over time due to electrification causing fluid property degradation.
Authorship and publication trends in the congenital hand surgery literature
Authors: Shah Ayush D. , Hu Caroline H. , Van Heest Ann E. , Bohn Deborah C.
Published: November 2024

This study assessed authorship and publication trends in congenital upper limb difference literature. Congenital upper limb difference literature is widely distributed across multiple journals; no single journal published a clear majority. Female authorship was more likely, though reasons for this remain unclear.
The effect of the theory of planned behavior based hand hygiene intervention program on the health outcomes and school absenteeism of the primary school students: Quasi-experimental study
Authors: Uyanık Gülçin , Dağhan Şafak
Published: November 2024

Background

Acute upper respiratory tract infections are the most common infections among school children. Improving water, sanitation, and hygiene facilities in schools is an important intervention for the healthy development of children. The most important component of this intervention is hand washing, which is the primary infection control measure.

Aim

This study aims to test the effect of the Theory of Planned Behavior (TPB) based hand hygiene intervention program on the health outcomes and school absenteeism of students.

Method

The study is quasi-experimental with pretest-posttest control groups. The study was conducted with 159 students (intervention: 82, control: 77) in two separate primary schools that were assigned to intervention and control groups. The intervention group were applied a TPB-based hand hygiene intervention program for the school children. The data were collected using the Student Questionnaire, Hand Hygiene Assessment Question Form, and Surveillance Form.

Findings

The mean Hand Hygiene Assessment Question Form Hand Hygiene Behavior scores did not differ between the groups in the pre- and posttest ( p > .05). In the posttest, the frequency of encountering a ten-week-upper respiratory tract infection symptom (U = 5277.50 p < .0001), school absenteeism days ( p = .046) and absenteeism episodes ( p = .043) was lower in the intervention group than in the control group.

Conclusions

The findings suggest that was concluded that the TPB-based hand hygiene intervention program did not make a difference in creating hand hygiene behavior in school children compared to the classical education. The program was effective in reducing upper respiratory tract infections and school absenteeism due to these infections.
Racial disparities in early postoperative proximal humerus fracture outcomes: Do minorities face longer operative times, extended hospital stays, and higher risks?
Authors: Kishan Arman , Zhu Alexander R , Zhu Stanley , Moon Gyeongtae S , Kishan Ansh , Suresh Sukrit J , Best Matthew J , Srikumaran Umasuthan
Published: November 2024

Background

Racial disparities in orthopedic surgery outcomes have been extensively documented, highlighting systemic biases in care. Proximal humerus fractures (PHFs), about 6% of all fractures, are rising, especially among the elderly. Despite the prevalence of PHFs, a research gap exists regarding racial disparities in postoperative complications and outcomes.

Methods

Data from the American College of Surgeons NSQIP database from 2006 to 2021 were analyzed, including 41,285 patients with PHFs. CPT and ICD codes guided inclusion and exclusion criteria. Propensity-score matching balanced a cohort of 17,052 patients. Demographic variables, comorbidities, and outcomes were analyzed using univariate statistics, chi-square tests, and Fisher's exact tests.

Results

Post propensity-score matching, significant demographic disparities emerged between white and minority patients. Minority patients had longer operative times ( p < .001) and hospital stays ( p = .001) than white patients. Minority patients also exhibited higher rates of mortality ( p = .04) and unplanned re-intubation ( p = .04).

Conclusion

This study revealed significant racial disparities in early postoperative outcomes for PHFs. Despite surgical advancements, minorities have prolonged operative times, extended hospital stays, and heightened risks of adverse events. Action is needed to ensure healthcare equity and justice and to address disparities in PHF surgical management across diverse demographics.

Level of evidence

III
Phase II trial of dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors SWOG/NCI experience: invasive mucinous or non-mucinous lepidic adenocarcinoma of the lung (formerly bronchioloalveolar carcinoma)
Authors: Chae Young Kwang , Othus Megan , Patel Sandip Pravin , Gerber David E. , Tanvetyanon Tawee , Kim Hye Sung , Chung Liam Il-Young , McLeod Christine M. , Lopez Gabby , Chen Helen X. , Sharon Elad , Streicher Howard , Ryan Cristopher W. , Blanke Charles D. , Kurzrock Razelle
Published: November 2024

Background:

Anti-programmed death-1 (PD-1)/cytotoxic T lymphocyte antigen-4 antibodies are efficacious in various malignancies.

Objectives:

This study presents the first results of ipilimumab–nivolumab in invasive mucinous or non-mucinous lepidic adenocarcinoma (invasive mucinous adenocarcinoma (IMA) or invasive non-mucinous lepidic adenocarcinomas (INLA), respectively) of the lung.

Design:

Dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors (DART) is a prospective, open-label, multicenter (1016 US sites), multi-cohort phase II trial of ipilimumab (1 mg/kg intravenously (IV) every 6 weeks) plus nivolumab (240 mg IV every 2 weeks).

Methods:

Participants histologically diagnosed with advanced IMA or INLA, who had not responded to at least one line of therapy, were included in the bronchioloalveolar carcinoma cohort. The primary endpoint was the overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (confirmed complete and partial responses (CR and PR)). Secondary endpoints were progression-free survival (PFS), overall survival (OS), clinical benefit rate (CBR; stable disease (SD) ⩾ 6 months plus ORR), and toxicity.

Results:

Eight evaluable patients (median age: 77 years; the number of prior therapies ranged from 0 to 4; one patient with prior exposure to a PD-1 inhibitor; comprising six IMA and two INLA) were treated. One IMA had a 40% regression (PFS 45.2+ months, PD-L1 0%, KRAS G12C mutated, tumor mutational burden [TMB] 13 mut/Mb). One INLA had 66% regression (PFS 23.8 months, PD-L1 unknown, no actionable mutations, TMB 3 mut/Mb). Overall ORR was 25.0% (2/8) and CBR, 62.5% (5/8); PFS for the patients with SD > 6 months was 43.4+, 11.7+, and 8.3 months. The median PFS was 16 months (5.3–not reached) and the median OS was 32.2 months (14.6–not reached). The toxicity profile was similar to previous reports.

Conclusion:

Ipilimumab plus nivolumab in the bronchioloalveolar carcinoma cohort (IMA, INLA) resulted in a durable ORR of 25.0% and CBR of 62.5% (PFS, 8.3 11.7+. 23.8 (PR), 43.4+ and 45.2+ (PR) months). Correlative studies to determine response and resistance markers are ongoing. Expanded prospective studies are warranted.

Trial registration:

ClinicalTrials.gov registry: NCT02834013.
Small-Sided-Game-Induced Mechanical Load in Adolescent Soccer: The Need for Care and Consideration for Athlete Preservation
Authors: Salter Jamie
Published: November 2024

Context:

The logistical efficiency and flexibility of small-sided games (SSG) to develop various soccer-specific attributes simultaneously make them a staple component of contemporary training programs in youth soccer. Their high ecological validity and consequential high utilization mean that if not considerately prescribed, players may be exposed to frequent repetitive mechanical stress that may induce maladaptation in skeletally and/or load-naïve or sensitive athletes. The purpose of this clinical review is to summarize mechanical load adaptations associated with the manipulation of area per player in SSG to outline the mechanistic pathway of load-related injuries in skeletally maturing athletes and to offer practical guidelines for coaches for the preservation of athlete health.

Evidence Acquisition:

A nonsystematic search of computerized databases of peer-reviewed articles in English between 2010 and the present was used, and a critical appraisal of existing literature was subsequently conducted.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

The temporary relative strength deficit and inefficiency of the musculotendinous system associated with accelerated growth increase the mechanical cost of activity. As a result, the load tolerance (ie, tolerant, naïve, or sensitive) of athletes is transiently reduced as the musculoskeletal system struggles to attenuate force absorption adequately. Repeated exposure to submaximal mechanical loads that stimulate the accumulation of “microdamage” in structural tissue may lead to aggravation and/or tissue failure at connective sites in skeletally fragile athletes.

Conclusion:

Coaches and practitioners need to individualize exposure to mechanical load for load-tolerant, naïve, and sensitive athletes during adolescence. Subtle changes to SSG prescription including modifying the area per player, inclusion of goalkeepers, constrained floaters, and management of work; rest ratios can offer practical and efficient methods to mitigate risk without derailing the development process. This, in turn, should contribute to reducing injury burden in this population and enhance developmental opportunities for young players.

Strength of Recommendation:

A. Recommendation based on consistent and good-quality evidence published from 2010 onwards.
Dupilumab Treatment for Aspirin-Exacerbated Respiratory Disease in a Real-World Setting: Impact on Quality of Life and Healthcare Utilization
Authors: Mullur Jyotsna , Maurer Rie , Ryan Tessa , McGill Alanna , Bensko Jillian C. , Laidlaw Tanya M. , Buchheit Kathleen M.
Published: November 2024

Background

Patients with aspirin-exacerbated respiratory disease (AERD) have difficult-to-treat asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) and often require treatment with biologic therapy for asthma or CRSwNP. Healthcare utilization in patients with AERD has not been well described since the advent of respiratory biologics.

Objective

To determine real-world healthcare utilization and quality of life among patients with AERD and to understand the impact of dupilumab, a monoclonal antibody targeting the interleukin 4 receptor, on patient-reported health outcomes and healthcare utilization.

Methods

We conducted a longitudinal survey study of 98 patients with AERD recruited from the Brigham and Women's Hospital AERD registry. Patients completed online questionnaires describing their medication history, healthcare utilization, and quality of life every 3 months for 2 years.

Results

At the end of 24 months, participants who were on dupilumab at the start of the study and those who started dupilumab had a significant reduction in the number of reported poor health days in the preceding month compared to patients not on dupilumab ( P < .001 and P < .01, respectively). Participants on dupilumab and those who started dupilumab also had significantly lower overall sinonasal outcome test-22 and asthma control test scores compared to those not on dupilumab over 24 months ( P < .05 for both groups).

Conclusion

Dupilumab therapy significantly improves health-related quality of life in patients with AERD, specifically as it pertains to patient assessment of days of overall poor health and quality of life related to sinonasal and asthma symptoms.
Cangrelor use in a pediatric patient with aneurysmal subarachnoid hemorrhage
Authors: Russo Riccardo , Molinaro Stefano , Mistretta Francesco , Gava Umberto , Morana Giovanni , Peretta Paola , Del Borrello Giovanni , Zeppa Pietro , Bergui Mauro
Published: November 2024

We herein report the case of a pediatric patient suffering from subarachnoid hemorrhage (SAH) due to a ruptured internal carotid artery (ICA) saccular aneurysm. Considering the unfavorable anatomy and irregular shape of the aneurysm, a flow diverter (FD) stent was positioned in addition to coils in an acute setting. Cangrelor (Kengreal, Chiesi, USA) IV bolus followed by maintenance IV infusion was administered in addition to ASA at the time of intervention. Transitioning from cangrelor to thienopyridine (clopidogrel) was done the day after the procedure without any ischemic or hemorrhagic complications. The patient was discharged symptom-free 24 days later. We discuss technical considerations focusing specifically on antiplatelet therapy management.
Enhancing recanalization success: Thrombectomy plus stent angioplasty by coaxial balloon technique for acute ischemic stroke with tandem occlusions
Authors: Yen Pao-Sheng , Kok Victor C. , Lin Yu-Hui , Wu Yu Tzu , Ko Li-Ying
Published: November 2024

Recanalizing acute ischemic stroke with carotid tandem occlusion (CTO) is technically challenging because distal embolic migration during revascularization can significantly influence outcomes. In this study, we aimed to introduce our coaxial balloon technique using a balloon-guiding catheter (BCG), angioplasty catheter, and aspiration catheter sequentially to prevent thrombus migration to a new vascular territory. We used this technique for six patients with CTO. Technical success with good revascularization of the CTO was achieved in all six patients (100%) without neurological complications, including one and five cases of modified Thrombolysis in Cerebral Infarction 2b and 3, respectively. The median duration of the procedure was 61 (interquartile range, 52–90) min. The mean National Institutes of Health Stroke Scale score at discharge was 3.5 (2–8), with favorable clinical outcomes at 90 days for three of six patients (50%). The coaxial balloon technique for CTO is safe and effective for revascularization in patients with acute ischemic stroke. Thrombectomy before proximal stenting was associated with shorter reperfusion times and better clinical outcomes. Therefore, this approach is recommended for tandem occlusions requiring stent angioplasty.
Balloon protection of the Labbe vein during venous sinus stenting
Authors: Leonard-Lorant Ian , Koch Guillaume , Goudot Mathilde , Hasiu Anca , Juravle Ciprian , Harangus Mihai , Beaujeux Rémy , Pop Raoul
Published: November 2024

Background: Endovascular treatment of dural venous sinus stenosis using auto-expandable stents is progressively becoming a central part in the management of patients with idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. One potential concern during stenting is impairment of venous outflow in the Labbé vein, which usually drains in close proximity to the culprit transverse sinus stenosis. Methods: We propose a technique which can counteract venous outflow impairment, consisting of temporary balloon protection of the Labbé vein during stent deployment. Results: We illustrate the use of this technique in a case of IIH with intrinsic dural sinus stenosis induced by a large arachnoid granulation situated close to the insertion of the Labbé vein. The stent was deployed under temporary balloon inflation in order to deflect the arachnoid granulation away from the vein ostium. Conclusions: In selected cases of intrinsic stenosis, temporary balloon protection can be used to avoid Labbé vein flow impairment during venous sinus stenting.
Principles of a controlled imaging environment for neonatal brain MRI: Strategies for optimal image quality and safety
Authors: Ebinesh Arulnathan , Saxena Swarna
Published: November 2024

Magnetic Resonance Imaging (MRI) is crucial for evaluating the neonatal brain, but high-quality images require a controlled environment. We discuss principles for creating this environment, including effective planning, presence of trained professionals, monitoring, preparedness for adversity, and ensuring optimal immobility. Planning reduces waiting times and anxiety, and a dedicated imaging team including a neonatologist and a radiologist improve image quality. Monitoring vital signs allows early identification of adverse events, while MR-compatible emergency equipment and a readily available hands-on resuscitation team reduces risk of such adverse events. Optimal immobility is critical for high-quality images. A controlled environment facilitates acquisition of optimal quality images in a quick and safe manner, enabling accurate diagnoses and timely interventions for neonates with brain abnormalities.
All-Suture Anchor Onlay Fixation for Medial Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of Fixation Constructs
Authors: Smith Benjamin L. , Bedi Asheesh , Hauck Oliver L. , Wijdicks Coen A. , Riboh Jonathan C.
Published: November 2024

Background:

The use of all-suture anchors (ASAs) for onlay patellar and femoral fixation of medial patellofemoral ligament (MPFL) grafts may provide clinical benefit, particularly in the small or pediatric knee; however, biomechanical data supporting the use of ASAs are lacking.

Purpose/Hypothesis:

The purpose of this study was to compare ASAs to larger interference implants for MPFL reconstruction in a time-zero biomechanical model. It was hypothesized that ASAs would have comparable cyclic elongation to interference fixation and would exceed published biomechanical values for the native human MPFL.

Study Design:

Controlled laboratory study.

Methods:

Eighteen fresh-frozen porcine patellas and femurs were divided into equal groups (n = 9 per group) for MPFL reconstructions. Patellar fixation utilized two 3.9-mm interference suture anchors (ISAs) or two 2.6-mm ASAs, while femoral fixation utilized one 6×20-mm interference screw (IS) or one 2.6-mm ASA. Human gracilis tendon grafts were used. Specimens were dynamically loaded for 100 cycles each in sequential 5- to 30-N (phase 1) and 5- to 50-N (phase 2) blocks at 1 Hz followed by load-to-failure testing at 305 mm/min.

Results:

No differences were found in cyclic elongation after phase 1 and phase 2 loading between ASA and interference implants on either the femoral or patellar side. On the femur, IS had significantly greater ultimate stiffness (54.2 vs 46.1 N/mm; P < .001) and ultimate load (366 vs 278 N; P = .019) compared to ASA. On the patella, ISAs had significantly greater ultimate stiffness (70.5 vs 53.1 N/mm; P < .001) but a significantly lower ultimate load (244 vs 307 N; P = .014) compared to ASAs. All groups significantly exceeded the published physiological values for native human MPFL stiffness and failure load.

Conclusion:

ASA onlay fixation had comparable cyclic elongation to that of interference fixation for femoral and patellar MPFL reconstruction. Although differences in ultimate stiffness and ultimate load were noted between implants, all of the values exceeded published values for the human MPFL.

Clinical Relevance:

This biomechanical study presents ASA cortical onlay fixation as a viable option for MPFL reconstruction. ASAs require less bone removal, potentially reducing the risk of patellar fracture and minimizing fixation complexity in the setting of open femoral growth plates. Future clinical studies will provide insight into successful tendon-to-bone healing, failure rates, and near- and long-term patient-reported outcomes.
Book review: Jamey E. Dorsey, The Battle for the Soul of Islam: Defining the Muslim Faith in the 21st Century
Authors: Zahir Azim
Published: November 2024

Jamey E. Dorsey, The Battle for the Soul of Islam: Defining the Muslim Faith in the 21st Century. London: Palgrave Macmillan, 2024, 216 pp. (paperback), ISBN-13: 978-9819728060.